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Neuro Management > Vestibular Disorders and Interventions > Flashcards

Vestibular Disorders and Interventions Flashcards

1
Q

what is BPPV?
what are the causes?

A
  • A peripheral vestibular disorder
  • mechanical disorder caused by otoconia displaced from the macula of the utricle
  • typically caused by infection, head trauma, vestibular weakness, advancing age
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2
Q

What are BPPV symptoms?
which is the most important symptom?

A
  • Vertigo with change in head position such as when turning over in bed, getting into or out of bed, or when bending over/coming up
  • Nausea with or without vomiting
  • Nystagmus (involuntary, rapid and repetitive movement of the eyes) – Most important symptom
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3
Q

what is cupulolithiasis?

A
  • Immediate
  • Persistent in duration
  • Nystagmus : No change in
    intensity
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4
Q

what is canalithiasis?

A
  • Latency within (1-40 sec)
  • Short in duration (< 1 min)
  • Nystagmus : Fluctuates in
    intensity
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5
Q

what are the canals involved in BPPV?

A
  • Torsion/rotational – vertical ( anterior and posterior) canals
    -Horizontal = horizontal canals
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6
Q

What are the steps for the loaded Dix Hall Pike?
what canal is indicated with up beating torsional nystagmus? what canal is indicated with downbeating torsional nystagmus? what activities are aggravating for individuals with downbeating torsional nystagmus?

A
  • The patient’s head is turned (45
    degrees) toward her affected ear while
    she is in a sitting position.
  • Flex head 30 degrees for 30
    seconds**
  • The patient is then moved into a
    supine position with her head extended
    (20-30 degree off the table) and rotated
    45 degrees toward her ear.
  • Upbeating torsional nystagmus = posterior canal
  • Downbeating torsional nystagmus = anterior canal (vertigo with bending over, emptying the
    dishwasher, weeding)
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7
Q

the epley maneuver is used to treat…

A

posterior SCC canalithiasis

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8
Q

what is the modified eply manuever ? what are the steps?

A
  1. rotate the head 45 degrees towards the side to be treated
  2. lie back (over a pillow to facilitate extension) while maintaining 45 degrees of rotation and at least 20 degrees of extension (chin above forehead)
  3. hold until nystagmus/ symptoms subside +30 seconds
  4. rotate head to opposite direction at 45 degrees while maintaining extension. Hold until nystagmus/symptoms subside +30 seconds
  5. roll onto that same side while maintaining 45 degrees of rotation, tuck chin to shoulder (assists with migration of otoconia towards utricle). Hold until nystagmus/ symptoms subside +30 seconds.
  6. help patient sit up while keeping head down. Sit beside your patient and watch for eye movements
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9
Q

How do you know if the modified Epley maneuver was successful?

A

there is absence of nystagmus upon rising

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10
Q

what test is used to assess the horizontal canals?
how can you determine canalithiasis vs cupulothiasis?

A
  • the supine roll test is used to assess the horizontal canal
  • a positive test is indicative of horizontal nystagmus without torsion
  • geotropic nystagmus ( geotropic- to ground) = canalithiasis; the involved ear (to treat) is generally the side with the stronger nystagmus
  • ageotropic nystagmus (ageotropic -away from ground) = cupulolithiasis; the involved ear (to treat) is generally the side with the weaker nystagmus
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11
Q

what is the treatment for horizontal canal BPPV?

A
  • the barbecue roll is used for the treatment of geotropic R horizontal canal BPPV
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12
Q

what are the steps for the barbecue roll?

A
  • Patient’s head should be in 20 degrees of cervical flexion.
  • After head turning toward the involved ear (A), the head is then turned 270°
    toward the unaffected side through a series of stepwise 90° turns (B-D)
    before resuming the sitting position (E).
  • Each position should be maintained for at least 15 seconds or until the induced nystagmus and vertigo are resolved.
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13
Q

what is the maneuver for the treatment of cupulolithiasis?

A
  • the liberatory (semont) maneuver
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14
Q
A
  1. The head is rotated 45° to the opposite side of the affected ear
  2. With assistance, the patient is then moved from sitting to right side-lying and stays in this position for 1 minute.
  3. The patient is then rapidly moved 180°, from right side-lying to left side-lying. The head should be in the original starting position, left rotated (nose down in final position) in this example. Note that the otoconia have
    been dislodged from the cupula. After 1 minute in this position, the patient returns to sitting
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15
Q

What is a maneuver that can be used as HEP to treat posterior SCC BPPV? what are the steps of the maneuver?

A
  • Brandt-daroff exercise
    1. Patient brought into sidelying position with the head rotated towards the other side
    2. Patients are instructed to rapidly lie on their side, sit up, lie on the opposite side,
    and then again sit up. Each position should be maintained for at least 30 seconds or until vertigo stops.
    These exercises are repeated serially 10-20 times, three
    times a day until patient is without vertigo for 2 consecutive days.
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16
Q

why would you use the epley maneuver?

A
  • BPPV due to canalithiasis
  • posterior SCC canalithiasis (Most common)
  • both anterior and posterior SCC
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17
Q

why would you use the liberatory/ semont maneuver?

A

-BPPV due to cupulolithiasis
-posterior SCC cupulolithiasis ( most common)
-both anterior and posterior SCC

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18
Q

what is the Brandt-Daroff exercise used for?

A
  • persistent/residual or mild vertigo even after epley
  • for the patient who may not tolerate epley
  • treatment of posterior SCC BPPV
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19
Q

why would you use the Barbeque Roll?

A

horizontal canal BPPV

20
Q

what is a central vestibular pathology?

A

Central nervous system - brain stem vascular disease, arteriovenous malformations, acoustic neuromas and
tumors of the brain stem and cerebellum, multiple
sclerosis, and vertebrobasilar migraine

21
Q

what is peripheral vestibular pathology?

A

Include inner ear and vestibular nerve. BPPV, followed by uncompensated Ménière disease, vestibular neuritis,
labyrinthitis, perilymphatic fistula, and acoustic neuroma.

22
Q

what are aspects of central vestibular pathology?

A
  • ataxia is often severe
    -abnormal smooth pursuit and abnormal saccadic eye movement
  • usually no hearing loss
  • diplopia, altered consciousness, lateropulsion
  • acute vertigo not usually supressed by visual fixation
  • nystagmus is pure vertical pendular nystagmus with NO rotational component and typically persists longer
23
Q

what are aspects of peripheral vestibular pathology?

A
  • ataxia mild
  • normal smooth pursuit and saccadic eye movement test
  • hearing loss, fullness in ears, tinnitus
  • acute vertigo suppressed by visual fixation
  • acute vertigo is usually intense (more than central vestibular pathology)
  • nystagmus is upbeating or downbeating torsional (vertical with rotational component) or horizontal nystagmus which can resolve within 7 days in a patient with UVH
24
Q

what is smooth pursuit?

A

Slow and smooth
movements of the eyes to follow a moving target in the environment

25
Q

what is saccade testing?

A

Rapid jerky movement of the eyes to bring the image of the target onto the fovea.
* i.e. a rapid movement of the eye between
fixation points

26
Q

what does abnormal smooth pursuit and saccades indicate?

A

central vestibular pathology

27
Q

what is nystagmus?

A

Involuntary biphasic,
rhythmic ocular oscillation which can be either physiological or pathological

28
Q

is VOR intact with BPPV?

A

yes

29
Q

what is the use of VOR?

A

For maintaining stable gaze while we move or the world moves around us

30
Q

An impaired VOR is indicative of …

A

-vestibular system asymmetry
- head movement/ velocity does NOT match movement and velocity
- there is retinal slip meaning the eyes lag behind causing blurring of vision with head or eye movements –> decrease in vision and postural control
-when slip occurs the patient complains of decreased visual acuity, blurry vision (horizontal) or jumpy vision (vertical)`

31
Q

what systems are required for balance?

A
  • inner ear/ vestibular
    -vision/ eyes
  • sensory receptors in legs
32
Q

Explain the conditions and interpretations of the CTSIB

A

Condition 1: Eyes open, firm surface (30s)
- All 3 systems are available, so if pt is having difficulty, all 3 systems
may be affected
Condition 2: Eyes closed, firm surface (30s)
- Somatosensory and vestibular dominant, Vision removed –> If swaying, Somatosensory is affected
Condition 4:Eyes open, foam surface (30s)
- Vision and vestibular dominant, somatosensory removed –> If swaying, Vision is affected
Condition 5: Eyes closed, foam surface (30s)
- Vestibular is dominant, somatosensory and vision removed –> If swaying, Vestibular is affected

33
Q

what is the order of recruitment for the balance system?

A

vision–> somatosensory–> and vestibular

34
Q

If a patient is dependent on vision
- what conditions will they be unstable in?
- what is the rationale?

A
  • conditions: 2,3,5,6
  • Because eyes are closed
    or conflict between vision
    and vestibular system in
    these conditions
35
Q

If a patient is somatosensory dependent
-what conditions will they be unstable in?
- what is the rationale?

A

-conditions: 4,5,6
-Because foam/compliant
surface present

36
Q

If a patient has vestibular weakness or loss
-what conditions will they be unstable in?
- what is the rationale?

A
  • conditions: 5,6
    -Somatosensory and visual
    system not available
37
Q

what is UVH?
what are differential factors of UVH?

A
  • Impairment of balance
    system in the inner ear,
    the peripheral
    vestibular system is not
    working properly in one
    ear (Viral insults,
    trauma, vascular
    events)
  • Dizziness or vertigo,
    poor balance, especially
    with head turns,,
    blurred vision,
    especially when turning
    your head quickly.
  • Nausea
  • Trouble walking,
    especially outdoors, in
    dark rooms, or in
    crowded places
38
Q

what is BVH?
what are differential factors of BVH?

A

-Ototoxicity ( especially
using antibiotics such as
gentamicin, streptomycin),
meningitis, autoimmune
disorder, head trauma,
tumor on the 8th cranial
nerve neuronitis
- OSCILLOPSIA (visual blurring with head
movements)
- disequilibrium
- no nausea
- gait ataxia

39
Q

what is otititis media? what are differential factors?

A

Infection of the
MIDDLE EAR
causing fever and
ear pain

40
Q

what is ototoxicity? what are differential factors?

A

Ear poisoning caused by
drugs (Aminoglycosides),
chemicals.

41
Q

what are head movements for vestibulo-ocular reflex adaptation ?

A
  • pitch movements, nodding the head
    up and down
  • yaw movements,
    turning the head right and left
  • rarely diagonal head movements
    It is imperative that the patient maintain
    gaze on the visual target at all times during adaptation exercises.
    Progression of adaptation exercises can also (D) progressively involve
    decreasing the base of support as the patient is able, from a wide stance to a narrow stance to a semitandem stance, to a full-tandem stance
42
Q

What is a UVH adaptation intervention?

A

Gaze Stabilization Exercises: Coordinate eye and head movements to maintain gaze stability (reset gain of VOR to 1)
- Gaze Stabilization VOR x 1 Viewing ; Target is stable, Head movements while eyes stay focused on
target.
- Gaze Stabilization VOR x 2 Viewing; Progression of X 1 Viewing, Target and Head / Eyes Move in Opposite
Directions

43
Q

What are BVH interventions?

A

Treatment of patients with a BVH is designed to address the primary
complaints of gaze instability during head motion, dysequilibrium, and gait ataxia.

44
Q

what is UVH? What are the associated symptoms?

A
  • balance system in your inner ear, peripheral vestibular system not working properly
  • resting (spontaneous) nystagmus, oscillopsia, disequilibrium, postural instability
45
Q

what is BPPV? what are the associated symptoms?

A
  • disorder arising from a problem in the inner ear
  • vertigo with change in head position
  • each episode of vertigo typically lasts <1 min
  • nystagmus
    -nausea with or without vomiting
46
Q

what is menieres disease? what are the associated symptoms?

A
  • recurrent and usually progressive vestibular disease
  • tinnitus
    -deafness sensation of fullness in the ear
  • vertigo
47
Q

what is acoustic neuroma? what are the associated symptoms?

A
  • tumor on vestibular nerve leading from inner ear to brain
  • hearing loss on one side
    -tinnitus in the affected ear
    -unsteadiness
    -loss of balance
    -dizziness
  • facial numbness

Neuro Management (5 decks)

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