21
- Observation (fear avoidance, movement patterns)
- VSR: lateropulsion, retropulsion, Fukuda
- Balance: mCTSIB
- Functional mobility screen: 30 second STS, 5x STS
- Gait: OGA, DGI/FGA, TUG, Gait speed
- MMT screen
- Cerebellar screening
Evaluation components: balance/VSR/other
Tendency to fall to one side
Lateropulsion
Average skew is how many diopters ?
9
It is not life threatening
Benign
It gets triggered by certain head positions or movements
Positional
If there is a L hypofunction, which way will the eyes beat?
Toward the right
How long after treating BPPV is there an increased fall risk?
30 minutes afterwards
Patient asked to take one step backward as if being pulled by hips for retropulsion... how many steps is a positive test?
3 or more steps
Diagnosis: BG disorders, frontal lobe disorders
- High/low (adjustable) table with tilt
- Appropriate feet/distance for visual acuity chart (unless handheld chart)
- Emesis bag (cleaner than trash bag/waste bin)
Environment for vestibular testing
It comes on suddenly, brief spells or intensification of symptoms
Paroxysmal
50 steps arms extended EC, abnormal = progressive turning toward one or more side 30-45 degrees due to asymmetric VSR
Fukuda
- Vertical misalignment of eyes due to otolith-ocular reflex unilaterally
- Subjective report will be diplopia
- Have patient look at your nose, cover one eye, the quickly remove the cover and see if eyes align
- NOT A MUSCULAR CAUSE
- Large amplitude skews point to CNS lesions
- Small amplitude can be seen in vestibular neuritis (PNS)
HINTS Plus -- Test of skew
+ if patient stable with EO, but loses balance with EC (positive with vestibular disorders)
Romberg
A false sense of rotational movement
Vertigo
- Change in head positions cause symptoms
- objective findings on test --> nystagmus
- Canalithiasis vs. cupulolithiasis
- Posterior canal (85-95%)
BPPV
- Eye chart (Snellen eye chart)
- 20 feet or 6 meters away, test one eye at a time
- Scored by the smallest line you can ready correctly with max 2 errors
- 20/20 is normal vision
- Large bottom number = worse than from normal vision
- EX: 20/40 = you correctly read at 20 feet what someone with normal vision can read at 40 feet
Visual acuity testing
Free flowing otoconia in SCC, latency 3-5 seconds, nystagmus and vertigo to follow, fatigues with repetition, more common
Canalithiasis
You put the patient in the position and they are symptomatic, but you do not see a nystagmus;; still treat the issue if they are symptomatic;; studies show this can develop into true BPPV if not treated at initial symptoms
Subclinical nystagmus
1. Two pens (different colors)
2. Foam pad
3. Visual acuity chart - Snellen
4. Tuning fork
5. Goggles
Equipment for vestibular testing
Otoconia stuck in cupula of affected SCC, immediate onset of nystagmus and vertigo, long lasting symptoms (greater than 1 min), weaker nystagmus
Cupulolithiasis
What are the (2) positioning testing for BPPV?
1. Dix-Hallpike
2. Horizontal roll test
As an alternative test for Dix-Hallpike, the PT can perform which test?
Sidelying test
What is the maneuver relating to the Diz-Hallpike test?
Epley maneuver
What is the maneuver associated with the horizontal roll test?
Gufoni's (canalithiasis) and BBQ roll (cupulolithiasis)
What does CRT stand for? How many units can you bill for this?
Canalith repositioning maneuvers
1 unit