Computerized dynamic posturography in a dizziness clinic – The Vancouver experience

Abstract

Introduction Computerized dynamic posturography (CDP) was developed by Nashner 30 years ago as a diagnostic tool and is now an important technique in therapeutic management of a patient. In Vancouver, CDP is a very important aspect of our diagnostic armamentarium. It serves as a very sensitive method of documenting balance system pathology. CDP is also very useful in documenting pathology and legitimizing complaints in the medical legal patient and also evaluates any aphysiological performance. Material and methods Patients referred to our tertiary care diagnostic undergo CDP assessment. It is helpful in documenting a balance system deficit, and also shows how and how well a patient has compensated. CDP also can recreate symptoms in a patient and this is extremely helpful diagnostically. Results Subtle complaints of vestibular origin are often referred to as “visually induced dizziness”. Patients often have symptoms such as nausea, sweating, a swaying sensation, or tiredness. However, they often emphasize that they are not noticeably off balance, and all standard tests including CDP are often normal. Although it is helpful to rule out severe pathology and/or suggest effective compensation for an undetectable deficit, a normal assessment sometimes leaves patients (and clinicians) frustrated. Discussion–conclusion A normal CDP is still very helpful because a patient's complaints are often reproduced by CDP. This suggests that the complaints are from the balance system, and in the absence of any complaints of rotatory vertigo, are probably otolithic in nature. Patients often benefit when they are reassured that their symptoms are real, are coming from the balance system, and are not psychiatric in nature. In the medical legal setting, CDP is also extremely helpful in assessment of the medical legal patient, both in legitimizing complaints and also in detecting any patterns of aphysiologic behavior.