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Management of aging/complex pts > Falls, dizziness, and vestibular > Flashcards

Falls, dizziness, and vestibular Flashcards

1
Q

The least stringent definition of a fall

A

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

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2
Q

The use of the least stringent definition recognizes that

A

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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3
Q

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

___ % of these falls sustain a serious injury

A

one third

20

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4
Q

secondary prevention
tertiary prevention

A
  • risk reduction for further falls
  • reduction of
    functional consequences of poor balance
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5
Q

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

A

primary for older adults

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6
Q

Secondary prevention for individuals with history of falls

A

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

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7
Q

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

A

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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8
Q

Sensory peripheral areas of impairment

Sensory central areas of impairment

A

visual, vestibular, somatosensory

cortical areas

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9
Q

Sensory peripheral areas of impairment: consequences

Sensory central areas of impairment: consequences

A

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

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

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10
Q

Motor peripheral areas of impairment

Motor central areas of impairment

A

muscles, joints

CNS areas: planning coordinating

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11
Q

Motor peripheral areas of impairment: conseq

Motor central areas of impairment: conseq

A

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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12
Q

Cognitive central areas of impairment and conseq

A

cortical/limbic areas: attention arousal judgement

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

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13
Q

Falls are the most common cause of

A

TBI

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14
Q

The most common fall related fracture

A

Hip

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15
Q

Individuals with higher risk of falls

A

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

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16
Q

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

A

hip

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17
Q

Why is polypharmacy bad?

most common med side effect

A

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

dizziness

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18
Q

Somatosensory age related risk factors

A

decreased light touch and proprio

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19
Q

Visual age related risk factors

Vestibular age related risk factors

CNS age related risk factor

A

decreased visual acuity, depth perception (light and dark)

changes in VOR, hair cells

decreased coordination

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20
Q

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

A

dizziness

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21
Q

Vertigo

A

illusion of motion – usually one of spinning or tilting

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22
Q

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

A

labyrinthine or 8th cranial
nerve dysfunction

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23
Q

A tilt vertigo is due to

A

utricle dysfunction

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24
Q

Rotational vertigo in a torsional plane is indicative of

A

anterior or
posterior SCC involvement

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25
Q

Dysequilibrium

A

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

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26
Q

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.

A

Motion intolerance

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27
Q

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

A

Oscillopsia

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28
Q

This is due to a reduced blood flow to the brain

common causes

A

Near syncope

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

29
Q

Visual health related risk factors

CNS health related risk factors

Neuromuscular

A

cataracts, CVA

CVA, MS

impaired postural alignment

30
Q

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

A

visual difficulties, especially with
complaints of motion sickness

31
Q

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

A

evoke a syncopal episode

32
Q

The two most common causes of decreased cardiac pump efficiency are

A

structural heart
diseases and arrhythmias

33
Q

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

A

170

34
Q

1/3rd of the patients experience vertigo without an

A

associated headache

35
Q

Autoimmune inner ear disease consists

A

consists of a syndrome of progressive hearing loss, tinnitus,
and/or dizziness caused by antibodies attacking the inner ear.

36
Q

In most cases, the symptoms of patients with ___________ spontaneously diminish over a period of weeks

_____ usually resolves first within days

A

unilateral
vestibular loss

nystagmus

37
Q

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

A

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

38
Q

The most common cause of vertigo in peripheral vestibular disorders

A

BPPV: benign paroxysmal positional vertigo

39
Q

BPPV is thought to be cause

A

by detached utricle otoliths or otolith debris entering one of
the semicircular canals

40
Q
A
40
Q
A
40
Q

Classic BPPV is the most common variety of BPPV and involves the

It is affected more than ____ % of the cases because of its

A

posterior semicircular
canal

90, gravity dependent position

41
Q

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

A

the treatment is
different

nystagmus

42
Q

With posterior canal-BPPV the direction of the nystagmus

While the direction of the nystagmus with horizontal canal-
BPPV

A

the direction of the nystagmus remains the same
with changing head positions

changes with changes in head movement direction

43
Q

Vertigo due to a disease originating from the central nervous system

caused by

A

Central vertigo

hemorrhagic or ischemic insults to the cerebellum, the
vestibular nuclei, and their connections within the brain stem

43
Q

posterior canal-BPPV is ______ specific

With horizontal-BPPV, nystagmus can be provoked moving in …..

A

direction

either horizontal
direction

44
Q

CPV (central positional vertigo) that occurs as spells is usually due to

Nystagmus can

these episodic signs and symptoms are

A

migraine

vertical or horizontal and is usually sustained

benign

45
Q

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

A

acoustic neuroma

46
Q

Persistent CPV is a rare entity that has been
attributed to

it does not …..

it is induced in all

A

cerebellar tumor or hemorrhage dorsolateral to the fourth ventricle

does not habituate with repeated testing

head positions

47
Q

CPN can be present without vertigo

yes or no

A

yes

48
Q

There are two sites where physical occlusion can
occur

A

upper cervical spine, initial segment of the vertebral artery

49
Q

Compression of the vertebral artery can lead to

What usually provides sufficient collateral circulation

this can lead to

A

insufficiency

carotid artery

dizziness

50
Q

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

A

vestibular, visual, and cervical inputs

51
Q

Meniere’s disease causes episodes of

A

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

52
Q

A Meniere’s episode generally involves severe

A

vertigo, imbalance,
nausea and vomiting.

53
Q

Is there a cure for Meniere’s disease

potential new cure

A

NO

low dose gentamicin

53
Q

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

A

perilymph fistula

54
Q

Dizziness induced by sound

A

Tullio’s phenomenon

55
Q

Cause more cases of vertigo than any other condition

A

migraines

56
Q

There are four phases in migraine, which includes the

A

prodrome, aura, headache, and
postdrome phase.

57
Q

Common migraine

A

without aura

58
Q

Classic migraine

A

with aura

58
Q

Conditions associated with migraine

A

motion sickness, anxiety disorders

59
Q

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

A

Mal de Debarquement Syndrome

60
Q

These conditions typically result in unilateral vestibular hypofunction

A

Labyrinthitis/Neuritis

61
Q

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

A

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

62
Q

Non-malignant tumors of the 8th cranial nerve

A

Acoustic Neuroma

63
Q

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

A

Bilateral Vestibular Hypofunction

63
Q

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

A

Barotrauma

Management of aging/complex pts (4 decks)

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