Vestibular Examination Flashcards
___ vestibular problems are more common
-peripheral (inner ear)
Team Approach
- PCP
- Neurologist
- Otolaryngolist
- Audiologist
- Psychologic/Psychiatrist
- PT/OT
Vestibular Function
- stabilize visual images on the retina (gaze stabilization)
- maintain postural stability
- provide information needed for spatial orientation
Vertigo
-turning: sense of movement of oneself or environment
Disequilibrium
-sense of imbalance
Oscillopsia
- sense of motion in environment
- Like cop camera
Dizziness
- common problem & reason for referral
- lightheadedness, nervousness, disequilibrium
Peripheral Vestibular Anatomy
- bony labyrinth
- membranous labyrinth
Bony Labyrinth
- 3 semicircular canals (horizontal, anterior, posterior)
- cochlea
- vestibule
- perilymphatic fluid
Membranous Labyrinth
- within bony labyrinth
- 5 sensory organs
- saccule, utricle
- motion sensors
- endolymph
Semicircular Canals
- 3
- ant, post, horizontal
- detect angular acceleration
Receptors
- ampula
- maculae
Ampulla
- small bulge at end of each semicircular canal
- contain haircells that project into cupula
- fires receptor cells
Maculae
- receptors for utricle and saccule
- Covering: statoconia
Hair Cells
-project in groups, arranged according to height
each hair cell has:
- 40-70 stereocilia
- 1 kinocilium
Hair Cells innervated by:
-afferent neuron
- excite: cilia move toward kinocilium
- Inhibit: cilia move away from kinocilium
Saccule
-linear accelearation
Utricle
-horizontal linear acceleration or static head tilt
SCC Pairings
- L/R horizontal
- L ant/R post
- R ant/L post
Firing of Vestibular receptors
- respond to brief head movements
- accommodate with ongoing movements
Central Vestibular System Anatomy
- 4 vestibular nuclei
- connect to: Mm, Nn controling eye movements, reticular formation, thalamus, cerebral cortex and cerebellum
Role in Postural Control
- vestibulospinal reflex system
- descending tracts
Descending tracts
- lateral vestibulospinal tract (ext Mm of neck, trunk, legs)
- medial vestbiulospinal tract (neck flex/ext Mm)
VOR
- vestibular-ocular reflex
- produces horizontal/vertical eye movements coordinated with head movements
- stabilizes eye in space
Horizontal VOR
-turn head to R–>increase firing of R vestib nucleus–>fires ipsilateral oculomotor nucleus–>R medial rectus fires
Vertical VOR
Similar to horizontal VOR
Nystagmus
- invol, alternating sequence of quick and slow phase eye movements
- normal reaction to rotation
- slow phase 1 direction followed by fast phase in opposite direction (named by fast phase)
Peripheral Vestibular Disorder
-any pathology involving the vestibular nerve, mechanical deformation of nerve, trauma to surrounding structures
Ex of Peripheral Vestibular Disorders
- BPPV
- Infectious Agents
- Perilymphatic Fistula
- Vascular Disease
- Tumor
- Cervical Vertigo
Unilateral Peripheral Vestibular Disorder S/Sx
- significant dizziness
- vertigo
- nausea
- postural instability
- static (resting nystagmus) & dynamic (abnormal gain) problems of VOR
- Nystagmus
BIlateral Peripheral Vestibular Disorder S/Sx
- more disequilibrium
- less dizziness
- postural instability and ataxia
- oculomotor disturbance
- oscillopsia
- possible impairments of strength, endurance, ROM
BPPV
- benign paroxysmal positional vertigo
- most common vestibular disorder
- vertigo with specific movements
- most commonly in posterior canal
BPPV due to:
-fragment of otoconia that lodge on cupula or semicircular canal
2 Types of BPPV
- Canalithiasis
- Cupulolithiasis
Canalitiasis
- most common type of BPPV
- otoconia free floating in SCC
- vertigo for <1 min
Cupulolithiasis
- relatively uncommon
- otoconia adhere to cupula
- vertigo onset immediately in test position and sustained
Nystagmus Upbeat
posterior canal
Nystagmus Downbeat
anterior canal
Nystagmus R Torsional
R side
Nystagmus L Torsional
L Side
Nystagmus Latency;
Short
-canalithiasis
Nystagmus Latency:
Long
-cupulolithiasis
Ex. Causes of Central Vestiblar Disorders
- MS
- Vascular trauma (stroke)
- Trauma
- Tumor
- Metabolic/degenerative/developmental problem
Central Vestibular Disorder S/Sx
- vertigo: long but less severe
- nystagmus: down/up or torsional
- VOR abnormalities
- Impaired VOR Cancellatoin
- impaired Mm tone, ataxia, imbalance
Medical Exam Tests
- ENG (electronystagmography)
- Caloric Irrigation Testing
- Rotary Chair Testing
- Computerized Dynamic Posturography
PT Exam:
History
- PMH: conditions that could cause vestib probs
- Meds
- Onset of Sx (cause/provoking)
- Description of Symptoms (dizzy, vertigo, loss of balance, fall Hx, hearing, ear pn)
Meclizine
- vestibular suppressant
- form of Dramamine
-can interfere with progress of PT treatment
Impairment Measures
- ROM (neck/CS)
- MMT (neck/CS)
- Coordination (cerebellar prob?)
- Sensation (parietal prob?)
- Endurance
- Pain
- Vitals (r/o cardiovascular disease)
Occulomotor Tests
- occular mobility & smooth pursuit
- saccadic eye movements
- spontaneous nystagmus
- head thrust test
- head shaking test
- dynamic visual acuity test
CTSIB
- clinical test of sensory integration & balance
- determine sensory system pt relies on to mntn balance
- timed (30 sec), sway
- EO/EC on firm/foam
Self-Report Measures
- dizziness handicap inventory
- activity specific balance confidence scale
- falls efficacy scale
Exam:
Body Function/Structure
- occulomotor tests
- Dix-Hallpike
- CTSIB
- Other impairment tests
Exam:
Activity
-DGI
Exam:
Participation
- Dizziness handicap inventory
- ABC Scale (more difficult items than FES)
- FES
Dizziness Handicap Inventory
- self-perceived handicap/disability due to vestibular disorder
- 3 domains: functional, emotional, physical
