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Evaluation of vestibular function Chunfu Dai M.D & Ph.D Balance is a highly integrated network vestibular system -rotatory stimulation and linear acceleration Information proprioceptive system - information input from the feet, ankle, hip, and neck ocular system - visual perception of spatial orientation is supplied by the central nervous system - integrated these information and translated to fine motor movements Static balance test Romberg test: useful in patients with an acute unilateral labyrinthine lesion Mann test: the patient stands heel to toe rather than with feet together Static posturography: Dynamic balance test Dynamic posturography Co-ordination function test: Point nose test Alternative movement Finger point Nystagmus Nystagmus Slow phase: hypoactivity Quick phase: hyperactivity Direction: quick movement of eye Plane: horizontal, rotary, vertical Degree: I: quick phase side II: quick phase side and look forward III: quick phase side, slow phase side and look forward Ocular dysmetria test: Smooth purpsuit test: Brainstem or cerebellum lesion Optokinetic nystagmus Brainstem, or cerebellum lesion Lesion in central never system Gaze nystagmus Lesion in central nerve system Caloric test: Horizontal semicircular canal Temperature: 44 and 30 Stimuli duration: 40s Rotation test Fistula sign Fistula was blocked by granuloma or cholesteatom Dead labyrinth Hennebert sign Tullio phenomeno (1) (2) (3) (4) (5) (6) gaze (fixation) test, ocular pursuit test, optokinetic test, static positional test, dynamic positioning test, and bithermal caloric test. The normal response as the chair is rotated is slow compensatory eye movement in the direction opposite the rotation with a fast saccade to return the eye in the forward position. The test has three parameters--phase (time for the slow phase eye movement in relationship to the head rotation velocity), gain (ratio of maximum eye velocity to maximum chair velocity), and symmetry (compares the slowphase eye velocity when rotating right versus left).52 the test addresses two major areas: (1) motor control test which examines the patient's motor system and the ability of the CANS to adapt to changing conditions, and (2) sensory organization test which examines proprioceptive, visual, and vestibular systems working as an integrated whole. characteristic Peripheral Central Spontaneous Nystagmus direction intensity Horizontal rotary Direction fixed Diminished by visual fixation Increased by gaze in direction of fast phase Any direction No change with visual fixation Gaze has little or no effect 2-10s Predominantly rotary <30s Yes Immediate onset Any direction >45 s No Evoked Nystagmus Latency Direction Duration fatigability