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Vestibular Flashcards

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1
Q

role of vestibular system

A

head orientation in space, postural stability, gaze stabilization

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2
Q

peripheral vestibular system functions

A

stabilizing visual images on the fovea of the retina during head movement to allow clear vision
maintaining postural stability
providing info used for spatial orientation

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3
Q

central vestibular system

A

brainstem processes provide primary control of many vestibular reflexes

  • vestibulo-ocular reflex stabilizes images on the retina during head movements
  • -posture in static and dynamic activities
  • -coordination of limb movements
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4
Q

vestibular system includes

A 
labyrinth
CN 8
vestibular nuclei (brainstem, pons)
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5
Q

labyrinth

A

bony: filled w/perilymph
membranous: filled w/endolymph
- –semicircular canals: head rotation movements
- –otolith organs: acceleration/deceleration (utricle and saccule)

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6
Q

semicircular canals SCC

A

Function: sense angular head velocity
ampulla - widened end of each SCC
cupula - gelatinous surrounds hair inside ampulla
vestibular hair cells - located in cupula
oriented at 90 to each other (2 floors and floor of room)
hor canal plane is tilted up 30 degrees
ant and post canals 45 degrees off of frontal plane

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7
Q

utricle

A

oriented horizontally

senses linear acceleration and tilt

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8
Q

saccule

A

oriented vertically

senses linear acceleration and tilt

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9
Q

otolith organ (in saccule and utricle)

A

macula-hair cells located
otolithic membrane- gel-like over the macula
otoconia- calcium carbonate crystals on top of otolithic membrane

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10
Q

optokinetic reflex

A

functions during movement of visual images
smooth pursuits
saccades

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11
Q

smooth pursuits

A

slower velocities of visual movement; visual tracking

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12
Q

saccades

A

quick eye movement between 2 targets

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13
Q

cervico-ocular reflex (COR)

A

eye movement triggered by neck movement, neck proprioceptors send info to brain and then to eyes

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14
Q

vestibulospinal reflex (VSR)

A

generates appropriate tone to maintain upright position; maintain postural control

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15
Q

vestibulo-ocular reflex (VOR)

A

functions during movement of head relative to gravity
(therapist passively turns head quickly—eyes should stay fixed)
stabilizes vision during head movement
pd eye movement in opp direction of head movement to maintain image on retina

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16
Q

nystagmus

A

non-voluntary rhythmic oscillation of the eyes

physiologic nystagmus vs. pathologic nystagmus

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17
Q

oscillopsia

A

illusion of movement of the visual environment
cause: impaired VOR results in retinal slip
patient complaint: everything bounces when I move, vision is blurry

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18
Q

vestibular dysfunction- peripheral

A

vestibular neuronitis
labyrinthitis
meniere’s disease - loss of function of cochlear nerve
acousitic neuroma
unilateral or bilateral vestibular hypofunction
BPPV- benign paroxysmal positional vertigo

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19
Q

vestibular dysfunction- central

A 
vestibular migraine
MS (nerve degeneration; can affect any nerve)
TBI, mTBI, post-concussion
cerebellar degeneration
cerebellar or vertebral artery infarct
arnold-chiari malformation
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20
Q

common vestibular dysfunction complaints

dizziness

A

sensation of whirling or feeling a tendency to fall

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21
Q

common vestibular dysfunction complaints

vertigo

A

illusion of movement, sense of environment moving

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22
Q

common vestibular dysfunction complaints

lightheadedness

A

feeling that fainting is about to occur

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23
Q

common vestibular dysfunction complaints

dysequilibrium

A

sensation of being off balanced

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24
Q

common vestibular dysfunction complaints

oscillopsia

A

subjective experience of motion of objects in the visual environment that are known to be stationary

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25
common vestibular dysfunction complaints | red flags
persistent, worsening vertigo and disequilibrium severe headache new onset of double vision, cranial palsies, dysarthria, ataxia, incoordination
26
activate EMS when you suspect a stroke - symptoms
``` sudden weakness confusion sudden dimness or loss of vision in one eye difficulty speaking sudden severe headache unexplained dizziness loss of balance difficulty walking ```
27
symptoms of dizziness and possible causes | vertigo
BPPV, unilateral vestibular hypofunction (UVH), unilateral central lesion affecting vestibular nuclei
28
symptoms of dizziness and possible causes | lightheadedness
orthostatic hypotension (drop of >20mmHg systolic, 10 mmHg diastolic, or both), hypoglycemia, anxiety, panic disorder
29
symptoms of dizziness and possible causes | dysequilibrium
bilateral vestibular hypofunction (BVH), chronic UVH, LE somatosensation loss, upper brainstem/vestibular cortex lesion, cerebellar and motor pathway lesions
30
symptoms of dizziness and possible causes | oscillopsia
UVH
31
duration of symptoms and possible causes | seconds to minutes
BPPV
32
duration of symptoms and possible causes | minutes to hours
meniere's disease (can lose hearing)
33
duration of symptoms and possible causes | days
vestibular neuronitis, UVH/BVH, migraine-associated dizziness
34
duration of symptoms and possible causes | variable
centra dizziness
35
aggravating factors and possible causes | BPPV
Rolling, sitting up in bed, checking blind spot, looking up
36
aggravating factors and possible causes | orthostatic hypotension
quick position changes from supine to sitting or sitting to standing
37
aggravating factors and possible causes | vestibular neuronitis, UVH, BVH
rapid head movement
38
BPPV
most common peripheral cause of vertigo | otoconia dislodged from macula and enter semicircular canals
39
BPPV - etiology
trauma, viral infection, natural aging process
40
BPPV - symptoms
sudden onset of vertigo, associated nystagmus, short duration, provoked by position changes and head movements, may last for days or months
41
BPPV - canalithiasis
vertigo lasts < 60 seconds, otoconia free floating through canals
42
BPPV - cupulolisthiasis
vertigo lasts > 60 sec, otoconia adhered to cupula
43
BPPV - canal involvement
posterior canal - 41-65% most common horizontal canal - 21-33% anterior canal - 17%
44
BPPV - positional testing | Dix-Hallpike
assessment for posterior and anterior cancal
45
BPPV - positional testing | roll test
assesses horizontal canal
46
treatments for posterior BPPV
epley maneuver - for canalithiasis | semont maneuver - for cupulolithiasis
47
treatments for horizontal BPPV
BBQ maneuver - - for canalithiasis | forced prolonged positioning maneuver - for cupulolithiasis
48
treatment for anterior canal BPPV
Deep head hanging maneuver - canalithiasis and cupulolithiasis
49
UVH or BVH
etiology- viral infection, trauma, vascular insult, tumor s/s - spontaneous nystagmus, constant vertigo, oscillopsia, impaired balance recovery - improve after 3-5 days, over several weeks (depends on chronic or acute)
50
chronic UVH
occurs with poor compensation and continued impaired VOR - dizziness with head movements, report oscillopsia and disequilibrium and gait instability
51
UVH or BVH | treatment
gaze stabilization and address balance deficits VOR adaptation ex - VORx1 - head moves while target is stationary - VORx2 - head moves opp dir of moving target substitution ex - saccades - active head/eye movements between 2 targets - remembered targets - working to use cervico-ocular reflex to stabilize gaze
52
post concussion symptoms
headaches, dizziness, fatigue, irritability, anxiety, insomnia, loss of concentration and memory, ringing in ears, blurry vision, noise and light sensitive
53
post concussion | trauma to brain can cause abnormal vestibular system function
- brain can receive abnormal signals about position and movement of the head in space - if vestibular system delivers inaccurate info to brain the brain must rely on visual input and proprioception to feel body in space - failure to compensate w/use of visual references and being aware of the surface one is sitting or standing on results in dizziness and sense of instability
54
post concussion vestibular treatment
BPPV treatment gaze stabilization exercises habituation ex address balance deficits
55
balance interventions | impairments
``` cognitive, vestibular, sensory, musculoskeletal, etc correct what can be changed prevent secondary complications when permanent impairments --adapt/learn new strategies --assess, adapt, accept ```
56
goals for vestibular rehab
``` improve balance improve trunk stability increase strength and ROM in order to improve musculoskeletal balance responses and strategies decrease the rate and risk of falls minimize dizziness ```
57
vestibulo-ocular retraining therapeutic guidelines | exercises
``` VOR and VSR stimulation ex ocular ex (smooth pursuits and saccades) balance ex gait ex combo ex (obstacle courses, functioning in public place) habituation training ex individualize each plan (always) motor learning principles --practice, feedback, repitition ```
58
vestibulo-ocular retraining therapeutic guidelines | what to use
start w/closed environment use of gravity; varying surface conditions COG controlled in each tx stage force plate system, EMG biofeedback foam, mirrors, rocker boards, BAPS boards, swiss balls, foam rollers, trampolines
59
habituation ex
goal is to assist in decreasing symptoms of vertigo, dizziness or nausea pick 2 or 3 of moderately provoking positions provoke symptoms for 30 sec wait for sym to pass, count to 10 then repeat movement perform 3-5x, 2x/day initially increase sym, but w/time will reduce symptoms will decrease within 2 wks
60
balance exercises and progressions begin with stand w/feet shoulder width apart, arms across chest
progress to: bring feet closer together. close eyes. stand on a sofa cushion or foam purpose: enhance the use of vestibular cues for balance by decreasing BOS. eyes closed increases reliance on vestibular cues for balance
61
balance exercises and progressions begin with practice ankle sways: medial lateral and anterior-posterior
progress to: doing circle sways. close eyes | purpose: teaches the patient to use a correct ankle strategy
62
balance exercises and progressions begin with attempt to walk with heel touching toe on firm surface
progress to: same ex on carpet purpose: enhance the use of vestibular cues for balance by decreasing BOS. doing the ex on carpet alters proprioceptive input, increasing difficulty
63
balance exercises and progressions begin with practice walking 5 steps and turning 180 degrees (left and right)
progress to: making smaller turns. close eyes | purpose:turning provides a greater challenge to the vestibular system
64
balance exercises and progressions begin with walk and move the head side to side, up and down
progress to: counting backward from 100 by threes | purpose:use distracting cognitive or motor demands to challenge balance

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