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Head Shake Computerized Dynamic Posturography in Peripheral Vestibular Lesions

K.G. Medical College, Lucknow, India

Sherrie Davis

Hospital of the University of Pennsylvania, Philadelphia

Rosemary Speers

CNA Corporation, Alexandria, VA

Neil T. Shepard

Mayo Clinic, Rochester, MN

Contact author: Neil T. Shepard, Mayo Clinic, Department of Otorhinolaryngology, 200 1st Street SW, Rochester, MN 55902. E-mail: shepard.neil{at}mayo.edu.

Purpose: To determine the sensitivity of a head shake modification to the Sensory Organization Test (SOT) of dynamic posturography in identifying (a) those patients with unilateral, peripheral vestibular hypofunction as indicated by caloric irrigation findings and (b) those patients who report that head movements provoke disruption in postural control.

Method: A prospective, single-blinded, random selection methodology was used with 91 patients stratified by the presence or absence of a significant caloric asymmetry and by the presence or absence of head movement provoked symptoms (independent variables). Postural control performance, as measured by EquiTest during the standard test and a head shake modification, served as the dependent variables.

Results: Receiver operating characteristic curves demonstrated only minor improvement in sensitivity (a) with the head shake modification for unilateral peripheral asymmetry and (b) for identification of those with complaints of head movement provoked imbalance.

Conclusions: The head shake modification to standard SOT increased the test sensitivity to identification of patients with unilateral, peripheral vestibular hypofunction and those with head movement provoked symptoms. However, this occurred with low specificity, resulting in no significant improvement in overall performance with this head shake protocol. Suggestions for further research to improve the performance of the head shake modification of SOT for clinical application are discussed.

Key Words: posturography, peripheral vestibular lesions, head shake, imbalance

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