Vestibular

Question 1

provides sensory input about both angular and linear acceleration
orients the head with respect to gravity
membranous labrinth

Answer 1

peripheral sensory apparatus

Question 2

somatosensory and visual cues
cerebellum
reticular formation, cortex

Answer 2

central processing system

Question 3

generates compensatory eye movements for gaze stability

body movements for postural stability with locomotion

Answer 3

motor output system

Question 4

contains 5 sensory organs
3 semicircular canals
2 otolith organs
motion sensors (hair cells)
endolymph

Answer 4

membranous labyrinth

Question 5

information from the semicircular canals is used to

Answer 5

stabilize vision

Question 6

normally as the head moves in one direction the eyes move in the opposite direction with equal velocity
regulated by the semicircular canals

Answer 6

VOR gain

Question 7

responsible for maintaining gaze stability at >60 deg/sec

Answer 7

vestibular system

Question 8

responsible for maintaining gaze stability at

Answer 8

smooth pursuit

Question 9

differences between sides int he tonic firing rate within the vestibular nuclei
indicates that one vestibular system is more active than the other

Answer 9

nystagmus

Question 10

nystagmus: fast beat is always towards the

Answer 10

more active/hyperactive side

Question 11

systolic BP drops by at least 20 mmHg within 3 min of standing and patient is symptomatic

Answer 11

orthostatic hypotension

Question 12

reaches a crescendo in 10 min associated with dizziness

Answer 12

panic attack

Question 13

spells last 4-60 min with/without heatache

Answer 13

migranes

Question 14

vertigo
peripheral
central

Answer 14

more common (with head movement)
less common

Question 15

nystagmus
peripheral
central

Answer 15

jerk (fast beat, slow beat)

vertical, pendular

Question 16

balance
peripheral
central

Answer 16

not as affected

affected

Question 17

smooth pursuit, saccades
peripheral
central

Answer 17

usually normal

abnormal

Question 18

hearing
peripheral
central

Answer 18

may include hearing loss, tinnitus, fullness in ears

usually normal

Question 19

compensation
peripheral
central

Answer 19

quick

slow

Question 20

oculomotor test
dix halpike
balance, mCTSIB
in the ICF model

Answer 20

body function and structure

Question 21

dynamic gait index
functional gait assessment
in the ICF model

Answer 21

activity

Question 22

dizziness handicap inventory
activities-specific balance confidence scale
falls efficacy
in the ICF model

Answer 22

participation

Question 23

self report
higher scores indicate greater handicap
score > 60 assiciated with impaired functional mobility and increased fall risk
useful to establish subjective improvement

Answer 23

Dizziness Handicap Inventory (DHI)

people with BPPV greater handicap

Question 24

self report
confidence level performing various tasks of daily living
correlates with physical functioning: 80 high level of funcitoning

Answer 24

Activities-specific Balance Confidence Scale

Question 25

small amplitude, quick movement and observe corrective saccades

Answer 25

Head thrust test | peripheral sign- UVL or BVL

Question 26

move head at the rate of 2Hz with 30 deg neck flexion and observe nystagmus;

Answer 26

head shake test horizontal systagmus: peripheral sign Vertical nystagmus- central sign

Question 27

VOR cancellation: Saccades or nystagmus is a

Answer 27

central sign

Question 28

Move head at 2Hz and if patient loses >3 lines in eyechart indicates hypofunction

Answer 28

dynamic visual acuity

Question 29

positional testing | test for horizontal SCC; positive on both sides

Answer 29

Roll test

Question 30

positional testing provocative position will produce torsional nystagmus or 1-5 sec latency nystagmus of brief duration (5-30 sec) reversal of nystagmus direction on return to upright position response is fatiguable

Answer 30

Dix Hallpike:

Question 31

positional testing | 16 positions tested. 0-10 is mild, 11-30 is moderate, 30-100 is severe

Answer 31

motion sensitivity quotient (MSQ)

Question 32

single most common cause of dizziness encountered in the clinic most common cause under age of 50 is TBI Over 50: vestibular degeneration (50% of individuals are over the age of 65)

Answer 32

Benign paroxysmal positional vertigo (BPPV)

Question 33

Brief (typically less than 1 min) episodes of vertigo associated with changes in head position relative to gravity (ex: lying down - rising from horizontal orientation)

Answer 33

BPPV | Classic Symptoms

Question 34

45 degree cervical rotation sit to supine with 20 degree cervical extension look for nystagmus and symptoms of vertigo

Answer 34

Dix-Hallpike test

Question 35

typical nystagmus with BPPV

Answer 35

latency: 1-5 sec Direction: typically mixed up-beating, torsional Duration: generally

Question 36

direction of nystagmus will tell you | duration will tell you

Answer 36

which canal is involved | type of BPPV: canalithiasis or cupulolithiasis

Question 37

treatment for BPPV 5 reps 2x per day hold each position for 30 sec head position is important

Answer 37

Brandt-Daroff exercises

Question 38

Acute, unilateral may have a viral etiology prolonged severe rotational vertigo with spontaneous nystagmus, imbalance and nausea hearing is usually spared

Answer 38

``` Unilateral Vestibular Hypofuntion Vestibular neuritis (UVL) ```

Question 39

``` spontaneous and gaze = evoked nystagmus in light and dark VOR abnormal both slow and thrust Romberg often positive sharpened romberg unable SL stance unable CTSIB-foam, EC unable Gait: wide based, slow cadence, decreased rotation Turn head while walking- unable ```

Answer 39

Acute UVL

Question 40

``` Spontaneous in dark, may have HSN VOR abnormal with rapid thrust toward side of lesion Romberg negative Sharpened romberg- romal with eyes open, unable with EC SL stance- normal CTSIB- on foam, EC- normal Gait- normal Turn head - normal slow cadence ```

Answer 40

compensated UVL