The document discusses vestibular function tests and clinical examinations, highlighting the high incidence of dizziness, particularly in older adults. It outlines the anatomy, physiology, and various examination methods including history taking, physical examinations, and laboratory tests that assist in diagnosing vestibular disorders. The importance of accurate diagnosis and management strategies aimed at minimizing functional limitations and preventing disability is emphasized.

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