Balance/Vestibular Flashcards
Children rely on what system heavily for balance
vision
VOR is
head/eye movement coordination
supports gaze stabilization
Vestibulospinal reflex (VSR)
attempts to stabilize the body and control movement.
assists with stability while head is moving as well as coordination of trunk during upright postures
Strategies for balance
ankle
hip
suspensory
stepping
ankle strategy is
first strategy
hip strategy is
elicited by greater force, challenge or perturbation through the pelvis and hips
hips will move in opposite direction from the head
muscles contract proximally to distally to counteract balance
suspensory strategy is.
lower center of gravity by knee flexion, crouching or squatting
Peripheral vertigo:
duration?
autonomic symptoms?
what kind of factor?
signs?
ears?
episodic and short duration
they are present
precipitating
pallor, sweating, nausea and vomiting
auditory fullness
tinnitus
Central vertigo:
autonomic symptoms?
consciousness?
neurological symptoms?
less severe
loss of it
diplopia, hemianopsia, weakness, numbness, ataxia, dyarthria
Types of peripheral vertigo?
BPPV
menieres
infection
trauma/tumor
metabolic disorders
acute alcohol intoxication
Types of central vertigo?
meningitis
migraine
complications of neurologic origin post ear infection
trauma/tumor
cerebellar degeneration disorders
MS
BPPV commonly affects which canal?
posterior semicurcular
Which way is nystagmus in posterior canal issues?
vertical
Which way is nystagmus in anterior canal issues?
down
Which way is nystagmus in horizontal canal issues?
horizontal (towards lowest ear)
When checking for nystagmus, what kinds of things are you looking for?
eye movement: horizontal, vertical, rotatory or mixed
type of eye movement: pendular or jerk
direction: bidirectional or unidirectional
nystagmus movement: binocular or monocular with symmetrical or dissociated movements
Congenital nystagmus
mild and does not change in severity over lifetime. Usually not associated with another pathology
Spontaneous nystagmus
imbalance of vestibular signals in oculomotor neurons causing constant drift in one direction countered by quick movement in opposite direction. Occurs after acute vestibular lesion and only lasts 24 hours
Peripheral nystagmus
occurs with peripheral vestibular lesion and is inhibited when patient fixates vision on object
Central nystagmus
central lesion of brainstem/cerebellum and is not inhibited by visual fixation on an object
Positional nystagmus
induced by change in head position
semicircular canals stimulate nystagmus that typically lasts only a few seconds
Gaze-evoked nystagmus
when eyes shift
inability to maintain stable gaze position
CNS pathology associated with brain injury and MS
Central lesion nystagmus:
direction?
visual fixation?
vertigo?
length?
etiology?
bidirectional or unidirectional
no inhibition or fixation
mild
chronic
demyelination of nerves, vascular lesion, cancer/tumor
Peripheral lesion nystagmus:
direction?
visual fixation?
vertigo?
length?
etiology?
unidirectional with fast segment of movement indicating the opposite direction of lesion
will inhibit nystagmus and vertigo
significant
minutes, days, weeks but finite period; recurrent
menieres, vascular disorders, trauma, toxicity, infection of inner ear
Balance Evaluation Systems Test (BESTest)
36 item tool assessing 6 different systems
Total scoring 108
Takes longer to administer
More comprehensive
Can diagnose underlying system affecting balance
condensed versions=Mini-BESTest and Brief-BESTest
Berg Balance Scale
fall risk test
14 tasks rated 0-4
out of 56
less than 45 is increased risk for falls
Clinical Test of Sensory Interaction on Balance (CTSIB)
assesses contributions of visual, somatosensory and vestibular
Test can identify which sensory system the patient relies on the most
6 different scenarios
Modified version does not include last two tasks
Three attempts given and if cannot hold positions for 30s then three trials are averaged.
Dynamic Gait Index (DGI)
8 item tool with varying gait tasks
24 score
<19=fall risk
Four square step test
ability to step in multiple directions two trials and take faster time
>15 seconds=fall risk
Fregly-Graybiel Ataxia Test Battery
8 test
Measures time spent in each test position and number of steps patient takes without falling
5 trials
Best suited for those with higher level motor skills and does not help the therapist diagnose the cause of the balance dysfunction
Fugl-Meyer Sensorimotor Assessment of Balance Performance Battery
tests hemiplegia
7 items with max score of 14
Even tho someone scores a 14 doesnt mean they have normal balance
Fullerton Advanced Balance Scale
10 item
more advanced and created for higher functioning adults to avoid ceiling affect.
Possible score of 40. <26 indicates increased risk for falls
Functional Gait Assessment
10 item tool
modification of DGI
higher level tasks to avoid ceiling
possible score of 30
<23 indicates risk for falls
Functional reach
age related standards:
20-40
41-69
70-87
3 trials
14.5-17 inches
13.5-15 inches
10.5-13.5 inches
has a high test-retest correlation and intrarater reliability
Multi-directional reach test
modified version of functional reach for stability anteriorly, posterioly and laterally
Romberg test
balance and ataxia
if there is a mild lesion on vestibular or somatosensory systems, the patient will typically compensate through the visual sense
Visual input removed then instability will be present if there is a larger somatosensory or vestibular deficit.
Ataxia on romberg it means there is sensory ataxia and not cerebellar
Sharpened Romberg
heel toe stance with non-dominant foot in front
increases the challenge to vestibular and somatosensory systems
Short Physical Performance Battery
3 item tool assesses lower extremity performance and risk for falling
recorded with times and times are converted to a score.
Max score of 12
<10 one or more mobility limitations and predictive of all-cause mortality
TUG
10 feet
Independence is in 10 s or less
>20s=limit for functional independence and may be at increased risk for falling.
>30s=high fall risk
Tinetti Performance Oriented Mobility Assessment
first section assesses balance
second section assesses gait
Max score of 28 combined
as score decreases, risk of falling increases
<19=high risk for falling
