PT Examination of Vestibular Disorders

Question 1

What 3 questions do you need to ask your vestibular patient?

Answer 1

1. HOW LONG have they had the Sx or how recently it occurred?
2. Is it CONSTANT or EPISODIC?
3. Under what CIRCUMSTANCES do the symptoms occur?

Question 2

What does the PT need to clarify with the patient?

Answer 2

• what the patient is experiencing when they say they are “dizzy”

Question 3

Vertigo is (2)? What does it indicate (3)?

Answer 3

• sense that the environment is moving, SPINNING
• tends to be EPISODIC
• BPPV
• UVH
• unilateral brainstem lesion affecting vestibular nuclei

Question 4

Lightheadedness is (1)? Is caused by (4)?

Answer 4

• feeling that your about to faint
• caused by orthostatic hypotension, hypoglycemia, anxiety, panic disorders
  (vague and less localizing)

Question 5

Dysequilibrium is (1)? Is caused/associated with (6)?

Answer 5

• sensation of being off balance
• BVH or chronic UVH
• LE somatosensory loss
• upper brainstem/vestibular cortex lesion
• cerebellar and motor pathway lesions

Question 6

What is oscillopsia (2)?

Answer 6

• subjective feeling of motion of objects that are stationary.
• can occur with head movements in patients with vestibular hypofunction (VOR deficits, lack of gaze stability)

Question 7

What class of drugs is used for vestibular suppression (3)?

Answer 7

• antihistamines
• benzodiazepines (lorazepam)
• anticholinergics (meclizine)

Question 8

What subjective/self-preception/questionnaires can be used for vestibular patients (4)?

Answer 8

• visual analog scale
• dizziness handicap inventory (DHI)
• vestibular rehab benefit questionnaire (VRBQ)
• motion sensitivity quotient (MSQ)

Question 9

What is the primary diagnostic indicator used to identify peripheral and central vestibular lesions?

Answer 9

• nystagmus

Question 10

Why does spontaneous nystagmus happen?

Answer 10

• acute unilateral insult/lesion because of asymmetry between the two vestibular systems and the brain perceives the healthy ear as excited.

Question 11

What is being tested with the Head Impulse test (5)?

Answer 11

• horizontal SCC
• observing the eyes, normal they will remain on target (PT’s nose)
• the side you rotate head to is the side being tested
• if loss of vestibular function, eye will not move as quick as head = eye move off target
• corrective saccade = rapid eye movement to reposition eyes on target

Question 12

What is the Head Impulse test sensitive for?

Answer 12

• indication of vestibular hypofunction in patients with compete loss.
• less sensitive in detection if incomplete loss

Question 13

True/False - A patient will have a (+) Head Impulse test if they have a unilateral peripheral lesion or pathology of the vestibular neurons (central)?

Answer 13

• true

Question 14

What degree do you hold a patients head when performing the Head Impulse test?

Answer 14

• flexes head 30°

Question 15

What does the Head Shake test checking for (4)?

Answer 15

• unilateral peripheral vestibular defect
• no nystagmus = normal VOR intact bilaterally
• Horizontal nystagmus = asymmetry between vestibular inputs (quick phase towards healthy ear, slow toward lesion ear)
• Vertical nystagmus = central lesion

Question 16

What does the dynamic visual acuity test for (4)?

Answer 16

• visual acuity during horizontal head movement
• at frequency of 2 Hz (2 cycles per second)
• normal = little of no change of acuity
• a 3 line or more change = vestibular hypofunction on one side

Question 17

The 3 VOR bedside test?

Answer 17

• Head impulse
• Head shake
• Dynamic visual acuity

Question 18

If patient has nystagmus during the Dix Hallpike what would the nystagmus be in provoking and return (sitting) position if the problem is in the posterior SCC?

Answer 18

• provoking position = upbeating torsional to affectied side

- return to sitting = downbeating and torsional

Question 19

If patient has nystagmus during the Dix Hallpike what would the nystagmus be in provoking and return (sitting) position if the problem is in the anterior/superior SCC?

Answer 19

• provoking position = downbeating and torsional

- return to sitting = upbeating and torsional

Question 20

Canalithiasis Nystagmus would present how?

Answer 20

• latent onset (up to 45 sec.)

- last < 1 minute

Question 21

Cupulolithiasis Nystagmus would present how?

Answer 21

• immediate onset

- last > 1 minute

Question 22

Contrindication to Dix Hallpike?

Answer 22

• acute fracture that prevents lying down quickly and rolling
• recent neck fracture, surgery, or instability
• Hx of vertebral dissection or unstable carotid disease
• recent retinal detachment

Question 23

To identify benign paroxysmal positional vertigo in anterior and posterior semicircular canals you use?

Answer 23

• Dix Hallpike test

Question 24

To identify benign paroxysmal positional vertigo in horizontal semicircular canals you use?

Answer 24

• Roll test

Question 25

Head rolled to the right with geotropic nystagmus means?

Answer 25

• horizontal canalithiasis

Question 26

Head rolled to the right with apogeotropic nystagmus means?

Answer 26

• horizontal cupulolithiasis

Question 27

What is the bow and lean test used to determine (3)?

Answer 27

• the effected ear if both sides are positive during the roll test.
• geotropic = affected ear is the same one that is the same direction to the bowing quick-phase nystagmus
• apogeotropic = affected ear is the one that is the same direction as the leaning quick phase nystagmus.