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Neuro 3 Final > Vestibular Rehabilitation > Flashcards

Vestibular Rehabilitation Flashcards

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1
Q

Vestibulo-Spinal Reflex =

A

reflex that helps maintain your balance and posture when your head moves

automatically adjusts your body position to stabilize you — without thinking about it

postural reflex, triggered by input from the vestibular system

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2
Q

VSR Functional example:

A

Head tilts or rolls to one side -> both the canals and otoliths are stimulated

Vestibular nerve and vestibular nucleus are activated

Impulses are transmitted via the lateral and medial vestibulospinal tracts to the spinal cord

Extensor activity is induced on the side to which the head is inclined, and flexor activity is induced on the opposite side.

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3
Q

VSR:

Head movement → detected by vestibular apparatus (otoliths + semicircular canals) =

A

Signal travels via vestibular nerve (CN VIII) to the vestibular nuclei in the brainstem.

Reflex pathways send signals down the spinal cord to activate postural muscles.

This happens automatically to maintain stability.

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4
Q

VSR = vestibular input ➔

A

spinal motor output to maintain posture

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5
Q

3 big ones:

Vestibulopathy-Vestibular Dysfunction

A
  1. Vestibular neuronitis, labyrinthitis
  2. Meniere’s disease
  3. Benign Paroxysmal Positional Vertigo (BPPV)
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6
Q

Vestibular Neuritis / Labyrinthitis

A

Vestibular Neuritis = Viral infection/inflammation of the vestibular nerve only.

Labyrinthitis = Involves both the vestibular and cochlear parts — so hearing is affected too.

Acute onset severe vertigo
Nausea, vomiting
Imbalance

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7
Q

Vestibular Neuritis / Labyrinthitis

Treatment:

A

Gaze stabilization exercises (VOR x1, VOR x2)

Balance retraining

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8
Q

Meniere’s Disease

A

inner ear disorder caused by abnormal accumulation of endolymphatic fluid

Episodic vertigo (spells lasting 20 min to several hours)

Fluctuating hearing loss (often low-frequency early on)

Tinnitus (ringing or buzzing in the ear)

Aural fullness (pressure or clogged sensation)

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9
Q

Meniere’s Disease

Treatment:

A

Gaze stabilization exercises

Balance training

Diet modifications (low salt diet to control fluid buildup)

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10
Q

BPPV (Benign Paroxysmal Positional Vertigo)

A

Most common cause of vertigo — due to dislodged otoconia moving into one of the semicircular canals (usually posterior)

Brief, intense vertigo triggered by position changes (rolling over, looking up, bending down)

No hearing loss or tinnitus (purely balance-related)

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11
Q

BPPV (Benign Paroxysmal Positional Vertigo)

Treatment:

A

Canalith repositioning maneuvers:

Epley maneuver (posterior canal)

BBQ Roll (horizontal canal)

Gufoni maneuver (horizontal canal)

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12
Q

Unilateral Vestibular Hypofunction/Loss =

A

Acute lesion to one labyrinth or vestibular nerve that leads to horizontal/torsional nystagmus

One of the peripheral vestibular receptors does not function properly -> Disrupts the normal symmetric input from the inner ears to the CNS

CNS interprets input as continuous head rotation: causes symptoms of vertigo, nausea, postural instability, and nystagmus

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13
Q

Unilateral Vestibular Hypofunction/Loss =

Nystagmus be partially or fully suppressed by ____

A

visual fixation; best observed when fixation is removed (e.g. Frenzel goggles)

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14
Q

UVH/UVL =

A

partial or complete loss of vestibular function on one side (right or left).

The other side is still functional.

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15
Q

UVH/UVL

Common Causes:

A

Vestibular neuritis (most common) → viral inflammation of the vestibular nerve

Labyrinthitis (infection of entire labyrinth)

Acoustic neuroma (tumor on vestibular nerve)

Meniere’s disease (advanced cases)

Surgical removal (vestibular nerve section for tumors)

Head trauma

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16
Q

UVH/UVL
Acute phase symptoms:

A

Severe vertigo

Nausea/vomiting

Spontaneous nystagmus (fast phase toward healthy ear)

Imbalance (especially with quick movements)

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17
Q

UVH/UVL
Chronic/compensated phase symptoms:

A

No more spinning vertigo

Still have imbalance

Trouble with quick head movements (oscillopsia)

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18
Q

The body can compensate over time for unilateral loss by:

A

Central nervous system plasticity

Strengthening use of vision and proprioception

PT helps speed this up!

✅ Vestibular rehab = critical to retrain VOR and balance.

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19
Q

Bilateral Peripheral Vestibular Hypofunction

A

Loss or severe reduction of vestibular function on BOTH sides — right and left labyrinths/vestibular nerves are affected

Since both sides are impaired, there’s no asymmetry → no spinning vertigo like you get with unilateral loss

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20
Q

Bilateral Peripheral Vestibular Hypofunction

Common Causes:

A

Ototoxicity (from drugs like gentamicin, aminoglycosides)

Bilateral vestibular neuritis (rare)

Autoimmune inner ear disease

Meningitis

Idiopathic (unknown cause)

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21
Q

Bilateral Peripheral Vestibular Hypofunction

Typical Symptoms:

A

Severe imbalance (especially in the dark or on uneven ground)

Oscillopsia (blurry/bouncy vision when moving) - due to loss of VOR

Gait instability

No true vertigo

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22
Q

Major difference - BVH from UVH:

A

No spinning vertigo, but much worse balance problems!

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23
Q

Bilateral Peripheral Vestibular Hypofunction

very dependent on ____ for balance now.

Patients have major trouble:

A

vision and somatosensation

Walking in the dark

Walking on uneven or compliant surfaces (grass, sand)

Falls are a huge risk

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24
Q

Outcome Measures: Vestibular Hypofunction

A

Assess function, balance, and fall risk in patients with vestibular disorders (UVH, BVH).

Dizziness Handicap Inventory (DHI)

Dynamic Gait Index (DGI)

Functional Gait Assessment (FGA)

Timed Up and Go (TUG)

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25
Dizziness Handicap Inventory (DHI) =
Self-report questionnaire about how dizziness impacts daily life. 25 items — physical, emotional, and functional questions. Scoring: Higher = worse perceived disability. Captures the patient's perception of how dizzy they are, not just clinical findings.
26
Dynamic Gait Index (DGI) =
8 walking tasks that challenge balance (e.g., walking with head turns, stepping over obstacles). Scoring: Higher = better. Identifies fall risk and functional ambulation issues in real-world settings.
27
Functional Gait Assessment (FGA) =
A modified and improved version of the DGI. Includes harder tasks (e.g., walking with eyes closed, backward walking). Scoring: Higher = better. Better sensitivity for vestibular dysfunction than DGI alone.
28
Timed Up and Go (TUG) =
Stand up from a chair, walk 3 meters, turn, walk back, and sit down. Fast screening for functional mobility and fall risk. If TUG >13.5 seconds → higher fall risk.
29
Subjective History =
Symptom description (spinning? lightheadedness? imbalance?) Onset and duration (sudden? episodic? constant?) Triggers (position changes? loud sounds? exercise?) Associated symptoms (hearing loss, headaches, numbness, visual changes)
30
Spinning vertigo + triggered by position
Likely peripheral (BPPV)
31
Imbalance without vertigo, severe ataxia
Likely central (brainstem/cerebellum)
32
Brief blackouts, chest pain
Non-vestibular (cardiac)
33
Oculomotor Exam
Smooth pursuits, saccades, gaze holding. Presence of gaze-evoked nystagmus (central sign). Head Impulse Test (HIT): Positive HIT = peripheral vestibular hypofunction.
34
Acute Vestibular Crisis =
Onset: Sudden, severe vertigo Duration: Hours to days Associated with: Vestibular neuritis, labyrinthitis Key symptom: Non-positional continuous vertigo initially, then gradual compensation
35
Positional Dizziness =
Onset: Triggered by specific head movements Duration: Seconds to less than 1 minute Associated with: BPPV Key symptom: Very brief, intense spinning when changing positions (e.g., rolling over in bed)
36
Episodic Attacks =
Onset: Comes and goes unpredictably Duration: Minutes to hours Associated with: Meniere’s disease, vestibular migraine Key symptom: Vertigo attacks + possible hearing changes (Meniere’s)
37
Chronic Imbalance =
Onset: Gradual or following acute event Duration: Persistent daily unsteadiness Associated with: Bilateral vestibular hypofunction, cerebellar stroke, central disorders Key symptom: Worsens in dark or on uneven surfaces
38
timing pattern: Sudden, prolonged (hours–days)
Vestibular neuritis, labyrinthitis
39
timing pattern: Brief, positional (seconds)
BPPV
40
timing pattern: Episodic attacks (minutes–hours)
Meniere’s disease, vestibular migraine
41
timing pattern: Chronic daily imbalance
BVH, central dysfunction
42
Standing up after lying down (e.g., getting up from bed) Think:
Orthostatic hypotension (blood pressure drop) Central hypoperfusion (cardiovascular dizziness) Not purely vestibular, but important to differentiate.
43
Lying down, sitting up, turning in bed (e.g., rolling side to side at night) Think:
BPPV — classic positional vertigo (brief, triggered by head movement)
44
Bending over, looking up (e.g., tying shoes, reaching overhead) Think:
BPPV (especially posterior canal) Orthostatic issues (blood pressure drop) Possible vertebrobasilar insufficiency (if associated with serious neuro signs)
45
Exertion (e.g., after running, walking, heavy physical work) Think:
Cardiac issues (arrhythmias, cardiac insufficiency) Respiratory insufficiency Dizziness triggered by exertion is not typical of vestibular disorders!
46
Spontaneous dizziness (no movement involved) Dizziness just happens on its own — not triggered by head or body movement. Think:
Meniere’s Disease (random attacks) Vestibular migraine Central causes (brainstem lesions)
47
Patient cannot explain trigger "It just happens sometimes, I don't know why." Think:
Central disorders (MS, cerebellar stroke) Vestibular migraine Psychogenic dizziness (anxiety-related)
48
Acute:
Acute (3 days or less) A sudden onset event that has just recently occurred. Likely a vestibular crisis (e.g., vestibular neuritis, labyrinthitis, stroke) Intense, continuous vertigo Severe nausea/vomiting Spontaneous nystagmus
49
Chronic:
Chronic (more than 3 days) Symptoms are persisting over time — patient may or may not still have vertigo, but imbalance is often the complaint now Daily imbalance Oscillopsia Less spinning, more unsteadiness
50
Spells/Episodes:
seconds = think BPPV — short, triggered by head movements minutes to hours = think Meniere’s disease, vestibular migraine, TIA (transient ischemic attack) days = think vestibular neuritis or stroke
51
Continuous Dizziness:
dizziness never stops: Could be a central cause (e.g., cerebellar stroke, MS) Or a poorly compensated peripheral cause (chronic UVH, BVH)
52
Spells vs Continuous Symptoms:
Short spells = positional Medium spells = inner ear disease or migraine Long spells = big vestibular injury Continuous dizziness = something that the brain hasn’t adapted to
53
What brings on the dizziness? Trigger patterns:
Specific movements that provoke it Activity type (exertion vs rest) Spontaneous episodes (no clear movement) Whether it's positional, exertional, or constant
54
Key Types of Dizziness Symptoms:
vertigo disequilibrium nausea lightheadedness oscillopsia motion sickness rocking/swaying
55
Vertigo =
(Spinning Sensation) "The room is spinning" or "I feel like I'm spinning." BPPV, vestibular neuritis, Meniere’s
56
Disequilibrium =
(Imbalance) I feel unsteady" or "I feel like I’m going to fall." BVH, stroke, cerebellar issues
57
Lightheadedness =
(Presyncope) "I feel faint" or "I feel like I'm about to pass out." Orthostatic hypotension, cardiac issues
58
Oscillopsia =
(Visual Blurring) "My vision bounces when I walk" or "Everything shakes when I move my head." BVH, severe UVH
59
Neurological Symptoms =
Double vision (diplopia) Slurred speech (dysarthria) Numbness, weakness Ataxia (incoordination)
60
Neuro symptoms -> think:
Central causes (brainstem stroke, MS, tumors) Emergency referral needed if acute onset.
61
Auditory Symptoms =
Hearing loss Tinnitus (ringing or buzzing) Aural fullness (feeling of pressure in ear)
62
Auditory Symptoms -> think:
Inner ear problems Meniere’s disease (fluctuating hearing loss + vertigo) Labyrinthitis (hearing loss + vertigo) Acoustic neuroma (gradual hearing loss + imbalance)
63
Headache =
Vestibular migraine Possible central cause
64
Headache -> think:
Vestibular migraine Possible central cause
65
Autonomic Symptoms =
Sweating Palpitations Nausea without spinning Feeling of impending doom
66
Autonomic Symptoms -> think:
Cardiac causes Orthostatic hypotension Anxiety/panic disorders
67
Visual Changes =
Blurred vision Visual motion sensitivity (getting dizzy when things move around them, like in a busy grocery store)
68
Visual Changes -> think:
Vestibular dysfunction (common) Central dysfunction
69
Diabetes -
Can cause peripheral neuropathy → impaired somatosensation → worsened balance. Microvascular disease could affect inner ear structures. Microvascular disease could affect inner ear structures.
70
Osteoporosis/Osteopenia -
Higher risk for fractures if they fall. Also interesting: there’s some evidence linking osteoporosis with higher rates of BPPV (likely due to calcium metabolism affecting otoconia). ✅ Must address fall prevention and balance rehab aggressively.
71
Anxiety/Depression -
Psychological conditions can amplify perception of dizziness. Anxiety can cause dizziness (hyperventilation, panic attacks). Vestibular dysfunction can cause secondary anxiety — vicious cycle. ✅ Must screen carefully — sometimes treat dizziness and anxiety together.
72
Migraine -
Strong association with vestibular migraine. Dizziness can occur with or without headache. Migraineurs are highly sensitive to visual motion, vestibular input. ✅ Think migraine if dizziness episodes are random, without clear mechanical triggers, and associated with visual aura, photophobia, etc.
73
Falls could indicate:
Vestibular loss (peripheral or central) Poor compensation Orthostatic hypotension Gait or strength deficits Fall mechanism (tripped vs dizzy vs blackout) gives clues to cause.
74
Why Do an Auditory Screen in Vestibular Patients?
Hearing changes + dizziness often mean the problem is in the inner ear, not just the vestibular nerve alone. Helps differentiate peripheral causes (labyrinthitis, Meniere’s, acoustic neuroma) from central causes (which usually don't involve hearing loss unless the brainstem is affected)
75
Unilateral hearing loss (one ear) points toward:
Meniere’s disease (fluctuating hearing loss) Labyrinthitis (sudden hearing loss + vertigo) Acoustic neuroma (gradual hearing loss + imbalance)
76
Tinnitus = ringing, buzzing, roaring in the ears. Often accompanies:
Meniere’s disease Acoustic neuroma Sometimes labyrinthitis
77
When Hearing Loss is NOT Expected:
Vestibular neuritis (because it only affects the vestibular nerve, not the cochlear nerve). BPPV (pure mechanical problem — no cochlear involvement). Central vestibular disorders (unless brainstem structures that involve hearing are affected — rare).
78
Finger Rub Test =
Stand about 2 feet away from the patient. Rub your fingers together near one ear (then the other). Ask the patient: ➔ "Can you hear this? Does it sound the same on both sides?"
79
Finger Rub Test Screens for:
Gross asymmetry in hearing. If hearing is reduced on one side, this suggests: Cochlear pathology (labyrinthitis, Meniere’s, acoustic neuroma).
80
Finger Rub Test Advantages =
Quick No equipment needed Good first-pass check for unilateral hearing loss.
81
Weber Test =
Strike a tuning fork (usually 512 Hz). Place the base of the vibrating tuning fork on the center of the patient’s forehead or the top of their head. Ask: ➔ "Where do you hear the sound: in the middle, or more to one side?" Weber Test helps confirm asymmetry if Finger Rub is suspicious. It’s still a screen, not a substitute for audiology referral.
82
Weber Tests Findings:
Sound heard louder in one ear = Conductive loss (bad ear louder) or Sensorineural loss (good ear louder)

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