Vestibular Rehab

Question 1

Purposes of Peripheral Vestibular System

Answer 1

Stabilize visual images on the fovea of the retina during head movement
Maintain postural stability
Provide information used for spatial orientation

Question 2

What are the SCC primarily involved in?

Answer 2

Gaze stabilization

Question 3

What are the otolith organs?

Answer 3

Saccule & Utricle

Question 4

What do the otolith organs respond to?

Answer 4

Linear acceleration and gravity, assist with postural stability

Question 5

What flows freely within the SCC and why?

Answer 5

Endolymph. Moves the otoconia in the cupula (sensory receptors)

Question 6

What is the tonic firing rate?

Answer 6

80 pulses per second

Question 7

Whats the relationship of the tonic firing rate?

Answer 7

For each degree/sec change in head velocity there is a 1 pulse/sec change in firing rate.

Question 8

What is VOR?

Answer 8

Vestibulo-ocular reflex. Maintains gaze stability during rapid head movements.

Question 9

What velocity does VOR operate up to?

Answer 9

400 deg/sec (60-400)

Question 10

What maintains gaze stability when head is moving at less than 60 deg/sec?

Answer 10

Smooth pursuit.

Question 11

What is the push-pull mechanism?

Answer 11

SCC’s work in pairs. Right ant/left post, right post/left ant, right and left horizontal.

Question 12

How does the push pull mechanism work?

Answer 12

As head is turned to the RIGHT, the R horizontal SCC is depolarized = increased firing rate, and L is hyperpolarized = decreased firing rate.

Question 13

What is the inhibitory cut off?

Answer 13

Hyperpolarization can only go to 0 not to neg numbers.

Question 14

What might people with vestibular problems have a history of?

Answer 14

Dizziness, vertigo, lightheaded, disequilibrium, oscillopsia

Question 15

How do you measure symptoms?

Answer 15

VAS, Dizziness Handicap Inventory (DHI), Functional disability scale, Motion sensitivity quotient.
FReq/duration of episodes, circumstances of provocation.

Question 16

How is the direction of nystagmus named?

Answer 16

By the FAST eye movement.

Question 17

When is nystagmus suppressed?

Answer 17

In the light and when pt is fixated on target.

Question 18

What is pendular nystagmus?

Answer 18

No fast or slow phase. Caused by CNS lesion. Usually cerebellum..

Question 19

Contraindications to Head Thrust Test

Answer 19

Cervical instability, recent whiplash injury, screen c-spine.

Question 20

Which ear is the fast phase of nystagmus towards? Slow?

Answer 20

Fast: The healthy ear
Slow: the involved ear

Question 21

Vestibular testing

Answer 21

Head thrust
Head shaking induced nystagmus
Clinical Dynamic Visual Acuity test
Caloric Testing
Rotary Chair Testing

Question 22

Otolith Tests

Answer 22

VEMP
Subjective Visual Vertical (SVV)
Subjective Visual Horizontal (SVH)

Question 23

Signs of central problem

Answer 23

Rare - less intense
Upbeat or pendular nystagmus.
Lateropulsion/head tilt (SVV & ocular torsion)
Ocular tilt reaction

Question 24

Peripheral pathology

Answer 24

Mechanical (BPPV)

Decreased receptor input

Question 25

What is BPPV?

Answer 25

Benign paroxysmal positional vertigo

Question 26

What causes BPPV

Answer 26

Otoconia are displaced in the SCC. Sx precipitated by change in head position (posiitonal vertigo, dizziness, nausea/nystagmus)

Question 27

What is the main treatment for BPPV?

Answer 27

Particle-repositioning maneuvers, if those fail then habituation.

Question 28

What are the particle repositioning maneuvers?

Answer 28

Epley, Liberatory-Semont, BBQ Roll

Question 29

What is Meniere's Disease?

Answer 29

Low freq hearing loss, episodic vertigo, maybe tinnitus related to endolymph build up gaze/postural stability

Question 30

What is a perilymphatic fistula?

Answer 30

Rupture of oval or round window (membrane between middle/inner ear), fluids leak into middle ear = vertigo/hearing loss. PT contraindicated. Unless hypofunction.

Question 31

What is an acoustic neuroma?

Answer 31

Vestibular schwannoma - benign tumor CN VIII Progressive hearing loss, tinnitus, dysequilibrium Balance/stab exercises.

Question 32

What else is motion sickness called?

Answer 32

Mal de Debarquement

Question 33

What is the sensory Conflict Theory?

Answer 33

Ongoing conflicting signals. Proprioceptive, vestibular, visual systems.

Question 34

What are symptoms of Motion sickness?

Answer 34

Pallor, nausea/emesis, diaphoresis, motion sensitivity | medication/habituation.

Question 35

Migrane related dizziness

Answer 35

similar to peripheral vestibular lesion. Vascular event occurs in vestibular structure. Migrane with/without aura, imbalance/vertigo without hearing loss or tinnitus. Throbbing headache, made worse by activity, nausea, sensitivity to light/noise.

Question 36

Contraindications to Vestibular Rehab

Answer 36

``` Unstable vestibular disorders Sudden loss of hearing Increased feeling of pressure in the ears Severe ringing in one or both ears Discharge of fluid from ears/nose Caution with acute neck injuries. ```

Question 37

Positional Tests

Answer 37

Hallpike-Dix | Roll Test - horizontal SCC

Question 38

In the hallpike-dix which ear is the ear being tested?

Answer 38

The one toward the ground in end position. Anterior/posterior SCC

Question 39

Canalithiasis

Answer 39

Free floating otoconia

Question 40

Cupulotlithiasis

Answer 40

Adherent otoconia

Question 41

Epley Maneuver

Answer 41

Canalith repositioning maneuver. | Hallpike dix - then rotate 45 deg --> SL -> 45 deg again --> sit up. Ant/post SCC.

Question 42

BBQ Roll

Answer 42

Canalith repositioning maneuver. TO Affected side first. Roll test, but keep rolling into prone face into table, keep head down and sit up. Keep head minimal movement 1 day. Horizontal SCC

Question 43

Liberatory Semont

Answer 43

Hallpike dix --> then switch person to other direction without moving head, "bang" head 3 times. Sit up. Can apply soft collar. For adherent otoconia in posterior SCC.

Question 44

Habituation exercise

Answer 44

Brandt-Daroff

Question 45

Gaze Stability exercise

Answer 45

VOR 1, VOR 2

Question 46

Fukuda Stepping

Answer 46

close eyes and march 30 seconds or until safety risk. Balance/inner ear test.