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Your Initial Visit

If you are experiencing dizziness problems, your first appointment at ACMC Balance Center will include a physical therapy evaluation to identify your current symptoms and assess your balance system, which includes three sensory inputs:

  1. Somatosensory - These are the nerves on the bottom of your feet and in your lower extremity joints.
  2. Vision
  3. Vestibular system or balance center of your inner ear. These senses guide the brain to make adjustments in your posture by generating muscle contractions throughout the lower extremities and trunk.

Testing by a physical therapist trained in vestibular rehabilitation will help your primary health care physician or advanced practice practitioner determine the appropriate treatment plan and have an assessment of your current abilities to monitor your progress.

Common Diagnostic Tests include:

Video Frenzel Goggle Evaluation
Frenzel goggles are used in the evaluation of patients with vestibular disorders. They magnify the eye, while an infrared camera captures the image, displaying it on a TV screen. The Frenzel goggles block the patient’s vision, to better evaluate the nystagmus, or reflexive, rhythmic jerking of the eyes. A single image of the eye fills the entire screen of the monitor. This allows the therapist to see even the slightest amounts of nystagmus, which can be hard to detect with the naked eye.

Computerized Dynamic Posturography (CDP)
This is a series of tests that measure how well you are able to maintain your balance under different conditions. You will be asked to stand as steadily as possible on a platform inside a small booth. The platform will have sensors that measure how well you maintain your balance as the walls of the booth move around you and the surface you are standing on moves under your feet. The tests will be conducted with your eyes open and with your eyes closed. You will be supported by a safety harness in case you become unsteady.

Audiometric (Hearing) Tests
Your doctor may order hearing tests as the hearing and motion sensing parts of your inner ears are sometimes both affected by the same disease. Basic hearing tests are designed to determine how well you can sense very faint sound at different frequencies, as well as how well you can comprehend speech.

Electronystagmography (ENG)
ENG is a group of tests that measure the associated eye movements generated by the inner ear to text how well the inner ear balance mechanism works. There is an interaction between the eyes, eye muscles and the inner ear balance system. During an electronystagmography or ENG test, eye movements are recorded by electrodes placed around the eyes or by special video cameras fitted on goggles placed over the eyes. A computer analyzes the eye movements and provides information about the kind of messages the inner ear is sending to control the movement of the eyes through the central nervous system. This is currently the best way to check how well the inner ear balance mechanism works.

Nystagmography Tests
This is a series of tests designed to document your ability to follow visual objects with your eyes and how your eyes respond to some types of information from your vestibular system. To monitor the movements of your eyes, your Audiologist may place electrodes around your eyes (electronystagmography-ENG) or may use an infrared video camera (VNG video nystagmography). Eye movement tests are useful, because some patients with balance system problems have problems seeing clearly when moving, or they get the erroneous sense that objects are moving.

  1. Occular Motility: You will be asked to follow with your eyes objects that jump from place to place or move smoothly. Your doctor will be looking for any slowness or inaccuracies in your ability to follow visual targets.
  2. Optokinetc Nystagmus: You will be asked to view a large, continuously moving visual image to see if your eyes can appropriately track these movements.
  3. Positional Nystagmus: Your doctor will move your head and body into various positions to make sure that there are no inappropriate movements of your eyes when your head is in different positions.
  4. Caloric Test: Your doctor will stimulate both of your inner ears (usually one at a time) with warm and then cold water. He or she will be monitoring the movements of your eyes to make sure that both your ears can sense this stimulation.

Some of the tests are designed to mimic different conditions you encounter in every day life. Other tests are designed to determine the source of your balance problem. The computerized tests are able to isolate the different sensory information you rely on to maintain your balance.

The test results provide a better understanding of your balance problem and can point to possible causes. This allows your doctor to focus on the abnormal system. The physical therapist will design your vestibular rehabilitation specific to your needs based on the outcome of this test.