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Semester 5 PMNM Exam 8 > Vestibular Exam > Flashcards

Vestibular Exam Flashcards

1
Q

Reflex System - VOR is what

A

Gaze stabilization with head movement

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2
Q

Reflex System - Gain is measuring what

A

Movement of they eye relative to the movement of the head - it should be 1.0 (where eye magnitude equals head movement magnitude)
Relationship of eye velocity to head velocity

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3
Q

Reflex System - COR

A

Cervical Ocular Reflex
Signals head movement relative to body position - Body rotates on stool while head remains stationary - common with whiplash

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4
Q

Reflex System - OOR

A

Oto ocular reflex
Controls vertical and horizontal eye movement via the linear VOR
Gaze stabilization with head tilt

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5
Q

Reflex System - VSR

A

Input from otoliths and canals

Stabilizes head and erect stance - output to antigravity muscles

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6
Q

Peripheral vs. Central imbalance

A

Peripheral - moderate

Central - severe

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7
Q

Peripheral vs. Central nausea

A

Peripheral - severe

Central - minimal

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8
Q

Peripheral vs. Central auditory

A

Peripheral - auditory problems

Central - rare

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9
Q

Peripheral vs. Central neuro symptoms

A

Peripheral - rare (no problems with coordination)

Central - Common

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10
Q

Peripheral vs. Central compensation

A

Peripheral - rapid (good recovery time)

Central - slow (months to years)

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11
Q

Peripheral vs. Central onset of symptoms

A

Peripheral - sudden onset of vertigo

Central - gradual worsening of symptoms

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12
Q

Peripheral vs. Central oscillopsia

A

Peripheral - mild unless bilateral

Central - severe

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13
Q

Peripheral Nystagmus - Spontaneous

A

Occurring when just sitting there
Combined movements
Well attenuate

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14
Q

Peripheral Nystagmus - Positional

A

Change position of head
Torsional upbeat
Latency is common
It will fatigue

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15
Q

Central Nystagmus - Spontaneous

A

Purely unidirectional
Won’t decrease with fixation
It will not stop

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16
Q

Central Nystagmus - Positional

A

Vertical upbeat (immediate)
Latency is uncommon
Usually will not fatigue - it will just keep going

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17
Q

Things to consider in vertigo

A

Define dizzy

Medications

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18
Q

Things to consider in vertigo - Define dizziness

A

Symptoms
Tempo
Circumstances - how long does it last, what makes it better/worse

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19
Q

Things to consider in vertigo - Medications

A 
Alcohol
Tranquilizers
Antihypertensives
Anticonvulsants
Amnoglycosides/Antibiotic
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20
Q

Acute unilateral vestibular loss - 9% of clinic visits with c/o dizziness are dx as ___ or ___

A

Neuritis

Labryinthitis

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21
Q

Acute unilateral vestibular loss - Neuritis

A

Sudden onset, vertigo, nausea, severe 3-4 days, worse in first 24 hours
Inflammation of the vestibular nerve

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22
Q

Acute unilateral vestibular loss - Labyrinthitis

A

Viral or bacterial infections
Inflammation of the SC canals
Linked to cochlea and hearing loss

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23
Q

Acute unilateral vestibular loss - head injury

A

Inner ear concussion
Fx to temporal bone
Increase in ICP leading to periplymph fistula

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24
Q

Episodic Unilateral Vestibular Loss - Meniere’s Disease

A

Increase in endolymph volume causing membranous labyrinthine distension and rupture

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25
Episodic Unilateral Vestibular Loss - Perilymphatic Fistula
Caused by disruption of labyrinth membranes, creating a passage between perilymph and the middle ear
26
Episodic Unilateral Vestibular Loss - perilymphatic fistula - events
Head injury Barotrauma Penetrating injury to tympanic membrane
27
Progressive Unilateral Vestibular Loss - Acoustic Neuroma
Usually around CN 8 at cbm/pontne Evident on MRI Slow onset
28
Progessive Unilateral Vestibular Loss - Acoustic Neuroma S/S
Progressive unilateral hearing loss Tinnitus Mild disequilbrium
29
Peripheral Bilateral Vestibular loss - incidence
11% | Irreversible so not a healing or recovering process
30
Peripheral Bilateral Vestibular loss - causes
``` Meningitis Polyneuropathy (diabetes) Neurofibromatosis Acoustic neuroma Congenital malformation Ototoxic drugs ```
31
Peripheral Bilateral Vestibular loss - Impact
44% change their driving habits 55% limit social activities and have problems with ADLs 31% increase in fall risk
32
Central Vertigo - Causes
CVA, HI Unable to retrain if cbm is involved Long term rehab
33
Central Vertigo - Symptoms
``` Dizziness not related to activity or position Falls/Disequilibrium Lightheaded (full/foggy) Spontaneous nystagmus Directional nystagmus Poor smooth pursuit ```
34
Non vestibular - dizziness and imbalance - Vestibular balance and rehabilitation therapy (VBRT)
Beneficial to people with a non vestibular dysfunction
35
Non vestibular - dizziness and imbalance -- people with symptoms that were provoked with head or visual motion (more of a motion sensitivity)
Improve with vestibular exercise/gaze stabilization and balance training
36
Non vestibular - dizziness and imbalance - Mal de Debarquement
Typically after cruise and they still feel like they are on boat Some people can persist for weeks or months
37
Non vestibular - dizziness and imbalance - Migraine associated dizziness
Can be with migraine or can be atypical migraine where it is just the symptoms of the migraine without the headache
38
Non vestibular - dizziness and imbalance - Primary anxiety and panic
Can make symptoms worse
39
Examination
``` Hx Medications Orientation ROM Sensory Strength Coordination Balance Gait ```
40
Medications - Meclizine
Prevent and rx nausea and motion sickness | Side effects - drowsiness, hypotension
41
Medications - Diazepam
For anxiety | Side effects - drowsy, ataxia, confusion, fatigue, respiratory depression
42
Medications - Meds to control nausea and vomiting
``` Trimethobenzamide Prochlorperazine Scopalamine Droperidol Side effects - Drowsy, Parkinsonism, blurred vision, confusion, changes in BP ```
43
Medications - often given for what reason
Hopes of decreasing the symptoms or to stop the level of discomfort Most of them will dampen the CNS system
44
Medical and Lab Examinations - Test for Labyrinthine, Vestibular Nerve
Caloric Test Rotary Chair Testing Quantified Dynamic Visual Activity
45
Medical and Lab Examinations - Test for Labyrinthine, Vestibular Nerve - Caloric Test
Hot/warm in the ear to test to identify which ear is impacted
46
Medical and Lab Examinations - Test for Labyrinthine, Vestibular Nerve - Rotary chair testing
Sit in a chair that spins n a dark room - measuring nystagmus to differentiate diagnosis
47
Medical and Lab Examinations - Test for Labyrinthine, Vestibular Nerve, Otolith
Vestibular evoked myogenic potential test (VEMP) | Subjective visual vertical test
48
Outcome measures - body structure
``` Dynamic visual acuity Sharpened romberg Sensory orientation test CTSIB Visual analog scale Motion sensitivity quotient ```
49
Outcome measures - activity and participation
``` 5XSTS Functional reach Gait velocity Mini BESTest Berg DGI/FGA 4 square step test Single leg stance TUG ```
50
Outcome measures - questionnaires
Dizziness Handicap Inventory Activities Specific Balance Confidence Scale Vestibular Activities of Daily Living Modified Fast Evaluation of Mobility, Balance, and Fear Baseline Questionnaire
51
Vestibular Exam
``` VOR deficiency: Spontaneous nystagmus Gaze holding nystagmus Smooth pursuit Saccadic eye movement VOR cancellation Slow VOR Rapid VOR Head thrust (Halmagyi) Optokinetic nystagmus Static dynamic visual acuity Post head shaking nystagmus ```
52
VOR 1
Eyes stationary | Head turning
53
VOR 2
Eyes and object turning in opposite directons focusing on an object
54
Vestibular exam - motion intolerance
Hallpike Motion sensitivity test Generally hallpike is gold standard for BPPV
55
Vestibular exam - disequilibrium
Motion specific Sensory condition Functional task specific
56
Differential Diagnosis/Red Flags - Lightheadedness
Can be from a lot of things
57
Differential Diagnosis/ Red Flags - Dysequilibrium without dizziness and no dx
Undiagnosed central cause | Need to refer
58
Differential/Red Flags - Sudden onset of hearing loss
Acoustic neuroma | Refer to neurologist
59
Differential/Red Flags- Drop attacks
Cardiopulm or neuro | Need to refer
60
Differential/Red Flags - Neck pain/instability
Cervical ligament instability
61
Differential/Red Flags - No tx effect after 30 days
Acoustic neuroma | Refer to neurologist or PCP
62
Differential/Red Flags - Facial numbness
Acoustic neuroma | Undx CNS disease
63
Differential/Red Flags - Vertigo with vertical nystagmus and downward gaze
Red flag to refer
64
Differential/Red Flags - Urgent referrals to physician
``` Unexplained unilateral hearing loss Orthostatic hypotension Unexplained drop attacks Suspected vertebrobasilar insufficency Unexplained neuro or CN dysfunction Vertigo with vertical nystagmus ```
65
Goals and interventions
Decrease dizziness symptoms during functional activities Improve balance Understanding HEP that they will do 3 or 4 times a day
66
Clinical practice guidelines for peripheral vestibular hypofunction - Vestibular PT is effective for
``` Acute, sub acute, and chronic unilateral vestibular hypofunction (UVH) Bilateral hypofunction (BVH) ```
67
Clinical practice guidelines for peripheral vestibular hypofunction - exercise is effective for improved
functional goals with dosage of minimum TID for total of 20 minutes - moderate evidence (min of three sessions per day)
68
Clinical practice guidelines for peripheral vestibular hypofunction - PT supervise vestibular rehab
Moderated evidence | Don't necessarily have to see them ongoing - is more of supervision
69
Clinical practice guidelines for peripheral vestibular hypofunction - saccades and smooth pursuit alone for UVH or BVH
DO NOT DO SACCADES OR SMOOTH PURSUIT ALONE!!!
70
Four primary exercise components
Exercise to promote gaze stability Habituation Balance and Gait Training Walking program
71
Four primary exercise components - Exercise to promote gaze stability
``` VOR adaptation VOR substitution VOR 1 VOR 2 Eyes to target and then head to target ```
72
Four primary exercise components - Habitutation exercises
Optokinetic stimuli (moving pattern) Virtual reality Bath address visual vertigo or motion difficulty

Semester 5 PMNM Exam 8 (8 decks)

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