UVH AND BVH ACTUAL EXAM QUESTIONS
WITH VERIFIED ANSWERS
What is unilateral vestibular hypofunction (UVH)/lesion (UVL)?
- a lesion in the peripheral vestibular system
- can affect L or R side
- affects VOR (eyes and vestibular system working together, especially when moving head)
What are 5 types of UVL? (and other)
- Meniere's
- Schwannoma/acoustic neuroma
- Superior canal dehiscence
- Neuritis
- Perilymphatic fistula
- other: sequela from other conditions: mTBI, falls, chronic positional vertigo, untreated BPPV
Why is untreated BPPV grouped into UVL diagnoses?
- maladaptations/decompensation secondary to a chronic issue
- vestibular system has not been used chronically, so it's not functioning normally
What are the strong recommendations for treatment of UVL according to CPGs?
- voluntary saccadic or smooth pursuit exercise should NOT be offered in isolation as gaze
stability exercise
- use adaptation and substitution for gaze stability exercise
What are the moderate evidence recommendations for treatment of UVL according to
CPGs?
- minimum of 20 minutes daily for at least 4-6 weeks for individuals with CHRONIC unilateral
vestibular hypofunction
What are the mod-weak evidence recommendations for treatment of UVH or BVH
according to CPGs?
- 3x/d for total of at least 12min/d for individuals with acute/subacute UVH
- 3-5x/d for a total of at least 20 min/d for 4-6 weeks for individuals with chronic UVH
- 3-5x/d for a total of 20-40 min/d for approx 5-7 wks for individuals with BVH
What are the VOR tests to do in an exam?
- head impulse test (HIT)
- head shake test (HS)
- VORx1, x2
- dynamic visual acuity (DVA)
, - foam eyes closed (best to show if vestibular system impacted)
What are some adaptation treatment ideas?
- VOR progression (2Hz)
- change background, time, pt position)
What are some substitution treatment ideas?
- gaze fixation
- upregulation of other systems
What are some habituation treatment ideas?
- Brandt-Daroff exercises (10-20x, 3x/d_
- other functional tasks, part to whole
What is persistent postural perceptual dizziness (PPPD)?
- persistent sensations of rocking, swaying, unsteadiness, and/or dizziness lasting >/= 3 mo
- AND PT and medical procedures/examinations do not result in explaining pts concerns
What are some common behavioral considerations for someone with persistent postural
perceptual dizziness?
- tend to be anxious, introverted, or a pre-existing anxiety disorder
- high levels of anxiety during vestibular symptoms may be more likely to develop PPPD
- primary predictor of PPPD - first experience of acute vestibular episode displays high levels of
anxiety and caution with expectations for a negative outcome
What is the treatment for PPPD?
- medication
- vestibular rehabilitation therapy (VRT)
- counseling cognitive behavioral therapy (CBT)
What are some expected findings for cervicogenic dizziness?
- decreased cervical ROM
- cervical pain
- inconclusive oculomotor tests
- decreased cervical kinesthetic sense
What are some causes of cervicogenic dizziness?
- trauma
- muscle fatigue
- degenerative changes
- inflammation
WITH VERIFIED ANSWERS
What is unilateral vestibular hypofunction (UVH)/lesion (UVL)?
- a lesion in the peripheral vestibular system
- can affect L or R side
- affects VOR (eyes and vestibular system working together, especially when moving head)
What are 5 types of UVL? (and other)
- Meniere's
- Schwannoma/acoustic neuroma
- Superior canal dehiscence
- Neuritis
- Perilymphatic fistula
- other: sequela from other conditions: mTBI, falls, chronic positional vertigo, untreated BPPV
Why is untreated BPPV grouped into UVL diagnoses?
- maladaptations/decompensation secondary to a chronic issue
- vestibular system has not been used chronically, so it's not functioning normally
What are the strong recommendations for treatment of UVL according to CPGs?
- voluntary saccadic or smooth pursuit exercise should NOT be offered in isolation as gaze
stability exercise
- use adaptation and substitution for gaze stability exercise
What are the moderate evidence recommendations for treatment of UVL according to
CPGs?
- minimum of 20 minutes daily for at least 4-6 weeks for individuals with CHRONIC unilateral
vestibular hypofunction
What are the mod-weak evidence recommendations for treatment of UVH or BVH
according to CPGs?
- 3x/d for total of at least 12min/d for individuals with acute/subacute UVH
- 3-5x/d for a total of at least 20 min/d for 4-6 weeks for individuals with chronic UVH
- 3-5x/d for a total of 20-40 min/d for approx 5-7 wks for individuals with BVH
What are the VOR tests to do in an exam?
- head impulse test (HIT)
- head shake test (HS)
- VORx1, x2
- dynamic visual acuity (DVA)
, - foam eyes closed (best to show if vestibular system impacted)
What are some adaptation treatment ideas?
- VOR progression (2Hz)
- change background, time, pt position)
What are some substitution treatment ideas?
- gaze fixation
- upregulation of other systems
What are some habituation treatment ideas?
- Brandt-Daroff exercises (10-20x, 3x/d_
- other functional tasks, part to whole
What is persistent postural perceptual dizziness (PPPD)?
- persistent sensations of rocking, swaying, unsteadiness, and/or dizziness lasting >/= 3 mo
- AND PT and medical procedures/examinations do not result in explaining pts concerns
What are some common behavioral considerations for someone with persistent postural
perceptual dizziness?
- tend to be anxious, introverted, or a pre-existing anxiety disorder
- high levels of anxiety during vestibular symptoms may be more likely to develop PPPD
- primary predictor of PPPD - first experience of acute vestibular episode displays high levels of
anxiety and caution with expectations for a negative outcome
What is the treatment for PPPD?
- medication
- vestibular rehabilitation therapy (VRT)
- counseling cognitive behavioral therapy (CBT)
What are some expected findings for cervicogenic dizziness?
- decreased cervical ROM
- cervical pain
- inconclusive oculomotor tests
- decreased cervical kinesthetic sense
What are some causes of cervicogenic dizziness?
- trauma
- muscle fatigue
- degenerative changes
- inflammation
