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-nm Npte > vestibular 1/16 > Flashcards

vestibular 1/16 Flashcards

1
Q

test central or peripheral vestibular issue?

sponatenous nystagmus

A

both

peripheral - acute

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2
Q

test central or peripheral vestibular issue?

gaze evoked nystagmus

A

peripheral

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3
Q

test central or peripheral vestibular issue?
head shaking
head thrust

A

peripheral

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4
Q

test central or peripheral vestibular issue?

dynamic visual acuity DVA

A

both

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5
Q

test central or peripheral vestibular issue?

valsalva

A

peripheral

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6
Q

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

A

peripheral

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7
Q

test central or peripheral vestibular issue?

saccadic eye movement

A

central

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8
Q

test central or peripheral vestibular issue?

convergence

A

central

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9
Q

test central or peripheral vestibular issue?

VOR cancellation

A

central

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10
Q

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
A

spontaneous nystagmus

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11
Q 
central or peripheral? what next?
\+ spontaneous nystagmus
\+ abnormal smooth pursuit
\+ saccadic eye motion
\+ abnormal VOR cancellation
A

known neurologic condition clinician knows

OR central vestibular signs > refer to MD

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12
Q

central or peripheral?

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

A

either

  • patient may have acute, not compensated by CNS, peripheral hypofunction
  • OR central vestibular sign and needs to be referred to MD
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13
Q

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

A

possible central vestibular dysfunction

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14
Q

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

A

possible central vestibular dysfunction

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15
Q

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

A

saccadic eye movement

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16
Q

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

A

VOR cancellation

tests ability to cancel VOR and move eyes together with head

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17
Q

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

A

normal

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18
Q

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

A

possible central vestibular dysfunction

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19
Q

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

A

gaze evoked nystagmus

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20
Q

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

A

peripheral lesion follows alexander’s law

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21
Q

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

A

central lesion

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22
Q

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

A

head shaking nystagmus

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23
Q 
central or peripheral? 
head shaking nystagmus test
\+ nystagmus
fast phase direction toward active or hypofunction side?
what other test aligns with?
A

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

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24
Q

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

A

head thrust test

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25
Q

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

A

peripheral - unilateral or bilateral hypofunction

delay occurs on impaired side

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26
Q

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

A

dynamic visual acuity DVA

tests VOR vestibulocular reflex, ability eyes stabilize target while head moves

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27
Q

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

A

normal

<=2 lines different

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28
Q

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

A

either
decreased VOR reflex
possible peripheral hypofunction or underlying central dysfunction

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29
Q

how to perform vertebral artery test? purpose of test?

A

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
30
Q

what positional test for BPPV posterior and anterior canals?

A

dix hallpike

31
Q

what positional test for BPPV horizontal canal?

A

horizontal roll test

32
Q

nystagmus as a horizontal beat towards the ground

A

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

33
Q

nystagmus as a horizontal beat towards the ceiling

A

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

34
Q

what to look for during positional tests for BPPV?

A
  • 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
35
Q

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

A

BPPV

Right posterior canal

36
Q

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

A

posterior semicircular canal

37
Q

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

A

BPPV

Left anterior canal

38
Q

how long does nystagmus last if canalithiasis?

A

<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

39
Q

how long does nystagmus last if cupulolithiasis?

A

> 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

40
Q

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
A

dix hallpike for BPPV in posterior and anterior canals

  • nystagmus down = anterior canal
  • nystagmus up = posterior canal
41
Q

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
A

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
42
Q

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

A

Stable unilateral deficit
Unilateral vestibular hypofunction
- adaptation

43
Q

What rehab category? Mech for recovery?

Post surgery on the vestibular system, neuromas

A

Stable unilateral deficit
Unilateral vestibular hypofunction
- adaptation

44
Q

What rehab category? Mech for recovery?

exposure to medication

A

stable bilateral deficit
bilateral vestibular hypofunction
- substitution, adaptation

45
Q

What rehab category? Mech for recovery?

acute vestibular neuritis or labyrinthitis

A

unstable unilateral or bilateral deficit

- not good candidate for PT until stable

46
Q

What rehab category? Mech for recovery?
acoustic neuroma
chemotherapy

A

unstable unilateral or bilateral deficit

- not good candidate for PT until stable

47
Q

What rehab category? Mech for recovery?
stroke
motion sensitivity

A

central vestibular deficit

-habituation

48
Q

What rehab category? Mech for recovery?
migraines
concussion

A

central vestibular deficit

-habituation

49
Q

What rehab category? Mech for recovery?

psychological anxiety

A

non vestibular deficit

- substitution

50
Q

What rehab category? Mech for recovery?

peripheral neuropathy

A

non vestibular deficit

- substitution, strengthening, postural stability training, compensation, manual therapy

51
Q

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

A

non vestibular deficit

- substitution, strengthening, postural stability training, compensation, manual therapy

52
Q

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

A

stable peripheral vestibular pathology

  • change vestibular system response to accommodate for lost ability
  • goal to improve gaze stability
53
Q

what rehab category use habituation? what is habituation?

A

stable bilateral OR central vestibular

  • expose individual to provoking stimuli to reduce symptoms be reducing sensitivity
  • nondescript dizziness to positional change or visual stimuli
54
Q

what rehab category use substitution? what is substitution?

A
  • 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
55
Q

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

A

Right posterior cupulolithiasis

  • Semont liberatory
  • retest Dix hallpik, if canalithiasis Eply canalith repositioning maneuver
56
Q

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

A

Left posterior canalithiasis

- Eply canalith repositioning

57
Q

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

A

select new positional test, try horizontal roll test

58
Q

Horizontal Roll test, nystagmus on both eyes but more active

on Right side - Right side beating toward ground <60 seconds

A

Right horizontal geotropic canalithiasis (more active side)

- Treat BBQ Roll

59
Q

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

A

Left horizontal ageotropic cupulolithiasis (less active side)

  • liberate with Gufoni/Casani maneuver
  • repeat Roll test, if canalithiasis (geotropic), treat with BBQ Roll
60
Q

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

A

Right anterior cupulolithiasis

- semont liberatory, eply canalith repositioning

61
Q

what describes cupulolithiasis in horizontal canal?

A
  • ageotropic nystagmus - beating away from the ground
  • side affected has LESS active ageotropic nystagmus
  • test with Horizontal roll test
  • liberate with Gufoni/Casani
62
Q

what describes canalithiasis in horizontal canal?

A
  • geotropic nystagmus - beating toward ground
  • side affected has MORE active geotropic nystagmus
  • test with Horizontal roll test
  • reposition canalith with BBQ Roll
63
Q

treatment for anterior or posterior canalithiasis

what was observed in Dix hallpike?

A

epley manuever

nystagmus <60sec

64
Q

treatment for left or right horizontal canalithiasis

what was observed in Horizontal roll?

A

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

65
Q

liberatory maneuver for anterior/posterior cupulolithiasis

what was observed in Dix hallpike?

A

semont (then retest Dix Hallpike > epley)

nystagmus >60sec

66
Q

liberatory maneuver for horizontal cupulolithiasis

what was observed in Horizontal roll?

A

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

67
Q

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.
A

Epley maneuver

for ant/post canal canalithiasis

68
Q

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.
A

BBQ roll

for horizontal canal BPPV canalithiasis

69
Q

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.
A

semont liberatory maneuver for ant/post cupulolithiasis

70
Q

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
A

gufoni, casani liberatory maneuver for horiz cupulolithiasis

-nm Npte (28 decks)

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