Vestibular

Question 1

Feeling that you are about to faint or “pass out“, do not feel as though you or your surroundings are moving

Answer 1

Lightheadedness

Question 2

Feeling that you or your surroundings are moving when there is no actual movement, feel as though you are spinning, falling, etc.

Answer 2

Vertigo

Question 3

What part of the vestibular system detects angular acceleration (any rotational movement)?

Answer 3

Semicircular canals

Question 4

What part of the vestibular system detects linear acceleration and gravity

Answer 4

Otoliths

• Utricle = horizontal acceleration
• Saccule = vertical acceleration
• Have hair cells that project into gelatinous matrix that have embedded otoconia

Question 5

What causes positional vertigo?

Answer 5

Crystals break free and float through semicircular canals

- can be caused by trauma, can be caused by certain head movements

Question 6

fluid in inner ear

Answer 6

Endolymph

- as we the head moves in one direction, the fluid moves another

Question 7

Reflex eye movement that stabilizes images during head movement; Produces eye movement in the direction opposite the head movement; Preserves the image in the center of visual field

Answer 7

Vestibulo-ocular reflex

- when moves to the right, eyes move to the left

Question 8

Provide automatic control of the postural muscles in order to stabilize the body

Answer 8

Vestibulospinal reflex

Question 9

What are the 3 sensory systems that contribute to balance?

Answer 9

1. Vestibular
2. Vision
3. Somatosensory (proprioception)

Question 10

What are the possible causes of vestibular dysfunction in the CNS?

Answer 10

1. Stroke or TIA
2. Multiple sclerosis
3. Trauma (TBI)
   - abnormally with oculomotor testing

Question 11

What S and S will you see with central pathology?

Answer 11

1. Abnormal smooth pursuit and saccadic eye movements
2. Diplopia
3. Altered conscious
4. More severe ataxia than with a peripheral lesion
5. Vertigo less intense than with a peripheral lesion and not suppressed by visual fixation
6. Spontaneous vertical nystagmus
7. Eyes oscillate at equal speeds
   - Keys to point towards central: problems with vision, problems with confusion - if pt has 2-3 of these and its not dx yet, refer out to get dx, then we can help

Question 12

How is PT incorporated with central lesions?

Answer 12

1. Educate on safety precautions and fall prevention strategies
2. Gait training
3. Balance exercises
4. Habituation exercises

Question 13

What are the types of peripheral vestibular dysfunction?

Answer 13

1. Mechanical (BPPV)
2. Decreased receptor input (UVH, BVH)
   - we have a firing rate in our inner ear, and on each side they should be the same; when firing is not the same on both sides, get hypofunction

Question 14

Otoconia misplaced in semicircular canals; Vertigo provoked by changes in head position in relationship to gravity; Most commonly involves posterior canal

Answer 14

Benign paroxysmal positional vertigo (BPPV)

- Anterior, posterior, horizontal are 3 but posterior is 90% of cases

Question 15

What is the Dix-Hallpike test

Answer 15

test for posterior canal BPPV

• 45* to side testing
• ~30* of ext
• tell pt to keep their eyes open
• latency – need to hold them in that position for a few seconds up to a min
• looking for nystagmus

Question 16

Vestibular nerve is firing less than it should

Answer 16

Decreased receptor input

1. UVH – Unilateral vestibular hypofunction more common, easier to tease out
2. BVH – Bilat. vestibular hypofunction – much more rare than UVH
   - hypofunction= if move head fast triggers it; if environment around you or loss of stimuli, it can trigger it; will walk into clinic grabbing stable furniture around them, with their head stable, etc

Question 17

What are the S and S of peripheral pathology?

Answer 17

1. Normal smooth pursuit and saccades (not normal in central)
2. Positional testing may reproduce nystagmus
3. May report hearing loss, fullness in ears, tinnitus
4. Mild ataxia
5. Vertigo usually intense and suppressed by visual fixation
6. Vertigo may be accompanied by nausea/vomiting
7. Nystagmus will have slow and fast phases
   - side sx are triggered = side problems are on
   - pt needs to keep keys open during tx

Question 18

Otoconia break free from the otoliths and float freely in one of the semicircular canals

Answer 18

Canalithiasis

Question 19

Otoconia break free from the otoliths and adhere to the cupula of one of the semicircular canals

Answer 19

Cupulolithiasis

Question 20

How do you treat BPPV

Answer 20

Positional tx techniques

- dix-hallpike position

Question 21

How do you treat UVH and BVH?

Answer 21

1. Gaze stability exercises - Holding up something with words on it, etc; trying to desensitize the brain- trigger what makes them dizzy, then
2. Gait training - b/c will be unsteady on their feet
3. Balance exercises
4. Habituation exercises - doing small amts of what makes them dizzy to desensitize brain

Question 22

Disorder of inner ear function; 40-60 years old; Low-frequency hearing loss; Episodic vertigo (mins, hours or days); Fullness in ear or tinnitus; Can be very limiting

Answer 22

Meniere’s disease

• Dizziness, regardless of what you’re doing – versus positional which they’re in a specific pos and that triggers it
• different from positional vertigo where there is no fullness in ear or tinnitus

Question 23

What is the medical tx for meniere’s disease?

Answer 23

Reduce fluid buildup

- Low sodium diet, avoid caffeine/alcohol, diuretics otherwise no good treatment for this