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Neuro > Vestibular > Flashcards

Vestibular Flashcards

1
Q

What is Meniere’s disease?

A
  • disorder of the membranous inner ear where there is an increase in endolymph (volume and pressure changes)
  • causes temporary hearing loss, tinnitus (ringing), vertigo (>20min x 2), feeling of fullness in ear
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2
Q

What are the components of the vestibular system?

A

Otolith organs: Utricle and Saccule
Semicircular canals
cochlea

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3
Q

What are the balance organs?

A

Otolith organs: Utricle and Saccule

Semiciruclar canals

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4
Q

How does the vestibular system tell the brain about movement?

A

Fluid in inner ear moves with movement which stimulates receptors sending signal to brain

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5
Q

What are the signs and symptoms of vestibular issues?

A
  • Vertigo
  • Dizziness
  • Dysequilibrium
  • Nausea
  • Disorientation
  • light headed
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6
Q

How do you uptrain the somatosensory system?

A
  • use of weights
  • Eyes closed
  • No shoes
  • change of surface
  • single leg stance
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7
Q

How do you decrease visual dependency?

A
  • Quick head turns
  • Walk backwards
  • ball toss
  • Eyes closed
  • low lights
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8
Q

How do you uptrain the vestibular system?

A
  • Tandem/Semi-tandem stance and walk
  • Walk with head or eye movement
  • Change of surface level
  • walk backwards
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9
Q

How do you habituate to motion?

A
  • head turns
  • Eye movements: gaze stabilization and smooth pursuit
  • Whole body changes
  • Riding elevators
  • Riding in cars
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10
Q

What is uptraining?

A

Substitution of alternate strategies???

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11
Q

What interventions are indicated for vestibular issues?

A
  • Adaptations
  • Substitutions of alternate strategies (uptraining)
  • Repositioning maneuvers
  • Habituation
  • Balance retraining
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12
Q

When performing habituation exercises what is necessary?

A

must provoke symptoms at the level the client can manage

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13
Q

What is the VOR and its function?

A

Vestibular Occular Reflex- Maintains gaze stabilization when the head moves to make vision clear
-When head moves VOR provides compensatory eye movement to keep objects in focus

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14
Q

Which cranial nerves impact the VOR?

A

Motoneurons of cranial nerves III, IV, and VI

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15
Q

What is the VSR and its function?

A

Vestibulospinal reflexes- affect whole body equilibrium by facilitating and inhibiting skeletal extensor muscle activity (postural responses based on otolith afferent inforamtion)
Ex: when laterally tilt head, stimulate otoliths and semicircular canals causing VSR to activate the extensors on side laterally flexing to and flexors of the contralateral side

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16
Q

What are examples of reduced vesibluar function Peripheral Vestibular disorders?

A

Reduced vestibular function:

  • labyrinthitis
  • neuronitis
  • age related degeneration of hair cells
  • drug induced ototoxicity that damage hair cells
  • brain trauma
  • vascular occlusions
17
Q

What are examples of distorted vestibular function Peripheral Vestiblar disorders?

A

It’s an inaccurate tansduction of sensory stimuli

-BPPV- otoconia from utricle displaced into semicircular canals

18
Q

What are examples of fluctuating vestibular function peripheral vestibular disorders?

A

-changes in endolymph fluid and electrolytes
(ie Meniere’s disease)
-Periplymphatic fisutlas (hole between middle ear and inner ear)

19
Q

What are central vestibular disorders?

A
  • vascular disorders, ischemia, or hemorrhage to brain stem or cerebellum
  • demyelinating disease (ex: MS)
  • Tumors
20
Q

What is being tested with vestibluar function tests (ex: the chair test)?

A

the VOR

21
Q

What is being tested with posturography and clinical balance tests?

A

the VSR

22
Q

What is the Dix-Hallpik maneuver?

A
  • Turn head to one side and then lay back with approximately 30 degrees of neck extension
  • Tests the posterior semicircular canal (most commonly involved in BPPV)
  • Should see direction of nystagmus to side that the head is turned if that is the involved ear (ex: head turned right, nystagmus will beat to the right)
23
Q

What are tests that were designed to assess postural control of individuals with vestibular dysfunction or other balance deficits?

A
  • Fudukas stepping test
  • walking with head rotation
  • Dynamic Gait Index
  • Walking on floor with EC (WOFEC)
  • Functional Reach test
24
Q

What is Fuduka’s stepping test?

A

50 steps in place, EO then EC. Have them start in box and measure how far they travel
Unilateral vestibular involvement = pt turns to affected side with EC
Bilateral vestibular involvement = pt falls with EC

25
Q

What is walking with head rotation?

A

pt ambulates on straight measured walkway, turning head every 2-3 steps
-Measure time it takes to walk and note number of cross steps or steps out of the walkway

26
Q

What is the WOFEC test?

A

walking on floor with EC

-Tandem walk up to 10 steps, EC, arms crossed

27
Q

What is functional reach test?

A

standing (more common) or sitting
Reach forward with straight arms
-reach <6 inches = increased fall risk

28
Q

What are appropriate interventions for reduced vestibluar function?

A
  • VOR exercises- gaze stabilization (change, speed, direction, and background)
  • Balance retraining exercises- target the VSR (change BOS, surface, what UE doing, EO, EC)
  • substitution exercise if no vestibular function remaining
  • Want to recruit VOR and VSR at same time- walking with head rotation, processing distorted or confusing visual information
  • general exercise is good too
29
Q

What are appropriate interventions for distorted vestibular function?

A
  • repositioning maneuvers: Brandt Darkoff- sit to sidelying on affected side, wait for symptoms to pass before position change;
  • habituation exercises
  • balance retraining
  • conditioning
30
Q

What is the Brandt Darkoff?

A

Repositioning technique: sit to sidelying on affected side,

  • wait for symptoms to pass before position change
  • change positions several times
  • either canalith repositioning occurs or habituation occurs
31
Q

What is the liberatory maneuver?

A
  • repostioning technique
  • performed once
  • sit to sidelying: affected ear down; hold 2-3 min
  • sit to sidelying: non-affected ear down; hold 5 min
  • Pt must remain vertical head position for 48 hours
32
Q

What are appropriate interventions for central vestibular dysfunction?

A

similar to peripheral dysfunction, but need to tailor

Ex: don’t give VOR exercises to cerebellar issue (VOR heightened) instead give VOR cancelling exercises

Neuro (11 decks)

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