Extra From Vestib Flashcards
What test identify movements that cause symptoms from the purpose of habituation
Motion sensitivity test
What should the motion sensitivity test identify
WHY those movements cause symptoms first
What is the normal score for the fukuda’s stepping test
Normal subjects move forward less than
50cm & turn less than 30 degrees
What is the recovery mechanism for VOR
Adaptation
What does adaptation involve a combination of
Head movements and visual input to modify VOR gain; requires “error signal” to initiate neuroplasticity
What is the normal VOR gain
1
What does substitution do
Used other strategies to replace lost vestibular function
When is substitution useful after
Bilateral VOR loss or w central dysfucntion or combination of peripheral and central dysfunction
in pts w bilateral VOR loss, increasing reliance on Cervico-ocular Reflex (COR) in which feedback from neck proprioception can cause stereotypical eye movements (but slower)
What vestibular rehab would u use
Sub
What is habituation
Repeated exposure to a stimulus decreases the brains pathological response to that stimulus- the brain gets used to it
What is the immediate response to habituation
Reduced sensitivity of Ca+ channels and decreased release of
neurotransmitter
What is the long term response to habituation
Change in size and number of synapses
To promote gaze stability what vestib rehab would u do
Adaption
What is the CPG for when clinicians should offer VR to patients
acute or subacute unilateral PVD/H/L
chronic unilateral PVH/L
BVD/H/L
What vestib rehab would u do for dizziness provoked by specific stimuli
Habituation
What vestib rehab would u do fro gaze stabilization; VOR adaptation or VOR sub
Eye head coordination exercises
Neuroplasticity only occurs with sufficient challenge to create “___ ___” but still achieve “___”
Erro signal
Success
If patient has motion sensitivity what vestib rehab would u do
Habituation
Use adaptation for ___ hypofucntion and substitution for ___ hypofunction
Uni
Bilateral
When should u do surface orientation/grounding exercises with vestib patients
For all pateints but especially for non BPV peripheral hypofunction (uni or bilateral)
What is the indication to do habituation exercises
Pts with notional sensitivity or central vestibular dysfunction or mixed vestibular dysfunction
T/F: fo habituation exercises u want to do repeated movement or Activity that casues dizziness until it no longer does
T
Brandt- Daroff is an classic example of a ___ exercise
Habituation
If eye movements alone cause dizziness in pts with knows CNS or CN lesion what exercises should u do
Oculomotor exercises
- ocular ROM
- vergence
- smooth pursuit
- saccades
- VORc
Habituation exercseis
How do u do habituation exerceies for vestib rehab for motion sensitivity
- choose up to 4 position that caused symptoms during the test
- perform movements quickly enough to produce motion sensitivity and do 2-3 reps , 2x a day for 8 weeks
What does Edwalds 1st law state
Eye movements are in the plan of the canal being stimulated
What does ewalds 3rd law state
For posterior and anterior canal , deflection of the cupula towards the canal creates a STRONGER response then when to deflects away
What does ewalds 2nd law state (for horizontal)
Excitation of any canal creates a strong vestibular stimulus and creates a greater response then inhibition
So if the otoconia are free floating (canal) in the HC , turning head towards the AFFECTED side will cause otoconia to move closer to cupula and this will push the endolymph into the supplant and deflect it away from the canal.. thus causing a greater response then when the head is turned away from the affected side bc the cupula deflects towards the canal
If otoconia are stuck (cupulo) turning head towards affected ear will cause cupula to deflect towards the canal (otoconia moves away from cupula) due to the weight and causes less of a response than when the head is turned away from the affected side and the cupula deflect always from canal
What does teh bow and lean test determine
Affected side in horizontal canal
What does the straight head handing test determine
Anterior canals (both sides)
How does the flow of sound travel thru the ear
Comes in thru the outer ear —> external auditory canal —> tympanic membrane (hits our ossicles tiny bones, vibration occurs —> thru the middle ear to the inner ear —> then to the vestibulocochlear n —> BS
How is the follow of sound in the inner ear
Cochlea (has hair cells that get stimulated by vibration) —> endolymph
Where is the otoconia located
Inner ear on the utricle and saccule
How much is the spikes/sec for excitation of the cupula
160
How much is the spikes/sec for resting and inhibition of the cupula
90
20
