Postural Stability Assessment | Dizziness Assessment
Deficits in postural stability are often noted in patients with traumatic neck pain and cervicogenic dizziness due to abnormal cervical afferent input. This disturbed afferent input impairs the tonic neck reflex to achieve postural stability. Treleaven et al. (2005) conducted the Clinical Test for Sensory Interaction in Balance, abbreviated as CTSIB in patients with traumatic neck pain with dizziness compared to patients with traumatic neck pain without dizziness and healthy controls. They found significantly greater sway and inability to complete the tasks in patients with dizziness.
The following modified sensory organization test can be performed in order to assess for impairments in postural stability. Visual and proprioceptive input from the lower limbs is altered as the tests progress. It is thought that people with neck disorders rely more on vision and other somatosensory inputs for balance and thus deficits will be greatest when these inputs (e.g. vision) are reduced:
- Narrow stance: Have the patient stand barefoot on the floor with the arms across the chest and hands touching his shoulders. The patient‘s feet are together with the ankle bones touching each other. Hold for 30 seconds. As a progression, the test is performed on a foam mat of approximately 10cm thickness with eyes open and then eyes closed
- Tandem stance: Have the patient stand barefoot in a tandem stance, again with the arms crossed on the shoulders and hold for 30 seconds. To progress repeat the test with the eyes closed.
- Single leg stance: Have the patient stand barefoot on one leg, with the other leg flexed and not touching the stance leg. Hold the position for 30 seconds. To progress, repeat the test with your eyes closed.
The tests are positive if the patient is unable to maintain the position for 30 seconds or portrays large increases in sway, slower responses to correct sway or rigidity to prevent sway.
According to the study by Treleaven et al. (2005), it is reasonable to expect that a healthy person under the age of 60 years can maintain stability for up to 30 seconds in the narrow stance tests. Healthy subjects under 45 years should also be able to complete tandem and single-leg stance tests.
Next to postural balance, your dizziness exam should include the following assessments:
- Gaze stability
- Saccadic Eye Movement
- Eye-Head Coordination
- Joint Position Sense Error
- Smooth Pursuit Neck Torsion Test
- Cervical Torsion Test
- Head-Neck Differentiation Test
- Andreas Johnson24/10/23Vestibular Rehabilitation GREAT COURSE
This course is super informative and detailed. I have learned a ton and feel confident in beginning to assess and treat vestibular clients.Mads Louis25/11/22Vestibular Rehabilitation EXCELLENT COURSE, THAT MAKES YOU READY TO TREAT DIZZINESS WITH CONFIDENCE
This course provides an excellent opportunity to learn how to treat and diagnose vertigo/dizziness patients, who previously were a mystery to treat.Andreas Johnson24/10/22Vestibular Rehabilitation GREAT COURSE
This course is super informative and detailed. I have learned a ton and feel confident in beginning to assess and treat vestibular clients.
- Jordi Holierhoek18/08/22Vestibular Rehabilitation EXCELLENT COURSE!
Fantastic course, very practical with enough depth! I learned a lot from first. He is an excellent teacher who knows his stuff. I would totally recommend this course.Stephen08/08/22Vestibular Rehabilitation GREAT COURSE FOR BEGINNERS AND THERAPISTS WITH SOME EXPERIENCE
Loved the course, can be done relatively quickly if you are like me and have a little bit of vestibular knowledge (it took me around 2 weeks), but the basics are all there so you can spend a bit more time getting into it if needed
I luckily had two patients in my ward needing vestibular rehabilitation just as I had finished this course, and I was able to help them straight awayKim Hansen30/03/22Vestibular Rehabilitation VESTIBULAR REHABILITATION
Really good and professional layout with Firat's professional experience as well as nice software touches by Physiotutors with questions in some videos for example. Firat approaches you in different ways of teaching with small videos, summaries, lectures and so on. Also fun to see that some of his references are people that I have a cooperation with here in Sweden. Even if there’s a whole division of information regarding vestibular hypofunction it would still be fun to have separate chapter for vestibular neuritis, but that’s just a small note. On the whole I’m totally happy and satisfied with this course, really good job done by Firat and Physiotutors, I will be keeping an eye out for more advanced courses in the future regarding this topic, maybe Firat can do a Masterclass version?
- Steve van Rijen26/03/22Vestibular Rehabilitation VESTIBULAR REHABILITATION
By far the best course i ever had.
It will take you a lot of time and effort to make it your own.
But i can tell, the reward is great.
you won’t be disappointedMarine Gandin27/01/22Vestibular Rehabilitation REALLY COMPLETE COURSE AND EASY TO LEARN
It takes me 6 full days to finish that course but it was a really good course!
I enjoyed every part of the “vestibular rehabilitation” by Firat.
I’m excited to start doing some practice with patient!
I didn’t need any further explanation but I saw that Firat answers very fast to the question on the unit.
Thank you very much for this amazing course!
Even if it is in an other language than mine, it was really easy to understand.
Thanks!Christiena den Tek28/12/21Vestibular Rehab COMPLETE COURSE ABOUT DIZZINESS AND THE WAY TO TREAT FOR PHYSIO'S
In the past I finished/followed a few courses about dizziness and treatment. I really enjoyed following this course because it’s very complete. There is overall information about the systems involved with dizziness problems, the pathologies, the exams and the overall physiotherapy treatment or other treatments. There is a nice mix between the way the information is given and the information is up to date science. The teacher (Firat) is a teacher that loves helping you out and if you have any questions he is quickly in his response.
I would recommened this course highly not only for those who just start learning things about the dizziness (patient) but also for those who are already working with these patients.
- Elisabetta12/12/21Vestibular Rehabilitation INCREDIBLY THOROUGH COURSE
Such a fantastic course!
The learning experience is enhanced by interactive material found in each module.
The instructor provides clear information, both theoretical and practical, easy to apply in clinical practice.
This is an excellent course, and I would definitely recommend it!Physiotutors27/08/21Vestibular Rehabilitation Firat really delivered on this course! While we have had some training in vestibular diagnostics and rehab in our own training, this course is on a whole other level! Building this course with Firat has increased our knowledge dramatically and we can absolutely recommend this course to any Physiotherapist as patients with vestibular problems will be among the most grateful patients when treated right.Anne Cahill02/08/21Vestibular Rehabilitation Thank You!!
This is a brilliant course. The learning materials are concise, clear and comprehensive. All the information given is easy to navigate, up to date and very useful for daily clinical vestibular rehabilitation practice. It is a much appreciated educational resource. Amazing!! Thank you for this excellent course.
- Astrid Schubart27/06/21Vestibular Rehabilitation I finished this course Vertigo this weekend and it’s been a long time since I’ve done such a great structured training. Lots of practical content. The lecturer shows in detail what is important. Firat Kesgin offers a lot of additional information and patient information.
I am really excited and looking forward to apply my new knowledge in practice.