informal tests of the systems involved in balance coupled with an accurate case history, can –help...

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.