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neuromuscular II > exam #2 intro to vestibular rehabilitation > Flashcards

exam #2 intro to vestibular rehabilitation Flashcards

1
Q

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

A

True

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2
Q

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

A

True

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3
Q

The vestibular system is only peripheral? True or False?

A

False; peripheral and central components

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4
Q

This structure sits inside the temporal lobe

A

labyrinth

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5
Q

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

A

semicircular canals (3), cochlea, vestibule
perilymphatic fluid

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6
Q

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

A

membranous portion of semicircular canals, utricle, saccule
endolymphatic fluid

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7
Q

Three types of semicircular canals?

A

anterior, posterior, horizontal

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8
Q

Otolitic organs: (2)

A

utricle, saccule

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9
Q

angular acceleration response:

A

anterior, posterior and horizontal SCC

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10
Q

linear acceleration response:

A

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

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11
Q

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

A

utricle
ampulla
endolympahtic

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12
Q

On the utricular end of the SCC its contain a _________

A

cupula

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13
Q

Cupula has a gelatinous barrier that contains ________ hair cells.

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

A

sensory
crista ampullaris
endolymph

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14
Q

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

A

stereocilia
kinocilia
excitation
inhibition

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15
Q

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

A

otoconia (otoliths)

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16
Q

The otoconia provides ________ and _____ to the gelatinous matrix

A

inertia and mass

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17
Q

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

A

hair cells; linear; head

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18
Q

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 _______

A

bending; macula

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19
Q

Horizontal linear acceleration:
Vertical linear acceleration:

A

utricle
saccule

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19
Q

Blood supply of the vestibular system:

A

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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19
Q

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

A

CN VIII: vestibulocochlear

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20
Q

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

A

cochlea; hearing

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21
Q

The vestibular branches split into two branches and supply:

A

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

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22
Q

VOR (vestibulo-ocular reflex)
–_______ ________ during head movements
–eye move _________ and ______ to the head
–head moves –> _____to vestibular nuclei (VN) —> oculomotor nuclei (ON) –> ______ muscles

A

gaze stabilization
equal and opposite
CN VIII; Ocular

23
Q

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

A

postural
limb
central

24
Q

VCR:
(1) use of ________ musculature to stabilize the head in space
(2) output is to the ______ musculature = head is stable with ______ movement

A

neck
cervical;body

25
Q

the central vestibular system starts when CN _____ communicates with the vestibular nucleus at the ________

A

CN VIII; brainstem

26
Q

Vestibular nuclei (4)
-superior
-descending
-medial
-lateral
-located in ______ and _____ travels to ________, other ____ and _______ nuclei

A

controls VOR
connects to the cerebellum (coordination/planning) and other nuclei (fine-tuning)
controls VOR/VSR
controls VSR
pons & medulla, VNs, & oculomotoror

27
Q

Cerebellum: the ________ is required to adapt VOR gain. ______ is required for VOR duration. _________ affects VSR.

A

flocculus; nodulus, anterior-superior vermis

28
Q

The blood supply for Central Vestibular System:
_____ feeds medulla and cerebellum
______ feeds cerebellum

A

PICA
AICA

29
Q

Ocular nuclei take input from ______ nuclei. Sends outputs to the ocular muscles via CN _____,___,_____ located in the ________

A

vestibular; CN II,IV, VI ; midbrain (brainstem)

30
Q

Ocular muscles determine _____ directions and output

A

nystagmus

31
Q

Six eye muscles: single
plane movement (larger muscles)
multiplane movement (smaller muscles)
–why is torsional nystagmus possible?

A

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

32
Q

Treatment differs from central vs. peripheral vs. both. True or False?
Mechanical vs Electrical: meaning?

A

True
mechanical = putting crystals back where they go (BPPV)
electrical = dysfunction in nerve or blood supply

33
Q

What helps dictate diagnostic findings (3)

A

eye movements
postural movements
sensory organization

34
Q

Nystagmus [Types/Directions]
vertical (persistent) =
horizontal =
direction changing =
sustained =
intermittent =
upbeating torsional =
downbeating torsional =

A

central
central or peripheral, geotropic = down (HC SCC), ageotropic = up (HC SCC)
central
central
peripheral
peripheral (PC SCC)
peripheral (AC SCC)

35
Q

subjective hx:
PMH:

A
36
Q

Exam/Vestibular Screen:
-clear ______ 1st
-mVAT bad psychometrics but protects ______ can be combined with 5Ds and 3Ns
-saccades - test? central or peripheral? CN?

A

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

37
Q

Exam/Vestibular Screen: test, central or peripheral?

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

(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

38
Q

Exam/Vestibular Screen: test, central or peripheral?
1. VOR 1/2
2. HIT - mechanical or electrical?

A
  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)
39
Q

Red Flags when Screening Vestibular System:

A

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)

40
Q

Vestibular outcome measures:

A

DHI
ABC
DGI
FGA
CTSIB
Fuduka Step Test

41
Q

When otoconia in the utricle gets dislodged into semicircular canal –> mechanical problem =

A

BPPV

42
Q

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

A

free floating
cupula; excitation
jam

43
Q

canalithiasis:
onset?
nystagmus?
senstaion?

cupulolithiasis:
onset?
nystagmus?
sensation of vertigo?

A

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

44
Q

Direction of Nystgamus: PCC:

A

up beating and torsional (torsional towards affected side

45
Q

Direction of Nystgamus: HCC:

A

horizontal with or with torsion
ageotrophic (cupulolithiasis) UP
geotrophic (canalithiasis) DOWN

46
Q

Direction of Nystgamus: ACC:

A

down beating and torsional (torsional towards the affected side)

47
Q

Assessment of BPPV
–PC and AC
–HC

A

dix hallpike (ear down one PT is testing)
roll test (testing both ears)

48
Q

Peripheral disorders: Treatment BPPV (canalith repositioning maneuvers)
–PC

A

epleys (canalithiasis)
semont liberatory (canalithiasis and cupulolithiasis)

49
Q

Peripheral disorders: Treatment BPPV (canalith repositioning maneuvers)
–AC

A

semont liberatory

50
Q

Peripheral disorders: Treatment BPPV (canalith repositioning maneuvers)
–HC

A

270 roll (BBQ roll) (canalithiasis)

51
Q

change in vestibular response to certain stimuli (neuroplastic change where there is a psychosocial balance of signaling)

A

adaptation

52
Q

decreased response to a stimulus with increased exposure (get used to it)

A

habituation

53
Q

Determining Treatment: BBPV
single canal, PC, canalithiasis:
multi-canal, and/or HC and/or cupilolithiasis

A

1-2 visits
may require more visit

54
Q

Determining Treatment: Unilateral Hypofunctions
–acute/subacute
–chronic

A

2-3 weeks
4-6 weeks
gaze stability exercise 3x/day for 12 mins acute/subacute, 3-5x/day 20 mins chronic

55
Q

Determining Treatment: Bilateral Hypofunctions

A

5-7 weeks
gaze stability exercise 3-5x/day for 20-40 mins

56
Q

Determining Treatment: Central

A

depends on what causes central –> remediation, compensation and or prevention

neuromuscular II (18 decks)

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