WorksheetsPeripheral Vestibular Hypofunction
Total questions: 22
Worksheet time: 16mins
PVH CPG: Vestibular rehab is beneficial for vestibular hypofunction that is acute/subacute/chronic or unilateral/bilateral.
True
False
PVH CPG: Saccades and smooth pursuit should be normal in PVH.
True
False
PVH CPG: Long term use of vestibular supplements will improve outcomes of PVH.
True
False
PVH CPG: Gaze stability exercises for ACUTE/SUBACUTE PVH should last AT LEAST
12min/day for 2-3 weeks
20min/day for 4-6 weeks
40minday for 5-7 weeks
PVH CPG: Balance training, both static & dynamic balance, for CHRONIC UNILATERAL PVH should be dosed for
20min/day for 4-6 weeks
20min/day for 6-9 weeks
10min/day for 4-6 weeks
30min/day for 6-9 weeks
The most common cause of peripheral vestibular hypofunction (PVH) is
trauma
vestibular neuritis
Meniere's disease
stroke
BPPV
Caloric irrigation is a process where water, either warm or cold, is blown into the ear to create nystagmus. A positive cold water test on a patient with PVH will have a ___ beating nystagmus to the affected ear.
contralateral
ipsilateral
bilateral
Which pair will have the BEST rehab potential for UVH?
67 y/o female
22 y/o female
27 y/o male
70 y/o male
age and gender do not matter
The primary approach of managing pt's w/ UVH is pharmacology-based.
True
False
Gold stand for diagnosing UVH is
ENG - electronystagmography
VNG - video nystagmography
caloric irrigation
The BEST test to diagnose BVH is
rotatory chair test
ENG
VNG
caloric irrigation
Frank is referred to your clinic with a dx of chronic UVH secondary to vestibular neuritis. His primary complaint is dizziness and vertigo at all times especially when grocery shopping. He states there is no visual blurring w/ head movement, however he mentions that he has had multiple falls since his dx. What is the BEST treatment approach?
gaze stability exercises like VOR x1 and VOR x2
habituation exercises using YouTube videos of crowded malls
general balance training for 20min/day for 4-6 weeks
general balance training for 20min/day for 6-9 weeks
convergence exercises like brock string
Jenny is referred to your clinic with a diagnosis of acute UVH. Her major complaint is visual blurriness w/ head movement which prevents her from driving safely. She denies all constitutional symptoms. Jenny wants to get back to driving as soon as possible. Select the BEST intervention(s) for Jenny.
gaze stability home exercises for a minimum of 3x/day for 20min/day for 4-6 weeks
gaze stability home exercises for a minimum of 3x/day for 12min/day for about 3 weeks
have Jenny drive you around Salem while you ask her to turn her head at every intersection
make an objective goal of improving her dynamic visual acuity score
VOR x1, VOR x2, and imaginary targets
Select the correct pair(s) of subjective report and outcome assessment for UVH.
if dizziness and/or vertigo then use dizziness handicap inventory & motion sensitivity test
if visual blurring w/ head movement then use dynamic visual acuity and gaze stabilization test
if visual blurring w/ head movement then use visual vertigo analog scale and dizziness handicap inventory
if imbalance and/or falls then use functional gait assessment (FGA) and timed up and go (TUG) test
if dizziness and/or vertigo then use dynamic visual acuity and UCLS dizziness questionnaire
If you suspect a pt to have a peripheral vestibular hypofunction, then you would expect the Head Impulse Test to be
negative
positive toward the affected ear
positive toward the unaffected ear
positive bilaterally
Chad walks into your clinic with a diagnosis of UVH. To confirm the MD diagnosis, you perform a HIT. HIT is positive toward the affected ear. What is your next step in the exam process and what should you expect?
perform dynamic visual acuity - if (+) and symptomatic - do gaze stability and habituation
perform dix hallpike to rule out BPPV as a secondary diagnosis
perform dynamic visual acuity - if (-) but symptomatic - do habituation exercises
perform dynamic visual acuity - if (+) and symptomatic - do gaze stability exercises only
perform dynamic visual acuity - if (-) and asymptomatic - consider dix Hallpike maneuver or check OH vitals
What vestibular treatment strategy involves repeated exposure to the specific stimulus that provokes dizziness in hopes to cause a reduction of symptoms over time?
brock string
imaginary targets
optokinetic stimuli videos
virtual reality scenarios (specifically of crowded grocery stores and malls)
adaptation and substitution progression maneuvers
Select the correct pairs.
adaptation - long-term changes in the neuronal response to head movements w/ the goal of reducing sx and normalizing gaze and postural stability
substitution - goal of promoting alternative strategies in place of missing vestibular function
substitution - long-term changes in the neuronal response to head movements w/ the goal of reducing sx and normalizing gaze and postural stability
adaptation - goal of promoting alternative strategies in place of missing vestibular function
Explain to your patient how to perform VOR x1 to improve their gaze stability.
Select the correct pairs.
overt saccades - corrective eye movements made after the head comes to rest
covert saccades - made earlier than when the head comes to rest, usually during the high velocity part of the head movement
overt saccades - made earlier than when the head comes to rest, usually during the high velocity part of the head movement
covert saccades - corrective eye movements made after the head comes to rest
Jeff is experiencing dizziness secondary to UVH. What are some musculoskeletal dysfunctions he may also present with to try and reduce his dizziness?
head-trunk locking when turning
minimization of trunk movements while walking
increase his awareness of surroundings by avoiding crowded places
have his mom drive him to work d/t his car-induced dizziness
walking as quickly as possible to reach his destination to "get the dizziness over with"
Hank is progressing well with your vestibular interventions for UVH. He no longer experiences symptoms with VORx1, but is still experiencing frequent dizziness during his daily routine. How would you APPROPRIATELY challenge Hank knowing this information?
have hank do VORx1 with vertical head movements and horizontal head movements
have hank do VORx1 with convergence
have hank do imaginary targets between 2 targets
have hank do VORx2
