Week 2/3 Vestibular LAB Exam and Intervention/BPPV Lab

Question 1

During weber, R sensorineural will be ______ on ___ side, if R conductive then it will be louder on ____ side

Answer 1

R sensorineural - louder on L

R conductive - louder on R

Question 2

During Rinne test, conductive vs sensorineural hearing loss clinical presentation

Answer 2

conductive - put on mastoid and can hear but can’t hear when next to ear

sensorineural - can’t hear both while on mastoid or next to ear

Question 3

What direction will spontaneous nystagmus be in peripheral hypofunction?

Answer 3

fast phase will beat away from involved side

Question 4

What is alexander’s law?

Answer 4

peripheral vestibular nystagmus increases in intensity with the gaze directed towards the fast phase

Question 5

what is 1st degree nystagmus?

Answer 5

only present when gaze directed towards fast phase

Question 6

What is 2nd degree nystagmus?

Answer 6

• present in primary gaze and when gaze directed towards fast phase
• strongest when gaze directed towards fast phase

Question 7

what is 3rd degree nystagmus?

Answer 7

present in all gazes
- strongest when gaze directed towards fast phase

Question 8

abnormal response to optokinetic nystagmus

Answer 8

direction of reduced motion leads to non-compensated vestibular condition

Question 9

Should a patient with a peripheral vestibular pathology have issues with smooth pursuit or saccades?

Answer 9

NO - these are central issues
- if they have breakdown, they should NOT complain of vertigo

Question 10

What is the gold standard in testing VOR?

Answer 10

head thrust or head impulse test

Question 11

What is an abnormal response to the head thrust or head impulse test?

Answer 11

corrective saccade and/or post-trust nystagmus

Question 12

What is a strong clinical indicator of non-compensated injury?

Answer 12

presence of post-headshake nystagmus

Question 13

abnormal results of head shake test

Answer 13

> 3 beats of nystagmus beating away from involved ear

Question 14

What is considered a significant vestibular issue during the dynamic visual acuity test?

Answer 14

> or = to 3 line degradation on snelling chart

Question 15

What pathology will do terribly with the dynamic visual acuity test?

Answer 15

bilateral hypofunction

Question 16

What is the skew deviation test looking for?

Answer 16

predictor of central vestibular involvement

Question 17

Normal and abnormal response to skew deviation

Answer 17

normal - eyes don’t move

abnormal - deviation of 1 eye while covered, followed by correction after uncovering it
- Need to go to ED

Question 18

What evaluates cerebellar control with regards to inhibition of VOR?

Answer 18

VOR cancellation - patient follows extend arms and thumbs

Question 19

abnormal response to VOR cancellation

Answer 19

+ corrective saccades (ipsilateral)

Question 20

What is a quick, bedside physical exam that can be performed on acute patients with vestibular symptoms?

Answer 20

HINTS test
- head impulse test
- nystagmus observation
- test of skew

Question 21

What are the 6 conditions of the CTSIB (clinical test of sensory organization and balance)

Answer 21

1) stand on firm surface, eyes open - E, S, V
2) stand on firm surface, eyes closed - S, V
3) stand on firm surface, visual conflict - S, V
4) stand on foam surface, eyes open - E, V
5) stand on foam surface, eyes closed - V
6) stand on foam surface, visual conflict - V

Question 22

What conditions during the CTSIB will a patient with peripheral vestibular hypofunction have difficulty with?

Answer 22

5) stand on foam surface, eyes closed - V
6) stand on foam surface, visual conflict - V

Question 23

What is the modified Romberg?

Answer 23

stand with arms by the side for 10 sec
- looking for compensatory movements to occur

Question 24

What is the Fakuda Step test?

Answer 24

stepping in place and start to deviate (turn) with their eyes closed
- March for 50 steps with eyes closed
- rotation greater than 30 degrees or 0.5m displacement = dysfunction

Question 25

What are the components of the Gans Sensory Organization Test (Gans SOT)?

Answer 25

• Modified Romberg
• CTSIB
• Fakuda Step Test

Question 26

Mini-Bestest and its MCID

Answer 26

• 14 item test observing anticipatory and reactive control, sensory organization and dynamic gait
• MCID: 4

Question 27

What are the major components of the Mini-BESTest?

Answer 27

• Anticipatory
• Reactive postural control
• Sensory orientation
• Dynamic gait

Question 28

Balance Error Scoring System (BESS) test and its MCID

Answer 28

6 standing conditions, eyes closed for all, 20 seconds each
- double limb, single limb, tandem on firm surface then on foam

MCID: 3

Question 29

Which outcome measure is more sensitive to peripheral pathologies?

Answer 29

BESS test - eyes are closed

Question 30

What test can be used to help ID malingering patients

Answer 30

Computerized Posturography Sensory Organization Testing

malingering - pretend to be ill or over exagerate

Question 31

VOR 1 vs VOR 2 gaze stability exercises

Answer 31

VOR 1 - keeping card still and moving head side to side

VOR 2 - moving card and head - card moves opposite of head

• can be used for adaption or substitution (compensation)

Question 32

What is the difference between short and long-term habituation?

Answer 32

Short-term habituation
- exposure to stim < 30 minutes
- results in pre-synaptic changes
Long-term habituation
- exposure to stim > 30 minutes
- results in post-synaptic changes (more long-term effect)