Falls, dizziness, and vestibular Flashcards by Ariyana Williams

The least stringent definition of a fall

“unintentional loss of balance that leads
to failure of the postural stability.”

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The use of the least stringent definition recognizes that

a person does not need to end up on the floor as a consequence of the postural control
system failing to meet a challenge

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More than _____ of adults 65
years and older fall each year

___ % of these falls sustain a serious injury

one third

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secondary prevention
tertiary prevention

risk reduction for further falls
reduction of
functional consequences of poor balance

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Muscle strengthening and endurance
program focused on the lower
extremities; patient education in
reducing environmental hazards that
represent fall risk

this is what type pf prevention and for who

primary for older adults

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Secondary prevention for individuals with history of falls

Exercise program and gait training; assessment and
modification of the environment

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Tertiary type of prevention for individuals with CNS pathology with chronic or progressive balance deficits

Exercise program, instruction in
ADL’s and gait training with assistive
devices; patient and caregiver
instruction on fall prevention and
safety

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Sensory peripheral areas of impairment

Sensory central areas of impairment

visual, vestibular, somatosensory

cortical areas

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Sensory peripheral areas of impairment: consequences

Sensory central areas of impairment: consequences

Decreased ability to sense position or
movement of the head or body in relation to
environment

Decreased ability to combine information
from relevant sensory input; perception of
space, true vertical or horizontal may be
distorted

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Motor peripheral areas of impairment

Motor central areas of impairment

muscles, joints

CNS areas: planning coordinating

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Motor peripheral areas of impairment: conseq

Motor central areas of impairment: conseq

Decreased ability to execute balance
strategies or reaction to postural sway

Decreased ability to plan and coordinate
postural control under static and dynamic
conditions

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Cognitive central areas of impairment and conseq

cortical/limbic areas: attention arousal judgement

Decreased ability to remember previously
successful strategies, or judge and attend to
postural dangers

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Falls are the most common cause of

TBI

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The most common fall related fracture

Hip

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Individuals with higher risk of falls

stroke, dementia, balance issues, using an AD, parkinson’s, LE sensory loss

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1 out of 5 _______ patients die within a year of injury

hip

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Why is polypharmacy bad?

most common med side effect

Patients who get medications from multiple different pharmacies miss interactions between their medications

dizziness

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Somatosensory age related risk factors

decreased light touch and proprio

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Visual age related risk factors

Vestibular age related risk factors

CNS age related risk factor

decreased visual acuity, depth perception (light and dark)

changes in VOR, hair cells

decreased coordination

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Non-specific term implying a sense of disturbed relationship to the space
outside oneself

dizziness

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Vertigo

illusion of motion – usually one of spinning or tilting

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Rotational vertigo in the horizontal plane is
due to horizontal SCC dysfunction, which commonly comes from

labyrinthine or 8th cranial
nerve dysfunction

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A tilt vertigo is due to

utricle dysfunction

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Rotational vertigo in a torsional plane is indicative of

anterior or
posterior SCC involvement

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Dysequilibrium

feeling of unsteadiness, impending loss of balance, which is a perceptual problem

Inability to deal with images coming past you. Can either due to the environment moving past the person or the person moving within the environment.

Motion intolerance

Illusion of movement due to loss of VOR during head movement, or a too active VOR resulting in spontaneous nystagmus

Oscillopsia

This is due to a reduced blood flow to the brain common causes

Near syncope orthostatic hypotension, anti-hypertensive medications, cardiac disease, and hyper- ventilation

Visual health related risk factors CNS health related risk factors Neuromuscular

cataracts, CVA CVA, MS impaired postural alignment

It is critical, therefore, to question the patient with dizziness about

visual difficulties, especially with complaints of motion sickness

The cerebral blood flow must be significantly reduced (at least 2/3rds) to

evoke a syncopal episode

The two most common causes of decreased cardiac pump efficiency are

structural heart diseases and arrhythmias

Arrhythmias can cause palpitations and syncope. This is seen in patients who have heart rates above

170

1/3rd of the patients experience vertigo without an

associated headache

Autoimmune inner ear disease consists

of progressive hearing loss, tinnitus, and/or dizziness

In most cases, the symptoms of patients with ___________ spontaneously diminish over a period of weeks _____ usually resolves first within days

unilateral vestibular loss nystagmus

The role of physical therapy in the management of patients with -BBPV -Unilateral vestibular hypofuction -motion sensitivity -bilateral vestibular loss -central vestibular

-canalith repositioning and adaptation exercises -adaptation and substitution, habituation -habituation -substitution, adaptation -habituation

The most common cause of vertigo in peripheral vestibular disorders

BPPV: benign paroxysmal positional vertigo

BPPV is thought to be caused by

by detached utricle otoliths

Classic BPPV is the most common variety of BPPV and involves the It is affected more than ____ % of the cases because of its

posterior semicircular canal 90, gravity dependent position

It is important to differentiate horizontal canal-BPPV from posterior canal-BPPV because..... through.......

the treatment is different nystagmus

With posterior canal-BPPV the direction of the nystagmus While the direction of the nystagmus with horizontal canal- BPPV

the direction of the nystagmus remains the same with changing head positions changes with changes in head movement direction

Vertigo due to a disease originating from the central nervous system caused by

Central vertigo hemorrhagic or ischemic insults

posterior canal-BPPV is ______ specific With horizontal-BPPV, nystagmus can be provoked moving in .....

direction either horizontal direction

CPV (central positional vertigo) that occurs as spells is usually due to Nystagmus can be these episodic signs and symptoms are

migraine vertical or horizontal and is usually sustained benign

An ........ develops within the eighth cranial nerve, usually within the course of the internal auditory canal

acoustic neuroma

Persistent CPV is a rare entity that has been attributed to it does not ..... it is induced in all

cerebellar tumor or hemorrhage does not habituate with repeated testing head positions

CPN can be present without vertigo yes or no

yes

There are two sites where physical occlusion can occur

upper cervical spine, initial segment of the vertebral artery

Compression of the vertebral artery can lead to What usually provides sufficient collateral circulation this can lead to

insufficiency carotid artery dizziness

inflammation or irritation of the cervical roots or facet joints would lead to a mismatch among

vestibular, visual, and cervical inputs

Meniere’s disease causes episodes of

vertigo, tinnitus, aural fullness, and fluctuating hearing loss and affect entire labyrinth

A Meniere’s episode generally involves severe

vertigo, imbalance, nausea and vomiting.

Is there a cure for Meniere's disease potential new cure

NO low dose gentamicin

a hole between the inner and middle ear caused by trauma, a cholesteatoma, otic syphilis, or displaced middle ear prosthesis.

perilymph fistula

Dizziness induced by sound

Tullio’s phenomenon

Cause more cases of vertigo than any other condition

migraines

There are four phases in migraine, which includes the

prodrome, aura, headache, and postdrome phase.

Common migraine

without aura

Classic migraine

with aura

Conditions associated with migraine

motion sickness, anxiety disorders

The term literally means sickness of disembarkment, and refers to prolonged and inappropriate sensation of movement after exposure to movement

Mal de Debarquement Syndrome

These conditions typically result in unilateral vestibular hypofunction

Labyrinthitis/Neuritis

There are a number of vestibular disorders that result in a reduction in function – vestibular hypofunction. These include

neuritis, labyrinthitis, acoustic neuroma, bilateral hypofunction, and head trauma

Non-malignant tumors of the 8th cranial nerve

Acoustic Neuroma

Reduction in function typically include imbalance and visual disturbances. The imbalance is worse in the dark, or on uneven surfaces

Bilateral Vestibular Hypofunction

Can occur to outer, middle, and inner ear, including the peripheral vestibular system and is due to pressure changes.

Barotrauma