Vestibular PT Exam Flashcards
What are the components of the PT exam for vestibular disorders?
History
Neuro screen vs exam
Oculomotor screen vs eval
Balance assessment
Positional assessment
Risk identification
What is the dizziness handicap inventory?
A 25 item self reported questionnaire of the life impact and perceived handicap from dizziness that includes three domains (functional, emotional, physical)
What does a score of 0-15 on the dizziness handicap inventory indicate?
No perceived handicap
What does a score of 16-34 on the dizziness handicap inventory indicate?
Mild handicap
What does a score of 35-52 on the dizziness handicap inventory indicate?
Moderate handicap
What does a score of 53-100 on the dizziness handicap inventory indicate?
Severe handicap
With a central problem, their HIT is typically ____ and resting nystagmus is usually _____
Negative, present
With a peripheral issue, HIT is typically _____ with ______ ______
Positive, saccadic intrusions
What is involved in the oculomotor exam?
Observation of normal ocular alignment
Testing for normal eye movt fxn
Testing central vision fxns and reflexes
Testing peripheral VOR fxn and dynamic vision
Testing of otolithic fxn
Differentiation of acute vertigo (rule out CVA)
What test can we use to observe for ocular alignment?
The cover/uncover test
What does the cover/uncover test show us?
Skew eye deviation
Phoria/tropia
Ocular tilt reflex (OTR)
What is phoria?
Resting eye position
What are we looking at with the cover uncover test?
We are looking at what happens to the covered eye when it’s uncovered and what the uncovered eye does when the other eye is covered
What skew direction with the cover uncover test indicates a central issue?
Vertical skew deviation
What a a typical sequence for the cover uncover test?
Cover one eye and look at the uncovered eye
Uncovered the eye and look at the uncovered eye
Cover the eye again and look at the covered eye
Uncover the eye again and look at the covered eye
Do on both sides
What are the triad of signs for the OTR (optic tilt reflex)?
Lateral head tilt
Skew deviation of the eyes
Ocular rotation
What is the interpretation of the cover uncover test?
It could be a central lesion affecting the vestibular nuclei
Or it could be an acute peripheral lesion affecting the otoliths
How do we perform the test for spontaneous nystagmus?
Holding the pts head with one hand, have the pt look straight ahead while you observe for nystagmus at rest
What is a normal result for the spontaneous nystagmus test?
No nystagmus
What is an abnormal result for the spontaneous nystagmus test?
Spontaneous nystagmus present
T/f: spontaneous nystagmus is NEVER normal
True
With a _____ vestibular issue, nystagmus may worsen going from fixation present to fixation removed, but with a _____ vestibular issue, nystagmus may not change with spontaneous nystagmus
Peripheral, central
If vertical/direction changing/different nystagmus in each eye is present with the spontaneous nystagmus test, would this indicate a peripheral or central issue?
Central