| Vestibulo-Ocular Reflex |
| Head Impulse Test (HIT)5
|
Clinician, facing and holding the subject’s head at arm’s length, performs a passive and unpredictable head rotational movement in a high acceleration ~ 20° to either side having the subject’s eyes fixed on the examiner’s nose. I may also be done vertically (Figure 1A, B, C). |
Corrective saccade back to the target |
| Head Shaking Test (HST)6
|
Subject’s wearing Frenzel goggle with the head positioned downwards by 30°. The examiner rapidly oscillate the head (2Hz) 20 times. When the movement stops the clinician observes the presence of nystagmus. |
Nystagmus; more than 5 beats |
| Dynamic Visual Acuity (DVA)7
|
Subject reads the lowest possible line in a ETDRS chart positioned 2 meters ahead, than the examiner manually oscillates the subject’s head horizontally at 2 Hz in each direction and the subject tries to read the same line (Figure 1D, E). |
Deviation of more than 2 lines above base line |
| Subjective Visual Vertical (SVV)8
|
Looking inside a bucket, without any peripheral vision, the subject vertically redirect a line drawn on the inner bottom of the bucket under the subject’s subjective perception. Results measured outside with a pendulum hanging over a protractor (Figure 1F, G, H). |
More than 2.5° deviation from 0° to either side |
| Minimal Ice Test (MIT)9
|
Subject is fitted with a Frenzel goggle and 0.2 mL iced water ( 1-3°C) is plunged in the ear canal with the head turned to side and bended 30° forward. After 10 sec the head is turned straigth and nystagmus is observed in the computer screen. After 5 min the same procedure is performed on the other ear. |
≠ between ears responses > 25% = canal paresis |
| Vestibulo Spinal Reflex |
| Modified Clinical Test of Sensory Interaction and Balance (mCTSIB)10
|
The subject stands on a firm surface with the feet slightly apart and crossed arms, first with eyes open and than with eyes closed, for 30 sec each. The same manoeuvre is repeated on a high density foam (Figure 2D). |
Normal and Minimal sway: grades 1 and 2. Moderate and Severe: grades 3 and 4 |
| Romberg Tandem Test (RTT)11
|
Subject stand with feet slightly apart and arms folded across the chest with eyes open for 30 seconds and then with eyes closed for 30 seconds. |
Marked sway, or: move the feet, open the eyes, uncross the arms |
| Past Pointing Test (PPT)12
|
The subject is instructed to extend the arms and place the index finger of one hand on the index finger of the examiner. The eyes are then closed, the arm raised above the head, then quickly returned to the perceived starting position. The procedure is repeated five times (Figure 2A, B, C). |
Index drift away from the target towards the compromised side |
| Fukuda Test (FT)13
|
Subject with arms extended and eyes closed, stepping in place with examiner counting for 50 steps (Figure 2E, F). |
Moves more than 50 cm ahead and turns toward one side of more than 45° |
| Fall Risk |
| Timed Up and Go (TUG)14
|
Subject rises from a standard height chair with armrests, walks 3m, turns, and returns to sit in the chair. The time to complete the path is measured with a stopwatch. |
More than 13.5 sec to complete the task |
| 5 Times Sit to Stand Test (5TSST)15
|
Subject seated in a chair with arms crossed under chest and feet fitted on the ground. Upon request, stands up and sit down for 5 times. Time measured with a stopwatch. |
More than 10 seconds to complete the task |
| Forward Reaching Test (FRT)16
|
Subject is asked to bend the trunk and reach as far forward as possible having both feet fixed and parallel. The extent of movement is measured with a simple yardstick. |
Score 15 cm or less indicate high risk for fall |
| Dynamic Gait Index (DGI)17
|
The subject is observed during an eight-item task within a 21 feet path walking. |
Score of 19 or less out of 24 points |
| Pull Test (PT)18
|
The subject stands with the feet slightly spread apart and is pulled backward by the shoulders (one or two steps backwards allowed) (Figure 2G). |
More than 2-3 steps to keep the balance or fall backward like a log |
