vestibular 1/16 Flashcards by Chris M

test central or peripheral vestibular issue?

sponatenous nystagmus

both

peripheral - acute

How well did you know this?

Not at all

Perfectly

test central or peripheral vestibular issue?

gaze evoked nystagmus

peripheral

How well did you know this?

Not at all

Perfectly

test central or peripheral vestibular issue?
head shaking
head thrust

peripheral

How well did you know this?

Not at all

Perfectly

test central or peripheral vestibular issue?

dynamic visual acuity DVA

both

How well did you know this?

Not at all

Perfectly

test central or peripheral vestibular issue?

valsalva

peripheral

How well did you know this?

Not at all

Perfectly

test central or peripheral vestibular issue?
dix hallpike
roll test for BPPV

peripheral

How well did you know this?

Not at all

Perfectly

test central or peripheral vestibular issue?

saccadic eye movement

central

How well did you know this?

Not at all

Perfectly

test central or peripheral vestibular issue?

convergence

central

How well did you know this?

Not at all

Perfectly

test central or peripheral vestibular issue?

VOR cancellation

central

How well did you know this?

Not at all

Perfectly

what test is this?

look for abnormal eye beating in ambient room light
test with goggles (to remove visual fixation, suppresses nystagmus)
try to identify direction of fast phase
nystagmus can be up beating, down beating, left beating, right beating, torsional

spontaneous nystagmus

How well did you know this?

Not at all

Perfectly

central or peripheral? what next?
\+ spontaneous nystagmus
\+ abnormal smooth pursuit
\+ saccadic eye motion
\+ abnormal VOR cancellation

known neurologic condition clinician knows

OR central vestibular signs > refer to MD

How well did you know this?

Not at all

Perfectly

central or peripheral?

nystagmus with goggles on (to remove visual fixation, suppresses nystagmus)

either

patient may have acute, not compensated by CNS, peripheral hypofunction
OR central vestibular sign and needs to be referred to MD

How well did you know this?

Not at all

Perfectly

central or peripheral?
during smooth pursuit and convergence eye exam
+ delay or saccadic intrusions during eye movement
+ abnormal double vision when >3-4 inches from nose

possible central vestibular dysfunction

How well did you know this?

Not at all

Perfectly

central or peripheral?
saccadic eye movements
+ abnormal multiple >2 movements to get to target, under or overshoots target

possible central vestibular dysfunction

How well did you know this?

Not at all

Perfectly

what test?
patient sits 18 inches away
ask patient look back and forth between 2 targets - R/L, up/down
- observe if hits target in 1-2 movments or multiple movement, under or overshoots target

saccadic eye movement

How well did you know this?

Not at all

Perfectly

what test?
patient sits with arm extended in front of nose and eyes on thumb nail
rotate trunk R/L, head rotates with trunk,
- nose and eyes remain aligned on thumbnail
- perform R/L, and up/down

VOR cancellation

tests ability to cancel VOR and move eyes together with head

How well did you know this?

Not at all

Perfectly

central or peripheral?
VOR cancellation
head moves together with minimal to no symptoms

normal

How well did you know this?

Not at all

Perfectly

central or peripheral?
VOR cancellation
+ abnormal, unable to keey eyes on target, dizziness, or other symptoms reported by patient

possible central vestibular dysfunction

How well did you know this?

Not at all

Perfectly

what test is this?
wear goggles (prevent visual fixation)
ask patient move eyes L, R, up, down, and back to center (only 30 degrees, not end range)
- observe for nystagmus when hold each direction

gaze evoked nystagmus

How well did you know this?

Not at all

Perfectly

central or peripheral?
gaze evoked nystagmus test
+ nystagmus direction fixed, always beat in same direction no matter which way patient looks

peripheral lesion follows alexander’s law

How well did you know this?

Not at all

Perfectly

central or peripheral?
gaze evoked nystagmus test
+ nystagmus direction changes based on direction patient looks (upbeat when look up, downbeat when look down)

central lesion

How well did you know this?

Not at all

Perfectly

what test?
wear goggles (prevent visual fixation)
head in 30deg cervical flexion
patient closes eyes
turn head R/L 20reps, ask patient open eyes at 18 reps
after 20, hold head stable observe if nystagmus present

head shaking nystagmus

How well did you know this?

Not at all

Perfectly

central or peripheral? 
head shaking nystagmus test
\+ nystagmus
fast phase direction toward active or hypofunction side?
what other test aligns with?

peripheral
- fast phase toward intact, more active neural side
- contralateral side has vestibular hypofunction
= coincides with + head thrust test

How well did you know this?

Not at all

Perfectly

what test?
ambient room light, fixate eyes on target like therapist’s nose
- hold head 30 deg cervical flexion
- quickly rotate head 30deg R/L while eyes remain fixated on target
- repeat R/L in random order, pause after each rep
- observe any delay, eye move off target and delay return to target

head thrust test

How well did you know this?

Not at all

Perfectly

central or peripheral? head thrust test + eye move off target and delay return to target what side is delay on active or impaired side?

peripheral - unilateral or bilateral hypofunction | delay occurs on impaired side

what test? patient sits 4 ft from eye chart - read down to lowest line they are able to easily read - manually move patient head side to side 120bpm (tik tok by kesha) as patient reads chart top to bottom - notice different between what is read at the bottom line while static vs moving

dynamic visual acuity DVA | tests VOR vestibulocular reflex, ability eyes stabilize target while head moves

central or peripheral? DVA 2 lines different when reading eye chart between static vs moving

normal | <=2 lines different

central or peripheral? DVA 3 lines or less different when reading eye chart between static vs moving

either decreased VOR reflex possible peripheral hypofunction or underlying central dysfunction

how to perform vertebral artery test? purpose of test?

goal compress vertebral arteries and observe cranial nerve involvement - helps clear the neck before positional testing or cervical mob/manip - safety first! 1. supine/sit neck in full extension and rotation 2. hold 30 seconds 3. repeat opposite side

what positional test for BPPV posterior and anterior canals?

dix hallpike

what positional test for BPPV horizontal canal?

horizontal roll test

nystagmus as a horizontal beat towards the ground

Geotropic beat toward Ground, indicates canalithiasis eg. if test R side, beat to Right horizontal canal

nystagmus as a horizontal beat towards the ceiling

Apogeotropic, beat Away from ground, indicates cupulolithiasis eg. if test R side, beat to Left/ceiling horizontal canal

what to look for during positional tests for BPPV?

- tell patient keep eyes open to look for nystagmus - note direction (canal) and time (cupulo vs canalithiasis) of nystagmus - assess nystagmus and vertigo note: keep wastebasket nearby for vomit

what does this mean? perform dix hallpike on Right side see nystagmus- Up and Right torsion

BPPV | Right posterior canal

Otoconia migrate from the utricle, most commonly settling in WHICH semicircular canal?

posterior semicircular canal

what does this mean? perform dix hallpike on Right side see nystagmus- Down and Left torsion

BPPV | Left anterior canal

how long does nystagmus last if canalithiasis?

<60 sec crystals are free, takes less than a minute for the crystals to stop moving after a particular change in head position has triggered a spin

how long does nystagmus last if cupulolithiasis?

>60 sec crystals stuck on the bundle of sensory nerves in semicircular canal will make the nystagmus and vertigo last longer, until the head is moved out of the offending position. - need to use liberatory movement before canalith repositioning

What test? - Position patient in long sitting - Rotate had 45° cervical rotation - Quickly guide patient back on mat with 20 to 30° of cervical extension - Patient must keep eyes open - Observe for vertigo and nystagmus, note direction and time (<>60sec) of nystagmus

dix hallpike for BPPV in posterior and anterior canals - nystagmus down = anterior canal - nystagmus up = posterior canal

What test? - Patient in supine, head and 20 to 30° of flexion - Roll patient head to right or left - Repeat on the opposite side - Patient must keep eyes open - Observe for both vertigo and nystagmus, note direction and time (<>60sec) of nystagmus

Roll test for BPPV in horizontal canal - nystagmus toward ground - geotropic, canalithiasis, affected side MORE active - nystagmus away from ground - ageotropic, cupulolithiasis, affected side LESS active

What rehab category? Mech for recovery? Postacute vestibular neuritis or Labrinthitis Inactive Ménière's

Stable unilateral deficit Unilateral vestibular hypofunction - adaptation

What rehab category? Mech for recovery? | Post surgery on the vestibular system, neuromas

Stable unilateral deficit Unilateral vestibular hypofunction - adaptation

What rehab category? Mech for recovery? | exposure to medication

stable bilateral deficit bilateral vestibular hypofunction - substitution, adaptation

What rehab category? Mech for recovery? | acute vestibular neuritis or labyrinthitis

unstable unilateral or bilateral deficit | - not good candidate for PT until stable

What rehab category? Mech for recovery? acoustic neuroma chemotherapy

unstable unilateral or bilateral deficit | - not good candidate for PT until stable

What rehab category? Mech for recovery? stroke motion sensitivity

central vestibular deficit | -habituation

What rehab category? Mech for recovery? migraines concussion

central vestibular deficit | -habituation

What rehab category? Mech for recovery? | psychological anxiety

non vestibular deficit | - substitution

What rehab category? Mech for recovery? | peripheral neuropathy

non vestibular deficit | - substitution, strengthening, postural stability training, compensation, manual therapy

What rehab category? Mech for recovery? postural instability, fall risk cervicogenic disorder

non vestibular deficit | - substitution, strengthening, postural stability training, compensation, manual therapy

what rehab category use gaze stability exercises for adaptation of VOR? what is adaptation?

stable peripheral vestibular pathology - change vestibular system response to accommodate for lost ability - goal to improve gaze stability

what rehab category use habituation? what is habituation?

stable bilateral OR central vestibular - expose individual to provoking stimuli to reduce symptoms be reducing sensitivity - nondescript dizziness to positional change or visual stimuli

what rehab category use substitution? what is substitution?

- all diagnoses; mostly stable bilateral vestibular deficits and non-vestibular deficits - replace or compensate lost and/or impaired function - eg. use AD, activity modification, increase strength/ROM/prop

Dix hallpike test to the Right - Upbeat and Right nystagmus >60 sec. What next?

Right posterior cupulolithiasis - Semont liberatory - retest Dix hallpik, if canalithiasis Eply canalith repositioning maneuver

Dix hallpike test to the Left- Upbeat and Left nystagmus <60 sec. What next?

Left posterior canalithiasis | - Eply canalith repositioning

Dix hallpike test to Right and Left. Both negative. What next?

select new positional test, try horizontal roll test

Horizontal Roll test, nystagmus on both eyes but more active | on Right side - Right side beating toward ground <60 seconds

Right horizontal geotropic canalithiasis (more active side) | - Treat BBQ Roll

Horizontal Roll test, nystagmus in both eyes beating away from ground, more active on Right side (nystagmus toward Left) >60 seconds

Left horizontal ageotropic cupulolithiasis (less active side) - liberate with Gufoni/Casani maneuver - repeat Roll test, if canalithiasis (geotropic), treat with BBQ Roll

Dix hallpike test to the Right - Downbeat and Right nystagmus >60 sec. What next?

Right anterior cupulolithiasis | - semont liberatory, eply canalith repositioning

what describes cupulolithiasis in horizontal canal?

- ageotropic nystagmus - beating away from the ground - side affected has LESS active ageotropic nystagmus - test with Horizontal roll test - liberate with Gufoni/Casani

what describes canalithiasis in horizontal canal?

- geotropic nystagmus - beating toward ground - side affected has MORE active geotropic nystagmus - test with Horizontal roll test - reposition canalith with BBQ Roll

treatment for anterior or posterior canalithiasis | what was observed in Dix hallpike?

epley manuever | nystagmus <60sec

treatment for left or right horizontal canalithiasis | what was observed in Horizontal roll?

BBQ roll geotropic nystagmus (toward ground) affected side MORE nystagmus

liberatory maneuver for anterior/posterior cupulolithiasis | what was observed in Dix hallpike?

semont (then retest Dix Hallpike > epley) | nystagmus >60sec

liberatory maneuver for horizontal cupulolithiasis | what was observed in Horizontal roll?

gufoni, casani (retest horzontal roll > BBQ roll) ageotropic nystagmus (away from ground) affected side LESS nystagmus

what test/maneuver? what for? 1. pt long‐sitting, turn head to clinician, hold clinicians arm, Clinician holds patient’s upper body. Patient lies back until their head is in 20 to 30 degrees of extension. Hold 60 sec. 2. Rotate pt head 45deg opp side, maintain cervical extension. Hold 60 sec. 3. Ask pt roll onto side and tuck chin. Clinician turn pt head so forehead on mat. Hold 60 sec. 4. Have pt return to sitting. Head in 20-30deg flexion. Wait 30 sec.

Epley maneuver | for ant/post canal canalithiasis

what test/maneuver? what for? 1. pt supine. place head 20-30deg flexion (whole treatment). Rotate head so affected side is down. Hold 60 sec. 2. Rotate head to neutral position. Hold 60 sec. 3. rotate head so unaffected side is down. Hold 60 sec. 4. Rotate head so looking at ground. Have patient roll onto stomach for comfort. hold 60 sec. 5. Rotate pt head so affected side down. Have pt roll onto side for comfort (now in starting position). Hold 60 sec. 6. pt slowly sit up from sidelying. wait 60 sec.

BBQ roll | for horizontal canal BPPV canalithiasis

what test/maneuver? what for? 1. Pt sit EOB facing clinician. Turns head away from suspected side (45 degrees rotation). Hold 1 minute 2. Patient moves sit‐to‐sidelying opposite side of head turn, maintaining head position. Hold 1 minute 3. SMOOTH and QUICK motion to sidelying on opposite side, maintaining head position. Clinician block head from hitting the mat. 4. Pt return to sitting. Head flexed 20-30deg.

semont liberatory maneuver for ant/post cupulolithiasis

what test/maneuver? what for? 1. pt move sitting to side‐lying with AFFECTED ear DOWN 2. pt quickly rotates head, nose is angled at 45 degrees 3. Hold 2‐3 minutes 4. Return to sitting

gufoni, casani liberatory maneuver for horiz cupulolithiasis