Term
Episodic Vertigo
Episodic Nystagmus
Triggered by changes in head position relative to gravity b/c otoconia moves |
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Definition
| Peripheral Vestibular Disorder |
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Term
| The most common vestibular disorder. A dysfunction of the inner ear; normally in the posterior semicircular canal |
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Definition
| Peripheral Vestibular Disorder |
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Term
| 4 things that vertigo or dizziness can cause. |
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Definition
Higher fall risk
Reduced activity
Reduced independence
Reduced quality of life |
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Term
| Name the 3 semicircular canals that each ear has |
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Definition
Anterior
Posterior
Horizontal |
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Term
| Name the 2 otolith organs that each ear has |
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Definition
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Term
| Each of these has a contralateral coplanar mate |
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Definition
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Term
| Does nystagmus occur for unilateral or bilateral involvement? |
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Definition
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Term
| Fluid that moves freely within the canals |
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Definition
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Term
| Enlargement at one end of the SCC |
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Definition
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Term
| A gelatinous barrier found within the ampulla. Contains sensory hair cells and projecting cilia. Movement of the cilia can cause an excitation or inhibition of the hair cell. |
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Definition
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Term
| When otoconia becomes dislodged from the gelatinous membrane and enters one of the SCC. This creates a disruption in the flow of endolymph and triggers inappropriate movement of the hair cells and symptoms of vertigo appear. |
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Definition
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Term
| What are the common causes of BPPV if under the age of 50? |
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Definition
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Term
| What are the common causes of BPPV if over the age of 50? |
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Definition
| Degeneration or dehydration of the gelatinous membrane |
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Term
| What is the cause of 50-70% of BPPV cases? |
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Definition
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Term
| Name the 2 forms of BPPV beginning with the most common. |
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Definition
Canalithiasis
Cupulolithiasis |
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Term
| Where otolith debris is free floating in the endolymph of SCC. This affects the posterior SCC most often. Symptoms subside with sustained positions because the otoconia settle in the endolymph. |
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Definition
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Term
| Where the otolith debris is adhered to the cupula. Symptoms are more persistent with positional change. |
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Definition
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Term
| Free floating otoliths produce __ effect due to gravity upon otoliths in SCC |
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Definition
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Term
| BPPV results in excited hair cells on __ side |
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Definition
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Term
| With BPPV, spinning is due to what? |
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Definition
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Term
| The duration of BPPV symptoms is dependent upon time for otholiths to do what? |
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Definition
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Term
| Are symptoms longer the cupulo or canal lithiasis? |
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Definition
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Term
| Can you have BPPV in any or all SCC? |
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Definition
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Term
| What are some subjective statements that a person with BPPV might give. |
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Definition
Room Spinning
Swaying, spacey
Headache, lightheaded
Comes and goes |
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Term
| What all should a PT ask during the subjective examination. |
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Definition
-Date of onset
-Previous medical management
-Mental Status
-Prior level of function
-Current limitations
-Hearing
-Vision
-Characteristics of symptoms
-Duration of symptoms
-Latency
-What actions effect symptoms |
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Term
| What are 2 standardized surveys to give for a vestibular examination |
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Definition
DHI (Dizziness Handicap Inventory)
ABC (Activity Specific Balance Confidence |
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Term
| What, in the systems review, should you do before starting vestibular testing? |
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Definition
BP/HR
Clear cervical
Cervical, shoulder ROM, lumbopelvic ROM/control, flexibility in hip flexors and hamstrings |
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Term
| Balance perception is controlled by what 3 systems? |
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Definition
Visual
Vestibular
Somatosensory |
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Term
| For examination of the visual system, there are tests to determine the dysfunction of what 3 things? |
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Definition
Saccadic movement
Smooth Pursuit
Vestibular-Ocular Reflex |
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Term
| The ability to rapidly direct the fovea to a target of interest |
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Definition
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Term
| How do you test saccadic movement? |
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Definition
-Quickly shift gaze between two specific targets
-Look for ocular-reflexes or overshooting, which would suggest central vestibular abnormality |
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Term
| The ability to track an object thru visual space |
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Definition
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Term
| How can you test smooth pursuit? |
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Definition
-Slowly follow target side to side, no more than 30 degrees in either direction
-Wach for saccadic eye movements, which would suggest a central vestibular abnormality |
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Term
| This is activated anytime the head is moving, it uses vestibular input to hold images stable on the retina during rapid head rotations |
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Definition
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Term
| What test can be done to test VOR? |
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Definition
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Term
-Hold head tilting forward 30 degrees and instruct pt to look forward at target
-Move head to one side, hold there, then move quickly and abruptly back to center
-Watch for corrective saccades or refixation, which indicates peripheral vestibular weakness. The direction of head movement that causes the refixation is the side of dysfunction. |
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Definition
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Term
| Name 5 tests to determine balance dysfunction. |
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Definition
Rhomberg
Sharpened Rhomberg
Single Leg Stance
Modified Clinical Test of Sensory Interaction in Balance (CTSIB)
Fukuda |
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Term
| The Rhomberg test is a static balance test. How do you do it? |
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Definition
- Stand with feet together and arms crossed on chest
- Maintain position eyes open for 30 sec
- Maintain position eyes closed for 30 sec
- Test could indicate vestibular dysfunction if position maintained with eyes open but not closed |
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Term
| The Sharpened Rhomberg test is a static balance test. How do you do it? |
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Definition
-Stand full tandem with arms crossed on chest
-Maintain position with eyes open for 30 sec
- Maintain position with eyes closed for 30 sec
-Test could indicate vestibular dysfunction if position was maintained with eyes open but not closed |
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Term
| How do you perform the Single Leg Test? |
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Definition
-Stand on 1 leg, not allowing legs to touch with arm crossed on chest
-Maintain position eyes open for 30 sec
-Maintain position eyes closed for 30 sec
-Test could indicate vestibular dysfunction if position maintained with eyes open but not closed |
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Term
| The Modified Clinical Test for Sensory Integration in Balance (mCTSIB) is a dynamic balance test and introduces foam. How do you do it? |
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Definition
-Stand on foam with feet together and arms cross on chest
-Maintain 30 sec eyes open
-Maintain 30 sec eyes closed
-Test could indicate vestibular dysfunction if maintained with eyes open but not closed |
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Term
| How do you perform the Fukuda Dynamic Step Test? |
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Definition
-March in place 50 steps with arms flexed at 90 degrees.
-Test done with eyes open, focused on target
-Test repeated with eyes closed
-Linear displacement greater than 20 incheas or rotational displacement greater than 30 degrees indicates peripheral vestibular dysfunction in the direction of the displacement |
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Term
| Name 4 standardized tests for examining function. |
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Definition
Dynamic Gait Index
Berg Balance Assessment
Tinetti Gait and Balance Assessment
Rivermead Mobility Index |
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Term
| Name 3 standardized tests for examining the vestibular sytem |
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Definition
Head-Shaking test
Roll test
Dix-Hallpike |
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Term
| The head shaking test is useful for diagnosis what? |
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Definition
| Unilateral Vestibular Deficit |
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Term
| How do you perform the head shaking test? |
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Definition
-Pt closes eyes and has neck flexed at 30 degrees
-PT oscillates the head horizontally 30 cycles
-Typically a person with unilateral vestibular dysfunction will demonstrate nystagmus |
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Term
| What does the roll test confirm? |
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Definition
| BPPV with horiztonal canal involvement |
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Term
| During the roll test, the ear facing down is the ear being tested. With horizontal canal BPPV, the test is positive when? |
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Definition
| When the involved ear is down, vertigo is present along with geotropic and ageotropic nystagmus. The patient is made to lie on a couch with the head position raised to 30 degrees. The head is then rolled quickly from one side to the other. |
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Term
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Definition
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Term
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Definition
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Term
| The vertebral artery test should be performed prior to dix-hallpike to rule out a vertebral artery dysfunction. How do you perform this test? |
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Definition
Hold 20-30 seconds; neck in extension, lat flexion and rotation.
This is positive when patient experiences visual hallucinations, diplopia, LOC, diaphoresis, vomiting.
Dizziness alone is not a positive. |
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Term
| Why is the dix-hallpike test done last? |
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Definition
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Term
| Explain the dix-hallpike test |
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Definition
-Test the probable unaffected side first
-Watch vessels within sclera to determine direction (focusing vision and light will decrease nystagmus)
-Name nystagmus; up/down beating with left or right torsion
-Pt will complain of dizziness or lightheadedness when sitting back up
-Have puke bucket nearby |
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Term
| What does the dix-hallpike test confirm? |
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Definition
| BPPV with anterior or posterior canal involvement |
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Term
| With the dix-hallpike test, what will show that the pt has posterior canal BPPV? |
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Definition
| It is positive if vertigo and upbeating ocular nystagmus noted on one side with delay of 1-40 seconds and cessation within 60 sec |
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Term
| With the dix-hallpike test, what will show that the patient has anterior canal BPPV? |
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Definition
| Positive if vertigo and downbeating ocular nystagmus noted on one side with a delay of 1-40 seconds and cessation within 60 sec |
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Term
| Upward direction of nystagmus means what? |
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Definition
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Term
| Downward direction of nystagmus means what? |
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Definition
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Term
| Right nystagmus means what? |
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Definition
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Term
| Left nystagmus means what? |
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Definition
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Term
| Toward the earth-canalithiasis in the horizontal canal |
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Definition
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Term
| Away from earth-canalithiasis in horizontal canal |
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Definition
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Term
| what does vertical nystagmus mean? |
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Definition
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Term
| If nystagmus lasts less than 30 seconds what does this mean? |
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Definition
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Term
| If nystagmus lasts more than 30 seconds, what does this mean? |
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Definition
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Term
| When in sustained position direction changing nystagmus indicates what? |
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Definition
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Term
-All tests (-), c/o dizziness with position changes
-16 transitions
-Baseline symptoms 0-5
-Demonstrate all positions
-Inform test is active
-Ask symptoms 0-5 and count duration to return to their baseline |
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Definition
| Motion Sensitivity Testing |
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Term
| What 3 things should you do for the assessment/plan |
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Definition
Identify dysfunction
Identify problem list or limitations
Identify patient goals |
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Term
| What is the prognosis for BPPV |
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Definition
Treatment is highly effective, quick resolution of symptoms.
Typically resolve in 1-3 weeks |
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Term
| What are the treatments for BPPV |
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Definition
-Modalities
-Manual therapy and stretching
-Ther ex/Ther ag for conditioning
-Neuromuscular re-education
-Patient education/HEP
-Particle repositioning maneuvers last |
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Term
| What is the plan of care for vestibular rehabilitation? |
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Definition
-Frequency: 3-4 times per week for 2-4 weeks
-Duration: 45-60 minutes as tolderated
-Focuse on gaze stabilization exercises, static and dynamic balance exercises, ROM, Conditioning exercises, and particle repositioning maneuvers to correct BPPC and decrease vertigo symptoms |
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Term
| Why would a person with BPPV have increased postural sway? (2) |
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Definition
Altered proprioceptive inputs
Altered or deprived visual inputs |
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Term
| Why would a person with BPPV have decreased dynamic postural control? |
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Definition
-Increased functional limitation
-Increased fall risk
-Increased general deconditioning |
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Term
| What are some interventions for balance? |
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Definition
-Eyes open followed by eyes closed for 1 minute each in 4 positions:
Feet together
Partial tandum
Full tandum
Single leg stance
-Firm surface progressing to foam
-Further progression as tolerated |
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Term
| What are some gaze stabilization exercises? |
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Definition
-Saccadic
-Smooth Pursuit
-VOR X1 and X2
-VOR exercise to repeatedly stimulate CNS with error signal
-Monitor closely to avoid over or under stimulation of vestibular system
-Motion Sensitivity |
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Term
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Definition
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Term
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Definition
| Object and head moving same or opposite direction |
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Term
| For improving VOR, what are some variables for exercise? |
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Definition
-Time/duration and speed of exercise
-Conflict of background or object
-Target distance
-Frequency
-Balance challenges |
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Term
| Cawthorne-Cooksey exercises are adaptation exercises that involve the head and eye. |
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Definition
-Eye movements between two points, 12 inches apart, for 1 minute each
-Head movements with eyes focused on target for 1 minute each
-Head movements alternating between fast and slow speeds with eyes focused on target for 1 minute each |
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Term
-Explain/demonstrate procedure prior to treatment
-May need additional assistance
-Have PPE ready
-May need valium if high anxiety
-Use of vibrator- 50% efficacy |
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Definition
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Term
-Determined by Dix-Hallpike position
-Side - canal involvement - canalithiasis or cupulolithiasis
-Epley maneuver (canalithiasis of ant and pos SCC)
- Sidelying maneuver (horizontal canalithiasis)
- 360 degree roll (horizontal canalithiasis)
-Semont/Liberatory Maneuver (cupulolithiasis of SCC) |
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Definition
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Term
| What was the sidelying maneuver treat? |
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Definition
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Term
| How do you perform the sidelying maneuver? |
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Definition
-Seated position
-Pt brought quickly to unaffected side
-Head of pt quickly turned 45 degrees downward 1-2 min.
-Pt returned to sitting
-Provide cervical collar/towel roll PRN |
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Term
| How do you perform the Semont/Liberatory Maneuver? |
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Definition
-Turn head 45 degrees horizontally toward the unaffected ear
-Quickly place the pt in sidelying on the affected side with the head rotated up at a 45 degree angle (remain in this position for 3 min)
-Move the pt quickly thru the seated position, holding the pt's head in place, until the pt is lying on the unaffected side looking toward the ground (45 degree angle)
-Forceful head shaking is sometimes used to help remove the otoconia
-Remain in position for 3 min then return to seated position |
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Term
| What are some post-treatment/ADL instructions after BPPV treatment? |
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Definition
-Wait 10 min after tx to allow otoconia to settle
-No prolonged neck flex/ext for 24 hours
-Avoid extreme head turns up/down, side/side for 1 week
-For 2 nights, sleep in semi-recumbent position (30-45 degrees) - recliner or with pillows
-Avoid lying on affected side until next treatment session
-Cervical collar/towel roll if compliance an issue |
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Term
| Brandt-Daroff is a good HEP. How many reps and what is the duration per position? |
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Definition
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Term
| What all could occur during the Brandt-Daroff HEP that would cause pt to need to stop. |
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Definition
-Sudden change/fluctuation in hearing
-Onset of pressure or feeling of fullness in ears to point of discomfort or pain
-Onset of ringing in ears or increased intensity of ringing if already have
-Fluid discharge from ears
-Pain/discomfort if neck, back associated with doing the exercise |
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Term
| What is the most common form of BPPV? |
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Definition
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Term
| What canal is most typically affected? |
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Definition
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Term
| What is the most common form of treatment for BPPV? |
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Definition
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