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NM conditions > Vestibular > Flashcards

Vestibular Flashcards

1
Q

what are the roles of the vestibular system

A

-stabilize visual image during head movement
-provide sensory info for spatial orientation
-maintain postural stability when statinoary and during movement

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2
Q

define postural control

A

-controls bodys position in space for stability and orientation between body segments and environemnt

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3
Q

define postural stability

A

maintenance of COM over BOS

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4
Q

define postural orientation

A

ability to maintain relationship between body segments and body

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5
Q

at what age do children have more developed somatosemsory system but vision is more dominant for balance

A

<7.5

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6
Q

what are peripheral vestibular structures

A

-vestibular end organ
-cranial nerve VIII

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7
Q

what is the peripheral vestibular blood supply

A

-basiliar artery
-AICA
-labrynthine artery
-anterior-vestibular artery
-common cochlear

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8
Q

what is in the peripiheral end organ

A

otoliths:
-utrticle: horz
-saccule: vertical

semicircular canals:
-ant, post, horz

hair cells convert head motion into neural firing

-bony labyrinth, membranous lab, endolymp, perilymph

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9
Q

what is a otolithic membrane

A

gelatinous macula

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10
Q

what does the otoconia do

A

provide shear forces for hair cell deflection

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11
Q

what do otoliths do

A

linear motion detection
-fwd/bckwd
-up/down
-tilt

-tonic discharge
-push/pull relationship

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12
Q

what do semicircular canals do

A

ampulla:
-cupula deflection for hair cell depolorization

-perpendicular relationship
-3 coplanar pairs
-angular motion detection
-tonic discharge
-push/pull relationship

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13
Q

describe how the peripheal and central meet

A

vestibular portion of CN VIII is a bipolar neuron with cell bodies in scarpa’s ganglion

-CN VII and VIII travel together through IAM and enter pontomedullary junction of brain

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14
Q

where do CN VII and CN VIII enter the brain?

A

cerebellopontine angle

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15
Q

what is the vestibulo cerebellum

A

flocculonodular lobe

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16
Q

what does the cerebellum do

A

interact with LVST, MVST, RST

-vestibulospinal mechanisms for postureal control continue to develop beyond 15 years old

-afferent impulses travel directly from the end organ to cerebellum

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17
Q

what does the thalamus do

A

-assists in discrimination between self movement and environmental movement

-multisensory integration for postural control

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18
Q

what is the vestibular cortex

A

-junction of parietal and insular lobe
-multisensory integration of vestibular information with somatosensation and vision
-sensory integrative capacity for postural control evolves between 7-15 years old

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19
Q

what do the vertebral arties do

A

PICA:
supplies inferior vestibular nuclei and inferior portions of cerebellum

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20
Q

what does basilar artery do

A

supplies pons and more superior vestibular nuclei

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21
Q

what is the VOR

A

vestibular ocular reflex
-stabilizes gaze during head movmenet

-VOR gain normal is 1:1
-intact and mature by age 1

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22
Q

what is VSR

A

vestibulo spinal reflexes

they coordinate head and body movements to maintain head in upright positions

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23
Q

what is LVST

A

lateral vestibulo-spinal tract

adjusts limb movement for balance

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24
Q

what is MVST

A

medial vestibulo-spinal tract

-cervical connections
-branches to extraocular muscles

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25
Q

what is VCR

A

vestibulo-colic reflex&raquo_space; head righting

-stabilizes head and neck
-produces coordinated movements to track a moving target

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26
Q

what is ATNR

A

aysmmetric tonic neck reflex

-neck rotation excites ipsilateral extensors and contralateral flexors

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27
Q

what is STNR

A

symmetrical tonic neck reflex

-neck flexed excites bilateral UE flexors and LE extensors

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28
Q

what is COR

A

cervico-ocular reflex

-eye movemnts driven by neck proprioceptors
-supplements the VOR when needed
-facilitated when vestibular organ injured
-can be elicited in those without labrynihts so afferents are though to come from cervical proprioceptors
-Oculo-cephalic reflex seen in indivudals who are comatose

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29
Q

what else is oculovestibulocephalic reflex

A

brainstem injury
dolls eyes

30
Q

what is CSR

A

cervicospinal reflex
-can supplement VSR by altering tone in the body
-related to tonic neck reflexes

31
Q

what is CCR

A

cervicocolic reflex
-stabilizes head on body
-may be facilitated after vestibular loss

32
Q

what are presentations of vestibular disorders

A

-decreased function
-complete loss
-acute, subacute, chronic
-flucutating

33
Q

what are some central patholiges

A

-TBI
-MS
-stroke
-brain tumor
-vestibular migraine

34
Q

what are some peripheral patholiges

A

-BPPV= most common cause true vertigo
-infection: neuritis is 2nd common cause of vertigo
-labrynthiis
-vestibular neuritis

35
Q

what is endolymphatic hydrops Menieres Disease

A

-acute episodes 30 min- 24 hours
-recovery usually within 72 hours
-progressive hearing and vestibular impairments
-endolymph hydrops= malabsorption of endolymph in the duct or sac
-surgery or ablation possible

-primarily medically managed but PT can educate people

36
Q

what is perilymph fistula

A

-common at round and oval windows
-inner and middle ear communicate
-congential, prior ear surgery, barotrauma, sneezing, blast

features include:
-vertigo after loud sounds
-surgery possible

medically managed and PT refer out

37
Q

what is superior canal dehiscence SCD

A

-creates a window through the bone
-can be seen on CT scan

features:
-vertigo and oscillopsia induced by loud noises
-surgy possible

medically managed, PT refe

38
Q

what is Mal de Debarquement Syndrome

A

-perception of motion when stationary and eyes are open
-usually occurs after prolonged exposure to motion, such as on a cruise
-difficulty adapting back to stable environment
-getting off the boat syndrome
-possible treatment w medication
-focus on somatosensory referencing to vestibular sense

-know how to examin for this
-specialized treatment beyond entry level

39
Q

what is Peripheral Neoplasms Acoustic Neroma

A

-a schwannoma, usually small, encapsulated, slow growing
-can be seen on MRI
-surgery possible

-common and appropriate for PT treatment

40
Q

what is Persistent Postural Perceptual Dizziness

A

-persistent dizziness
-non spinning vertigo
-perceived unsteadiness

-result of long term maladaptation
-occurs after a neuro-otologic, medical or psychological event that triggered vestibular symptoms

common and appropriate for PT treatment

41
Q

what is ototoxicity

A
  1. aminoglycoside antibitoics like gentamicin
  2. chemotherapy drugs: cisplatin and carboplatin
42
Q

what is whiplash injury

A

-common with flex-ext injury
-20% of those with whiplash and dizziness can take longer than 20 weeks to return to work
-primary symptom neck pain 60-100%
-20-58% with head injury or whiplash will have dizziness or dysequilibrium

43
Q

what is whiplash exam

A

common findings:
-occitpital or bitemporal headache
-neck pain
-not straight head

nonspecific findings:
-dizzy
-sense of falling
-hard to read
-feel tired

44
Q

talk about cervicogeneic dizziness and muscle spindles

A

-acute neck injury can cause chemical, ischemic or inflammatory events that affect spindles

-chronic neck pathology can cuase additional secondary problems with spindles= fatiguability, atrophy, altered joint mechanics,

45
Q

talk about cervical vertigo

A

-NOT an illusory perception of rotational, linear or rocking movement

-defined as dizziness: an unpleasant and vague feeling involving spatial discomfort, unsteadiness and dullness

46
Q

what kind of mechanism is whiplash

A

proprioceptive cervical

47
Q

talk about cervicogeneic dizziness according to landel 2014

A

-cervical somatosensory mismach between vestibular and visual info

-decreased cervical ROM
-neck pain
-WAD: chronic form
-dysequilibirum and NOT true vertigo NOT spinning

48
Q

what is some medical diagnostic testing

A
  1. ENG
  2. VNG
  3. oculomotor function
  4. positional tets
  5. caloric testing
49
Q

what is rotary chair testing

A

-used to determine whehter or not dizzy is due to disoder of inner ear vs brain and uni vs bilateral impairment

50
Q

what is the 3 part rotary chair test

A
  1. chair test: chair turned slowly, wearing goggles
  2. optokinetic: view moving stripes
  3. fixation: chair rotation and person looks at dot of light that rotate with them
51
Q

what are VEMPs

A

vestibular evoked myogenic potential

-test otolith function
-can help diagnose superior canal dehiscence, Menieres

52
Q

what is some PT testing?

A

-frenzel goggles
-bucket test
-dynamic posturophy AKA sensory organization testing

53
Q

how do you asssess postural control

A

input
processing
output

54
Q

what are some diagnostis specific tests

A

VOR and VOR cancellation

55
Q

what are some oculomotor tests

A

quality of movement and symptom provocation

56
Q

what are some head movemnet tests

A

quality of movement and symptom provocation

57
Q

what is an otolith test

A

head righting

58
Q

what is a semicricular canal test

A

BPPV

59
Q

what are some chief complaints

A

-diziiness
-imbalance

60
Q

what is the description of dizziness

A

-vertigo
-oscillopsia
-lighteaded
-disequilibrium
-confused or disorientated

61
Q

what are some precipitating events

A

-fall
-MVA
-concussion
-illness
-ototoxicity
-whiplash
-diet changesr

62
Q

what are some subjective questionnaires

A

ABC
DHI

63
Q

how do you screen for vertebral artery

A

-neck trauma
-cervical surgery /arthritis
-sensitivity (poor)
-specificity 67-97%
-hallmark signs of vertebrobasilar insufficiency warrant extreme caution and referral
-modiifed positions if pt has vestibular complaints
-modified version is slouch test

64
Q

what are the 5 D’s

A

-diplopia
-dysphagia
-dysarthria
-dizziness
-drop attack

65
Q

what are the 3 N’s

A

-nausea
-nystagmus
-numbness

66
Q

what are static observations during an oculomotor exam

A

-ocular malalignment: head tilt towards side of lesion
may be otolithic or central dysfunction

-ocular torsion: eye on involved side rotates down

-skew deviation: vertical malalignment

67
Q

what is HINTS exam

A

Head Impulse Test
Nystagmus
Test of vertical Skew

68
Q

talk about remediation = adaptation/uptraining

A

-produce an error signal and recalibrate vestibular input
-uptrain or force use particular senses
-central selection, prioritization, integration

69
Q

talk about sensory habituation= desensitization

A

repetition of provoking movements with cautious symptom provocation and settling

70
Q

talk about sensory subsitution=compensation

A

if sensory info missing
-inherent limitations: may need additional compensations under certain circumstances

71
Q

what is temporary prevention

A

while “uncompensated”, avoid:

-swimming
-dark environments
-running on a soft surface
-driving in rain, snow, dark

NM conditions (25 decks)

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