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unit 13 > Vestibular > Flashcards

Vestibular Flashcards

1
Q

Name two common ototoxins that can cause dizzyness

A

Aspirin

Amino Glycosides: broad spectrum antibiotics

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2
Q

The best test for vestibular dysfunction is what?

A

pt hx

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3
Q

Name two red flags in a hx you would refer out for?

A

Sudden onset of hearing loss

Headaches

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4
Q

Other than PMH what do you want to know as part of a persons medical hx?

A

PSH: past surgical hx

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5
Q

PANAS is what?

A

screen for anxiety and depression

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6
Q

ABC is what

A

Activities of balance Confidence scale

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7
Q

DHI is what?

A

dizziness handicap index

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8
Q

Duration matches with what etiology

Seconds
Minutes
Hours/Days

A

Seconds: BPPV, perilymph fistula, orthostatic hypotension

Minutes: TIA, migraines

Hours/Days: Meniere’s Disease

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9
Q

8 components of occulomotor exam

A

Spontaneous nystagmus

Gaze evoked nystagmus

Saccades

Smooth pursuit

Optokinetic Nystagmus

Convergence

Skew Deviation

Extraocular ROM

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10
Q

4 tests for VOR

A

VOR

VORc

HTT

Dynamic Visual Acuity Test

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11
Q

What does abnormal VORc tell you?

A

Eyes are unable to keep up. Central sign!

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12
Q

+R HTT you’ll see what? what side it eh problem on?

A

Corrective saccade to get the eyes back on target

R side

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13
Q

Gaze evoked nystagmus, you see the nystagmus change direction when you move position, what does this mean?`

A

Central impairment!

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14
Q

How fast do you rotate the pts head for dynamic visual acuity?

What is a + test?

A

2Hz or 120 bpm

Jump of 3 or more lines and 4 or more dropped letters within a line

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15
Q

name the three tests performed with light fixation removed

A

spontaneous nystagmus

Gaze holding nystagmus

Head Shaking Nystagmus

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16
Q

What is normal head shake test

A

always done with goggles on, start w/ eyes closed

Normal would be no nystagmus when they open their eyes

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17
Q

Name three otolith function tests

A

Cover cross cover test (which is also the skew in the occulomotor screen)

Ocular tilt reaction

SVV/bucket test

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18
Q

What does an abnormal ocular tilt reaction look like?

A

both eyes will not roll away (no ocular counter rolling)

Dependent eye will not move up (this is the part you’ll see in room light)

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19
Q

What deviation on the bucket test is considered abnormal?

What does this tell you?

A

> 2.5 degrees from true vertical

Problem with the saccule on the same side as the deviation

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20
Q

Videonystagmography

A

different positions w/goggles on they measure amplitude, velocity and direction of nysagmus

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21
Q

What are some signs of central nystagmus

A

Resting, pure vertical or direciton changing nystagmus other UMN signs, CONSTANT vertigo

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22
Q

Differentiate between neuritis and labyrinthitis

central or peripheral?

A

Neuritis: no hearing loss

Labyrinthitis: hearing loss

Peripheral!

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23
Q

True or false antivert/meclizine is a treatment for BPPV?

A

False! its a vestibular supressant which should only be used in someone who cannot keep their eyes open cause they’re vomitting etc.

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24
Q

Labrynthitis and neuritis we want them taking or not taking vestibular supressants?

A

NOT TAKING

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25
Q

what is the most common thing to cause bilateral vestibular loss?

A

ototoxic antibiotics

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26
Q

Known risk factors for BPPV

A

old age, DM

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27
Q

What is the most common cause of otologic dizziness

A

BPPV

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28
Q

If someone has transient having loss do you think its Meniere’s disease?

A

no, hearing loss is constant.

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29
Q

Pt presentation for meniere’s

A

fullness in ear, decreased hearing, tinnitus (waves), rotational vertigo, postural imbalance, nystagmus, nausea and vomitting

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30
Q

Can you predict when attacks of meniere’s are going to occur?

A

No! they’re spontaneous

Pt may have an aura

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31
Q

Will you be able to trigger dizziness in a Menieres pt?

A

no! Its spontaneous

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32
Q

What is Betahistine drug therapy used for? When is it taken?

A

Meniere’s disease.

Taken when the feel one coming on to stop it before it comes on

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33
Q

Low salt diet, vestiublar suppressant during attack, intratympanic introduction of ototoxic antibiotics generally used for treatment of what kind of disorder?

A

Meniere’s disease

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34
Q

If Meniere’s Disease is stable is PT indicated?

A

NO

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35
Q

End stage Meniere’s or post treatment (surgically or intratympanic gentamycin) creates what?

A

Unilateral hypofunction

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36
Q

Dizziness/disequilibrium caused by abnormal afferent activity from the neck is what?

A

Cervicogenic dizziness

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37
Q

Diagnosis of cervicogenic dizziness is what?

A

dizziness associated w/neck movement

Time association btwn neck pain and onset of dizziness

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38
Q

What has a frequent association with traumatic injury and cervical arthritis?

A

Cervicogenic dizziness

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39
Q

subjective report of someone with CGD would be what?

A

“swimming”
“floating”
“detached”
“off”

NOT room spinning!

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40
Q

Dizziness inceased with cspine motion and no los of hearing is probably what?

A

Cervicogenic dizziness

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41
Q

Does someone with cervicogenic dizziness have nystagmus?

A

no!

42
Q

Mismatch between vestibular, visual and cervical inputs, perceived as dizziness and disequilibrium is describing what etiology of neck pain?

A

cervicogenic dizziness

43
Q

What reflex is exaggerated or abnormal in patients with CGD

A

COR: perpetuated by movements of the neck

44
Q

Provoked room spinning dizziness is likely what?

A

BPPV

45
Q

Onset of BPPV

A

sudden

W/ positional changes

46
Q

> 60 seconds:

<60 seconds:

A

> 60 seconds: cupula

<60 seconds: canal

47
Q

upbeating:
Downbeating:

A

Upbeating: posterior
Downbeating: anterior

48
Q

Does cupula or canal have latency?

Does cupula or canal extinguish?

A

Canal

Canal: cupula persists it hasn’t settled anywhere its just chilling there

49
Q

Explain the BBQ roll (write it)

A

start in supine, put head so affected ear is dependent (towards strong side)

Slowly rotate head to neutral (15 seconds)

Slowly rotate head to opposite side (15 seconds)

Pt body and head to prone

Tuck chin

Quadriped –> sitting –> standing

50
Q

Casini explanation

A

Whole body to INVOLVED side (weak)

IMMEDIATELY head down (2min)

Sit up maintaining head turn

51
Q

Appiani explanation

A

Whole body to UNINVOLVED side (weak) 2 min here

Then turn head down (2 more min)

Sit up maintaining head

52
Q

Guffani explanation

A

whole body to INVOLVED side (weak) stay here until nystagmus stops +15 seconds

Head facing up 45 degrees stay here until stops + 15 sec

Maintain head turn and sit up

53
Q

You perform a SRT and you see apogeotropic nystagmus that is not persistent what do you do? (ageotropic is cupula so it normally is persistent)

A

Gufoni Maneuver

54
Q

When lateral canal BPPV occurs post treatment for PSCC BPPV, this tells you what?

A

the side you just treated is the involved side. there was canal conversion.

55
Q

Post treatment instructions?

A

none

56
Q

Recurrence rate of BPPV?

A

30% in a year

57
Q

What may pt feel after tx?

A

lightheadedness for up to 2-3 days

58
Q

Liberatory decreases or increases the risk of canal conversion?

A

Decreases risk! It’s more violent

59
Q

Vestibular neuritis, do they experience hearing loss?

A

NO

60
Q

onset of VN

A

sudden

61
Q

What does the evidence say about the recovery of long term vestibular hyopfunction?

A

Recovery can occur treat them!

Early is better

62
Q

What is the deficit in VN?

A

unilateral hypofunction

63
Q

What tests would be positive for someone with vestibular neuritis?

A

Spontaneous nystagmus (acute in room light, chronic w/fixation removed), + head shaking, abnormal VOR, +Head shake

64
Q

What is the most common cause of bilateral vestibular loss?

A

ototoxic drugs

65
Q

How to treat bilateral vestibular loss

A

there is no VOR to recalibrate , work on balance, gait, and ensure they’re seeing someone for bilateral hearing loss

66
Q

Vestibular migraine, central or peripheral?

A

central

67
Q

Is dizziness w/o HA able to be classified as a vestibular migraine?

A

Yes, no HA necessary

68
Q

Is vestibular migraine or Meniere’s higher incidence?

A

Vestibular Migraine

69
Q

Tx for vestibular migraine

A

migraine diet
migraine pain medication: even if they don’t have a HA
stress reduction: good sleep, regular meals, PT (balance and decrease movement restrictions)

70
Q

Unilateral vs. bilateral lesion for static problems

Unilateral
Gaze stability
Postural stability

Bilateral
Gaze stability
Postural stability

A

Unilateral
Gaze stability: spontaneous nystagmus
Postural stability: asymmetry in stance

Bilateral
Gaze stability: no nystagmus
Postural stability: symmetrical in stance

71
Q

Dosage for movement of the head for someone with VN

A

no good evidence for it

72
Q

tx with or w/o AD for someone with acute vestibular problem?

A

treat w/o but send them home w/one if they need it

73
Q

is adaptation or compensation the original goal in individuals with acute vestibular problems

A

adaptation

74
Q

What should tx be based on

A

individualized!

75
Q

When does adaptation occur

A

when there is a retinal slip = an error signal

This is a slow process

76
Q

Is adaptation context-specific

A

Yes! you want to get them back specific tasks.

Get them moving!

Graded activities

77
Q

Gaze exercises are used to adapt what?

A

the VOR!

78
Q

Tx for bilateral vestibular disorder

A

they don’t have a VOR but she gives it a shot anyway

79
Q

compensatory or adaptive? After a large grade transitional movement, wait before moving

A

Compensatory

80
Q

Compensatory or adaptive?

Eyes first then head?

A

Compensatory

81
Q

name four things you can modify to progress gaze stabilization exercises

A
  • time
  • speed of head movement
  • target
  • position of the body
  • surface
  • stance
  • background
82
Q

Reliable outcome measures for vestibular specific?

A

none use balance

83
Q

Dosing for VOR adaptation exercises

A

2 minutes tops for x1 and x2

5 minutes tops for all other

30-60 second rest between trials

start with 2-3x a day

84
Q

Good documentation to support the necessary treatment time to make an impact on the vestibular system

A

functional impairments, changes in activity, rating of symptoms, develop fittness goals etc.

85
Q

Progression of VOR habituation exercises

A 
x1 horizontal 
x1 vertical  
Btwn two targets 
remebered targets 
x2 horizontal 
x2 vertical
86
Q

MSQ is used for what population?

A

non-vestibular causes of dizziness, motion induced complaints

87
Q

what is intensity ranked from on the MSQ

A

0-5

88
Q

Dosing of MSQ

A

pick three positions, you want to do each position for three reps

89
Q

What is the total score of MSQ?

A

All intensity ( minus if the baseline intensity was not zero) + duration

90
Q

What is the motion sensitivity quotient equation?

A

of positions(total score) all divided by 20.48

91
Q

What is the goal of the MSQ after therapy?

A

<10% of their quotient

92
Q

What exercises should you be choosing for HEP from MSQ

A

middle of the line provoking exercises to ensure carryover at home

93
Q

true or false, pts should be wearing glasses during occulomotor screening?

A

true!

94
Q

What do we think about vertical spontaneous nystagmus?

A

red flag!

95
Q

What about a gaze holding nystagmus would point you towards a central sign?

A

if the nystagmus changed direction

96
Q

When are you not super worried about a smooth pursuit that is abnormal?

A

If it is not accompanied by other central signs

if the individual is over 65 yrs

97
Q

When is normal convergence, where do you measure from?

A

<5cm

Measure from bridge of nose

98
Q

How many skips is normal saccadic eye movement?

A

2 skips or less

99
Q

What would be a central sign for optokinetic nystagmus?

A

if their eyes are moving smoothly

100
Q

Abnormal VORc tells you what?

A

Central sign

101
Q

cross cover cross test is for what two things

A

occulomotor scan as well as otolith function

unit 13 (6 decks)

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