Final Exam Study Guide (Review from Midterm) Flashcards
no visual target; Eyes closed; Eyes covered
vision denied
eye nerves
LR 6 SO 4 all the rest are 3
Lateral rectus → CN VI
Superior Oblique → CN IV
Medial rectus → CN III
Superior rectus → CN III
Inferior rectus → CN III
Inferior oblique → CN III
Ampullopetal/utriculopetal
endolymph flow towards the ampulla
Ampullofugal/utriculofugal
endolymph flow away from the ampulla
endolymph movement in HSCC
toward ampullae = excitation
Away from ampullae = inhibition
Excitatory in the direction of the head movement & inhibitory away from the direction of the head movement (ant & post are opposite)
endolymph movement in PSCC/ASCC
Toward ampullae = inhibition
Away from ampullae = excitation
Inhibitory in the direction of the head movement & excitatory away from the direction of the head movement
vestibular peripheral system
Includes the labyrinth and the 8th cranial nerve before it enters the brainstem.
Each ear has ____ sensory organs
5
vestibular central system
Brainstem to the cortex, processes balance and movement signals
When discussing vestibular anatomy, “central” refers to
BS to cortex
When discussing vestibular anatomy, “peripheral” refers to
Labyrinth & 8th nerve up to the point it enters the brainstem
“Vision denied” refers to eyes closed (ENG) or eyes covered (VNG) or the scenario where the patient is without a visible target
t
What are the two sensory structures within the peripheral vestibluar system and what type of stimuli does each respond to?
The two sensory structures in the peripheral vestibular system are the crista ampullaris and the maculae. The crista ampularis is responsive to angular (rotational) movement and the maculae is responsive to linear (translational) movement and to gravity.
sensory structures in vestib system
Cristae Ampullaris → sensory structures inside the semicircular canals (SCCs) that detect angular (rotational) head movement.
arranged orthogonal or roughly right angles to each other
Maculae (Otolithic Organs)
Responsive to linear (translational) movement and to gravity
Arranged perpendicular to each other
The semicircular canals are located within the membranous labyrinth, contain periplymph and are surrounded on the outside by endolymph and the bony labyrinth
f
SCC located within membraneous labyrinth that contains endolymph & is surrounded on the outside by perilymph and the bony labyrinth
The semicircular canals function
in a complimentary or push-pull relationship with the opposite ear
The semicircular canals detect motion in
the pitch, yaw and roll planes
The semicircular canals are arranged
orthogonal or roughly right angles to each other
They function in a complimentary or push-pull relationship with the opposite ear
Left anterior SCC - Right posterior SCC
Left horizontal SCC - Right horizontal SCC
Left posterior SCC - Right anterior SCC
gelatinous membrane, 6 total (3 each ear in ampullae)
Extremely sensitive to motion
cupula
The otolithic organs are arranged
perpindicular to each other
The utricle is larger and oriented above the saccule which is smaller and oriented below
t
Displaced otoconia from the utricular macula is what causes
BPPV
Movement toward kinocilium
→ Depolarization → Increased nerve activity/electrical potential
Movement away from kinocilium
→ Hyperpolarization → Decreased nerve activity
Movement of hair cell stereocilia toward the kinocilium results in hyperpolarization and an increase in neural activity
F
Movement of hair cell stereocilia toward the kinocilium results in depolarization and increase in neural activity
For the horizontal SCCs, endolymph movement toward the ampulla (i.e., ampullopetal) results in an __________ response, whereas endolymph movement away from the ampulla (i.e., ampullofugal) results in an __________ response
excitatory/inhibitory
For the anterior and posterior SCCs, endolymph movement toward the ampulla (i.e., ampullopetal) results in an __________ response, whereas endolymph movement away from the ampulla (i.e., ampullofugal) results in an __________ response.
inhibitory/excitatory
striola orientation in utricle and saccule
Utricle → oriented toward the striola
Saccule → oriented away from striola
What are the 3 vestibular reflexes we discussed and give a brief description of the purpose of each.
Vestibulo-ocular reflex (VOR) – generates reflexive eye movement to enable clear vision during head movement
Vestibulocollic reflex (VCR) – acts on the neck musculature to stabilize the head helping to keep the head in horizontal gaze position relative to gravity (accomplished w/ neck musculature rather than eye musculature)
Vestibulospinal reflex (VSR) – generates compensatory body movements to maintain head and postural stability in upper and lower limbs
If an individual was reporting oscillopsia, which vestibular reflex would you expect to be impaired?
VOR
What are the 3 cranial nerves involved in eye movement?
Oculomotor (III), Trochlear (IV) and Abducens (VI)
nerve innervation
LSU on top → innervated by superior vestibular nerve
L → lateral ampullary nerve
S → superior ampullary nerve
U → Utricle
utricle, anterior part of saccule(?), and horiz & anterior canals
PS below → innervated by inferior vestibular nerve
P → posterior ampullae
S → saccule
posterior part of saccule, and posterior canal
nerve branches
Anterior Semicircular Canal → Superior vestibular nerve branch
Horizontal Semicircular Canal → Superior vestibular nerve branch
Posterior Semicircular Canal → Inferior vestibular nerve branch
Utricle → Superior vestibular nerve branch
Saccule → Inferior vestibular nerve branch
Which of the following regarding epidemiology and population demographics of dizziness / balance disorders is FALSE?
Dizziness is one of the most common complaints in outpatient clinics
Dizziness is the #1 complaint to medical providers for individuals over 70 years of age
The number of older individuals (those over 65 years of age) is expected to decrease by 2030 driving healthcare costs down
Falls are one of the leading causes of brain injury (TBI) and fractures
50% of individuals over age 70 will experience BPPV at some point
The number of older individuals (those over 65 years of age) is expected to decrease by 2030 driving healthcare costs down
By the year 2030 the population of individuals 65 years or older will double worldwide
By 2050, the population of individuals 85 or older will quadruple
Medicare costs are expected to rise to $929 billion placing significant stress on medical economics and health care systems of US
Which of the following statements are TRUE? Select ALL that apply.
Dizziness is a general term which may include descriptions such as lightheadedness, floating, pre-syncope, or loss of equilibrium but without sensation of rotation
Vertigo is a term used to describe sense of rotational movement either of onself (subjective) or one’s surroundings (objective)
Vertigo is more likely to be of central (or non-vestibular) origin whereas “dizziness” is more likely to be of peripheral origin
Many individuals do not fully understand the distinction between dizziness and vertigo therefore it is important to question them about their specific complaint when taking your case history
Imbalance is always peripheral in origin and not likely to be related to central conditions or other factors
Dizziness is a general term which may include descriptions such as lightheadedness, floating, pre-syncope, or loss of equilibrium but without sensation of rotation
Vertigo is a term used to describe sense of rotational movement either of onself (subjective) or one’s surroundings (objective)
Many individuals do not fully understand the distinction between dizziness and vertigo therefore it is important to question them about their specific complaint when taking your case history
general term which may include descriptions such as lightheadedness, floating, pre-syncope, or loss of equilibrium but without sensation of rotation
dizziness
term used to describe sense of rotational movement either of onself (subjective) or one’s surroundings (objective)
vertigo
Hair cells are arranged away from the striola in the utricle and toward the striola in the saccule
F
toward in utricle & away in striola
What is the most common bedside exam used to screen VOR function and briefly describe how it is performed. What would a normal result versus an abnormal result look like?
Halmagyi head thrust or head impulse test.
Clinician grasps patient by the head and uses rapid unexpected head turns to examine the VOR
Patient is asked to keep his/her eyes focused on a target (e.g., clinician’s nose or forehead)
Head should be thrust in the direction of or plane of semicircular canals
Head movement should not exceed 20-30 degrees in any direction but must be high acceleration (>3000 deg/sec/sec)
Head should be held briefly at the end of impulse to monitor for re-fixation saccades
Normal individual will exhibit no corrective / re-fixation saccades and the Impaired individual will exhibit re-fixation saccades in direction of lesion
Name one bedside test that can be used to screen VSR function for postural stability.
Fukuda/Unterberger
bedside test that detects SCC dysfunction in all canals
head impulse
what is nystagmus
Rhythmic, oscillating motions of the eyes
how is nystagmus characterized
by a slow and fast phase
nystagmus is described by
direction of the fast phase (central component)
RB, LB, UB, DB, Torsion
nystagmus is measured by
the magnitude of the nystagmus based upon the slow phase (peripheral component)
deg/s
Nystagmus beats toward a _____ ear and away from an _____ ear
sstimulated
inhibited
When analyzing nystagmus, we “describe” nystagmus based upon the direction of the fast phase (central component) but “measure” the magnitude of the nystagmus based upon the slow phase (peripheral component
t
Which of the following statements is TRUE regarding nystagmus?
Nystagmus beats toward a stimulated ear and away from an inhibited ear
Nystagmus beats toward an inhibited ear and away from an stimulated ear
Nystagmus is independent of stimulation
Rightward (yaw) rotations generate leftward nystagmus
Nystagmus direction is solely dependent upon the neural integrator
Nystagmus beats toward a stimulated ear and away from an inhibited ear
For paretic lesions, what is TRUE regarding nystagmus?
Nystagmus typically beats away from the affected ear
For irritative lesions (like Meniere’s disease), when active, what is TRUE regarding nystagmus?
Nystagmus typically beats toward the affected ear
Poorly compensated or decompensated vestibular lesions may sometimes have nystagmus patterns that do not obey the conventional directions?
T
Speed of motion of the eyes is the same in both directions
No distinct fast and slow phases (sinusoidal pattern)
pendular nystagmus
movements in one direction is faster than in the other
Slow and fast phase → Eyes move slowly in one direction and then jerk back in the other direction
jerk nystagmus
How to describe nystagmus
Direction: Right-beating, left-beating, up-beating, down-beating.
Intensity: Measured by amplitude (size of movement) and frequency (speed of oscillations)
Gaze Position: Intensity may change based on the direction of gaze
central nystagmus
no nystagmus at center gaze
if they stare at a target it stays the same or goes away
If it gets worse to side but no pre-existing center gaze → gaze-evoked
peripheral nystagmus
patient has nystagmus at center gaze
if they stare at a target it stops or slows down
If it gets worse to side of fast phase and goes away at slow phase with pre-existing center gaze → Alexander’s
When examining ENG/VNG tracings, which of the following are TRUE?
For horizontal recordings, upward deflections represent rightward eye movements and downward represent leftward eye movements
For horizontal recordings, upward deflections represent lefward eye movements and downward represent rightward eye movements
For horizontal recordings, upward deflections represent rightward eye movements and downward represent leftward eye movements
A patient arrives at your clinic for acute vertigo. Upon examination you note a right-beating nystagmus in center gaze (spontaneous) which increases in magnitude when they gaze to their right and decreases in magnitude when they gaze to their left. What is the phenomena or finding they are demonstrating?
Is this a central sign, a peripheral sign or a non-localizing finding?
alexanders
peripheral
Which of the following are TRUE regarding ENG/VNG testing? Select ALL that apply.
When analyzing oculomotor normative data you should also visually inspect oculography morphology to confirm abnormal data points actually look abnormal
Poor vision, certain medications and patient arousal / fatigue can affect oculomotor findings
Abnormalities encountered during the oculomotor exam are more likely to be peripheral findings than central findings
Oculomotor abnormalities should be repeatable for them to be considered truly abnormal
If you have 1 or 2 data points in the “abnormal” range, it is still considered an abnormal oculomotor exam
When analyzing oculomotor normative data you should also visually inspect oculography morphology to confirm abnormal data points actually look abnormal
Poor vision, certain medications and patient arousal / fatigue can affect oculomotor findings
Oculomotor abnormalities should be repeatable for them to be considered truly abnormal
When an individual has a pre-existing nystagmus and gazes in the direction of the fast phase of the nystagmus, the magnitude increases. Gazing away from the fast phase causes it to reduce in magnitude. This is a peripheral sign. It is the ONLY exception to your oculomotor battery which otherwise denotes central findings only.
alexanders law
Which of the following types of eye movements do we NOT test during ENG/VNG testing?
Saccades
Smooth pursuits
Gaze Holding
Optokinetic (OPK/OKN)
Vergence
Vergence
What is the weakest subtest in your oculomotor exam?
OPK/OKN
Eye recording technique that uses changes in the corneo-retinal potential and surface electrodes to track eye movement
EOG/ENG
Eye recording technique that uses pupil localization technology, mirrors and infrared diodes to track eye movements
VOG/VNG
Eye recording technique that uses a metallic loop embedded in the eye or in a tight fitting contact to detect changes in electromagnetic fields and detect eye position
Scleral search coils
Eye recording technique that requires extra time for the eyes to “adapt” to light and darkened environments when goggles open/closed
EOG/ENG
Eye recording technique that has higher resolution and allows for video playback
VOG/VNG
Vestibular tests are tests of function and can therefore be affected by medications, arousal state and patient effort
t
List 3 things or questions you would ask a patient who complained of dizziness prior to performing a vestibular evaluation? We discussed several in class. Be brief but specific.
Description = What are you experiencing
Timing = How long does it last when present or is it continuous
Frequency = How often does it occur
Provoking Factors = What causes it
Associated Symptoms
Any Other Medical Hx
Medications
ENG/VNG Test Battery Overview
Oculomotor Exam (Ocular Motility Tests)
Calibration → vertical and horizontal
Spontaneous (center gaze)
Gaze holding / Position Maintenance → horizontal & vertical (leftward, rightward, upward, downward)
Saccades
Pursuit/Tracking (horizontal & vertical)
Optokinetic (OPK/OKN)
VOR
Vergence → not performed due to inability of the systems to track torsional (3D) movement
Positioning/Positional Exams
Dix-Hallpike Maneuver
Static Positional testing (supine head right, head center, head left, lateral right, lateral left)
Caloric Irrigations
Right warm, left warm, right cool, left cool
COWS → cold opposite, warm same
What are the 3 parameters we evaluate when performing saccade testing and what does each measure?
Velocity = speed of eye movement
Accuracy = ability to correctly acquire the target without over or undershooting
Latency = time it takes to acquire the target post-stimulus movement
What are the two parameters we evaluate when performing pursuit testing and what does each measure?
Gain = eye movement relative to target
Symmetry(phase) = rightward vs leftward comparison
Saccadic hypometria
(undershoots) → stair step
Saccadic hypermetria
(overshoots) → spike in front
what value is abnormal in OPK/OKN
> 25% asymmetry is abnormal
what is vergence
Directing vision from a far object to a near one
thumb in front of you and as you bring it to the nose the eyes have to come together to see it or when you move it away the eyes move outward to see it
What is BPPV? How does it occur? Briefly describe the two variants.
Benign Paroxysmal positional vertigo.
Otoconia become dislodged from the utricle and end up in the semicircular canals. Movement of the head causes the otoconia in the canal to move and stimulates the vestibular system causing false sense of vertigo.
“Canalithiasis” or otoconia freely moving in the endolymph and “Cupulolithiasis” or otoconia in contact with the cupula are the 2 types.
otoconia freely moving in the endolymph
canalithiasis
otoconia in contact with the cupula
cupulolithiasis
the most common presenting in 90-95% of cases
PSCC BPPV
criteria for BPPV
Latency
Vertigo & nystagmus begin 1 or more seconds after the head is tilted toward the affected ear & increases in severity to a maximum
Duration less than 1 minute
Nystagmus reduces gradually after 10-40s and eventually stops with maintenance of the head in the provocative position
Linear-rotary nystagmus
Nystagmus is linear-rotary with fast phase beating toward the ear facing down or upward when the PT’s faze is directed toward the uppermost ear
Reversal
When PT returns to a seated position, vertigo or nystagmus may reoccur in the opposite direction and be less violent
Fatigability
Constant repetition of this maneuver results in a lessening of the symptoms
Otolithic crisis of Tumarkin
Rare but happens in severe symptoms of Meniere’s
Characterized by sudden and unexpected falls without warning
The otolith organs misfire, making the brain think the body is moving when it’s actually still
This triggers an abrupt postural response, causing the person to suddenly lose balance and collapse
common features of posterior canalithiasis BPPV
Delayed onset latency (nystagmus and vertigo begin after a short interval upon putting patient in offending position)
Duration (nystagmus and vertigo eliminate in 1 minute or less)
Linear rotary direction (nystagmus is up-beating or down-beating torsional)
Reversal (nystagmus may show a milder and reversed direction upon bringing the patient back up post maneuver)
Escalation - contsant repetition of the offending maneuver will cause the nystagmus to decrease on subsequent trials
common features of cupullithiasis
Latency → Immediate onset after placing PT in provoking position
Little to no fatigue over time
HSCC canalithiasis BPPV
Geotropic → nystagmus beats toward the ground & changes with head position
Ex: DH to the right, creates RB nystagmus & DH to the left creates LB nystagmus
HSCC cupulolithiasis BPPV
Ageotropic → nystagmus beats away from the ground & changes with head position
Ex: DH to the right, LB nystagmus & DH to left creates RB nystagmus?
Which maneuver is used to EVALUATE FOR anterior and posterior canal BPPV?
Dix-Hallpike maneuver
Which maneuver is used to EVALUATE FOR horizontal canal BPPV?
The Supine Head Roll (Pagnini-McClure) maneuver
how to perform DH
Turn their head 45 deg, lay them back & watch for nystagmus
Bring them back quickly and leave them laying in this position for at least 30s with head extended 30 deg below horizontal
Sit them back up after nystagmus stops
Watch for nystagmus with head neutral sitting up
Repeat on the other side
how to perform supine head roll
The patient lies flat in a supine position → supine head center (open & closed)
The clinician quickly rotates the head 90° to one side and watches for nystagmus for 30s (Supine head turn right)
The head is returned to neutral and then turned 90° to the other side for 30s (Supine head turn left)
Whole body lateral (turn) right & left
*only need to perform if nystagmus was present and observed in steps 1-3; if no nystagmus present in 1-3 move on to calorics
This is done to see if neck torsion is the contributing factor to the nystagmus (open and closed)
Hold for 30s
nystagmus beats towards the ground/ear that is down
geotropic
nystagmus beats away from the ground/ear that is down
ageotropic
How geo & ageo differ from UB & DB
Geo & ageo are horizontal findings
UB & DB are vertical findings
Static Positional Nystagmus Criteria (Abnormal Test Results - only need to meet ONE)
Nystagmus that changes direction in any head position
It is present in at least 3 head positions
It is intermittent in all head positions (little here, little there)
One or more positions that has a slow phase magnitude (velocity) >/=4-6 deg/s
What maneuvers, that we discussed in class, are used to TREAT anterior/posterior canalithiasis BPPV.
The Epley (canalith repositioning) maneuver
The Semont (Liberatory) maneuver
Whatmaneuvers, that we discussed in class, are used to TREAT horizontal canal canalithiasis BPPV.
The BBQ roll (Lempert maneuver)
how to perform epley
Most common
Start with the involved side down and roll away from the effected ear/problem/vertigo
Hold each position for 30-60s
how to perform semont
Used for PC BPPV & cupulolithiasis
Performed initially on the involved side and is held for 1-3 minutes then moved in one quick motion to the final position (3)
Starts as the modified DH & point is that you load the canal and condense the otoliths with step 2
how to perform BBQ roll
Used for the geotropic/canalithiasis variant
Performed initially on involved side, roll away from affected ear
Performed in 90 degree steps, held 30-60 sec in each
Sometimes also used for ageotropic variant but less effective
Difficult for some patients to perform, variations on final position
DH to the R post (canalithiasis). What is the canal tested? BPPV Type? nystagmus features? treatment?
R post (L Ant)
R PSCC canalithiasis
Delayed onset, upward & rightward torsional fast phases, <1min response duration
R Epley (CRT)
DH to the R post (cupulolithiasis). What is the canal tested? BPPV Type? nystagmus features? treatment?
R post (L Ant)
R PSCC cupulolithiasis
Immediate onset, upward & rightward torsional fast phases, >1min response duration
R Semont w/ head turned L
DH to the R (L Ant) (canalithiasis). What is the canal tested? BPPV Type? nystagmus features? treatment?
L ant (R post)
L ASCC Canalithiasis
Delayed onset, downward & leftward torsional fast phases, <1min response duration
L Epley (CRT)
DH to the R (L Ant) (cupulilithiasis). What is the canal tested? BPPV Type? nystagmus features? treatment?
L ant (R post)
L ASCC Cupulolithiasis
Immediate onset, downward & leftward torsional fast phases, >1min response duration
L Semont w/ head turned L
if I perform a R DH and nystagmus shows Delayed onset, upward & rightward torsional fast phases, <1min response duration
what is the canal being tested? what BPPV type? & what treatment?
R post (L ant)
Canalithiasis R PSCC
R Epley (CRT)
if I perform a R DH and nystagmus shows Immediate onset, upward & rightward torsional fast phases, >1min response duration
what is the canal being tested? what BPPV type? & what treatment?
R post (L ant)
Cupulolithiasis R PSCC
R Semont w/ head turned L
if I perform a R DH and nystagmus shows Delayed onset, downward & leftward torsional fast phases, <1min response duration
what is the canal being tested? what BPPV type? & what treatment?
L ant (R post)
Canalithiasis L ASCC
L Epley (CRT)
if I perform a R DH and nystagmus shows Immediate onset, downward & leftward torsional fast phases, >1min response duration
what is the canal being tested? what BPPV type? & what treatment?
L ant (R post)
Cupulolithiasis L ASCC
L Semont w/ head turned L
DH to the L (L pos) (canalithiasis). What is the canal tested? BPPV Type? nystagmus features? treatment?
L post (R ant)
Canalithiasis L PSCC
Delayed onset, upward & leftward torsional fast phases, <1min response duration
L Epley (CRT)
DH to the L (L pos) (Cupulolithiasis). What is the canal tested? BPPV Type? nystagmus features? treatment?
L post (R ant)
Cupulolithiasis L PSCC
Immediate onset, upward & leftward torsional fast phases, >1min response duration
L Semont w/ head turned R
DH to the L (R ant) (canalithiasis). What is the canal tested? BPPV Type? nystagmus features? treatment?
R ant (L post)
Canalithiasis R ASCC
Delayed onset, downward & rightward torsional fast phases, <1min response duration
R Epley (CRT)
DH to the L (R ant) (cupulolithiasis). What is the canal tested? BPPV Type? nystagmus features? treatment?
R ant (L post)
Cupulolithiasis R ASCC
Immediate onset, downward & rightward torsional fast phases, >1min response duration
R Semont w/ head turned R
if I perform a L DH and nystagmus shows Delayed onset, downward & rightward torsional fast phases, <1min response duratio
what is the canal being tested? what BPPV type? & what treatment?
R ant (L post)
Canalithiasis R ASCC
R Epley (CRT)
if I perform a L DH and nystagmus shows Immediate onset, downward & rightward torsional fast phases, >1min response duration
what is the canal being tested? what BPPV type? & what treatment?
R ant (L post)
Cupulolithiasis R ASCC
R Semont w/ head turned R
if I perform a roll test and nystagmus shows Horizontal, geotropic fast phases (toward down ear), stronger w/ R ear down, may have delayed onset & will fatigue over time
what is the canal being tested? what BPPV type? & what treatment?
R HSCC
Canalithiasis R HSCC
BBQ Roll; leftward roll
if I perform a roll test and nystagmus shows Horizontal, ageotropic fast phases(beats away from ear down), stronger w/ L ear down, more immediate onset & longer response duration
what is the canal being tested? what BPPV type? & what treatment?
R HSCC
Cupulolithiasis R HSCC
Modified Semont, Cassani or Brandt Daroff Exercises*
if I perform a roll test and nystagmus shows Horizontal, geotropic fast phases (toward the down ear), stronger w/ L ear down, may have delayed onset & will fatigue over time
what is the canal being tested? what BPPV type? & what treatment?
L HSCC
Canalithiasis L HSCC
BBQ Roll; righward roll
if I perform a roll test and nystagmus shows Horizontal, ageotropic fast phases (beats away from ear down), stronger w/ R ear down, more immediate onset & longer response duration
what is the canal being tested? what BPPV type? & what treatment?
L HSCC
Cupulolithiasis L HSCC
Modified Semont, Cassani or Brandt Daroff Exercises
What would nystagmus look like with a bilateral and equal vestibular deficit?
Both ears are out
No vertigo (need asymmetry to get it)
Complaint is balance & have issues walking, driving, getting in and out of bed etc. - anything not relying on the vision system
Does nystagmus persist indefinitely after a permanent lesion?
No it goes away
Body changes to recover
Can spontaneous nystagmus be caused by problems in places other than the ear?
Yes
Central pathways
Unilateral L vestibular lesion (decreased output)
What is the PT subjective experience
Why would they have these symptoms
Describe their nystagmus
What is the PT subjective experience
sensation is rotation
Why would they have these symptoms
perceive motion in the direction of the fast component for acute vestibulopathy (e.g., acute right UW 🡪 left beating nystagmus and leftward sense of rotation)
Describe their nystagmus
Left vestibular loss = r beating nystagmus
PT has nystagmus when looking straight on. When they look to the right it gets worse but when they look to the left it gets better. What is this
Alexanders law
what are positioning tests
DH
side-lying maneuver
dynamic (AC/PC)
what are positional testing
static
HC
supine head roll & supine head center, left, right and lateral left and right
