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VESTIBULAR

FUNCTION
TESTS
H.Babar-Craig

VFT

Balance maintained by :
1. Vestibular system
2. Eyes
3. Proprioceptors in the muscles

VFT

Investigating the vestibular system


consists of the following,

1. Testing the vestibulospinal reflexes


2. Testing spontaneous and provoked
nystagmus
3. Tests on vestibular and optokintic
systems

Vestibulospinal Reflexes
ROMBERGS TEST
Patient stands with feet together, arms
by the side with eyes open then closed
Peripheral vestibular lesions- the
bodys centre of gravity is displaced to
the side of the labyrinthine lesion
Central disturbances- pattern of
unsteadiness of gait and direction of
fall are irregular.

Vestibulospinal Reflexes

UNTERBERGERS Stepping Test


Stepping on the spot with the eyes closed
and arms outstretched for 30 sec
Peripheral disorders- rotation of body axis
to the side of the labyrinthine lesion
Central disorders the deviation is irregular

Only deviations of > than 30o is significant

Vestibulospinal Reflexes

POSITIONAL TESTS ( cerebellar lesions)

1.Parallel supine arms- arm on side of


cerebellar lesion sinks down as a result
of loss of tone
2. Finger-nose pointing- overshooting
indicates cerebellar lesion
3. Dysdidokinesia- central cerebellar
lesion

Nystagmus

Involuntary rhythmical oscillation of eyes


away from the direction of gaze, followed
by return of eyes to their original
position.
The direction of the fast component
determines the direction of the
nystagmus ( towards the dominant
vestibular centre, inhibitory impulses are
suppressed i.e the side of the lesion )

Spontaneous Nystagmus

First Degree nystagmus present


only when the eyes deviate to the
side of the lesion
Second Degree nystagmus present
when patient looks straight ahead
Third Degree nystagmus present in
both directions

Positional Nystagmus

Hallpike Manouvre
Patient sits on bed, head turned 45
degrees to left or right.
Patient is rapidly laid back with head over
edge of bed 30 degrees below the
horizontal. Eyes open look for nystagmus.
After 30 sec return patient to upright
position
Repeat with head to other side

Vestibulo-ocular reflex

ROTATIONAL TESTS
Nystagmus Induced by accelerating and
decelerating rotating chair, tests both
labyrinths simultaneously
CALORIC TESTS
COWS- cold water opposite side, warm
water same side, direction of nystagmus
Extent of caloric response indicates
function of labyrinth

Vestibulo-ocular Reflex

Electronystagmograghy
Positive potential between the
cornea and retina recorded as eyes
move from straight ahead gaze
Test includes different head
positions, eyes open, closed and
caloric tests