exam #2 intro to vestibular rehabilitation Flashcards
Pts with DM are 70% more likely to experience vestibular dysfunction compared to those w/o. True or False?
True
Vestibular dysfunctions can be trauma-induced? True or False?
True
The vestibular system is only peripheral? True or False?
False; peripheral and central components
This structure sits inside the temporal lobe
labyrinth
The bony labyrinth consists of 3 parts ________,_______,_________ and filled w/ __________
semicircular canals (3), cochlea, vestibule
perilymphatic fluid
The membranous labyrinth consists of 3 parts ________,________,_________ and filled w/ ___________
membranous portion of semicircular canals, utricle, saccule
endolymphatic fluid
Three types of semicircular canals?
anterior, posterior, horizontal
Otolitic organs: (2)
utricle, saccule
angular acceleration response:
anterior, posterior and horizontal SCC
linear acceleration response:
utricle: horizontal (moving walkway)
saccule: vertical (elevator)
semicircular canals are attached to the ______ and have an enlarged end called the _______ and filled with _________ fluid
utricle
ampulla
endolympahtic
On the utricular end of the SCC its contain a _________
cupula
Cupula has a gelatinous barrier that contains ________ hair cells.
Hair cells sits in _______ ______ and will deflect when _______ moves
sensory
crista ampullaris
endolymph
supporting hair cells
the main hair cell
–movement of stereocilia toward kinocilia
–movement of stereocilia away from kinocilia
stereocilia
kinocilia
excitation
inhibition
the utricle and saccule contains specialized structure known as __________ which are small calcium carbonate crystals.
otoconia (otoliths)
The otoconia provides ________ and _____ to the gelatinous matrix
inertia and mass
Gelatinous mass contains _____ cells which are responsible for detecting _______ acceleration and ________ position changes
hair cells; linear; head
When the head moves, the otoconia and gelatinous matrix shift, ________ the hair cells. The region of the gelatinous matrix containing the hair cells is called the _______
bending; macula
Horizontal linear acceleration:
Vertical linear acceleration:
utricle
saccule
Blood supply of the vestibular system:
Basilar, PICA, AICA, labyrinthine arteries affected = cerebellum & inner ear (canals, utricle, saccule, cochlea) affected –> central and peripheral problem
AVA, common cochlear, PVA affected = inner ear (canals, utricle, saccule, cochlea) affected –> peripheral problem
Which cranial nerve goes from inner ear to the vestibular nuclei in the medulla and pons
CN VIII: vestibulocochlear
The cochlear branch of CN VIII innervates the ______ which is responsible for _______
cochlea; hearing
The vestibular branches split into two branches and supply:
Superior vestibular nerve - utricle, AC, HC
Inferior vestibular nerve - saccule and PC
VOR (vestibulo-ocular reflex)
–_______ ________ during head movements
–eye move _________ and ______ to the head
–head moves –> _____to vestibular nuclei (VN) —> oculomotor nuclei (ON) –> ______ muscles
gaze stabilization
equal and opposite
CN VIII; Ocular
VSR (vestibulo-spinal reflex):
(1) big role in _________stability
(2) adjusting ______motion appropriately for the position of the head
(3)_______ output is the skeletal muscles
postural
limb
central
VCR:
(1) use of ________ musculature to stabilize the head in space
(2) output is to the ______ musculature = head is stable with ______ movement
neck
cervical;body
the central vestibular system starts when CN _____ communicates with the vestibular nucleus at the ________
CN VIII; brainstem
Vestibular nuclei (4)
-superior
-descending
-medial
-lateral
-located in ______ and _____ travels to ________, other ____ and _______ nuclei
controls VOR
connects to the cerebellum (coordination/planning) and other nuclei (fine-tuning)
controls VOR/VSR
controls VSR
pons & medulla, VNs, & oculomotoror
Cerebellum: the ________ is required to adapt VOR gain. ______ is required for VOR duration. _________ affects VSR.
flocculus; nodulus, anterior-superior vermis
The blood supply for Central Vestibular System:
_____ feeds medulla and cerebellum
______ feeds cerebellum
PICA
AICA
Ocular nuclei take input from ______ nuclei. Sends outputs to the ocular muscles via CN _____,___,_____ located in the ________
vestibular; CN II,IV, VI ; midbrain (brainstem)
Ocular muscles determine _____ directions and output
nystagmus
Six eye muscles: single
plane movement (larger muscles)
multiplane movement (smaller muscles)
–why is torsional nystagmus possible?
medial rectus (CN III)
lateral rectus (CN VI)
superior rectus (CN III)
inferior rectus (CN III)
superior oblique (CN IV)
inferior oblique (CN III)
oblique muscle
LR6(SO4)3
Treatment differs from central vs. peripheral vs. both. True or False?
Mechanical vs Electrical: meaning?
True
mechanical = putting crystals back where they go (BPPV)
electrical = dysfunction in nerve or blood supply
What helps dictate diagnostic findings (3)
eye movements
postural movements
sensory organization
Nystagmus [Types/Directions]
vertical (persistent) =
horizontal =
direction changing =
sustained =
intermittent =
upbeating torsional =
downbeating torsional =
central
central or peripheral, geotropic = down (HC SCC), ageotropic = up (HC SCC)
central
central
peripheral
peripheral (PC SCC)
peripheral (AC SCC)
subjective hx:
PMH:
Exam/Vestibular Screen:
-clear ______ 1st
-mVAT bad psychometrics but protects ______ can be combined with 5Ds and 3Ns
-saccades - test? central or peripheral? CN?
vertebral artery
license; drop attacks, diplopia, dizziness, dysarthria,, dysphasia, nystagmus, n&v, numbness (facial)
fixate on one pt. move to another; central; CN III, IV, VI
Exam/Vestibular Screen: test, central or peripheral?
- smooth pursuit - CN?
- convergence/divergence - CN?
- VOR cancellation -
(1) H test, central, CN III, IV, VI
(2) thumb seeing double (6cm out), single vision = abnormal; central; CN III, IV, VI
(3) thumb out in front side to side –> stable on thumb, blurred background = normal central, central
Exam/Vestibular Screen: test, central or peripheral?
1. VOR 1/2
2. HIT - mechanical or electrical?
- VOR 1: target stay stationary pt. moves head side to side
VOR 2: target moves opp. of pt. head turns
–can be central or peripheral - apply an unpredictable, rapid rotation of head (<20º) in the plane of ea. canal; peripheral; electrical (ear not getting input)
Red Flags when Screening Vestibular System:
direction changing nystagmus
positive HINTS exam
sustained nystagmus
vertical nystagmus
+ mVAT
acute interactive N+V
UMN signs
unstable vitals
not responding to position maneuvers
other symptoms of stroke: FAST (face arms speech time)
Vestibular outcome measures:
DHI
ABC
DGI
FGA
CTSIB
Fuduka Step Test
When otoconia in the utricle gets dislodged into semicircular canal –> mechanical problem =
BPPV
canalithiasis vs. cupulolithiasis:
canalithiasis is when the otoconia are _____ _____ in the canal
cupulolithiasis theories:
1. that the otoconia adhere to the _____
2. there that fluid displacements from movement of otoconia past the cupula cause ______
3. otoconia _____ where too many otoconia move together and get stuck
free floating
cupula; excitation
jam
canalithiasis:
onset?
nystagmus?
senstaion?
cupulolithiasis:
onset?
nystagmus?
sensation of vertigo?
latent onset of nystagmus (1-40 sec.)
nystagmus goes away within 60 secs.
sensation of vertigo lasts the length of the nystagmus
immediate onset of nystagmus
nystagmus is persistent and may last entire time head in affected position
sensation of vertigo last the length of nystagmus
Direction of Nystgamus: PCC:
up beating and torsional (torsional towards affected side
Direction of Nystgamus: HCC:
horizontal with or with torsion
ageotrophic (cupulolithiasis) UP
geotrophic (canalithiasis) DOWN
Direction of Nystgamus: ACC:
down beating and torsional (torsional towards the affected side)
Assessment of BPPV
–PC and AC
–HC
dix hallpike (ear down one PT is testing)
roll test (testing both ears)
Peripheral disorders: Treatment BPPV (canalith repositioning maneuvers)
–PC
epleys (canalithiasis)
semont liberatory (canalithiasis and cupulolithiasis)
Peripheral disorders: Treatment BPPV (canalith repositioning maneuvers)
–AC
semont liberatory
Peripheral disorders: Treatment BPPV (canalith repositioning maneuvers)
–HC
270 roll (BBQ roll) (canalithiasis)
change in vestibular response to certain stimuli (neuroplastic change where there is a psychosocial balance of signaling)
adaptation
decreased response to a stimulus with increased exposure (get used to it)
habituation
Determining Treatment: BBPV
single canal, PC, canalithiasis:
multi-canal, and/or HC and/or cupilolithiasis
1-2 visits
may require more visit
Determining Treatment: Unilateral Hypofunctions
–acute/subacute
–chronic
2-3 weeks
4-6 weeks
gaze stability exercise 3x/day for 12 mins acute/subacute, 3-5x/day 20 mins chronic
Determining Treatment: Bilateral Hypofunctions
5-7 weeks
gaze stability exercise 3-5x/day for 20-40 mins
Determining Treatment: Central
depends on what causes central –> remediation, compensation and or prevention
