1. Informal Tests of the Systems Involved in Balance Coupled with an accurate case history, can –Help identify potential source of complaint –Help rule out certain etiologies –Help prevent provoking further problems during testing.

2. Ocular Range of Motion/Gaze Stability Move a target (18” from nose) 35-40 degrees Left and Right. 30-35 degrees Up and Down. 25-30 degrees Diagonally Pausing 15-20 second Volitional Saccades

3. Frenzel lens exam: Lenses magnify pt’s eyes Reduce visual fixation

4. Monocular Eye Cover Looking for vertical shift in gaze Suggests abnormality in otolithic organs/pathways.

5. Vertebral Artery Test 1. Avoid Basilar Stroke. 2. Differential diagnosis. Rationale Procedure 1. Sitting or Supine. 2. Patient turns head. 3. Hyper-extension of neck and posterior head pitch.

6. Vertebral Artery Screening

7. Passive Head Rotation screening for bilateral weakness.

8. Halmagyi Head Thrust rapid isolated unidirectional screening for low VOR gain on side turning towards.

9. Copyright restrictions may apply. Della Santina, C. C. et al. Arch Otolaryngol Head Neck Surg 2002;128:1044-1054. Passive head thrust test results for a healthy subject

10. Copyright restrictions may apply. Della Santina, C. C. et al. Arch Otolaryngol Head Neck Surg 2002;128:1044-1054. Passive head thrust test results unilateral vestibular deficiency (UVD)

11. Head Shake “No” movement vigorously for 15-20 secs then examine with Frenzel lenses. Nyst usually away from lesion side.

12. Pneumatic Otoscopy Looking for Hennebert’s sign.

13. Post-Rotary Nyst in swivel chair

14. Hallpike Maneuver Detection of BPPV Does not require equipment Similar to first steps of Epley

15. VSR/Postural Control Past-Pointing – arms out pointing with index fingers to examiners hands, then up and back to examiner’s hands 2 to 3 times w/ eyes open and several times with eyes closed. Both arms move toward weaker ear.

16. Romberg -- eyes closed, feet together. Tandem (Sharpened) Romberg – eyes closed heel to toe.

17. Modified CTSIB eyes open firm surface eyes closed firm surface eyes open compressible surface eyes closed compressible surface

18. Fukuda 50 steps in place with eyes closed. Rotate toward weaker labyrinth.

19. Casual Gait walking 15 feet, with eyes open. With and without head turns.