– Vestibular Assessment & Reset

This is one of my favorite assessments and resets to perform. It is also quite simple. The goal is to test the patient’s ability to resist pushing their arms down using three different positions of the clients’ head.

Important note for testers (and patients): Ask the patient if they have shoulder pain or issues. If they do, be very careful when implementing this test. If the patient experiences pain or discomfort (beyond the normal effort felt in muscles activated), stop the assessment. Do not do it.

Assessment instructions:

The patient will stand and extend both arms forward, completely locked out, and parallel to the floor

The client will maintain a neutral neck position and look straight ahead

Next, on the count of three, the tester (with hands placed on patients’ upper forearms near the elbows) firmly pushes on patients’ arms attempting to break the starting position of arms parallel to the ground

Testers: make a mental note of how easy or difficult it was to break the patient’s starting position

Now, have the patient bring their right ear as close as possible towards the right shoulder. The patient should be looking forward and the head should not be turned – rather, right ear is closer to right shoulder

Repeat step 3

Testers: make a mental note of how easy or difficult it was to break the patient’s starting position

Now, have the patient bring their left ear as close as possible towards the left shoulder. The patient should be looking forward and the head should not be turned – rather, left ear is closer to left shoulder

Repeat step 3

Testers: make a mental note of how easy or difficult it was to break the patient’s starting position

In which head position did the patient most easily break or have difficulty resisting?

Vestibular Reset – The Barbeque Roll

Let’s say the patient broke easiest with head position to the right and let’s do a version of a reset known in the physical therapy world as The Barbeque Roll.

Reset Instructions:

Because the patient demonstrated weaker with their head positioned to the right, we will start with the patient laying down on the floor on their right side

Next, the tester will cue the patient in a very specific 8-step process:

a. Turn head to the right and look towards the floor. Wait a few seconds
b. Then have the patient roll onto their belly and continue looking at the floor. Wait a few seconds
c. Cue the patient to turn their head and look to the right. Wait a few seconds
d. Cue patient to roll onto their left side. Wait a few seconds
e. Cue patient to look towards the ceiling. Wait a few seconds
f. Have the patient roll onto their back and keep looking at the ceiling
g. Cue patient to look to their right. Wait a few seconds
h. Cue patient to roll back to starting position

Now, have the patient carefully stand up.

Repeat the assessment exactly the same way as in steps 1-7 above. Make a mental note of any differences you feel in the patient’s ability to resist pushing down their arms.

There is a good probability that you will notice an increased resistance in all three head positions, and especially in the head position that demonstrated the most weakness.

Why?

There are three canals inside of each ear. They carry fluid and crystals. When the fluid and crystals are not optimally distributed, strength and movement are often times compromised.

Testers: You may wish to observe your patient walking prior to performing the vestibular test. After administering the Barbeque Roll, assess strength as described previously, and also watch them walk again. Do you notice any differences or improvements in posture, stride length, stride symmetry, head position, reciprocal arm swing, velocity, or rotations? There is a good chance you will see some improvements.

Important note: As of this writing, in all the years I have been doing this reset, on only two occasions, performing the full 360-degree Barbeque Roll was too much for my client. When finishing the reset, the client felt worse, lost strength and movement was slightly compromised. You cannot know if or when this will occur. However, the next time you administer this test and reset with that client (and not during the same session, but in a future session a day or two later), try doing a 180-degree roll instead.