Balance, dizziness, vertigo and falling are complex phenomenon to diagnose, treat and manage. And easy to dismiss. They are often associated with the ageing process and strategies to manage the condition and avoid falling are vital. Sometimes it is due to peripheral or central vestibular pathology which need appropriate specialist treatment.
The W.H.O. has advised that everyone over the age of 65 should be screened for balance. Every 11 seconds an older adult is seen in an emergency department for a fall-related injury, leading to a domino-effect of negative consequences* We can help.
Our Balance Screening Clinic is being driven by Roxanne Loock (MA Audiology) and Marcelle Ferenczy (MA Audiology) both University of Pretoria Masters graduates with a special interest in the vestibular system.
Encouraged by local ENT specialists who have a need for advanced vHIT (Video Head Impulse Test) equipment, we have capitalized on new vestibular diagnostic equipment and put together an audiological and vestibular screening protocol to help medical practitioners form a picture of what sort of vestibular issue might be at play.
Please feel free to refer your dizzy or at-risk patients for a screening assessment and fall risk management.
1) vHIT (Video Head Impulse Test). Advanced vestibular testing.
The vHIT provides quick and objective measurements of the vestibular ocular reflex (VOR). The results allow the healthcare professional to efficiently assess all six semicircular canals and their associated neural reflexes. It is an excellent first diagnostic assessment tool.
2) Vestibular Bedside Tests:
- Dix-Hallpike (BPPV – Benign Paroxysmal Positional Vertigo)
- Head roll (Horizontal BPPV)
- Bucket (Utricular functioning, brainstem functioning, Central compensation)
- Cover/Uncover (Vertical ocular misalignment. Differentiating benign peripheral conditions from CNS conditions like stroke)
- MCTSIB– Modified Clinical Test of Sensory Interaction in Balance (Vestibulo-spinal reflex. Dependence on somatosensory cues and vestibular organs)
- DVA – Dynamic Visual Accuity (How well you can maintain visual acuity with movement)
- DGI – Dynamic Gait Index (A test of gaze stability)
- Pursuit tracking screening (A test for the cortex, brainstem, cerebellum. Ocular-motor test)
- Pseudo random saccades screening (Test for presence/absence of central vestibular lesion)
3) Full Diagnostic Audiological Assessments.
Balance problems and a history of falling are coincident with hearing loss.
4) Reporting & Treatment
- Comprehensive patient self-reporting questionnaire, vHIT report, bedside test results, audiological report, summary and recommendations.
- Referral to appropriate specialists when indicated: ENT, Neurologist, Physiotherapist etc.
- Patient education: managing their condition and fall avoidance strategies.