Exam 1 (Bedside Screenings) Flashcards
Why would we do bestside vs diagnostic tests?
These tests help distinguish between stroke patients and benign vestibulopathy, guiding triage decisions and necessary testing referrals
Evaluates input from the inner ear (IE) to the feet
VSR evals
what are screenings for VSR function
romberg & fukuda (unterberger)
Oldest & most common (1846) screening
romberg
what is the romberg
Performed as part of a neuro exam to evaluate balance, proprioception (requires healthy function of dorsal colums in spinal cord & location of joints), and coordination (ataxia)
measure the degree of functional disequilibrium caused by central vertigo, peripheral vertigo, and head trauma
what is the premise behind the romberg
PT who has issues with somatosensory can still maintain balance by compensating with vestibular function and vision
Not sensitive to unilateral or non-acute deficits
how is romberg performed
Patient stands with feet together, arms close, first with eyes open, then closed for 10-15 seconds.
Can be more difficult with tandem stance
positive romberg
Acute peripheral vestibular lesions → falls towards the weakened side
Usually more sway when eyes closed
suggests loss of coordination is sensory due to loss of proprioception
negative romberg
suggestive of ataxia
no deficits during romberg
chronic vestibular damage
Equal sway with eyes open and closed in romberg
suggest possible proprioceptive or cerebellar site
what is the fakuda
Assesses labyrinthine function and vestibulospinal reflexes
Published by Unterberger in 1939 and modified in 1959 by Fukuda - 100 steps on marked floor
contra indications of fukuda
PT must be able to maintain balance with eyes closed Romberg testing
Normative data → Adult (18-64) and Elderly Adult (65+)
how is fukuda performed
Patient marches in place with eyes closed and arms up for 50 steps
Do not bias patient with auditory/other stimuli
normal fukuda
no significant angular deviation (i.e., less than 30-45 deg rotation)
abnormal fukuda
excessive rotation exceeds 45 degrees for 100 step test or exceeds 30 degrees for 50 step test, or if excessive sway, translation or staggering is noted during (Fukuda, 1959)
Rotates toward the affected side
what are the tests for VOR
halmalgi head thrust (head impulse), active/passive head shake, and dynamic visual acuity (passive head rotation with snellen chart)
what is head impulse
Bedside screening to detect SCC dysfunction in all canals
Useful to detect peripheral vestibulopathy
how is halmalgi head thrust performed
clinician quickly turns the patient’s head to assess the functional VOR while the patient focuses on a target (e.g., clinician’s nose)
The head is moved in the direction of the semicircular canals with a high acceleration (>3000 deg/sec²) but no more than 20-30 degrees. The head is briefly held to observe for re-fixation saccades
normal halmalgi head thrust
no corrective / re-fixation saccades
impaired halmalgi head thrust
saccades in the direction of the lesion
Ex: if right is inhibited, normally turn to right excites r canal but because it is inhibited it doesn’t excite and causes the eyes to slip past the target and then refix back to the target
what is active/passive head shake
evaluates the status of the patient’s velocity storage integrator
how to perform active/passive head shake
Patient wears Frenzel lenses or VNG goggles, and either actively shakes their head or has it passively moved at 2Hz for 20 seconds
After stopping the head, the patient opens their eyes, and the clinician observes for any nystagmus
Clinician notes if any nystagmus is observed post headshake or if any pre-existing nystagmus is enhances after-headshake
normal active head shake
no post-headshake nystagmus
abnormal head shake
post-headshake nystagmus or enhanced post-headshake nystagmus which will be directed toward the better ear (active side) or away from the impaired ear. Post-headshake nystagmus indicates poor dynamic compensation of the vestibular system
what is the Dynamic Visual Acuity (Passive Head Rotation w/ Snellen Chart)
Screens for oscillopsia
Caused by vestibular loss especially bilateral losses
how is Dynamic Visual Acuity (Passive Head Rotation w/ Snellen Chart) is performed
The patient is seated the proper distance from a Snellen Eye Chart and instructed to read the lowest line possible
The clinician then stands behind the patient and moves their head back and forth in a horizontal fashion (actively) or alternatively the patient can move their head themselves passively (less preferred) in a 20-30 deg arc at 2Hz
The patient is again asked to read the lowest line possible while the head is rotated
normal Dynamic Visual Acuity (Passive Head Rotation w/ Snellen Chart)
Patient’s will have no line change or just a single line change in visual acuity
abnormal Dynamic Visual Acuity (Passive Head Rotation w/ Snellen Chart)
Those with oscillopsia will have a line change of 2 or greater during head movement (McCaslin, Dundas, Jacobsen 2008)
limitation of dynamic visual acuity
you can’t tell which side is effected
laterality is not good but functionality is good
