Geriatric Assessment Tool Kit

Vestibular Exam & Treatment

Table of Contents:

1. Name that Nystagmus! (Hint: #3,4,6 are easy ones to start with)

A. View Clip	B. Answer Questions	C. Check Your Answers
#1 The R EYE is all you see. Mov213 DCPN.mp4 DCPN.mp4	First the therapist tells the patient to gaze to the Left. What happens? Then he tell her to gaze center. What happens? Last, he tells her to gaze Right. What happens?	Check your answer.
#2: Human demo of Halpike Dix shows the Right EYE with a tiny video inset of full body positioning. It is hard to see, but the L ear is positioned down. bppv.mp4	Describe the nystagmus in the supine position. Describe the nystagmus when brought to sitting What is the diagnosis?	Check your answer.
#3: Human demo of HPD, showing movements by therapist (R ear down position) and a R EYE video. bppv_dix-hallpike.mp4	Describe the nystagmus in the supine position. Describe the nystagmus when brought to sitting What is the diagnosis?	Check your answer.
#4: Patient with Meniere's Disease. Both EYES are shown. Menieres.mp4	Describe the nystagmus during R and L gaze.	Check your answer.
#5: UVL: Unilateral Vestibular Lesion: Vestibular Neuritis Left EYE There is an inset video, but all the patient does is sit on the plinth. There is no audio, but you can see the change of gaze direction. vnsmall.mp4	Describe the nystagmus during R and L gaze.	Check your answer.
#6: Central Lesion. Full face view of both eyes nystagmusA.mp4	Describe the nystagmus	Check your answer.
#7: R EYE nystagmusB.mp4	Describe the nystagmus	Check your answer.
#8: Cerebellar Degeneration. Right Eye This clip has audio with the therapist telling the patient to follow the horizontal movements of his finger. nystagmusC.mp4	Name the nystagmus at each gaze position that is held by the patient: left center right center	Check your answer.
#9: Central Lesion: R EYE. Pendular Nystagmus This is just an example. There is no question. Gaze moves slowly from center to left gaze. Note the pendulum-like movements of the eye opm_small.mp4

2. BPPV: Exam & Treatment

1. Diagnostic maneuver for BPPV: Hallpike-Dix
Intervention for BPPV Canalithiasis: Canalith Repositioning Treatment (CRT), aka "Eppley"

hpd-eppley.mp4

2. Intervention for BPPV Cupololithiasis: Liberatory Maneuver, aka "Semont"

When HPD elicited nystagmus lasts longer than 30 sec., the Liberatory Maneuver will be indicated as treatment for Cupulolithiasis.

Nose points up, and then patient holds that position when flipped (nose pointed into the mat), and therapist shakes her head at the end.

Mov172_semont_with_rap.mp4

3. Physiology & Anatomy animations

1. Middle-Ear-Pressure.gif
-- how the middle ear equalizes pressure via the Eustachian tube, i.e. how ears "pop"

2. Outer-middle-inner-ear.gif
-- shows anatomical zones

3. Vestibular nerve.gif
-- show the mechanism of hair cell deflection in the cupula from the endolymphatic fluid from the SCC that happens with head movement. The signal travels along the Vestib nerve to the Vestibular nuclei in the Pons and Medulla, and then on to the Parietal Cortex.

4. Vestibule and canals.gif
-- indicates the anatomic zones of the Vestibule and the SCC.

Credit:
All video clips and animations, except <hpd-eppley.mp4>, are used with permission from Dizziness-and-Balance.com
Created by Timothy C. Hain, M.D. http://www.dizziness-and-balance.com/index.html Accessed 8-21-2006

"Vestibular Examination & Treatment" learning module authored by Carmen Casanova Abbott PT, PhD and Evan Prost PT, DPT
University of Missouri Physical Therapy Department. Updated 7-7-2021.