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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

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Symptoms Possible Causes Management
Syncope with lightheadedness Postural or exerciseinduced hypotension Cardiac dysrhythmia or defects

Cease treatment Take BP

Refer to physician

Dizziness accompanied by decreased arousal or change in consciousness Brainstem infarct Cease treatment Seek immediate medical attention

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 present

  • Loss of balance and ataxia increase ...

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