NCS Vestibular Rehabilitation 2 — Questions and Answers
Question 1: Gaze stabilization exercises in vestibular rehabilitation primarily aim to improve which reflex?
- Vestibulo-spinal reflex (VSR)
- Vestibulo-ocular reflex (VOR) (Correct answer)
- Optokinetic reflex
- Cervico-ocular reflex
Correct answer: Vestibulo-ocular reflex (VOR)
Gaze stabilization exercises (VOR x1 and x2 viewing tasks) are designed to enhance VOR gain and improve retinal image stability during head movement.
Question 2: The Sensory Organization Test (SOT), a component of computerized dynamic posturography, evaluates the relative contributions of which three sensory systems to balance?
- Auditory, proprioceptive, and visual
- Visual, vestibular, and somatosensory (Correct answer)
- Tactile, visual, and auditory
- Proprioceptive, auditory, and vestibular
Correct answer: Visual, vestibular, and somatosensory
The SOT systematically alters visual and surface conditions across six conditions to isolate the relative contributions of visual, vestibular, and somatosensory inputs to postural control.
Question 3: The supine roll test (Pagnini-McClure test) is the primary diagnostic maneuver for BPPV affecting which canal?
- Posterior semicircular canal
- Anterior semicircular canal
- Horizontal semicircular canal (Correct answer)
- All semicircular canals equally
Correct answer: Horizontal semicircular canal
The supine roll test positions the horizontal canal in the plane of gravity; rolling the supine patient's head 90° to each side elicits geotropic or apogeotropic horizontal nystagmus if canaliths are present.
Question 4: In the Barbecue roll (Lempert) maneuver used to treat horizontal canal BPPV, the patient is rotated:
- 45° toward the unaffected side once
- 360° in four sequential 90° steps toward the unaffected side (Correct answer)
- 90° toward the affected side only
- 180° in one continuous motion toward the ceiling
Correct answer: 360° in four sequential 90° steps toward the unaffected side
The Barbecue roll maneuver guides canaliths from the horizontal canal back to the utricle by rotating the patient 360° in four 90° incremental steps toward the unaffected side.
Question 5: Habituation exercises for vestibular dysfunction are MOST appropriate for patients with:
- Acute vestibular neuritis within the first 48 hours of onset
- Active BPPV requiring canalith repositioning
- Chronic motion sensitivity from stable unilateral vestibular hypofunction (Correct answer)
- Complete bilateral vestibular loss
Correct answer: Chronic motion sensitivity from stable unilateral vestibular hypofunction
Habituation exercises, which use repeated exposure to symptom-provoking movements to reduce sensitivity, are most effective in patients with stable peripheral vestibular lesions causing motion-triggered symptoms.
Question 6: Which caloric test finding indicates unilateral peripheral vestibular hypofunction?
- Bilateral caloric weakness greater than 25%
- Directional preponderance greater than 30%
- Unilateral weakness exceeding 25% asymmetry between ears (Correct answer)
- Enhanced bilateral caloric responses
Correct answer: Unilateral weakness exceeding 25% asymmetry between ears
Using Jongkees' formula, a unilateral caloric weakness exceeding 25% asymmetry between the two ears indicates ipsilateral peripheral vestibular hypofunction.
Question 7: 'Canal conversion' during BPPV canalith repositioning refers to:
- Complete resolution of BPPV without residual symptoms
- Canaliths migrating from one semicircular canal to another during the maneuver (Correct answer)
- Conversion from peripheral to central BPPV etiology
- Spontaneous disappearance of nystagmus mid-maneuver
Correct answer: Canaliths migrating from one semicircular canal to another during the maneuver
Canal conversion occurs when repositioning maneuvers inadvertently shift debris into a different semicircular canal (e.g., posterior to horizontal), requiring recognition of the changed nystagmus pattern and a different treatment approach.
NCS Vestibular Rehabilitation 2
Gaze stabilization exercises in vestibular rehabilitation primarily aim to improve which reflex?