“You cannot definitively call something bilaterally hypofunction unless you’re doing something else. Rotational chair testing is typically your gold standard for that, but you could do something like a video head impulse test, and I could also help you out too. So the problem is you may only get a VNG report that has caloric testing on it. They may not have access to some of the other testing. So if you do have someone who’s suspected for bilateral hypofunction based on the caloric, they may recommend some additional testing or just highlight that that’s a possibility.
The other component of that is when you’re talking about bilateral hypofunction, you can get some cerebellar influence there. And so, when you’re looking at those patients, if you have a patient who’s presenting to you with say, abnormal head thrust testing, caloric abnormalities, they’re ataxic, and your smooth pursuit is abnormal, I’m more likely looking at those patients with cerebellar versus a patient who looks really pretty much neurologically intact, their ocular motors look good, and they’re presenting as more of a peripheral system misfunction. There are some specific tests that are done in the vestibular lab that can give you a yay or nay on if it’s cerebellar or peripherals.”
RESOURCES & LINKS:
This Q&A is an excerpt from the Vestibular Health Summit Sessions
Dr. Jamie M. Bogle currently works at the Mayo Clinic in Scottsdale, Arizona. During her time at Mayo Clinic Scottsdale, she has provided patient care, mentored 17 students, and developed the Mayo Clinic Sport Neurology and Concussion Program which provides baseline concussion measurements and post-concussion testing in a team approach with neurology and neuropsychology. In addition to this, she also holds academic ranks at not only Mayo Clinic, but three other universities (University of Colorado at Boulder, Salus University, and Gallaudet University). She lectures on vestibular sciences, diagnostics, and treatment. In addition to academic teaching, she has also presented at numerous conferences and seminars including at the American Academy of Audiology, American Speech-Language-Hearing Association, and the American Balance Society.
Bridgett Wallace, PT, DPT
Bridgett Wallace, PT, DPT, has a doctorate of physical therapy and holds competency-based certifications in vestibular rehabilitation and concussion management. Dr. Wallace has been treating patients with dizziness and balance disorders for more than 20 years and is the founder and President of 360 Balance & Dizziness – a specialty clinic for the evaluation and treatment of dizziness and balance disorders that includes both audiology and therapy services. She is also the co-founder and Director of Clinical Education for 360 Neuro Health Institute, which provides online, mobile, and live educational offerings for healthcare providers.
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