Balance/Vestibular

Question 1

Children rely on what system heavily for balance

Answer 1

vision

Question 2

VOR is

Answer 2

head/eye movement coordination
supports gaze stabilization

Question 3

Vestibulospinal reflex (VSR)

Answer 3

attempts to stabilize the body and control movement.
assists with stability while head is moving as well as coordination of trunk during upright postures

Question 4

Strategies for balance

Answer 4

ankle
hip
suspensory
stepping

Question 5

ankle strategy is

Answer 5

first strategy

Question 6

hip strategy is

Answer 6

elicited by greater force, challenge or perturbation through the pelvis and hips
hips will move in opposite direction from the head
muscles contract proximally to distally to counteract balance

Question 7

suspensory strategy is.

Answer 7

lower center of gravity by knee flexion, crouching or squatting

Question 8

Peripheral vertigo:
duration?
autonomic symptoms?
what kind of factor?
signs?
ears?

Answer 8

episodic and short duration
they are present
precipitating
pallor, sweating, nausea and vomiting
auditory fullness
tinnitus

Question 9

Central vertigo:
autonomic symptoms?
consciousness?
neurological symptoms?

Answer 9

less severe
loss of it
diplopia, hemianopsia, weakness, numbness, ataxia, dyarthria

Question 10

Types of peripheral vertigo?

Answer 10

BPPV
menieres
infection
trauma/tumor
metabolic disorders
acute alcohol intoxication

Question 11

Types of central vertigo?

Answer 11

meningitis
migraine
complications of neurologic origin post ear infection
trauma/tumor
cerebellar degeneration disorders
MS

Question 12

BPPV commonly affects which canal?

Answer 12

posterior semicurcular

Question 13

Which way is nystagmus in posterior canal issues?

Answer 13

vertical

Question 14

Which way is nystagmus in anterior canal issues?

Answer 14

down

Question 15

Which way is nystagmus in horizontal canal issues?

Answer 15

horizontal (towards lowest ear)

Question 16

When checking for nystagmus, what kinds of things are you looking for?

Answer 16

eye movement: horizontal, vertical, rotatory or mixed
type of eye movement: pendular or jerk
direction: bidirectional or unidirectional
nystagmus movement: binocular or monocular with symmetrical or dissociated movements

Question 17

Congenital nystagmus

Answer 17

mild and does not change in severity over lifetime. Usually not associated with another pathology

Question 18

Spontaneous nystagmus

Answer 18

imbalance of vestibular signals in oculomotor neurons causing constant drift in one direction countered by quick movement in opposite direction. Occurs after acute vestibular lesion and only lasts 24 hours

Question 19

Peripheral nystagmus

Answer 19

occurs with peripheral vestibular lesion and is inhibited when patient fixates vision on object

Question 20

Central nystagmus

Answer 20

central lesion of brainstem/cerebellum and is not inhibited by visual fixation on an object

Question 21

Positional nystagmus

Answer 21

induced by change in head position
semicircular canals stimulate nystagmus that typically lasts only a few seconds

Question 22

Gaze-evoked nystagmus

Answer 22

when eyes shift
inability to maintain stable gaze position
CNS pathology associated with brain injury and MS

Question 23

Central lesion nystagmus:
direction?
visual fixation?
vertigo?
length?
etiology?

Answer 23

bidirectional or unidirectional
no inhibition or fixation
mild
chronic
demyelination of nerves, vascular lesion, cancer/tumor

Question 24

Peripheral lesion nystagmus:
direction?
visual fixation?
vertigo?
length?
etiology?

Answer 24

unidirectional with fast segment of movement indicating the opposite direction of lesion
will inhibit nystagmus and vertigo
significant
minutes, days, weeks but finite period; recurrent
menieres, vascular disorders, trauma, toxicity, infection of inner ear

Question 25

Balance Evaluation Systems Test (BESTest)

Answer 25

36 item tool assessing 6 different systems Total scoring 108 Takes longer to administer More comprehensive Can diagnose underlying system affecting balance condensed versions=Mini-BESTest and Brief-BESTest

Question 26

Berg Balance Scale

Answer 26

fall risk test 14 tasks rated 0-4 out of 56 less than 45 is increased risk for falls

Question 27

Clinical Test of Sensory Interaction on Balance (CTSIB)

Answer 27

assesses contributions of visual, somatosensory and vestibular Test can identify which sensory system the patient relies on the most 6 different scenarios Modified version does not include last two tasks Three attempts given and if cannot hold positions for 30s then three trials are averaged.

Question 28

Dynamic Gait Index (DGI)

Answer 28

8 item tool with varying gait tasks 24 score <19=fall risk

Question 29

Four square step test

Answer 29

ability to step in multiple directions two trials and take faster time >15 seconds=fall risk

Question 30

Fregly-Graybiel Ataxia Test Battery

Answer 30

8 test Measures time spent in each test position and number of steps patient takes without falling 5 trials Best suited for those with higher level motor skills and does not help the therapist diagnose the cause of the balance dysfunction

Question 31

Fugl-Meyer Sensorimotor Assessment of Balance Performance Battery

Answer 31

tests hemiplegia 7 items with max score of 14 Even tho someone scores a 14 doesnt mean they have normal balance

Question 32

Fullerton Advanced Balance Scale

Answer 32

10 item more advanced and created for higher functioning adults to avoid ceiling affect. Possible score of 40. <26 indicates increased risk for falls

Question 33

Functional Gait Assessment

Answer 33

10 item tool modification of DGI higher level tasks to avoid ceiling possible score of 30 <23 indicates risk for falls

Question 34

Functional reach age related standards: 20-40 41-69 70-87

Answer 34

3 trials 14.5-17 inches 13.5-15 inches 10.5-13.5 inches has a high test-retest correlation and intrarater reliability

Question 35

Multi-directional reach test

Answer 35

modified version of functional reach for stability anteriorly, posterioly and laterally

Question 36

Romberg test

Answer 36

balance and ataxia if there is a mild lesion on vestibular or somatosensory systems, the patient will typically compensate through the visual sense Visual input removed then instability will be present if there is a larger somatosensory or vestibular deficit. Ataxia on romberg it means there is sensory ataxia and not cerebellar

Question 37

Sharpened Romberg

Answer 37

heel toe stance with non-dominant foot in front increases the challenge to vestibular and somatosensory systems

Question 38

Short Physical Performance Battery

Answer 38

3 item tool assesses lower extremity performance and risk for falling recorded with times and times are converted to a score. Max score of 12 <10 one or more mobility limitations and predictive of all-cause mortality

Question 39

TUG

Answer 39

10 feet Independence is in 10 s or less >20s=limit for functional independence and may be at increased risk for falling. >30s=high fall risk

Question 40

Tinetti Performance Oriented Mobility Assessment

Answer 40

first section assesses balance second section assesses gait Max score of 28 combined as score decreases, risk of falling increases <19=high risk for falling