Vestibular Rehab Flashcards

Question

Direction Changing Nystagmus

Answer 1

CENTRAL sign Looking left, left beating nystagmus Looking right, right beating nystagmus

Answer 2

Significant overshooting is a central sign Multiple undershoots is a central sign ***One undershoot is considered normal

Answer 3

Look for quality of movement Pt follows your finger as you move it

Answer 4

Ask pt to focus on your nose, slowly move head side to side, observing for visual fixation Discriminates LEFT from RIGHT dysfunction -- One of the most effective Direction of HEAD MOVEMENT = DIRECTION of Dysfunction Positive sign - If eyes go with head turn then correct back to focus on examiner

Answer 5

Almost always a cerebellar pathology

Answer 6

``` Saccades Coordination deficits Spasticity VOR Cancellation Vertical Gaze Nystagmus ```

Answer 7

Suggestive of a bilateral lesion Reading Snellen chart while head is turning side to side 3 line difference?

Answer 8

Sensitive for concussions Move head back and forth Nystagmus often seen in patients with unilateral vestibular lesions

Answer 9

Romberg EO/EC/Foam Sharpened Romberg EO/EC/Foam SLS RESULTS WILL VARY WITH PT'S ABILITY TO VISUALLY FIXATE

Answer 10

Gait with head rotation Gait with absent vision Decreased BOS Singleton's Test Gait Velocity Standardized Assessments

Answer 11

Pt may lose balance when turning to affected side Pt walks towards examiner, turns around to one side and assumes the Romberg position with eyes closed Left vs Right Does NOT distinguish central vs peripheral

Answer 12

Head thrust | Singleton's

Answer 13

16 positions Crazy long test Most he'll do is 4 positions Just need to answer the question about motion making them dizzy

Answer 14

Epilepsy Demyelinating diseases Tumors Vascular (including CVA, VBI) Traumatic Degenerative changes

Answer 15

Onset All at once - stroke Insidious onset - tumor

Answer 16

Cerebellum throttles input (diminishes input)

Answer 17

Bag of rocks When you tilt your head to the side, it tells your body you're tilted to the side

Answer 18

Tells brain when we're moving Spinning to the R - hair cells will deflect to side sending message to brain that you're spinning

Answer 19

Utricle crystals can get into semicircular canals and send confusing signals to brain

Answer 20

1 second delay before true vertigo and nystagmus begins Looking for combination of nystagmus and vertigo Symptoms DECREASE with repetition of this test BPPV

Answer 21

Took crystal that was out of whack and brought it out of the semicircular canal to be reabsorbed into utricle

Answer 22

Full extension and full rotation This occludes the Vertebral artery and they can get these symptoms Hallpike does not engage this amount of extension and full rotation You can test for VBI in sitting before applying Hallpike maneuver

Answer 23

Complaints upon return to sitting are common Make sure the therapist is supporting the pt from BEHIND for 60 seconds after a positive Hallpike or Eppley maneuver

Answer 24

Posterior semi-circular canal (SSC) becomes gravity sensitive (SSCs normally respond to dynamic changes while otoliths respond to static positioning) More common in the elderly, and usually idiopathic; with identifiable causes including head trauma, viral labyrinthitis, vestibular neuritis, and perilymph fistula

Answer 25

Rocks from utricle are free floating in the inner ear

Answer 26

Rocks become adhered to the cupula (end organ in the ampulla) making it gravity sensitive Expect IMMEDIATE nystagmus which may not fatigue Use the Liberatory maneuver

Answer 27

Epley - posterior Liberatory - posterior adherence OR horizontal nystagmus withOUT latency BBQ Roll - horizontal canal involvement WITH latency Brandt's exercises - repeat til symptoms relax

Answer 28

Don't sleep on affected side for 1 week

Answer 29

Generally pts respond quickly to a few txs (generally 1x a week) with a decrease in symptoms greater than 75% Prognosis - excellent, 80% elimination of dizziness each successive maneuver

Answer 30

Nystagmus in all quadrants

Answer 31

Nystagmus in specific direction of gaze

Answer 32

Rotational nystagmus

Answer 33

Vertical nystagmus

Answer 34

Horizontal nystagmus

Answer 35

50% of otolithic causes of dizziness

Answer 36

Mismatch between both ears So when a pt is spinning, the L is functioning correctly and R is sending poor information Causes motion sensitivity*** characteristic complaint Cause - ear infection (development of an UNCOMPENSATED vestibular hypofunction) Other symptoms - minimally decreased balance (use hard balance tests), slightly ataxic with head rotations during gait

Answer 37

Neuronitis (no hearing loss) Labyrinthitis (hearing loss) Weakness/damage to one vestibular organ Acoustic neuromas

Answer 38

VOR exercises Repeated movements Balance retraining

Answer 39

Excellent Pts will get back to all premorbid activities We can teach them to compensate with full vestibular fx on good side and visual/somatosensory systems

Answer 40

Usually happens from ototoxic medications - they damage hair cells of vestibular system (Streptomycin, vancomycin...usually given after open heart surgery) Pts have problems reading, driving (secondary to Oscillopsia), and difficult with visually stimulating situations ***Oscillopsia primary complaint

Answer 41

Positive Snellen chart (Oscillopsia test) Pts with complete or severe vestibular loss may be unable to perform Romberg EC/Foam LOB with Fukuda's stepping test Gait analysis reveals increased BOS (> 2-4 in)

Answer 42

Ototoxic drugs Inner ear autoimmune disease Paget's disease Bilateral tumors Meningitis Endolymphatic hydrops

Answer 43

Train other systems Assistive devices Strengthening, stretching of LE's Use reachers Gait training to eliminate furniture walking Modify home to minimize fall risks

Answer 44

Classic - episodic debilitating vertigo that lasts hours to a day or two, then it's gone Days weeks months years normal and then they'll have another hit Progressive unilateral hearing loss Dx test - simple hearing test Onset btwn 30-50 years

Answer 45

Tumarkin's otolithic crisis Meniere's disease

Answer 46

Malabsorption of fluid Mechanical problem at the ear

Answer 47

During remission, tx aimed at reduction of episodes Dietetic programs - restricting salt, water, alcohol, and nicotine Ablation surgery after they have it 3 times a week in frequency After ablation, considered to have Unilateral Vestibular Hypofunction

Answer 48

One of the presentations of dizziness that come back negative

Answer 49

Most have dizziness with personal movement, but some had vertigo while still sitting or in supine

Answer 50

Transient neurological symptoms (sensory, motor, or cognitive)

Answer 51

Reduction of risk factors Stop smoking Reduce estrogen supplements Diet - avoid aged alcohols, red wine, MSG, chocolate, nuts, cheese, Nutrasweet, caffeine Keep diary to ID causative factors If several migraines per month, consider prophylactic meds

Answer 52

Tinnitus in both Phonophobia and photophobia in migraines Naps usually help migraines Motion sickness common in migraines

Answer 53

Causation - blowing nose, BM Report hearing a pop in the past Symptoms will reside with rest and reoccur with activity

Answer 54

Absolute bed rest for 5-10 days with head elevated Avoidance of straining, sneezing, coughing, or head hanging positions Use of stool softeners If symptoms last > 4 weeks or hearing loss worsens consider exploratory tympanotomy with surgical packing of fistula

Answer 55

Altered afferent proprioceptive signals from upper cervical spine Correlated with whiplash/neck pain Can see with balance/gait dysfunction Neck movement usually aggravates symptoms

Answer 56

Cervical traction as both diagnostic test and tx Focus on upper cervical spine Cervical kinesthesia exercises

Answer 57

Finger stationary Pt moves head and keeps object in focus 10 min rule - no worse for wear 10 min after exercises

Answer 58

Moving finger, moving head in opposite directions Keeping object in focus 10 min rule - no worse for wear 10 min after exercises

Answer 59

Ask them to do it in ONE area or with glasses off VOR for visual acuity If someone wears glasses all the time, they would need to do training with glasses on Pts that use reading glasses need to train with glasses both on and off

Answer 60

Week 1 and 2

Answer 61

# Choose up to 4 activities that bring on mild to moderate dizziness Client performs these exercises quickly As motion sensitivity improves, can substitute more difficult activities Duration of symptoms more important than intensity of symptoms

Answer 62

Decreased number of provoking positions Increased number of reps before symptom occurrence Decreased intensity of symptoms Shorter duration of symptoms

Answer 63

Parallels VOR, contributes to a slow-component eye rotation in the direction opposite to head movement in place of a deficient vestibular system Generated by joints in neck Works at slower speeds than VOR

Answer 64

Visualize target, turn head, see if you're still focused on it

Answer 65

Tx of gaze evoked nystagmus Look at different sides of number board Given during week 3 or 4

Answer 66

Central dysfunction Try to work on decreasing amount of undershoots and avoiding overshoots

Answer 67

After stroke Easier to focus on something distally than closely because of double vision

Answer 68

Vestibular inhibitor Helpful if the system is sending excessive, overwhelming information ACUTE stage of ear infection, CVA, MS, Meniere's Long term use depresses the system we're trying to retrain in PT DISCUSS WITH REFERRAL SOURCES

Answer 69

Horizontal then Vertical

Answer 70

COR exercises Assistive devices Compensation

Answer 71

Differentiate subjective complaints of dizziness Understand most common types of vestibular causes of dizziness and their presentation Develop a treatment plan for each dx based on case studies presented

Answer 72

Corrects all at once

Vestibular Rehab Flashcards

(96 cards)