Vestib Rehab 1 Flashcards
what happens when stereocilia are deflected towards the Kinocilia?
excitiation/depolarization!!! of firing rate
this is known as the push-pull mechanism
What happens when stereocilia are deflected away from the Kinocilia?
inhibition of firing rate.
this is known as the push-pull mechanism
what is a healthy vestibular system firing rate?
70-100 spikes/sec
T or F?
The firing rate of each vestib system should be equal and opposite when the head turns?
YES, otherwise is pathological
what does the utricle detect..
horizontal or vertical acceleration or head tilt?
horizontal acceleration and head tilt
what does the saccule detect..
horizontal or vertical acceleration or head tilt?
vertical acceleration…
think of it ya sacc goes up n down type shit
These structures are filled with endolymph fluid..
1. Semicircular Canals
2. Cupula
3. Maculae
- Semicircular Canals
These structures contains hair cells that deflect with head movement (Select all that apply)…
- Semicircular Canals
- Cupula
- Maculae
- Cupula
- Maculae
These structures contain otoconia….
a) Semicirular canals
b) Utricle
c) Saccule
b) Utricle
c) Saccule
These sense rotational head movement.
a) Semicirular canals
b) Saccule
c) Utricle
a) Semicirular canals
When you turn your head to the left, which of the following is accurate in an intact vestibular system?
a) Left Vestibular Apparatus is Excited and Right Inhibited; Eyes Go Right
b) Left Vestibular apparatus is Inhibited and RightExcited; Eyes go Left
c) Left Vestibular Apparatus is Excited and Right Inhibited; Eyes Go Left
d) Left Vestibular apparatus is Inhibited and RightExcited; Eyes go Right
a) Left Vestibular Apparatus is Excited and Right Inhibited; Eyes Go Right
what vestib pathology is more common, peripheral or central?
peripheral,
which includes UVH, BVH, BPPV
Someone comes into the ER complaining of sudden onset dizziness with nausea and vomiting. What other questions will you ask to rule in or out serious pathology?
Did you hit your head?
describe the dizziness for me please?
Is the dizzziness any better or worse when you change your position?
Did you recently have any illnesss?
Do you see double at all?
A patient comes into an outpt PT clinic describing their symptoms as everything is bouncing when they’re walking. What are they describing?
a) Vertigo
b) Nystagmus
c) Tinnitus
d) Oscillopsia
d) Oscillopsia
this is when the room appears to be moving around you when it really isnt… ya trippin
T or F?
BPPV room spinning dizziness sx last for <15 secs
TRUE!
short duration but very debilitating
What are common movements that can exacerbate BPPV sx?
looking up
sit to supine/supine to sit/rolling
bending down w/ head up
what canal is most commonly affected with bppv?
post (85-90%)
horiz (5-15%)
ant (RARE)
Explain the difference b/w canalathiasis and cupulothiasis!
Canalathiasis is when the otoconia are displaced and free-floating in the SCC, sx last <15 secs
cupulothiasis is when the otoconia are displaced and stuck in the cupula (in the cup of jello yano) sx last 60-90 secs
Nystagmus is always named after the ____ motion/beat.
FAST
T or F?
The roll test assesses the ant SCC
FALSE,
the roll test tests the horizontal SCC
the dix hallpike or sidelying test tests both the post and ant SCC
what screening assessments must you do before conducting dix hallpike?
Cerv AROM + VBI b4 dix hallpike
What-sided vertebral artery is being tested when the pt looks up and to the left?
the contra or right side, because you are closing the left vertebral artery.
looking left = tests R artery bloodflow
when tx post/ant SCC BPPV…
when would you utilize the sidelying test opposed to the dix hallpike?
the side-lying test is for pts who don’t have a lot of cerv ext or cannot tolerate it.
T or F?
When doing the sidelying test, the ear up facing the ceiling is the one you are treating?
FALSE,
its the ear that is down on the table
Explain the steps of the sidelying test..
- vbi and cerv AROm screen
- pt turns head 45deg to opposite side that you wan test
- pt is quickly laid down onto the ear being tested
- observe for 1 min
- (+) if pt has nystagmus, vertigo, or repro of sx
When completing a dix hallpike test on a pt’s R vestib sys … you notice an torsional upbeating nystagmus.
What canal is implicated?
R post SCC
T or F?
a downbeating nystagmus in dix hallpike implicates the Post SCC.
FALSE
a downbeating nystagmus implicated the ant SCC
explain why and how you would do the roll test?
why= horizontal SCC
how= pt in supine, flex pt head 20-30deg and then quickly rotate head to side you suspect implicated. hold for 1 min
When testing the horizontal SCC…
Geotropic nystagmus indicates the otoconia are where?
otoconia are in the canal
When testing the horizontal SCC…
Ageotropic nystagmus indicates the otoconia are where?
otoconia are stuck in the cupula
Movement of fluid and otoconia TOWARDS the cupula is _________?
excitatory
Movement of fluid and otoconia _________the cupula is Inhibitory?
AWAY
the epley maneuver treats what kinda BPPV?
Post/ant SCC canalathiasis BPPV
Explain the steps of the epley maneuver (CRM)
- pt long sit
- rotate pt head 45deg towards affect side
- quickly bring pt down to supine w/ head off table end and cerv into ext
- hold for 30 secs or until nystagmus/dizziness ends
- Rotate to other side and hold for 30 secs or until nystagmus/dizziness ends
- Have pt then get onto their shoulder on the side they are currently turned to and look towards the ground, hold for 30 secs or until nystagmus/dizziness ends
- bring pt into short sit and GAURD!!!
- pop some bottles if ya did it right
When would you do a liberatory semont maneuver?
for post/ant canal cupulothiasis
describe how to do the liberatory semont maneuver to treat R Post SCC cupulo
- have pt rot head 45deg to left
- lower swiftly onto Right side
- hold for 1 min
- with PT assistance the pt is RAPIDLY put onto left side while maintaining the same head position (tell pt to land on forearms and elbows)
- hold for 1 min, eyes should be down towards the ground
- slowly bring back to sitting and guard
what does the bbq roll maneuver tx?
horizontal canal BPPV
Explain how to do the roll test
- pt is supine with 20-30deg of cerv flx
- quickly rotate head to a side, hold for 1 min
- bring pt head back to midline
- rot pt head to the opp direction and hold for 1 min
geotropic nsyt = canalathiasis in horiz SCC of down ear
ageotropic nyst = cupulothiasis in other ear
explain how to do the bbq roll maneuver
(tx for horiz SCC canalathiasis)
FINISH THIS CARD SLIDE 56
- pt is supine with 20-30deg of cerv flx
- quickly rotate head to a side, hold for 30 secs
- maintaining 30deg of cerv flx rot pt head to the opp direction and hold for 30 secs
- now roll onto the shoudler and then onto belly and have pt look down.
- cue pt to tuck chin and hold for 30 secs
- roll onto the shoulder of the affected ear (head in neutral now) and hold for 30 secs
- slowly sit up and GUARD!!
prolonged positioning may also help when done right for horiz SCC tings.
A pt with left horizontal SCC cupulothiasis asks what side they should sleep on? whats your answer?
pts w/ Left horizontal SCC cupulothiasis or R horizontal canalithiasis can both benefit from laying on their LEFT side
Cupulo = same side sleep canalathiasis = opp side sleep
prolonged positioning may also help when done right for horiz SCC tings.
A pt with left horizontal SCC canalathiasis asks what side they should sleep on? whats your answer?
pts w/ right horizontal SCC cupulothiasis or Left horizontal canalithiasis can both benefit from laying on their RIGHT side
what is canal conversion?
when the crystals find theyselves in new canal they werent originally in. can happen after a shitty attempt at CRM or naturally months after tx in clinic.
how long after successfully tx a pt w/ BPPV should you follow up w/ em?
1 month after to ensure they ight
The patient c/o vertigo while looking up at their phone when lying in bed.
How would you examine them?
a) Dix Hallpike
b) Roll Test
c) sidelying test?
a) Dix Hallpike
tis the gold standard, stand on it
The patient c/o vertigo while looking up at their phone when lying in bed.
Which canal and area is involved if the nystagmus is upbeating for 15 seconds?
a) Posterior Canal
b) Anterior Canal
c) Posterior Cupula
d) Anterior Cupula
a) Posterior Canal
<60 secs indicates crystals in canal
upbeating nystagmus is post canal
downbeating nyst is ant canal
The patient c/o vertigo while looking up at their phone when lying in bed. They have (+) dix hallpike with Upbeating nystagmus…
What intervention do you perform?
a) Epley
b) Liberatory Semont
c) BBQ Roll
d) Gufoni Manuever
e) Give pt crisp high five and tell them to figure it out
a) Epley
its what ya do after the dix hallpike dummy
