Vestibular Examination

Question 1

What is lightheadedness often a sign of?

Answer 1

cervicogenesis and orthostatic hypotension

Question 2

Objective tests/measures:

Answer 2

Cervical ROM/Cervical Instability
Ease of movement, color, expression
How person moves
Gross Strength and Mobility
Ocular Motor System
Special Tests
Balance Assessment

Question 3

Red Flags for vertebral artery:

Answer 3

Diaphoresis
Dysphagia
Dysarthria
Drop Attacks
Diploplia

Question 4

Saccadic

Answer 4

for rapid eye movements to bring new objects being viewed on to the fovea

Question 5

Smooth Pursuit

Answer 5

for eye movements to keep a moving image centered on fovea

Question 6

Vestibulo-ocular

Answer 6

keeps image steady on fovea during head movements

Question 7

Vergence

Answer 7

to keep image on fovea predominately when the viewed object is moved near

Question 8

Central dysfunction signs:

Answer 8

saccads, smooth pursuits and vergence

Question 9

Testing for fixed gaze nystagmus:

Answer 9

Use your finger or pen and take patient to 30 degrees left, right, up and down from center and hold gaze
Observe for any nystagmus at 30 degrees (about 4-6 inches)
Feels strained to the patient

Question 10

Testing for saccades:

Answer 10

Rapid conjugate movements of the eyes to pace the object of interest on the fovea
Have patient look between 2 targets approximately 15 degrees apart
Nose, pen, nose, pen in left right and up and down

Question 11

VOR Cancellation:

Answer 11

Grasp patient’s head and tilt forward 30 degrees (HC is in horizontal plane)
Have patient hold thumbs in front of them, arms extended
You move their head and hands in same direction back and forth observing for ability to keep eyes on moving target while head in motion

Question 12

Abnormal VOR cancellation test:

Answer 12

saccadic eye movements

Question 13

VOR

Answer 13

Tilt patient’s head down 30 degrees
Start slowly moving head side to side while they focus on your nose, gradually increasing speed
Repeat in vertical plane

Question 14

Head thrust test

Answer 14

Grasp patient’s head with your hands and patient focuses on examiners nose, with head tilted down 30 degrees
Head is rapidly thrust from midline to one side approximate 10 degrees only, repeat other side

Question 15

Head Shaking Nystagmus:

Answer 15

Tilt patient’s head down approximately 30 degrees
Have patient close eyes and you shake their head side to side 20x at 2Hz,
Have patient open their eyes and fixate on target