Week 2/3 Vestibular LAB Exam and Intervention/BPPV Lab Flashcards
During weber, R sensorineural will be ______ on ___ side, if R conductive then it will be louder on ____ side
R sensorineural - louder on L
R conductive - louder on R
During Rinne test, conductive vs sensorineural hearing loss clinical presentation
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
What direction will spontaneous nystagmus be in peripheral hypofunction?
fast phase will beat away from involved side
What is alexander’s law?
peripheral vestibular nystagmus increases in intensity with the gaze directed towards the fast phase
what is 1st degree nystagmus?
only present when gaze directed towards fast phase
What is 2nd degree nystagmus?
- present in primary gaze and when gaze directed towards fast phase
- strongest when gaze directed towards fast phase
what is 3rd degree nystagmus?
present in all gazes
- strongest when gaze directed towards fast phase
abnormal response to optokinetic nystagmus
direction of reduced motion leads to non-compensated vestibular condition
Should a patient with a peripheral vestibular pathology have issues with smooth pursuit or saccades?
NO - these are central issues
- if they have breakdown, they should NOT complain of vertigo
What is the gold standard in testing VOR?
head thrust or head impulse test
What is an abnormal response to the head thrust or head impulse test?
corrective saccade and/or post-trust nystagmus
What is a strong clinical indicator of non-compensated injury?
presence of post-headshake nystagmus
abnormal results of head shake test
> 3 beats of nystagmus beating away from involved ear
What is considered a significant vestibular issue during the dynamic visual acuity test?
> or = to 3 line degradation on snelling chart
What pathology will do terribly with the dynamic visual acuity test?
bilateral hypofunction
What is the skew deviation test looking for?
predictor of central vestibular involvement
Normal and abnormal response to skew deviation
normal - eyes don’t move
abnormal - deviation of 1 eye while covered, followed by correction after uncovering it
- Need to go to ED
What evaluates cerebellar control with regards to inhibition of VOR?
VOR cancellation - patient follows extend arms and thumbs
abnormal response to VOR cancellation
+ corrective saccades (ipsilateral)
What is a quick, bedside physical exam that can be performed on acute patients with vestibular symptoms?
HINTS test
- head impulse test
- nystagmus observation
- test of skew
What are the 6 conditions of the CTSIB (clinical test of sensory organization and balance)
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
What conditions during the CTSIB will a patient with peripheral vestibular hypofunction have difficulty with?
5) stand on foam surface, eyes closed - V
6) stand on foam surface, visual conflict - V
What is the modified Romberg?
stand with arms by the side for 10 sec
- looking for compensatory movements to occur
What is the Fakuda Step test?
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
