Gaze Stabilization Test in a case of concussion

In this video you will see Dr Katherine Beckwith using the Gaze Stabilization Test (GST) to measure the function of VOR in a case of a patient with concussion following a head injury. You will see techniques for performing the GST and a discussion of results also takes place.

You can read the full transcript below.

Patient's history

So the patient we're seeing today is a young and active 26-year-old male who enjoys outdoor activities such as rock climbing. Unfortunately, a few days ago, he did have an accident that resulted in a head injury. At that time, he was seen at the emergency room and presented with dizziness, nausea and fatigue.

It's been a couple of days since he was seen in the emergency room. So we're going to do some testing to see where he's at, at this point.

Patient's symptoms

Hey, Ted, thanks for coming in today. I looked over your chart. It says you're 26 and that you had an accident recently, where you hit your head. Is that correct?

Yeah. This weekend, I was rock climbing and I fell, and I hit my head went to the ER because I was throwing up it was really, really bad. So that was about two or three days ago. So I still have a bunch of... definitely pain and dizziness, especially when I move my head too much. Yeah.

Okay, great. Well, let's do some testing today to see how you're doing.

Placing the headband

All right, so I'm just getting the sensor off of the charger. I'm gonna turn it on and the sensor is gonna go on this headband. So and then the headband is gonna go around your head, we can tighten it up as we need to.

And what's nice about this is you can leave your glasses on. So that's gonna sit set up nice and tall for me looking straight ahead. Perfect. And let's make sure that's centered there. There we go. Now I'm gonna tighten it up. Let me know when it feels secure. Okay, okay, perfect.

Patient instructions

Okay, so for the test, I'm going to give you this remote control. And what's going to happen is the first trial that we're going to do, you're going to keep your head still, you're going to see a box on the television and inside the box, there is going to be an optotype, to you, it's going to look like a bracket.

Your job is to tell me which way the opening to the bracket is facing. Is it facing up, to the right, down, or to the left. When you decide that you're going to press which direction that opening is on your remote control.

So up, right, down, or left. After that, we're going to do a couple with me moving your head at a certain speed or a certain velocity. And again, your job is just to tell me which way the bracket is facing. If you don't know, I don't want you to guess. You can just tell me I don't know, and I'll enter that for you.

Trial 1: Head still

Okay, as a reminder for this portion of the test, you're going to keep your head still. Inside the box that's on the television, the bracket is going to show up, it'll be either opening to the top, to the right, to the bottom, or to the left. You're going to use the remote control to press which way the bracket is opening. If you're not sure that's okay, let me know and I can mark that on the computer for you.

Okay, all right. Here we go. Perfect. All done with that portion.

Trial 2: Head moving rightward

So for this one, I'm gonna be moving your head side to side to the beat of the metronome. Your job is the same though you're going to use the remote control to indicate which way the bracket is opening. Again, if you're not sure let me know and I'll mark that on the computer.

Trial 3: Head moving leftward

All right, we're gonna do that one more time.

Trial 4: Head moving downward

Okay, so for this one you're going to be turning your head up and down. I'm gonna have one hand on the top of your head and one hand underneath your chin. Again, your job is just to indicate using the remote control which way the bracket is opening.

Right very good. All right, we're gonna do that one more time again.

Trial 5: Head moving upward

I don't know. Can we take a break? Yeah, just need a break. All right, we're gonna go ahead and try that again if you're ready. Okay. Same thing your head is going to be moving up and down. Your job is to tell us which way the bracket is facing.

I'm feeling too sick. Can we take a break? I can't do it. Okay, that's okay. Very good. All right.

Test results

So these are your test results from today. When your head was moving to the right, you did really well. When your head was moving towards the left you had a little bit of difficulty identifying which way the bracket was facing. When we moved your head up and down, you had a little bit more difficulty as well. And there was the one test that we weren't able to complete.

This information is really good because we can use this to come up with a treatment plan and then modify some home exercises for you and then when you come back, we can retest this to see the progress that you've made.