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Lifespan > Vestibular Rehab > Flashcards

Vestibular Rehab Flashcards

1
Q

True vertigo

A

An illusion of movement: either you feel that you’re moving, or that the room is moving

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2
Q

Imbalance

A

A tendency to fall, especially in darkness

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3
Q

Lightheadedness, Giddiness, Queasiness, Sea-sickness or Nausea

A

These are a person’s rxns to vertigo or imbalance

Sometimes referred to as vegetative symptoms

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4
Q

Faintness

A

Weakness

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5
Q

Harder to treat continuum

A

True vertigo

Imbalance

Lightheadedness, Giddiness, Queasiness, Sea-sickness or Nausea

Faintness

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6
Q

Causes of Dizziness

A

Otologic
Neurologic
General medical
Psychiatric/undiagnosed

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7
Q

Otologic cause of Dizziness

A

BPPV

Meneiere’s disease

Unilateral Vestibular paresis

Bilateral Vestibular paresis

Middle Ear Dysfx

Fistula

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8
Q

Causes of Neurological Dizziness

A

Stroke and TIA

Vertebrobasilar migraine

Nystagmus

Sensory ataxia

Basal ganglia dysfunction

Cerebellar ataxia

Seizure

Miscellaneous disorders

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9
Q

Causes of Medical Dizziness

A

Cardiovascular - hypotension, cardiac arrhythmia, CAD

Infection

Medication

Hypoglycemia

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10
Q

Correlation btwn anxiety disorders and dizziness

A

HIGH correlation

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11
Q

BPPV

A

Nystagmus: +

Duration: Seconds

Specific symptoms: Acute spinning

Precipitating action: Turning in bed

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12
Q

Vestibular Neuritis

A

Nystagmus: +

Duration: 48-72 hours

Specific symptoms: Acute onset, motion sensitivity, vomiting

Precipitating action: N/A

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13
Q

Meniere’s Disease

A

Nystagmus: +

Duration: 1-24 hours (Acute)

Specific symptoms: Fullness of ear, hearing loss, tinnitus, vomiting

Precipitating action: N/A

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14
Q

Bilateral Vestibular Disorder

A

Nystagmus: -

Duration: Permanent

Specific symptoms: Gait ataxia, oscilliopsia

Precipitating action: N/A

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15
Q

Fistula

A

Nystagmus: +

Duration: Seconds

Specific symptoms: Loud tinnitus

Precipitating action: Head trauma, sneezing, nose blowing

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16
Q

Subjective Exam

A 
Chief complaint
Onset
Duration
Frequency
Associated symptoms
Provocative positions/situations
Remitting positions/situations
PMH, FH, SH
Medications
Diagnostic test results
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17
Q

Oscillopsia

A

Decreased ability to stabilize gaze

Snellen chart test

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18
Q

Specific Questions

A

Oscillopsia

Headaches

Positioning symptoms

Motion sensitivity

Issues in dark, busy environments

Exertion induced

Coordination issues

Incontinence/memory loss

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19
Q

Fistula

A

Hole that can happen from trauma

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20
Q

Peripheral causes of dizziness

A

Inner ear

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21
Q

Central causes of dizziness

A

Brain

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22
Q

Tests for coordination

A

Finger to nose

Toe tapping with noise

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23
Q

Oculomotor Examination

A 
Ocular motility
Nystagmus
Saccades
Smooth pursuit
Head thrust
VOR Cancellation
Dynamic Visual Acuity (DVA)
Head Shaking Nystagmus
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24
Q

Vertical Nystagmus

A

CENTRAL finding until proven otherwise

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25
Q

Direction Changing Nystagmus

A

CENTRAL sign

Looking left, left beating nystagmus

Looking right, right beating nystagmus

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26
Q

Saccades

A

Significant overshooting is a central sign

Multiple undershoots is a central sign

***One undershoot is considered normal

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27
Q

Smooth Pursuits

A

Look for quality of movement

Pt follows your finger as you move it

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28
Q

VOR

Head Thrust

A

Ask pt to focus on your nose, slowly move head side to side, observing for visual fixation

Discriminates LEFT from RIGHT dysfunction – One of the most effective

Direction of HEAD MOVEMENT = DIRECTION of Dysfunction

Positive sign - If eyes go with head turn then correct back to focus on examiner

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29
Q

VOR Cancellation

A

Almost always a cerebellar pathology

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30
Q

Signs of Central Involvement

A 
Saccades
Coordination deficits
Spasticity
VOR Cancellation
Vertical Gaze Nystagmus
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31
Q

DVA

A

Suggestive of a bilateral lesion

Reading Snellen chart while head is turning side to side

3 line difference?

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32
Q

Head Shaking Test

A

Sensitive for concussions

Move head back and forth

Nystagmus often seen in patients with unilateral vestibular lesions

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33
Q

Static Balance

A

Romberg EO/EC/Foam

Sharpened Romberg EO/EC/Foam

SLS

RESULTS WILL VARY WITH PT’S ABILITY TO VISUALLY FIXATE

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34
Q

Dynamic Balance

A

Gait with head rotation

Gait with absent vision

Decreased BOS

Singleton’s Test

Gait Velocity

Standardized Assessments

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35
Q

Singleton’s Test

A

Pt may lose balance when turning to affected side

Pt walks towards examiner, turns around to one side and assumes the Romberg position with eyes closed

Left vs Right

Does NOT distinguish central vs peripheral

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36
Q

Left vs Right

A

Head thrust

Singleton’s

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37
Q

Motion Sensitivity

A

16 positions

Crazy long test

Most he’ll do is 4 positions

Just need to answer the question about motion making them dizzy

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38
Q

Types of Central Lesion

A

Epilepsy

Demyelinating diseases

Tumors

Vascular (including CVA, VBI)

Traumatic

Degenerative changes

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39
Q

Tumor vs Stroke

A

Onset

All at once - stroke

Insidious onset - tumor

40
Q

Cerebellum and Inner Ear

A

Cerebellum throttles input (diminishes input)

41
Q

Utricle

A

Bag of rocks

When you tilt your head to the side, it tells your body you’re tilted to the side

42
Q

Semicircular Canals

A

Tells brain when we’re moving

Spinning to the R - hair cells will deflect to side sending message to brain that you’re spinning

43
Q

Utricle and Semicircular Canal

A

Utricle crystals can get into semicircular canals and send confusing signals to brain

44
Q

Hallpike test Latency

A

1 second delay before true vertigo and nystagmus begins

Looking for combination of nystagmus and vertigo

Symptoms DECREASE with repetition of this test

BPPV

45
Q

Eppley Maneuver

A

Took crystal that was out of whack and brought it out of the semicircular canal to be reabsorbed into utricle

46
Q

VBI

A

Full extension and full rotation

This occludes the Vertebral artery and they can get these symptoms

Hallpike does not engage this amount of extension and full rotation

You can test for VBI in sitting before applying Hallpike maneuver

47
Q

Rebound Phenomenon

A

Complaints upon return to sitting are common

Make sure the therapist is supporting the pt from BEHIND for 60 seconds after a positive Hallpike or Eppley maneuver

48
Q

BPPV Pathogenesis

A

Posterior semi-circular canal (SSC) becomes gravity sensitive (SSCs normally respond to dynamic changes while otoliths respond to static positioning)

More common in the elderly, and usually idiopathic; with identifiable causes including head trauma, viral labyrinthitis, vestibular neuritis, and perilymph fistula

49
Q

Canalithiasis

A

Rocks from utricle are free floating in the inner ear

50
Q

Cupulolithiasis

A

Rocks become adhered to the cupula (end organ in the ampulla) making it gravity sensitive

Expect IMMEDIATE nystagmus which may not fatigue

Use the Liberatory maneuver

51
Q

Treatment of BPPV

A

Epley - posterior

Liberatory - posterior adherence OR horizontal nystagmus withOUT latency

BBQ Roll - horizontal canal involvement WITH latency

Brandt’s exercises - repeat til symptoms relax

52
Q

After a maneuver…

A

Don’t sleep on affected side for 1 week

53
Q

Estimated tx length

A

Generally pts respond quickly to a few txs (generally 1x a week) with a decrease in symptoms greater than 75%

Prognosis - excellent, 80% elimination of dizziness each successive maneuver

54
Q

Spontaneous nystagmus

A

Nystagmus in all quadrants

55
Q

Gaze-evoked nystagmus

A

Nystagmus in specific direction of gaze

56
Q

Posterior canal

A

Rotational nystagmus

57
Q

Anterior canal

A

Vertical nystagmus

58
Q

Horizontal canal

A

Horizontal nystagmus

59
Q

BPPV what percentage?

A

50% of otolithic causes of dizziness

60
Q

Unilateral Vestibular Hypofunction

A

Mismatch between both ears

So when a pt is spinning, the L is functioning correctly and R is sending poor information

Causes motion sensitivity*** characteristic complaint

Cause - ear infection (development of an UNCOMPENSATED vestibular hypofunction)

Other symptoms - minimally decreased balance (use hard balance tests), slightly ataxic with head rotations during gait

61
Q

Unilateral Vestibular Hypofunction

Pathogenesis

A

Neuronitis (no hearing loss)

Labyrinthitis (hearing loss)

Weakness/damage to one vestibular organ

Acoustic neuromas

62
Q

UVH treatments

A

VOR exercises
Repeated movements
Balance retraining

63
Q

UVH Prognosis

A

Excellent

Pts will get back to all premorbid activities

We can teach them to compensate with full vestibular fx on good side and visual/somatosensory systems

64
Q

Bilateral Vestibular Hypofunction

A

Usually happens from ototoxic medications - they damage hair cells of vestibular system (Streptomycin, vancomycin…usually given after open heart surgery)

Pts have problems reading, driving (secondary to Oscillopsia), and difficult with visually stimulating situations

***Oscillopsia primary complaint

65
Q

PT Eval

BVH

A

Positive Snellen chart (Oscillopsia test)

Pts with complete or severe vestibular loss may be unable to perform Romberg EC/Foam

LOB with Fukuda’s stepping test

Gait analysis reveals increased BOS (> 2-4 in)

66
Q

Pathogenesis BVH

A

Ototoxic drugs

Inner ear autoimmune disease

Paget’s disease

Bilateral tumors

Meningitis

Endolymphatic hydrops

67
Q

BVH tx

A

Train other systems

Assistive devices

Strengthening, stretching of LE’s

Use reachers

Gait training to eliminate furniture walking

Modify home to minimize fall risks

68
Q

Meniere’s disesase

A

Classic - episodic debilitating vertigo that lasts hours to a day or two, then it’s gone

Days weeks months years normal and then they’ll have another hit

Progressive unilateral hearing loss

Dx test - simple hearing test

Onset btwn 30-50 years

69
Q

Drop attacks

A

Tumarkin’s otolithic crisis

Meniere’s disease

70
Q

Pathogenesis of Meniere’s disease

A

Malabsorption of fluid

Mechanical problem at the ear

71
Q

Meniere’s disease tx

A

During remission, tx aimed at reduction of episodes

Dietetic programs - restricting salt, water, alcohol, and nicotine

Ablation surgery after they have it 3 times a week in frequency

After ablation, considered to have Unilateral Vestibular Hypofunction

72
Q

Migraine

A

One of the presentations of dizziness that come back negative

73
Q

Vestibular migraine aura

A

Most have dizziness with personal movement, but some had vertigo while still sitting or in supine

74
Q

Migraine with Aura

A

Transient neurological symptoms (sensory, motor, or cognitive)

75
Q

Migraine tx

A

Reduction of risk factors

Stop smoking

Reduce estrogen supplements

Diet - avoid aged alcohols, red wine, MSG, chocolate, nuts, cheese, Nutrasweet, caffeine

Keep diary to ID causative factors

If several migraines per month, consider prophylactic meds

76
Q

Meniere’s vs Migraine Aura without headache

A

Tinnitus in both

Phonophobia and photophobia in migraines

Naps usually help migraines

Motion sickness common in migraines

77
Q

Perilymphatic fistula

A

Causation - blowing nose, BM

Report hearing a pop in the past

Symptoms will reside with rest and reoccur with activity

78
Q

PF tx

A

Absolute bed rest for 5-10 days with head elevated

Avoidance of straining, sneezing, coughing, or head hanging positions

Use of stool softeners

If symptoms last > 4 weeks or hearing loss worsens consider exploratory tympanotomy with surgical packing of fistula

79
Q

Cervicogenic dizziness

A

Altered afferent proprioceptive signals from upper cervical spine

Correlated with whiplash/neck pain

Can see with balance/gait dysfunction

Neck movement usually aggravates symptoms

80
Q

Cervicogenic dizziness tx

A

Cervical traction as both diagnostic test and tx

Focus on upper cervical spine

Cervical kinesthesia exercises

81
Q

VOR x1 Viewing

A

Finger stationary

Pt moves head and keeps object in focus

10 min rule - no worse for wear 10 min after exercises

82
Q

VOR x2 Viewing

A

Moving finger, moving head in opposite directions

Keeping object in focus

10 min rule - no worse for wear 10 min after exercises

83
Q

Bifocals and VOR

A

Ask them to do it in ONE area or with glasses off

VOR for visual acuity

If someone wears glasses all the time, they would need to do training with glasses on

Pts that use reading glasses need to train with glasses both on and off

84
Q

VOR training

A

Week 1 and 2

85
Q

Habituation

A

Choose up to 4 activities that bring on mild to moderate dizziness

Client performs these exercises quickly

As motion sensitivity improves, can substitute more difficult activities

Duration of symptoms more important than intensity of symptoms

86
Q

Improvement in Habituation indicated by…

A

Decreased number of provoking positions

Increased number of reps before symptom occurrence

Decreased intensity of symptoms

Shorter duration of symptoms

87
Q

Cervico-ocular reflex

A

Parallels VOR, contributes to a slow-component eye rotation in the direction opposite to head movement in place of a deficient vestibular system

Generated by joints in neck

Works at slower speeds than VOR

88
Q

Imaginary target exercise

A

Visualize target, turn head, see if you’re still focused on it

89
Q

Number Board

A

Tx of gaze evoked nystagmus

Look at different sides of number board

Given during week 3 or 4

90
Q

Saccades improvement

A

Central dysfunction

Try to work on decreasing amount of undershoots and avoiding overshoots

91
Q

Convergence exercises

A

After stroke

Easier to focus on something distally than closely because of double vision

92
Q

Antivert

A

Vestibular inhibitor

Helpful if the system is sending excessive, overwhelming information

ACUTE stage of ear infection, CVA, MS, Meniere’s

Long term use depresses the system we’re trying to retrain in PT

DISCUSS WITH REFERRAL SOURCES

93
Q

VOR order

A

Horizontal then Vertical

94
Q

No vestibular system?

A

COR exercises
Assistive devices
Compensation

95
Q

Vestibular Rehab Goals

A

Differentiate subjective complaints of dizziness

Understand most common types of vestibular causes of dizziness and their presentation

Develop a treatment plan for each dx based on case studies presented

96
Q

Double vision

A

Corrects all at once

Lifespan (18 decks)

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