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Neuromuscular Conditions II > Vestibular Examination > Flashcards

Vestibular Examination Flashcards

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

A
  • vestibulospinal reflex system

- descending tracts

24
Q

Descending tracts

A
  • lateral vestibulospinal tract (ext Mm of neck, trunk, legs)
  • medial vestbiulospinal tract (neck flex/ext Mm)
25
Q

VOR

A
  • vestibular-ocular reflex
  • produces horizontal/vertical eye movements coordinated with head movements
  • stabilizes eye in space
26
Q

Horizontal VOR

A

-turn head to R–>increase firing of R vestib nucleus–>fires ipsilateral oculomotor nucleus–>R medial rectus fires

27
Q

Vertical VOR

A

Similar to horizontal VOR

28
Q

Nystagmus

A
  • 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
Q

Peripheral Vestibular Disorder

A

-any pathology involving the vestibular nerve, mechanical deformation of nerve, trauma to surrounding structures

30
Q

Ex of Peripheral Vestibular Disorders

A
  • BPPV
  • Infectious Agents
  • Perilymphatic Fistula
  • Vascular Disease
  • Tumor
  • Cervical Vertigo
31
Q

Unilateral Peripheral Vestibular Disorder S/Sx

A
  • significant dizziness
  • vertigo
  • nausea
  • postural instability
  • static (resting nystagmus) & dynamic (abnormal gain) problems of VOR
  • Nystagmus
32
Q

BIlateral Peripheral Vestibular Disorder S/Sx

A
  • more disequilibrium
  • less dizziness
  • postural instability and ataxia
  • oculomotor disturbance
  • oscillopsia
  • possible impairments of strength, endurance, ROM
33
Q

BPPV

A
  • benign paroxysmal positional vertigo
  • most common vestibular disorder
  • vertigo with specific movements
  • most commonly in posterior canal
34
Q

BPPV due to:

A

-fragment of otoconia that lodge on cupula or semicircular canal

35
Q

2 Types of BPPV

A
  • Canalithiasis

- Cupulolithiasis

36
Q

Canalitiasis

A
  • most common type of BPPV
  • otoconia free floating in SCC
  • vertigo for <1 min
37
Q

Cupulolithiasis

A
  • relatively uncommon
  • otoconia adhere to cupula
  • vertigo onset immediately in test position and sustained
38
Q

Nystagmus Upbeat

A

posterior canal

39
Q

Nystagmus Downbeat

A

anterior canal

40
Q

Nystagmus R Torsional

A

R side

41
Q

Nystagmus L Torsional

A

L Side

42
Q

Nystagmus Latency;

Short

A

-canalithiasis

43
Q

Nystagmus Latency:

Long

A

-cupulolithiasis

44
Q

Ex. Causes of Central Vestiblar Disorders

A
  • MS
  • Vascular trauma (stroke)
  • Trauma
  • Tumor
  • Metabolic/degenerative/developmental problem
45
Q

Central Vestibular Disorder S/Sx

A
  • vertigo: long but less severe
  • nystagmus: down/up or torsional
  • VOR abnormalities
  • Impaired VOR Cancellatoin
  • impaired Mm tone, ataxia, imbalance
46
Q

Medical Exam Tests

A
  • ENG (electronystagmography)
  • Caloric Irrigation Testing
  • Rotary Chair Testing
  • Computerized Dynamic Posturography
47
Q

PT Exam:

History

A
  • 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
Q

Meclizine

A
  • vestibular suppressant
  • form of Dramamine

-can interfere with progress of PT treatment

49
Q

Impairment Measures

A
  • ROM (neck/CS)
  • MMT (neck/CS)
  • Coordination (cerebellar prob?)
  • Sensation (parietal prob?)
  • Endurance
  • Pain
  • Vitals (r/o cardiovascular disease)
50
Q

Occulomotor Tests

A
  • occular mobility & smooth pursuit
  • saccadic eye movements
  • spontaneous nystagmus
  • head thrust test
  • head shaking test
  • dynamic visual acuity test
51
Q

CTSIB

A
  • 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
Q

Self-Report Measures

A
  • dizziness handicap inventory
  • activity specific balance confidence scale
  • falls efficacy scale
53
Q

Exam:

Body Function/Structure

A
  • occulomotor tests
  • Dix-Hallpike
  • CTSIB
  • Other impairment tests
54
Q

Exam:

Activity

A

-DGI

55
Q

Exam:

Participation

A
  • Dizziness handicap inventory
  • ABC Scale (more difficult items than FES)
  • FES
56
Q

Dizziness Handicap Inventory

A
  • self-perceived handicap/disability due to vestibular disorder
  • 3 domains: functional, emotional, physical

Neuromuscular Conditions II (15 decks)

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