Term
| general dx PT will recieve |
|
Definition
|
|
Term
| Differential dx for symptom of dizziness (7) |
|
Definition
neurocardiogenic
sinus
medication
stress/anxiety
C spine
CNS
vestibular dysfunction-pns? |
|
|
Term
| Vestibular differential dx: Neurocardiogenic screen (3) |
|
Definition
Blood pressure
Reponse to positional changes
tilt table test |
|
|
Term
| Vestibular differential dx: Sinus screen |
|
Definition
pt report
palpation of sinuses |
|
|
Term
| Vestibular differential dx: how can the sinuses induce diziness |
|
Definition
| the sinus puts increased internal pressure through the eustachian tube onto the vestibular apparatus which is also recieving external pressure from the ear |
|
|
Term
| Vestibular differential dx: medication/stress screen |
|
Definition
discuss medications/side effects
ask about personal life/caffeine habits |
|
|
Term
| Pharmacologic induced dizziness: example medications (7) |
|
Definition
antidepressants
Ca channel blockers
Beta blockers
ACE inhibitors
Musle relaxants
Pain medications
Acid reflux |
|
|
Term
| Pharmacologic induced dizziness: Ca channel blocker side effects (3) |
|
Definition
dizziness
lightheadedness
headache |
|
|
Term
| Pharmacologic induced dizziness: beta blockers side effects (3) |
|
Definition
|
|
Term
| Pharmacologic induced dizziness: ACE-inhibitors side effects |
|
Definition
| dizziness d/t BP being lowered |
|
|
Term
| Pharmacologic induced dizziness: muscle relaxants side effects |
|
Definition
drowsiness
(dizziness isn't there but that's my guess as well) |
|
|
Term
| Pharmacologic induced dizziness: pain medications side effects (3) |
|
Definition
confusion
drowsiness
nausea |
|
|
Term
| Pharmacologic induced dizziness: acid refulx medications side effects (4) |
|
Definition
bleeding gums
irregular heart beat
dizziness
headache |
|
|
Term
| Stress, anxiety, and vertigo |
|
Definition
pt's who complain of dizziness including vertigo may also exhibit symptoms of anxiety and they may or may not be present with an identifiable vestibular pathology
often both disorders are present and become interrelated |
|
|
Term
| C-Spine diff dx: questions to discuss with hx |
|
Definition
recent trauma or injury to the neck area
any neck pain
limited neck motino |
|
|
Term
| What can equal cervicogenic dizziness |
|
Definition
| upper cervical spine dysfunction |
|
|
Term
| Cervicogenic dizziness: mm and their nn involvment |
|
Definition
SCM (C2 and C3)
Trapezius (C3 and C4) |
|
|
Term
| Cervicogenic dizziness: type I mechanoreceptors location and function |
|
Definition
type 1 facet jts
active at rest and with motion |
|
|
Term
| Cervicogenic dizziness: type II mechanorecpetors location and function |
|
Definition
deep capsule and fat pads
active with start and finish of motion |
|
|
Term
| Cervicogenic dizziness: what is it? |
|
Definition
| non specific sensation of altered orientation in space and dysequilibrium originating from abnormal afferent activity from the neck |
|
|
Term
| Cervical Somatosensory Information: where does it start? |
|
Definition
| sensory information from mm spindles, type I and II jt receptors with motion of occiput on C1 |
|
|
Term
| Cervical somatosensory information: sensory information from mm spindles, type I and II jt receptors with motion of occiput on C1 and goes where |
|
Definition
| afferent fibers from receptors of C1-C3 dorsal root ganglion transmits sensory information |
|
|
Term
| cervical somatosensory information: afferent fibers from receptors of C1-C3 dorsal root ganglion transmits sensory information, where does this information go |
|
Definition
|
|
Term
| cervical somatosensory information: vestibular nuclei transfer information where next |
|
Definition
| central vestibular processing (cerebellum) |
|
|
Term
| what type of images should be requested to examine the upper cervical vertebra |
|
Definition
open mouth (dens)
lateral view
flexion/extension film |
|
|
Term
| Cervical exam/Eval: utilize exam info to determine if pt is what? and do what from there? |
|
Definition
hyper or hypo mobile in the C spine
determine level of C spine
determine tx |
|
|
Term
| Vestibular diff dx: CNS screen (3) |
|
Definition
neurological screen
CN
UMN signs
cerebellar signs |
|
|
Term
|
Definition
|
|
Term
| PNS vs CNS symptoms of dizziness: severe nausea and vomiting |
|
Definition
|
|
Term
| PNS vs CNS symptoms of dizziness: moderate nausea and vomiting |
|
Definition
|
|
Term
| PNS vs CNS symptoms of dizziness: mild imbalance |
|
Definition
|
|
Term
| PNS vs CNS symptoms of dizziness: severe imbalance |
|
Definition
|
|
Term
| PNS vs CNS symptoms of dizziness: hearing loss common |
|
Definition
|
|
Term
| PNS vs CNS symptoms of dizziness: hearing loss rare |
|
Definition
|
|
Term
| PNS vs CNS symptoms of dizziness: neurologic symptoms rare |
|
Definition
|
|
Term
| PNS vs CNS symptoms of dizziness: neurologic symptosm common |
|
Definition
|
|
Term
| PNS vs CNS symptoms of dizziness: oscillopsia mild |
|
Definition
|
|
Term
| PNS vs CNS symptoms of dizziness: oscillopsia severe |
|
Definition
|
|
Term
| PNS vs CNS symptoms of dizziness: rapid compensation |
|
Definition
|
|
Term
| PNS vs CNS symptoms of dizziness: slow compensation |
|
Definition
|
|
Term
| CNS related nystagmus will look like what |
|
Definition
| spontaneous nystagmus that persists with fixation |
|
|
Term
| Peripheral vs Central Induced Nystagmus: unidirectional with fast phase opposite the lesion |
|
Definition
|
|
Term
| peripheral induced nystagmus is unidirectional with the fast phase opposite the lesion. what does this mean? |
|
Definition
| if the lesion is in the left ear, the bast bast is to the rgith |
|
|
Term
| Peripheral vs Central Induced Nystagmus: nystagmus becomes more pronounced with gaze toward the side of the fast beating component [non affected ear] |
|
Definition
|
|
Term
| Peripheral vs Central Induced Nystagmus: nystagmus may be uni or bi directional |
|
Definition
|
|
Term
| Peripheral vs Central Induced Nystagmus: may be purely vertical or torsional |
|
Definition
central
torsional is seen with BPPV though |
|
|
Term
| Peripheral vs Central Induced Nystagmus: not inhibited by visual fixation |
|
Definition
|
|
Term
| Peripheral vs Central Induced Nystagmus: direction of facet compoonent may be directed toward the side of gaze (left beating in left gaze, right beating in right gaze, up beating in up gaze) |
|
Definition
|
|
Term
| persistent down beating nystagmus suggests what (2) |
|
Definition
Chiari
bilateral lesion of flocculonodular lobe cerebellum |
|
|
Term
| primary purpose of the saccadic system |
|
Definition
| orient gaze to visual targets for foveal viewing |
|
|
Term
| function of the pursuit system |
|
Definition
| maintain visual targets within the fovea when the target/stimulus is in motion or the invidiual is in motion |
|
|
Term
| neither the saccadic or the pursuit system are effected by what |
|
Definition
| presence or absence of vestibular information |
|
|
Term
| convergence test procedure |
|
Definition
| adduct both eyes to maintain gaze on a target approaching the face |
|
|
Term
| smooth pursuits tests what nn wise |
|
Definition
| paramedian pontine reticular formation which sits nexts to the abducens nucleus |
|
|
Term
| disorder of horizontal saccades frequently d/t what (3) |
|
Definition
lesions in the pons (internuclear opthalmoplegia [INO])
6th CN palsy
weakness of lateral and medial ocular mm |
|
|
Term
| INO: adducting eye motion vs abduction eye motion |
|
Definition
adducting eye is slowed
abducting eye has normal velocity and has a nystagmus |
|
|
Term
| INO is d/t a lesion in what? which connects where |
|
Definition
MLF
connects the paramedian pontine reticular formation and the oculomotor nucleus
lesioned d/t CVA or MS |
|
|
Term
| failure of Convergence is d/t what |
|
Definition
weakness of medial rectus
CN III |
|
|
Term
| somatosensory system is made up of/fed by what (6) |
|
Definition
dorsal column/medial lemniscus
spinocerebellar tract
proprioceptive feedback regarding limb position
sensory awareness of environement through feet (gravel, sand, grass, etc)
neck proprioception integrates with vestibular system |
|
|
Term
| what needs to be tested to assess the anatomy of balance |
|
Definition
localization
proprioception
vibration |
|
|
Term
| Vestibular function testing: 5 ways to do it |
|
Definition
Electronystagmography (ENG)
Videonystamography (VNG)
Rotary Chair
Audiometric testing
Posturography |
|
|
Term
|
Definition
recording eye movements by using electrodes around the eye
uses electrical field changes to estimate the position of the eyes
indirect method |
|
|
Term
|
Definition
not used very frequently
sometimes in small children/babies
or when ptosis is present |
|
|
Term
|
Definition
recording of eye moveents by estimating the position of the eyes
direct method
can observe and record the video of the eye movements |
|
|
Term
| movements recorded by a VNG are translated into what |
|
Definition
representation of
Yaw (horizontal)
Pitch (vertical)
NOT TORSIONAL, but can see and comment on torsional components |
|
|
Term
| Components of ENG/VNG tests (6) |
|
Definition
ocular motor
spontaneous fixation removed
headshake nystagmus testing
Dix hallpike and roll tests
positional nystagmus testing
caloric testing |
|
|
Term
| Ocular motor testing includes (4) |
|
Definition
saccades horizontal
saccades vertical
smooth pursuits
ocular ROM/gaze stability |
|
|
Term
| Nystagmus can be described in what 4 ways |
|
Definition
direction fixed
direction changing
geotrophic
ageotrophic |
|
|
Term
| Describing nystagmus: direction fixed apperance and indication |
|
Definition
fast beat always towards more active neural side
indicates PNS |
|
|
Term
| Describing nystagmus: direction changing indicates what |
|
Definition
|
|
Term
| Describing nystagmus: geotrophic means what |
|
Definition
|
|
Term
| Describing nystagmus: ageotrophic means what |
|
Definition
|
|
Term
| Nystagmus performed with fixation removed: (4) |
|
Definition
spontaneou
hyperventilation
headshake nystagmus
positional testing (hallpike, roll test) |
|
|
Term
| caloric irrigation testing: procedure |
|
Definition
| looks at one peripheral vestibular receptor at a time |
|
|
Term
| caloric irrigation testing: evaluates what structure |
|
Definition
| only evaluates horizontal canal at low frequency (.004 Hz) |
|
|
Term
| caloric irrigation testing: idea behind the test |
|
Definition
| stimulates the canal with a change in temperature (using water or air) |
|
|
Term
| caloric irrigation testing: what does COWS mean |
|
Definition
Cold opposite (inhibits)
Warm Same (excites) |
|
|
Term
| caloric irrigation testing: what will happen when you irrigate with cool water on the right |
|
Definition
inhibitor action
results in left beating nystagmus |
|
|
Term
| caloric irrigation testing: what will happen when you irrigate with warm water on the right |
|
Definition
excitatory action
right beating nystagmus |
|
|
Term
| Intrepeting the Caloric Test: average what for each of the irrigations (W/C R, W/C L) |
|
Definition
|
|
Term
| Intrepeting the Caloric Test: what will result in a reduced vestibular response comparing right to left |
|
Definition
|
|
Term
| Intrepeting the Caloric Test: what difference in reduced vestibular respone is considered clinically significant |
|
Definition
| mroe than 25-30% difference |
|
|
Term
| Intrepeting the Caloric Test: this is the best test for what? |
|
Definition
determining whether vestibular defect is peripheral or central
for ID'ing the side of the defect |
|
|
Term
| Intrepeting the Caloric Test: weakness of the test |
|
Definition
| cannot be ued to determine bilateral vestibular loss |
|
|
Term
| Rotary Chair Testing: is used to asess what |
|
Definition
horizontal semicircular canal
or superior vestibular nerve that innervates the canal |
|
|
Term
| Rotary Chair Testing: goals (4) |
|
Definition
ID normal function
differentiate btwn compensated and uncompensated unilateral vestibualr loss
ID bilateral vestibular loss
expands ability to evaluate the vestibular system (high frequencyies from .01 to 1 Hz) |
|
|
Term
| gold standard for ID'ing bilateral vestibular loss |
|
Definition
|
|
Term
| Two protocols of rotary chair testing |
|
Definition
step test
sinusoidal harmonic acceleration (SHA) |
|
|
Term
| Rotary Chair Testing: step test protocol |
|
Definition
measures one side at a time
sudden high acceleration from 0 degrees/sec to 60 or 120 continued rotation for 1-3 mins |
|
|
Term
| Rotary Chair Testing: Sinusoial Harmonic Accelration protocol |
|
Definition
| series of rotation tests over a range of frequencies .01 to 1.0 Hz |
|
|
Term
| Rotary Chair Testing: 3 measurements of rotary chair testing |
|
Definition
|
|
Term
| Rotary Chair Testing: what does Gain measure |
|
Definition
eye velocity/chair velocity (head velocity)
gives the strength fo the response |
|
|
Term
| Rotary Chair Testing: what does Phase measure |
|
Definition
| Timing of the response is the difference between the equivalent moments of the stimulus and response |
|
|
Term
| Rotary Chair Testing: what does asymmetry measure |
|
Definition
relationship btwn the strength of the response to rotation in both directions
Are both sides working togeter? |
|
|
Term
| Interpreting Results from Rotary Chair Testing: low gain in SHA or (B) step test implies what |
|
Definition
| bilateral vestibular hypofucntioning |
|
|
Term
| Interpreting Results from Rotary Chair Testing: high gain indicates what |
|
Definition
| cerebellar lesion (decreased inhibitory response to medial vestibular nucleus) |
|
|
Term
| Interpreting Results from Rotary Chair Testing: increased phase lead indicates what |
|
Definition
| usually suggests peripheral vestibular problem |
|
|
Term
| Interpreting Results from Rotary Chair Testing: decreased phase lead indicates what |
|
Definition
| suggests central (cerebellar) involvement |
|
|
Term
| Interpreting Results from Rotary Chair Testing: asymmetry suggests what |
|
Definition
lack of compensation
may never be fully compensated at higher frequencies |
|
|
Term
| key component of a thorough diagnostic evaluation is what? |
|
Definition
| audiometric (hearing) assessment |
|
|
Term
| why is an audiometric (hearing) test so important |
|
Definition
| some pt's with dizziness and balance disorders develop hearing problems as a result of the condition |
|
|
Term
| audiometric (hearing) testing: what will display hearing deficiences? |
|
Definition
| audiogram (graphic representation of audiometric data) |
|
|
Term
| audiometric (hearing) testing: 2 parts of speech evaluation |
|
Definition
speech reception threshold test
speech discrimination |
|
|
Term
| audiometric (hearing) testing: speech evaluation: what is the speech reception threshold (SRT) test used to measure |
|
Definition
measure the lowest level at which you can repeat words
it is common to use 2 syllable words with equal stress on each word for the SRT |
|
|
Term
| audiometric (hearing) testing: speech evaluation: what is speech discrimination |
|
Definition
| used to assess your ability to understand and repeat single-syllable words presented at a loud volume |
|
|
Term
| types of hearing loss: (3) |
|
Definition
sensorineural
conductive
mixed |
|
|
Term
| types of hearing loss: sensorineural |
|
Definition
| describes hearing loss caused by a problem in the inner ear or the nerve that sends signals to the brain |
|
|
Term
| types of hearing loss: conductive |
|
Definition
| describes hearing loss d/t a problem with the portion of the middle ear that conducts sound from the outer eater canal to the inenr ear, the inner ear is not affected |
|
|
Term
| types of hearing loss: mixed |
|
Definition
hearing loss with a sensorineural and conductive component
mixed hearing loss is caused by a problem with the conductino of sound through the middle ear and an inner ear or nerve loss |
|
|
Term
| What is Posturagraphy (CDP-Computerized dynamic posturogaphy) |
|
Definition
| a test to qualify balance |
|
|
Term
| Posturography (CDP-Computerized dynamic posturogaphy)most common protocol |
|
Definition
| Sensory Organization Test |
|
|
Term
| Posturography (CDP-Computerized dynamic posturogaphy): condition 1 |
|
Definition
| platform and visual surroundings stable with EO |
|
|
Term
| Posturography (CDP-Computerized dynamic posturogaphy): condition 2 |
|
Definition
|
|
Term
| Posturography (CDP-Computerized dynamic posturogaphy): Condition 3 |
|
Definition
| visual conflict, platform stable EO |
|
|
Term
| Posturography (CDP-Computerized dynamic posturogaphy): Condition 4 |
|
Definition
| platform moving, visual surroundings stable with EO |
|
|
Term
| Posturography (CDP-Computerized dynamic posturogaphy): condition 5 |
|
Definition
| platform moving, eyes closed |
|
|
Term
| Posturography (CDP-Computerized dynamic posturogaphy): condition 6 |
|
Definition
| platform moving, visual surroundings conflict, Eyes open |
|
|
Term
| Interpreting Posturography (CDP-Computerized dynamic posturogaphy) results: loss of balance or increased sway in the follow conditions: C2, C3, C5, and C6 |
|
Definition
| interpreted as visual dependency |
|
|
Term
| Interpreting Posturography (CDP-Computerized dynamic posturogaphy) results: loss of balance or increased sway in the follow conditions: C4, C5, C6 |
|
Definition
|
|
Term
| Interpreting Posturography (CDP-Computerized dynamic posturogaphy) results: loss of balance or increased sway in the follow conditions: C5, and C6 |
|
Definition
|
|
Term
| Interpreting Posturography (CDP-Computerized dynamic posturogaphy) results: a positive finding is identified as what |
|
Definition
| generally increased sway, putting hands out to touch wall or verbally expressing concern or fear of falling |
|
|
Term
| Interpreting Posturography (CDP-Computerized dynamic posturogaphy) results: increased sway or loss of balance only on later trials with normal performance on inital trials of same condition indicates what |
|
Definition
|
|
Term
| Interpreting Posturography (CDP-Computerized dynamic posturogaphy) results: loss of balance or increased sway on inital trial of each sensory condition indicates what |
|
Definition
| inability to handle novel postural challenges |
|
|
Term
| Posturography (CDP-Computerized dynamic posturogaphy): pros and cons |
|
Definition
can be a good way to quantify balance
not used to dx |
|
|
Term
| Clinical indications for Posturography (CDP-Computerized dynamic posturogaphy): think Waddel's |
|
Definition
posturography is helpful in detecting symptom exaggeration
may be useful in detection of malingering |
|
|
Term
| Clinical indications for Posturography (CDP-Computerized dynamic posturogaphy): cervical spine |
|
Definition
cervicogenic dizziness
static posturography not useful
dynamic posturography, incorporating sway referencing, may be more sensitive |
|
|
Term
| Clinical indications for Posturography (CDP-Computerized dynamic posturogaphy): peripehreal neuropathy |
|
Definition
posturography is not a reasonable primary method of dx peripheral neuropathy
many more direct methods that do a better job (measuring sensation) |
|
|
Term
| Medical diagnostics as a whole |
|
Definition
| medical tests with a clinical exam help to make best possible dx but no one test is 100% accurate for cause of dizziness and imbalance |
|
|
Term
| If you doubt yourself about a dizzines dx, do this |
|
Definition
| refer to a colleague who knows what they are doing in examining and estabilshing a rehab program |
|
|
