Final Exam Flashcards
Below are FC’s on VESTIBULAR:
1) What is vertigo
2) What is BPPV:
- What is Gaze Stability
- What is the VOR
- What is Oscillopsia:
2A) Would VOR issues most likely be unilateral or bilateral?
- Would Oscillopsia issues most likely be unilateral or bilateral?
- What is episodic / fluctuating vestibular issues?
3) So if there are issues within the inner ear, is that a peripheral or central issue.
- When is it a central issue
3A) Will VERTICAL nystagmus be a peripheral or central issue?
- Horizontal nystagmus is a central or peripheral issue
- Saccades and nystagmus present during occular testing would indicate CNS or PNS issue
4) Explain what you can do in your exam to rule things in / out to determine where their imbalance is coming from:
5) What is the best TEST to really get an official gauge of their sensory systems that play into balance?
- Other good tests to determine balance:
6) What are saccades
- Will saccades be normal or abnormal if there is a peripheral issue
- So if you see an abnormality (not tracking right) during saccades, this suggest a peripheral or central issue
7) A left or right (horizontal) nystagmus is a central or peripheral issue
- A vertical nystagmus is a central or peripheral issue
8) Peripheral vestibular issues can manifest in what ways:
9) From point above, how would:
- Unilateral manifest:
10) If you do a Hallpike on both sides and see NO nystagmus, is there a BPPV or canal issue?
- If you do all the ocular tests and don’t find anything, do they have a central issue?
- How do you name a nystagmus (LBN for example)
11)
- Downbeat torsional would indicate _______ canal issue.
- Upbeat torsional is an _______ canal issue.
- Horizontal / Side beat indicates _______ canal issue.
- It is NAMED for the _____ phase.
- 93% of all canal issues are ______ canal?
12) T or F: *** 85% of meds cause nausea and dizziness. Some cause orthostatic hypotension as well.
13)
- The utricle and saccule detect LINEAR motion (utricle being YOU poking head out, and saccule is verticle)
- The Horizontal canal detects horizontal rotation of head mvmts
- The Brandt is not first option test for posterior canal
I JUST STOPPED TAKING NOTES. MAIN POINTS ARE IN “MY DOCS” … review ALL of the vestibular content in MY DOCS
1) A sensation of spinning / whirling and loss of balance due to issues in the inner ear.
2) Episodes of dizziness and a sensation of spinning with certain head movements. When crystals of the inner ear get lose and caught in semicircular canals, causing nystagmus and vertigo.
- Gaze Stabilization: if you can’t keep vision from bouncing, your balance will thus be off as well. Are they able to look at something and keep fixed looking at it, and then move head while staying looking at it. Then add speed of head mvmt as intervention
- Vestibular Ocular Reflex: The vestibulo-ocular reflex is a reflex, where activation of the vestibular system causes eye movement. This reflex functions to stabilize images on the retinas during head movement by producing eye movements in the direction opposite to head movement, thus preserving the image on the center of the visual field
- Oscillopsia: is a visual disturbance / blurryness caused by nervous system disorders that damage parts of the brain or inner ear that control eye movements and balance. One possible cause is the loss of your vestibulo-ocular reflex (VOR).
2A) Unilateral
- Bilateral
- Like BPPV where it isn’t dizzyness all the time, but in episodes (and NO dizzyness between episodes)
3) Peripheral
- If and when it gets to brainstem. Stroke. TBI. Tumor. Demyelination of nerves.
3A) Central
- Peripheral
- CNS
4)
- MS: Do they have the strength, how is their alignment/posture
- Neuro: Do they have sensation and proprioception
- Do proprioception tests
- Visual / VOR / Central: Do visual gase / VOR / nystagmus checks
- Vestibular: Do head movement tests
5) CTSIB
- Berg, TUG, DGA
6) Fast eye movements. So as the PT, hold your finger to the side of your face 8 or so inches. Have the patient move their eyes back and forth from your nose to your finger quickly.
- Normal
- Central issue
7) Peripheral
- Central
8)
- Unilateral
- Bilateral
- Fluctuating
- BPPV
9)
- Unilateral: balance issues, vertigo, blurred vision, nausea
- Bilateral: Occilopsia, imbalance
- Fluctuating: Episodic, not related to position
- BPPV: Horizontal or torsional nystagmus
10) NO
- NO
- The direction it beats fastest. So a LBN (left beat nystagmus means it beats to the left fastest). If going DOWN is fast, then name it DOWN.
11)
- Posterior
- Anterior
- Horizontal
- FAST
- Posterior
12) TRUE
13) Ok
For the VESTIBULAR content, I did NOT get much from her lectures. Go to “MY DOCS” and the vestibular worksheet from integrated lab, and know all those assessments / interventions. I put good summary of MAIN points she went over.
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Below are FC’s on MAIN points of the w/c wheelchair prep material
1) T or F: You would spot someone in a w/c going up/down a curb or ramp just like you’d do with someone on crutches (PT is behind going up, and in front going down)
1A) We know a w/c is used for mobility / locomotion, but why is posture assessment of a pt in a w/c so important
2) What is a “spotter strap”
- If you don’t have an official spotter strap for w/c’s, what can you use?
3) If someone is pushing their w/c up a hill/incline, what should they do to be more efficient
4) Ideal measurements of a w/c for these below should be:
- Seat width:
- Seat height:
- Back height:
- Leg length:
- Trunk width:
- Armrest height:
- Ideal w/c posture is:
5) We focussed on the “Wheelchair Skills Program” which has a standardized wheelchair skills test you can assess on pt’s:
- What does it assess
- What part of ICF model does it focus on
- Does it apply to manual or power w/c users
- It scores performance and safety, but which scores have higher reliability
6) There are different versions of the test. Explain
- Will these tests be the same
- Would the test assess ability to do a wheelie on the manual or powered w/c test?
- How are items scored?
- How would someone “fail” a task
- Would a higher or lower % score be better?
- As you are administering the test, can you educate and correct or help the pt?
7) Big picture - why would we do this? Why give an objective standardized test for w/c use?
8) For wheelchair skills test:
- How many versions are there ***
- Why 5
- What does WCU and CG mean on test
- But how many test items on test
- How many skills tested
- Is it off a pass/fail
- Does it focus on activity level
- Is it for manual or power w/c users
- Is there a version for caregivers
- Do they get 1 or multiple attempts at activity
- Can you help / instruct / coach them
- Can you perform items in any order
9) There are 2 major categories of scoring:
- Which one has higher reliability
- How do you score the performance section:
- Would 40% be a good score on this test
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1) TRUE
1A) They sit in it (potentially) for hours a day. Thus, proper posture is critical for their overall health, function, and comfort
2) A spotter strap is used to assist the spotter in controlling a manual wheelchair during skills in which there is the risk of a rear tip or of the wheelchair running away (e.g.down an incline).
- Gait belt
3) Lean forward
4)
- Seat width: Measure from L to R greater trochanter and add 2 inches
- Seat height: Feet rest comfortable on ground
- Seat depth: 2 inches less than femur (so you don’t compress popliteal artery on back of knee).
- Back height: To inferior angle of scapula (or 4 inches below axilla)
- Leg length:
- Trunk width:
- Armrest height: Add 1 inch above olecranon height with arm in natural resting position.
- 90/90/90 all the way up chain.
5)
- Regular w/c activities
- Activity level
- Both (and scooters)
- Performance
6) One version is for a powered w/c, one for manual, one for scooter
- No
- Manual
- On a pass / fail
- If they couldn’t do it independently, or did it unsafely
- Higher. A higher score means they performed more tasks correctly / safely. Higher than 80% means they are GOOD at w/c skills.
- No. It is just to assess what they can / can’t do. You can educate after test is done.
7) Like every standardized test - to get good baseline of function, know what areas need improvement (use as interventions), and track progress overtime.
8)
- 5
- For manual, power, and scooter (manual and power each have a caregiver version)
- Wheelchair user and Care Giver
- 16
- 29-32 ish
- Yes
- Yes
- Yes (and scooter users)
- Yes
- 1
- No
- Yes
9) Performance and safety
- Performance
- # passed skills / (# of possible skills - #NP - #TE) * 100
- No. You want 80% or higher
Below are FC’s on w/c training course online
1) Why is w/c posture so important
2) Poor w/c posture can lead to what:
3) WHat is “Reference Neutral” w/c posture
4) Do most patients achieve this ideal or “referenced neutral” posture
5) What is “optimal sitting posture”
6) What effects w/c posture
- Internal factors:
- External factors:
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1) It impacts a persons overall health, function, and comfort (and pain)
2)
- Pain
- Pressure ulcers
- Spinal deformities
- ROM issues
- Contractures, weakness, atrophy
- Pressure ulcers
- Difficulty breathing, swallowing, digestion, voice
- Poor self esteem
3) “Ideal posture” …
- Pelvis is upright, ASIS’s level
- Spine maintains 3 curves
- Shoulder over pelvis, head vertical and level
- 90/90/90
- Feet flat on floor, or on foot supports
- Hips in neutral (or slight ABduction)
- Trunk upright
4) NO
5)
- As symmetrical, balanced, and aligned as comfortably / structurally possible (given condition and comfort)
- It is their resting posture or “home base”
- NOT collpased though
- Allows movement and action much better
- More comfortable
6)
- Internal: ROM, tone, spasticity, contractures, comfort, pain, fatigue
- External: Gravity, w/c set up or fit
Hello all,
Here is a list of key points that can help you with your studying for the final exam. This is NOT an exhaustive list. 50% of the exam is devoted to vestibular and wheelchair content.
- From the vestibular section make sure you study
a) the tests for the vestibular system and which ones you should use based on a patient’s presentation
b) Central vs peripheral diagnoses
c) Structures of the vestibular system and with which plane of movement they are associated
d) Clinical presentation of vestibular diagnoses - Theories of motor learning and control
- Sensory reweighting
- Task taxonomy (task classification … stability vs. mobility, open vs. closed)
- Developmental skills
- Infant protective reactions
- Ageism
- ICF model
- Standing balance, strategies
- Pediatric vestibular
- How to calculate corrected age
- Types of practice and feedback and open vs closed environment
- Don’t forget the key points that Dr. Knight will state in class for the wheelchair skills.
OK
1)
a) Look at “My Docs”
b)
c) Anterior (yes/no), Posterior (lateral head flexion), horizontal (head rotation). YOUtricle, SACKule
d)
50% of the test is on vestibular and w/c skills. So must go back and really review vestibular and be able to tell (like in the cases) whether it is a central or peripheral issue.
Review “My Docs” for all vestibular content.
Also, review “My Docs” on all w/c related content.
I asked Dr. K what we needed to know for the Wheelchair Skills Test … waiting to hear back.
- She said know it in general, and know cut off scores. So look it up more.
- And the safety portion has a LOWER reliability than the performance portion.
- I think it is people with >80% scores have great/advanced w/c skills. So low % is low w/c skills.
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Below are MORE FC’s on vestibular content
1) What are 4 ways a PERIPHERAL vestibular issue can manifest
2) Would vertigo manifest from unilateral or bilateral vestibular issue
- Would occilopsia manifest from unilateral or bilateral vestibular issue
- If BPPV is episodic it is ______ (meaning it could last minutes, or hours, or days)
- If balance is NOT effected outside of episodes, it is _______
- When it lasts short time (minutes or seconds), and typically worse in morning or in supine
3) Why (or what) causes central issues
4) What ways can you test if vestibular system is off
5) Why would you want to do a VBI test on all vestibular / balance pt’s
- Would you also assess BP, pulse, listen for palpitations, ask about heart history?
6) If a pt is in the neurocom / biostep - what steps signify vestibular issues
7) Does COM move around COP or COP move around COM
8) All the occulomotor tests to assess nystagmus and tracking and gaze stability, saccades, etc. - those were tests to determine if there was a peripheral or central issue
9) If eyes are good, then you check vestibular through doing what
10) So, taking a step back …. what is vertigo:
11) So if someone had NO nystagmus / saccades during ocular testing and you did a Dix-Hallpike on them, could this help their vertigo issues?
- If they DID have nystagmus / saccades during ocular testing, would Dix Hallpike help their vertigo issues?
11A) If you did see nystagmus during ocular testing, if it was horizontal or torsional, it would be a ________ vestibular issue.
- If the nystagmus was vertical, multidirectional, or longer than 1 min, it would be a _______ vestibular issue
- If nystagmus is seen during GAZE stabilization, it is most likely a _______ issue
- True or False: Peripheral vertigo/issues is unidirectional nystagmus (only goes one direction). Central vertigo/issues is multidirectional nystagmus or changes or last longer than a minute?
- If someone gets vertigo upon quickly changing positions, this is peripheral or central?
- Can you do a head shake and get nystagmus, and then do Dix-Hallpike and get nothing? YES. If so, it is NOT BPPV, but some other peripheral issue.
- Upbeat torsion = ______ canal
- Downbeat torsion = ______ canal
- Horizontal nystagmus = ______ canal
- Vertical or changing / multi-direction nystagmus =
- If it goes FAST to the right, it is called:
- Can you have bilateral BPPV?
- When she says “is it compensated” - what does she mean?
- What is VBRT?
- Central s/s: Constant imbalance for months, absence of vertigo, pt reports poor vision when head moves (VOR issues), double vision, slurred speech, dizziness doesn’t change with head mvmts, falls and imbalance.
- If you do Right Hallpike and get nystagmus one way, then do a Left Hallpike and get opposite nystagmus direction … then it probably is a _______ issue.
- So even if it is horizontal nystagmus, direction changing nystagmus is a ______ issue
- From point above, what do you do with this pt
- T or F: Drugs / meds OFTEN cause dizziness or vertigo?
12) Peripheral vertigo presents how:
13) How do CENTRAL vertigo symptoms differ
14) T or F: BPPV is just crystals out of place
15) What are habituation exercises
16)
- The peripheral part of vestibular system is all the inner ear.
- The CENTRAl part of vestibular system is the brainstem and cerebellum
- The first step to diagnose cases with vestibular system abnormalities is localisation of the lesion: determining whether the lesion is in the peripheral or central vestibular system is critically important for making differential diagnosis and predicting prognosis.
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1)
- Unilateral
- Bilateral
- Fluctuating
- BPPV
2) Unilateral
- Bilateral
- Fluctuating
- Fluctuating
- BPPV
3)
- Vascular ischemia
- Tumor
- Demyelinating disease (MS)
4)
- CTSIB
- Dix-Hallpike
- ENG or VNG (electro and vestibularneurogram)
5) To rule out any vascular issue that is causing the “lightheadedness”
- YES
6) Step 5 and 6
7) COP moves around COM
8) Central
9) Dix-Hallpike manuever, head shake, DGI, etc.
10) Vertigo implies an abnormal sensation of movement or rotation of the patient or his or her environment. It is often confused with dizzyness, lightheadedness, etc. Dizziness and lightheadedness could be do BP changes, BPPV, vascular issue, meds, or some central issue. Some patients with CENTRAL disease may complain of disequilibrium, imbalance, or difficulty maintaining an upright posture
11) Probably yes
- No
*** The Dix-Hallpike test can help distinguish central vertigo from peripheral vertigo.
11A) Peripheral - Central - Central - True - Peripheral - True - Anterior - Posterior - Horizontal - Central issue - RBN (Right beat nystagmus, named for direction is beats fastest) - YES - Compensation means there is no more Nystagmus, or it gets cured from crystal Coming out. - Vestibular Balance Rehab Therapy - Ok - Central - Central - Recommend a neuro eval - TRUE
12)
- Nausea
- Vomiting
- Auditory complaints
- Abrupt onset
13) Gradual onset, and not as severe/intense
14) TRUE
15) Habituation exercises … doing head Movement reps back and forth (head Moves from side to side, up and down, Diagonol. Progress with more ROM and Higher speeds. Then have blank wall as Background, then move to dynamic Background.
