vestibular function test and its clinical aplication Khushali Jogani The Sarvajanik College Of Physiotherapy, Rampura,Surat.

1. VESTIBULAR FUNCTION
TESTS AND ITS CLINICAL
EXAMINATION
By: Khushali Jogani
The SarvajanikCollege Of Physiotherapy
Rampura,Surat

2. CONTENTS
 Introduction
 Anatomy
 Physiology
 Examination
-History
-scales
-physical examination
-Bedside testing and manuevers
-Laboratory testing
 References

3. 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

4.  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

5. ANATOMY

7. PHYSIOLOGY
 Important for understanding the signs and
symptoms
 Principles are:
-tonic firing rate
-Vestibular reflexes
-push-pull mechansim
-inhibitory cut off
-velocity storage system

8. 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)

9.  (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)

12.  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

13. 3. Push pull mechanism
 Faulty interpretation will lead to difficulty in gaze
stabilization,postural stability and motion
perception.

14. 4. Inhibitory cut off
5. Velocity storage system

15. EXAMINATION
HISTORY
 It can be divided into:-
-elements that help with diagnosis
-elements that lead to goals for management
including physical therapy

16.  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

17.  Elements that lead to goals for management,
including physical therapy
-obtaining patient subjective complaints

19. -UsingVAS (visual analogue scale ) to quantify the
intensity of specific symptoms

20. -impact on functional activities using
MULTIDIMENSIONAL DIZZINESS INVENTORY

21. -perceived disability

22. -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

24. -Dizziness Handicap Inventory

25. -Motion Sensitivity Quotient

26. 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 withVOR
-static imbalance
-dynamic imbalance

27. BED SIDE TESTING
 HeadThrust test
 Head Shaking NystagmusTest
 ClinicalVestibular DynamicVisual
acuityTest

28. 1.HeadThrustTest
- 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

30. 2.Head Shaking Induced Nystagmus
Test
-useful in diagnosis of unilateral peripheral
vestibular defect.
3. DynamicVisual AcuityTest
-it is measurement of visual acuity during
horizontal motion of head

31. 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)

32. Hallpike –dix test

33.  RollTest for Horizontal Semicircular Canal

34. 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

35. LABORATORYTESTS
 Electronystagmography(ENG) or
Videonystagmography (VNG)
 CaloricTesting
 Rotatory ChairTesting
 Quantified DynamicVisual Acuity
 SubjectiveVisualVertical
 Computerised Dynamic Posturography
 Vestibular Evoked Myogenic PotentialTest(VEMP)

36. Electronystagmography

37. CaloricTesting

38. Rotatory ChairTesting

39. Quantified DynamicVisual AcuityTest

40. Computerised Dynamic Posturography

41. 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)

42.  General vestibualr testing
ByT. Brandt, M. Strupp/ClinicalNeurophysiology
 American physical therapy association
By Barbara Susan Robinson

43. THANKYOU