Vestibular Rehab

Question 1

Spontaneous Nystagmus

Answer 1

Head stationary
Look straight ahead
PT observes

Question 2

Spontaneous Nystagmus
Unilateral
Bilateral
Central

Answer 2

U - acute, frequently seen
B - possible but infrequent
C - frequently seen, non fatiguable

Question 3

Smooth pursuit and Gaze holding Nystagmus

Answer 3

Head stationary
Pt follows PT finger to 30 degrees R, L, up, down with a 15 second hold at each point
PT observes eye movement and any saccadic movement

Question 4

Gaze holding Nystagmus
Unilateral
Bilateral
Central

Answer 4

U - typically normal
B - typically normal
C - nystagmus

Question 5

Optokinetic Nystagmus

Answer 5

Slide striped paper in front of pt visual field

Question 6

Optokinetic Nystagmus
Unilateral
Bilateral
Central

Answer 6

U - normal (should see saccadic eye movement)

C - absence of saccadic eye movements indicated eye lesion

Question 7

Smooth Pursuit Nystagmus
Unilateral
Bilateral
Central

Answer 7

Uni - Typically normal
Bilat - Typically normal
Cent - Usually abnormal (CN 3, 4, 6)

Question 8

Saccadic Eye movement

Answer 8

Head stationary 
PT 2 fingers, 15 degrees to R and L of pt nose 
Pt looks alternating R and L 
May do horizontal and vertical 
PT observes

Question 9

Saccadic Eye movement
Unilateral
Bilateral
Central

Answer 9

Uni - typically normal
Bilat - typically normal
Cent - frequently see overshooting, undershooting

Question 10

VOR cancellation -

Answer 10

Head flexed to 30 degrees with pt focus on PT nose
PT rotates head 30 degrees R, L they move in the same direction
PT observes for saccadic eye movements

Question 11

VOR cancellation - Alternative method

Answer 11

Pt moves head and eyes together to follow a moving target

PT can use finger for patient to track

Question 12

VOR cancellation
Unilateral
Bilateral
Central

Answer 12

Abnormal if acute
Typically normal
Saccadic eye movements typical

Question 13

VOR Head thrust (Halmagyi)

Answer 13

Pt head flexed to 30 degrees and focused on PT nose

PT moves pt rapidly rapidly R for small amplitude - Repeat with L

Question 14

VOR Head Thrust - Alternative method - head shaking nystagmus

Answer 14

Pt focuses on PT finger while pt shakes head R and L

Question 15

VOR Head thrust
Unilateral
Bilateral
Central

Answer 15

Uni - saccades noted which is a typical abnormal finding, especially in acute phase
Bilat - usually abnormal findings
Central - usually normal

Question 16

Static and dynamic visual acuity (DVA)

Answer 16

Pt sits 4 meters from visual eye chart (with eyeware)
Reads to lowest line possible, PT notes # of line
PT behind pt, pt head to 30 degrees flex and PT moves pt head bilaterally 2 Hz while pt reads to lowest line

Question 17

Static and dynamic visual acuity (DVA)
Unilateral
Bilateral
Central

Answer 17

Uni - Typically abnormal with dec of 3 or more lines on chart
Bilat - abnormal
Cent - usually normal (less than 3 line change)

Question 18

Hallpike Dix test

Answer 18

Positive for BPPV