Videonystagmography (VNG) Setup Quiz
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Questions and Answers

Input the patient information, use first and last name, for ID use the first two letters of the ______ name, and first letter of their last name followed by their birth year.

first

The patient sits in the chair ______ inches away from the TV.

36

Keep the ______ clean, use an antibacterial wipe to maintain cleanliness.

goggles

Select ______ Testing. The patient’s eyes will be on the screen.

<p>Start</p> Signup and view all the answers

Instruct the patient to keep their head still and only have their eyes follow the ______.

<p>dot</p> Signup and view all the answers

Place the black goggle ______ on for spontaneous nystagmus tests.

<p>cover</p> Signup and view all the answers

Instruct the patient to imagine a dot far away from them and focus on that ______ without moving their eyes.

<p>dot</p> Signup and view all the answers

Before you perform the test, show the patients the ______ on the TV frame.

<p>dots</p> Signup and view all the answers

When I say ______, you look at where the top dot was.

<p>up</p> Signup and view all the answers

Do this ______ times in each direction, holding for 1.5-2 seconds before switching.

<p>5</p> Signup and view all the answers

For Gaze Stability, you should 'keep your eye on the ______ at all times.'

<p>dot</p> Signup and view all the answers

In the Antisaccades test, when a new dot appears, look where the dot would be if it was on the ______ side.

<p>opposite</p> Signup and view all the answers

If the cursor is not staying on the ______, the patient’s eyelashes may be causing a disturbance.

<p>pupil</p> Signup and view all the answers

If at any point, the patient gets ______ or nauseous, pause the test and wait for them to improve.

<p>dizzy</p> Signup and view all the answers

During the VNG, check up on the patient to see if they need to take a ______ and feel ok to continue.

<p>break</p> Signup and view all the answers

For the OPK test, ask the patient if they have a history of ______.

<p>seizures</p> Signup and view all the answers

What should you do if the calibration is stuck on a dot for more than 7 seconds during the VNG setup?

<p>Manually click approve after about 7 seconds.</p> Signup and view all the answers

Why is it important to have the patient's eyes at the same level as the green dot during the VNG set-up?

<p>It ensures accurate calibration and testing results.</p> Signup and view all the answers

What is the purpose of the Ocular Counter Roll test in the VNG procedure?

<p>It assesses the patient's ability to maintain eye fixation while their head is moved.</p> Signup and view all the answers

What action should be taken during the test if there is a calibration error?

<p>Adjust the chair position slightly or click default settings if problems persist.</p> Signup and view all the answers

How often should you check on the patient for feelings of discomfort during the VNG procedure?

<p>Periodically throughout the test.</p> Signup and view all the answers

What instruction should you give to the patient during the Spontaneous Nystagmus Vertical Saccades test?

<p>Show the patient the dots on the TV frame.</p> Signup and view all the answers

What does instructing the patient to keep their eyes wide and blink as little as possible during the Ocular Counter Roll test help achieve?

<p>It allows for more accurate tracking of eye movements.</p> Signup and view all the answers

If a patient expresses feelings of nausea during the VNG, what should you do?

<p>Pause the test and wait for the patient to feel better before continuing.</p> Signup and view all the answers

What are the main instructions given to a patient during the Horizontal Saccades test?

<p>The patient is instructed to look at the left dot when prompted and then the right dot, each for 1.5-2 seconds.</p> Signup and view all the answers

During the Pursuits test, what is the patient instructed to do?

<p>The patient is instructed to follow the dot with their eyes without moving their head.</p> Signup and view all the answers

Why might the goggles need to be recalibrated during VNG testing?

<p>Recalibration may be necessary if the data lines during a test are completely off, indicating the goggles were moved.</p> Signup and view all the answers

What should be done if a patient feels dizzy or nauseous during the VNG test?

<p>The test should be paused and the patient should be monitored until they improve.</p> Signup and view all the answers

What do you instruct the patient to do to eliminate interference from their eyelashes during testing?

<p>Instruct the patient to keep their eyes open wide or pull the eyelid up slightly before tightening the goggles.</p> Signup and view all the answers

What is the focus of the Antisaccades test?

<p>The focus is on having the patient look at the position where a new dot would be, opposite the center dot, then back to the center.</p> Signup and view all the answers

What preparatory question should be asked before performing the OPK test?

<p>Ask the patient if they have a history of seizures.</p> Signup and view all the answers

What are the patient’s instructions regarding head movement during Saccadometry?

<p>The patient must look at the new dot and then back to the center dot using only their eyes, not their head.</p> Signup and view all the answers

What role does the heart rate play in compensating for a drop in blood pressure in patients with POTS?

<p>The heart rate increases to maintain blood flow to the brain when blood pressure drops.</p> Signup and view all the answers

In the context of autonomic disorders, how is orthostatic hypotension defined?

<p>Orthostatic hypotension occurs when systolic blood pressure drops by 20 points or diastolic drops by 10 points upon standing.</p> Signup and view all the answers

Why is a heart rate increase alone not considered a pathology in patients with POTS?

<p>The heart rate increase is a compensatory mechanism that prevents a drop in blood pressure.</p> Signup and view all the answers

What is the relationship between heart rate and blood pressure in a closed cardiovascular system?

<p>Heart rate and blood pressure work in tandem to maintain stable blood flow, adjusting in response to each other.</p> Signup and view all the answers

How does dysautonomia affect a patient’s response to changes in body position?

<p>Dysautonomia impairs the autonomic nervous system, leading to inadequate blood pressure regulation when standing.</p> Signup and view all the answers

What physiological mechanisms underpin tilt table therapy for autonomic disorders?

<p>Tilt table therapy gradually acclimates patients to upright positions, helping improve autonomic regulation.</p> Signup and view all the answers

What distinguishes POTS from orthostatic hypotension in terms of heart rate response?

<p>In POTS, the heart rate increases without a corresponding drop in blood pressure, whereas orthostatic hypotension shows reduced blood pressure with less heart rate compensation.</p> Signup and view all the answers

What symptoms can result from a failure to maintain stable blood pressure in autonomic disorders?

<p>Patients may experience dizziness, lightheadedness, and, in severe cases, fainting.</p> Signup and view all the answers

What role does body mapping play in the blood shunting mechanisms of individuals with TBI and dysautonomia?

<p>Body mapping helps individuals recognize the position of their body parts, affecting their ability to shunt blood effectively. Without proper body mapping, they cannot adequately direct blood flow to various body parts, particularly the head.</p> Signup and view all the answers

How do vestibular, visual, and proprioceptive deficits impact the heart rate and blood pressure in individuals with TBI?

<p>These deficits hinder the individual's ability to accurately perceive their body's position in space, affecting blood flow regulation. As a result, patients may experience instability in heart rate and blood pressure.</p> Signup and view all the answers

What changes occur in autonomic symptoms when proprioceptive or vestibular systems are improved?

<p>Improving these systems helps patients to better perceive their body positioning, leading to more effective blood shunting and a reduction in autonomic symptoms. As they gain awareness, symptoms can alleviate even without external interventions.</p> Signup and view all the answers

What conditions must be met regarding blood pressure and heart rate when a patient lies down at a certain angle?

<p>When lying down at a specific angle, blood pressure and heart rate must remain stable for proper physiological function. Decompensation occurs when these parameters become unstable, indicating a failure in the autonomic regulation.</p> Signup and view all the answers

Why is understanding the concept of decompensation important for managing patients with TBI and dysautonomia?

<p>Understanding decompensation helps healthcare providers recognize when a patient's physiological state is at risk, indicating a need for intervention. Timely identification can prevent complications and improve overall treatment outcomes.</p> Signup and view all the answers

Study Notes

VNG Set-Up

  • Launch OTOACCESS program; input patient details: first & last name, ID format: first two letters of first name, first letter of last name, and birth year.
  • Select “Micromedical VNG” from the menu.
  • Position patient chair 36 inches from the TV; align chair with ground markers for accuracy.
  • Center patient in front of the TV; ensure the green dot is at eye level.
  • Maintain cleanliness of goggles using antibacterial wipes; apply goggles on the patient securely.
  • Start testing once goggles are fitted; patient's eyes will focus on the screen.
  • Adjust clarity using side knobs; check TV and patient's eyes for optimal sharpness.
  • Center on pupil using toggle; perform calibration as per instructions.
  • Regularly check patient comfort and provide breaks as necessary.

Running VNG Procedures

  • Ocular Counter Roll:
    • Patient focuses on a green dot; perform calibration and torsion measures.
    • Move patient’s head while keeping their eyes on the dot; maintain focus while minimizing blinks.
  • Spontaneous Nystagmus Tests:
    • Use black goggle cover for tests.
    • Central Test: Instruct patient to focus on an imagined distant dot.
    • Vertical Saccades: Guide patient through looking at frame dots upon verbal cues.
    • Horizontal Saccades: Similar to vertical saccades but directed left and right.
  • Gaze Stability:
    • Instruct patient to keep eyes fixed while head remains still; conduct five tests.
  • Pursuits:
    • Patient follows a dot with their eyes only, avoiding head movement; execute both horizontal and vertical versions.
  • Random Saccade:
    • Similar instruction as pursuits; applied to horizontal and vertical configurations.
  • OPK:
    • Confirm seizure history; if present, skip test; else instruct patient to watch moving bars.
  • Saccadometry:
    • Look at center dot; when a new dot appears, shift gaze accordingly without head movement.
  • Antisaccades:
    • Instruct to look at center dot; upon dot appearance, shift to the opposing side equally before returning to center.

Troubleshooting Tips

  • If cursor tracking is unstable, check for disturbances from eyelashes; instruct patient on eye positioning.
  • Ensure no simultaneous blinking when starting the test to avoid data discrepancies.
  • Correct significant data issues by recalibrating without starting over from scratch.
  • Advise patient to remove mascara if it interferes with sensor detection of the pupil.
  • Immediately pause testing if the patient experiences dizziness or nausea; wait for recovery before deciding on test continuation or termination.
  • Consistently check on patient’s comfort and readiness to proceed throughout the testing session.

VNG Set-Up

  • Launch OTOACCESS program; input patient details: first & last name, ID format: first two letters of first name, first letter of last name, and birth year.
  • Select “Micromedical VNG” from the menu.
  • Position patient chair 36 inches from the TV; align chair with ground markers for accuracy.
  • Center patient in front of the TV; ensure the green dot is at eye level.
  • Maintain cleanliness of goggles using antibacterial wipes; apply goggles on the patient securely.
  • Start testing once goggles are fitted; patient's eyes will focus on the screen.
  • Adjust clarity using side knobs; check TV and patient's eyes for optimal sharpness.
  • Center on pupil using toggle; perform calibration as per instructions.
  • Regularly check patient comfort and provide breaks as necessary.

Running VNG Procedures

  • Ocular Counter Roll:
    • Patient focuses on a green dot; perform calibration and torsion measures.
    • Move patient’s head while keeping their eyes on the dot; maintain focus while minimizing blinks.
  • Spontaneous Nystagmus Tests:
    • Use black goggle cover for tests.
    • Central Test: Instruct patient to focus on an imagined distant dot.
    • Vertical Saccades: Guide patient through looking at frame dots upon verbal cues.
    • Horizontal Saccades: Similar to vertical saccades but directed left and right.
  • Gaze Stability:
    • Instruct patient to keep eyes fixed while head remains still; conduct five tests.
  • Pursuits:
    • Patient follows a dot with their eyes only, avoiding head movement; execute both horizontal and vertical versions.
  • Random Saccade:
    • Similar instruction as pursuits; applied to horizontal and vertical configurations.
  • OPK:
    • Confirm seizure history; if present, skip test; else instruct patient to watch moving bars.
  • Saccadometry:
    • Look at center dot; when a new dot appears, shift gaze accordingly without head movement.
  • Antisaccades:
    • Instruct to look at center dot; upon dot appearance, shift to the opposing side equally before returning to center.

Troubleshooting Tips

  • If cursor tracking is unstable, check for disturbances from eyelashes; instruct patient on eye positioning.
  • Ensure no simultaneous blinking when starting the test to avoid data discrepancies.
  • Correct significant data issues by recalibrating without starting over from scratch.
  • Advise patient to remove mascara if it interferes with sensor detection of the pupil.
  • Immediately pause testing if the patient experiences dizziness or nausea; wait for recovery before deciding on test continuation or termination.
  • Consistently check on patient’s comfort and readiness to proceed throughout the testing session.

Tilt Table Therapy and Autonomic Disorders

  • Tilt table therapy is primarily used to treat autonomic disorders, notably postural orthostatic tachycardia syndrome (POTS).
  • POTS is characterized by a significant increase in heart rate upon standing, serving as a compensatory mechanism for a drop in blood pressure.
  • A stable blood pressure is crucial for maintaining consistent blood flow to the brain; fluctuations can lead to symptoms like dizziness or fainting.

Cardiovascular System Dynamics

  • The cardiovascular system operates as a closed system, balancing heart rate and blood pressure.
  • An increased heart rate compensates for decreased blood pressure to prevent dizziness or fainting.
  • Distinction between POTS and orthostatic hypotension: in POTS, heart rate rises without a corresponding drop in blood pressure, while orthostatic hypotension involves a blood pressure decline without adequate compensation.

Orthostatic Hypotension

  • Orthostatic hypotension occurs when systolic blood pressure drops by 20 points or diastolic by 10 points upon standing.
  • Even minimal drops (5-10 points) can indicate a problem, highlighting the need for monitoring.

Physiological Mechanisms in TBI and Dysautonomia

  • Body mapping theories suggest a lack of spatial awareness of body parts can hinder effective blood shunting.
  • Individuals with dysautonomia often face vestibular, visual, and proprioceptive deficits that lead to mapping issues regarding the positioning of their bodies and heads.
  • Improved awareness of body position can enhance autonomic symptoms and shunt blood more effectively when proprioceptive and vestibular systems are corrected.

Impact of Positioning

  • When lying down, blood pressure and heart rate are typically stable; however, altering angles can induce compensatory shifts in the cardiovascular response, crucial for patients undergoing tilt table therapy.

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Description

Test your knowledge on the setup procedures for Videonystagmography (VNG) in clinical settings. This quiz covers patient information entry, equipment configuration, and operational steps. Perfect for students and professionals in audiology and vestibular testing.

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