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Vestibular System Flashcards

1
Q

Two systems involved in vestibular system

A

Peripheral vestibular system

Central vestibular system

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2
Q

Where are the receptors of the peripheral vestibular system located?

A

Receptors located in the inner ear, connected to the auditory organ (i.e., cochlea)

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3
Q

T/F: The central peripheral vestibular system responds to inner ear stimulation, angular acceleration of the head, gravity, and possibly vibration

A

False. The peripheral vestibular system responds to inner ear stimulation, angular acceleration of the head, gravity, and possibly vibration

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4
Q

T/F: If a vibrator is put on a muscle belly, more vestibular input will be present than if a vibrator is put on a bony structure

A

False. If a vibrator is put on a muscle belly, going to be mostly prop. Closer you are to bony structure, the closer it is to vestibular input.

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5
Q

T/F: Vibrations are detected by the proprioceptive system

A

False. Vibrations are detected by the vestibular system, closer to bony structures

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6
Q

T/F: If you stand on something that is vibrating and your whole body is moving, you are using prop. But if you are only vibrating a little and your head isn’t moving, you are using both prop and vestib.

A

False. You are using both prop and vestib when your whole body, including your head, is moving

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7
Q

The vestibular system that is a multimodal system: works intimately with visual and prop systems; close linkages with cerebellum, reticular system, and autonomic nervous system

A

Central vestibular system

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8
Q

System that has close links with cerebellum, reticular system, and autonomic nervous system

A

Central vestibular system.

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9
Q

System that explains why you want to throw up when on a boat/car

A

Want to throw up when on boat/car b/c vestibular info you are getting, which is close to the ANS and cerebellar system

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10
Q

T/F: specific functions of the central vestibular system can be broken up into multiple levels

A

False. Specific functions of the central vestibular system cannot be completely isolated. Must make sure you’re treating the vestib, not cerebellar system

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11
Q

All of the following EXCEPT which are functions of the vestibular system?
A. Awareness of head and body position relative to gravity
B. Antigravity muscle tone
C. Social-emotional regulation
D. Posture and equilibrium
E. Stable visual field
F. Physical and emotional security

A

C. Social-emotional regulation

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12
Q

T/F: Postural control problems are always linked to vestibular processing problems

A

False. Not always a vestibular processing problem

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13
Q

What are the two main types of vestibular processing problems?

A
  1. Underactive vestibular-proprioceptive functions (under)
  2. Fearful and overwhelmed by vestibular sensations (over)
    - Can have quality of life issues when system doesn’t work efficiently
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14
Q

T/F: It is rare that a child with just vestibular processing problem is referred when very young

A

True. Usually a mild problem and can still function. We see kids that are unable to make it work

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15
Q

Involves slow or inefficient processing of vestibular-proprioceptive functions

A

Underactive vestib-prop problems

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16
Q

How may an infant or toddler with an underactive vestib-prop system appear?

A
  • Slower to master gravity
  • difficult to assess when infants
  • Usually see in a very subtle way
  • Need to look at reflexes that are vestib. based e.g., moro reflex–doesn’t react when moves back in space
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17
Q

T/F: It is easy to assess underresponsive vestib-prop problems in infants

A

False. Need to look at reflexes e.g., with moro reflex, doesn’t react when moves back in space

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18
Q

How may preschoolers and kindergarteners with underactive vestib-prop systems appear?

A

-Difficulty adapting to preschool challenges involving postural control

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19
Q

How may school-age children with underactive vestib-prop functions appear?

A
  • Lay on ground
  • Postural control not too good
  • Ask parents if ride tricycle with pedals
  • May seek lots of vestib input e.g., run, jump twirl
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20
Q

A child who seeks a lot of vestibular input e.g., run, jump, twirl, may have what kind of problem?

A

Underactive vestibular-proprioceptive problem

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21
Q

Problem that involves over-responsiveness and anxiety with vestibular sensations

A

Gravitational insecurity

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22
Q

An infant or toddler with this problem will be distressed every time the parent moves him/her

A

Gravitational insecurity. Child may cry or bite

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23
Q

A preschooler who does the following probably has what condition?

  • Fearful of movement
  • Fear of being above ground
  • moves slow
  • Shuffles
  • Won’t climb
A

GI

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24
Q

A school-aged child with a limited reperatoire of movement strategies and participation in gross motor activities probably has what condition?

A

GI

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25
Q

T/F: A child with GI may end of having motor planning problems

A

True

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26
Q

How many adults react to children with GI?

A
  • Parents: puzzlement, anxiety, frustration, irritation, anger, anger, disappointment
  • Teachers: impatience, mislabeling
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27
Q

How can SI problems shape the identity of a child? How can we prevent negative self-perceptions?

A
  • Often identify self as lazy, shy, difficult, problem child b/c heard so many times
  • Treat as early as possible
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28
Q

How do children with vestibular difficulties generally respond to intervention?

A

Respond well to intervention:

  • Improvements in postural and general motor control
  • Improvements in comfort with movement sensations
  • Improvements in confidence and motor skills
  • Provide education to parents/teachers
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29
Q

T/F: Ayres found that children who are overresponsive to vestib respond better to therapy

A

False. Kids underresponsive to vestib. respond better to therapy

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30
Q

Structure housed within the bony labrinth of the temporal bone that is oriented in three planes and responds to movement in three different ways

A

Semicircular canals

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31
Q

Contains three paired structures (superior, posterior, horizontal) that are oriented at right angles to each other, and therefor detect movement of the head in three dimensional space

A

Semicircular canals, within the bony labrinth of the temporal bone

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32
Q

The post-rotary nystagmus test tests the function of what structure?

A

The horizontal semicircular canal. Must put head at 30 degrees of flexion when doing test to put horizontal canal in right position

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33
Q

Structure that responds to angular movement: acceleration and deceleration

A

Semicircular canal.

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34
Q

T/F: When a child is spinning around without moving his head, he is exciting his vestibular system

A

False. Not doing much with vestibular system when head isn’t moving

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35
Q

T/F: The semicircular canals respond to constant velocity

A

False. With constant velocity without acceleration or deceleration, receptors align and won’t respond.

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36
Q

Why do you do the post-nystagmus rotary test in two different directions?

A

Because constant velocity without acceleration or deceleration will keep the receptors of the semicircular canals aligned, so they won’t respond

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37
Q

T/F: if a child is sensitive to vestibular input, you should provide him with what kind of input

A

Prop. But be careful–can get sick afterward

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38
Q

What part of the semicircular canals send impulses to the vestibulocochlear nerve during angular momentum?

A

Movement/bending of hair cells send impulses during angular movementum (acceleration or deceleration)

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39
Q

T/F: semicircular canals only respond to linear movement.

A

False. Semicircular canals only respond to angular acceleration. Otolith organs respond to linear acceleration

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40
Q

Housed at the base of the semicircular canals

A

Otolith organs

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41
Q

T/F: Utricle otolith organ has receptors oriented horizontally while saccule otolith organ has receptors oriented vertically

A

True.

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42
Q

Vestibular structure that is always working, even when standing in an upright position

A

Otolith receptors, utricle and saccule. As long as there is gravity, there is a response (unlike semicircular canal) b/c pressure on hair cells

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43
Q

Hair cells of this structure sends impulses during rate of linear head movement and static position of head in space

A

Otolith receptors, utricle(horizontal) and saccule (vertical)

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44
Q

T/F: Any head position or movement generates vestib. stimulation

A

true

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45
Q

Which system provides the brain with a reference point for spatial orientation?

A

Spatial orientation

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46
Q

Which structure is critical for us due to the pull of gravity

A

Otoliths

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47
Q

When using vestibular stim. in tx, you must consider…

A
  • Head position and plane of movement
  • Speed or velocity of movement
  • Linear vs. angular movement
  • velocity change vs. constancy
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48
Q

T/F: If a child is swinging and moving very slowly, he is receiving a lot of vestib. input

A

False. Going to be little input that he is getting

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49
Q

Linear AND angular movement

A

Arc movement

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50
Q

T/F: The semicircular canals will respond more when moving farther away from the body axis

A

False. The closer to the body axis, the more the semicircular canals will react

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51
Q

T/F: When moving in a tight circle, mostly the otoliths are working

A

False. When moving in a tight circle, mostly semicircular is working.

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52
Q

T/F: Semicircular movements are more important to the vestibular system than linear movements

A

True.

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53
Q

When moving in larger circles/arcs, what structure/s are at work?

A

Semicircular canal and otoliths (semicircular and linear input)

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54
Q

If you spin a child in tight circles and he wants to do it again, what does this mean?

A

He is underresponsive to vestibular input

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55
Q

Relays vestibular info down the spinal cord, to nearby structures of the brainstem and cerebullum, and upward to higher centers of the brain

A

The four vestibular nuclei, on each side of the brainstem

  • Superior
  • Medial
  • Lateral
  • Inferior
56
Q 
If a child has poor extension against gravity, this is probably due to:
A. Reticular Formation via Vestibular
B. Lateral Vestibular Spinal Tract 
C. Vestibular and Cerebellum 
D. Medial vestibular spinal tract
A

B. Lateral vestibular spinal tract influences antigravity extension

57
Q

How does the vestibular system influence a great variety of functions in the body?

A

Via its connections

58
Q

How does the vestibular system affect the lateral vestibular spinal tract?

A

vestibular nuclei descends down LVST pathway that goes to musculature in the trunk–important in antigravity extension

59
Q

How does the vestibular system affect the medial vestibular spinal tact?

A

vestibular nuclei descends down MVST to the neck and upper trunk–important for co-contraction/proximal joint stability related to the upper neck and trunk

60
Q 
If a child has poor co-contraction, this is probably due to...
A. Reticular Formation via Vestibular
B. Lateral Vestibular Spinal Tract 
C. Vestibular and Cerebellum 
D. Medial vestibular spinal tract
A

D. MVST. Important for co-contraction/proximal joint stability related to the upper neck and trunk

61
Q

How does the vestibular system affect the cerebellum?

A

Brain stem pathway allows the vestibular nuclei to cross over to the cerebellum (vestibulocerebellar pathways), affecting postural control and integrates with proprioception

62
Q 
If a child has poor postural control, this may be due to:
A. Reticular Formation via Vestibular
B. Lateral Vestibular Spinal Tract 
C. Vestibular and Cerebellum 
D. Medial vestibular spinal tract
A

C. Vestibular and cerebellum. Vestibular nuclei cross over to cerebellum, affected postural control and integrates with prop

63
Q

How does the vestibular system affect bilateral motor control?

A

At the level of the vestibular system, the vestibular nuclei goes in both directions, thus affecting bilateral motor control (coordinates both sides of the body)

64
Q

How does the vestibular system affect the reticular formation/arousal?

A

A. The vestibular nuclei ascends to the reticular formation/limbic system, thus affecting arousal

65
Q

How does the vestibular system affect emotional regulation?

A

The vestibular nuclei ascends to the reticular/limbic system, thus affecting emotions e.g., GI

66
Q

Why is the vestibular system important for maintaining a stable filed of vision?

A

At the brain stem level, the vestibular nuclei have connections with the ocular system, thus impacting maintaining a stable field of vision (motor/vestib. occular connection)
-What you check for with PRN test

67
Q

Why is the vestibular system important for spacial relations?

A

The vestibular nuclei ascend to the cortex, influencing perception of space (spacial relations)

68
Q

Central connections from the vestibular nuclei include…

A

A. Descending to spinal cord
B. To nearby structures in the brain stem (cerebellum, reticular formation, extraocular muscles)
C. Ascending to reticulo-limblic system, cortex

69
Q

The Lateral vestibulospinal tract (LVST), Medial vestibulospinal tract (MVST), and the reticulospinal tract are the three _______

A

The LVST, MVST, and reticulospinal tract are the three vestibulospinal descending pathways

70
Q

What structures are responsible for:

  • Influencing extensor muscle tone
  • Integrating vestibular with visual and prop info (head stability, head righting and equilibrium rxns)
  • Can activate autonomic effects
A

The vestibulospinal pathways (LVST, MVST, reiticulospinal tract)

71
Q

Which structure conveys primarily otolith organ inputs (antigravity)

A

The lateral vestibulospinal tract (LVST)

72
Q

T/F: The Lateral vestibulospinaal tract conveys primarily semicircular canal inputs while the MVST conveys mostly otolith organ inputs

A

False. The LVST conveys mostly otolith organ inputs (antigravity/extensor muscle) while the MVST conveys mostly semicircular canal inputs (neck and upper trunk muscles, co-contraction)

73
Q

How does the vestib. system interact with prop?

A
  • Vestib. activity alters muscle activity, hence prop input
  • Prop input inhibits activity in the vestibular nuclei via prop directly to the vestib. nuclei and prop input to cerebellum that projects back to vestib. nuclei
74
Q

Responsible for neck and upper trunk muscle facilitation/inhibition and co-contraction via the semi-circular canals

A

MVST

75
Q

Responsible for extensor muscles and antigravity movements

A

LVST

76
Q

Regulates muscle tone throughout body when we are not moving, has both excitatory and inhibitory influence, and projects to the ANS

A

The reticulospinal tract

77
Q

Influences alertness in response to vestibular input

A

Reticular formation

78
Q

T/F: Slow rhythmic vestib. input increases arousal while rapid unpredictable vestib. input decreases arousal

A

False. Slow rhythmical vestib decreases arousal while rapid unpredictable vestib. input increases arousal

79
Q

Vestibular Pathways with extensive connections that mediate proprioception

A

Vestibulocerebellar pathways

80
Q

Send ascending info from the vestib. system to cranial nerve centers for compensatory eye movements

A

Vestibulo ocular pathways -vestib. input activates eye movements in predictable ways

81
Q

If a child does not maintain a stable field of vision or his eyes move in the same direction as his head, this is probably not working correctly

A

Vestibulo-occular reflex (VOR)

82
Q

Normal reflexive eye movements introduced by angular acceleration

A

Vestibular nystagmus

83
Q

T/F: Per-rotary nystagmus occurs when the eyes beat slowly in the direction of the rotation while post-rotary nystagmus occurs when the eyes beat in the opposite direction of rotation back to midline

A

True. PRN is mediated by CNS probably in brainstem

84
Q

Duration of postrotary nystagmus reflects duration of rotation. This is called ________

A

Velocity storage.

85
Q

T/F: Unusually short postrotary nystagmus by indicate brainstem inefficiency. However, duration is not usually affected by arousal level and visual stimulation

A

False. Duration is also normally affected by arousal level and visual stimulation

86
Q

Visually based illusion of movement

A

Vection

87
Q

Eyes follow motion of moving visual field with contrasting vertical bars and snap back rhythmically.

A

Optokinetic nystagmus. Induced by visual system activity alone and used to measure central vestib. system in research

88
Q

Continuation of nystagmus after optokinetic nystagmus stops, reflects central vestib. function

A

Optokinetic after-nystagmus

89
Q

Nystagmus that occurs without vestibular or visual stimulus

A

spontaneous nystagmus

90
Q

Nystagmus that occurs following a change in head position

A

Positional nystagmus

91
Q

Nystagmus that occurs following a shift in gaze

A

Gaze nystagmus

92
Q

Nystagmus that produces constant shimmering eye movements; probably genetic in origin

A

congenital nystagmus

93
Q

The _______ and visual systems work together to mediate eye movements

A

The vestibular and visual systems work together to mediate eye movements

94
Q

T/F: The vestibular system controls all types of eye movements

A

False

95
Q

T/F: Postrotary nystagmus is a pure vestibular measure

A

False. It is influenced by light, vision, and arousal level

96
Q

Ascending vestib. pathway that influences emotoinal responses to vestib. stimulation and increased eye contact during vestib. stimulation

A

Reticular-limbic pathways, project to reticular system and then to limbic structures, thalamus, and hypothalamus

97
Q

Prolonged postratary nystamgus may indicate dysfunction where?

A

At higher level cortical areas i.e., inadequate inhibition

98
Q

Region of the cortex that is responsible for processing vestibular input related to spatial aspects of body self-consciousness

A

Temporoparietal junction (TPJ)

99
Q

Region of the cortex that is responsible for processing vestibular input related to position and movement of the head

A

Parietoinsular vestibular cortex (PIVC)

100
Q

Region of the cortex responsible for processing vestibular input related to vestibular and visual

A

Medial superior temporal region (MST)

101
Q

Region of the cortex responsible for processing vestibular input related to the body and world-centered space reference

A

Ventral intraparietal region (VIP)

102
Q

System that integrates sensory info from the personal space (somatosensory, prop, visual, and auditory signals) with signals from the extrapersonal space (visual and auditory)

A

Central vestibular system

103
Q

Contributes to generating spatial representation of the bodily self in relation to the external world (self location and self consciousness)

A

Central vestibular system

104
Q

T/F: All natural vestibular stimuli are multimodal

A

True

105
Q

The only system lacking a primary sensory cortex

A

Central vestibular system

106
Q

T/F: Vestibular percept of body position is always endocentric (relative to self)

A

False. Vestibular percept of body position is always exocentric (relative to surrounding space )

107
Q

Structures in vertebrates that contribute to spatial orientation

A

Vestibular labrynths in vertebrates contribute to spatial orientation-similar across vertebrates

108
Q

Why did central relays e.g., vestibular nuclei, reticular information originally develop?

A

To interpret vestibular sensation and translate it into motor responses (similar to development of labrynths)

109
Q

At 6 months, this structure matures and is evident when baby does the landau reflex (prone extension)

A

The lateral vestibulospinal tract –antigravity, otoliths

110
Q

T/F: the duration of postrotary nystagmus generally decreases with age

A

False. Generally rises with age

111
Q

T/F: According to SI theory, vestibular bilateral disorders (postural/ocular disorders) and modulation disorders (GI and aversion to movement) are both Peripheral vestibular processing problems

A

False, according to SI theory, they are central vestibular processing theories

112
Q

T/F: The following terms should be treated differently:

  • Postural and bilteral integration
  • Vestibular and bilateral integration
  • Bilateral integration and sequencing (BIS)
  • Vestibular-prop bilateral integration and sequencing
A

False. There is variation in terms used for the same type of problem:vestibular-bilateral problems

113
Q

A child with the following signs may have what problem?

  • Strong anxiety in response to vertical linear input (even very gentle movement)
  • Slow guarded movement
  • Avoidance of movement on surfaces that are unstable (even slightly) or at different heights)
A

GI

114
Q

T/F: Vestibular under-responsiveness may involve seeking of intense vestib. input, especially rotary

A

True

115
Q

How can you assess vestibular function via observation?

A
  • Look for postural control and equilibrium responses

- Emotional responses: avoidance vs seeking out of specific kinds of movement sensations

116
Q

What may be some alternative explanations for behavior related to poor vestibular functioning?

A

0Limited experiences compared with peers

-Neuromotor impairment

117
Q

What standardized tests can you use to assess vestibular functioning?

A

The SIPT: SWB, PRN, BMC

BOT balance subtests

118
Q

The following structured clinical observations will test for what?
Prone extension
Flat board reach, tilt board tip, tilt board reach
Supine over bolster, step backward

A

Vestibular functioning

119
Q

What is the goal in tx when working with a child with vestibular processing difficulties?

A

An actively involved child who enjoys movement activity

120
Q

When working with a child with vestib. processing problems, what should you be on the lookout for ?

A
  • Linear vs. angular stimuli
  • Sustained vs. transient stimuli
  • Slow/position-related vs. fast/movement-related stimuli
121
Q

When treating a child with vestib. processing problems, how can you use visual and prop input?

A
  • Use increased prop through resistance and active movement to modulate vestib. input
  • May give prop input passively (joint compression and traction), especially if child is over stimulated by vestibular input
  • Manipulate visual environment (e.g.,add visual targets to inhibit vestib. input, dim lighted to facilitate vestibular input)
122
Q

The following are classic core signs of what condition?

  • Poor prone extension
  • Slight hypotonicity, especially proximal extensors
  • Poor co-contraction and proximal stability
  • Poor balance reflected in low SWB score
  • May crave intense vestibular stimulation
  • Some may be posturally insecure
  • May have depressed duration of PRN
A

Vestibular-Bilateral difficulties

123
Q

T/F: According to theory, a child with vestibular bilateral difficulties has a under active central vestibular system due to brainstem based inefficiency

A

True

124
Q

How may hemispheric specialization be affected in a child with vestibular-bilateral difficulties?

A
  • Language delays
  • Visual perceptual problems
  • Delays in establishing hand preference
125
Q

T/F: A child with vestibular-bilateral difficulties may appear normal with above average IQ

A

True. But may also:

  • Affected by social context
  • Clumsiness associated with poor balance
  • Poor posture
  • May seem weak
126
Q

T/F: A child with vestibular-bilateral difficulties may appear normal with above average IQ

A

True. But may also:

  • Affected by social context
  • Clumsiness associated with poor balance
  • Poor posture
  • May seem weak
127
Q

How can you increase challenges for a child with vestib-bilateral differences once you have first focused on simple postural-ocular responses?

A
  • Increase challenge to balance and equilibrium (maybe best by transient inputs)
  • Then increase challenges to bilateral integration, including bilateral projected action sequences if these are problematic
128
Q

Involves anticipation of when to move and is graded from simple to complex (kicking ball that is still while you are still –>run to kick ball that is still–>kick ball moving toward you when you stand in one place –>run to kick ball that is rolling)

A

Bilateral projected action sequences

129
Q

Involves anticipation of when to move and is graded from simple to complex (kicking ball that is still while you are still –>run to kick ball that is still–>kick ball moving toward you when you stand in one place –>run to kick ball that is rolling)

A

Bilateral projected action sequences

130
Q

The following problems are all associated with what problem?

  • Fear of everyday movement experiences
  • Changes in vertical space are different
  • Avoidance of new head positions
  • Anxiety when feet are away from floor
  • Extremely cautious and restricted movement
  • Emotional and behavior problems common
A

GI

131
Q

The following would explain what condition?

  • Poor vestibular modulation of otolith input
  • Prop problem involving inadequate modulation of vestib. input
A

GI

132
Q

When working with a child with GI, how can you grade interventions?

A
  • Start with activities child can tolerate; usually involves keeping feet or body on or close to floor with limited movement
  • Gradually increase demands for excursion through space, but challenges must be finely graded
  • Stay very close to child initially to give physical support, slowly moving away and supporting less frequently
  • Be sure to address other modulation, postural, and praxis issues as child expands repertoire of movement experiences
133
Q

When working with a child with GI, as he expands his repertoire of movement experiences, what do you need to also address?

A

Be sure to address other modulation, postural, and praxis issues

134
Q

Strong feelings of discomfort, nausea, vomiting, dizziness, or vertigo following angular acceleration, especially rotation

A

Intolerance to movement

135
Q

Theory behind why a child has an intolerance to movement

A

Poor modulation of semicircular canal input

136
Q

T/F: OTs will normally treat children with intolerance to movment

A

False. Not treat by OT if no other signs of SI are present. May have to address if coexists with other conditions being treated

137
Q

When present in SI tx (if coexists with other conditions being treated), how should intolerance to movement by addressed?

A

-Avoid/reduce intensity of angular acceleration and use strong doses of prop during vestib. activities

SI (8 decks)

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