Deck 29: Intervention for Vestibular Impairment

Question 1

The aging peripheral vestibular system includes demineralization of the otoliths.Which functional deficit can be expected?

A)Declines in ability to run on uneven surfaces
B)Declines in peripheral visual cues for
C)Declines in vestibular oculomotor reflex (VOR) function in dynamic postures
D)Declines in ocular counter-rolling with associated head tilt

Answer 1

D

Question 2

A 10 year-old patient diagnosed with a left otitis media presents to the school therapist with complaints of increased symptoms of blurred vision and imbalance.His motion sensitivity score is 43.5%.He complains about inability see the teacher's PowerPoint slides from his seat,which is in the front of the room.He also complains of increased difficulty playing his interactive virtual reality games using Xbox.The therapist wants to set up a treatment plan,which will include two to three visits per week for 6-8 weeks.What should he include in his treatment plan?

A)Slow VOR × 1 exercises for gaze stability
B)A canolith repositioning maneuver (CRM) for a left side lesion
C)VOR × 2 exercises for gaze stability
D)Computerized dynamic posturography training for postural stability

Answer 2

A

Question 3

A Dix-Hallpike CRM is performed on a patient with right anterior vertical canal impairment.What would be an expected eye movement response?

A)Up-beating right torsional eye movement
B)Up-beating left torsional eye movements
C)Down-beating right torsional eye movements
D)Down-beating left torsional eye movements

Answer 3

C

Question 4

An initial evaluation is conducted for a 35 year-old male patient who has been diagnosed with recent left ear labyrinthitis associated with severe vestibular signs and symptoms.Which mechanism of recovery might best be used to guide the plan of care?

A)Adaptation
B)Habituation
C)Substitution
D)Compensation

Question 5

A Lempert maneuver is performed on a patient with a right horizontal canal impairment related to cupulolithiasis.What would be an expected eye movement response?

A)Geotropic nystagmus due to debris in the long arm of the horizontal canal
B)Apogeotropic nystagmus due to debris in the long arm of the horizontal canal
C)Geotropic nystagmus due to debris in the short (anterior) arm of the horizontal canal
D)Apogeotropic nystagmus due to debris in the short (anterior) arm of the horizontal canal

Question 6

An initial evaluation is conducted for a 50 year-old female status post-resection of a right ear acoustic neuroma associated vestibular signs and symptoms.She presents to the outpatient clinic 2 months after surgery.Which mechanism of recovery might best be used guide the plan of care?

A)Adaptation
B)Habituation
C)Substitution
D)Repositioning

Question 7

Patient education is crucial for those who suffer from benign paroxysmal positional vertigo (BPPV) because the reoccurrence rate at 5 years post-treatment is:

A)15%
B)25%
C)35%
D)50%

Question 8

A modified CRM is performed on a patient with a left posterior vertical canal impairment.Upon sitting up at the end of the maneuver the therapist notices rotary transient nystagmus in the opposite direction from the original nystagmus.What could be an explanation for this phenomenon?

A)Contralateral canal stimulation
B)Decreased patient ability to fixate to inhibit eye movements
C)Cervico-ocular reflex responses to the maneuver
D)Some of the otoconia may have fallen back into the canal

Question 9

A therapist assesses a patient's motion sensitivity and finds that the patient has increased symptoms with sit-to-stand movements and increased mediolateral postural sway with the eyes closed during static standing.The patient also complains of increased symptoms on elevators and riding escalators.Symptoms suggest which anatomical structure(s) should be further assessed and targeted for exercise training?

A)Semicircular canals
B)Otoliths
C)Peripheral vestibular system
D)General central vestibular system

Question 10

An initial evaluation is conducted for a 78 year-old patient who has been diagnosed with balance and vestibular signs and symptoms related to treatment of bladder cancer with Cisplatin.Which mechanism of recovery might best be used to guide the plan of care?

A)Adaptation
B)Habituation
C)Substitution
D)Compensation

Question 11

A therapist in an acute care setting reviews the medication list for his patient before performing attempting an initial evaluation to address the patient's complaint of dizziness and vertigo.The chart indicates that the physician has prescribed Meclizine.What is this medication primarily used for to help manage patient symptoms during the acute phase?

A)Reduce inflammation secondary to bacterial infection
B)Reduce symptoms related to headache
C)Reduce symptoms related to insomnia
D)Reduce symptoms related to motion sickness

Question 12

Therapist is treating a 7 year-old female whose parents are concerned because she does not want to play with her friends anymore and has multiple falls at school.Her grades have also declined in school because she hates reading because the "words keep jumping all over the place".During the initial evaluation,the therapist notices that the patient has a positive medical history for shunts in both ears at age 4 years.She also sits on the plinth with rounded trunk posturing and has difficulty standing still in static positions.Which functional activities might the therapist include in her plan of care based on the assessment?

A)VOR × 1 viewing for gaze stability while sitting in a standard chair (for safety) instead of standing
B)General strength and conditioning program
C)Gaze stability exercises with progressive developmental postures
D)None;patient should be referred back to the referring physician for further testing

Question 13

Patient is a 20 year-old roller derby skater who presents to the clinic with complaint of increased dizziness and vertigo especially during matches due to bright lights and high noise.Which conditions might the therapist incorporate into the patient's progressive plan of care?

A)Gaze stability exercises while in a sitting position
B)Gaze stability exercises while standing with the feet in a parallel position on a firm surface in a treatment room
C)Gaze stability exercises while fast walking on a treadmill in the busy gym
D)Gaze stability exercises while standing with the feet in a tandem position on a compliant surface in a treatment room

Question 14

Therapist has been working with a 70 year-old male who was recently discharged from the hospital due to a severe urinary tract infection.The patient has been receiving therapy twice a week for 2 weeks however the patient continues to complain about impaired balance without any dizziness.The patient has bilateral hearing aids however refuses to use them because they aggravate the "ringing" in his ears.The therapist reassesses his plan of care to see how he might alter the plan.What guiding principle should be considered for this patient's rehabilitation prognosis?

A)He might need to cut back on the number of times he wants his patient to perform the exercises
B)Bilateral vestibular loss generally requires a longer episode of care therefore he might just need to give his patient more time to respond
C)He might encourage his patient to wear at least one hearing aid during sessions to make sure the patient hears all instructions
D)The patient must not be compliant therefore he might have the patient keep a daily exercise journal

Question 15

A 26 year-old patient presents to the clinic with a diagnosis of a peri-lymphatic fistula with associated vestibular signs and symptoms related to a recent dental surgical procedure.What treatment rationale might be best used by the therapist?

A)Unstable unilateral deficit;inappropriate for vestibular rehabilitation
B)Stable unilateral deficit;appropriate for vestibular rehabilitation
C)Central vestibular deficit;appropriate for vestibular rehabilitation
D)Nonvestibular deficit;inappropriate for vestibular rehabilitation