Vestib Rehab Flashcards
Pts with vestib have _____ increase for Risk of falls
8fold
Vestib system give info on
Linear/angular accel
Rotation of head
Position in space
Outcomes of vestib system?
Postural stability
Gaze stability
Bodyposition/orientation
Periph vestib?
CentraL?
Results?
Inner ear/ vestib nerve
Vestib nuclei/cerebellum/BS
Motor output is result
Fx of semicircular?
What is the ampulla?
Cupula?
Angular acceleration receptor
At the end of semicircular contains sensory organ.
Ant: Pitch
Post: roll
HorizontaL : head side to side tilted 30 deg.
Senses fluid in canals (ampulla) and sends info to vertib nerve of excite/inhibit.
Otolith?
Macula?
Utricle: horizonal linear accel
Saccule: Vertical linear accel.
Gel mass with hair that senses otoconia (crystals) movement
Info goes from periph vestib to central.
.
VOR?
Provide gaze stabilty with head movement.
Stmulated by movment at 2 Hz
Ratio oh head and eyes is 1 as long as cerebellum in tact.
Vestibulospinal reflex?
Stabilize body in reaction to vestib input.
Info takien in-> vetib nerve-> processed-> adjust.
Bppv
Peripheral mechanical dfx
Canalithiasis: Otoconia break off and free float in endolymph
Cupulolithiasis: otoconia break off and adhere to cupula.
Vestib hypofunction unilateral
Unilateral: fx decrease secondary to
Neuritis (swelling no hearing involved)
Labyrinthitis: swelling and hearing involved
Acoustic neuroma: slow growing tumor on CN VIII
Turning right= eyes lag to catch up
Vestib hypofunction bilateral
Dont get dizzy if they have full loss.
Pt relies of vision somatosensory/ Wide BOS/Inc falls.
Often caused by ototoxicity not a good prognosis
Central dizziness
Lesion in central pathways. Or like motion sickness/ sensory mismatch
Red flag: no known diagnosis.. usually
Have nystagmus after movement and u need to work on habituation/meds/vision therapy.
Cervicogenic Dizziness. (Dx with exclusion)
Associated with neck pain (think whiplash)
Tx with manual and vestib rehab
Differential Dx for dizziness?
Rule out positional testing of BP
Systemic
Cardio
CNS
PERipheral NS
MS
Multi
Some subjective things to ask?
Describe it When/what provokes it Anyhting before the symptoms? Anything along with the dizziness. How long it last? Time before it starts? How often? PMH.
Vemp testing for?
How is unilateral vestib loss tested?
BilateraL?
Otolith Function
Caloric testing (hot cold)
Rotatory chair.
Dizziness handicap inventory?
ABC
0=never/2=sometimes/3= yes. Lower is better.
25 qs
Lower score= increase fall risk. Balance confidence.
Parts of oculomotor exam?
Spontaneous nystagmus : just gaze Gaze evoked nystagmus: look 30 deg each way. Smooth pursuit: from 18 inches away. Saccade Converge/diverge
VeStibular testing:
Headthrust: manip in 30 deg flexion. Change directions checking saccades (unilat vestib hypofx)
VOR: look while turning head.
Dynamic visual acuity
Head shake nystagmus
Contra for positional vertigo?
C spine unstable
RA/Downs
Vascular dissection symptoms
C spine stuff and shunts/cardio2
How to do Dix-Hallpike
Long sit-> rotate head to 45 deg
Lie them back and extend 30 deg. Maintain for 60 seconds.
Look for symptoms : for post canal.
DOWNBEAT NYSTAGMUS REFER TO MD
Canalithiasis
How to differentiate bw cupolo and canal bppv with dixhalpike?
Duration. Canal is shorter.
Horizontal roll test BPPV?
Flex head 30 deg/ rotate 45 deg
Beating toward ground is: Geotropic: Canalithiasis
Beating toward ceiling is: Ageotropic: Cupulothiasis
