Dizziness In Orthopaedic Physical Therapy Practice: History And Physical Examination Page 14
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30Sustained cervical rotation test L+/R+/-_______________________________________________________
Latency
_____sec
> 60 sec
Vertical downbeat nystagmus
Duration
____ sec
Non-accommodating
Other nystagmus
Fatigable
Y/N
Geotropic
Horizontal nystagmus
Apogeotropic
Torsional nystagmus
Hautant test
Midrange +/-
EXT-ROT L+/R+/-
Latency with + EXT-ROT position
Y/N
VESTIBULO-OCULAR EXAMINATION
Dynamic visual acuity Decrease by ≥ 2 lines on Snellen chart +/-___________________________________
Doll’s head test Catch-up saccades towards fi xation target +/-______________________________________
Head-shaking nystagmus test +/ -
Nystagmus towards side lesion
Nystagmus away from side lesion
Head thrust test +/-
Corrective saccade on head moving right
Corrective saccade on head moving left
BPPV EXAMINATION
Hallpike-Dix L+/R+/-_______________________________________________________________________
Positive bilateral
L<R
L >R
Torsional nystagmus
Latency
_____sec
> 60 sec
Vertical downbeat nystagmus
Duration
____ sec
Non-accommodating
Other nystagmus
Fatigable
Y/N
Geotropic
Horizontal nystagmus
Apogeotropic
Straight head-hanging test +/-____________________________________________________________
Latency
_____sec
> 60 sec
Torsional nystagmus
Duration
____ sec
Non-accommodating
Vertical downbeat nystagmus
Fatigable
Y/N
Other nystagmus
Horizontal nystagmus
Roll test +/-____________________________________________________________________________
L < R
Torsional nystagmus
L > R
Vertical downbeat nystagmus
Latency
_____sec
Other nystagmus
Duration
____ sec
Geotropic
Fatigable
Y/N
Apogeotropic
Horizontal nystagmus
Walk-rotate-walk test L+/R+/-____________________________________________________________
CERVICOGENIC DIZZINESS EXAMINATION
Neck torsion test L+/R+/-________________________________________________________________
Latency
Immediate
_____sec
Torsional nystagmus
Duration
____ sec
Vertical downbeat nystagmus
Fatigable
Y/N
Other nystagmus
Horizontal nystagmus
BREATHING-RELATED TESTS
Hyperventilation test
Dizziness +/-
Nystagmus
+/-
Minimal latency
+/- Latency _____sec
Valsalva test
Dizziness +/-
Nystagmus
+/-
Minimal latency
+/- Latency _____sec
Cough test
Dizziness
+/-
Dizziness in Orthopaedic Physical Therapy Practice:
History and Physical Examination / 235
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