Somatosensory, Balance, and Vertigo Flashcards
Having a patient standing on foam would be an example of stressing what system?
somatosensory
What is the Vestibuloocular Reflex (VOR)?
VOR allows for head/eye movement coordiation. This reflex supports gaze stabilization through eye movement that counters movement of the head. Maintains a stable image on the retina during movement.
What is the Vestibulospinal Reflex (VSR)?
Attempts to stabilize the body and control movement. The reflex assists with stability while the head is moving as well as coordination of the trunk during upright postures
How does muscle contraction pattern differ with an ankle strategy vs a hip strategy?
Ankle: contract distal to proximal
Hip: contract proximal to distal
What is a suspensory strategy? Example?
used to lower the center of gravity during standing or ambulation in order to better control the center of gravity. Examples include tasks that require mobility and stability like surfing
What symptoms may be present with Peripheral Vertigo? (7)
- episodic and short duration
- autonomic symptoms present
- precipitating factor
- pallor, sweating
- nausea and vomiting
- auditory fullness
- tinnutus
What symptoms may be present with Central Vertigo?
- autonomic symptoms less severe
- loss of consciousness can occur
- Nuerlogical symptoms: diplopia(double vision), hemianopsia, weakness, numbness, ataxia, dysarthria
Is Meniere’s disease a cause of central or peripheral vertigo?
peripheral
What are 6 causes of central vertigo?
- meningitis
- migraine headache
- complications of neurologic origin post ear infection
- trauma/tumor
- cerebellar degeneration
- MS
What is oscillpsia? what does it occur with?
movement of objects viewed, occurring with nystagmus
What is the difference between peripheral, central, and positional nystagmus?
Peripheral: occurs with a peripheral vestibular lesion and is inhibited when the patient fixates their vision on an object
Central: occurs with a central lesion of the brainstem/cerebellum and not inhibited by visual fixation on an object
Positional: induced by change in head position
What is gaze-evoked nystagmus and what pahtologies is it associated with?
nystagmus occuring when the eyes shift from a primary position to an alternate position.
Caused by patient’s inability to maintain a stable gaze position. Typically indicative of CNS pathology associated with brain injury or MS
How does visual fixation affect nystagmus with Central vs. Peripheral lesions?
Central: no inhibition with fixation
Peripheral: will inhibit nystagmus and vertigo
The direction of the FAST segment of nystagmus indicates what?
the HEALTHY ear
What is the cut-off score for the BERG and what does it indicate?
score <45/56 indicates an increased risk for falling
What balance exam has 8 test conditions and five trials of each condition are performed, used for patients with higher level motor skills?
Fregly-Graybiel Ataxia Battery Test
What balance assessment is used specifically for patients with heiplegia?
What is the maximum score on the test?
Fugl-Meyer Sensorimotor Assessment of Balance Performance Battery
Max score is 14
What are age related norms on the functional reach test for Functional Reach Test and what does a score outside these norms indicate?
20-40: 14.5-17 inches
41-69: 13.5 - 15 inches
70-87: 10.5 - 13.4 inches
Increased falls risk if outside of norms
How is the Romberg test performed?
- standing, feet together, upper extremities folded, looking at a fixed point straight ahead with eyes open
- eyes closed
“normal” if able to maintain position for 30 seconds
How is the Sharpended Romberg performed?
- Heel toe stance, arms crossed, focused on fixed point
- eyes closed
increases challenge on both vestibular and somatosensory system
What is the distance for the TUG?
What is the rating scale for the TUG?
What are the cut-off scores for the TUG?
walk approximately 10 feet
5 point ordinal scale with 1 as “normal” and 5 as “severely abnormal” in terms of postural sway, excessive movements, reaching for support, side stepping
<10 seconds independent
>20 seconds limit of functional independence and may be at risk of falling
>30 seconds high risk of falling
What is the cut-off score for the Tinetti Performance Oriented Mobility Assessment?
a score of <19/28 indicates a high risk for a fall
What are the two different sections in general on the Tinneti Performance Oriented Mobility Assessment?
- assess balance with STS, immediate standing balance, slight push, turn 360
- gait at normal speed and rapid speed
What are the five levels of Functional Balance Grades (o’sullivan pg. 233) and what do they each mean?
4 Normal: patient able to maintain steady balance without handhold support (static). Patient accepts max challenge and can shift weight eassily within full range in all directions (dynamic)
3 Good: patient able to maintain balance without handhold support, limited postural sway (static). Patient accepts moderate challenge able to maintain balance while picking up object off floor (dynamic)
2 Fair: patient able to maintain balance with handhold support, may require occasional min assistance (static). Patient accepts min challenge, able to maintain balance while turning head/trunk (dynamic)
1 Poor: patient requires handhold support and mod to max assist to maintain posture (static). Patient unable to accept challenge or move without loss of balance (dynamic)
0 Absent: patient unable to maintain balance.
