This time we’ll be looking at therapy specific outcome measures that may be appropriate in this population.
Management of balance impairment, guided by the Balance Evaluation Systems Test, in a patient following cerebellar infarct: a case report as originally seen in the New Zealand Journal of Physiotherapy
This test was not appropriate at the time of assessment for my patient as she was too severely involved, so I didn’t do it. Typically, I’ll do the Clinical Test of Sensory Organization and Balance (CTSIB) for the same purpose as what the BESTest is: to determine which area of balance is most problematic and needing to be addressed. It’s the Sensory Organization Test (SOT) with computerized posturography, just without the computer; so it doesn’t require $100,000 equipment to do, just your eyeballs. For this reason, I’ve heard it called “the poor therapist’s posturography”. I also addressed how I’ve returned to doing the full CTSIB here. I’ve never clinically used the BESTest personally, but it’s available free and has lots of research backing it. The article I looked at did the full BEST, but there is also a mini-BEST, which is much more clinic friendly and has good correlation to the full test. (Why would you ask 36 questions when 12 will do?)
That was the only “article” specific to this population for outcome measures in the balance realm. And it was really more of a poster. Sad. I know.
So since I didn’t use that, what did I do?
I used the Motion Sensitivity test to get the Motion Sensitivity Quotient (MSQ)— a quantifiable number on the dizziness. I chose this as 1) moving seemed to bring on the worst symptoms and 2) I could modify the number of positions tested to whatever test positions the patient could tolerate (which wasn’t very many on the initial eval) and still come out with a number that would be comparable to a re-assessment later on down the road.
As part of the MSQ, I also used a visual analog scale (VAS), although it wasn’t really visual… just a subjective rating of how “bad” the dizziness was from 0-5 with 0 being nothing and 5 being the worst ever.
Other outcome measures that look at the severity of dizziness that might be appropriate in this population (again, there is NO literature to back up any of this) include:
That’s it specific to dizziness that I’m familiar with. Do you use something else? Let us know in the comments! I didn’t pick the DHI in this case as it’s a self-report questionnaire and 1) my case had not attempted most of the things described to give a report as again, she was too acute and too severe, 2) reading and concentrating for comprehension for long periods of time increased her symptoms including headache and 3) she had moderate cognitive deficits, so I wasn’t sure how accurate or reliable her self-report would be.
Other general balance outcome measures might be appropriate as well, but that’s a huge list, so I won’t go into those.
I’m currently in the midst of doing a literature review in preparation to write a case report. If you would like more background information on the case or information about the project, please click here. If you would like to see other article reviews related to this project, please click here.