lab 2: PVH exam (non BPPV) Flashcards by sophia carrasco

what are the oculomotor tests that we would perform on a non BPPV patient (central test that must be done before proceeding to VOR)

•Spontaneous Nystagmus (not on practical)
•Gaze Evoked Nystagmus
•Ocular ROM (not on practical)
•Vergence
•Skew-Eye Deviation, OTR (not on practical)
•Smooth Pursuit
•Saccades

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what are the vestibulo ocular reflex (VOR) test that can be done (exact sequence)

•Head Shake Nystagmus Test
•Head Impulse Test
•Dynamic Visual Acuity
•VORx1
•VOR x 2
•VORc

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what should u do before conducting visual and vestibular test

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how do u test spontaneous nystagmus (not on practical)

test 1st with fixation (room light) and then with frenzels (no fixation)

normal if no nystagmus

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what is a positive for central vestibular with spontenoaus nystagmus

no change in intensity of nystagmus

direction changing

pure horizontal/vertical

is not fatigable with frenzels

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what is postivie for peripheral vestibular when dong the spontaneous nystagmus test

nystagmus intensity increased
is unidirectional/ direction fixed
rotary component
fatgiagle with frenzels

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Nystagmus is named for the ____ phase directed towards the healthy/intact/unaffected ear.

fast

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when is nystagmus greatest ? minimal or absent?

greatest wehn gaze is dreicted towards the healthy ear followed by a center gaze

minimal or absent when gaze is directed towards the impaired ear

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when does the intensity of nystagmus increased

when the eye moves in the direction of the fast phase (towards healthy ear(

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how do u perform gaze evoked nystagmus

pt head is still and have pt follow target (X) held at eye level 12-18” away with fixation (room light) and have patient gaze center then L and R to determine degress of nystagmus then do it without fixation (w frenzels)

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what is a positive central sign for gaze evoked nystagmus test

intensity of nystagmus will increase with gaze in ANY direction; NOT FATIGABLE

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what is a positive peripheral sign (non BPPV) show from the GEN test

intensity of nystagmus increased with gazing in direction of fast phase (alexander’s LAW) ; fatigable

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what is 3rd degress (1st day ; acute lesion) for a positive non BPPV GEN test

nystagmus present with gaze center, gaze toward & gaze away from side of lesion; most intense when gaze directed towards healthy ear.

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what is 2nd degress (after a few days) for a positive non BPPV GEN test

nystagmus present with gaze center & away fromn side of lesion (healthy ear)

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what is 1st degress (within 1 week , chronic) for a positive non BPPV GEN test

nystagmus present only with gaze away from
side of lesion (healthy ear)

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what will determine acute v chronic lesion ? and what will that determine

degress of nystagmus

determine dosage of vestibular exercise

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what is alexander’s law

nystagmus increases in intensity as patient gazes
further in the direction of the fast component of the nystagmus
(intact ear)

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if a patient has L Peripheral Vestibular Hypofunction (PVH) (non-BPPV), you would see what if it was acute (1-2) days… what degree of nystagmus

R beating horizontal nystagmus with L face that increased in center gaze and further increased with R gaze (toward healthy ear; away from side of lesion)

3rd degree

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if a patient has L Peripheral Vestibular Hypofunction (PVH) (non-BPPV), you would see what if it was after 2-3 days… what degree of nystagmus

No nystagmus in L gaze position, R
beating nystagmus in center gaze that increases when looking toward R
(towards healthy ear; away from side of lesion)

2nd degree

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if a patient has L Peripheral Vestibular Hypofunction (PVH) (non-BPPV), you would see what if it was chronic ; within a week … what degree of nystagmus

no nystagmus in center gaze or gaze towards L side (lesion side) but R beating horizontal nystagmus present in R gazed (towards healthy ear)

1st degree

how to test vergence for non BPPV

slowly bring target (X) twaords pateints nose , ask the patient to keep their eyes on the target and inform you at what point do they get diplopia (double vision)

what is the normal and abnormal test for vergence

normal: target at least 6cm from nose before double vision

abnormal: disconjuate eye movement or double vision before target is at 6 CM

what will a skewed eye do with the skew deviation test

will jump back to target with uncover

what will a non skewed eye do during the skew deviation test

eye will cause skewed eye to jump back to the target with cover

what are the 2 visual tracking test done

smooth pursuit and saccades (both central signs)

how do u perform smooth pursuit ? how far is the target held and what °

With head still, ask pt to follow a target (X) held 12-18” in front at eye level; move target slowly ~ 30 deg in each direction

what is abnormal with smooth pursuit

saccadic intrusions

how do u perform the saccades test and how far in front and at what angel is the target held

with head held still, ask pt to quickly look back-forth between your nose (center target) and X held to R or L of center; target is eye level and 12 -18 “ in front; R/L target held ~30 deg from center. Repeat up/down, diagonally.

what is the abnormal sign for saccades

overshooting or undershooting

how fast do u need to move the head to elicit VOR

2 Hz

how do u perform the VOR: head shake nystagmus test w frenzels

Place frenzels on patient. Ask pt to close eyes. Then, pitch pt’s head down 30 deg, & passively shake their head side to side quickly (2 Hz velocity) for 20 sec. using a metronome (120/240 bpm). After 20 sec, stop, have them open eyes and look straight ahead (gaze center). Observe for nystagmus. If present, have them then look to R and L to degree (acute v chronic)

what does teh VOR: Head Shake Nystagmus Test (HSNT) w Frenzels stimulate

horizontal canal VOR

what is the abnormal response to VOR: Head Shake Nystagmus Test (HSNT) w Frenzels

peripheral vestibular imbalance w direction fixed nystagmus beating towards the active/intact side

what test for the VOR do u have to use frenzels with

head shake nystagmus test

what is the sequence for testing non BPPV peripheral vestibular hypo function

 Head Shake Nystagmus Test (HSNT) *  Head Impulse or Head Thrust Test (HIT/HTT)  Dynamic Visual Acuity (DVA)  VOR x 1  VOR x 2  VORc

In the Horizontal (or Lateral) canals, ampullopetal flow (towards ampulla) creates a stronger response (is stimulated more) bc why

it deflects the cupula away from the canal.

how do u perform the VOR: Head Impulse or Head Thrust Test (HIT or HTT)

sit in front of th pet at eye level about 12-18” away then pitch pts head down about 30° then ask pt to fixate on ur nose while you PASSIVELY and SLOWLY move pt head side to side each direction several times (this stimulates horizontal canal VOR)) then QUICKLY and unexpectedly thrust patients head 10-20° to one side then stop observe if their eyes remain on ur nose or if they jump to one side then come back repeat 3 times

what is the abnormal testing for VOR: Head Impulse or Head Thrust Test (HIT or HTT)

pt eye jump to side of the thrust then refixate indicating vestibular hypo function to the side of the head thrust (2nd law)

how do u perform VOR: Dynamic Visual Acuity (DVA) Test

ask pt to flex their head 30° and place eye chart at eye level test static visual acuity first by asking the patient to read the lowest line possible then w the patients head still tiled passively move their head side to side at 2hz (120/240 bpm) and ask them to read the lowest line

when performing the VOR: Dynamic Visual Acuity (DVA) Test how do u know if the abnormal finding are unilateral or bilateral

 Unilateral Vestibular Hypofunction: >3-line difference or (+) dizziness  Bilateral Vestibular Hypofunction: >3-line difference, (-) dizziness, (+) oscillopsia, (+) postural instability

what is VORx1

active head movement at 2 Hz w target stable

how to preform VOR x1

Ask pt to actively move their head side (20-30 deg) at 120/240 bpm on metronome while keeping their eyes on the (X) in the center, held 12 – 18 inches away at eye level. Keep going until and when X blurs.

what is the abnormal finding for VOR x1

target becomes blurry or jumping and/or (+) dizziness or unable to move head at 2 Hz (before 2 mins) document speed at which target become blurry if cant move heard at 2Hz then determine speed they can do it at (baseline )

what is VOR x 2

active head movement w target moving opposite to head as fast as they can

do u use a metronome for VOR 2

naur

what is the Mechanism for suppressing VOR during combined eye-head tracking when eyes and head move together in same direction; assesses visual-vestibular integration in CNS  Lesions in cerebellum (flocculus or paraflocculus)

VOR cancellation

how to perform VORc ? (you are only performing this as an intervention on the practical not a test even tho it is part of the oculomotor and VOR testing)

patient is in rotary stool and then extend arms in front of them while focusing on thumb PT flexed head down to 30° then passively moves pts head side to side as the pt keeps their eyes on their thumbs to a beat of 50bpm

what is the sensory organization test

modified CTSIB (not on practical)

what is the **motion sensitivity test** used for ? )not on practical)

identify movements that cause symptoms for the purpose of habituation

what are the **vestibular specific functional measures** (not on practical)

- fukuda step test - functional gait assessment - vestibular disorders activities of daily living scale (VADL)