Last minute Final Material

Question 1

What is the difference between action systems, perceptual systems and cognitive systems?

Answer 1

ACTION systems involve motor cortices and other areas of the frontal cortex for higher level planning, brainstem, spinal networks, cerebellum, BG, LMN and muscles. They incorporate movement strategies to be used during perturbed stance

PERCEPTUAL systems involve vision, somatosensory and vestibular components

COGNITIVE systems are present even though postural control is unconscious there is a lot of attention that is required. dual tasking can either increase or decrease sway depending on the age of the individual, postural task and balance activities

Question 2

As a healthy adult what is postural control primarily achieved through?

Answer 2

FEEDFORWARD

through feedforward we can prepare sensory and motor systems for anticipated movements and environments (central set)

Question 3

What is the difference between feedforward and feedback?

Answer 3

feedforward is proactive or anticipatory. It uses the motor cortex to command for voluntary movement and anticipatory adjustments to achieve desirable body orientation

feedback control is reactive and uses sensory inputs for processing and integration of info on body orientation

Question 4

what is the difference between anticipatory postural control and reactive control?

Answer 4

anticipatory = feed forward
It involves the activation of postural muscles in anticipation of potentially destabilizing voluntary movement. There is a preselection of tuning sensorimotor systems for upcoming events. It is very modifiable to the task and hand. The preprogrammed responses maintain the stability

reactive= feedback
response to external perturbation and is automatic

Question 5

What is the difference between motor strategies and sensory strategies that contribute to posture control?

Answer 5

motor strategies involve alignment, sitting strategies (reaching, PNF) and looking at the ability to maintain balance under the 4 contexts

Sensory strategies involve the Clinical Test for Sensory Interaction in Balance which is testing to see what strategy a patient uses in specific conditions. These strategies also integrate all the sense and look at visual and surface dependency as well as vestibular loss

Question 6

At what degree is the horizontal canal targeted?

Answer 6

at a 30 degree head tilt to test for asymmetry

Question 7

What is the initial response when the posterior canal is affected?

Answer 7

upbeating and torsional

Question 8

What is the initial response for canalithiasis?

Answer 8

geotrophic

Question 9

what is the initial response for cupulothiasis?

Answer 9

apogeotropic

Question 10

What is the initial response when the anterior canal is affected?

Answer 10

downbeating and torsional

Question 11

What are the tests for the vertical canals

Answer 11

dix hallpike test and sidelying test

Question 12

what are the tests for the horizontal canals

Answer 12

roll test and bow and lean test

Question 13

How is BPPV treated for the posterior canal?

Answer 13

Canalith repositioning and Epley maneuver

Question 14

how is anterior canalithiasis treated

Answer 14

CRT

Question 15

how is posterior cupulothiasis and canalithiasis treated

Answer 15

liberatory and brandt-daroff habituation exercise

Question 16

treatment of horizontal canalithiasis

Answer 16

Bar B Que roll, liberatory maneuver and forced prolonged position

Question 17

what is vertigo

Answer 17

illusion of movement

Question 18

what is lightheadness

Answer 18

feeling that fainting is about to occur

Question 19

what is oscillopsia

Answer 19

subjective experience of motion of objects in the visual environment that are known to be stationary

Question 20

what is disequilibirum

Answer 20

sensation of being off balance

Question 21

What are the key elements in taking a history for a patient with dizziness

Answer 21

Identification of symptoms as well as their duration and circumstances under which they occur

Question 22

2. What is the Motion Sensitivity Quotient measuring

Answer 22

Provides a subjective score of an individual’s sensitivity to motion

Question 23

3. How is nystagmus named?

Answer 23

Named by the direction of the fast component (the reset)

Question 24

5. Describe a positive head thrust tes

Answer 24

In a patient with a loss of vestibular function the VOR will not move the eyes as quickly as the head rotation and the eyes move off the target. The pt. will then make a corrective saccade to reposition the eyes on the target. The appearance of a corrective saccade indicates vestibular hypofunction.

Question 25

Why is it important to perform this test at high velocity

Answer 25

that is the best way to target the VOR

Question 26

6. Describe a positive dynamic visual acuity test

Answer 26

. A 3 line or more decrement in visual acuity during head movement is suggestive of vestibular hypofunction

Question 27

7. What exercises are commonly provided to a pt with vestibular hypofunction? What is the rationale for providing these exercise

Answer 27

Unilateral vestibular hypofunction (UVH) has exercises based off the goals of improving stability of gaze during head movement, demonstrating diminished sensitivity to the motion, improved static and dynamic postural stability EXERCISES: gaze stability, postural stability and motion sensitivity (habituation) BVH goals are to demonstrate improved stability of gaze during head movement, reduced complaint of gaze instability, improves static and dynamic balance, improve central preprogramming of eyes EXERCSIES: incorporate sequenced eye and head movements and use of imaginary targets to improve gaze stability. Balance exercises

Question 28

9. Describe the difference between X1 and X2 exercises

Answer 28

In x1 exercises the patient is asked to move the head horizontally as quickly as possible while maintaining focus on a stable target In x2 exercises the patient is required to move the head and target in opposite directions

Question 29

10. Describe the difference between adaptation and habituation exercise

Answer 29

Adaptation exercises are an excellent starting point for rehab of patients with vestibular hypofunction. They are designed to expose patients to retinal slip (occurs when the image of an object moves off the fovea and results in visual blurring). Retinal slip is necessary as a signal to drive vestibular adaptation Habituation exercises were the first successful method used to treated vestibular disorders. Provoking exercises are performed 3 to 5 times each 2-3 times a day. They are designed to reproduce the dizziness and the pt should be encouraged that the symptoms will decrease within 2 weeks. Purpose is for the reduction in symptoms to a repeatedly performed movement.

Question 30

What are contraindications for vestibular rehab

Answer 30

* Unstable vestibular disorders such as menieres disease * Uncontrolled migraine * PLF * Unrepaired superior semicircular canal * Sudden loss of hearing * Increased feeling of pressure or fullness to point of discomfort in ears * Severe ringing in ear

Question 31

Central vs. Peripheral vestibular symptoms

Answer 31

``` CENTRAL- abnormal smooth pursuit and abnormal saccades. no hearing loss pendular nystagmus persistent vertical nystagmus ``` ``` PERIPHERAL normal smooth pursuits hearing loss acute vertigo suppressed by visual fixation slow and fast phases of nystagmus spontaneous horizontal nystagmus ```

Question 32

what type of pathology is it if there are issues with saccades

Answer 32

central

Question 33

if there is difficulty with eyes tracking what type of issue is it

Answer 33

central

Question 34

VOR cancellation test is used for what disorder

Answer 34

central

Question 35

what does the head thrust test examine

Answer 35

peripheral disorders

Question 36

what does the dynamic visual accutiy test examine

Answer 36

peripheral disorders