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Medical PCM I > Vestibular Rehab > Flashcards

Vestibular Rehab Flashcards

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USMLE® Step 1 flashcards
1
Q

Purposes of Peripheral Vestibular System

A

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

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2
Q

What are the SCC primarily involved in?

A

Gaze stabilization

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3
Q

What are the otolith organs?

A

Saccule & Utricle

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4
Q

What do the otolith organs respond to?

A

Linear acceleration and gravity, assist with postural stability

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5
Q

What flows freely within the SCC and why?

A

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

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6
Q

What is the tonic firing rate?

A

80 pulses per second

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7
Q

Whats the relationship of the tonic firing rate?

A

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

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8
Q

What is VOR?

A

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

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9
Q

What velocity does VOR operate up to?

A

400 deg/sec (60-400)

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10
Q

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

A

Smooth pursuit.

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11
Q

What is the push-pull mechanism?

A

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

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12
Q

How does the push pull mechanism work?

A

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

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13
Q

What is the inhibitory cut off?

A

Hyperpolarization can only go to 0 not to neg numbers.

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14
Q

What might people with vestibular problems have a history of?

A

Dizziness, vertigo, lightheaded, disequilibrium, oscillopsia

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15
Q

How do you measure symptoms?

A

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

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16
Q

How is the direction of nystagmus named?

A

By the FAST eye movement.

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17
Q

When is nystagmus suppressed?

A

In the light and when pt is fixated on target.

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18
Q

What is pendular nystagmus?

A

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

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19
Q

Contraindications to Head Thrust Test

A

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

20
Q

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

A

Fast: The healthy ear
Slow: the involved ear

21
Q

Vestibular testing

A 
Head thrust
Head shaking induced nystagmus
Clinical Dynamic Visual Acuity test
Caloric Testing
Rotary Chair Testing
22
Q

Otolith Tests

A

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

23
Q

Signs of central problem

A

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

24
Q

Peripheral pathology

A

Mechanical (BPPV)

Decreased receptor input

25
Q

What is BPPV?

A

Benign paroxysmal positional vertigo

26
Q

What causes BPPV

A

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

27
Q

What is the main treatment for BPPV?

A

Particle-repositioning maneuvers, if those fail then habituation.

28
Q

What are the particle repositioning maneuvers?

A

Epley, Liberatory-Semont, BBQ Roll

29
Q

What is Meniere’s Disease?

A

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

30
Q

What is a perilymphatic fistula?

A

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

31
Q

What is an acoustic neuroma?

A

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

32
Q

What else is motion sickness called?

A

Mal de Debarquement

33
Q

What is the sensory Conflict Theory?

A

Ongoing conflicting signals. Proprioceptive, vestibular, visual systems.

34
Q

What are symptoms of Motion sickness?

A

Pallor, nausea/emesis, diaphoresis, motion sensitivity

medication/habituation.

35
Q

Migrane related dizziness

A

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.

36
Q

Contraindications to Vestibular Rehab

A 
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.
37
Q

Positional Tests

A

Hallpike-Dix

Roll Test - horizontal SCC

38
Q

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

A

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

39
Q

Canalithiasis

A

Free floating otoconia

40
Q

Cupulotlithiasis

A

Adherent otoconia

41
Q

Epley Maneuver

A

Canalith repositioning maneuver.

Hallpike dix - then rotate 45 deg –> SL -> 45 deg again –> sit up. Ant/post SCC.

42
Q

BBQ Roll

A

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

43
Q

Liberatory Semont

A

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.

44
Q

Habituation exercise

A

Brandt-Daroff

45
Q

Gaze Stability exercise

A

VOR 1, VOR 2

46
Q

Fukuda Stepping

A

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

Medical PCM I (10 decks)

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