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PTRS 853 Final > Vestibular Rehabilitation > Flashcards

Vestibular Rehabilitation Flashcards

1
Q

Functions of the vestibular peripheral sensory apparatus (2)

A
  1. Input on angular and linear acceleration
  2. Orients the head with respect to gravity
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2
Q

Functions of the vestibular central processing system (3)

A
  1. Somatosensory and visual cues
  2. Large contribution from cerebellum
  3. Involvement of reticular formation and cortex
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3
Q

List the 2 major motor outputs of the vestibular system

A
  1. Output to the eyes [gaze stability]
  2. Output to the postural system [stability w/locomotion]
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4
Q

List the 5 sensory organs contained in the peripheral sensory apparatus

A

3 semicircular canals [ant, post, lat]

2 otolith organs [utricle, saccule]

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5
Q

List the function of:

  1. Semicircular canals
  2. Otolith organs
A
  1. Angular acceleration
  2. Linear acceleration
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6
Q

Semicircular canals: Each canal plane is ______1______ to the other canal planes. The planes of the semicircular canals between ____2____ conform closely to each other forming 3 coplanar __3__. These are associated with a ______4______ change in the quantity of semicircular canal ___5___. These planes of the canals are close to the planes of the _________6__________, thus allowing simple connections relating the two.

A
  1. Perpendicular
  2. Labyrinths
  3. Pairs
  4. Push-Pull
  5. Output
  6. Extraocular Muscles
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7
Q

Describe the effect of the push-pull change

A

The push-pull change makes the vestibular system twice as sensitive. Conversely if one canal is effected, the vestibular system can still sense movement, just with less sensitivity.

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8
Q

VOR Gain: Normally as the head moves in one direciton the __1__ move in the opposite direction with equal ____2____. VOR Gain = ____________3___________. VOR is regulated by the _______4________. The vestibular system responsible for maintaing gaze stability at ___5___. While the CNS is response for ________6________ for maintaining gaze stability at ___7___.

A
  1. Eye
  2. Velocity
  3. Eye velocity/Head velocity
  4. Semicircular canals
  5. > 60 deg/sec
  6. Smoot pursuit
  7. < 60 deg/sec
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9
Q

Term: differences between sides in the tonic firing rate within the vestibular nuclei

A

Nystagmus

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10
Q

Nystagmus: Indicates that one vesitbular system is ______1______ than the other. ___2____ beat always toward more active side. If fast begint right, right side is _____3_____ or left side is _____4______. Nystagmus is named for the _______5______ of the ___6___ beat.

A
  1. More active
  2. Beat
  3. Hyperactive
  4. Hypoactive
  5. Direction
  6. Fast
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11
Q

List the 6 causes of dizziness

A
  1. Peripheral vestibular disorder
  2. Non-vestibular causes (i.e. disuse disequilibirum)
  3. Orthostatic hypotension
  4. TIA from vertebrobasilar ischemia
  5. Panic attacks
  6. Migraines
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12
Q

List 4 peripheral vestibular disorders that cause dizziness

A
  1. BPPV
  2. Meniere’s
  3. Neuritis
  4. Perilymphatic fistula
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13
Q

Define orthostatic hypotension

A

Systolic BP drops by at least 20 mmHg wihtin 3 min of standing and patient is symptomatic (c/o dizziness)

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14
Q

Describe how the following conditions differ from vestibular dizziness

  1. TIA from vertebrobasilar ischemia
  2. Panic attacks
  3. Migraines
A
  1. Also c/o N/T and isolated weakness
  2. reaches a crescendo in 10 min associated w/dizziness
  3. Last 4-60 min w/ or w/o HA [difficult to ddx from vestibular]
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15
Q

Vertigo is more common with _____1_____ issues. Nystagmus is __2__ with peripheral issues and ____3____ or ____4____ with central issues. Balance is more affected in ____5____ issues. Smooth pursuit and saccades is abnormal in _____6_____ issues. Hearing is usually affected in _____7_____ issues and includes sx such as hearing loss, tinnitus, and fullness in the ears. Compensation of peripheral issues is ____8____ while it is ____9____ in central issues.

A
  1. Peripheral
  2. Jerky
  3. Vertical
  4. Perpendicular
  5. Central
  6. Central
  7. Peripheral
  8. Quick
  9. Slow
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16
Q

List the tests to exam body function and structure for vestibular problems (3)

A
  1. Oculomotor tests
  2. Dix-Hallpike
  3. Balance: mCTSIB
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17
Q

List the tests to exam activity for vestibular problems (2)

A
  1. DGI
  2. Functional Gait Assessment
18
Q

List the tests to exam participation for vestibular problems (3)

A

QUESTIONNAIRES

  1. Dizziness handicap inventory
  2. Activities-specific balance confidence scale
  3. Falls efficacy
19
Q

List the activity categories for the dizziness handicap inventory

A

0-14 = NO limitation

16-26 = mild limitation

28-44 = moderate limitation

> 46 = severe limiation

> 60 = imparied funtional mobility and increased fall risk

20
Q

__________ is directly related to mobility in the home.

A

Confidence

21
Q

List the best order of the physical exam for patient comfort/tolerance (8)

A
  1. Oculomotor Function [saccade, smooth pursuit, visual acuity S/D]
  2. Nystagmus
  3. Sensory testing
  4. ROM testing [c-spine]
  5. Motor testing
  6. Verebrobasilar artery testing
  7. Balance testing [functional gait, mCTSIB]
  8. Positional testing [dix-hallpike, roll test]
22
Q

Oculomotor testing: VOR (2)

A
  1. Head thrust [observe saccades 3+ = hypofunction]
  2. Dynamic visual acuity test [3+ line loss = hypofunction]
23
Q

With peripheral vestibular issues nystagmus on dix hallpike with be ____1____ and ____2____.

A
  1. Upward
  2. Torsional
24
Q

List the scoring for mild, moderate, and severe on the motion sensitivity quotient

A

Mild = 0-10

Moderate = 11-30

Severe = 30-100

25
Q

Prefered test for static balance

A

Modified CTSIB

26
Q

Prefered test for dynamic balance

A

Functional Gait Assessment

27
Q

Condition:

  • Single most common cause of dizziness encountered in the clinic
  • 20-30% of patients
  • 50% over the age of 65
  • Most common cause under 50 = TBI, over 50 = vestibular degeneration
  • Less likely to seek medical attention b/c dizziness is not constant
A

Benign Paroxysmal Positional Vertigo (BPPV)

28
Q

Condition: Patient Presentation

  • Breif (< 1 min) episodes of vertigo assoc. w/change in head position relative to gravity
  • Imbalance (>50%)
  • Trouble walking (48%)
  • Nausea (35%)
A

BPPV

29
Q

Condition: Pathophysiology

Otoconia dislodged and migrate into semi-circular canals [most likely in the posterior canal]

A

BPPV

30
Q

Dix-Hallpike Test: __1__ degrees of cervical rotation, sit to supine with ___2___ degrees of cervical extension. Nystagmus should disappear in less than __3__ min. Which ever ear is ___4___ is the side being tested or the problem side.

A
  1. 45
  2. 30
  3. 1
  4. Lower
31
Q

BPPV Exam: The direction of the nystagmus will tell you which ___1___ is involved and the ____2____ will tell you the type of BPPV. ______3______ = free floating otoconia, sx will go away in less than 1 minutes, 90% of BPPV

A
  1. Canal
  2. Duration
  3. Canalithiasis
32
Q

BPPV is a ____1____ functioning of the ear while neuritis is a ____2____ functioning of the ear.

A
  1. Hyper
  2. Hypo
33
Q

Condition:

  • Acute, unilateral
  • Viral etiology
  • Prolonged severe rotational vertigo with spontagenous nystagmus
A

Vestibular Neuritis [unilateral]

34
Q

Condition: Patient Presentation

  • Severe rotational vertigo
  • Spontaneous nystagmus
  • Imbalance
  • Nausea
  • Hearing usually spared
A

Vestibular neuritis [unilateral]

35
Q

Condition:

  • Spontaneous and gaze=evoked nystagmus in light and dark, HSN
  • VOR abnormal both slow and thrust
  • Romberg often positive
  • Sharpened Romberg unable
  • Single leg stance unable.
  • CTSIB-foam, EC unable
  • Gait: Wide based, slow cadence, ,decreased rotation
  • Turn head while walking- unable
A

Acute Unilateral Vestibular Neuritis

36
Q

Condition:

  • Spontaneous in dark, may have HSN
  • VOR abnormal with rapid thrust toward side of lesion
  • Romberg negative
  • Sharpened Romberg- normal with eyes open. Unable with EC
  • SLS- Normal
  • CATSIB- on foam, EC- normal
  • Gait- normal
  • Turn head- normal, slow cadence
A

Compensated Unilateral Vestibular Neuritis

37
Q

Describe the tx plan for BPPV vs. Neuritis

A

BPPV = Canalith Repositioning Maneuver, Brandt-Daroff Exercises

Neuritis = adaptation/habituation exercises, eye exercises, balance exercises

38
Q

Condition: Goals

  1. During ambulation
  2. Improve patient’s ability to see clearly during head movement
  3. Improve the overall general physical condition and activity level
  4. Reduce the patient’s social isolation
  5. Decrease patient’s disequilibrium and dizziness with movement
A

Unilateral Lesion [Neuritis]

39
Q

List Guidelines for developing vestibular exercises (6) [for neuritis]

A
  1. The best stimulus to induce adaptation is one producing an error signal
  2. Adaptation takes time
  3. Adaptation of the vestibulo-ocular system is context specific
  4. Adaptation is affected by voluntary motor control
  5. Patient’s should work at the limit of their ability
  6. Create a visual slip so the brain works to make the image clear
40
Q

Gaze Stability Exercises: Proven to improve __1__. __2__% increase in dynamic visual acuity and ___3___% decrease in fall risk. Has ____4____ carry over.

A
  1. VOR
  2. 70
  3. 70-75
  4. Functional
41
Q

Habituation Exercises (5)

A
  1. Repeated exposure to provocative stimulus
  2. Results in reduction of pathological response
  3. Produce mild-mod sx
  4. Rest b/t movement until sx stop
  5. May take 4-8 wks for sx to decrease

PTRS 853 Final (10 decks)

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