VNG Pro User`s Manual
Contents
1. e Patient position e Head Movements e Head angles OKN Admistration For optkinetic testing the patient tracks multiple stimuli Stimuli are moved at a rate programmed in each direction Clockwise and counterclockwise Warnings e Patient position e Head Movements e Head angles Active head rotation AHR This test records the movements of the eyes and head This requires that you have placed the headphones Admistration The patient must move his head to the right or left when you hear a click in the respective ear Warnings e Patient position Supine Administration The examiner places the patient in each position and evaluates him or her for a minimum of 20 30 seconds Mental tasking is used to keep the patient from suppressing nystagmus Visual suppression must also be avoided by the use of infrared goggles or with the patient s eyes closed with electrodes Some standard positions used include the following e Supine Head 20 30 e Supine head right 60 22 e Supine head left 60 e Supine Head 20 30 Primary position Warnings e Patient position Dix Hallpike Dix Hallpike is performed over a stretcher that allows lie down and sit the patient quickly Admistration The Dix Hallpike maneuver is performed by turning a patient s head to the right or left and then briskly assisting him or her to a supine position with the head hanging to the right or left The patient is left in this position for a2. 60 is abnormal Symmetry gt 30 difference 1s abnormal SPV lt 6 0 is abnormal gt 2 beats horizontal with average velocity gt 6 0 deg sec 1 delay onset of nystagmus 2 paroxysmal nystagmus 3 associated with vertigo 4 fatigable nystagmus Unilateral weakness of more than 25 is abnormal Bilateral weakness sum of velocities of all 4 irrigations lt 20 sec Directional preponderance gt 25 difference Symmetrical low gain impaired vision or likely CNS parietal lesion Unilateral Usually peripheral undermost ear Bilateral peripheral both ears or CNS BPPV both horizontal and vertical nystagmus with possible rotation observed Caloric weakness is a function of the labyrinth or VIII cranial nerve vestibular portion Unilateral indicates disabled side Bilateral peripheral organs acute unilateral lesion or perhaps CNS cerebellar Directional preponderance is not localizing High fixation index is a prime indicator of CNS 50 While Videonystagmography is the most widely used clinical laboratory test to assess vestibular function remember that normal VNG test results do not necessarily mean that a patient has typical vestibular function VNG abnormalities can be useful in the diagnosis and localization of site of lesion however many abnormalities are no localizing therefore the clinical history and otologic examination of the patient are vital in formulating
3. Time record Print 30 sec Adquisition Warnings Screen Print Report Results Time Test Gaze 80 AHR 35 zi il Spontaneous 40 Smooth 30 Calorics 75 Saccades 30 Supine 60 5 OKN 25 ixHallpike 100 2 DixHallpike l PHallpikeLR 60 5 46 Tab Acquisitions Warnings Screen Print Report Results Adquisition Next step adquisition x Footswitch Enabled a Wireless Footswitch m Warning alarm test a 7 Test Instructions Tests may be performed in any sequence defined by the user Mark the Next step Acquisition desired by test When stop recording of the test data vV Stop the test window v Next the test next window will be open automatically VY Result the test analysis window will be open automatically 47 Hardware Exclusively to use technical support 48 ABNORMALITY THRESHOLD These comments are generalities Exceptions may occur TEST SPONTANEOUS Nystagmus slow component followed by fast component Bilateral gaze nystagmus eyes open and looking to right or left SMOOTH PURSUIT TRACKING Gain eye velocity target velocity Phase lag or lead of eye relative to target Asymmetry right gain left gain SACCADE TEST Velocity peak eye velocity Latency reaction time in msec Accuracy undershoots overshoots ABNORMALITY 2 Beats horizontal in 5 sec with average
4. a diagnosis and treatment plan for a patient presenting with dizziness or vertigo 51 Freyss Diagram It was designed to perform the bilateral bi thermal caloric test Freyss butterfly or diagram shows the nystagmus intensity together with he results of absolute symmetry and preponderance In its most traditional form Freyss butterfly represents the number of nystagmic flaps observed in a 30 second period It also requires the stimulus corresponding to Hallpike rules irrigate 125cc of water at 30 and 44 C during 30 seconds The patient shall be in horizontal position with the head at 30 degrees In these conditions it is possible to use the results of the normative data published by G Freyss giving the symmetry normative limits lt 15 and a directional preponderance 12 It is also possible to evaluate a hypo sensitivity condition lt 30 saccades or hyper sensitivity gt 122 saccades of a single ear if you add up the saccades induced by both ears with hot and cold stimulus right nystagmus beat 4 In general the graph is centered in a point the ordinate axis represents the nystagmus intensity and the abscissa axis 1s graduated in percentage There are two limits x 100 and x 100 Rightwards nystagmic flaps are positive while the leftwards ones are negative The results obtained from the right ear are represented in line X 100 and the left ear ones in line x 100 left nystagmus beat Both points cor
5. excellent f Yellow regular EEE Roo Calibration This is not a true calibration to determine the amplitude of the eye movements in degrees but more an allowance for a correction factor due to the individual anatomical differences of the orbit of the eye These corrections are especially important in the evidence that eye movements are compared to a target stimulus from a known position speed are compared with a target stimulus of a known position velocity In other test calibration is not essential However if the mask has been repositioned or removed since the initial calibration was carried out the procedure must be repeated Calibration recommended e Optokinetic tests e Smooth pursuit test e Saccade test e Gaze test e AHR During the calibration the patient is requested to fixate upon points that are onto the stimulus projector monitor The resulting eye movements will be processed by the Vng Pro vestibular system Setting Calibration The calibration parameters can be set for each test To do so Open Setup protocols Create New protocols Add test Add calibration set oe See Setup software protocols VNG PRO STANDARD USE The parameters that defined on the protocols procedure cannot be changed once the test has been performed The advantage of such software architecture is that it ensures that the conditions under which the measurement is performed can be reproduced at any time even the patien
6. release v Analysis To print the measure data of a test v CPT Current Procedural Terminology codes are numbers assigned to every task and service a medical practitioner may provide to a patient on USA They are then used to determine the amount of reimbursement that a practitioner will receive They ensure uniformity The codes are developed maintained and copyrighted by the AMA American Medical Association v DHI dizziness Handicap inventory score v Warning warning state v Records eye position trace 32 v Only printing window To print one or more specific sections of the records See Create record print windows v Print Nystagmus mark on to printout eyes position trace show nystagmus mark v Print current view printout current page Analysis Goto Analysis window Toolbar bottom Print Print report Exit quit the report window 33 Edit Nystagmus The nystagmus analysis constitutes a major part vngpro system The software searches for nystagmus beats on the eye movement trace and detects automatically In adicion to detecting nystagmus beats the software also calculates other important recording parameters slow phase velocity Nystagmus frequency Even so VngPro offers a function to allows you to overrule partial or total the automatic analysis performed by the software algorithm With the possibility of adding or deleting nystagmus marks you may optimize the results of the analysis by exerting your own pro
7. velocity of gt 6 deg sec Gain Age 50 and under lt 70 or gt 140 Age 60 69 lt 65 or gt 145 Age 70 79 lt 60 or gt 150 Age 80 89 lt 55 or gt 155 Age 90 and above lt 50 or gt 160 Gain asymmetry gt 30 Latency Age 50 and under gt 260 msec Age 60 69 gt 270 msec Age 70 79 gt 280 msec Age 80 89 gt 290msec Age 90 and above 300 msec SIGNIFICANCE CNS nystagmus in all gaze directions or direction changing nystagmus in same gaze direction SPONTANEOUS NYSTAGMUS CNS brain stem PVS direction fixed horizontal or torsional nystagmus Inhibited by fixation follows Alexander s law rule out drugs lack of alertness Low gain in one direction CNS lesion Marked saccadic pursuit stair step tracking CNS lesion Significant saccadic slowing overshooting or undershooting CNS lesion or ocular disorder Lower velocity of trailing eye Internuclear ophthalmoplegia Brain stem 49 OPTOKINETIC NYSTAGMUS Gain eye velocity target velocity DIX HALLPIKE CALORIC TEST Directional Preponderance nystagmus beats stronger one way than another Fixation Index when nystagmus is at its peak the ratio of velocity with no fixation to velocity with fixation Velocity Age 50 and under lt 240 deg sec Age 60 69 lt 230 sec Age 70 79 lt 220 sec Age 80 89 lt 210 sec Age 90 and above lt 200 sec Accuracy lt 55 Gain lt
8. E23 Because of your problem are you afraid people think you are intoxicated E24 Has your problem places stress on your relationships with members of your family or friends E25 Because of your problem are you depressed Score Functional Emotional Physical Because of your problem do you avoid driving your vehicle during the daytime oO 0 Ob oO oO OO OO O 0 oO oO oO oO l 0O Al OA O Oo oO 0 Ob oO oO Oo OO O 0 oO 0 l Al OO l O0 Ol O Oo 57 Troubleshooting 58
9. VNG Pro User s Manual BETA DRAFT 270712 The VNG Goggles The VNG goggles hold the cameras that are used to record the eye images The cameras use infrared light IR which is not visible to the naked eye The IR illumination enables sessions to be performed in complete darkness The mirrors simultaneously direct IR illumination toward the pupil and reflects an image of the eye back to the video camera The mirror reflects short wave infrared 700 800 nm and passes visible wavelengths The VNG goggles can function in both free field of view and light occluding mode The front cover plate of the mask is magnetically fixed and can easily be removed Before using the VNG goggles please consider the following e The goggles and cameras contain sensitive electronic and optical devices Do not expose the goggles or cameras to mechanical shock e VNG goggles are not to be used around explosive gases Patient stimulus relative position and head angles record and tracking VNG Pro has two different kinds of sensors to monitor test conditions Ultrasound sensor to get 3D static patient position relative to visual stimulator It is consisting on ultrasound receptor positioned on to visual stimulator and an ultrasound emitter located on goggles System measures the patient head position relative to the center of visual stimulator Accelerometers to get tilt fr of patient head Three Axis F EN Low g micromachined eS SS T Accelerome
10. ata recorded Saccades 0 2Hz a Analysis Windows Toolbar bottom Home Return Home window Back return previous window Go to select another Window Start Recording video eyes and warning state Next forward window Test review windows operations Show all tests done and allows select each of them to re play records video and the warnings and view their analysis 10 Starting the test Patient Patient Name Chart Number Gender Session Name Date Clinic Doctor Technician Last Name Protocolo Complete First Name 7 DoB 23 07 2012 Unknown f More Session 2012 07 23 10 58 E 23 07 2012 jaaaaa DocApe DocName E TecNom tecApe E Options New O Load Anamnesis Options Analysis Protocol cowe E Support Shut Down 2 To create a session l Enter a patient data required or load a patient file stored For include another data press More 2 Create a new session Once complete the patient data Press Start Session Patient option Ej j More Demographics Data address Phone etc Anamnesis Medical release Anamnesis 11 New patient File Load a patient File stored Session Options ims pis Report View report preview Analysis window A New Session Open a session stored Auto session name Add a new item in the list Toolbar bottom Shut down Close VNG pro Setup Se
11. brief period while eye movements are observed Finally the patient is returned to a sitting position The testing 1s conducted whit fixation suppression This test records the patient position and plotting themself Show e Patient Head Calorics Admistration The patient is placed in a reclining position with his or her head at a 30 angle This position orients the lateral semicircular canals in the most vertical plane Careful otoscopic examination allows the stimulus to be directed appropriately and at an equivalent depth in each ear canal Protocol for caloric stimulation alternating binaural bithermal caloric stimulation includes the following conditions 23 Right ear cool RC Left ear cool LC Left ear warm LW Right ear warm RW During each stimulation the cool or warm stimulus is delivered for a preset time that is determined by the type of stimulus and normative data The countdown timer show the warm or cold stimulation time and recovery times The testing is conducted whit fixation suppression Important It should explore the ears outer and middle before proceeding with the caloric test See Patient Considerations Status of the outer and middle ear Warnings e Head Movements e Head position 30 24 Test Review On this screen you can see list evidence in buttons form The active buttons are those corresponding to the tests done Pressing these buttons you can access to review it Analys
12. comparison the subscale emotional functional physical scores are converted to percentage scores Toolbar bottom 14 Back return previous window Go to select another Window Next forward window 15 Position The flat panel TV is used it should be centered in front of the patient s eyes and because of the reduced distance it becomes extremely important that the distance between the patient s eyes and the screen is kept within close and precise limits For various flat panels TV sizes the following distances between patient s eyes and screen can be setting See Software Setup Advanced Tab Screen VNGPro Head Position Place the patient in the correct position in front of stimulator As the patients distance to the screen is a key part of the geometry to produce the visual stimulation in degrees it should only be changed on purpose But do not worry about to return the chair to its original position in case it has been moved VNG is controlling it all the time Toolbar bottom Home Return Home window Back return previous window Go to select another Window Next forward window 16 Goggles The Video Goggles shall be put in such a way that it fits the patient s face the best possible Both elastic strips shall be firmly fixed to the patient s head To center the image on eye displayed move the mirrors slowly but don t touch it It is advisable that the environment where the study is performed
13. cy direction etc The protocol Tree is similar to the one in Windows Explorer and can consist of up to two levels First Level Displays screen Test Second level Displays description paradigm Velocity frequency Etc for performed tests Hide Tests detail You can hide single tests that belong to a specific protocol so it can be displayed in a more compact form Next to the level to be closed click The tests descriptions that are beneath the corresponding level will be hidden 40 Show Tests detail To show the hidden test click beside the corresponding level The tests description will be shown again E g Saccades 04 Hz 30 Random T aad V Spontaneous 40 ae M Calibration Center Test time 309sec Frequency 0 4 Hz a i Paradigm Ramdom T arate Test Time sec 30 All tests are saved The test disabled unchecked don t be included on the protocol sequence and should use the GO TO function to open this window Ta A gt Edit Allow modify protocols add Remove Move test y or calibration process Except the protocols predefined Move up Move Down Delete Enable Disable 41 New To create a new protocol windows sequence type a name on the fh N textbox and select the Test by type Subtype You can select in the drop down list It is showed below Y Posture Hallpike Phalpike Posture Visual Stimulation Gaze OKN Saccades Smooth pursuit Caloric At AHR Nystagmus Sp
14. d pattern for about 5 second while the calibration proceeds When it is finish the test screen opens automatically Calibration Tell patient to look at the target of the Stimulator The Step progress bar indicates when the step is complete and the Total progress bar when the calibration process is complete Step 2 5 succefully done Calibrating next position T ed 4 ap Toolbar bottom Back return previous window Go to select another Window Next forward window 20 Data acquisitions Spontaneous Admistration Spontaneous nystagmus denotes movement of the eyes without a cognitive visual or vestibular stimulus The tests are conducted with vision occluded and with the eyes on primary position Warnings e Patient position e Head Movements e Head angles Gaze Admistration For gaze testing the patient is instructed to look straight ahead and then to fixate on a target to the right left up and down Warnings e Patient position e Head Movements e Head angles Saccades Admistration For saccadic testing one may place dots on the Monitor at specified distances from each other and then instruct the patient to look back and forth between the dots keeping the head fixed Warnings e Patient position e Head Movements e Head angles 21 Smooth pursuit Admistration The patient is instructed to follow a sinusoidal moving target with his or her eyes only Warnings
15. ding the eyes and head movement The gain phase and THD of the vestibular ocular reflex are analyzed e Gain refers to the ratio of the eye velocity to the head velocity e Phase refers to delay between the head and the eyes movement wave forms normalized to the period and multiplied by 360 e THD Total harmonic distortion It is refer a global measurement to tracking test in frequency and amplitude If the peak is around the target frequency better was tracking 29 Head shaking Nystagmus The head shake nystagmus HSN test is most useful in the assessment of vestibular disorders that produce asymmetries in vestibular function e Nystagmus Count e SPV sec is average slow phase velocity Supine These are VNG test to diagnose BPPV and other vestibular complaints Parameters are calculated for horizontal channel all positions e Nystagmus Count e Latency sec is calculated from the difference in time between head displacement and the onset the first nystagmus e SPV sec is average slow phase velocity Dix Hallpike These are very important as part of the standard VNG to diagnose BPPV and other vestibular complaints Parameters are calculated for horizontal channel both side DixHallpike Right DixHallpike Left e Nystagmus Count e Latency sec is calculated from the difference in time between head displacement and the onset the first nystagmus e SPV sec is average slow phase velocity Caloric The cal
16. dquisition Patient Position Head Angles Head Movements Normal v Pi Tab Screen Installing the Projector Monitor 44 To produce stimulation patterns of correct size position and angle velocity the required information about the geometry of the screen setup in your laboratory These values will have to be updated whenever the projection screen geometry is changed Complete parameters on inch 1 Gnch 2 54cm Warnings Screen Print Report Results Adquisition Horizontal in 14 76 Border in Vertical in Stimulator OK Tab Print Report Check uncheck the items you are want print It is possible change on Print report session Warnings Screen Print Report Results Adquisition M Warnings M Analytic Analysis M Graphic Analysis M Medical Release CPT Code M Dizziness Handicap Inventory Records Only Printing Window M Print Nystagmus Mark 45 Tab Result Time plot displays the history of eye position data The time axis is always horizontal and directed to the right Here you can choose the Time window time axis to be displayed or printed The offset time area relative to the whole area allocated for the chart is defined here and the scrollbar may be used to change the chart visibility Not so in the printing that will print only the defined time window For example OKN Recorded 60 sec Time Viewer 30 sec
17. ease your problem Does walking on uneven terrain increase your problem Does bending over increase your problem Because of your problem do you restrict your travel for duty or recreation Because of your problem do you have difficulty getting into or out of bed Does your problem significantly restrict your participation in social activities Because of your problem do you have difficulty reading Because of your problem do you have someone accompany you when you leave quarters Because of your problem is it difficult for you to take care of yourself bathe dress prepare a meal Because of your problem is it difficult for you to walk around your quarters in the dark All 4 0 oO oO 0l O OA Ob OO oO O ODO Most 3 LJ m Oo oO oO oO oO OO Ob oO oO O OO 2 E m Oo 0 oO oO oO oO oO Ob OO oO O OO Some Never 0 E Ll Oo 0 oO oO oO oO oO Ob OO oO O OO 56 F15 F16 Because of your problem is it difficult for you to go for a walk by yourself F17 Because of your problem is it difficult for you to walkup and down stairs F18 Because of your problem do you avoid driving your vehicle in the dark F19 Does your problem interfere with your job or your military duties F20 Because of your problem is it difficult for you to concentrate E21 Because of your problem do you feel frustrated E22 Because of your problem are you afraid to stay home alone
18. eye movement is to fixate visually both quickly and accurately on a new object The eye movement should be equal in amplitude to the distance between the former object of interest and the new target 28 Smooth pursuit The smooth pursuit system is responsible for following targets within the visual field Care should be taken in interpreting smooth pursuit test results in geriatric and pediatric patients Tracking is also affected by attention and patient cooperation Gain Phase and THD should all be taken into consideration when interpreting smooth pursuit e Gain refers to the ratio of the eye velocity non saccadic to the target velocity e Phase refers to delay between the target and the tracking wave forms e THD Total harmonic distortion It is refer a global measurement to tracking test in frequency and amplitude If the peak is around the target frequency better was tracking OKN For optokinetic testing the patient tracks multiple stimuli Gain and Asymmetry should all be taken into consideration when interpreting OKN e Gain refers to the ratio of the eye velocity to the target velocity e Asymmetry refers to gain significantly worse in one direction than another Active head rotation AHR The vestibular autorotation test provides a measure of vestibular function during active head rotation As such it is a test of canal function during natural active movement a common situation for patients This test 1s performed recor
19. fect ENG test results for 72 hours post ingestion results are unpredictable because alcohol can be an agonist or antagonist Patient preparation Inform patients that VNG may cause dizziness nausea or both Patients should be advised to limit food intake prior to examination and arrange for transportation after the examination which usually takes 1 1 5 hours For many parts of the test mental tasking 1s necessary to prevent central suppression of responses If the examiner does not speak the patient s language or the patient is hearing impaired an interpreter may be necessary to assist in giving instructions explanations and mental tasking VNG pro Considerations This algorithm accuracy depends on several factors The eye image quality e An accurate eye detection procedure training during the installation e The patient s co operation blink keeping eyes open wearing no eye makeup others e The calibration process Recorded eye angles and patient sensors will be processed according type of test Software collects on real time this data Right Left eye images eye position velocity Stimulator target position Patient position Warning Position Head angles sensors Warning Movement Angles Warnings 1 Relative subject position to the visual stimulation to achieve desired stimulus 2 Head angles 3 Head tilt Warning State on recording es o Wrong Warning State Analysis n Green
20. fessional opinion To enter manual editing mode click the edit mode button the Edit Toolbar will appear In this mode graph displayed the Horizontal Channel alone The Nystagmus analysis show in properties chart The slow phase and fast phase detected and the criteria used to determine to the nystagmus existence v Automatic edition Sensitivity Move the slider to increase or decrease sensitivity and re analyze Fy the record again v Manually Detection Original beats collected are shown Click on the set nystagmus marks to view its Show parameters Step by Step Add 1 First click display a message on the criteria used to exclude this nystagmus second Click Set nystagmus Start Third Click Set Nystagmus End Delete Click over Nystagmus to remove it It is not contributing to the analysis 34 iz 30 Horizontal Slow Phase Detection Start End Height Velocity Average Error Maximum Error L C Coefficient Cancel Fast Phase Right Part 0 Start End Height Velocity Average Error Maximum Error L C Coefficient Part 1 Start End a sensitivity G 1 __ O A Re Analyze Criteria First Order Segmented Search Minimum Jump Loc Width Relative Jump Velocity I Coefficient Isolated Noise Toolbar Cancel Nystagmus edition or modification will be disregarded Ok New edition will be saved 35 Create print windows To print one or m
21. is Saccades Dix Hallpike Toolbar bottom Exit quit the window a T m _ Optokinetic Spontaneous a 25 Analysis The test will be opened and test data will be displayed in the test analysis window Smooth Pursuit oi 028 03 O4 rget o5 06 OF O 09 03 O4 05 06 OF O8 09 Target Prequer z y Hz Frequency Hz Target Prequency Hz On Textbox down select the current record to display To view Horizontal or vertical channel alone click on it Zoom out Zoom in Time scale Zoom out Zoom in amplitude Scale 26 Edit Nystagmus manually When reviewing an editable test you can click on edit Icon to open the Edit mode and display the Edit toolbar The Edit icon appears example from Caloric test See Edit Nystagmus Tab graphical analysis Graphs that display the measuring process over time are shown in the bottom of the window Those graphs that show analyzed Ag data e g the Gain in the smooth pursuit test The abnormal threshold is the dotted gray area See ABNORMALITY THRESHOLD The software displays all test information in a single display screen This allows the user to simultaneously view the data collection along the analysis displays In each measurement diagram you can maximize and minimize the display of the measured data by using the zoom option Tab Plot the head trajectory in each Cartesians dimensions x y Z Tab warning and eyes display Toolbar bot
22. is dark or it is possible the goggles are occluded in order to avoid fixing due to light filtration in the case of caloric tests or lack of concentration in the case of visual stimulation tests Setup goggles Tell patient to look at the target of the Stimulator Setup goggles and mirrors so the pupils matches the image center Verify that the warnings are OK Press Next to continue or press video button to receive a detailed instruction iy View Demo Video Toolbar bottom Home Return Home window Back return previous window Go to select another Window Next forward window 17 Angles Head Angle Verify the angles of the patient s head Toolbar bottom Home Return Home window Back return previous window Go to select another Window Next forward window 18 Eyes selection It especially relevant for the settings in the Test define which eye s record to analyzing VNGPro Eye Selection Select eye to analyze Select eye with best vision Toolbar bottom Home Return Home window Back return previous window Go to select another Window Next forward window 19 Calibration On protocols setting are determine what stimulus type you want to use for calibration Center right left down and up If you check the Perform Calibration option a calibration will be performed before test recording is started Request the patient to fixate upon points that are projected onto a monitor in a pre define
23. ontaneous Questionnaire DHI DHI military Demonstration Position Angles Goggles LYNN NNN Y Configuration Eyes selection Test selection Calibration v CUSTOM Set your calibration criteria vertical horizontal center in the list order it considers appropriate v AUTO recommended In this mode the calibration algorithm will proceed automatically through the whole calibration sequence by criteria It s set before visual tests and after in which test the patient s head has been moved e g Posture Test Type soft normal hard perform the calibration more or less strict way Your Protocol is now fully programmed for VNG testing Store it and you can start testing or calibration process VNGPro Protocol Name My protocol Options Tests Calibration gt F Gaze 80 E Hallpike Left 100 PreStimulus sec 10 Type Normal Add PostStimulus sec 60 PostReturn sec 30 Test Stimulus Left twee SO Type Posture SubType Hallpike 7 Add Parameters Stimulus Let PreStimulus sec 10 4 gt PostStimulus sec 40 lt gt PostReturn sec 30 lt gt Total Test Delete Erase the selected protocol 43 Advanced Toolbar Back return previous window Default Reset all parameters Save and Exit Store all new parameters and coming back to previous window Tab warnings Select the warning control Soft Normal Hard Warnings Screen Print Report Results A
24. ore specific sections of the record plotted follow these steps 1 Add a print area Click of the graph in it will appear clasps to enclose the selected area 2 Move a print area Click on the graph locate the print area on the desired record part 3 Delete a print area Click on the center of clasps to delete it This out areas to be print by Only printing window option Calorics Parameters Abs Prep Dir Prep Right Beating Left Beating Symmetry Right Ear Left Ear 30 Velocity s 36 Software Setup VNGPro Setup Groups Management Database Protocols 4 ie x AL wire Advanced Hardware and Clinics Here you can add or remove items Lists Edit the list to be available in patient records Doctor Administrators 37 2 lt Management database Database Management FirstName Chart j m Walter Date Session S 17 07 2012 New Session 17 07 2012 S1 17 07 2012 So wa Delete patient file Delete patient session List Filter Search a inside the patient list By e Chart e Last name e First name E Delete 4 List Filter a S Delete ww View Sessions by Patient PF Last Name First Name List Filter 38 39 7 ka Pd Protocol You can see predefined and Add new research protocols VNGPro Protocol Options Detail Right Toolbar AI Details Show the test description Time frequen
25. oric tests evaluate the viability of the peripheral end organs by stimulating them with warm and cool water or air The resulting dizziness and nystagmus is taken as an index of the viability of the organ The culmination phase area 1s automatically defined Nystagmus that lie outside the area does not contribute to the analysis e Time SPV show the slow phase velocity evolution of the tests performed To be able to appreciate the test symmetry it 1s possible to generate an interpolating line that automatically fits 30 Freyss graph show the frequency Hz and slow phase velocity s as well as absolute and directional preponderance data right and left nystagmus beats symmetry frequency and slow phase velocity for each ear Parameters show the absolute and directional preponderance data right and left nystagmus beats symmetry frequency and slow phase velocity for each ear Unilateral weakness RF44 RE30 1 F44 I F3MA x100 RE44 RE30 LE44 LE30 Abs Prep RE44 LE30 RE30 LE44 RE44 RE30 LE44 LEI30 Dir Prenonderances RF44 1 F30 1 F44 RE30 x100 RE44 RE30 LE44 LE30 Right Beat RE44 LE30 Left Beat RE30 LE44 Right Ear RE44 RE30 Left Ear LE44 LE30 31 Report The VNG system gives you the multiples printing option VNGPro cain cen A Settings lt M Edit Analysis Page 2 3 Settings v Graphics graphical analysis v Medical
26. responding to the intensity measure of a bilateral isotherm cold or hot are thus connected defining a straight line and the equation may be represented as y a x b whose slope is positive for cold tests and negative for hot tests Once the four tests are completed then the intersection point projections in X and Y of both straight lines represent the following two results In the vertical projection the lateral symmetry value or channel paresis X is represented in percentage If the nystagmus direction for each of the four tests 1s as expected then you may use the traditional Jongkee s formula RE44 RE30 LE44 LE30 x100 RE44 RE30 LE44 LE30 In the horizontal projection the absolute preponderance Y is calculated using the following formula RE44 LE30 RE30 LE44 RE44 RE30 LE44 LEI30 52 The hyper or hyposensitivity condition for each ear is assumed from segment length covered by the butterfly wing in the axis x 100 for the right side and x 100 for the left side Freyss diagram for slow phase speeds The diagonal intersection coordinates represent the unilateral weakness calculated using Jongkee s formula The absolute directional preponderance is not shown as a percentage but as an absolute value in degrees per second This format offers different advantages as the ability to compare the preponderance speed against the speed of any nystagmus that may be present The relati
27. s on the physical emotional and functional aspects of daily activities and there are mow three possible answers yes Sometimes and no to each question The maximum total score indicating maximum handicap is 100 There are seven questions that comprise the physical subscale maximum score of 28 and nine questions each on the functional and emotional subscale maximum scores of 36 For ease of comparison the subscale scores are converted to percentage scores See appendix Dizziness Handicap Inventory Data acquisition windows operations Display on real time eyes position or velocity graphically and the target line whose plot is comparation criteria The graphical outputs which are frequently employed to evaluate results The eye position or speed sec is plotted against time whose description is the following e Plot Horizontal position vs time on a Cartesian arithmetic coordinate scale Green Line e Plot Vertical position vs time on a Cartesian arithmetic coordinate scale Blue line e Target position Red line Below the window are the test warnings and also are displayed the eyes video When the subject is ready press the Start button to record the test Tests have a configurable time limit and they will stop automatically However you can stop a test manually at any time pressing Next or Go to buttons For each test recorded data and video are saved If restart the test done it is overwriting d
28. t position or movements head In general all windows have a bottom toolbar where the controls that allow forward the Next Back return to Home and Go to a particular window and a toolbar that allow perform actions on the window itself In some cases VNG PRO advances to the next window automatically upon the occurrence of the event expected This action can be scheduled See Software setup Tab Acquisitions The VNG Pro user interface is available in English New patient To Create Patient File required enter First name last name chart birth of date DOB gender and more data optional Naming session as you can have multiple sessions for the same patient Select the test protocol to perform see Software Setup Protocols Opening an existing file Press Load button and select the patient on the list and open the File Opening an existing session For the patient press Load session button and select the session on the list and open the File Starting a test When you have completed patient data and the session can begin the study VNG PRO will instruct you step by step in a simple and safe way to perform the tests programmed Dizziness handicap Inventory The dizziness handicap inventory DHI is an optional 25 item questionnaire which was designed to measure the self perceived disability or handicap caused by symptoms of dizziness or imbalance The individual questions are designed to address the impact of the symptom
29. t to assess the patient prior to head hanging or Dix Hallpike maneuvers This may include having the patient engage in mental tasking e g counting reciting multiplication tables while gradually tilting the head back and then holding Change in cognitive status or reports of lightheadedness may be significant This screening method 1s especially important for older patients Status of the outer and middle ear This should be evaluated prior to caloric assessment Presence of drainage in the outer ear canal precludes the use of water irrigation it may also affect air caloric stimulation because moisture will change the calibrated temperature thus limiting interpretation Pressure equalization tubes or perforation of the tympanic membrane precludes the use of water calorics If unilateral large perforations limit interpretation of air calorics Large perforations can increase stimulation with cool air above calibrated expectation and can exhibit a cooling effect for warm air because moisture of the middle ear mucosa is evaporated Excessive cerumen must be removed prior to any vestibular stimulation Middle ear fluid affects stimulation of the vestibular system with air and water Medications Many medications can affect test results With physician approval patients should discontinue all medications unless contraindicated for 24 72 hours prior to testing Any medications taken should be clearly noted on the test results Alcohol ingestion can af
30. ter is used as tilt Gri _ St sensor measuring gravidity pS E f vector projection at each axis aa eae is 4 AL E and convert it in angles These sensors are just intended to help trained doctor to positioning patient in right place and with right head angles for each type of test and keeping a record of these parameters Never are intended to use these sensor s data into test analysis just to monitor test conditions Depending of test type host software indicates to hardware witch sensor monitor for example if an optokinetic test will be performed patient needs to use visual stimulator so system active ultrasound sensors to monitor patient relative position respect stimulator to achieve desired stimulus System Description System requirement e PC Intel core2 duo 2 GHz 2GB RAM Video card with 128MB dedicated memory Hard Disk 250GB USB Port 2 0 e Supported Operating Systems Windows XP SP2 Operating System Windows Vista Business SP1 Windows Vista Ultimate with or without SP1 Windows 7 32 amp 64 bit DirectX and Windows Media distribution Patient Consideration Vision Patients must have adequate vision to follow targets for the oculomotor portion Physical status If the patient has back or neck injuries consideration should be given for some positional testing head hanging and the Dix Hallpike maneuver to avoid further complications To screen for vertebrobasilar insufficiency the clinician may wan
31. tom Back return previous window Play Replay the test done record warnings and videos 27 General In this section you will find the information needed to understand the data displays and analysis options Spontaneous Spontaneous nystagmus This may indicate either central or peripheral pathology The presence of nystagmus with eyes open is always diagnostically significant e Nystagmus Count e SPV sec is average slow phase velocity Gaze These nystagmus tests document and measure the inability of the eyes to maintain a static position Nystagmus and slow phase velocity are evaluated for each position e Nystagmus Count e SPV sec is average slow phase velocity Saccades Saccadic test results are influenced by patient cooperation and visual acuity Velocity latency and accuracy should all be taken into consideration when interpreting saccades e Velocity sec is approximately proportional to saccadic amplitude for sizes 5 and 20 After amplitude reaches 20 saccadic velocity undergoes a soft saturation with respect to further increase in amplitude Velocity asymptote 1 e 7 The usual upper limit for saccadic velocity is about 750 sec and the lower limit is set at 350 sec e Latency msec is calculated from difference in time between target displacement and the onset of the first saccade toward the new target position e Accuracy keeping in mind that the goal of a saccadic
32. tup hardware and software Support Request technical support remote if it is available or by email Start session 12 Custom Protocol Shows sequence of the windows to follow The list includes patient preparation calibration and test All are included in the protocol you selected See Software Setup Protocol You can remove some items unchecking them These changes do not be saved Custom Protocol MTest Selection Eyes Selection M Calibration Center Horizontal and Vertical 30 MOKN Horizontal Left 30 s 25 MOKN Horizontal Right 30 s 25 M Calibration Center MHallpike Left 100 M Calibration Center MHallpike Right 100 View Detail Test View detail Test allows look more data Test Frequency direction Time etc Toolbar bottom Home Return Home window Back return previous window Go to select another Window Next forward window 13 Dizziness handicap inventory mon It is and optional questionnaire There are three possible answers yes sometimes and no to each questio VNGPro Dizziness Handicap Inventory n 1 Does looking up increase your problem Y es S ometimes N o er Automatic Press the answer button or type the letters Y yes S Sometime or N No Dizziness Handicap Inventory Military have four choices But it work the same way a Automatic Next question is automatic checked or Manually For ease of
33. u afraid people may think you are intoxicated F16 Because of your dizziness is it difficult for you to go for a walk by yourself P17 Does walking down a sidewalk increase your dizziness E18 Because of your dizziness is it difficult for you to concentrate Because of your dizziness is it difficult for you to walk F19 around your house in the dark 20 Because of your dizziness are you afraid to stay home alone E21 Because of your dizziness do you feel handicapped E27 Has your dizziness placed stress on your relationships with members of your family or friends E23 Because of your dizziness are you depressed F24 Does your dizziness interfere with your job or household responsibilities P25 Does bending over increase your dizziness Score Functional Emotional POV SICA Siesa CO 0 oO oO O OO oO oO O DO Oo 0 oOo oO oO oO gp oO oO oO oO O Total Score 0 0 oO O 0 Oo oOo 0 0 Oo DO 55 Dizziness Handicap Inventory Military Pl P 2 P3 P4 P5 P6 P7 F8 F9 F10 Fl F12 F13 F14 Does looking up increase your problem Does walking down the aisles of the commissary or PX without a cart increase your problem Does performing more ambitious activities like sports dancing or military common duties tasks increase your problem Do quick head movements increase your problem Does turning over in bed incr
34. ve directional preponderance is also shown in since this format is more familiar 53 Dizziness Handicap Inventory Civil Yes 4 P1 Does looking up increase your problem c Because of your dizziness do you feel frustrated E2 L Because of your dizziness do you restrict your travel for F3 l l business or recreation 0 PA Does walking down the aisle of a supermarket increase your dizziness Because of your dizziness do you have difficult getting F5 C into or out bed Does your dizziness significantly restrict your F6 participation in social activities such as going out to C dinner going to the movies dancing or going to parties F7 Because of your problem do you have difficulty reading C Does performing more ambitious activities like sport P8 dancing or household chores such as sweeping or putting 0 dishes away increase your dizziness Because of your problem are you leave home without E9 l having someone accompany you Because of your dizziness have you been embarrassed in E10 front of others p11 Do quick movements of your head increase your dizziness F12 Because of your dizziness do you avoid heights oo oO 0 OO P13 Does turning over in bed increase your dizziness Some 3 0 oO l l No 2 0 oO oO O UD Because of your dizziness 1s it difficult for you to do E14 strenuous housework or yard work E15 Because of your dizziness are yo
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