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Vestibular Flashcards

1
Q

role of vestibular system

A

head orientation in space, postural stability, gaze stabilization

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2
Q

peripheral vestibular system functions

A

stabilizing visual images on the fovea of the retina during head movement to allow clear vision
maintaining postural stability
providing info used for spatial orientation

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3
Q

central vestibular system

A

brainstem processes provide primary control of many vestibular reflexes

  • vestibulo-ocular reflex stabilizes images on the retina during head movements
  • -posture in static and dynamic activities
  • -coordination of limb movements
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4
Q

vestibular system includes

A 
labyrinth
CN 8
vestibular nuclei (brainstem, pons)
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5
Q

labyrinth

A

bony: filled w/perilymph
membranous: filled w/endolymph
- –semicircular canals: head rotation movements
- –otolith organs: acceleration/deceleration (utricle and saccule)

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6
Q

semicircular canals SCC

A

Function: sense angular head velocity
ampulla - widened end of each SCC
cupula - gelatinous surrounds hair inside ampulla
vestibular hair cells - located in cupula
oriented at 90 to each other (2 floors and floor of room)
hor canal plane is tilted up 30 degrees
ant and post canals 45 degrees off of frontal plane

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7
Q

utricle

A

oriented horizontally

senses linear acceleration and tilt

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8
Q

saccule

A

oriented vertically

senses linear acceleration and tilt

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9
Q

otolith organ (in saccule and utricle)

A

macula-hair cells located
otolithic membrane- gel-like over the macula
otoconia- calcium carbonate crystals on top of otolithic membrane

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10
Q

optokinetic reflex

A

functions during movement of visual images
smooth pursuits
saccades

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11
Q

smooth pursuits

A

slower velocities of visual movement; visual tracking

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12
Q

saccades

A

quick eye movement between 2 targets

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13
Q

cervico-ocular reflex (COR)

A

eye movement triggered by neck movement, neck proprioceptors send info to brain and then to eyes

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14
Q

vestibulospinal reflex (VSR)

A

generates appropriate tone to maintain upright position; maintain postural control

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15
Q

vestibulo-ocular reflex (VOR)

A

functions during movement of head relative to gravity
(therapist passively turns head quickly—eyes should stay fixed)
stabilizes vision during head movement
pd eye movement in opp direction of head movement to maintain image on retina

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16
Q

nystagmus

A

non-voluntary rhythmic oscillation of the eyes

physiologic nystagmus vs. pathologic nystagmus

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17
Q

oscillopsia

A

illusion of movement of the visual environment
cause: impaired VOR results in retinal slip
patient complaint: everything bounces when I move, vision is blurry

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18
Q

vestibular dysfunction- peripheral

A

vestibular neuronitis
labyrinthitis
meniere’s disease - loss of function of cochlear nerve
acousitic neuroma
unilateral or bilateral vestibular hypofunction
BPPV- benign paroxysmal positional vertigo

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19
Q

vestibular dysfunction- central

A 
vestibular migraine
MS (nerve degeneration; can affect any nerve)
TBI, mTBI, post-concussion
cerebellar degeneration
cerebellar or vertebral artery infarct
arnold-chiari malformation
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20
Q

common vestibular dysfunction complaints

dizziness

A

sensation of whirling or feeling a tendency to fall

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21
Q

common vestibular dysfunction complaints

vertigo

A

illusion of movement, sense of environment moving

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22
Q

common vestibular dysfunction complaints

lightheadedness

A

feeling that fainting is about to occur

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23
Q

common vestibular dysfunction complaints

dysequilibrium

A

sensation of being off balanced

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24
Q

common vestibular dysfunction complaints

oscillopsia

A

subjective experience of motion of objects in the visual environment that are known to be stationary

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25
Q

common vestibular dysfunction complaints

red flags

A

persistent, worsening vertigo and disequilibrium
severe headache
new onset of double vision, cranial palsies, dysarthria, ataxia, incoordination

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26
Q

activate EMS when you suspect a stroke - symptoms

A 
sudden weakness
confusion
sudden dimness or loss of vision in one eye
difficulty speaking
sudden severe headache
unexplained dizziness
loss of balance
difficulty walking
27
Q

symptoms of dizziness and possible causes

vertigo

A

BPPV, unilateral vestibular hypofunction (UVH), unilateral central lesion affecting vestibular nuclei

28
Q

symptoms of dizziness and possible causes

lightheadedness

A

orthostatic hypotension (drop of >20mmHg systolic, 10 mmHg diastolic, or both), hypoglycemia, anxiety, panic disorder

29
Q

symptoms of dizziness and possible causes

dysequilibrium

A

bilateral vestibular hypofunction (BVH), chronic UVH, LE somatosensation loss, upper brainstem/vestibular cortex lesion, cerebellar and motor pathway lesions

30
Q

symptoms of dizziness and possible causes

oscillopsia

31
Q

duration of symptoms and possible causes

seconds to minutes

32
Q

duration of symptoms and possible causes

minutes to hours

A

meniere’s disease (can lose hearing)

33
Q

duration of symptoms and possible causes

days

A

vestibular neuronitis, UVH/BVH, migraine-associated dizziness

34
Q

duration of symptoms and possible causes

variable

A

centra dizziness

35
Q

aggravating factors and possible causes

BPPV

A

Rolling, sitting up in bed, checking blind spot, looking up

36
Q

aggravating factors and possible causes

orthostatic hypotension

A

quick position changes from supine to sitting or sitting to standing

37
Q

aggravating factors and possible causes

vestibular neuronitis, UVH, BVH

A

rapid head movement

38
Q

BPPV

A

most common peripheral cause of vertigo

otoconia dislodged from macula and enter semicircular canals

39
Q

BPPV - etiology

A

trauma, viral infection, natural aging process

40
Q

BPPV - symptoms

A

sudden onset of vertigo, associated nystagmus, short duration, provoked by position changes and head movements, may last for days or months

41
Q

BPPV - canalithiasis

A

vertigo lasts < 60 seconds, otoconia free floating through canals

42
Q

BPPV - cupulolisthiasis

A

vertigo lasts > 60 sec, otoconia adhered to cupula

43
Q

BPPV - canal involvement

A

posterior canal - 41-65% most common
horizontal canal - 21-33%
anterior canal - 17%

44
Q

BPPV - positional testing

Dix-Hallpike

A

assessment for posterior and anterior cancal

45
Q

BPPV - positional testing

roll test

A

assesses horizontal canal

46
Q

treatments for posterior BPPV

A

epley maneuver - for canalithiasis

semont maneuver - for cupulolithiasis

47
Q

treatments for horizontal BPPV

A

BBQ maneuver - - for canalithiasis

forced prolonged positioning maneuver - for cupulolithiasis

48
Q

treatment for anterior canal BPPV

A

Deep head hanging maneuver - canalithiasis and cupulolithiasis

49
Q

UVH or BVH

A

etiology- viral infection, trauma, vascular insult, tumor
s/s - spontaneous nystagmus, constant vertigo, oscillopsia, impaired balance
recovery - improve after 3-5 days, over several weeks (depends on chronic or acute)

50
Q

chronic UVH

A

occurs with poor compensation and continued impaired VOR - dizziness with head movements, report oscillopsia and disequilibrium and gait instability

51
Q

UVH or BVH

treatment

A

gaze stabilization and address balance deficits
VOR adaptation ex
- VORx1 - head moves while target is stationary
- VORx2 - head moves opp dir of moving target
substitution ex
- saccades - active head/eye movements between 2 targets
- remembered targets - working to use cervico-ocular reflex to stabilize gaze

52
Q

post concussion symptoms

A

headaches, dizziness, fatigue, irritability, anxiety, insomnia, loss of concentration and memory, ringing in ears, blurry vision, noise and light sensitive

53
Q

post concussion

trauma to brain can cause abnormal vestibular system function

A
  • brain can receive abnormal signals about position and movement of the head in space
  • if vestibular system delivers inaccurate info to brain the brain must rely on visual input and proprioception to feel body in space
  • failure to compensate w/use of visual references and being aware of the surface one is sitting or standing on results in dizziness and sense of instability
54
Q

post concussion vestibular treatment

A

BPPV treatment
gaze stabilization exercises
habituation ex
address balance deficits

55
Q

balance interventions

impairments

A 
cognitive, vestibular, sensory, musculoskeletal, etc
correct what can be changed
prevent secondary complications
when permanent impairments
--adapt/learn new strategies
--assess, adapt, accept
56
Q

goals for vestibular rehab

A 
improve balance
improve trunk stability
increase strength and ROM in order to improve musculoskeletal balance responses and strategies
decrease the rate and risk of falls
minimize dizziness
57
Q

vestibulo-ocular retraining therapeutic guidelines

exercises

A 
VOR and VSR stimulation ex
ocular ex (smooth pursuits and saccades)
balance ex
gait ex
combo ex (obstacle courses, functioning in public place)
habituation training ex
individualize each plan (always)
motor learning principles
--practice, feedback, repitition
58
Q

vestibulo-ocular retraining therapeutic guidelines

what to use

A

start w/closed environment
use of gravity; varying surface conditions
COG controlled in each tx stage
force plate system, EMG biofeedback
foam, mirrors, rocker boards, BAPS boards, swiss balls, foam rollers, trampolines

59
Q

habituation ex

A

goal is to assist in decreasing symptoms of vertigo, dizziness or nausea
pick 2 or 3 of moderately provoking positions
provoke symptoms for 30 sec
wait for sym to pass, count to 10 then repeat movement
perform 3-5x, 2x/day
initially increase sym, but w/time will reduce symptoms
will decrease within 2 wks

60
Q

balance exercises and progressions
begin with
stand w/feet shoulder width apart, arms across chest

A

progress to: bring feet closer together. close eyes. stand on a sofa cushion or foam
purpose: enhance the use of vestibular cues for balance by decreasing BOS. eyes closed increases reliance on vestibular cues for balance

61
Q

balance exercises and progressions
begin with
practice ankle sways: medial lateral and anterior-posterior

A

progress to: doing circle sways. close eyes

purpose: teaches the patient to use a correct ankle strategy

62
Q

balance exercises and progressions
begin with
attempt to walk with heel touching toe on firm surface

A

progress to: same ex on carpet
purpose: enhance the use of vestibular cues for balance by decreasing BOS. doing the ex on carpet alters proprioceptive input, increasing difficulty

63
Q

balance exercises and progressions
begin with
practice walking 5 steps and turning 180 degrees (left and right)

A

progress to: making smaller turns. close eyes

purpose:turning provides a greater challenge to the vestibular system

64
Q

balance exercises and progressions
begin with
walk and move the head side to side, up and down

A

progress to: counting backward from 100 by threes

purpose:use distracting cognitive or motor demands to challenge balance

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