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Reliability and Diagnostic Accuracy of Clinical Tests of Vestibular Function for Children

Christy, Jennifer B. PT, PhD; Payne, JoAnne MA, CCC-A; Azuero, Andres PhD, MBA; Formby, Craig PhD

doi: 10.1097/PEP.0000000000000039
Research Article

Purpose: To determine reliability, diagnostic values, and minimal detectable change scores, 90% confidence (MDC90) of pediatric clinical tests of vestibular function.

Methods: Twenty children with severe to profound bilateral sensorineural hearing loss and 23 children with typical development, aged 6 to 12 years, participated. The Head Thrust Test, Emory Clinical Vestibular Chair Test, Bucket Test, Dynamic Visual Acuity, Modified Clinical Test of Sensory Interaction on Balance, and Sensory Organization Test were completed twice for reliability. Reference standard diagnostic tests were rotary chair and vestibular evoked myogenic potential. Reliability, sensitivity, specificity, predictive values, likelihood ratios, and MDC90 scores were calculated.

Results: Reliability ranged from an intraclass correlation coefficient of 0.73 to 0.95. Sensitivity, specificity, and predictive values, using cutoff scores for each test representing the largest area under the curve, ranged from 63% to 100%. The MDC90 for Dynamic Visual Acuity and Modified Clinical Test of Sensory Interaction on Balance were 8 optotypes and 16.75 seconds, respectively.

Conclusions: Clinical tests can be used accurately to identify children with vestibular hypofunction.

This study shows that clinical tests can be used to identify accurately children with vestibular hypofunction.

Department of Physical Therapy, School of Health Professions (Dr Christy), and Department of Community Health, Outcomes and Systems, School of Nursing (Dr Azuero), The University of Alabama at Birmingham, Birmingham, Alabama; Department of Communicative Disorders (Ms Payne and Dr Formby), College of Arts and Sciences, The University of Alabama, Tuscaloosa, Alabama.

Correspondence: Jennifer B. Christy, PT, PhD, Department of Physical Therapy, The University of Alabama at Birmingham, 1720 2nd Ave S, SHPB 360X, Birmingham, AL 35294 (

Grant Support: This study was funded by a research grant from the Section on Pediatrics, awarded to Dr Christy.

The authors declare no conflicts of interest.

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins and the Section on Pediatrics of the American Physical Therapy Association.