Somatosensory, Balance, and Vertigo

Question 1

Having a patient standing on foam would be an example of stressing what system?

Answer 1

somatosensory

Question 2

What is the Vestibuloocular Reflex (VOR)?

Answer 2

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.

Question 3

What is the Vestibulospinal Reflex (VSR)?

Answer 3

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

Question 4

How does muscle contraction pattern differ with an ankle strategy vs a hip strategy?

Answer 4

Ankle: contract distal to proximal
Hip: contract proximal to distal

Question 5

What is a suspensory strategy? Example?

Answer 5

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

Question 6

What symptoms may be present with Peripheral Vertigo? (7)

Answer 6

1. episodic and short duration
2. autonomic symptoms present
3. precipitating factor
4. pallor, sweating
5. nausea and vomiting
6. auditory fullness
7. tinnutus

Question 7

What symptoms may be present with Central Vertigo?

Answer 7

1. autonomic symptoms less severe
2. loss of consciousness can occur
3. Nuerlogical symptoms: diplopia(double vision), hemianopsia, weakness, numbness, ataxia, dysarthria

Question 8

Is Meniere’s disease a cause of central or peripheral vertigo?

Answer 8

peripheral

Question 9

What are 6 causes of central vertigo?

Answer 9

1. meningitis
2. migraine headache
3. complications of neurologic origin post ear infection
4. trauma/tumor
5. cerebellar degeneration
6. MS

Question 10

What is oscillpsia? what does it occur with?

Answer 10

movement of objects viewed, occurring with nystagmus

Question 11

What is the difference between peripheral, central, and positional nystagmus?

Answer 11

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

Question 12

What is gaze-evoked nystagmus and what pahtologies is it associated with?

Answer 12

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

Question 13

How does visual fixation affect nystagmus with Central vs. Peripheral lesions?

Answer 13

Central: no inhibition with fixation

Peripheral: will inhibit nystagmus and vertigo

Question 14

The direction of the FAST segment of nystagmus indicates what?

Answer 14

the HEALTHY ear

Question 15

What is the cut-off score for the BERG and what does it indicate?

Answer 15

score <45/56 indicates an increased risk for falling

Question 16

What balance exam has 8 test conditions and five trials of each condition are performed, used for patients with higher level motor skills?

Answer 16

Fregly-Graybiel Ataxia Battery Test

Question 17

What balance assessment is used specifically for patients with heiplegia?

What is the maximum score on the test?

Answer 17

Fugl-Meyer Sensorimotor Assessment of Balance Performance Battery

Max score is 14

Question 18

What are age related norms on the functional reach test for Functional Reach Test and what does a score outside these norms indicate?

Answer 18

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

Question 19

How is the Romberg test performed?

Answer 19

1. standing, feet together, upper extremities folded, looking at a fixed point straight ahead with eyes open
2. eyes closed

“normal” if able to maintain position for 30 seconds

Question 20

How is the Sharpended Romberg performed?

Answer 20

1. Heel toe stance, arms crossed, focused on fixed point
2. eyes closed

increases challenge on both vestibular and somatosensory system

Question 21

What is the distance for the TUG?

What is the rating scale for the TUG?

What are the cut-off scores for the TUG?

Answer 21

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

Question 22

What is the cut-off score for the Tinetti Performance Oriented Mobility Assessment?

Answer 22

a score of <19/28 indicates a high risk for a fall

Question 23

What are the two different sections in general on the Tinneti Performance Oriented Mobility Assessment?

Answer 23

1. assess balance with STS, immediate standing balance, slight push, turn 360
2. gait at normal speed and rapid speed

Question 24

What are the five levels of Functional Balance Grades (o’sullivan pg. 233) and what do they each mean?

Answer 24

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.