Group 6: Facilitated by Kathy Gill-Body
Patient problem: Patient comes to PT evaluation with diagnosis of bilateral vestibular
hypofunction
Question: What elements of evaluation should be included?
1. Assumptions
a. Patient referred to therapy without vestibular diagnosis
b. Practice in an outpatient setting with no specialized vestibular assessment
equipment
2. History: Features of history include the following:
a. clinical complaint usually that of unsteadiness or difficulty walking, rarely
dizziness or vertigo.
b. functional limitations often include problems reading, walking in the dark,
turning in small or crowded spaces, showering and washing hair (closing
eyes), reaching or bending and keeping balance.
c. Medical history may include use of vestibulotoxic medications, such as
gentamicin or some cancer drugs; some patients have been on dialysis.
d. Changes in speech, memory, flexibility, strength or sensation associated
with onset of imbalance would not be expected.
3. Subjective
a. descriptions of symptoms and functional limitations (stairs, work capacity,
driving)
b. Dizziness Handicap Inventory
4. Exam
a. Oculomotor exam of EOMs, saccades, pursuit, gaze holding should be
normal
b. Rapid head thrusts should be positive bilaterally
c. Dynamic visual acuity should be impaired
d. Static Balance exam of Romberg eyes open/closed, Tandem Romberg
eyes open/closed, and Foam Romberg eyes open/closed should show
impairment in eyes closed tests.
e. Patient’s perception of dizziness and imbalance (0-10 scale) is helpful in
showing improvement in symptoms. In patients with severe imbalance,
widening base of support may be necessary.
f. Gait assessment, including with head turns
g. Functional measures could include Berg or Dynamic Gait Index as patient
able to perform, TUG. Fall risk assessment is indicated.