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Year 2: Neuromuscular II > Test 2: Intro to Vestibular Rehab > Flashcards

Test 2: Intro to Vestibular Rehab Flashcards

1
Q

purpose of the vestibular system

A

estimate body position and motion

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2
Q

incidence of vestibular dysfunction

A

15 million people in US

increases with age

can happen in kids (5.3% population) - only 29% treated

can occur secondary to other conditions; those with DM are 70% more likely; HTN also positively correlated

can be a result of trauma; 40-60% of those with head trauma who were not hospitalized had vestibular dysfunction

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3
Q

describe the general anatomy of the vestibular system

A

intricate network of accelerometers

peripheral and central components

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4
Q

labyrinth sits inside what bone

A

temporal

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5
Q

what are the bony portions of the 3 semicircular canals

A

cochlea
vestibule

filled with perilymphatic fluid

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6
Q

what makes up the membranous portions of the 3 semicircular canals

A

utricle
saccule

filled with endolymphatic fluid

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7
Q

the utricle and saccule detect what type of motion

A

utricle = horizontal linear acceleration

saccule = vertical linear

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8
Q

3 types semicircualr canals

A

anterior
posterior
horizontal

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9
Q

otolithic organs

A

utricle
saccue

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10
Q

what is an ampula

A

enlarged end of the semicircular canals

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11
Q

anatomy of semicircular canal

A

attached to utricle

filled with endolymphatic fluid; moves opposite of head motion

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12
Q

ampula anatomy

A

on utricular end of SCC

contains cupula

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13
Q

describe the hair cells and how direction is related to excitation/inhibition

A

tall ones all on one side; move toward tall ones = excitation

move toward little/away from tall ones = inhibition

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14
Q

cupula anatomy

A

gelatinous barrier that contains sensory hair cells

hair cells sit in crista ampullaris

cupula will detect when endolymph moves

cupula moves opposite of ampula?

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15
Q

what are stereocillia

A

supporting hair cells

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16
Q

what are kinocilia

A

main hair cells

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17
Q

what is caused when the stereocilia move toward the kiinocilia

A

exictation

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18
Q

what is caused when the stereocilia move away from the kinocilia

A

inhibition

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19
Q

what are otoconia

A

“crystals”

provide inertial mass for hte gelatinous matrix

made of calcium carbonate

can be impacted by nutrition

can get more brittle with age

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20
Q

otolithic organs contain what

A

otoconia
gelatinous matrix
hair cells
macula

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21
Q

examples of when utricle and saccule may be indicated

A

utricle = active with walking

saccule = active when riding elevator

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22
Q

describe CN VIII

A

cochlear portion goes to cochlea

vestibular portion splits to superior and inferior
- superior goes to utricle, AC, HC
- inferior goes to saccule and PC

CN VIII goes from inner ear to vestibular nuclei in medulla and pons

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23
Q

describe VOR (vestibulo-ocular reflex)

A

gaze stabilization

eye movements equal and opposite to head

head moves > CN VIII to vestibular nuclei > oculomotor nuclei > ocular mm

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24
Q

describe VSR (vestibulo-spinal reflex)

A

large role in postural stability

adjusting limb motion appropriately for the position of the head

output is to the skeletal mm

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25
Q

describe VCR (vestibulo-colic reflex)

A

use of neck musculature to stabilize the head in space

output is to the cervical mm

chickens!

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26
Q

where does the central vestibular system start

A

when CN VIII communicates with the vestibular nuclei in brainstem

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27
Q

describe the 4 vestibular nuclei

A

superior = controls VOR

descending = connects to cerebellum and other nuclei

medial = controls VOR and VSR

lateral = controls VSR

located in pons and medulla

messages go to cerebellum, other VNs, and oculomotor nuclei

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28
Q

portions of the cerebellum and their role in the vestibular system

A

flocculus = required to adapt VOR gain

nodulus = required for VOR duration

anterior = superior vermis affects VSR

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29
Q

PICA feeds what

A

medulla and cerebellum

30
Q

AICA feeds what

A

cerebellum

31
Q

damage to AICA and PICA can be concerning for vestibular why

A

vestibular system may be intact but if there is a problem in the medulla/cerebellum it can affect processing of vestibular info

32
Q

ocular nuclei purpose

A

take inpits from vestibular nuclei

send outputs to the ocular mm via cranial nn II, IV, and VI

located in midbrain

33
Q

ocular mm determine what

A

nystagmus direction and output

34
Q

eye mm that are single plane movements (larger mm) and their corresponding nerves

A

medial rectus - CN III
lateral rectus - CN VI
superior rectus - CN III
inferior rectus - CN III

35
Q

eye mm that are multiplane movements (smaller mm) and their corresponding nn

A

superior oblique (CN IV)

inferior oblique (CN III)

obliques are why torsional nystagmus is possible (up and to the side beat = sup oblique)

36
Q

treatment differs for vestibular dysfunction depending on what

A

electrical = nn dysfunction (blood supply, compression, damage, etc)

mechanical = putting something back (i.e. crystals)

central vs peripheral vs both

37
Q

what diagnostic findings can help you understand the type of vestibular dysfunction involved

A

eye movements
postural movements
sensory organization

38
Q

nystagmus that indicates CNS

A

pure vertical and directional changing

persistent

39
Q

BPPV nystagmus

A

up beating

torsional

slowly goes away; not persistent

posterior canal of SCC

40
Q

how is nystagmus named

A

by the fast phase

which side it goes to quickly

easier to see looking at white of eye not pupil

41
Q

geotropic horizontal

A

down toward ground with horizontal nystagmus

42
Q

ageotropic horizontal

A

away from ground horizontal

43
Q

horizontal nystagmus is what part of nervous system indicated

A

CNS or PNS

44
Q

subjective hx to take with vestibular

A

describe the dizziness
- spinning = vertigo
- dysequilibrium/”off”/floaty = more balance related/VSR; not pure BPPV usually
- lightheaded = cardiac or upper cervical instability

duration
- intermittent (peripheral)or constant (central)
- seconds = BPPV
-days/hours/min/moth = something else

other S&S
- gait, balance, N&V, sensation of motion at rest, limb weakness, sensory changes

traumatic/precipitating factors?
episodic?
recent viral infection?
tinnitis? (roaring = menniers)
HA?
drop attack? (turn head and fall over fully conscious; occluding vertebral artery)
change with head turn?

45
Q

PMH to look at with vestibular pts

A

HTN
DM
HAs
migraine
hearing changes
autoimmune disease
recent viral infections
underlying CNS disorders
vascular
pharmacological
cervical injuries
falls

46
Q

exam/vestibular screen

A

clear verterbral artery - SAFETY
- modified vertebral artery position

5Ds and 3Ns

saccades- central (CN III, IV, VI output)

smooth pursuit - central (CN III, IV, VI)

convergence/divergence - central (CN III, IV, VI)

VOR cancel (central)

VOR (central or peripheral)

Head impulse (peripheral)

position testing - dizzy/nystagmus when you put in plane of SCC

balance/gait

HINTS (to rule out central)

47
Q

5 Ds and 3 Ns

A

numbness-face
nystagmus
N&V
dizziness
dysphagia
drop attacks
dysarthria
diploplia

48
Q

red flags for vestibular pts

A

direction changing nystagmus (central)
positive HINTS (acute CVA)
sustained nystagmus (central)
vertical nystagmus (central)
positive vertebral artery screen
acute intractable N&V (send to hospital; may need steroids)
UMN signs
unstable vitals
not responding to positioning maneuvers
other S&S of stroke (FAST)

49
Q

vestibular outcome measures

A

dizziness handicap index (DHI)

ABC

DGI

FGA

CTSIB

fujuda step test (close eyes, march 30s, see if they turn)

50
Q

what is BPPV

A

when otoconia in utricle get dislodged into SCC

mechanical problem

51
Q

canalithiasis vs cupulolithiasis and theories involved

A

controversial topic

canalithiasis
- otoconia are free floating in canal

cupulolithiasis
- otoconia adhered to cupula
- theory lacks evidence

another theory = fluid displacement from movement of otoconia past cupula causes excitation

theory 3 = otoconia jam where many otoconia move together and get stuck

no consensus

52
Q

canalithiasis general S&S

A

latent onset of nystagmus (1-40 sec)

nystagmus goes away within 60 sec

sensation of vertigo lasts length of nystagmus

most common form of BPPV

53
Q

cupulolithiasis general S&S

A

immediate onset of nystagmus

nystagmus persistent and may last for entire time the head is in the affected position

sensation of vertigo lasts the length of nystagmus

54
Q

nystagmus for posterior canal

A

up beating and torsional

torsional toward affected side

55
Q

horizontal canal nystagmus

A

with or without torsion

ageotropic (cupulo) or geotropic (canal)

56
Q

anterior (superior) canal nystagmus

A

down beating and torsional

torsion toward affected side

57
Q

assessment for PC and AC

A

dix hallpike

58
Q

assessment for HC

A

roll test

59
Q

PC repositioning maneuvers

A

Epley (canalithiasis)

semont liberatory (canalithiasis or cupulolithiasis)

60
Q

AC repositioning maneuvers

A

semont liberatory

61
Q

HC repositioning maneuver

A

270 roll (BBQ roll)

canalithiasis

62
Q

unilateral hypofunctions

A

injury in peripheral component of vestibular system that changes input to the CNS from one side

i.e. vestibular neuritis and labrynthitis

63
Q

bilateral hypofunctions

A

injury to the peripheral component fo the vestibular system that changes the inpit coming to the CNS from both sides

i.e B ototoxicity in setting of chemo agents

64
Q

adaptation

A

change in vestibular response to certain stimuli

neuroplastic change where there is a physiological balance of signaling

65
Q

habituation

A

decreased response to stimulus with increased exposure

get pt used to it

66
Q

POC for BPPV

A

single canal, posterior canal, canalithiasis = 1-2 visits

multi canal and or horizontal canal and or cupulolithiasis - may require more visits

67
Q

POC for unilateral hypofunction

A

2-3 weeks in acute/sub acute phase

4-6 weeks in chronic phase

gaze stability exercises 3x/day for 12 min for acute/subacute

gaze stability exercises 3-5x/day for 20 min in chronic

68
Q

bilateral hypofunction POC

A

5-7 weeks

gaze stability

3-5 days for 20-40 min

69
Q

central problems POC

A

depends on what causes the central and if you are doing remediation, compensation, and/or prevention

70
Q
A

Year 2: Neuromuscular II (18 decks)

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