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100

What are the (3) treatments for chronic subjective dizziness and PPPD? 

1. Vestibular habilitation
2. Cognitive behavioral therapy
3. Medications 

100

Never healed from initial injury; not adapting after an issue and not recovering as expected; habilitation (decreasing response to a non-noxious stimulus) of the vestibular system is the treatment for these patients 

Chronic subjective dizziness 

100

- ABCs
- DHI 

Outcome measures for activity and participation 

100

What does HINTS Plus stand for? 

- HI = head impulse test (VOR assessment)
- N = nystagmus type
- TS = Test of skew
- Plus : acute hearing loss 

100

Area of stroke commonly affected which supplies the labyrinth and close relation to brainstem and cerebellum 

AICA 

200

- "Lightheaded"
- Presyncope
- Syncope
- Orthostatic hypotension
- Lightheadedness: stay hydrated 

Cardiac issues 

200

- Four square step test
- BBS
- Functional reach/modified functional reach
- CTSIB/mCTSIB
- Mini BESTest
- Romberg/sharpened romberg
- Unipedal stance test (SLS) 

Outcome measures for postural stability 

200

- Precipitants: vestibular crisis, medical event, acute anxiety
- Acute adaptation: visual somatosensory dependence, high risk postural control strategies, environmental
- Predisposing factors: introverted temperament, pre existing anxiety
- Recovery: neuro-otologic, medical, behavioral
- Behavioral comorbidity: anxiety disorders, phobic disorders, depression
- Provoking factors: upright posture, motion (self, environment), visual demands (complexity, precision) 

Chronic subjective dizziness 

200

- Resting eye position
- Oculomotor testing
- Gaze stability assessment
- Visual acuity tests
- Findings 

Evaluation components: oculomotor/VOR 

200

T/F: Fast phase horizontal nystagmus can also be classified as central origin? 

TRUE ** 

300

Acute moderate to severe sensorineural hearing loss associated with vertigo could mean ______ 

Labyrinth infarction 

300

- Starts shortly after an acute event that leads to vertigo/balance issues
- Presentation: dizziness without vertigo and fluctuating unsteadiness that is provoked by environmental or social stimuli

Persistent postural perceptual dizziness (CSD?) 

300

Acute hearing loss is a red flag and is NOT always due to a viral infection but could be ischemia/infarct of ______ and _____. 

Cochlea; labyrinth 

300

How do you perform an active VOR test? 

Holding pencil and turning head as fast as they can while keeping the object in focus 

300

What does the acronym INFARCT mean in HINTS Plus? 

- IN = impulse negative
- FA = fast phase alternating
- RCT = refixation during cover test

400

- Numbness
- Tingling
- Unilateral hearing loss
- Progressive hearing loss
- Slurred speech
- Tremors
- Poor coordination
- UMN s/s: clonus, spasticity
- LOC
- Rigidity
- Visual field loss
- Memory loss
- CN dysfunction
- Spontaneous nystagmus
- Vertical nystagmus without torsional component 

Red flags 

400

- DGI
- FGA
- TUG, TUG manual, TUG cognitive
- FTSTS/30 second sit to stand
- Gait speed 

Outcome measures for dynamic stability 

400

Clearing tests before VOR and positional testing: (2) 

1. VBI
2. Cervical AROM 

400

- Head impulse (thrust) test
- Positive test means VOR is disrupted due to lesions in peripheral afferents, vestibular nucleus or efferent neurons
- If PNS positive, you will see a corrective saccade
- Normal in cerebellar lesions (Neuron arc is normal)
- PICA strokes can also have normal HIT
- Can, however, be positive in some strokes, therefore HIT, skew deviation of eyes and HINTS can assist in PNS vs. CNS differentiation 

HINTS plus -- VOR assessment 

400

Acute, spontaneous, continuous vertigo, particularly when they have nystagmus 

Who to use HINTS Plus with 

500

- 180 bpm in a 20 degree range
- Horizontal and vertical
- Positive signs is an inability to maintain gaze stability 

Active VOR (screen) 

500

Nystagmus is named by which phase of beating? 

Fast phase ** 

500

- Have patient look at your nose
- Passively rotate patients head, slow to start then fast
- Positive sign is an inability to maintain gaze stabilization on nose
   - 20-30 degrees downward facing of the patient... not just looking straight ahead 

Passive VOR -- Head impulse test 

500

In general, which two nystagmus are CENTRAL in origin 

1. Purely torsional
2. Purely vertical *** 

500

T/F: fast phase is side of dysfunction? 

FALSE.. 

Slow phase is side of dysfunction *** 
Nystagmus is named from fast phase