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Neuromuscular Conditions II > Vestibular Examination > Flashcards

Vestibular Examination Flashcards

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1
Q

___ vestibular problems are more common

A

-peripheral (inner ear)

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2
Q

Team Approach

A
  • PCP
  • Neurologist
  • Otolaryngolist
  • Audiologist
  • Psychologic/Psychiatrist
  • PT/OT
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3
Q

Vestibular Function

A
  • stabilize visual images on the retina (gaze stabilization)
  • maintain postural stability
  • provide information needed for spatial orientation
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4
Q

Vertigo

A

-turning: sense of movement of oneself or environment

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5
Q

Disequilibrium

A

-sense of imbalance

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6
Q

Oscillopsia

A
  • sense of motion in environment

- Like cop camera

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7
Q

Dizziness

A
  • common problem & reason for referral

- lightheadedness, nervousness, disequilibrium

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8
Q

Peripheral Vestibular Anatomy

A
  • bony labyrinth

- membranous labyrinth

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9
Q

Bony Labyrinth

A
  • 3 semicircular canals (horizontal, anterior, posterior)
  • cochlea
  • vestibule
  • perilymphatic fluid
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10
Q

Membranous Labyrinth

A
  • within bony labyrinth
  • 5 sensory organs
  • saccule, utricle
  • motion sensors
  • endolymph
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11
Q

Semicircular Canals

A
  • 3
  • ant, post, horizontal
  • detect angular acceleration
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12
Q

Receptors

A
  • ampula

- maculae

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13
Q

Ampulla

A
  • small bulge at end of each semicircular canal
  • contain haircells that project into cupula
  • fires receptor cells
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14
Q

Maculae

A
  • receptors for utricle and saccule

- Covering: statoconia

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15
Q

Hair Cells

A

-project in groups, arranged according to height

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16
Q

each hair cell has:

A
  • 40-70 stereocilia

- 1 kinocilium

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17
Q

Hair Cells innervated by:

A

-afferent neuron

  • excite: cilia move toward kinocilium
  • Inhibit: cilia move away from kinocilium
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18
Q

Saccule

A

-linear accelearation

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19
Q

Utricle

A

-horizontal linear acceleration or static head tilt

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20
Q

SCC Pairings

A
  • L/R horizontal
  • L ant/R post
  • R ant/L post
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21
Q

Firing of Vestibular receptors

A
  • respond to brief head movements

- accommodate with ongoing movements

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22
Q

Central Vestibular System Anatomy

A
  • 4 vestibular nuclei

- connect to: Mm, Nn controling eye movements, reticular formation, thalamus, cerebral cortex and cerebellum

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23
Q

Role in Postural Control

Study These Flashcards
A
  • vestibulospinal reflex system

- descending tracts

24
Q

Descending tracts

Study These Flashcards
A
  • lateral vestibulospinal tract (ext Mm of neck, trunk, legs)
  • medial vestbiulospinal tract (neck flex/ext Mm)
25
VOR
- vestibular-ocular reflex - produces horizontal/vertical eye movements coordinated with head movements - stabilizes eye in space
26
Horizontal VOR
-turn head to R-->increase firing of R vestib nucleus-->fires ipsilateral oculomotor nucleus-->R medial rectus fires
27
Vertical VOR
Similar to horizontal VOR
28
Nystagmus
- invol, alternating sequence of quick and slow phase eye movements - normal reaction to rotation - slow phase 1 direction followed by fast phase in opposite direction (named by fast phase)
29
Peripheral Vestibular Disorder
-any pathology involving the vestibular nerve, mechanical deformation of nerve, trauma to surrounding structures
30
Ex of Peripheral Vestibular Disorders
- BPPV - Infectious Agents - Perilymphatic Fistula - Vascular Disease - Tumor - Cervical Vertigo
31
Unilateral Peripheral Vestibular Disorder S/Sx
- significant dizziness - vertigo - nausea - postural instability - static (resting nystagmus) & dynamic (abnormal gain) problems of VOR - Nystagmus
32
BIlateral Peripheral Vestibular Disorder S/Sx
- more disequilibrium - less dizziness - postural instability and ataxia - oculomotor disturbance - oscillopsia - possible impairments of strength, endurance, ROM
33
BPPV
- benign paroxysmal positional vertigo - most common vestibular disorder - vertigo with specific movements - most commonly in posterior canal
34
BPPV due to:
-fragment of otoconia that lodge on cupula or semicircular canal
35
2 Types of BPPV
- Canalithiasis | - Cupulolithiasis
36
Canalitiasis
- most common type of BPPV - otoconia free floating in SCC - vertigo for <1 min
37
Cupulolithiasis
- relatively uncommon - otoconia adhere to cupula - vertigo onset immediately in test position and sustained
38
Nystagmus Upbeat
posterior canal
39
Nystagmus Downbeat
anterior canal
40
Nystagmus R Torsional
R side
41
Nystagmus L Torsional
L Side
42
Nystagmus Latency; | Short
-canalithiasis
43
Nystagmus Latency: | Long
-cupulolithiasis
44
Ex. Causes of Central Vestiblar Disorders
- MS - Vascular trauma (stroke) - Trauma - Tumor - Metabolic/degenerative/developmental problem
45
Central Vestibular Disorder S/Sx
- vertigo: long but less severe - nystagmus: down/up or torsional - VOR abnormalities - Impaired VOR Cancellatoin - impaired Mm tone, ataxia, imbalance
46
Medical Exam Tests
- ENG (electronystagmography) - Caloric Irrigation Testing - Rotary Chair Testing - Computerized Dynamic Posturography
47
PT Exam: | History
- PMH: conditions that could cause vestib probs - Meds - Onset of Sx (cause/provoking) - Description of Symptoms (dizzy, vertigo, loss of balance, fall Hx, hearing, ear pn)
48
Meclizine
- vestibular suppressant - form of Dramamine -can interfere with progress of PT treatment
49
Impairment Measures
- ROM (neck/CS) - MMT (neck/CS) - Coordination (cerebellar prob?) - Sensation (parietal prob?) - Endurance - Pain - Vitals (r/o cardiovascular disease)
50
Occulomotor Tests
- occular mobility & smooth pursuit - saccadic eye movements - spontaneous nystagmus - head thrust test - head shaking test - dynamic visual acuity test
51
CTSIB
- clinical test of sensory integration & balance - determine sensory system pt relies on to mntn balance - timed (30 sec), sway - EO/EC on firm/foam
52
Self-Report Measures
- dizziness handicap inventory - activity specific balance confidence scale - falls efficacy scale
53
Exam: | Body Function/Structure
- occulomotor tests - Dix-Hallpike - CTSIB - Other impairment tests
54
Exam: | Activity
-DGI
55
Exam: | Participation
- Dizziness handicap inventory - ABC Scale (more difficult items than FES) - FES
56
Dizziness Handicap Inventory
- self-perceived handicap/disability due to vestibular disorder - 3 domains: functional, emotional, physical

Neuromuscular Conditions II (15 decks)

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