FINALS: Vestibular Rhab

Question 1

What is the primary function of the vestibular system?

Answer 1

Stabilize visual images on the retina during head movement for clear vision.
Maintain postural stability during head movement.
Provide information for spatial orientation (direction, distance).

Question 2

What are the components of the Peripheral Vestibular System?

Answer 2

Vestibular labyrinth: Detects linear and angular head movements.
Semicircular canals (SCC): Detect angular movements (anterior, posterior, horizontal).
Otolith organs (saccule and utricle): Detect linear movements

Question 3

What is the function of Vestibulo-Ocular Reflex (VOR)?

Answer 3

To maintain gaze stability during rapid head movements.

Question 4

What are the key principles of the vestibular system?

Answer 4

Tonic Firing Rate: Baseline firing rate of ~80 pulses/second.
Push-Pull Mechanism: Balance of excitation/inhibition between paired SCCs.
Inhibitory Cut Off: Hyperpolarization on one side is limited to zero.

Question 5

What is Benign Paroxysmal Positional Vertigo (BPPV)?

Answer 5

A common peripheral vestibular disorder caused by dislodged otoconia, leading to vertigo during specific head movements.

Question 6

What test is used to diagnose BPPV?

Answer 6

Dix-Hallpike Test or Supine Roll Test, depending on the canal involved.

Question 7

What are the characteristics of Posterior Canal BPPV?

Answer 7

Brief, intense vertigo lasting <1 minute.
Nystagmus: Upbeat and torsional.
Diagnosed with the Dix-Hallpike maneuver.

Question 8

What is the Canalith Repositioning Maneuver (Epley Maneuver) used for?

Answer 8

To treat posterior canal BPPV by repositioning dislodged otoconia back into the utricle.

Question 9

Differentiate between canalithiasis and cupulolithiasis.

Answer 9

Canalithiasis: Otoconia move freely in the semicircular canals (transient symptoms).
Cupulolithiasis: Otoconia adhere to the cupula (persistent symptoms).

Question 10

What interventions are used for Unilateral Vestibular Lesion (UVL)?

Answer 10

Gaze stability exercises (VOR training).
Postural stability exercises (standing, dynamic movements).
Motion sensitivity training (habituation exercises).

Question 11

What symptoms suggest a Central Vestibular Disorder?

Answer 11

Persistent nystagmus (vertical, downbeat, or upbeating).
Neurological signs (e.g., dysmetria, ataxia).
Gaze-evoked or rebound nystagmus.

Question 12

Name a test used for Dynamic Visual Acuity.

Answer 12

Dynamic Visual Acuity Test (DVA): Assesses VOR function by measuring visual acuity during head movement.

Question 13

What is the significance of the Supine Roll Test?

Answer 13

Used to diagnose Lateral Canal BPPV.

Question 14

What are common exercises for Bilateral Vestibular Lesions (BVL)?

Answer 14

Gaze stabilization exercises.
Balance training with reduced base of support.
Eye-head coordination exercises.

Question 15

What interventions are recommended for Meniere’s Disease?

Answer 15

Avoidance of triggers: CATS (Caffeine, Alcohol, Tobacco, Stress).
Vestibular rehabilitation after symptom control.

Question 16

What home exercises are recommended for vestibular rehabilitation?

Answer 16

Gaze Stabilization: 3–5 times daily, 20–40 minutes/session.
Balance exercises: Vary base of support, surfaces, and dynamic tasks.

Question 17

What is oscillopsia, and what causes it?

Answer 17

Definition: The perception of a bouncing or unstable visual field during head movement.
Cause: Bilateral vestibular hypofunction (poor VOR function).

Question 18

What are the types of nystagmus associated with vestibular disorders?

Answer 18

Spontaneous nystagmus: Present at rest; indicative of acute vestibular dysfunction.
Positional nystagmus: Triggered by changes in head position (e.g., BPPV).
Gaze-evoked nystagmus: Occurs during specific eye positions; seen in central disorders.

Question 19

What is the purpose of habituation exercises in vestibular rehab?

Answer 19

To reduce symptoms of dizziness through repeated exposure to motion or sensory stimuli that provoke symptoms.

Question 20

What are the typical causes of Unilateral Vestibular Loss (UVL)?

Answer 20

Vestibular neuritis.
Labyrinthitis.
Vestibular schwannoma (acoustic neuroma).
Trauma or surgery affecting the vestibular nerve.

Question 21

What is the role of the Vestibulospinal Reflex (VSR)?

Answer 21

To maintain postural stability and control of body movements during head movements.

Question 22

What are some common symptoms of Peripheral Vestibular Disorders?

Answer 22

Vertigo.
Nystagmus (usually mixed horizontal-torsional).
Imbalance.
Motion sensitivity.

Question 23

How does cervicogenic dizziness differ from vestibular dizziness?

Answer 23

Cervicogenic dizziness: Associated with neck pain and stiffness; often positional.
Vestibular dizziness: Caused by dysfunction in the vestibular system; includes vertigo and nystagmus.

Question 24

What is the Head Impulse Test (HIT) used for?

Answer 24

To test for VOR function in individuals with suspected peripheral vestibular hypofunction.

Question 24

What is the most common vestibular dysfunction in children?

Answer 24

Benign Paroxysmal Vertigo of Childhood (BPVC).

Question 25

What is the goal of compensation in vestibular rehabilitation?

Answer 25

To enhance the brain’s ability to use alternative sensory inputs (vision, proprioception) to compensate for vestibular deficits.

Question 26

What does a positive Romberg test indicate in vestibular assessment?

Answer 26

Impaired balance with eyes closed, suggesting reliance on visual input and possible vestibular or proprioceptive dysfunction.

Question 27

What medications are commonly used for acute vestibular symptoms?

Answer 27

Antihistamines: Meclizine, dimenhydrinate.
Benzodiazepines: Diazepam, lorazepam (short-term use).
Antiemetics: Ondansetron, promethazine.

Question 28

What are the clinical signs of acute vestibular neuritis?

Answer 28

Sudden onset of severe vertigo.
Spontaneous horizontal-torsional nystagmus (unilateral).
Imbalance without hearing loss.

Question 28

What is HINTS to INFARCT, and why is it used?

Answer 28

A bedside clinical test to differentiate central (stroke) from peripheral vestibular disorders:

Head Impulse Test (normal in central lesions).
Nystagmus (direction-changing in central lesions).
Test of Skew (positive in central lesions).

Question 29

What does the bucket test evaluate?

Answer 29

It assesses subjective visual vertical (SVV) to identify vestibular or otolith dysfunction.

Question 30

What is Perilymphatic Fistula?

Answer 30

An abnormal connection between the inner and middle ear that can cause vertigo and hearing loss.

Question 31

How does Vestibular Migraine present?

Answer 31

Episodic vertigo lasting minutes to hours.
Often accompanied by headache, photophobia, or phonophobia.
No significant hearing loss

Question 32

What are key features of Superior Canal Dehiscence Syndrome (SCDS)?

Answer 32

Autophony (hearing one’s own voice/lungs).
Vertigo triggered by loud sounds or pressure changes (Tullio phenomenon).

Question 33

What are the contraindications for the Epley Maneuver?

Answer 33

Severe cervical spine instability or injury.
Recent neck surgery.
Uncontrolled vascular disorders.

Question 34

What are key signs of central origin in vestibular dysfunction?

Answer 34

Purely vertical nystagmus with Dix-Hallpike.
Direction-changing nystagmus without positional changes.
Resting nystagmus.
Neurological symptoms (gait & speech dysfunction).
Non-fatiguing vertical nystagmus.
Presence of saccades (always central).

Question 35

What percentage of BPPV cases involve the posterior canal?

Answer 35

85-95% of cases.

Question 36

Which test is the gold standard for diagnosing posterior canal BPPV?

Answer 36

Dix-Hallpike Test (Sensitivity: 82%, Specificity: 71%).

Question 37

What type of nystagmus indicates canalithiasis in lateral canal BPPV?

Answer 37

Geotropic nystagmus (beating toward the affected ear).

Question 38

What are the key features of nystagmus in posterior canal BPPV?

Answer 38

Mixed torsional and vertical movement.
Fatigues with repeated maneuvers.

Question 39

What intervention strategies are used for vestibular dysfunction?

Answer 39

Canalith repositioning maneuvers (Epley, Semont).
Adaptation.
Habituation.
Substitution.
Balance and gait training.

Question 40

What is the purpose of substitution exercises for vestibular dysfunction?

Answer 40

To use visual and somatosensory cues to compensate for vestibular deficits.

Question 43

: How often should gaze stabilization exercises be performed at home?

Answer 43

3-5 times daily for 20-40 minutes.