Practice

Assessment & outcomes

Accurate assessment is the foundation of VRT — it classifies the deficit into gaze instability, motion sensitivity or postural imbalance, each of which points to a different exercise module. The same tools, repeated, track progress.

  • Gaze instabilityHIT / vHITDynamic Visual AcuityGaze stabilisation (X1 / X2)
  • Motion / visual sensitivityVVAShabituation testingHabituation · visual desensitisation
  • Postural imbalance · fall riskCDP / SOT · CTSIBBerg · FGA · TUGBalance & gait training
  • Self-reported handicapDHIABC scaleTracks progress · sets goals
Assessment drives intervention: each impairment domain has its measuring tools and the module it points to. Re-running the same tools at ~4–6 weeks quantifies progress.

Subjective scales

The Dizziness Handicap Inventory — 25 items across physical, functional and emotional domains — quantifies perceived handicap and is sensitive to change, making it the workhorse for tracking VRT.1 The ABC scale captures balance confidence (and the psychological side of fall risk), while the Visual Vertigo Analog Scale grades dizziness provoked by visual motion — flagging the visual dependence that points to desensitisation work.2

Objective vestibular & balance testing

The head impulse test (and quantified vHIT) probes semicircular-canal VOR function — a corrective catch-up saccade marks hypofunction and lateralises it.3 Dynamic visual acuity measures gaze stability during head motion, and computerised dynamic posturography (the Sensory Organization Test) quantifies how vestibular, visual and proprioceptive inputs combine — revealing sensory dependence a bedside exam can miss.4 At the bedside, Romberg, tandem gait and the CTSIB (firm vs foam, eyes open/closed) interrogate the same systems without instrumentation.

A clinician performs the head impulse test, marking the small, rapid head rotation used to probe the VOR.
The head impulse test: a small, brisk head turn while the patient fixates a target — a catch-up saccade marks hypofunction.From Practical Guide to Diagnosis & Management of Vertigo (Prahlada N.B).
Dynamic visual acuity testing — a patient reads an eye chart while the clinician oscillates the head.
Dynamic visual acuity: the patient reads the smallest line they can while the head is moved — a drop versus static acuity signals a VOR deficit.From Practical Guide to Diagnosis & Management of Vertigo (Prahlada N.B).
Four panels showing a patient standing on firm and foam surfaces with eyes open and eyes closed.
The CTSIB / Sensory Organization concept: firm versus foam, eyes open versus closed, isolates whether balance leans on vision, proprioception or vestibular input.From Practical Guide to Diagnosis & Management of Vertigo (Prahlada N.B).

Functional mobility & fall risk

The Timed Up and Go screens functional mobility — over ~13.5 s flags elevated fall risk in older adults.5 The Berg Balance Scale (14 tasks) and the Functional Gait Assessment (gait under challenge — head turns, obstacles, narrow base) grade postural control and are responsive to rehabilitation, making them ideal repeat measures.6

13.5 s051013.5202530lower fall riskelevated fall risk
A Timed Up and Go over ~13.5 s flags elevated fall risk in older adults — a quick screen to repeat through the programme. Cut-off is a guide, not a hard rule.

Re-assessment drives the programme

Beyond classifying the deficit, the baseline carries prognostic weight and sets the schedule for review. Re-running the same validated tools at baseline, mid-treatment (~4–6 weeks) and discharge gives objective evidence to continue, modify or stop — and a weekly symptom diary adds day-to-day pattern and accountability.

Key points

  • Classify the deficit: gaze instability (HIT/DVA), motion sensitivity (VVAS), postural imbalance (CDP/BBS/TUG).
  • DHI is the workhorse outcome measure; ABC adds balance confidence.
  • Low VOR gain + impaired DVA → adaptation; high visual-vertigo scores → habituation.
  • Repeat the same tools at ~4–6 weeks to quantify progress objectively.