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A:NEURO 3 > vestibular rehab foundational knowledge > Flashcards

vestibular rehab foundational knowledge Flashcards

1
Q

what are the 2 systems that the vestibular system is broken down to

A

peripheral and central

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2
Q

the inner ear and 8th cranial nerve is apart of which vestibular system?

A

peripheral

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3
Q

the vestibular nuclei , cerebellum and higher cortical connections is apart of what vestibular system

A

central

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4
Q

what 2 things give us spatial awareness

A

vision and somatosensation

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5
Q

spatial awareness gives us what 3 things

A

balance and gaze stability

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6
Q

what is the most common complaint with people with vestibular problems

A

dizziness

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7
Q

what is a a strong predictor of falls in the elderly people

A

presence of dizziness

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8
Q

____ 2nd only to LBP in occurrence in adults

A

dizziness

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9
Q

Vestibular therapists use ______ to re-train the brain to interpret and utilize vestibular inputs more accurately.

A

neuroplasticity

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10
Q

Vestibular system functions to sense _____… resulting symptoms of ____

A

movement
malfunction

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11
Q

what is it called when someone experiences false sense of movement i.e spinning , r4ocking , swaying

A

vertigo

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12
Q

what kind of movement does the semicircular canals detect

A

angular and rotational

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13
Q

what part of the ear detects linear movement

A

saccule and utricle

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14
Q

what is included in the inner ear

A

semi circular canals

cupola

cochlea

endolymoh

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15
Q

what is important in terms of converting mechanical energy from the nervous system and it is a fluid that fulls the inner ear

A

endolymph

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16
Q

what has hair receptors cells that get stimulated by the sound vibration ?

A

cochlea

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17
Q

what is the hair cells within the ampula

A

cupula

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18
Q

how do the semi circular canals line up with each other

A

the L post canal is lines up with the R anterior canal

the R anterior canal is lined up with the L postioer canal

and both horizontals line up together

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19
Q

what happens with the endolymph when the head turns to the L

A

endolymph moves thru the horizontal canal and thru the cupula and bends the hair cells , inhibiting the R ear adn then exciting the L ear

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20
Q

when you turn ur head to the R the endolymph move to the __

A

left

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21
Q

what sits on top of the hair cells in the utricle and saccule

A

odoconia

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22
Q

what are microscopic calcium carbonate crystals , that respond to gravity or movement

A

otoconia , located in the uticle and saccule

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23
Q

what part of the ear detects when u move ur head up , down , left , right and forward and backwards

A

utricle and saccule

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24
Q

what nerve of the vestibuylochoclear nerve is responsible for sound info and which one is responsible for movement info

A

cochlear and vestibular

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25
Q

where does the vestibulocochlear n travel to

A

the BS

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26
Q

what part of the brain gets a lot of the sound signals bc it control movement coordination and balance

A

cerebellum

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27
Q

what tract is activated by reflex when we move our head and it sends a signal straight from BS down to SC to our spinal mm to balance us

A

vestibulospinal tract

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28
Q

what Cranial nerves are invovled in the vestibulo- ocular reflex

A

oculomotor nerve (3)
trochlear n (4)
abducens nerve (5)

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29
Q

what is the vestibular ocular reflex

A

maintains gaze stability during head motion ; controlling eye head coordination

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30
Q

what is the vestibulo spinal reflex

A

maintains head and body equilibrium by facilitation or inhibiting skeletal mm activity thus controlling coordination for balance

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31
Q

what is the cervical ocular reflex

A

reflex output to motor cells , signals head position on body

,maintains gaze stability secondary to VOR

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32
Q

where does the otolith ocular reflex receive input from and what does it control

A

utrucle and saccule ; output to eye mm

controls horizontal and vertical eye movement via linear VOR

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33
Q

what reflex Maintains gaze stability during head motion thus controlling eye-head coordination

A

vestibular ocular reflex

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34
Q

what higher cortical places in the brain have connections with the vestibular systems

A

thalamus, visual cortex , hippocampus

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35
Q

the ____ vestibular system affects the motion system

A

peripheral

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36
Q

• BPPV
• Neuritis
• Labyrinthitis
• Acoustic neuroma
• Hypofunction
• Unilateral
• Bilateral
• Endolymphatic Hydrops/Meniere’s
• Fistula/Dehiscence

these are all pathophysiology of what part of the vestibular system

A

peripheral

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37
Q

problems with the peripheral vestibular system affects ___ and ____ of movement information

A

sensation and perception

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38
Q

what problem is it when the otoconia become dislodged from the utricle or saccule and displaced into a semi circular canal and affects endolymph flow thru the canal and cupula deflection

A

benign paroxysmal positional vertigo (BPPV)

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39
Q

what causes BPPV

A

idiopathic
head trauma
inflammation
ischemia
pressure fluctuations

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40
Q

what are risk factors after BPPV

A

age
female
vitamin D deficiency
hypertension
migraine
hyperliipemia

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41
Q

what are the symptoms of BPPV

A

10-60 sec spell of vertigo with changes in head position against gravity

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42
Q

what is BPPV

A

when otoconia come out from the utricle or saccule and displace into the semi circular canal

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43
Q

T/F: BPPV is positional and changes with head position

A

T

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44
Q

what are the two different types of BPPV

A

canalithiasis and cupuloithiasis

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45
Q

what is BPPV Canalithiasis

A

when otoconia are free floating in the semicircular canal , causing abnormal flow of endolymph with changes in head position against gravity

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46
Q

How is the onset , symptoms and how long does canalithiasis BPPV last

A

latent onset of vertigo and nystagmus (seconds)

symptoms gradually intensity then subside (episodic)

last less than 1 min

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47
Q

pertaining to cupuloithiasis BPPV what is the onset , how are the symptoms , and how long does it last

A

more immediate onset of vertigo and nystagmus

symptoms intensity remains the same

lasts as long as the head is held in the provoking position

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48
Q

what is BPPV; cupuloithiasis

A

otoconia are stuck to the cupula , causing deflection of the cupula with change in head position against gravity

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49
Q

what part of the ear is common for ear infection

A

middle eat

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50
Q

what part of the ear is more common for virtual infection

A

inner ear

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51
Q

what is the pathophysiology of neuritis/ labyrinthitis

A

inflammation of the inner ear ( labyrinthitis) or vestibular n (neuritis), causing vestibular hypesitmulation and may result in damage leading to hypofunction

52
Q

what is the main difference between neuritis and labyrinthitis

A

neuritis has no hearing loss invovled and it affects the nerve

labyrinthitis includes hearing loss and affects the actual strucutre of the inner ear

53
Q

what are causes of neuritis/ labyrinthitis

A

viral infection 98% and head injury

54
Q

is it common from neuritis to reoccur

A

no viral infections are very unlikely to ever reoccur bc of the body immune system

55
Q

what are the symptoms of neuritis/ labyrinthitis

A

sudden onset of vertigo, nausea , lasting 3-7 days with residual balance and dizziness lasting 1-2 weeks

often follows other illness (respiratory infection)

56
Q

what is hypofunction

A

damage to the inner ear or vestibular n that results in a diminished or weaker neurological signal

can be unilateral or bilateral

57
Q

what is the hallmark for bilateral hypofunction

A

when the patient sees things jumping/bouncing (called oscillopsia)

58
Q

what are causes of hypofunction

A

neuritis
labrinthitis
ménière’s disease
acoustic neuroma
ototixic medication
gentamicin
meningitis
ear sx

59
Q

symptoms of hypofunction

A

affects VOR and VSR
postural instability
gaze instability
movement related to dizziness
motion sensitivity
foggy headedness
knesiphobia
oscillopsia

60
Q

in Hypofunction ____ allows for CNS compensation

A

neuroplasticity

61
Q

what is the pathophysiology of acoustic neuroma

A

benign , slow growing tumor of the myelin sheath (schwann cells) covering the acoustic/ cochlear or vestibular n causing compression of CN 8

62
Q

what are the casues of acoustic neuroma

A

idipathic or genetic

63
Q

what is acoustic neuroma also called

A

cerebellopontine angle tumor, vestibular or acoustic schwannoma

64
Q

what are the symptoms of acoustic neuroma

A

gradual onset** of unilateral hearing loss
tinnitus
imbalance
motion sensitivity
facial numbness/weakness

65
Q

T/F: acoustic neuroma lacked TRUE vertigo symptoms

A

T

66
Q

what is the pathophysiology of endolymphastioc hydrops/ Meniere’s

A

Build-up of endolymphatic fluid within the inner ear,
causing pressure on the inner ear membranes and hair cells. Can cause inflammation and damage over time.

can be unilateral or bilateral

67
Q

is Endolymphatic Hydrops/Meniere’s a one time thing or can it be reoccurring

A

reoccurring

68
Q

what are causes of Endolymphatic Hydrops/Meniere’s

A

idiopathic (meniere’s)
sodium/potassium imbalance (systemic)
middle ear congestion

69
Q

symptoms of Endolymphatic Hydrops/Meniere’s

A

REOCCURING episodes of vertigo lasting 1-3 days with gradual improvement over 1-2 weeks

low frequency hearing loss

70
Q

what is the pathophysiology of Fistula/Dehiscence

A

Structural “hole” in the inner
ear, then unable to regulate endolymph fluid
pressure and flow.

71
Q

is Fistula/Dehiscence reoccurring or one time

A

reoccuring

72
Q

is Fistula or Dehiscence the structural hole in the inner ear

A

dehiscence

73
Q

what are the causes of Fistula/Dehiscence

A

trauma , head injury , or valsalva (rare)

74
Q

what are say symptoms of Fistula/Dehiscence

A

reoccuring spells of vertigo , possible associated with loud sounds and barometric pressure changes , hearing hypersentivitiy, imbalance and motion sensitivity

75
Q

• Stroke
• Brain tumor
• Multiple Sclerosis lesions
• Degenerative neurological conditions
• Vestibular Migraine
• PPPD
• MDDS
• Anything affecting the central vestibular connections in the brain and brainstem

these are all pathophysiology of what part of the vestibular system

A

central

76
Q

pathophysiology in the central vestibular system affects ____ and ____ of movement information

A

perception and integration

77
Q

what kind of disorder is a vestibular migraine

A

sensory perception disorder

is sure with how th brain receives and interprets sensory information

78
Q

since the causes of a vestibular migraine is UNKNOWN what are the risk factors (4) and common triggers (6) for it

A

Risk factors: female, Magnesium deficiency, migraine history

• Common triggers: Stress, hormone fluctuations, weather changes, poor sleep,
caffeine, alcohol,

79
Q

what are the symptoms of a vestibular migraine

A

recurring r episodes of vertigo
lasts 1-5 days

often associated with headache , photophobia , photophobia , brain fog , anxiety , dissociative symptoms and visual issues

80
Q

what is the pathophysiology of persistent postural positional dizziness (PPPD) (aka chronic functional dizziness)

A

autonomic and emotional hyper responsiveness to vestibular stimulus

81
Q

what are the causes of PPPD

A

abnormal adapatation following a vestibular trauma ( BPPV , vestibular migraine , unilateral vestibular pathology)

82
Q

what are the symptoms of PPPD

A

constant visual motion sensitivity and imbalance coupled with anxiety , kinesiophobia , “visual vertigo” , “space motion discomfort” ,

last over > 3 months

83
Q

what is the pathophysiology of Mal de Debarquement (MDDS)

A

mal adaptation following disembarking a moving vehicle (continue sensation of movement after getting off of something that has been moving) `

84
Q

what are the casues of Mal de Debarquement (MDDS)

A

unknown but associated with anxiety and emotional responses to dizziness

85
Q

what are the symptoms of Mal de Debarquement (MDDS)

A

persistent sensation of rocking or swaying that lasts beyond the expected period of adaptation

86
Q

what are the non vestibular pathology associated with cardiovascular

A

• Orthostatic hypotension
• Low/high blood pressure
• Vertebral basilar artery insufficiency

87
Q

what are the non vestibular pathology associated with metabolic

A

• Low/high blood sugar
• Dehydration
• Infection (UTI, URI)
• Medications

88
Q

what is the most common self report outcome measure for dizziness/vertigo

A

dizziness handicap inventory (DHI)

89
Q

what does the dizziness handicap inventory (DHI) asl

A

25 questions about how dizziness is impacting function

yes, no, sometimes

0: no handicap , 100: complete handicap

90
Q

what is the most importantly part of the assessment process for a vestibular patient

A

the subjective

91
Q

during the subjective what are u looking for

A

clues for differential diagnosis and functional impact

92
Q

what is vertigo

A

illusion of movement (spinning , rocking ,swaying , falling)

93
Q

what is disequilibrium

A

sense of being off balance

94
Q

what is the symptoms of a cardiovascular problem pertaining to a vestibular patient

A

light headed , pre syncope , tunnel vision

95
Q

what is the symptoms of a anxiety problem pertaining to a vestibular patient

A

floating , swimming ,rocking

96
Q

what is the symptoms of a visual problem pertaining to a vestibular patient

A

diplopia (seeing double)
oscillopsia (vision jumping)

97
Q

what is the tempo (frequency and duration) of vestibular neuritis or labrinthitis

A

sudden onset/acute
lasting days
single event

98
Q

what is the tempo (frequency and duration) of BBPV

A

short spells (seconds)
recurring

99
Q

what is the tempo (frequency and duration) of bilateral hypofunction

A

gradual onset over months/years
constant/ chronic

100
Q

what is the tempo (frequency and duration) of meniere’s or vestibular migraine

A

sudden/acute
recurring spells (hours-days)

101
Q

what is the tempo (frequency and duration) of wallenberg infarct

A

sudden onset/acute
hours-days
single event

102
Q

what is the tempo (frequency and duration) of orthostatic hypotension

A

short spells (seconds -mins)
recurring

103
Q

what is the tempo (frequency and duration) of MDDS or PPPD

A

constant
fluctuating severity ,
chronic

104
Q

what is the aggravating and easing factor for BPPV

A

A: positional like lying down , sitting up or turning over

E: holding still, time

105
Q

what is the aggravating and easing factor for gaze instability

A

A: head movement , visual vestibular mismatch

E: holding still, closing eyes

106
Q

what is the aggravating and easing factor for imbalance

A

A: walking , darkness , unstable surfaces , standing up

E: sitting , support from UEs

107
Q

what is the aggravating and easing factor for vestibular neuritis

A

A: spontaneous, exacerbated by head movements

E: holding still , closing eyes , meds

108
Q

what is the aggravating and easing factor for vestibular migraine or meniere’s

A

A: spontaneous , exacerbated by head movements and common triggers

E: holding still, closing eyes, meds

109
Q

what are the co morbidities for a vestibular issue

A

diabetes
BP
auto immune conditions
anxiety
depression
peipheral neuropathy

110
Q

what meds are considered vestibular suppressants

A

meclizine
dramamine
valium

111
Q

____ is a common medication side effect

A

dizziness

112
Q

what are some diagnostic test done for vestibular tests

A

audiogram , VNG/ ENG

113
Q

what is nystagmus

A

rapid repeating eye movement

114
Q

how is nystagmus names

A

by the fast phase from the patients perspective

115
Q

what is slow phase and fast phase nystagmus caused by in the vesitbular system

A

slow: VOR
fast: caused by corrective saccades by cerebellum

116
Q

what nystagmus id casues by the CNS

A

smooth pursuit and saccades - BS and cerebellum

117
Q

peripheral vestibular nystagmus ….

slow phase caused by ____
fast phase caused by ___ _____
____ fixed
usually _____
decreased in intensity with _____
gaze towards ___ phase increased intensity (____ law)

A

VOR
corrective saccade
direction
horizontal
fixation
fast
alexander’s

118
Q

what is the exceptions for peripheral vesitbular nystagmus

A

BBPPV

119
Q

what is alexander’s law for peripheral vestibular nystagmus

A

gaze towards the fast phase increased intensity

120
Q

so if a patient comes in with left nystagmus and it is peripheral vestibular what should happen when the patient looks left and looks right and what fixation

A

pertaining to alexander’s law when the painter looks L the intensity should increased bc the patient is gazing toward the fast phase side and when she looks to the eR it should decreased

and it should decreased with fixation bc it is a peripheral issue

121
Q

central nervous system nystagmus

___ changing (often follows gaze)
can be ___ or _____
not affected by ____
_____
usually from a ___

A

direction
vertical or pendular
fixation
congenital
trauma

122
Q

if you are examining a patient w nystagmus and their nystagmus changes when they look to the L and when they look to the R what system is it

A

central bc it is direction changing

123
Q

what are 3 tools used for observing nystagmus

A

frenzel and infrared goggles
VNG/ENG (nystagmography)
rotary chair

124
Q

what does the frenzel and infrared goggles take away

A

fixation

125
Q

what is the gold standard for identifying unilateral vestibular hypofunction

A

VNG/ENG (nystagmography)

126
Q

what is the rotary chair the gold standard for

A

identifying bilateral hypofunction

127
Q

what is the purpose of an examination for a vestibular patient

A

screen for vestibular involvement
DD
identify impairments

A:NEURO 3 (5 decks)

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