MM108 - Proactive and Reactive VOR Tests for Vestibular Assessment and Rehabilitation

Abstract:
The vestibulo-ocular reflex (VOR) is one of the most important reflexes used in day-to-day life. Sometimes the VOR is proactively initiated (looking both ways before crossing the street, shopping grocery store shelves) and other times, the VOR is reactive (safety mechanism such as reaction to sound behind you). This session will review clinical tests used to evaluate both the proactive and reactive VOR. We will also review clinical cases that demonstrate abnormalities in testing and how you can utilize these VOR tests for follow-up during rehabilitation.

Summary:
The vestibulo-ocular reflex (VOR) is one of the most important reflexes used in day-to-day life. Sometimes the VOR is proactively initiated (looking both ways before crossing the street, shopping grocery store shelves) and other times, the VOR is reactive (safety mechanism such as reaction to sound behind you). We will quickly review the anatomy and physiology of the high-frequency VOR in order to get a baseline for what clinical tests are utilized in our current test battery (vHIT, DVA, GST) and what new assessments can be considered (fvHIT).

This session will review these clinical tests used to evaluate both the proactive and reactive VOR. Evaluating a patient from this lens helps with a holistic view of a patient's function in order to make the best recommendations for their needs.

As a part of this session, we will review clinical examples that demonstrate abnormalities in reactive and proactive VOR tests. We will also discuss tracking rehabilitation progress utilizing these same tests.

Attendees will leave with an understanding of the following:

• General review of the VOR anatomy and physiology
• Proactive versus reactive VOR (initiation versus reaction and why this matters for our patients)
• DVA, GST, vHIT and fvHIT tests, including when and how these can be beneficial in rehabilitation
• Clinical case examples of abnormal reactive and proactive VOR tests

Brief Summary of Clinical Takeaways:
Attendees of this session will:

• Understand general VOR anatomy and physiology
• Be able to define proactive versus reactive VOR and why this matters for making vestibular recommendations
• Describe the Functional Vision Head Impulse Test and its clinical niche in functional VOR assessment