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What is Involved in a Vestibular Assessment: Common Vestibular Tests

By Cheryl Wylie, MSc (PT)

Vestibular tests are diagnostic evaluations that assess the function of the vestibular system, which contributes to balance and spatial orientation. These tests discussed below are tests done in a vestibular physiotherapy assessment both in clinic and as well as virtually.


BPPV Positional Testing (Dix-Hallpike Maneuver)

  • Purpose: Used to diagnose benign paroxysmal positional vertigo (BPPV), a common vestibular disorder.

  • Procedure: The patient is quickly moved from a sitting to a lying position with the head turned to the side and tilted backward, causing dizziness and nystagmus (involuntary eye movement). If this test is positive, it will make the patient feel dizzy or experience vertigo lasting 10-20 seconds typically. During this time your practitioner will observe your eyes for nystagmus.

 

Dynamic Visual Acuity

  • Purpose: Used to assess the vestibulo-ocular reflex, which is the patients ability to stabilize gaze

  • Procedure: The patient is asked to read an eye chart with their head still and then again with their head moving. The examiner is looking for the difference between the two scenarios as well as symptom provocation. 

 

Head Impulse Test*

  • Purpose: used to assess the function of the vestibulo-ocular reflex (VOR), which helps stabilize gaze and maintain visual focus during head movements.

  • Procedure: The examiner delivers rapid, unpredictable, and brief horizontal head movements to either side, typically rotating the patient's head about the vertical axis. The examiner observes the patient's eye movements for any corrective saccades (rapid, involuntary eye movements) that may occur.

*This test is not done virtually

 

Clinical Test of Sensory Interaction in Balance (CTSIB)

  • Purpose: Assesses how different sensory inputs (visual, vestibular, and somatosensory) affect balance.

  • Procedure: Patients perform balance tasks under various sensory conditions, such as eyes open or closed, on a stable or unstable surface, holding your head in a certain positions, moving your head, or holding weights. This is done both statically (standing still) and dynamically (e.g. walking, banding, turning)

Motion Sensitivity Testing

There are two forms of motion sensitivity: visual motion sensitivity and vestibular motion sensitivity.

  • Visual motion sensitivity refers to an enhanced sensitivity or heightened response to visual stimuli, such as movement in the environment, scrolling text, flashing lights, or rapid changes in visual scenes.

  • Vestibular motion sensitivity refers to increased sensitivity to movement. This can occur with changes in head or body positions, being in a moving vehicle, and walking.

Each of these motion sensitivities are tested differently. 


Visual Motion Sensitivity Testing
  • Purpose: Evaluates how visual stimuli, such as moving patterns or scrolling text, affect an individual's symptoms.

  • Procedure: The patient may be asked to view moving visual stimuli on a screen or perform specific tasks while exposed to visual motion. The examiner observes and assesses the patient's response, including the onset of symptoms.

 

Vestibular Motion Sensitivity Testing
  • Purpose: Assesses the impact of head and body movements on symptoms.

  • Procedure: Patients may be instructed to perform various head and body movements, such as turning the head, bending forward, or standing up from a seated position. The examiner observes for any motion-induced symptoms.

 

These tests, along with the subjective interview, aim to assess and address the specific impairments and symptoms associated with vestibular disorders. Vestibular physiotherapists, such as those at Healing Vertigo, will design an individualized treatment plan based on the results of these assessments to improve the patient's overall function and reduce symptoms of dizziness and imbalance. Contact us today to learn more about in-person or virtual vestibular physiotherapy testing and how vestibular rehabilitation can help you.

About the Author

Cheryl Wylie, is a vestibular physiotherapist and owner of Healing Vertigo. She is also the creator of our Vertigo Treatment App, and instructs vestibular courses to other healthcare professionals.
She offers vestibular therapy for all Ontario Residents. If you're interested in working with Cheryl, connect below!


Disclaimer: This advice is not meant to be a substitute for advice from a medical professional regarding diagnosis, prognosis, or treatment. Always seek advice from your physician, physiotherapist, or other qualified healthcare provider with questions you may have regarding a healthcare condition. The information of this website and email, including but not limiting to text, graphics, videos, images, and other materials are for informational purposes only. Reliance on the information on this website and email is soley at your own risk.