11/1 - Vestibular Part One and BPPV

Question 1

Define Postural Stability

Answer 1

i.e. Balance- maintenance of the COM within the BOS-

Question 2

Visual system recognizes..
Vestibular system recognizes..
Somatosensory system recognizes…

Answer 2

motion.
head motion.
relative body movement and positions.

Question 3

Components of Vestibular System

Answer 3

Peripheral- End organ and nerve terminals, CN VII

Central-CN VII and VIII, vestibular nuclei and brainstem, thalamus, projections into cerebral cortex.

Question 4

Otoliths

Answer 4

Detect linear motion.
Tonic discharge.
Utricle-horizontal
Saccule- vertical

Question 5

Semicircular Canals

Answer 5

Perpendicular/Coplanar
Detect angular motion
Tonic discharge
Turn left- L is excited, R is inhibited- VOR
Anterior-Posterior-Horizontal

Question 6

Vascular Supply

Answer 6

PICA- lower vestbular nuclei

AICA and its branches- Utricle, Saccule, SCCs

Question 7

Patient Interview

Answer 7

Vertigo-lightheadness-confusion
Falls?
Severity 0-10
What activities provoke?

Question 8

Medical Diagnosis

Answer 8

ENG
Rotary Chair
Dynamic posturography

Question 9

Outcome Measures

Answer 9

Dizziness Handicap Inventory (DHI)
Activities-Specific Balance Confidence Scale (ABC)
Dynamic Gait Index (DGI)
Functional Gait Assessment (FGA)
Timed Up and Go
Static Tests-Functional Reach, Single Limb Stance, Tandem Stance

Question 10

Examination

Answer 10

Visual Tracking
Saccadic eye movement
VOR and VOR cancellation
Head movement- quality and symptom provocation
Vestibular tests
MMT
Proprioception

Question 11

Interventions: Prevention and Compensations

Answer 11

Prevent: Swimming, Dark environments, running on soft surfaces, driving in weather.
Compensate: ADs

Question 12

Interventions

Answer 12

Uptrain or Adapt
Desensitize 
Balance strategies
Gait training
Take exams that provoke- slow them down, make less stimulating. 
2-4 exercises, several times a day

Question 13

Meniere’s Disease

Answer 13

Acute: 30 minutes to 24 hours, recover within 72
Progressive hearing/vestibular impairments
Malabsorption of endolymph in duct and sac (endolymphatic hydrops)

Question 14

TBI/MS

Answer 14

Where is damage?
Uptrain vestibular when able. 
Compensate with vision and somatosensory when able. 
Fatigue
Compensate with aids and strategies

Question 15

Cervicogenic Dizziness

Answer 15

Not spinning
Neck pain- decreased CROM
Test DNF endurance
Head-neck rotation testing
Address pain, ROM, muscle, and strength in Cspine

Question 16

Benign Positional Vertigo

Answer 16

Canalithiasis- otoconia become dislodged from utricle/saccule and float in SCC
Cupulolithiasis- otoconia adhere to cupula in SCC

Question 17

Hallpike-Dix

Answer 17

BPV of Posterior and Anterior SCC
Head rotated 45 degrees from long sit to supine with 20-30 degrees of neck extension.
Look for horizontal nystagmus or complaints

Question 18

Roll Test

Answer 18

BPV for Horizontal SCC

Sitting to Supine with 20-30 flexion- rotated 90 degrees to one side.

Question 19

Interventions

Answer 19

Roll for Horizontal

Hallpike to opposite hall pike for P/A

Question 20

Vertebral Artery Test

Answer 20

Dizziness quality
Neck trauma
Cervical sx
Warrant extreme caution and physician referral