Transcript Informal Tests of Balance

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 Diagonally
Pausing 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
Rationale
1. Avoid Basilar Stroke.
2. Differential diagnosis.
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.
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)
Copyright restrictions may apply.
Della Santina, C. C. et al. Arch Otolaryngol Head Neck Surg 2002;128:1044-1054.
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
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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.