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N-Eval > MIDTERMS: Vestibular System > Flashcards

MIDTERMS: Vestibular System Flashcards

1
Q

What is the primary function of the vestibular system?

A

It provides information about orientation in space.

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2
Q

What can disorders of the vestibular system cause?

A

Abnormal movement sensations, visual instability, and loss of balance.

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2
Q

Describe the pathway of the VOR.

A

Signals from the semicircular canals (SCC) go to the vestibular nuclei.
Vestibular neurons decussate in the contralateral oculomotor nucleus.
Activates ipsilateral superior rectus and contralateral inferior oblique muscles.

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2
Q

What does VOR gain and phase refer to?

A

The relationship between head movement and eye movement, important for image stabilization.

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2
Q

What are the two major parts of the vestibular system?

A

Peripheral vestibular system and central vestibular system.

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3
Q

What are the key components of a physical therapy examination?

A

History and systems review
Identification of symptoms (e.g., dizziness, vertigo)
Observation for nystagmus
Tests and measure

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3
Q

What are the three primary functions of the peripheral vestibular system?

A

Stabilizing visual images on the fovea of the retina during head movement.
Maintaining postural stability, especially during head movement.
Providing information for spatial orientation.

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3
Q

Name the three semicircular canals of the peripheral vestibular system.

A

Horizontal canal
Posterior (inferior) canal
Anterior (superior) canal

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4
Q

: What is nystagmus and why is it important in vestibular assessments?

A

Nystagmus is the primary diagnostic indicator for vestibular disorders, helping differentiate between peripheral and central lesions.

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4
Q

What is the function of the vestibulo-ocular reflex (VOR)?

A

To maintain stability of an image on the fovea of the retina during rapid head movements.

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4
Q

What are some tests and measures used in vestibular assessments?

A

Visual Analogue Scale
Dizziness Handicap Inventory
Functional Disability Scale
Motion Sensitivity Quotient
Examination of eye movement

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4
Q

What does fixation indicate during nystagmus observation?

A

If nystagmus diminishes with fixation, it is likely peripheral. If it remains unchanged or worsens, it is likely central.

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5
Q

List some symptoms that may indicate vestibular dysfunction.

A

Dizziness
Vertigo
Lightheadedness
Dysequilibrium
Oscillopsia

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5
Q

Name some conditions that can cause dizziness.

A

Perilymphatic fistula
Endolymphatic hydrops
Mal de Débarquement
Migraine headaches
Orthostatic hypotension
Anxiety
Disuse disequilibrium

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5
Q

What key structures make up the central vestibular system?

A

Brainstem (vestibular nuclei and reticular formation)
Cerebellum
Ocular motor nuclei (III, IV, VI)
Thalamus and cortex
Parieto-insular vestibular cortex

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5
Q

What does the dynamic visual acuity test measure?

A

It measures visual acuity during horizontal motion of the head.

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5
Q

What is the purpose of the head impulse test?

A

To examine the VOR at high acceleration, checking for corrective saccades that indicate impaired VOR function.

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5
Q

What are some pertinent subjective findings to gather during a vestibular assessment?

A

Medications
History of falls
Confidence in balance
Difficulty with activities of daily living (ADL)
Auditory disability
Tinnitus

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5
Q

Describe the head-shaking induced nystagmus test.

A

Vision occluded
Clinician flexes the head 30°
Oscillates horizontally for 20 cycles at 2 Hz
Opens eyes to check for nystagmus.

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6
Q

What is the Roll test used for?

A

To identify horizontal semicircular canal BPPV, performed by rapidly rotating the head while observing for nystagmus and vertigo.

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6
Q

Name some balance and functional tests used in assessments.

A

Romberg
Sharpened Romberg
Single Leg Stance (SLS)
Singleton Test
Dynamic Gait Index (DGI)
Berg Balance Scale
Tinetti Balance Test (POMA)
Timed Up and Go (TUG)
Functional Reach
Clinical Test of Sensory Integration and Balance (CTSIB)

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6
Q

Describe the spontaneous nystagmus test procedure.

A

Have the patient sit quietly and look forward. Observe for nystagmus:

Normal: No nystagmus noted
Abnormal: Presence of pendular, pure vertical, or rotary nystagmus.

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6
Q

What is the VOR test used for?

A

To assess the function of the vestibulo-ocular reflex (VOR) and evaluate the semicircular canal function.

6
Q

What are saccades and smooth pursuits in the context of vestibular testing?

A

Saccades are rapid eye movements between fixation points, while smooth pursuits are the ability to track a moving object smoothly.

6
Q

What is the significance of the Sharpened Romberg test?

A

Assesses balance in a narrower base of support, stressing vestibular and proprioceptive systems more.

6
Q

Describe the Dix-Hallpike test.

A

A positional test for BPPV, performed with the patient in a long-sitting position, head rotated 45° to one side, and then quickly moved to a supine position with head extended beyond horizontal while observing for nystagmus.

6
Q

What does a positive Romberg test indicate?

A

Sensory ataxia due to proprioceptive or vestibular dysfunction.

7
Q

What does poor performance on the Single Leg Stance (SLS) indicate?

A

Possible balance deficits linked to increased fall risk, especially in the elderly.

8
Q

What does the Dynamic Gait Index (DGI) assess?

A

It tests eight facets of gait in older adults, with scoring indicating fall risk.

<19/24: predictive of falls
22/24: safe ambulation

9
Q

What is a concerning score on the Berg Balance Scale?

A

Scores below 45/56 indicate a greater fall risk, commonly used in stroke and elderly populations.

10
Q

How is the Tinetti Balance Test (POMA) scored?

A

<18: high fall risk
19-23: moderate fall risk
24: low fall risk

11
Q

What does the Timed Up and Go (TUG) test measure?

A

The time taken to stand, walk 3 meters, turn, and sit down. A time >12 seconds suggests fall risk.

12
Q

What does the Functional Reach Test measure?

A

The distance a person can reach forward without losing balance; a reach of less than 6 inches is predictive of falls.

13
Q

What does the Clinical Test of Sensory Integration and Balance (CTSIB) assess?

A

It evaluates sensory organization for balance under various sensory conditions, identifying deficits related to vision, proprioception, or vestibular issues.

13
Q

What are central vestibular disorders and their causes?

A

Disorders affecting the brain stem, cerebellum, or small parts of the cerebrum, often caused by trauma, vascular issues, or degenerative diseases.

14
Q

What symptoms are associated with Wallenberg’s Syndrome?

A

Difficulty swallowing, hoarseness, vertigo, nausea, vomiting, nystagmus, and balance/gait incoordination.

14
Q

What is Pusher Syndrome?

A

A condition characterized by ipsilateral or contraversive pushing, lateral postural imbalance, and a tendency to fall towards the affected side.

15
Q

A patient takes 15 seconds to complete the Timed Up and Go (TUG) test.
Q: What does this timing suggest regarding the patient’s functional mobility?

A

A time >12 seconds indicates an increased risk of falls, suggesting potential mobility deficits.

15
Q

What are common features of AICA involvement?

A

Vertigo, imbalance, lateropulsion, and loss of pain and temperature sensation on the ipsilateral face and contralateral body, along with unilateral hearing loss.

15
Q

Describe the difference between cupulolithiasis and canalithiasis in BPPV.

A

Cupulolithiasis occurs when otoconia adhere to the cupula, while canalithiasis involves free-floating otoconia in the semicircular canals.

16
Q

What is the purpose of postural stability exercises?

A

To improve balance by encouraging the development of balance strategies while being safe enough for the patient to perform independently, incorporating head movements.

16
Q

What is the importance of distinguishing peripheral from central vestibular pathology?

A

Observation of nystagmus characteristics, recovery time, and the presence of ocular torsion and skew deviation can help differentiate between the two.

16
Q

What symptoms are associated with acoustic neuroma?

A

: Progressive hearing loss, tinnitus on the affected side, headaches, and numbness around the mouth, without nystagmus or acute vertigo.

16
Q

A 70-year-old male presents with frequent falls and difficulty maintaining balance. During the examination, he exhibits a positive Romberg test.
Q: What does a positive Romberg test indicate in this patient?

A

It suggests sensory ataxia due to proprioceptive or vestibular dysfunction.

16
Q

An elderly patient shows poor performance on the Single Leg Stance (SLS) test, struggling to hold the position for more than 5 seconds.
Q: What does this result imply about her risk?

A

Poor performance indicates balance deficits that may be linked to an increased risk of falls.

17
Q

A 75-year-old male is evaluated using the Dynamic Gait Index (DGI) and scores 18 out of 24.
Q: What does this score indicate regarding his fall risk?

A

A score of <19 suggests he is at predictive risk for falls in older adults.

17
Q

A 65-year-old female struggles to maintain her balance during the Sharpened Romberg test, which she performs with a narrower base of support.
Q: What is the significance of the Sharpened Romberg test in assessing her condition?

A

It assesses her balance under more challenging conditions, further stressing her vestibular and proprioceptive systems.

18
Q

A 68-year-old female with a history of stroke scores 40 on the Berg Balance Scale during her rehabilitation session.
What does her score suggest about her fall risk?

A

Scores below 45 indicate a greater fall risk, so she should be monitored closely.

18
Q

A 60-year-old male with suspected vestibular dysfunction experiences vertigo and has a positive Clinical Test of Sensory Integration and Balance (CTSIB) result.
Q: What does this result suggest about his balance impairments?

A

It indicates that his balance impairments may be due to deficits in vision, proprioception, or vestibular function.

19
Q

A patient presents with symptoms of Wallenberg’s Syndrome, including vertigo and gait incoordination.
Q: What underlying condition might be affecting his balance and coordination?

A

Central vestibular dysfunction due to issues such as trauma or vascular problems affecting the brainstem.

20
Q

A patient with Pusher Syndrome demonstrates a strong tendency to push toward their affected side during therapy sessions.
Q: What intervention strategies might help this patient improve their balance and reduce falls?

A

Strategies should focus on teaching the patient to use visual and tactile cues to maintain an upright posture and improve their awareness of body orientation.

21
Q

An elderly patient experiences bilateral vestibular hypofunction and has difficulty with balance and gait.
Q: What types of activities or therapies might benefit this patient?

A

Recommended activities include pool exercises for buoyancy and Tai Chi to improve balance, flexibility, and strength.

22
Q

A 50-year-old male presents with dizziness and hearing loss on the affected side, diagnosed with an acoustic neuroma.
Q: What are the key symptoms he is likely experiencing?

A

Progressive hearing loss, tinnitus on the affected side, headaches, and potential numbness around the mouth.

23
Q

A patient exhibits pendular nystagmus and a skew deviation during the examination.
Q: What does this combination of signs suggest?

A

It indicates possible central vestibular pathology, distinguishing it from peripheral vestibular disorders.

24
Q
A

N-Eval (20 decks)

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