The HS-SOT is a two-condition enhancement to the standard SOT that is appropriate for patients who perform within the normal range on the standard SOT, yet remain symptomatic.
15 minutes
Adult
18 - 64
yearsElderly adult
65 +
yearsInitially reviewed by Elizabeth Dannenbaum, MscPT for the Vestibular EDGE task force of the Neurology section of the APTA.
Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association’s Multiple Sclerosis Taskforce (MSEDGE), Parkinson’s Taskforce (PD EDGE), Spinal Cord Injury Taskforce (PD EDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (Vestibular EDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.
For detailed information about how recommendations were made, please visit:
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Abbreviations: |
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HR |
Highly Recommend |
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R |
Recommend |
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LS / UR |
Reasonable to use, but limited study in target group / Unable to Recommend |
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NR |
Not Recommended |
Recommendations for use based on acuity level of the patient:
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Acute (CVA < 2 months post) (SCI < 1 month post) (Vestibular < 6 weeks post) |
Subacute (CVA 2 to 6 months) (SCI 3 to 6 months) |
Chronic (> 6 months) (Vestibular > 6 weeks post) |
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Vestibular EDGE |
LS |
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LS |
Recommendations based on vestibular diagnosis
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Peripheral |
Central |
Benign Paroxysmal Positional Vertigo (BPPV) |
Other |
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Vestibular EDGE |
LS |
LS |
LS |
LS |
Recommendations for entry-level physical therapy education and use in research:
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Students should learn to administer this tool? (Y/N) |
Students should be exposed to tool? (Y/N) |
Appropriate for use in intervention research studies? (Y/N) |
Is additional research warranted for this tool (Y/N) |
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Vestibular EDGE |
No |
No |
No |
Yes |
All the studies investigated the HS-SOT with people doing a yaw movement. No studies were found investigating the psychometric properties when pitch or roll head movements were performed.
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(Pang et al., 2011)
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Minimal Detectable Change Value
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Young Adults < 50 y.o, n = 92 |
Older Adults > 50 y.o, n = 73 |
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Condition 2 |
2.7 |
3.6 |
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Condition 5 |
16.2 |
22.7 |
(Pang et al., 2011)
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Equilibrium Score (%) Mean (SD)
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Young Adults < 50 y.o, n = 92 |
Older Adults > 50 y.o, n = 73 |
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Condition 2 |
92.6 (2.3) |
91.7 (2.3) |
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Condition 5 |
56.0 (12.7) |
47.0 (14.2) |
(Park et al., 2012)
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Equilibrium Score (%) : Mean (SD)
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Young Adults 20-49 yo n = 36 |
Adult 40-59 yo, n = 36 |
Older Adults 60-79 yo, n = 30 |
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Condition 2 |
91.38 (2.38) |
88.75 (5.06) |
84.83 (7.59) |
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Condition 3 |
39.20 (10.77) |
32.88 (12.33) |
19.10 (7.01) |
(Pang et al., 2011)
Younger adults: excellent test –retest reliability for HS-SOT condition 2 and condition 5 (ICC (3.2 > 0.75). Older adults moderate to good test-retest reliability (ICC(3.2) > 0.50).
(Pang et al., 2011; Park et al., 2012)
In healthy adults and older adults the HS-SOT scores were significantly lower than the respective SOT scores : condition 2: p = 0.01, condition 5 p < 0.001
(Lim et al., 2012)
Compared the Dizziness Handicap Questionnaire (DHI) with the SOT and HS-SOT in follow up of patients with unilateral vestibular neuritis (n = 32) finding:
(Mishra et al., 2009)
HS-SOT has poor sensitivity and specificity in identifying people with unilateral caloric weakness.
(Honakar et al., 2009)
Suggested modifying the head shake SOT by adding head displacements at 15 deg/sec and 120 deg/sec, as well as the traditional 60 deg/sec. Healthy adults were tested (n = 40), Wilcoxon signed-ranks test showed significant differences in the performance by varying the speed of head movement. They suggested testing with these additional head speeds would eliminate the floor and ceiling effect noted by Mishra et al. (2009).
Lim, H. W., Kim, K.-M., et al. (2012). "Correlating the Head Shake–Sensory Organizing Test With Dizziness Handicap Inventory in Compensation After Vestibular Neuritis." Otology & Neurotology 33(2): 211-214.
Mishra, A., Davis, S., et al. (2009). "Head shake computerized dynamic posturography in peripheral vestibular lesions." American Journal of Audiology 18(1): 53.
Pang, M. Y., Lam, F. M., et al. (2011). "Balance performance in head-shake computerized dynamic posturography: aging effects and test-retest reliability." Physical Therapy 91(2): 246-253.
Park, M. K., Lim, H.-W., et al. (2012). "A head shake sensory organization test to improve the sensitivity of the sensory organization test in the elderly." Otology & Neurotology 33(1): 67-71.
We have reviewed more than 500 instruments for use with a number of diagnoses including stroke, spinal cord injury and traumatic brain injury among several others.