BPPV Exam Tests

Dix, Side lying, supine roll, bow and lean

Tests for CNS Vest Dysfuntion

Nystagmus observation, smooth pursuit, saccades, test of skew, VOR cancellation

Peripheral Vestibulopathy Tests (5)

Nystagmus observation, HIIT, Head shake test, DVA, Optokinetics

Effect of fixation for peripheral vest dysfunction

<p>DECREASES nystagmus </p>

Effect of fixation on central vest dysfunction

<p>no change, or increases nystagmus</p>

Direction of nystagmus in peripheral vest.

<p>MIXED, horizonal + torsional </p><p>FAST PHASE BEATS AWAY FROM AFFECTED SIDE </p>

Direction of CNS nystagmus

<p>SINGEL PLANE, horizontal, vertical, torsion, NOT MIXED TOGETHER </p>

Effect of gaze on peripheral nystagmus

<p>WILL NOT CHANGE DIRECTION </p><p>INCREASES TOWARDS DIRECTION OF FAST PHASE (left nystagmus worse when looking left)</p>

Effect of gaze on CNS dysfunction

<p>DOES NOT CHANGE </p><p>or reverses direction </p>

Alexander's law (degrees of nystagmus)

<p>1st degree = only present when directed towards fast phase </p><p>2nd degree = present in primary gaze, and in direction of fast phase </p><p>3rd degree = present in ALL gazes </p>

When to use visual fixation blockers (frenzel/video lenses)

<p>spontaneous nystagmus, head shake tests, eye movements during maneuvers</p>

VOR test procedure

<p>move head slowly 30 degrees below horizontal</p><p>+test = corrective saccades or nystagmus</p>

DVA dynamic visual acuity positive test

<p>&gt;3 line degredation is significant </p><p></p>

HIIT test responses

<p>positive test if corrective saccades or post-thrust nystagmus </p><p>if vertigo + no eye movement = CNS red flag!</p>

Head shake test

<ol class="tight" data-tight="true"><li><p>fixation removed</p></li><li><p>120bpm horizontal head shake for 20 seconds</p></li><li><p>PT opens pt eyes and assess nystagmus </p></li></ol><p></p>

Head shake test responses

<p>peripheral = positive if &gt;3 beats horizontal away from involved ear</p><p>CNS = vertical nystagmus </p>

DVA purpose

<p>functional challenge to VOR</p><p>can help identify acute vs chronic </p>

Optokinetic nystagmus

<p>pt visual field needs to be at least 80% </p><p>+test is an asymmetrical response </p>

Test of skew response

<p>+test is eye deviation with one eye covered, and relaxing when uncovering </p>

VOR cancellation procedure (cerebellar control)

<p>head and hands move </p><p>+test = corrective saccades same side as cerebellar issue </p>

HINTS Test items

<p>HIIT</p><p>Nystagmus</p><p>Test of Skew</p>

Motion Sensitivity Quotient

<p>Likert scale rating sensitivity to certain positions </p>

Motion Sensitivity Quotient classifications

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Dizziness Handicap Inventory

<p>25 item self-report level of handicap from dizziness</p>

Dizziness Handicap Inventory subscales

<p>physical</p><p>emotional </p><p>functional </p>

CTSIB test 6 conditions

<ol class="tight" data-tight="true"><li><p>firm surface eyes open</p></li><li><p>firm surface eyes closed</p></li><li><p>firm surface visual conflict</p></li><li><p>foam surface eyes open</p></li><li><p>foam surface eyes closed</p></li><li><p>foam surface visual conflict </p></li></ol><p></p>

Mini BEST #of items and MCID

<p>14 items (anticipatory/reactive control, sensory organization, dynamic gait)</p><p>MCID: 4 points </p>

BESS what it is? MCID?

<p>6 condiditons for 20 seconds each</p><p>measures # of errors in each condition with a max of 10 per </p><p>MCID: 3</p>

Romberg, Sharp Rom, Unipedal

<p>romberg = narrow</p><p>sharp = tandem</p><p>unipedal = duh </p><p>eyes open 30 seconds —&gt; eyes closed 30 seconds </p><p>LOOK FOR FALLING TOWARDS SIDE OF INJURY </p><p>*arms crossed </p>

4 Square Step test: Vest Cutoff

<p>&gt;12seconds = FALL RISK </p>

1-6 visual fixed vs sway referenced support