Neuro_Vestibular

  1. Vestibular disorders - general S/S - 5
    • Dizziness
    • Vertigo
    • Nystagmus
    • Blurred vision - gaze instability d/t VOR dysfunction
    • Dysequilibrium or postural instability
  2. U/L vestibular disorders (peripheral vestibulopathy) - Name - 5
    • BPPV
    • Vestibular nuritis
    • Labyrintitis
    • Meniere’s disease
    • Tumor - Acoustic neuroma
  3. U/L vestibular dysfunction - S/S - 3
    • VEERING TO 1 SIDE (major U/L sign)
    • Abnormal VOR response = nystagmus, loss of gaze stabilization, oscillopsia (illusion that environment is moving)
    • Impairement in balance/gait
  4. Meniere’s disease – define; S/S - 7
    • U/L vestibular disorders (peripheral vestibulopathy) - recurrent & usually PROGRESSIVE
    • Tinnitus
    • Deafness
    • Fullness/P in ear
    • Nausea
    • Vomiting
    • Episodic vertigo
    • Low-frequency hearing loss
  5. BPPV – S/S - 4
    • U/L Peripheral vestibular disorder of CN VIII
    • Brief episodes of vertigo (<1 min - all w/head movement; stop within 30 sec of static Episodic vertigo
    • Nausea
    • Blurred vision
    • Autonomic changes
  6. BPPV - Treatment; describe
    • Treatment - Epley
    • Sitting, turn head to symptomatic side @ 45 deg --> lie on back --> stay 5 min --> turn head 90 deg to opposite side --> stay 5 min --> turn body on side in direction you are facing--> stay 5 min
  7. BPPV - Test; describe; (+)
    • Test - Dix-Hallpike
    • Turn pts head horizontally 45 deg & quickly move pt down to supine w/neck extension 30 deg
    • (+) for BPPV on side that produces symptoms
  8. Labyrintitis, vestibular neuritis - describe
    • Acute infection w/prolonged attacks or symptoms
    • Persists several days to several weeks
  9. Peripheral vestibulopathy - Nystagmus
    • Unidirectional
    • Rotary AND linear
    • Suppresses w/fixation
    • Matches w/vertigo
  10. B/L vestibular disorders (central vestibulopathy) - Name - 5
    • MS
    • Stoke
    • TBI
    • Tumor
    • Ototoxicity
  11. Central vestibulopathy - Nystagmus
    • Direction changing
    • Rotary OR linear
    • Unable to suppress w/fixation
    • Can be separate from vertigo
  12. Central vestibulopathy - lesion location
    • Pons (brainstem)
    • Cerebellum
    • Parietal cortex
  13. Habituation training - describe
    Repetition of movements & positions that provoke dizziness/vertigo
  14. Hip or ankle strategy?
    •     1                  2
    • Image Upload 1     Image Upload 2
    • 1 = Ankle strategy
    • 2 = Hip strategy
  15. Romberg test - describe; tests what; do what to INC sensitivity of Romberg test?
    • Pt stand w/feet in normal stance position w/eyes open than w/eyes closed
    • Tests posterior column (sensory) ataxia
    • Sharpened/Tandem Romberg - tandem heel-to-toe
  16. Functional Balance Grades - Normal - Static/Dynamic - describe
    • Static - Pt able to maintain balance w/o hand-hold support
    • Dynamic - Pt accepts MAX challenge; can shift weight easily at full range in all directions
  17. Functional Balance Grades - Good - Static/Dynamic - describe
    • Static - Pt able to maintain balance w/o hand-hold support, limited postural sway
    • Dynamic - Pt accepts MOD challenge; able to maintain balance while picking object off floor
  18. Functional Balance Grades - Fair - Static/Dynamic - describe
    • Static - Pt able to maintain balance w/hand-hold support; MAY require occasional Min-assist
    • Dynamic - Pt accepts MIN challenge; able to maintain balance while turning head/trunk
  19. Functional Balance Grades - Poor - Static/Dynamic - describe
    • Static - Pt needs hens-hold support + Mod-Max assistance
    • Dynamic - Pt unable to accept challenge or move without loss of balance
  20. INC risk for falls - 5 tests + scores
    • Dynamic Gait Index - Around 11
    • Functional Reach Scale - <10 in
    • TUG (Timed Up & Go) - >30 sec high risk/>20 sec INC risk
    • Berg Balance scale <45
    • Tinneti POMA <19
  21. Dynamic Gait Index - describe test; Score for normal + INC risk for falls
    • Evaluates pts ability to modify gait in response to changing task demands
    • Normal - 21
    • INC risk for falls - 11
  22. Functional Reach Scale - describe test; Score for normal + INC risk for falls
    • Pt makes fist & reaches against wall - measured by place of 3rd MCP
    • Normal - >12.2 in
    • INC risk for falls - <10 in
  23. TUG (Timed Up & Go) - describe test; Score for normal + INC & high risk for falls
    • Tests both static & dynamic balance
    • Pt has to rise from chair, walk 3 m, turn around, walk back to chair, & sit down
    • Pt uses mobility aids that they would normally require
    • Normal for frail/elderly/disabled = 11-20 sec
    • INC risk for fall = >20 sec
    • High risk for fall = >30 sec
  24. Berg Balance Scale - Tests what? what # = high risk for falls?
    • Balance - Static + dynamic in sitting & standing
    • Functional reach
    • Tandem standing 
    • NO GAIT
    • <45
  25. Tinetti Performance Oriented Mobility Assessment (POMA) - assesses what 2? scores for each; score for INC risk for falls
    • Assesses gait & balance in older adults
    • Gait max = 12
    • Balance max = 16
    • Total = Gait + Balance = 28
    • <19 HIGH RISK FOR FALLS
  26. Pts w/ vestibular losses benefit from training of what strategies? - 2
    • Visual
    • Proprioceptive
  27. Balance - critical component is sensory input from what? - 3
    • Somatosensory
    • Visual
    • Vestibular
  28. Somatosensation - responsible for what? - 4
    • Discriminative touch
    • Proprioception
    • Fast pain
    • Discriminative Temp
  29. CTSIB Test - Loss of balance on condition - 4, 5, 6 - what is responsible?
    Somatosensory - surface dependant
  30. CTSIB Test - Loss of balance on condition - 5 + 6 - what is responsible?
    Vestibular deficiency
  31. CTSIB Test - Loss of balance on condition - 2, 3, 6 - what is responsible?
    Visual deficiency
  32. CTSIB Test - Loss of balance on condition - 3-6 - what is responsible?
    Sensory deficiency
  33. CTSIB Test - Loss of balance d/t somatosensory deficiency - what conditions?
    4, 5, 6
  34. CTSIB Test - Loss of balance d/t vestibular deficiency - what conditions?
    5, 6
  35. CTSIB Test - Loss of balance d/t visual deficiency - what conditions?
    2, 3, 6
  36. CTSIB Test - Loss of balance d/t sensory deficiency - what conditions?
    3-6
  37. CTSIB Test - Condition 1 tests what? - 2
    Visual & proprioceptive systems
  38. CTSIB Test - Condition 2 tests what? - 1
    Proprioceptive systems
  39. CTSIB Test - Condition 5 tests what? - 1
    • Vestibular system Condition 5 eliminates vision & proprioception
    • & would MOST resemble dark movie theaters & parking garages where terrain is often sloped or uneven
  40. CTSIB Test - Condition 6 tests what? - 1
    • Visual deficiency
    • Visual conflict would more accurately resemble movements in a crowd or among moving objects
Author
Tanuisha
ID
325573
Card Set
Neuro_Vestibular
Description
Neuro_Vestibular
Updated