Informal Tests of the Systems Involved in Balance
• Coupled with an accurate case history, can– Help identify potential source of complaint– Help rule out certain etiologies– Help prevent provoking further problems
during testing.
Ocular Range of Motion/Gaze Stability
• Move a target (18” from nose)35-40 degrees Left and Right.30-35 degrees Up and Down.25-30 degrees DiagonallyPausing 15-20 second
• Volitional Saccades
Frenzel lens exam:
• Lenses magnify pt’s eyes
• Reduce visual fixation
Monocular Eye Cover
• Looking for vertical shift in gaze
• Suggests abnormality in otolithic organs/pathways.
Vertebral Artery Test
1. Avoid Basilar Stroke. 2. Differential diagnosis.
Rationale
Procedure 1. Sitting or Supine. 2. Patient turns head. 3. Hyper-extension of neck and posterior head pitch.
Vertebral Artery Screening
Passive Head Rotation
• screening for bilateral weakness.
Halmagyi Head Thrust
• rapid isolated unidirectional screening for low VOR gain on side turning towards.
Copyright restrictions may apply.
Della Santina, C. C. et al. Arch Otolaryngol Head Neck Surg 2002;128:1044-1054.
Passive head thrust test results for a healthy subject
Copyright restrictions may apply. Della Santina, C. C. et al. Arch Otolaryngol Head Neck Surg 2002;128:1044-1054.
Passive head thrust test results unilateral vestibular deficiency (UVD)
Head Shake
• “No” movement vigorously for 15-20 secs then examine with Frenzel lenses. Nyst usually away from lesion side.
Pneumatic Otoscopy
• Looking for Hennebert’s sign.
Post-Rotary Nyst
• in swivel chair
Hallpike Maneuver
• Detection of BPPV
• Does not require equipment
• Similar to first steps of Epley
VSR/Postural Control
• Past-Pointing – arms out pointing with index fingers to examiners hands, then up and back to examiner’s hands 2 to 3 times w/ eyes open and several times with eyes closed. Both arms move toward weaker ear.
Romberg
• -- eyes closed, feet together.
• Tandem (Sharpened) Romberg – eyes closed heel to toe.
Modified CTSIB
• eyes open firm surface
• eyes closed firm surface
• eyes open compressible surface
• eyes closed compressible surface
Fukuda
• 50 steps in place with eyes closed. Rotate toward weaker labyrinth.
Casual Gait
• walking 15 feet, with eyes open.
• With and without head turns.