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Neuro 2 Midterm Exam > Lecture 9: Vestibular Assessment and Treatment > Flashcards

Lecture 9: Vestibular Assessment and Treatment Flashcards

1
Q

What is first important part to distinguish in a potential vestibular assessment?

A

is it vertigo or just dizziness

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2
Q

What is the difference in how long sx last?

A

BPPV- short duration

UVH- long lasting

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3
Q

Under what circumstances will sx occur?

A

only head turns- BPPV

with or without head turns, random- UVH

trouble in dark- bilateral VH

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4
Q

Does the patient experience double vision?

A

central finding

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5
Q

Does the patient experience hearing loss?

A

labyrinths or meniere’s

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6
Q

Which of the patient symptoms are disturbing function the most?

A

N/V, vertigo- BPPV, UVH

imbalance and persistent lightheadedness- bilateral or Central

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7
Q

What are the 5 neurological D’s that could indicate central pathology?

A

dizziness, diplopia, dysarthria, dysphagia, drop attacks

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8
Q

What other signs and symptoms that may be a red flag during an eval?

A

numbness, weakness, slurred speech, tremors, LOC, memory loss, rigidity, Babinski sign, clonus, spasticity

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9
Q

What is a commonly used outcome measure a patient can self report?

A

Dizziness handicap inventory

self perceived handi cap as a result of vestibular disorder

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10
Q

What are examples of objective ocular motor tests?

A
  1. ocular alignment
  2. smooth pursuit
  3. Saccades
  4. VOR Cancellation
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11
Q

What if any of these oculomotor tests are positive?

A

likely indicative of CNS problems

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12
Q

What are the components of the smooth pursuit test?

A

tests pts ability to track object

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13
Q

What are the components of the saccades test?

A

pt is asked to move eyes back and forth from finger to nose horizontally and vertically

abnormal if pt over shoots and under shoots target

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14
Q

What type of test is commonly seen in pts post concussion?

A

Vergence- eyes both adduct as an object moves closer towards nose

abnormal = likely CNS problem, ask pt about any recent trauma

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15
Q

What is VOR cancellation?

A

tests the calibration capability of the cerebellum

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16
Q

What are 4 types of VOR testing?

A
  1. Dynamic Visual Acuity
  2. VOR x 1
  3. Head Thrust
  4. Head Shake
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17
Q

If any of the VOR tests are positive what does this likely indicate?

A

UVH

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18
Q

What is the Dynamic Visual Acuity test?

A

looking at visual chart and if loss of 2-3 lines indicates hypo function

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19
Q

What is VOR x1?

A

pt will focus on object and turn head

if sx are provoked or pt has trouble focusing likely UVH

20
Q

What is the procedure of head thrust test?

A

pt head flexed 30 degrees , random side to side thrusts to either side

most widely used clinical test hypo function

21
Q

What does an abnormal head thrust finding indicate?

A

inability to maintain visual fixation on nose with corrective saccades

thrust to right and center = right UVH

thrust to left and center = left UVH

22
Q

What is Head shake test?

A

done with frenzy goggles

pt flexes head and PT moves it 20 times with eyes closed and opens eyes and see if nystagmus is present

23
Q

What are abnormal findings for a head shake test?

A

if nystagmus to right- left UVH

if to left- right UVH

24
Q

What is an important concept to remember about nystagmus in general?

A

nystagmus will generally beat to the side of irritation in BPPV and away from side of lesion in hypo function

25
Q

What is an example of a VSR test?

A

Fukuda step test - attempts to isolate the VSR, detects UVH if positive

26
Q

What is procedure for Fukuda?

A

pt stands with eyes closed and arms elevated to 90 degrees and marches for 50 steps with eyes closed

if pt turns head more than 30 degrees to one side positive for UVH to that side

27
Q

What are two recommended outcome measures specific to vestibular pathology?

A
  1. DGI- 19/24 indicates fall risk

2. FGA- 22/30 indicates fall risk

28
Q

What is the motion sensitivity quotient?

A

objective measures a pts motion sensitivity, involves 16 rapid changes in head position and recorded by intensity, duration and number of positions that provoke it

29
Q

What are three additional diagnostic tests for vestibular dysfunction?

A
  1. ENG- can determine whether dysfunction is peripheral or central
  2. Rotary Chair test- very expensive
  3. Dynamic posturography- fancy CTSIB
30
Q

What is one of the main treatments for BPPV?

A

Canalith Repositioning maneuver or CRM is most advocated for pts with posterior canalathiasis

31
Q

What are some guidelines for the CRM?

A

30 second in each position, requires 180 of head motion

retest after 15 mins

32
Q

What should patient avoid for the rest of day after CRM?

A

excessive head movements, remain upright 20 mins after procedure , sleep on back with several pillows

33
Q

What is another common manual technique used for BPPV?

A

Liberatory maneuver for cupulolithiasis

“face plant test”

34
Q

What type of specific exercises can be used as a follow up treatment for BPPV?

A

Brandt Daroff

specific habituation exercises to help pts re use positions they may have been avoiding

35
Q

What are three key treatment concepts for vestibular rehab?

A
  1. Adaptation
  2. Substitution
  3. Habituation
36
Q

What is the rationale for adaptation exercises in vestibular rehab?

A

improves VOR gain by reducing retinal slip

37
Q

What is retinal slip?

A

difference between eye and head velocity , if VOR is impaired then a retinal slip is generated which sends an error signal to brain

38
Q

When are adaptation exercises implemented?

A

when residual vestibular function is present and recovery is expected

appropriate for UVH, bilateral, peripheral or central dysfunction

39
Q

What is a common adaptation exercise?

A

VOR x 1, pt must always have a clear image and can continue with mod sx

progress to VOR x2

40
Q

What are parameters for adaptation exercises and what are the progressions?

A

1-2 minutes, 3-4 times a day

progress by longer duration, faster movement and change position of body

41
Q

What is the rationale for substitution for vestibular rehab?

A

implements visual and somatosensory input from cervical spine to compensate for vestibular loss

appropriate for complete or severe bilateral loss

42
Q

What types of exercises are used for substitution rehab?

A

can use VOR x1, ocular exercises and balance exercises to enhance somatosensation

practice 2-5 mins, 3 x a day

43
Q

What is the rationale for habituation for vestibular rehab?

A

repeated exposure to provocative stimuli results in a reduction of pathological response to a stimulus

aka Brandt Daroff exercises

44
Q

What is the method for BD exercises?

A

execute a series of 4 provoking movements 2-4 times a day

45
Q

What is important to remind patients about BD exercises?

A

symptoms will be provoked during these movements, sx should decrease within 15-30 mins of exercises, usually 7-10 days before body adjusts, may take 4 weeks for sx to diminish

Neuro 2 Midterm Exam (11 decks)

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