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CNS compensation

With the exception of BPPV, vestibular rehab exercises are designed to promote what?

rotational vertigo

illusion of self-motion or object motion

positional vertigo

vertigo/dizziness precipitated by changes in head position

vestibular vertigo

rotational vertigo, positional vertigo, or recurrent dizziness with nausea and oscillopsia or imbalance

females

is vertigo more common in males or females?

older

is vertigo more common in older or younger adults?

unilateral vestibular loss

loss or diminished function of one peripheral vestibular system

labyrinthitis

UVL diagnosis characterized by: sudden or gradual onset of hearing loss, severe vertigo, nausea/vomiting. Symptoms plateau in approx. 24 hours, and last 3-4 days. Gradually recovery over 5-7 weeks.

vestibular neuritis

UVL diagnosis characterized by: acute onset of severe rotatory vertigo, spontaneous nystagmus, postural imbalance, nausea/vomiting. Recovery gradual over 48-72 hours, with gradual return of balance over 6 weeks.

fluctuating hearing loss, tinnitus, episodic attacks of vertigo

What is the triad of symptoms associated with Meniere's disease?

Meniere's Disease

UVL diagnosis caused by a decrease in endolymph re-absorption, resulting in an accumulation of fluid in the compartment which leads to rupture, causing paralysis of the vestibular/auditory mechanisms.

salt, water, alcohol, caffeine, nicotine

General dietary restrictions for the treatment of Meniere's disease include the restriction of what (5)?

diuretics

What general type of medication is prescribed for the treatment of Meniere's disease?

no

Are vestibular exercises appropriate for most cases of Meniere's disease?

vestibular

Section of what nerve has a 90-95% success rate for treating Meniere's disease?

Acoustic neuroma

nerve sheath tumor usually found in the internal auditory canal or cerebellopontine angle

progressive unilateral SNHL

The primary complaint with an acoustic neuroma is the insidious onset of what?

watchful waiting, radiosurgery, surgical removal

What are the three therapeutic options for treating acoustic neuroma?

perilymph fistula

An opening between the inner and middle ear through the round or oval windows, perilymph leaks into the middle ear space, which causes vestibular symptoms.

aminoglycosides

one major cause of Bilateral vestibular loss is ototoxicity caused by exposure to what group of antibiotics?

aminoglycosides

streptomycin, gentamicin, amikacin, tobramycin, netilmicin are all examples of what?

ototoxicity

oscillopsia, ataxia, nausea/vomiting, light headedness or episodic vertigo, tinnitus, or inabililty to walk in the dark or read while walking are all signs and symptoms of what?

dysequilibrium, oscillopsia, hearing loss/vertigo

What are three primary symptoms reported by patients with ototoxicity?

fall

patients with BVL are more likely to do what, compared to normal subjects their age or patients with UVL?

no

In a patient with BVL, will position and movement tests provoke vertigo?

decreased

What happens to static standing balance in patients with BVL?

dynamic posturography

Type of test that is used to determine which system a person relies on to maintain balance (vestibular, vision, somatosensory)

visual

Research has shown that patients with BVL are initially more dependent on which system for maintaining standing balance?

ataxic

The gait pattern of a patient with BVL is usually what?

Dynamic gait index

Measure used to assess the ability to modify gait during changes in task performance for individuals with balance impairments i.e. BVL.

gaze and postural stability

Vestibular rehab focuses on the recovery of what?

saccadic, smooth pursuit

In order to compensate for the loss in VOR function, exercises used to treat patients with BVL are used to foster the substitution of what eye movements?

vertigo

The illusion of motion of self or the environment

dizziness

lightheadedness or feeling like you are going to pass out. Generalized weakness/blurred vision.

dysequilibrium

Feeling of "bad balance" experienced while standing or walking.

peripheral

symptoms that are worse in the AM and better in the PM may indicate which type of vestibular problem (peripheral or central)?

central

Symptoms that are better in the AM and worse in the PM may indicate which type of vestibular problem (peripheral or central)?

Dizziness handicap inventory

self assessment inventory designed to evaluate physical and emotional factors associated with dizziness and vestibular system disease.

vestibular suppressants

Antihistamines, benzodiazepines, and anticholinergic drugs are all examples of what?

dizziness handicap inventory

What is the best tool to determine if a patient has BPPV?

vestibular

class of eye movement that holds images steady on the retina during brief head rotations

optokinetic

class of eye movement that holds images steady during sustained head rotation

smooth pursuit

class of eye movement that holds the image of a small moving target on the fovea

saccade

class of eye movement that brings images of objects of interest onto the fovea

visual fixation

class of eye movement that holds the image of a stationary object on the fovea

mechanoreceptors

vestibulo-ocular reflexes rely on labyrinthine ___________ to sense head accelerations

vestibulo-ocular, visually mediated

What 2 reflexes help stabilize gaze?

saccadic

Which eye system is responsible for shifting gaze?

saccade

Which eye system generates a high-velocity ballistic movement to scan the environment?

pursuit

Which eye system maintains a target in motion on the fovea while the head remains stationary?

vestibulo-ocular

Which eye system maintains a stable gaze with head movements?

VOR

What is the primary mechanism for gaze stability?

angular

Which component of the VOR is mediated by the SCCs and activated by head movements in any direction?

Linear

which component of the VOR is mediated by the otoliths and activated by high frequency head movements when near targets are being viewed?

brainstem and cerebellum

Gaze-evoked vertical nystagmus suggests lesions affecting what areas of the brain?

peripheral

If nystagmus stabilizes with fixation, it is of what origin?

central

If nystagmus does not stabilize with fixation, it is of what origin?

low

A person with damage to the pursuit system will most likely have _____ gain.

nystagmus

repetitive, tremor-like oscillating movement of the eyes

quick phase

Nystagmus is named by the direction of what?

away from

In peripheral vestibular nystagmus (mixed horizontal-torsional trajectory), the quick phase usually beats _________ the side of the lesion.

vestibular nuclear or cerebellar vermis

Vertical nystagmus is 80% sensitive for what types of lesions?

primary

In what eye position is spontaneous nystagmus observed?

gaze evoked

type of nystagmus observed during the test of smooth pursuit eye movements.

30

Gaze evoked nystagmus occurs when the eyes are ____ degrees eccentric

sensorineural, conductive, mixed

What are the three types of hearing loss?

sensorineural

What is the most common form of hearing loss (90% of cases).

middle

conductive hearing loss is caused by a problem in what area of the ear?

air

Is the inner ear more sensitive to sound conducted by air or bone?

bone

In a pure conductive loss, is the affected ear more sensitive to air or bone conducted sound?

512 hz

What is the frequency of the tuning fork that is most commonly used to test for hearing loss?

Rinne

Which test firsts test air conduction by holding the tuning fork outside the external auditory meatus, then tests bone conduction by holding the tuning fork on the base of the mastoid process?

bone

In a negative Rinne test indicating conductive loss, which would be louder, Air conduction or bone conduction?

Weber

Which test places the tuning fork at midline on the forehead, and asks the patient if they can hear the sound equally in both ears or better in one ear?

right

If a person has a conductive hearing loss on the right side, which side will they perceive the sound in the Weber test?

balance

the ability to conrol the body's center of mass relative to the limits of stability associated with a specific task and to the environment in ahiwhc it is preformed

limit of stability

maximum anterior, posterior and lateral distance from center while maintaining the center of gravity within the base of support.

12, 16

The limit of stability should be approximately ____ degrees front to back, and ____ degrees side to side.

center of gravity

An imaginary point in space about which the sum of the forces and moments equals zero

ankle, hip, stepping

What are the 3 normal balance strategies?

distal to proximal

The normal sequencing of balance strategies generally moves in what direction?

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