VNG analysis
16 Pages

VNG analysis

Course Number: AUD 831, Spring 2010

College/University: A.T. Still University

Word Count: 1944

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Principles of VNG Analysis Amanda Cerka Mroz, M.A., CCC-A Principles of VNG analysis 1. Set up for success 2. Clean up responses 3. Assess each result 4. Check your work 3 1. Set up for success Goggle placement Optimal data collection depends on optimal camera positioning! Video adjust Calibration Range 4 1 Goggle placement 1. Click on Video Adjust View eyes while placing the camera 2. Loosen the...

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of Principles VNG Analysis Amanda Cerka Mroz, M.A., CCC-A Principles of VNG analysis 1. Set up for success 2. Clean up responses 3. Assess each result 4. Check your work 3 1. Set up for success Goggle placement Optimal data collection depends on optimal camera positioning! Video adjust Calibration Range 4 1 Goggle placement 1. Click on Video Adjust View eyes while placing the camera 2. Loosen the back and top headbands on the goggles 3. Place the goggles on the bridge of the patients nose and pull the back headband over the patients head 4. Position the goggles so that pupils are center and level 5. Tighten the headbands Goggles should be snug; patient may have raccoon eyes afterwards 6. Fine-tune the positioning with the knobs (H,F,V) 5 Goggle placement Horizontal Horizontal knob: adjusts the distance between the cameras Focus Focus knob: adjusts the distance between the cameras and the patients pupils Vertical knob: adjusts the camera up and down *Most commonly used Vertical 6 Goggle placement tips Position the back headband as low as it can go Below the inion if possible The two straps of the back headband may be positioned so that one is above inion and other is below Make sure the top headband is straight Generally need to leave this with as much length as possible The top headband can assist with raising and lowering the goggles on the patients face 7 2 Video Adjust Auto-adjust is a good place to start Manual adjust should be used for optimizing the image Brightness and Contrast can be done individually or for both eyes together; Threshold affects both eyes Adjust Both Eyes is for manual adjustment of Brightness and Contrast 8 Video Adjust Poor video adjustment = Poor tracing 9 Video Adjust Watch the crosshairs as patient moves eyes side to side, up and down Make sure crosshairs stay with pupils at extreme positions 10 3 Video Adjust tips Dimly lit room is best for software to differentiate between pupil and iris Light will affect softwares ability to auto-adjust If there is a lot of light in the room, do the auto and manual adjust with the goggle cover closed Adjustment settings are kept between patients Auto-adjust not necessary for each patient Manually tweak to optimize Consider obtaining: Make-up remover White eye-liner pencil Eyelash curler 11 Calibration Calibration adjusts the recording system so that deflections correspond to amplitude of eye movements The position of the patient in relation to the light bar affects the amount of eye movement required to follow the calibration stimulus The required distance is 4 feet Software assumes this distance during calibration Sets outermost light at 30 degrees right/left (used for Gaze) Acceptable range 38 to 44 Range function on light bar monitors distance during testing 12 Calibration Can be done with tracking or saccadic stimulus ICS Chartr 200 uses tracking stimulus (+/- 10 degrees) Instruct the patient to follow the target and only move his/her eyes Start the calibration and wait for the target and tracing to match up When at least one good cycle has recorded, click on Accept and the calibration will be immediately applied Record 2 more cycles to verify calibration 13 4 Calibration: GOOD A signals the point at which Accept was clicked 14 Calibration: GOOD 15 Calibration: POOR 16 5 Calibration tips Calibrate once for VNG Recheck/redo calibration if goggles are removed and replaced Be aware of goggle position while moving the patient Avoid using the default horizontal calibration No one is average Speed doesnt matter, so its okay to slow down the stimulus if software allows it Chartr 200 defaults to 30 deg/sec Option to slow to 20 deg/sec 17 2. Clean up responses Know what youre measuring Delete stray data points Verify measurements Identify the peak of the response 18 Understand what youre measuring Slow phase Fast phase Looking for nystagmus presence, absence, status change Intensity of nystagmus Determined by the slow phase What is the Slow Phase Velocity (SPV)? Direction of nystagmus Determined by the fast phase Is it horizontal, vertical, or torsional? Latency and duration of nystagmus When does it start and how long does it last? 19 6 Delete stray data points 20 Verify measurements Spot-check computers measurement of nystagmus at logical points throughout the response Scroll through measured beats Click on waveform in desired spot to measure any beat Press Ctrl and R/L arrow keys to adjust amplitude of measured beat or measure new beat Click on Insert to make measurement permanent For changing measurement AND for adding a new beat 21 Verify measurements Must click on Insert to change or add a measurement 22 7 Verify measurements Assign primary Allows operator to select which test will print with report or which caloric irrigation will be included in the Pods/Butterfly Example: The operator tested RW twice because the first response was smaller than expected Rename tests Allows operator to change the test name when data were collected in the wrong place Example: The patient was positioned as body left but the operator accidentally recorded it in body right 23 Identify the peak of the response Locate Peak: computer picks the peak of the response Set Peak: operator picks the peak of the response Click on a beat at the peak of the response Click on Set Peak The peak of the response is an average of beats Software defaults to averaging 3 beats, but can be adjusted up to averaging 10 beats for each peak The average is taken from the (3) largest beats in the 10-second window around the chosen beat 24 Identify the peak of response Selected the beat Peak of response 25 8 Identify the peak of the response Beat SPV Peak SPV 26 3. Assess each response Analyzing Saccade and Tracking results Analyzing Optokinetic (OPK) results Analyzing Gaze and Positional results Analyzing Caloric results 27 Analyzing Saccade and Tracking results Delete stray data points Need enough raw data points accepted to have at least 3 averaged points for movements in each direction (leftward and rightward movements) Normative data depends on the age of the patient Ages 10 and older Normative data from ENG testing Data points will be rejected if the patient response is too far off of the target Not paying attention Anticipating the target 28 9 Analyzing Saccade and Tracking results Time Anticipating target No data points 29 Analyzing Saccade and Tracking results Patient moving head to follow target Operator reported patients eyes were barely moving! 30 Analyzing Saccade and Tracking results Patient not attending to the task 31 10 Analyzing Optokinetic (OPK) results The appearance of the nystagmus will vary according to directions given Watch each dot as it goes through the center Follow the dot from one side of the light bar to the other The patient should perform equally in each direction Nystagmus SPV should be greater than 75% of the target velocity for each direction For stimulus at 40 deg/sec, patient should perform at 30 deg/sec or better in each direction Analyze the patients best performance 32 Analyzing Optokinetic (OPK) results Follow the dot Watch the center 33 Analyzing Gaze and Positional results Scroll to where analysis should begin, then click Begin Allows analysis for 140 seconds after the Begin point Delete beats that are likely artifact Disorders result in consistent abnormalities Artifacts are common if patient is not attending to the task Measure and insert data points Locate or Set peak 34 11 Analyzing Caloric results Scroll to where analysis should begin, then click Begin Allows analysis for 140 seconds after the begin point Delete stray data points Normal caloric response will grow and subside gradually Onset of fixation light can cause eyes to jump Measure and insert data points Locate or Set peak 35 Analyzing Caloric results 36 Analyzing Caloric results Warm Right Left 27 49 Cool 31 28 Difference 4 21 The warm/cool results for each ear should be similar If Left Cool were 49, then there would be a UW of 26% If Left Warm were 28, then the results would be WNL The computer will not make this decision for you 37 12 4. Check your work Cross-check key elements Patient information Tracking and OPK Gaze and Positionals Positionals and Calorics Interpretation Assistant Positionals Calorics 38 Use patient information to check results Compare results with patients description of problem Does the problem occur upon standing up quickly? Does the problem occur upon rolling over in bed? Is the problem described as a general imbalance? Compare results with patients subjective responses Does the patient report feeling dizzy during any particular test? Compare results with patients health history Is the patient taking seizure medications? Anti-depressants? Has the patient suffered a head trauma in the past? Is the patient an alcoholic? 39 Check Optokinetic (OPK) results with Tracking results OPK tested on a light bar tests visual pursuit system Results (normal/abnormal) should be consistent with tracking findings If OPK results dont match tracking results Did the patient have trouble understanding the directions? Did the patient have trouble attending to the task? Can the patient do the task at a slower rate? If the patient can do the OPK task long enough to get 5-6 beats in a row, you can stop the test Theres no need to run it for a long period 40 13 Check Gaze results with Positional results If Gaze testing reveals some nystagmus with vision, try testing without vision Does the nystagmus get larger when vision is denied? Does the nystagmus stay the same or get smaller when vision is denied? You should see the same nystagmus in the positional testing with vision If you dont see it initially in the positionals with vision, ask the patient to look at a particular point Intentional gaze in Gaze and Positional testing should match 41 Check Positional results with Caloric results Spontaneous nystagmus Nystagmus that beats in the same direction with same amplitude in all positions This bias creates a directional preponderance in the caloric testing Baseline shift to account for it Any bias left after shifting baseline is true Gain Asymmetry Positional nystagmus Nystagmus that changes in direction or amplitude with different positions This is not likely to create a significant trend in the caloric testing No need to baseline shift 42 Interpretation Assistant Interpretation Assistant will validate and analyze the results of the testing Available for positional and caloric testing Option found in the Review mode after analyzing Analyze the data of each position with vision and without vision, collected separately Collect responses for all four caloric irrigations and analyze the data The output of the validation and analysis is displayed to the clinician and can be pasted into the VNG/ENG report 43 14 Positional Interpretation Assistant Valid results 44 Positional Interpretation Assistant Invalid results 45 Caloric Interpretation Assistant Valid results 46 15 Caloric Interpretation Assistant Invalid results 47 Example of Data Analysis ICS Chartr 200 VNG 48 Thank you! Questions? acerkamroz@gnotometrics.com 16

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