CNS-NP

Nonprogressive Disorders of the Central Nervous System

Central Vestibular Dysfunction

Vertigo of Central Origin Description/Overview

Central vestibular dysfunction (CVD) symptoms include:

• Severe balance loss

• Vertigo, that is persistent; not diminished by visual fixation

• Nausea

• Severe oscillopsia (feeling that stationary objects are moving)

• Nystagmus (vertical and/or pendular) in which speed is constant

CVD is often accompanied by:

• Incoordination (dysdiadochokinesia, ataxia)

• Postural imbalance

• Hearing loss

Medical Red Flags

Physical Therapy Examination

History

Refer to Tab 2 for full details of history.

• Obtain a description and circumstances of falls and loss of balance

• Hx of eye glasses, including any recent changes and date of last ophthalmologic exam

Subjective

• Have the patient describe their "dizziness," including situations that worsen symptoms and duration of symptoms

• With a visual analog scale (10 cm line), have the patient rate their level of:

  • Disequilibrium

  • Oscillopsia

  • Vertigo

  • Head-movement induced symptoms

Tests and Measures

Cranial and Peripheral Nerve Integrity

Consideration

• Frenzel lenses magnify the eyes allowing assessment of nystagmus

Assessment

• Cranial nerves with attention to II, III, IV, VI, & VIII

• Refer to Tab 6 for testing of vestibular system including:

  • Dix-Hallpike maneuver

  • Vestibular ocular reflex (VOR)

  • Head-thrust test

  • Head-shaking nystagmus test

Potential findings

• Smooth pursuit and saccadic eye movements are usually impaired

• Abnormalities of cranial nerves IX through XII may result from neoplasms

Gait, Locomotion, and Balance

Balance assessment

• Perform during functional activities with or without the use of assistive, adaptive, and orthotic devices/equipment

• Static Balance Tests (Refer to Tab 2)

  • Romberg Test

  • Tandem (Sharpened) Romberg Test

  • One-legged Stance Test

• Dynamic Balance Tests (Refer to Tab 2)

  • Functional Reach Test

  • Multi-Directional Reach Test

  • Berg Balance Test

  • Clinical Test for Sensory Interaction in Balance (CTSIB) or modified CTSIB

  • Performance-Oriented Mobility Assessment

Potential findings

• Falls to one direction may indicate vestibular system imbalance

• Unsteadiness in Romberg "eyes-open" may indicate cerebellar dysfunction

• Tandem Romberg is usually positive

• One-legged stance is often not possible

Gait and locomotion assessment (Refer to Tab 2)

• 4-Item Dynamic Gait Index

• Assess gait while turning head from side to side

Potential findings

• Ataxic gait may be ...