Vestibular System Testing

Double-legged Stance
under Conditions of
Sensory Deprivation

(Nashner 1982)
Vision

Conditions # 1-3 : Normal surface

Conditions # 4-6 : Support surface
EQUITEST System at
PERFORM Center

rotates with body sway

# 1 & 4 : eyes open

# 2 & 5 : eyes closed
# 3 & 6: visual surround moving
with body sway
Double-legged Stance
under Conditions of
Sensory Deprivation

(Nashner 1982)
Vision

Conditions # 1-3 : Normal surface

Conditions # 4-6 : Support surface
EQUITEST System at
PERFORM Center

rotates with body sway

# 1 & 4 : eyes open

# 2 & 5 : eyes closed
# 3 & 6: visual surround moving
with body sway
 When standing still, does our
nervous system rely more heavily
on vision or somatosensory info?
It appears that under normal
conditions, the nervous system may
weigh the importance of
↑ Difficulty
somatosensory info for postural
control more heavily than vision
(condition 2 vs. 4)
Less stable, the greater the sway
 Neuro
 Neurological lesions : people rely
predominantly on: vision during the
early part of their balance recovery
process and then use more
somatosensory inputs
  can play with light & remove their
vision (dim light, blindfold) to have
them use proprioception
 Postural study:
- Aging
Participants :
• ≥ 65 years old
• healthy
• Fall more often : conditions 5 & 6
Why ?

Based on Fig 8.5, can older adults perform

double-legged stance using only one accurate
sense?
Vestibular system is so good in young adults that
it compensates for 2 other senses

Reducing the availability of 2 senses

appears to have a significant effect on
postural steadiness in healthy older adults
but not in young adults…why?
 Postural study:
- Vestibular Loss

To maintain standing
balance, elderly
people with
vestibular loss need
their… vision or their
somatosensory
system

Vision
 Disorders to the Vestibular System
Disorders to the vestibular system can be
caused by:
Disease, aging & injury

Vestibular disorders are often associated

with one or more of these symptoms:
1) Vertigo
Feeling that you are spinning or that the
world around you is spinning (when it is
not)
• The sensation of movement is
called subjective vertigo and the
perception of movement in
surrounding objects is called
objective vertigo
2) Dizziness
Feeling of being lightheaded, woozy, or
unbalanced
 Disorders to the Vestibular System
2) Dizziness
Feeling of being lightheaded, woozy, or unbalanced

Benign Paroxysmal Positional Vertigo (BPPV)

3) Balance & Spatial Orientation
Imbalance, stumbling, difficulty
walking or difficulty with coordination
Difficulty maintaining straight posture;
Tendency to look downward to
confirm the location of the ground 
Tendency to touch or hold onto
something when standing 
https://www.dizziness-and-
Difficulty walking in the dark  balance.com/disorders/bppv/bppv.html

4) Vision
Trouble focusing or tracking objects with the eyes; objects or words on a page
seem to jump, bounce, float, or blur or may appear doubled (ex. Nystagmus)
- Pieces of crystals
Hallpike Maneuver
(otoconia) break free
from otolithic organ
- Goes into posterior semi
circular canal  when
you stop moving, the
crystals are still moving &
push on the receptors,
causing AP & illusion of
movement
 Hallpike Maneuver Tests
(each position is held for 1 to 2 minutes or until
nystagmus and vertigo subside)
Nystagmus = involuntary movement of eyes
Treatment: Epley Maneuver (Canalith
Repositioning)
(each position is held for 1 to 2 minutes or
until nystagmus and vertigo subside)
Series of positioning
of the head to move
crystals from the semi
circular canals
 CLINICAL APPLICATIONS
Clinical Evaluation of the
Vestibular System
Changes in vestibular nerve firing rates when
the head turns to the right
Horizontal semi circular canal sends a signal
& AP fired to vestibular nuclei up to the brain
so you feel you are moving your head
On the opposite side, firing shut down

 Nystagmus triggered by malfunction of semi

circular canal

CLINICAL APPLICATIONS Clinical Evaluation of the

Vestibular System
(A) View looking down on the top of a person’s head illustrates
the fluid motion generated in the left and right horizontal canals
and the changes in vestibular nerve firing rates when the head
turns to the right.
 CLINICAL APPLICATIONS
Clinical Evaluation of the Vestibular System
* No head movement
Spontaneous nystagmus (2), where the
eyes move rhythmically from side to side
in the absence of any head movements,
occurs when one of the canals or nerves is
damaged. In this situation, net differences
in vestibular nerve firing rates exist even
when the head is stationary because the
vestibular nerve innervating the intact
canal fires steadily at rest, in contrast to a
lack of activity on the damaged side.

https://www.youtube.com/watch?v=9LsHp-tgx8w
 Nystagmus
Vision through
Nystagmus:
https://en.wikipedia.org/wiki/Nystagmus
 Nystagmus
Nystagmus caused by Multiple Sclerosis:

https://www.youtube.com/watch?v=9LsHp-tgx8w
 CLINICAL APPLICATIONS
Clinical Evaluation of the Vestibular System

According to the figure below, is the H2O irrigation producing a

right or left head turn? Are the eyes, turning to the right or left
side? ANSWER: Right head turn + eyes in opposite direction (left)

(C) Caloric testing of vestibular function

is possible because irrigating an ear
with water slightly warmer than body
temperature generates convection
currents in the canal that mimic the
endolymph movement induced by
turning the head to the irrigated side.
Irrigation with cold water induces the
opposite effect. These currents result in
changes in the firing rate of the
associated vestibular nerve, with an
increased rate on the warmed side and
a decreased rate on the chilled side
 Exercise Protocol for Vestibular
Rehabilitation
 Problems = vertigo, dizziness, balance, spatial orientation
 Exercises involving eye movement, head tilt, up & down
body movement, walking with head turn
 Goal: Progressive stimulation of the vestibular system
during daily life exercises/activities

https://www.youtube.com/
watch?v=P-3Zd95PzDk