Medical Tests 

Balance assessment

Definition

Our ability to maintain balance and stability depends on three different bodily systems that work in concert, providing sensory information to the brain. The visual system provides images about our immediate environment. The vestibular system (inner ear) helps us sense balance and spatial orientation. The somatosenory system relays information from muscles, joints and pressure from the bottom of your feet.

A balance assessment examines how well the systems are working —separately and together. The assessment will help us determine which may be contributing to your specific symptoms, and give direction for treatment.

How a balance assessment is done

As specified by your referral and based on your symptoms and medical history, the assessment may include the following tests:

Rotational chair

Also known as the rotary chair test, this test evaluates your vestibular system. You sit in a motorized chair and wear infrared video goggles that record your eye movements as the chair twists back and forth at different speeds. The test is helpful in assessing inner ear function and determining how well your vestibular system is working with your eyes to keep your vision focused while you're in motion.

Vestibular Myogenic Evoked Potential (VEMP)

This is another way of assessing the vestibular system. You'll be seated in a chair and listen to a series of clicking sounds. Electrodes on your head and neck measure your muscles' response to the sound, which can indicate how well organs in the inner ear that are crucial to balance are functioning.

Video Health Impulse Test (vHIT)

The vHit evalutes the vestibular-ocular reflex, which allows you to keep your vision focused even when your head or body is moving. For the test, you're seated in a chair and outfitted with a pair of lightweight video goggles. The examiner moves your head and the goggles record your eye movements in response to the motions.

VideoNystagmoGraphy (VNG)/ElectroNystagmoGraphy (ENG)

The VNG/ENG evaluation consists of three subtests of your visual and vestibular systems. The tests use either special goggles (VNG) or electrodes placed around your eyes (ENG) to record eye movements in response to stimuli.

  • The oculomotor test assesses your vision system by measuring voluntary and involuntary eye movements as you track moving lights without moving your head.
  • In the positional (or positioning) test, the examiner slowly moves your head into different positions while monitoring the movements of your eyes. It's a way of checking the vestibular system.
  • The calorics test measures the response when warm and cool air are blown into each ear canal as a way to evaluate the performance of the vestibular system on each side.

How to prepare for a balance assessment

Certain substances can influence the body's response to the tests, reducing their value and validity. With that in mind:

48 hours prior to the assessment

Stop taking any of the following medications:

  • Anti-nausea medication (Dramamine, Compazine, Borine, Marezine, Vontrol, Phenergan, Thorazine, etc.)
  • Anti-vertigo medication (Antivert, Ruvert, Meclizine, etc.)
  • Tranquilizers (Valium, Librium, Atarax, Vistaril, Equanil, Miltown, Triavil, Xanax, Serax, Etrafon, Darcovet, Diazepam, etc.)
  • Narcotics and barbiturates (Codeine, Demerol, Dilaudid, Morphine, Percodan, Phenaphen, etc.)
  • Sedatives (Nembutal, Seconal, Dalmane, Doriden, Placidyl, Quaalude, Butisol, Feldene, or any other sleeping pills)
  • Antihistamines (Chlor-Trimeton, Dimetane, Disophrol, Benadryl, Actifed, Teldrin, Triaminic, Seldane, or any over the counter cold remedy)

Don't forego important life-saving medications such as insulin, seizure, blood pressure or heart medicines.

24 hours before the assessment:

  • Don't consume any alcohol, including beer or wine.

On the day of the assessment:

  • Don't smoke or use any tobacco products.
  • Don't use makeup or skin oils, especially around your eyes.
  • Eat light meals.
  • Wear your glasses or contact lenses. Corrected vision is helpful for the testing.

These instructions are crucial for a successful evaluation. Please follow them precisely.

To learn more about getting a balance assessment, contact the Balance and Falls Center.

UCSF Health medical specialists have reviewed this information. It is for educational purposes only and is not intended to replace the advice of your doctor or other health care provider. We encourage you to discuss any questions or concerns you may have with your provider.

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