Vestibular Flashcards
Imbalance
Tendency to fall, especially in darkness.
True vertigo
Illusion of movement.
You feel that the room is moving or you are moving
How to simply determine if it’s vestibular issue
If the room is spinning.
BPPV nystagmus? Duration? Specific symptom Precipitating action
Yes
Seconds
Acute spinning
Turning in bed
Vestibular neuritis nystagmus? Duration? Specific symptom Precipitating action
Yes
48-72 hrs
Acute onset, motion sensitivity, vomiting
None
Ménière's disease nystagmus? Duration? Specific symptom Precipitating action
Yes
1-24 hrs(acute)
Fullness of ear, hearing loss, tinnitus, vomiting
None
Bilateral vestibular disorder nystagmus? Duration? Specific symptom Precipitating action
None
Permanent
Gait ataxia, oscillopsia
None
Fistula nystagmus? Duration? Specific symptom Precipitating action
Yes
Seconds
Loud tinnitus
Head trauma, sneezing, nose blowing
Oscillopsia (definition and which condition does it occur?)
Visual ocular mismatch. IMAGES don’t stay stable when you move around.
Occurs in bilateral vestibular hypofunction
If the patient has exertion induced vertigo what condition is it? What do you do as their PT?
Fistula
Refer back to MD
If the patient has incontinece or memory loss what caused this!
Improper shunt alignment
What is the saccades test?
Look from target to target (hold 2 fingers up)
Significant overshooting or multiple movements of the eyes is a central sign
1 undershoot is normal
What is the smooth pursuits test?
H pattern
Look for QUALITY of movements
Are there “catch up” signs
What is a positive VOR head thrust sign?
If the patients eyes move along with their head and are unable to keep an eye on you
If the patients head is thruster left during the VOR head thrust and they have a positive sign is the dysfunction on the left or right?
Left
How many line difference is a positive dynamic visual acuity test?
3 or more line difference
What does the dynamic visual acuity test suggest the patient has if it’s positive?
Bilateral vestibular hypofunction
For the head shaking test how many Hz, cycles, and degrees does the patient move?
2 Hz
20 cycles
30°
Which condition is most often nystagmus seen during the head shaking test?
Which direction does the nystagmus usually beat AWAY from?
Unilateral vestibular lesion
Nystagmus usually beats away from the”bad” side
Which are the 2 mm. That should be strengthened the most to prevent falls?
Glute max
Tub anterior
Which 5 findings suggest a central lesion?
Vertical gaze nystagmus Saccades VOR cancellation Coordination deficits Spasticity
Which semicircular canal is most often effected during BPPV?
Posterior semicircular canal
During the hallpike maneuver how Many degrees is their head rotated at first?
How many degrees is it extended at the end?
What is this testing for?
45° rotated (unaffected side first)
30° extended
Vertigo
Due to the rebound phenomenon how long should you wait behind the patient after a positive hallpike?
60 seconds
What is the difference between canalithiasis and cupulothiasis?
During canalithiasis the octopus becomes DISLODGED and there’s latency and fatigue following the hallpike test.
During cupulothiasis the otoconia becomes ADHERED to the cupula and you can expect immediate nystagmus which may not fatigue following the hallpike maneuver
Do most nystagmus eyes beat away or toward the side of the lesion?
AWAY
What are the 6 steps of the epley maneuver?
See slides 42-44
When is it appropriate to begin a patient on Brandt’s exercises?
After their symptoms have decreased 50%-75% with the epleys maneuver.
How often are the Brandt exercises performed?
3x per day for x5 cycles
How to perform the Brandt exercises
See slides 46-48
What maneuver do you use or immediate nystagmus in the hallpike maneuver which does not fatigue?
Liberatory maneuver
How to perform the Liberatory maneuver
Slides 50-52
When what technique is used for horizontal canalithiasis?
Barbecue roll
Which condition would a person who had a positive sharpened Romberg with eyes closed on foam have?
Unilateral vestibular hypofunction
What is the classic symptom of bilateral vestibular hypofunction?
Oscillopsia
Which condition is episodic, rotational vertigo, reduction In hearing(unilateral) tinnitus, postural imbalance, nystagmus, nausea and vomiting. Episodes last 30min-24hours
Ménière’s disease
If someone is dizzy when stressed what is the most likely pathology?
Migraines.
Which condition presents with history of a minor head injury or “pop” sound and symptoms can be recreated with sneezing, nose blowing, or valsalva maneuver?
Perilymphatic fistula
How do we treat dizziness?
Various habituation techniques.
