Balance Tests, Examination indications and types

Balance Tests

Balance tests, or vestibular balance testing. What are they, what conditions do they indicate, what are the different types and how to perform each one?

By Dr. Heba hegzy Last updated Nov 8, 2022

Table of Contents

Balance tests, also known as vestibular balance testing, are a series of tests used to diagnose balance disorders, which cause you to feel dizzy or unsteady on your feet.

Overview

Balance tests are a class of tests used to detect balance disorders, such as Dizzying or Vertigo. Dizziness symptoms include vertigo (the sensation that you or your surroundings are spinning) and lightheadedness (the sensation that you are about to faint).

To maintain good balance, various systems in your body must cooperate. The vestibular system is the most important. This system is located in your inner ear and consists of special nerves and structures that aid in your balance. Your vision and sense of touch are also important for good balance. Problems with any of these systems can result in a balance disorder.

Balance disorders can occur at any age, but they are more common in the elderly. It’s one of the main reasons why older people fall more often than younger people.

purpose of the balance tests

balance assessment tests are used to identify whether you have a problem with the balance as well as, what is causing it.

Balance disorders can be caused by a variety of factors, including:

Meniere’s syndrome
Vertigo with benign paroxysmal positional vertigo (BPPV)
Migraines
Vestibular neuropathy
Injuries to the head
Medication-related side effects

If you are experiencing symptoms of a balance disorder, you may require a balance test. The following are the symptoms:

Feeling dizzy or as if you’re floating.
Dizziness or the sensation of spinning while standing still.
Feeling disoriented or having blurry vision
Stumbling or losing your balance while walking.
Tinnitus (ringing in the ears).

Simple balance tests

Here is a list of balance tests:

leg standing balance test

Standing Balance Test: stand on one leg as long as you can.
Stork Stand Test: stand on one leg’s toes for as long as possible while the free leg rests on the inside of the opposite knee.
Flamingo Balance: Stand on one leg while balancing on a beam.
One Leg Stand: stand for 30 seconds with one foot off the ground.
Stick Lengthwise Test: Balance on a stick for as long as possible while standing sideways on the balls of both feet.

Walking Balance

Beam Walk Balance Test
Field Sobriety Test with Walk and Turn

Dynamic Balance

Bass test
Balance Board test
Star excursion balance test
The Y Balance Test

Types of diagnostic balance tests

A primary health care provider or an ear disorder specialist can perform clinical tests of balance.

Several tests are usually required to diagnose balance disorders. You may be subjected to one or more of the following tests:

1- Electronystagmography (ENG) and videonystagmography (VNG) tests

These tests capture and quantify your eye movements. To maintain a good balance, your vision system must function properly. Electrodes (small sensors that attach to the skin) will be deposited over the skin around your eyes for an ENG test. Special goggles will be placed over your eyes for the VNG test. The following steps are included in both tests:

Sitting in a dimly lit room.
Following light patterns on a screen.
Moving into different positions as you follow the light pattern.
Each ear will be filled with warm and cool water or air. This should cause the eyes to move in predictable patterns. If the eyes do not respond in these ways, it may indicate that the inner ear nerves have been damaged.

2- Rotary chair test

A rotary test is another name for it. This test will also track your eye movements. During this examination:

You will be seated in a motorized chair that is computer-controlled.
You will wear special glasses that will record your eye movements as the chair moves back and forth and in a circle.

3- Posturography test

Also referred to as computerized dynamic posturography (CDP). This test assesses your ability to balance while standing. During this examination:

You’ll be standing barefoot on a platform while wearing a safety harness.
A landscape screen will surround you.
The platform will move to test your ability to stay upright on a moving surface.

4- Vestibular-evoked myogenic potentials (VEMP) test

This test estimates how specific muscles react to sound. It can reveal if there is an issue with your inner ear. During this examination:

You will sit in a chair and recline.
You’ll put on your earphones.
Sensor pads will be placed around your neck, on your forehead, and under your eyes. Your muscle movements will be recorded by these pads.
Your earphones will receive clicks and/or bursts of tones.
You will be asked to lift your head or eyes for short amounts of time while the sound is playing.

5- Dix-Hallpike maneuver

This test evaluates how your eyes react to sudden movements. During this test:

Your provider will quickly move you from a sitting to a lying down position and/or move your head in different positions.
Your provider will examine your eye movements to determine if you have a false sense of motion or are spinning.

A video head impulse test, a more recent version of the Dix-Hallpike maneuver, may also be performed. You will wear goggles during this test to record your eye movements while your doctor gently turns your head.

Balance Error Scoring System

The Balance Error Scoring System assesses static postural stability in a portable, cost-effective, and objective manner. The BESS can be used to evaluate the impact of mild head injury on static postural stability in the absence of highly-priced, advanced postural stability assessment tools.

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Risks of balance tests

Certain tests may cause dizziness or nausea. However, these feelings usually pass within a few minutes. If the dizziness lasts for an extended period of time, you may want to arrange for someone to drive you home.

Result interpretations

If your results were abnormal, your doctor may order additional tests and/or place you on a treatment plan. Depending on the cause of your balance disorder, you may be treated with:

Medication to alleviate dizziness and nausea.
If you have Benign paroxysmal positional vertigo (BPPV), your provider may perform a series of specialized head and chest movements on you. This can aid in the repositioning of particles in your inner ear that has become dislodged. The Epley maneuver, or canalith repositioning, is another name for the procedure.
Vestibular rehabilitation is another name for balance retraining therapy. A provider who specializes in balance rehabilitation may design an exercise program and other steps to improve your balance and prevent falls for you. This may entail learning to walk or use a cane.
Changes in diet and lifestyle. Certain lifestyle changes may help relieve the symptoms of Meniere’s disease or migraine headaches. Physical activity should be increased, certain foods avoided, and smoking should be avoided. Consult your doctor about which changes are best for you.
Surgery. If medications or other treatments are ineffective, you may require surgery to correct an inner ear problem. The type of surgery will be determined by the cause of your balance disorder.

Balance tests have contributed greatly to the understanding of the causes of dizziness and fall, but they must be performed by specialists, and talk to your doctor if you have any concerns about your results.