Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NEUROMUSCULAR II (Potter) > EXAM 2 > Flashcards

EXAM 2 Flashcards

1
Q

horizontal canals cause vertigo sx when you move your head

A

side to side

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

a VOR less than ___ indicates the eyes are moving slower than the head

A

1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

vestibular sx often produce a ____output to correct

A

motor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

vestibular anatomy is broken into 3 main categories, what are they

A

peripheral sensory apparatus (inner ear)
central processing center
motor ouput sx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what is peripheral sensory apparaus

A

inner ear

Provides sensory input about BOTH angular and linear acceleration

Orients the head with respect to gravity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is central processing center

A

Somatosensory and visual cues
Cerebellum
Reticular formation, cortex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what is motor output sx

A

Generates compensatory eye movements for gaze stability

Body movements for postural stability with locomotion (through vestibulospinal tract

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

explain how your body detects movement in the inner ear

A

Canals detect head movement (ant, post and lateral)hair cells are sensory organs, when endolymph fluid moves it effects hair cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what makes up the labyrinth (inner ear)

A 
Contains 5 sensory organs:
3 semicircular canals
Anterior
Posterior
Lateral

2 otolith organs
Utricle
Saccule

Hair cells-motion sensors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

each ear canal is ___to the other

A

perpendicular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

explain the “push pull” reaction of the inner ear cannals

A

bc of the positioning of the canals, turning head 1 way would excite 1 canal but inhibit it’s opponent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

information from the canals is used to

A

stabalize vision

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Macula of the utricle is oriented in the ___plane

A

horizontal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

macula of the sacule is oriented in the ___ plane

A

vertical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

information from the otolith organs is used for

A

balance control

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

both the sacule and urtricle have

A

macula (hair cells and crystals here)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

2 central processors (vestibular)

A

vestibular nuclei

cerebellum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

explain how firing rate of nuclei can make a person feel dizzy

A

Both vestibular nuclei (each side) will fire at a certain frequency. For example, turning head to right, the right vestibular nuclei has higher frequency of firing (how your brain knows you have turned to the right) eyes and postural muscles will fall in line with what the brain tells them.

But, if one side of the nuclei is not firing as much, the other is firing all the time and the brain thinks the person is always turning head to the side it’s firing, so the eyes and postural muscles will try to fall in line (even though it’s not right) = dizziness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

your eyes remain stationary during walking bc of your

A

VOR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

deficit of the VOR results in

A

osscilopsia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

the VOR is regulated by

A

Regulated by afferent input from semicircular canals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

VOR is induced by ___ speed

A

FAST

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

nystagmus indicates

A

1 vestibular sx is more active than the other

when the vestibular nuclei aren’t equal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

nystagmus is classified/named by

A

the direction of quick beat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

explain hypo/hyper active sides with nystagmus

A

If sx come on when head is turned to the right, then right side is hypofunction side

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

what is disuse disequilibrium

A 
sedentary lifestyle (they don’t move much, but when they do get up they get dizzy)
NON vestibular issue
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

examples of disuse disequilibrium

A

ortho hypotension
panic attacks
migraine
TIA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Bacterial infection of the labyrinth

Can cause hearing loss

A

vestibular labyrinthitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

these occur at the round or oval window
these seperate the middle ear and the inner ear
d/t trauma or injury

A

perilymph fistula

peripheral vest. disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

what irritates a perilymp fistula

A

auditory stimulus
strain/increase in pressure

causes sx of vertigo or imbalance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

what is Meniere’s disease

A

a peripheral vestibular disorder
Onset in fourth- sixth decades of life (older pts get)
Malabsorption of endolymph in the endolymphatic duct and sac = too much endolymp

Devastating vestibular and HEARING LOSS
Fullness in ear, reduced hearing,
rotational vertigo, nausea.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

bilateral vestibular Loss is often caused by

A

often caused by toxic drugs (if they are in sepsis)

Gentamyacin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

sx of peripherial vestibular disorders

A

Hearing loss, tinnitus, VERTIGO, nystagmus, gait ataxia, impaired VOR

vertigo with head movement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

list the anatomy or the disorders assct. with peripheral disorders

A

Peripheral sensory apparatus

Vestibular neuritis, labyrinthitis, BPPV, Meniere’s, Perilymphatic fistula, Acoustic Neuroma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

sx of central vestibular disorders

A

saccades, Oscillopsia, nausea, disequilibrium, ataxia, impaired smooth-pursuit eye movements, impaired VOR, headache, diploplia, bad Balance probs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

what constitues a central vestibular disorder

A

Damage to vestibular nuclei, or central pathways that serve VOR and VSR, brain stem or cerebellum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

with VOR, moving your head in 1 direction…your eyes move the ___ direction (if normal)

A

opposite

at equal velocity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

what is VSR

A

is a reflex body movement that maintains your posture and stabilizes your body; this reflex keeps you upright.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

peripherial vestibular disorder, vertigo is brought on by

A

head mvmt

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

balance is really effected with ____ vestibular disorders

A

central and bilateral are bad

may have some issues with peripheral, but not as bad

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

hearing loss or tinnitus occur with ___ vestibular disorders

A

peripheral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

compensation for peripheral vest. disorders occurs ___, whereas compensation for central disorders occurs ___

A

peripheral – fast

central–slow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What is DHI

A

dizziness handicapp inventory
higher score is worse
60 is fall risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

For each of the following activities, please indicate your level of self confidence by choosing a corresponding number from the following scale

0% 10 20 30 40 50 60 70 80 90 100%
No confidence completely confident

A

activities specific
balance
confidence scale

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

ABC under ___ increased fall risk

A

67

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

BPPV is usually

A

unilateral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

sx with BPPV come on d/t

A

head position changes

the crystals fall out of place and land in one of the cannals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

with BPPV, direction of nystagmus tells you___

duration of nystagmus tells you ___

A

Direction of the nystagmus will tell you which canal is involved
Duration will tell you the type of BPPV: canalithiasis or cupulolithiasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

anticipatory vs reactive control mechanisms

A

Anticipatory control mechanisms occur when you are expecting something to happen- ex: reaching to pick up a shoe from your chair so your back extensors kick in and you may grab the chair

Reactive control: occurs when you don’t know it’s coming

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

loss of selective mvmt is an issue with the

A

cortex itself

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

quiet stance (balance maintanance) is affected by

in a healthy adult

A

Body alignment/ position/posture

Muscle tone: Neural and non-neural factors

Postural tone: Influenced by somatosensory system, cutaneous afferent input, visual and vestibular systems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

anticipatory control is ___ initiated

A

self

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

amt of anticipatory control is based on

A

experience

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

what are the 3 motor strategies to maintain balance

A

ankle
hip
stepping

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

what are 3 sensory strategies to maintain balance

A

vestibular
somatosensory (proprioception)
vision

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

what are the quicker motor strategies for balance

A

ankle = fast

these kick in first usually

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

ankle strategies usually occur with what amplitude of mvmt

A

smaller

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

if you push a person posteriorly, what muscle kicks in for ankle strategy (lower leg is opp of hip)

A

tib ant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

if pt is on a balance beam (small surface and Med/Lat) what strategies are likely to be dominant to keep them balanced

A

hip

hip strategies are for smaller surface area

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

for hip strategies, if you are pushed forward what kicks in

A

quads

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

for medial lateral forces, what strategies are dominant

A

hip (like balance beam - heel to toe activities)

but remember - for narrow BOS it’s ankle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

2 responses that occur with med/lat strategies

A

Cross-over response

Lateral step response

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

general reason why stroke pts have balance issues (adaptive)

A

for healthy people = Our balance responses are highly flexible – they adapt to forces and env around us

But – stroke pts don’t have variability and adaptability of movement (they are in synergy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

when eyes are closed, what sx is used (by adults)

A

proprioception

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

at quiet stance, what sx are used

A

all 3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

at perturbed stance, what sx are used

in a healthy adult

A

Somatosensory/proprioception big role (bc they are faster)

Vestibular system becomes more active if:
Support surface moves vertically (up down)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

lack of ____ is usually the issue of cognition with regards to balance

A

attentiveness/attention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

what is the cycle of balance issues and fear of falls

A

Imbalance = leads to a big fear of falling

When someone fears falling they decrease their activity which leads to secondary impairment (like weakness) which can exacerbate future falls

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

most falls occur at ___ and are d/t ____

A

home - bathroom

tripping

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

big issue with pts who fall at home (the study listed)

A

51% cannot get up by themselves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

this area of the brain controls adaptation abilities to modify muscle amplitude to respond to the need to move bc of env demands

A

cerebellum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

number of meds for elderly that increase their fall risk

A

4 or more

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

classifications of meds that increase fall risk

A 
Psychotropic
Tricyclic antidepressants
Seronin-reuptake inhibitors
Cardiac medications
Hypoglycemic agents
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

explain how stroke pts sequence their movement patterns

A

Stroke pts sequence proximal to distal
pts post stroke have better mvmt proximally than distally (using hip hike to walk)

These pts use proximal strategies over distal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

based on the sequence of movement pattern of stroke pts, they use what strategies more

A

HIP (proximal)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

issue of sequencing with PD pts

A

they co-contract

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

impaired adaptation (in order to move and respond) is due to

A

synergy

cognition issues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

impaired timing is due to

A

timing occurs in cerebellum or fast twitch fiber loss dt coritical issue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

what pts have impaired timing

A

stroke

PD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

what pts have impaired scaling

A

Hypermetria – cerebellar issue (too much mvmt-issues regulating force)

Hypometria- Parkinsons pt

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

what LOWER (below knee) ext muscles kick in if COM is placed forward

A

gastroc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

what is the issue with strategies (muscles firing) for pts with PD when their COM is displaced

A

instead of sequential muscles kicking in normally in order to respond, PD pts have co contraction and everything kicks in at same time so normal response does not occur

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

according to the study, what is the issue with strategies (muscle firing) for pts with cerebellar disorders when COM is displaced

A

they have the sequencial response, but it’s over done so the opposing muscle has to kick in too (this becomes cyclical)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

loss of sensation or proprioception, pts have to rely on

A

vision

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

what is stability limit and why is it important

A

how far a person can move before losing balance

this is altered significantly if any of the 3 sx are lost/altered

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

what is inflexible weighting

A

a sensory selection prob
when pts dont use the correct sx for balance

ex: a pt post stroke who wont alter their stance or shift wt to effected side to prevent a fall

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

3 main reasons PD pts fall

A

postural instability
festiation/freezing
toppling over

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

pathology with highest risk for falls

A

PD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

we should teach pts with stroke to fall to what side

A

non effected

fxs occur more when they fall on effected

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

post stroke, In pts are more likely to fall when

A

first 3 weeks of rehab (new normal and new env), then post dc from IP their risk increases again

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

balance deficits with stroke pts in quiet stance

A

⬆ reliance on uninvolved LE
⬆ sway
⬆ reliance on visual input
⬆deficits with dual-task conditions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

balance deficits in stroke pts during anticipatory activity

A

⬇ weight shift involved LE
⬆ time to shift weight to involved LE
⬆ sway with UE movement with slowed motor latencies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

balance deficits in stroke pts during reactive activity

A

slow muscle responses
synergistic responses
lack of coordination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

when do MS pts typically fall

A 
during movement (not quiet)
turning, reaching
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

why do more men with MS fall typically

A

bc their MS is often more progressed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

quick tests for ataxia

A

finger to nose

heel to shin

97
Q

if vestibular sx is all a pt has (If that’s their best of the 3 sx) what is their likely outcome

A

bad balance probs
vest. is used last by healthy adults
Vest doesn’t stand well on its own

98
Q

pts with MS fall usually bc of what 2 things

A

fatigue

distractions

99
Q

important considerations when coming up with tx plan for balance (her general ones)

A 
Static vs. progressive condition
Acute vs chronicity
Single- vs. multi-system involvement
\+ and - prognostic indicators
What can we change?  What can’t be changed?
100
Q

main concepts when tx balance with PD pts (the study we read)

A

With PD you are trying to help COM not be forward (alter their COM)

We want to give them increased excursions of motion

101
Q

main concepts when tx balance in stroke pts (study we read)

A

use BEST test

if they have balance issues work on balance not gait

102
Q

main concepts with tx balance in pts with MS (study we read)

A

incorporate sensation with dynamic balance

103
Q

Flexibility in what muscles is most relevant for standing balance

A

ant tib for if you are pushed backwards, gastroc for pushed forward

104
Q

how might ROM effect balance

A

loss of strategies if tone is effected

105
Q

will strength training alone do anything for balance

A

no

106
Q

what muscles can contribute to decreased lateral stability which increases fall/fx risk

A

hip abd

107
Q

is closed or open chain better for balance tx

A

To help balance work on closed chain txs

108
Q

how does timing/speed of muscle contraction play into tx for balance

A

Stepping responses are fast

Pts with neuro probs have more issues with fast speed

Responding quickly can be a coordination therex bc it’s working on timing

always do slow and fast speeds

109
Q

tandem or single leg have to do with stance ___

A

position

110
Q

what 2 pathologies do you want to increase excursion of mvmt

A

PD

stroke (towards effected side)

111
Q

for ataxic pts you want to ____ excursion of mvmt

A

decrease

112
Q

how would you increase challenge of perturbations

A

change:

force, frequency, surface level changes, eyes closed, velocity of the perturbation

113
Q

balloon toss or badmitton are ex of ____ control reactions

A

reactive

114
Q

3 sensory sx

A

visual
proprioception (somatosensory)
vestibular

115
Q

when training balance, do you just want to do single task activities

A

no, incorporate dual task also

116
Q

what is stroop task

A

a dual task activity

a neuro/psych test where color doesn’t match word

117
Q

does altering env alone decrease fall risk

A

no

pts tend to add items to alter rather than take items away

118
Q

for neuro pts is RW or SW better

A

RW requires least amt of attention

standard walkers require alot of attention

119
Q

balance impariments, use what type of tests (OM)

A

predictive

120
Q

psychometrics for predictive (diagnostic) tests

A

Sensitivity
Specificity
Probabilities
Likelihood Ratios

121
Q

psychometrics for evaluative tests

A

MDC

MDIC

122
Q

sensitivity tells you

A

tells you how accurate the test is at identifiying the condition

123
Q

How confident can we be in the diagnostic capabilities of the test has to do with

A

LR

124
Q

probabilities deal with

A

the pt

if it starts with ….the pt

125
Q

Probability that a patient with a + test result will have the condition

A

high prob

126
Q

Probability that a patient with a - test result will not have the condition

A

low prob

127
Q

interpret this data

Postest prob test ≤ cut off
the Standards for the OM is 69/108
pt score is 61.3%

6 months 69%
12 months 43%

A

this is the LESS than

this means, if the pts score is less than the standard that is listed, than they have 69% chance of falls at 6 months and 43% chance of falls at 12 months

Retro-pts score
prospective -comparison scores

128
Q

you want pos LR to be ___ and neg LR to be __

A

pos you want value to be high
neg you want to be low

In order to be in the green/confident category

129
Q

formula for LR

A

Probability of + test in pt WITH condition/Probability of - test in pt WITHOUT condition

130
Q

high confidence of LR (for pos and neg)

A

5 or greater (this is a pos LR)

.2 or lower (this is neg LR)

131
Q

moderate confidence of LR

A

+ LR 2-5

- LR 0.2 – 0.5

132
Q

a LR of 1 or close to 1 is

A

not relevant, like it’s neutral (.5-1 dont use)

133
Q

list some specifics of the activities balance confidence scale

A

generic
16 items
self reported
Scoring: items rated on 0 – 100% continuous scale (higher = better); summed and divided by 16 = total score on 0 – 100 point scale

134
Q

use ABC for what type of pts

A

community dweller, high level tasks, higher functioning pts.

ABC is for balance

135
Q

specifics of the Tinettes (FES) OM test

A

Type of measure: Generic
Self-report
Purpose: perception of ability to complete various tasks without falling
Items: 10 – mainly household tasks
Scoring: 0 – 10 point scale (higher = better); scores summed; total score 0 - 100
Limitations:
Ceiling effect

136
Q

lower level functioning and concerns/fear of falling,
SNF pts
what OM to use

A

Tinetti (FES)

FES is for FALLS

137
Q

target population for Tinetti (FES)

A

SNF pts

homebound pts

138
Q

specifics of BEST Test

A

Generic
Performance-based
Purpose: assist with identifying the underlying postural control systems responsible for poor functional balance
Items: 27 tasks / 36 items testing 6 systems
Scoring: 3 – 4 point scale; total score and subtest scores are obtained and calculated as a percentage of the total score
Limitations: time consuming (20 – 30 min.)

139
Q

dimensions tested in BEST test

A 
biomechanical
stability limits
reactive
anticipatory
sensory
gait

BRAGSS

140
Q

4 components tested in mini BEST

A

anticipatory
reactive
sensory
gait

RAGS

141
Q

immediatley post stroke, the pt tone is

A

flaccid

142
Q

what OM is good for testing turning in place

A

BERG

143
Q

4 approaches to vestibular rehab

A

Adaptation
Substitution
Habituation
compensation

144
Q

4 main categories of vestibular disorders

A

Unilateral
Bilateral peripherial hypofunction
Central –ex MS
BPPV

145
Q

difference in approach for partial vs full loss in regards to vest tx

A

partial - remediate

full -compensatory

146
Q

Why are ROM exercises important to do with vestibular pts

A

ROM of head and neck is important bc they often develop muscle imbalances from compensation and not moving dt sx

147
Q

tx approach of vestibular pts depends on

A

Unilateral or bilateral involvement

Complete or partial vestibular loss

148
Q

neuroplasticity indicates what

A

CNS is adapting

149
Q

gaze stabalization exercises are _____ approach

A

adaptation

150
Q

explain gaze stabalization exercises

A

Gaze stabilization ex retrain/restore eye/head muscle mvmts and retrain the sensitivity of the VOR

Aim to improve VOR by inducing retinal slip
Involve active eye & head movement to improve coordination between the two

151
Q

gaze stabalization (adaptation) is good for what pts

A

unilateral

or bilateral with incomplete loss

152
Q

explain substitution as a tx approach

A

Aim to improve the patient’s ability to use various sensory systems to improve balance control (vision/proprioception)

Use central preprogramming to improve gaze stability and postural stability

Stress system by reducing sensory cues –>forces patient to rely on other systems/cues

153
Q

what is central pre programming

A

uses compensatory eye movements (use eye mvmts that are slower and maybe don’t correlate with head mvmt equally) purposefully not equal

used in substitution

154
Q

what approach do you use for pts with car sickness (motion sickness)

A

habituation

155
Q

how long does habituation take

A

weeks to months

156
Q

explain principle of habituation

A

Learned suppression of vertigo through repetitive exposure to provoking movements

157
Q

compensation is used to improve__

A

NOT to improve VOR

but rather, to improve function

158
Q

compensation is used for what pts

A

central issues
bilateral issues
complete loss

159
Q

examples of compensation

A

lighting
railings
assistive devices
(alternative strategies for function)

160
Q

peripherial unilateral pts, what approach to use

A

adaptation/restoration

161
Q

how long does tx for peripherial unilateral take

A

6-8 weeks

162
Q

how to tx peripheral unilateral pts

A 
Gaze stabilization exercises (matching eye to head)
Vestibular stimulation (X1 viewing)
Visuovestibular stimulation (X2 viewing)
High level balance retraining
Conditioning
Education
163
Q

how could you progress gaze stabalization exercises (X1, X2)

A

change background of what they are looking at
change standing surface
increase distance btwn them and object

164
Q

VOR is really bad for what pts

A

Bilateral peripheral

165
Q

prognosis for bilateral peripheral pts

A

not good

can take years, but may not fully recover

166
Q

____ is a sign of retinal slip

A

oscilopsia

167
Q

balance is poor and assistive devices needed for what type of pts

A

bilateral

168
Q

why will bilateral complete loss yield a neg head shaking test

A

For typical nystagmus issues, there is a mismatch btwn R and L that causes the imbalance (if there are B issues, there is no mismatch).

169
Q

vertical nystagmus indicates a _____ problem

A

o Vertical nystagmus indicates central problem

170
Q

sx of bilateral peripheral disorder

A

Gaze instability & oscillopsia
Negative head shaking test if a complete loss
Postural instability, especially when vision or proprioception is reduced
Gait abnormalities: WIDE BOS
INSENSITIVE to motion in environment
Deconditioning

171
Q

tx approach for bilateral peripheral disorder

A

substitution

172
Q

what sx do you want to increase when tx bilateral peripheral

A

increase vision and proprioception

173
Q

fall risk for bilateral pts is

A

very high

174
Q

focus of tx for bilateral pts is what 4 things

A

occulomoter ex (2 horizontal targets)
balance ex
education
conditioning

175
Q

use ___ approach for central disorder pts

A

compensatory

176
Q

dosing of habituation

A

Select up to 4 movements

Perform quickly - provoke symptoms

Rest after each movement until sx. stop

3 – 5 sets of each

2 – 3 x/day

177
Q

for BPPV, what two canals are tx the same

A

ant/post same

hor different

178
Q

most common tx for ant/post BPPV

A

Canalith Repositioning Maneuver (CRM; a.k.a. Epley)

179
Q

explain Epley/Canalith positions

A

start seated
supine (head turns)
SL
ends seated

180
Q

how often do you typically have to perform the Epley manuever

A

1 x

181
Q

most common location of BPPV

A

right post

182
Q

canalithiasis vs cupulothiasis

A

In canalithiasis the particles reside in the canal portion of the semicircular canals

Cupulolithiasis refers to densities adhering to the cupula of the crista ampulla.

183
Q

education you should provide to pts post Epley manuever

A

take it easy for 1-2 days

you may feel “off”

184
Q

Epley only treats which _____athiasis

A

canalithias

185
Q

what ant/post BPPV manuever is self done, and is for both ___athiasis

A

Brandt-Daroff Habituation Exercises

186
Q

More violent rapid movements –used as a last resort for canalithiasis ant/post BPPV

A

Liberatory (Semont) manuever

187
Q

what do you need to assess before doing vertigo tx (neck/head movements)

A

Need to test for vertebral artery dysfunction before doing tests that involve neck motion.

For vert art test have them lean forward/sb/rotate

188
Q

ataxia of the eye (difficulty stopping eye mvmt) is what

A

saccades

189
Q

if the saccades test is pos, what should you do

A

refer bc it may indicates a CNS issue

190
Q

more than 2 saccade jumps indicates what

A

cerebellar issues-CNS

191
Q

to test for saccades, you only go about ___ degrees up/down/lateral

A

20

192
Q

torsional nystagmus correlates with what disorder

A

BPPV

193
Q

what degrees is uses with nystagmus

A

30 up/down/lateral

194
Q

absence of nystagmus indicates normal vest sx, T or F

A

absence of nystagmus doesn’t mean normal vestibular system! (suppression or resolution could have occured)

195
Q

upbeat/downbeat nystagmus indicates what type of disorder

A

CNS

196
Q

frenzel lenses are used to test ___

A

nystagmus

they cannot stabalize gaze so it’s really evident

197
Q

head thrust test, tests the ___ canals

A

hor

peripheral or central issue

198
Q

steps to head thrust test

A

Patient seated in front of PT; PT grasps patient’s head and flexes neck to 30degrees; patients head is thrust (eyes open) either R or L in unpredictable manner (to about 5 to 10 degrees; PT observes for corrective saccades; repeat in each direction 3 times

199
Q

with peripheral loss, head thrust results are what when going towards involved side

A

sx are worse

will not be able to hold gaze and saccades will be present

200
Q

head shake test, tests what canals

A

hor

201
Q

explain head shake test

A

back and forth x 20 cycles then keep ahold of head and have them open eyes and observe for nystagmus

202
Q

so head thrust looks for___ while head shake looks for ___, and both tests you position pt at ____

A

thrust -saccades
shake -nystagmus
both 30 degrees neck flexion

203
Q

pos head shake test indicates what disorder

A

UNILATERAL periperial disorder of a horizontal canal

204
Q

dynamic visual acuity test, tests what canals

A

hor

205
Q

Patient in front of a wall-mounted eye chart;
PT asks patient to read the lowest line s/he can see on the chart (test static first);
patient then asked to read the chart while the PT oscillates patient’s head at frequency of 2 Hz (dynamic); PT compares visual acuity in static vs. dynamic condition
abNormal: over 3 line difference indicating vestibular hypofunction (3 lines up or more is pos)

this is what test

A

dynamic visual acuity

206
Q

test to dx ant/post BPPV

A

dix hallpike

207
Q

contraindications for dix hallpike

A

o Vertebral artery syndrome

o Cervical spine instability or other issues

208
Q

in dix hallpike, if pt has sx and nystagmus when head is turned to the post left, which canals are involved

A

the side you are turning towards is effected side

left post

209
Q

what are the pairings of the semi-circ-canals

A

Horizontal canals: rotation in the horizontal plane

Left anterior and right posterior (LARP)

Right anterior and left posterior (RALP)

210
Q

cranial nerve-controls the down and inward movement of the eye

A

trochlear

4

211
Q

3 CN responsible for eye mvmt

A

3,4,6

212
Q

occulomotor nerve movements

A

everything other than abduct and down and inward

213
Q

what test would you perform for unilateral peripheral vest issue

A

head shake test for nystagmus

214
Q

what tests would you perform for central vest issues

A

neuromotor functional tests

a series of neuromotor function tests

215
Q

looking from nose to finger tests for

A

saccades

216
Q

frenzel lenses are used when ___ is present

A

nystagmus

217
Q

resting/static nystagmus indicates

A

can mean acute peripheral vestibular lesion (although not likely seen without Frenzel lenses) or brainstem/peripheral lesion

218
Q

head thrust tests, tests what

A

assess the integrity of the VOR; tests horizontal canal

looking for sacaddes

219
Q

head shake test, tests for what

A

assess the integrity of the VOR in patients with unilateral peripheral vestibular deficit
looks for nystagmus

220
Q

chance that pt does or does not have the condition

A

probability

221
Q

disequilibrium,
‘ataxia,
‘impaired’smooth-pursuit’eye’movements,’ (saccades)
impaired’VOR

all sx of

A

central disorders

222
Q

test for CN function

A

H test

223
Q

which lasts longer cupolithiasis or canalothiasis

A

cupolothiasis lasts longer than canalothias

224
Q

typical motor strategies go ___ to ___

A

distal to proximal

ankle first usually

225
Q

main sensory strategy used by adults

A

somatosensory

226
Q

odds of pt having a disease based on pos or neg result

A

LR

227
Q

3 self reported OM for this unit

have to do with participation

A

FES - low function
DHI
ABC - high function

228
Q

X1 X2 viewing is for

A

unilateral peripheral disorder

hypofunction

229
Q

dosing of X1 X2 viewing exercises

A

1-2 min x 5 x/day

230
Q

going up in an elevator would enact which of the 3 sensory sx

A

vestibular

if vertical changes are made vestibular is enacted

231
Q

dynamic visual acuity test is for what type of disorders

A

bilateral of hor canals

232
Q

Roll test is for

A

HORIZONTAL BPPV

233
Q

horizontal targets - move eyes then head
imaginary targets- turn head, close eyes, image

these treat what

A

bilateral disorders

234
Q

peripheral disorder associated with CN 8 (non malignant tumor)

A

acoustic neuroma

235
Q

Cranial N test

A

H test

236
Q

how to test for saccades (2 ways)

A

nose to finger eye follow

head thrust

237
Q

with saccades nose to finger follow test, what degrees to rotate L/R

A

20 for saccades

238
Q

head shake is flex neck to ___ degrees, rotate head ___ degrees L/R, for ___ cycles

A

30/30/ 20 cycles

NEUROMUSCULAR II (Potter) (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions