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Head Shake

Head Shake Sensory Organization Test

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Purpose

The HS-SOT is a two-condition enhancement to the standard SOT that is appropriate for patients who perform within the normal range on the standard SOT, yet remain symptomatic.

Acronym HS-SOT

Area of Assessment

Balance – Vestibular
Vestibular

Administration Mode

Computer

Cost

Not Free

Diagnosis/Conditions

  • Vestibular Disorders

Key Descriptions

  • The test consists of repeating SOT condition 2 (eyes closed on a firm surface) and condition 5 (eyes closed on a sway-referenced support surface) while the patient wears a head movement monitor and performs a continuous rhythmic head movement about a specified yaw, pitch, or roll axis.
  • The patient is instructed to maintain the frequency (approximately one turn per second) and amplitude (approximately 30 degrees in each direction for the yaw axis) of movement so that the average velocity of movement is maintained at or above a set minimum.
  • For each condition, the patient is given one (unscored) practice trial, followed by up to five scored trials.
  • There are three outcome measures:
    1) Equilibrium Score Ratio: a comparison of the average equilibrium score over the trials of head shake condition compared to the comparable condition with head fixed
    2) Equilibrium Score: Graphical representation of the individual raw equilibrium scores
    3) Movement Axis Velocity: Graphical representation of the average head velocity scores for the selected movement

Equipment Required

  • Neurocom Sensory Organization Test apparatus

Time to Administer

15 minutes

Required Training

Reading an Article/Manual

Age Ranges

Adult

18 - 64

years

Elderly adult

65 +

years

Instrument Reviewers

Initially reviewed by Elizabeth Dannenbaum, MscPT for the Vestibular EDGE task force of the Neurology section of the APTA.

ICF Domain

Body Function

Measurement Domain

Motor
Sensory

Professional Association Recommendation

Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association’s Multiple Sclerosis Taskforce (MSEDGE), Parkinson’s Taskforce (PD EDGE), Spinal Cord Injury Taskforce (PD EDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (Vestibular EDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.

For detailed information about how recommendations were made, please visit:  http://www.neuropt.org/go/healthcare-professionals/neurology-section-outcome-measures-recommendations

Abbreviations:

 

HR

Highly Recommend

R

Recommend

LS / UR

Reasonable to use, but limited study in target group  / Unable to Recommend

NR

Not Recommended

Recommendations for use based on acuity level of the patient:

 

Acute

(CVA < 2 months post)

(SCI < 1 month post) 

(Vestibular < 6 weeks post)

Subacute

(CVA 2 to 6 months)

(SCI 3 to 6 months)

Chronic

(> 6 months)

(Vestibular > 6 weeks post)

Vestibular EDGE

LS

 

LS

Recommendations based on vestibular diagnosis

 

Peripheral

Central

Benign Paroxysmal Positional Vertigo (BPPV)

Other

Vestibular EDGE

LS

LS

LS

LS

Recommendations for entry-level physical therapy education and use in research:

 

Students should learn to administer this tool? (Y/N)

Students should be exposed to tool? (Y/N)

Appropriate for use in intervention research studies? (Y/N)

Is additional research warranted for this tool (Y/N)

Vestibular EDGE

No

No

No

Yes

Considerations

All the studies investigated the HS-SOT with people doing a yaw movement. No studies were found investigating the psychometric properties when pitch or roll head movements were performed.

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Non-Specific Patient Population

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Minimal Detectable Change (MDC)

(Pang et al., 2011)

Minimal Detectable Change Value

 

 

 

 

Young Adults

< 50 y.o, n = 92

Older Adults

> 50 y.o, n = 73

Condition 2

2.7

3.6

Condition 5

16.2

22.7

Normative Data

(Pang et al., 2011)

Equilibrium Score (%)

Mean (SD)

 

 

 

 

Young Adults

< 50 y.o, n = 92

Older Adults

> 50 y.o, n = 73

Condition 2

92.6 (2.3)

91.7 (2.3)

Condition 5

56.0 (12.7)

47.0 (14.2)

 

(Park et al., 2012) 

Equilibrium Score (%) : Mean (SD)

 

 

 

 

 

Young Adults

20-49 yo n = 36

Adult

40-59 yo, n = 36

Older Adults

60-79 yo, n = 30

Condition 2

91.38 (2.38)

88.75 (5.06)

84.83 (7.59)

Condition 3

39.20 (10.77)

32.88 (12.33)

19.10 (7.01)

Test/Retest Reliability

(Pang et al., 2011)

Younger adults: excellent test –retest reliability for HS-SOT condition 2 and condition 5 (ICC (3.2 > 0.75).  Older adults moderate to good test-retest reliability (ICC(3.2) > 0.50).

Criterion Validity (Predictive/Concurrent)

(Pang et al., 2011; Park et al., 2012)

In healthy adults and older adults the HS-SOT scores were significantly lower than the respective SOT scores : condition 2: p = 0.01, condition 5 p < 0.001

(Lim et al., 2012)

Compared the Dizziness Handicap Questionnaire (DHI) with the SOT and HS-SOT in follow up of patients with unilateral vestibular neuritis (n = 32) finding: 

  • At 0-1 week both SOT and HS-SOT were correlated to DHI (p < 0.05) 
  • However at 1 month - 5 months only the HS-SOT was correlated to DHI and not SOT 
  • HS-SOT condition 5 continued being correlated at 6 months, while condition 2 was not. 

(Mishra et al., 2009)

 HS-SOT has poor sensitivity and specificity in identifying people with unilateral caloric weakness.

Floor/Ceiling Effects

(Honakar et al., 2009)

Suggested modifying the head shake SOT by adding head displacements at 15 deg/sec and 120 deg/sec, as well as the traditional 60 deg/sec. Healthy adults were tested (n = 40), Wilcoxon signed-ranks test showed  significant differences in the performance by varying the speed of head movement. They suggested testing with these additional head speeds would eliminate the floor and ceiling effect noted by Mishra et al. (2009).

Bibliography

Lim, H. W., Kim, K.-M., et al. (2012). "Correlating the Head Shake–Sensory Organizing Test With Dizziness Handicap Inventory in Compensation After Vestibular Neuritis." Otology & Neurotology 33(2): 211-214.

Mishra, A., Davis, S., et al. (2009). "Head shake computerized dynamic posturography in peripheral vestibular lesions." American Journal of Audiology 18(1): 53.

Pang, M. Y., Lam, F. M., et al. (2011). "Balance performance in head-shake computerized dynamic posturography: aging effects and test-retest reliability." Physical Therapy 91(2): 246-253.

Park, M. K., Lim, H.-W., et al. (2012). "A head shake sensory organization test to improve the sensitivity of the sensory organization test in the elderly." Otology & Neurotology 33(1): 67-71.