Part 10 Flashcards
Symptoms of non-compensated unilateral vestibular deficit (UVD)
- Blurred vision w head movement (oscillopsia)
- spatial disorientation and imbalance with head/body motion or everyday activities (VSR)
Pre-appointment questionnaires
patients should have 2, a standardized scale to determine how much it impacts their life and a medical intake history form
Step 1 Characterize symptoms
symptoms need to fit into 1 of 4 categories
Vertigo
Postural
Vestibulo-visual
Dizziness
Internal vertigo
sensation of self motion when no motion is occuring or sensation of disorted self motion during an otherwise normal head movement (rotational motion, linear or tilt)
when is internal vertigo worsened
when head is moved
Most common type of dizziness
vertigo
non-vertiginous dizziness
sensation of disturbed or impaired spatial orientation without a false or distorted sense of motion
vestibulo–visual symptoms
visual symptoms that usually result from vestibular pathology or interplay b/w visual and vestibular systems
ex., false sense of motion or tilting of the visual surround and visual disorientation (blur) linked to vestibular failure
postural symptoms
balance symptoms related to maintenance of postural stability occuring while upright (Seated standing or walking)
not applied when linked to changing body position with respect to gravity
Vestibular symptoms
peripeheral- dysfunction of end organs or nerves (BPPV, Labyrinthis, meniers)
Step 2 time course
is it acute, episodic, chronic
acute
> 24 continuous vertigo (how long did it last at peak)
episodic
similar signs and symptoms lasting seconds to hours
chronic
constant vestibular sympytoms for weeks to years
- duration since when
evolution
step 3 identify triggers
spontaneous or triggered
triggered:
positional (after change in head position)
head motion (during change in head positon)
visually induced
sound induced
valsalva induced
orthostatic
other
step 4: associated symptoms
isolated or non isolated associated with
- auditory, vegetative or neurologic
4 steps
- characterize symptoms
- Time course
- identify triggers
- associated symptoms
Describe dizziness
sos toned
since when
Occurance
symptoms
triggers
ontological
neurological
evolution
duration
Deadly Ds
acute phase probably stroke
dysarthia, dysphonia etc.
headache
severe sudden sustained
acute phase shows what
that its not a vestibular sign and need to be sent to ER . (deadly Ds headache)
Chronic component
Disco HAT
Darkness
imbalance
supermarket effect
cognitive function
Oscillopsia (DVA)
head movements
autonomic functions
tiredness
ideal vestibular rehabilitation therapy candidates are
stabilized and non-compensated
clinimetrics
dizziness related QOL measure
why do we do clinimetrics
- measures of impairment do not correlate sig. with DRQOL unless loss is profound
- demonstrate efficency of treatment
- gather information that can lead to correct diagnosis
Vertigo symptom scale (VSS)
Yardley 1992
2 sub scales to differentiate vertigo from anxiety symptoms
Dizziness handicap inventory
Functional, physical and emotional impact on disability
greater than 10 referred to balance specialists
54+ severe handicap
PT vestibular task force ranking highly recommend acute and chronic (>6 weeks)
Positional alcohol nystagmus 1 (PAN I)
30 min after alcohol. Fuses to cupula, making lighter, sensitive to gravity
positionally provoked geotropic nystagmus towards L ear
Positional alcohol nystagmus (PAN II)
5-10 hours stop drinking
alcohol defuses from cupulla making heavier
positionally provoked ageotropic nystagmus (towards upper ear)
