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PT 942 Phys Rehab II > Vestibular Disorders > Flashcards

Vestibular Disorders Flashcards

1
Q

The 3 primary functions of the peripheral vestibular system?

A
  1. stabilizing visual images during head movements (for clear vision)
  2. maintaining postural stability (especially with head movements)
  3. providing information for spatial orientation
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2
Q

Each semicircular canal has a contralateral coplanar mate, so one side is being depolarized/excited while the opposite is being hyperpolarized/inhibited. Which pairs are working together if a person is turning their head to the left?

A
  • left lateral (horizontal) canal is being depolarized/excited
  • right lateral (horizontal) canal is being polarized/inhibited.
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3
Q

Name the semicircular canal coplanar pair’s that work together.

A
  • left and right lateral (horizontal) canal’s
  • left anterior (superior) and right posterior canal’s
  • right anterior (superior) and left posterior canal’s
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4
Q

What are the 2 otolith organs?

A
  • saccule

- utricle

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5
Q

How does the brain detect the direction head movement?

A
  • by comparing input from coplanar pairs

- motion of endolymph results in opening or closing of transduction channels of hair cells

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6
Q

What is the ampulla?

A
  • located at the enlarged end of each canal

- within the ampulla lies the cupola (gelatinous barrier that contains the sensory hair cells)

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7
Q

Which otolith organ is excited during horizontal linear acceleration and/or static head tilt?

A
  • utricle (vertical hair cells)
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8
Q

Which otolith organ is excited during vertical acceleration?

A
  • saccule (hair cells are lateral)
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9
Q

What part of the central vestibular system provides primary control of many vestibular reflexes?

A
  • brainstem
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10
Q

Where does vestibular pathways terminate (cortical area)?

A
  • junction of parietal and insular lobes
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11
Q

When sitting still what does the cerebellum pay more attention to?

A
  • info from somatosensory system (touch, pressure, joint position)
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12
Q

When you move what does the cerebellum pay more attention to?

A
  • vision and vestibular inputs
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13
Q

What is VOR gain and phrase?

A
  • gain is equal and opposite velocity of head and eye’s

- phase is equal and opposite head and eye relationship

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14
Q

What is VOR responsible for?

A
  • maintaining stability of an image on the fovea of the retina during rapid head movements (rapid compensatory eye movements in opposite direction of the head when moving/rotating)
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15
Q

Peripheral vestibular pathology can be one of two types?

A
  • mechanical (BPPV, most common)

- decreased receptor input (UVH or BVH)

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16
Q

What most commonly causes unilateral vestibular hypofunction?

A
  • virus, trauma, vascular events
17
Q

What most commonly causes bilateral vestibular hypofunction?

A
  • most common is ototoxicity

- others include meningitis, autoimmune disorders, head trauma

18
Q

Define otoconia?

A
  • the “crystals”
  • located in the gelatinous matrix
  • calcium carbonate
19
Q

What is cupulolithiasis?

A
  • otoconia adhere to the cupula of one of the SCC’s
20
Q

What is canalithiasis?

A
  • otoconia are floating freely in one of the SCC’s
21
Q

BPPV symptoms?

A
  • NYSTAGMUS and VERTIGO with HEAD POSITIONING

- occasionally nausea, vomiting, disequilibrium

22
Q

UVH symptoms?

A
  • SPONTANEOUS NYSTAGMUS (at rest)
  • vertigo
  • visual blurring
  • oscillopsia during head movements
  • postural instability
  • dysequalibrium
23
Q

BVH symptoms?

A
  • DYSEQUILIBRIUM (unsteadiness)
  • oscilliopsia
  • gait ataxia
24
Q

Red Flags that require referral to neurologist?

A
  • horizontal or vertical diplopia (double vision) lasting longer than 2 weeks
  • pure vertical nystagmus
  • spontaneous up-beating nystagmus
  • positive test for skew deviation
25
Q

Contraindications to vestibular rehab (8)?

A
  • acute episode of Meniere’s disease
  • uncontrolled migraine
  • PLF
  • unrepaired superior semicircular canal dehiscence
  • sudden loss of hearing
  • increase feeling of pressure or fullness in one of both ears that is uncomfortable
  • post surgical, observe for fluid in ears
  • acute neck injuries may not tolerate
26
Q

What % of patients sustaining mild head injury (TBI) complain of vertigo?

A
  • 78%

- 20-37% still after 6 mo - 5 yrs later

27
Q

Central nervous system pathology that could cause vestibular symptoms that needs to be filtered out during the exam(6)?

A
  • CVA
  • Vertebrobasilar insufficiency (VBI)
  • TBI
  • MS
  • Nystagmus
  • Other indicators (lateropulsion, visual perceptual difficulties, oculomotor signs, skew deviation of the eyes)
28
Q

Compare common symptoms of Central vs Peripheral vestibular pathology (7).

A
  1. Central - ataxia, severe (Peripheral - mild)
  2. Central - abnormal smooth pursuit and saccades (Peripheral - both normal)
  3. Central - usually no hearing loss but if so is sudden/permanent (Peripheral - may be hearing loss, fullness in ears, tinnitus)
  4. Central - Sx diplopia, altered consciousness, lateropulsion (Peripheral - none of those)
  5. Central - acute vertigo not usually suppressed by fixation (Peripheral - acute vertigo suppressed by visual fixation) (Peripheral vertigo usually intense)
  6. Central - pendular nystagmus (Peripheral - slow and fast phases of nystagmus)
  7. Central - pure persistent vertical nystagmus regardless of positions (Peripheral - spontaneous horizontal nystagmus)
29
Q

What symptoms would be common in Meniere’s disease (4)?

A
  • low frequency hearing loss and episodic vertigo
  • sense of fullness in ears and tinnitus
  • episodes can last several hours
  • PT indicated for chronic meniere’s
30
Q

How can a PT help motion sickness?

A
  • habituation training can be effective if debilitating
31
Q

Why is it important to know if your vestibular patient has MS?

A
  • can cause symptoms just like UVH (CN VIII)
32
Q

What % of patients with migraine-related dizziness had abnormal nystagmus during episode?

A

100%

33
Q

What is cervicogenic dizziness?

A
  • pathology affecting c-spine and related soft tissue
  • upper c-spine sends proprioceptive input to contralateral vestibular nucleus
  • soft tissue injury or joint dysfunction might alter afferent input

PT 942 Phys Rehab II (15 decks)

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