vestibular rehab foundational knowledge Flashcards
(127 cards)
1
Q
what are the 2 systems that the vestibular system is broken down to
A
peripheral and central
2
Q
the inner ear and 8th cranial nerve is apart of which vestibular system?
A
peripheral
3
Q
the vestibular nuclei , cerebellum and higher cortical connections is apart of what vestibular system
A
central
4
Q
what 2 things give us spatial awareness
A
vision and somatosensation
5
Q
spatial awareness gives us what 2 things
A
balance and gaze stability
6
Q
what is the most common complaint with people with vestibular problems
A
dizziness
7
Q
what is a a strong predictor of falls in the elderly people
A
presence of dizziness
8
Q
____ 2nd only to LBP in occurrence in adults
A
dizziness
9
Q
Vestibular therapists use ____ to re-train the brain to interpret and utilize vestibular inputs more accurately.
A
neuroplasticity
10
Q
Vestibular system functions to sense _____… resulting symptoms of ____
A
movement
malfunction
11
Q
what is it called when someone experiences false sense of movement i.e spinning , r4ocking , swaying
A
vertigo
12
Q
what kind of movement does the semicircular canals detect
A
angular and rotational
13
Q
what part of the ear detects linear movement
A
saccule and utricle
14
Q
what is included in the inner ear
A
semi circular canals
cupola
cochlea
endolymoh
15
Q
what is important in terms of converting mechanical energy from the nervous system and it is a fluid that fulls the inner ear
A
endolymph
16
Q
what has hair receptors cells that get stimulated by the sound vibration ?
A
cochlea
17
Q
what is the hair cells within the ampula
A
cupula
18
Q
how do the semi circular canals line up with each other
A
the L post canal is lines up with the R anterior canal
the R anterior canal is lined up with the L postioer canal
and both horizontals line up together
19
Q
what happens with the endolymph when the head turns to the L
A
endolymph moves thru the horizontal canal and thru the cupula and bends the hair cells , inhibiting the R ear adn then exciting the L ear
20
Q
when you turn ur head to the R the endolymph move to the __
A
left
21
Q
what sits on top of the hair cells in the utricle and saccule
A
odoconia
22
Q
what are microscopic calcium carbonate crystals , that respond to gravity or movement
A
otoconia , located in the uticle and saccule
23
Q
what part of the ear detects when u move ur head up , down , left , right and forward and backwards
A
utricle and saccule
linear movement
24
Q
what nerve of the vestibuylochoclear nerve is responsible for sound info and which one is responsible for movement info
A
cochlear and vestibular
25
where does the **vestibulocochlear n** travel to
the BS
26
what part of the brain gets a lot of the sound signals bc it control movement coordination and balance
cerebellum
27
what tract is activated by reflex when we move our head and it sends a signal straight from BS down to SC to our spinal mm to balance us
vestibulospinal tract
28
what Cranial nerves are invovled in the **vestibulo- ocular reflex**
oculomotor nerve (3)
trochlear n (4)
abducens nerve (6)
29
what is the **vestibular ocular reflex**
maintains gaze stability during head motion ; controlling eye head coordination
30
what is the vestibulo spinal reflex
maintains head and body equilibrium by facilitation or inhibiting skeletal mm activity thus controlling coordination for balance
31
what is the cervical ocular reflex
reflex output to motor cells , signals head position on body
,maintains gaze stability secondary to VOR
32
where does the **otolith ocular reflex** receive input from and what does it control
utrucle and saccule ; output to eye mm
controls horizontal and vertical eye movement via linear VOR
33
what reflex Maintains gaze stability during head motion thus controlling eye-head coordination
vestibular ocular reflex
34
what higher cortical places in the brain have connections with the vestibular systems
thalamus, visual cortex , hippocampus
35
the ____ vestibular system affects the **motion system**
peripheral
36
• BPPV
• Neuritis
• Labyrinthitis
• Acoustic neuroma
• Hypofunction
• Unilateral
• Bilateral
• Endolymphatic Hydrops/Meniere’s
• Fistula/Dehiscence
these are all pathophysiology of what part of the vestibular system
peripheral
37
problems with the peripheral vestibular system affects ___ and ____ of movement information
sensation and perception
38
what problem is it when the otoconia become dislodged from the utricle or saccule and displaced into a semi circular canal and affects endolymph flow thru the canal and cupula deflection
benign paroxysmal positional vertigo (BPPV)
39
what causes BPPV
idiopathic
head trauma
inflammation
ischemia
pressure fluctuations
40
what are risk factors for BPPV (6)
age
female
vitamin D deficiency
hypertension
migraine
hyperliipemia
41
what are the symptoms of BPPV
10-60 sec spell of vertigo with changes in head position against gravity
42
what is BPPV
when otoconia come out from the utricle or saccule and displace into the semi circular canal
43
T/F: BPPV is positional and changes with head position
T
44
what are the two different types of BPPV
canalithiasis and cupuloithiasis
45
what is BPPV Canalithiasis
when otoconia are free floating in the semicircular canal , causing abnormal flow of endolymph with changes in head position against gravity
46
How is the onset , symptoms and how long does canalithiasis BPPV last
latent onset of vertigo and nystagmus (seconds)
symptoms gradually intensity then subside (episodic)
last less than 1 min
47
pertaining to cupuloithiasis BPPV what is the onset , how are the symptoms , and how long does it last
more immediate onset of vertigo and nystagmus
symptoms intensity remains the same
lasts as long as the head is held in the provoking position
48
what is BPPV; cupuloithiasis
otoconia are stuck to the cupula , causing deflection of the cupula with change in head position against gravity
49
what part of the ear is common for ear infection
middle ear
50
what part of the ear is more common for **virtual infection**
inner ear
51
what is the pathophysiology of **neuritis/ labyrinthitis**
inflammation of the inner ear ( labyrinthitis) or vestibular n (neuritis), causing vestibular hypesitmulation and may result in damage leading to hypofunction
52
what is the main difference between **neuritis** and **labyrinthitis**
neuritis has **no hearing loss** invovled and it affects the nerve
labyrinthitis **includes hearing loss** and affects the **actual strucutre** of the inner ear
53
what are causes of **neuritis/ labyrinthitis**
viral infection 98% and head injury
54
is it common for **neuritis** to reoccur
no viral infections are very unlikely to ever reoccur bc of the body immune system
55
what are the symptoms of **neuritis/ labyrinthitis**
sudden onset of vertigo, nausea , lasting 3-7 days with residual balance and dizziness lasting 1-2 weeks
**often follows other illness (respiratory infection)**
56
what is hypofunction
damage to the inner ear or vestibular n that results in a diminished or weaker neurological signal
can be unilateral or bilateral
57
what is the **hallmark** for **bilateral hypofunction**
when the patient sees things jumping/bouncing (called oscillopsia)
58
what are causes of hypofunction
neuritis
labrinthitis
ménière’s disease
acoustic neuroma
ototixic medication
gentamicin
meningitis
ear sx
59
**symptoms** of **hypofunction**
affects VOR and VSR
postural instability
gaze instability
movement related to dizziness
motion sensitivity
foggy headedness
kinesiphobia - fear to exercise
oscillopsia- boucing world
60
in Hypofunction ____ allows for CNS compensation
neuroplasticity
61
what is the pathophysiology of **acoustic neuroma**
benign , slow growing tumor of the myelin sheath (schwann cells) covering the acoustic/ cochlear or vestibular n causing compression of CN 8
62
what are the casues of **acoustic neuroma**
idiopathic or genetic
63
what is acoustic neuroma also called
cerebellopontine angle tumor, vestibular or acoustic schwannoma
64
what are the symptoms of **acoustic neuroma**
**gradual onset of unilateral hearing loss**
tinnitus
imbalance
motion sensitivity
facial numbness/weakness
65
T/F: acoustic neuroma lacked TRUE vertigo symptoms
T
66
what is the pathophysiology of **endolymphastioc hydrops/ Meniere’s**
Build-up of endolymphatic fluid within the inner ear,
causing pressure on the inner ear membranes and hair cells. Can cause inflammation and damage over time.
can be unilateral or bilateral
67
is **Endolymphatic Hydrops/Meniere’s** a one time thing or can it be reoccurring
reoccurring
68
what are causes of **Endolymphatic Hydrops/Meniere’s**
idiopathic (meniere’s)
sodium/potassium imbalance (systemic)
middle ear congestion
69
symptoms of **Endolymphatic Hydrops/Meniere’s**
REOCCURING episodes of vertigo lasting 1-3 days with gradual improvement over 1-2 weeks
low frequency hearing loss
70
what is the pathophysiology of **Fistula/Dehiscence**
Structural “hole” in the inner
ear, then unable to regulate endolymph fluid
pressure and flow.
71
is Fistula/Dehiscence reoccurring or one time
reoccuring
72
is Fistula or Dehiscence the structural hole in the inner ear
dehiscence
73
what are the **causes** of **Fistula/Dehiscence**
trauma , head injury , or valsalva (rare)
74
what are the **symptoms** of **Fistula/Dehiscence**
reoccuring spells of vertigo , possible associated with loud sounds and barometric pressure changes , hearing hypersentivitiy, imbalance and motion sensitivity
75
• Stroke
• Brain tumor
• Multiple Sclerosis lesions
• Degenerative neurological conditions
• Vestibular Migraine
• PPPD
• MDDS
• Anything affecting the central vestibular connections in the brain and brainstem
these are all pathophysiology of what part of the vestibular system
central
76
pathophysiology in the central vestibular system affects ____ and ____ of movement information
perception and integration
77
what kind of disorder is a vestibular migraine
sensory perception disorder
issue with how the brain receives and interprets sensory information
78
since the causes of a **vestibular migraine** is UNKNOWN what are the risk factors (3) and common triggers (6) for it
Risk factors: female, Magnesium deficiency, migraine history
* Common triggers: Stress, hormone fluctuations, weather changes, poor sleep,
caffeine, alcohol,
79
what are the symptoms of a **vestibular migraine**
recurring r episodes of vertigo
lasts 1-5 days
often associated with headache , photophobia , phonophobia , brain fog , anxiety , dissociative symptoms and visual issues
80
what is the pathophysiology of **persistent postural positional dizziness (PPPD)** (aka chronic functional dizziness)
## Footnote
central issue
autonomic and emotional hyper responsiveness to vestibular stimulus
81
what are the causes of PPPD
abnormal adapatation following a vestibular trauma ( BPPV , vestibular migraine , unilateral vestibular pathology)
82
what are the **symptoms** of PPPD
constant visual motion sensitivity and imbalance coupled with anxiety , kinesiophobia , “visual vertigo” , “space motion discomfort” ,
last over > 3 months
83
what is the pathophysiology of **Mal de Debarquement (MDDS)**
mal adaptation following disembarking a moving vehicle (continue sensation of movement after getting off of something that has been moving) `
84
what are the casues of **Mal de Debarquement (MDDS)**
unknown but associated with anxiety and emotional responses to dizziness
85
what are the symptoms of **Mal de Debarquement (MDDS)**
## Footnote
central issue
persistent sensation of rocking or swaying that lasts beyond the expected period of adaptation
86
what are the **non vestibular** pathology associated with **cardiovascular**
* Orthostatic hypotension
* Low/high blood pressure
* Vertebral basilar artery insufficiency
87
what are the **non vestibular pathology** associated with **metabolic**
* Low/high blood sugar
* Dehydration
* Infection (UTI, URI)
* Medications
88
what is the most common self report outcome measure for **dizziness/vertigo**
dizziness handicap inventory (DHI)
89
what does the **dizziness handicap inventory (DHI)** ask
25 questions about how dizziness is impacting function
yes, no, sometimes
0: no handicap , 100: complete handicap
90
what is the most importantly part of the assessment process for a vestibular patient
the subjective
91
during the subjective what are u looking for
clues for differential diagnosis and functional impact
92
what is vertigo
illusion of movement (spinning , rocking ,swaying , falling)
93
what is disequilibrium
sense of being off balance
94
what is the symptoms of a cardiovascular problem pertaining to a vestibular patient
light headed , pre syncope , tunnel vision
95
what is the symptoms of a **anxiety** problem pertaining to a vestibular patient
floating , swimming ,rocking
96
what is the symptoms of a **visual** **problem** pertaining to a vestibular patient
diplopia (seeing double)
oscillopsia (vision jumping)
97
what is the tempo (frequency and duration) of **vestibular neuritis or labrinthitis**
sudden onset/acute
lasting days
single event
98
what is the tempo (frequency and duration) of BBPV
short spells (seconds)
recurring
99
what is the tempo (frequency and duration) of **bilateral hypofunction**
gradual onset over months/years
constant/ chronic
100
what is the tempo (frequency and duration) of **meniere’s or vestibular migraine**
sudden/acute
recurring spells (hours-days)
101
what is the tempo (frequency and duration) of **wallenberg infarct**
sudden onset/acute
hours-days
single event
102
what is the tempo (frequency and duration) of **orthostatic hypotension**
short spells (seconds -mins)
recurring
103
what is the tempo (frequency and duration) of **MDDS or PPPD**
constant
fluctuating severity ,
chronic
104
what is the **aggravating** and **easing** factor for **BPPV**
A: positional like lying down , sitting up or turning over
E: holding still, time
105
what is the **aggravating** and **easing** factor for **gaze instability**
A: head movement , visual vestibular mismatch
E: holding still, closing eyes
106
what is the **aggravating** and **easing** factor for **imbalance**
A: walking , darkness , unstable surfaces , standing up
E: sitting , support from UEs
107
what is the **aggravating** and **easing** factor for **vestibular neuritis**
A: spontaneous, exacerbated by head movements
E: holding still , closing eyes , meds
108
what is the **aggravating** and **easing** factor for **vestibular migraine or meniere’s**
A: spontaneous , exacerbated by head movements and common triggers
E: holding still, closing eyes, meds
109
what are the co morbidities for a vestibular issue
diabetes
BP
auto immune conditions
anxiety
depression
peipheral neuropathy
110
what **meds** are considered **vestibular suppressants**
meclizine
dramamine
valium
111
____ is a common medication side effect
dizziness
112
what are some diagnostic test done for vestibular tests
audiogram , VNG/ ENG
113
what is nystagmus
rapid repeating eye movement
114
how is nystagmus names
by the fast phase from the patients perspective
115
what is slow phase and fast phase nystagmus caused by in the vesitbular system
slow: VOR
fast: caused by corrective saccades by cerebellum
116
what nystagmus is casues by the CNS
smooth pursuit and saccades - BS and cerebellum
117
peripheral vestibular nystagmus ….
slow phase caused by ____
fast phase caused by ___ _____
____ fixed
usually _____
decreased in intensity with _____
gaze towards ___ phase increased intensity (____ law)
VOR
corrective saccade
direction
horizontal
fixation
fast
alexander’s
118
what is the exceptions for peripheral vesitbular nystagmus
BBPPV
119
what is **alexander’s law** for peripheral vestibular nystagmus
gaze towards the fast phase increased intensity
120
so if a patient comes in with left nystagmus and it is peripheral vestibular what should happen when the patient looks left and looks right and what fixation
pertaining to alexander’s law when the painter looks L the intensity should increased bc the patient is gazing toward the fast phase side and when she looks to the eR it should decreased
and it should decreased with fixation bc it is a peripheral issue
121
central nervous system nystagmus
___ changing (often follows gaze)
can be ___ or _____
not affected by ____
_____
usually from a ___
direction
vertical or pendular
fixation
congenital
trauma
122
if you are examining a patient w nystagmus and their nystagmus changes when they look to the L and when they look to the R what system is it
central bc it is direction changing
123
what are 3 tools used for observing nystagmus
frenzel and infrared goggles
VNG/ENG (nystagmography)
rotary chair
124
what does the frenzel and infrared goggles take away
fixation
125
what is the **gold standard** for identifying **unilateral vestibular hypofunction**
VNG/ENG (nystagmography)
126
what is the **rotary chair** the **gold standard** for
identifying bilateral hypofunction
127
what is the purpose of an examination for a vestibular patient
screen for vestibular involvement
DD
identify impairments
