VESTIBULAR FUNCTION

TESTS AND ITS CLINICAL

EXAMINATION
By: Khushali Jogani
The Sarvajanik College Of Physiotherapy
Rampura,Surat
CONTENTS
 Introduction
 Anatomy
 Physiology
 Examination
-History
-scales
-physical examination
-Bedside testing and manuevers
-Laboratory testing
 References
INTRODUCTION
 Incidence of dizziness is 5.5 percent or greater
than 15 million people per year in united states
 It increases as age increases
 Cawthorne and Cookey were the first one to
introduce exercises for dizziness
 Accurate diagnosis –minimization of functional
limitation-prevention of disability
 Mostly peripheral vestibular system is the origin
for patients signs and symptoms
 Function of peripheral vestibular system
-stabilization of visual images on the fovea of
retina during head movement to allow clear vision
-maintaining postural stability, especially during
movement of head
-providing information used for spatial orientation
ANATOMY
PHYSIOLOGY
 Important for understanding the signs and
symptoms
 Principles are:
-tonic firing rate
-Vestibular reflexes
-push-pull mechansim
-inhibitory cut off
-velocity storage system
1. Tonic firing rate
 resting firing rate is 70 to 100 spikes/s
 increase tonic firing rate means each vestibular
system detects head motion through excitation or
inhibition
2. Vestibular reflexes
 vestibulospinal reflex ( it helps to maination
centre of gravity)
 vestibulocollic reflex(it helps to maintain stability
of head during movement of torso)
 (VOR) vestibular ocular reflex( it helps in
maintaining stability of an image on the fovea of
retina during rapid head movements)

-pathway can be describes as three neuron arc

-horizontal head rotation about the vertical Z-

axis (yaw)
- head extension or flexion about the horizontal
Y-axis(pitch)
-lateral head tilt about the horizontal X-axis (roll)
 VOR gain
eye velocity/head velocity= -1
 VOR phase
described as zero phase shift
 VOR operates at head velocities as great as 350 to
400 degree/s
3. Push pull mechanism

 Faulty interpretation will lead to difficulty in gaze

stabilization,postural stability and motion
perception.
4. Inhibitory cut off
5. Velocity storage system
EXAMINATION
HISTORY
 It can be divided into:-
-elements that help with diagnosis
-elements that lead to goals for management
including physical therapy
 Elements that help with diagnosis are :
-tempo
-symptoms
1.vertigo
2.dysequilibrium
3.oscillopsia
4.light headedness
5.rocking or swaying
6.motion sickness
7. nausea and vomiting
-circumstances
-how it affects the patients life
-medications
 Elements that lead to goals for management,
including physical therapy
-obtaining patient subjective complaints
-Using VAS (visual analogue scale ) to quantify the
intensity of specific symptoms
-impact on functional activities using
MULTIDIMENSIONAL DIZZINESS INVENTORY
-perceived disability
-fall history
-where, when, what was thinking about
- frequency of falls, any injuries associated with
that
-confidence in balance using ABC scale(Activities
Specific Balance Confidence Scale)
-interference with daily activities
-interference with recovery
-PANAS scale( Positive Affect Negative Affect
Scale) if anxiety or depression is affecting
-Dizziness Handicap Inventory
-Motion Sensitivity Quotient
 PHYSICAL EXAMINATION
- what is nystagmus
-observation for nystagmus
tools used are 1. frenzel lenses
2.infrared camera system
3.opthalmoscope
4.ganzfeld
-skew eye deviation
-problems with VOR
-static imbalance
-dynamic imbalance
BED SIDE TESTING
 Head Thrust test
 Head Shaking Nystagmus Test
 Clinical Vestibular Dynamic Visual
acuity Test
1.Head Thrust Test
- used to examine semicircular canal function
- it can give indication for complete loss of
function in affected labyrinth
-less sensitive in detecting hypofunction in
patients with incomplete loss of function
2.Head Shaking Induced Nystagmus
Test
-useful in diagnosis of unilateral peripheral
vestibular defect.
3. Dynamic Visual Acuity Test
-it is measurement of visual acuity during
horizontal motion of head
 Maneuver –Induced vertigo
and eye movements
if mechanical problem (BPPV) dan certain
manuevers should be performed that evoke
nystagmus
1. positional testing( Hallpike-Dix test)
Hallpike –dix test
 Roll Test for Horizontal Semicircular Canal
 Visual tracking
-smooth pursuit eye movement
-cancellation of vestibulo ocular reflex
-saccadic eye movement

 Stance and gait examination

-Romberg test
-Sharpened romberg (heel to toe tandem stance) test
-Fukuda’s Stepping test
-Retropulsion test
LABORATORY TESTS
 Electronystagmography(ENG) or
Videonystagmography (VNG)
 Caloric Testing
 Rotatory Chair Testing
 Quantified Dynamic Visual Acuity
 Subjective Visual Vertical
 Computerised Dynamic Posturography
 Vestibular Evoked Myogenic Potential Test(VEMP)
Electronystagmography
Caloric Testing
Rotatory Chair Testing
Quantified Dynamic Visual Acuity Test
Computerised Dynamic Posturography
REFERNCES
 Physical Rehabilitation
By Susan B O’ Sullivan(fifth edition)
 Vestibular Rehabiliation
By Susan J. Herdman( third edition)
 Rehabiliation Medicine :Principles and
Practice
By Joel A Delisa and Bruce M. Gans(third
edition)
 General vestibualr testing
By T. Brandt, M. Strupp/ClinicalNeurophysiology
 American physical therapy association
By Barbara Susan Robinson
THANK YOU