Vestib Rehab

Question 1

Pts with vestib have _____ increase for Risk of falls

Answer 1

8fold

Question 2

Vestib system give info on

Answer 2

Linear/angular accel
Rotation of head
Position in space

Question 3

Outcomes of vestib system?

Answer 3

Postural stability
Gaze stability
Bodyposition/orientation

Question 4

Periph vestib?

CentraL?

Results?

Answer 4

Inner ear/ vestib nerve

Vestib nuclei/cerebellum/BS

Motor output is result

Question 5

Fx of semicircular?

What is the ampulla?

Cupula?

Answer 5

Angular acceleration receptor

At the end of semicircular contains sensory organ.

Ant: Pitch
Post: roll
HorizontaL : head side to side tilted 30 deg.

Senses fluid in canals (ampulla) and sends info to vertib nerve of excite/inhibit.

Question 6

Otolith?

Macula?

Answer 6

Utricle: horizonal linear accel
Saccule: Vertical linear accel.

Gel mass with hair that senses otoconia (crystals) movement

Question 7

Info goes from periph vestib to central.

Answer 7

.

Question 8

VOR?

Answer 8

Provide gaze stabilty with head movement.
Stmulated by movment at 2 Hz

Ratio oh head and eyes is 1 as long as cerebellum in tact.

Question 9

Vestibulospinal reflex?

Answer 9

Stabilize body in reaction to vestib input.

Info takien in-> vetib nerve-> processed-> adjust.

Question 10

Bppv

Answer 10

Peripheral mechanical dfx

Canalithiasis: Otoconia break off and free float in endolymph

Cupulolithiasis: otoconia break off and adhere to cupula.

Question 11

Vestib hypofunction unilateral

Answer 11

Unilateral: fx decrease secondary to
Neuritis (swelling no hearing involved)
Labyrinthitis: swelling and hearing involved
Acoustic neuroma: slow growing tumor on CN VIII

Turning right= eyes lag to catch up

Question 12

Vestib hypofunction bilateral

Answer 12

Dont get dizzy if they have full loss.
Pt relies of vision somatosensory/ Wide BOS/Inc falls.

Often caused by ototoxicity not a good prognosis

Question 13

Central dizziness

Answer 13

Lesion in central pathways. Or like motion sickness/ sensory mismatch

Red flag: no known diagnosis.. usually

Have nystagmus after movement and u need to work on habituation/meds/vision therapy.

Question 14

Cervicogenic Dizziness. (Dx with exclusion)

Answer 14

Associated with neck pain (think whiplash)

Tx with manual and vestib rehab

Question 15

Differential Dx for dizziness?

Answer 15

Rule out positional testing of BP
Systemic
Cardio

CNS
PERipheral NS
MS
Multi

Question 16

Some subjective things to ask?

Answer 16

Describe it
When/what provokes it
Anyhting before the symptoms?
Anything along with the dizziness. 
How long it last? Time before it starts? How often?
PMH.

Question 17

Vemp testing for?

How is unilateral vestib loss tested?
BilateraL?

Answer 17

Otolith Function

Caloric testing (hot cold)

Rotatory chair.

Question 18

Dizziness handicap inventory?

ABC

Answer 18

0=never/2=sometimes/3= yes. Lower is better.
25 qs

Lower score= increase fall risk. Balance confidence.

Question 19

Parts of oculomotor exam?

Answer 19

Spontaneous nystagmus : just gaze
Gaze evoked nystagmus: look 30 deg each way.
Smooth pursuit:  from 18 inches away. 
Saccade
Converge/diverge

Question 20

VeStibular testing:

Answer 20

Headthrust: manip in 30 deg flexion. Change directions checking saccades (unilat vestib hypofx)

VOR: look while turning head.

Dynamic visual acuity

Head shake nystagmus

Question 21

Contra for positional vertigo?

Answer 21

C spine unstable
RA/Downs
Vascular dissection symptoms
C spine stuff and shunts/cardio2

Question 22

How to do Dix-Hallpike

Answer 22

Long sit-> rotate head to 45 deg
Lie them back and extend 30 deg. Maintain for 60 seconds.

Look for symptoms : for post canal.

DOWNBEAT NYSTAGMUS REFER TO MD

Canalithiasis

Question 23

How to differentiate bw cupolo and canal bppv with dixhalpike?

Answer 23

Duration. Canal is shorter.

Question 24

Horizontal roll test BPPV?

Answer 24

Flex head 30 deg/ rotate 45 deg

Beating toward ground is: Geotropic: Canalithiasis

Beating toward ceiling is: Ageotropic: Cupulothiasis

Question 25

What is motion sensitivity quotient?

Answer 25

Patient rates intensity with movements. Position test.

Question 26

BPPV maneuvers?

Answer 26

CRT : canalithiasis
Semont Maneuver: cupulothiasis
BBQ roll:
Brandt-daroff.

Question 27

CRT maneuver: epley

Answer 27

Rotate 45
Extend 30 deg
Wait 30 seconds after symptoms resolve
Go to middle- 30 seconds
Go to other side->
Go to sidelying with chin tuck
Sit up with chin tucked.

For canalithiasis

Question 28

Semont maneuver

Answer 28

In sit
Rotate 45 and quick sidelie to affected side
After time2 mins-> go to side lie on other side with same head roation.

For cupulothiasis

Question 29

BBQ roll:

Ca

Answer 29

Supine: affected ear down roll to side of unaffected. Prone and chin tuck.

Canalithiasis

Question 30

Brandt-daroff:

Answer 30

Post cupulothiasis

Semont-> sitting not other side.

Question 31

Interventions for uni/bilateral vestib hypofunction

Answer 31

VOR x1
VOR x2

120 bpm=2Hz

Patient must turn head*

12-20 min/day

Question 32

What to use for bilateral vestib loss?

Answer 32

Active eye-head movemnt

Imaginary target

Question 33

What is intervention for Central dizziness?

Answer 33

Habituation

Question 34

Balance retraining:

Answer 34

Static-dynamic
Dual task

What can be used to help?

Question 35

Flu-like illness

Answer 35

Neuritis
Labrynthitis for
Unilateral vestibular hypofx