Vestibular Classifications

Question 1

seated unsupported with eyes closed; PT asks patient to report any sensation of motion inside head, ask for description of motion.

Test name
Abnormal
Normal

Answer 1

test for sensation of motion at rest
normal: patient reports no sensation of motion
Abnormal: patient reports feeling motion
Observation: postural sway

Question 2

Intervention for sensation of motion at rest: vestibular and somatosensory integration at rest

Answer 2

Setting: patient performs task with eyes closed with weights weighted blanket or heavy objects
-resting n legs
-axial loading with hands

Question 3

Seated unsupported, turn head side to side eyes closed repeat with head nods up down

Test
Abnormal
Normal

Answer 3

Head motion provoked dizziness (Canal function)
normal: denies increase in symptoms
abnormal: pt reports dizziness or nausea

• asymmetry of information from inner ear canals or brain

Question 4

What is intervention for head motion provoked dizziness (canal function)

Answer 4

rolling: supine to prone eyes closed
Head turns/EC
Spinning in circles: standing with eyes closed

Question 5

instruct the patient to keep eyes focused on a target hold the head with both hands and quickly move head from neutral into rotation perform in both horizontal and vertical planes

test
abnormal
normal

Answer 5

Gaze stability
head impulse test: VOR

normal: eyes maintain on the target
abnormal: eyes slip off the target and require a catch up saccade to refocus on the target

Question 6

passive head turns using a snellen chart at 1-3 Hz
test
normal
abnormal

Answer 6

Gaze stability with head turns
VOR

normal: letters stay in focus
abnormal: pt reports object blurs or slips loss of more than 2 lines of acuity on the snellen chart

Question 7

pt to keep eyes fixed on a stable target while actively rotation the head side to side

Answer 7

Gaze stabiltity with head turns
VOR
normal: object stays visible
abnormal: object blurred

Question 8

What is the intervention for impaired VOR gaze stability with head turns?

Answer 8

active head turns while attempting to fix eyes on stable target

progress speed, progress different angels

Question 9

patient sits on tilt board with feet flat on board and hands on lap
PT manually tilts board from side to side perform EO EC

Answer 9

Otolith function: head righting response

abnormal: increased ankle strategy, hip strategy, use of arms, indicates patient has inefficient vestibular postural responses

Question 10

What are interventions for impairment to otolith function: head righting response?

Answer 10

tilt board/rocker board
lateral reaching
tandem stance or tandem gait
2by 4

Question 11

What three things could impact impaired postural control?

Answer 11

1. vestibular
2. somatosensory
3. visual

Question 12

Foam feet apart ,eyes closed, hands at side 30 sec hold
Pt responds with abnormal: excessive sway, inefficient ankle hip strategy
What sense is impaired on and intervention

Answer 12

impaired: vestibular

balance training on complaint narrow surfaces to decrease joint stiffness EC with without head motions altered or impaired visual input

2by4 training

Question 13

stands on firm surface unsupported, feet together, eyes closed

pt responds with abnormal: loss of balance prior to 30 sec

impaired and intervention?

Answer 13

impaired: somatosensory

intervention: rocker board with ankle strategy
walking on uneven surfaces for ankle strategy practice

Question 14

foam feet apart, eyes open, hands at side
abnormal response: LOB prior to 30 sec

reliance and intervention

Answer 14

reliance on Somatosensory

Intervention:
balance training on compliant narrow surface
eyes open–eyes closed
with and without head motion

Question 15

feet together on firm surface with hands at sides, eyes closed

abnormal response: increased sway compared to eyes open sway pattern pt feels very off balance with eyes closed compared to eyes open

Answer 15

reliance: visual

intervention: balance tasks eyes closed: firm and progress to compliant surfaces
walking with head turns
smooth pursuits- follow moving target with eyes

Question 16

seated: patient looks quickly between targets on command

seated: have patient perform tracking in all planes by following a slow moving target with their eyes

seated: patient focus on a target that PT moves from 10” away to <3” away

Answer 16

oculomotor testing
1. saccades
2. smooth pursuits/visual tracking
3. convergence/divergence

treatment if impaired: perform oculomotor task until symptoms provoked rest and repeat and tolerable

Question 17

patient is seated in a swivel chair or stand ask the patient to watch themselves in a mirror while rotating torso repeatedly left/right patient is instructed to keep head straight perform with eyes open and closed

abnormal: head rotate with moving torso

Answer 17

cervicogenic dizziness
body rotation under stable head
intervention: laser and target
therapeutic exercise and manual therapy to correct cervical spine impairments

Question 18

Symptoms of dizziness or nausea occur during oculomotor testing

Answer 18

Visual Motion Hypersensitivity

treatment: compensation: more time spent closing eyes during the day
decrease screen time
use of hat

adaptation: figure 8 blank background, standing

Question 19

joint loading or increased surface area contact increase dizziness/nausea

Answer 19

Somatosensory Hypersensitivity

progressive and/or graded exposure to joint loading with increased surface area tactile input
beach walking
stomping on the ground