exam #2 intro to vestibular rehabilitation Flashcards by Demond Fleming

Pts with DM are 70% more likely to experience vestibular dysfunction compared to those w/o. True or False?

True

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Vestibular dysfunctions can be trauma-induced? True or False?

True

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The vestibular system is only peripheral? True or False?

False; peripheral and central components

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This structure sits inside the temporal lobe

labyrinth

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The bony labyrinth consists of 3 parts ________,_______,_________ and filled w/ __________

semicircular canals (3), cochlea, vestibule
perilymphatic fluid

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The membranous labyrinth consists of 3 parts ________,________,_________ and filled w/ ___________

membranous portion of semicircular canals, utricle, saccule
endolymphatic fluid

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Three types of semicircular canals?

anterior, posterior, horizontal

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Otolitic organs: (2)

utricle, saccule

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angular acceleration response:

anterior, posterior and horizontal SCC

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linear acceleration response:

utricle: horizontal (moving walkway)
saccule: vertical (elevator)

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semicircular canals are attached to the ______ and have an enlarged end called the _______ and filled with _________ fluid

utricle
ampulla
endolympahtic

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On the utricular end of the SCC its contain a _________

cupula

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Cupula has a gelatinous barrier that contains ________ hair cells.

Hair cells sits in _______ ______ and will deflect when _______ moves

sensory
crista ampullaris
endolymph

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supporting hair cells
the main hair cell
–movement of stereocilia toward kinocilia
–movement of stereocilia away from kinocilia

stereocilia
kinocilia
excitation
inhibition

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the utricle and saccule contains specialized structure known as __________ which are small calcium carbonate crystals.

otoconia (otoliths)

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The otoconia provides ________ and _____ to the gelatinous matrix

inertia and mass

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Gelatinous mass contains _____ cells which are responsible for detecting _______ acceleration and ________ position changes

hair cells; linear; head

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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

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Horizontal linear acceleration:
Vertical linear acceleration:

utricle
saccule

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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

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Which cranial nerve goes from inner ear to the vestibular nuclei in the medulla and pons

CN VIII: vestibulocochlear

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The cochlear branch of CN VIII innervates the ______ which is responsible for _______

cochlea; hearing

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The vestibular branches split into two branches and supply:

Superior vestibular nerve - utricle, AC, HC
Inferior vestibular nerve - saccule and PC

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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? 1. smooth pursuit - CN? 2. convergence/divergence - CN? 3. 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?

1. 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 2. 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