Modified head shake sensory organization test: Sensitivity and specificity

Julie A. Honaker, Kristen L. Janky, Jessie N. Patterson, Neil T. Shepard

Research output: Contribution to journalArticlepeer-review

16 Scopus citations


The Sensory Organization Test (SOT) of Computerized Dynamic Posturography (EquiTest™ equipment) is a valuable tool for investigating how an individual uses balance system sensory input (vestibular, vision, proprioception/somatosensory) to maintain quiet stance; however, it is limited as a screening tool for identifying peripheral vestibular system dysfunction. Previous research has shown that adding horizontal head-shake to portions of the standard SOT battery improved the identification of peripheral vestibular system asymmetry; however, flaws in the methods were noted. The objective of this work was to evaluate the sensitivity and specificity of the modified head-shake SOT (HS-SOT) protocol for identification of peripheral vestibular system lesion. Fifteen patients with chief complaint of instability, vertigo, and/or lightheadedness, with and without a caloric unilateral weakness (UW) and fifteen age-matched healthy controls were included in the final analysis. Ten of the 15 patients demonstrated a caloric UW ≥ 25%. Participants completed standard conditions 2 and 5 of SOT with head still and during four horizontal head-shaking tasks (i.e., HS-SOT2-60°/s, HS-SOT2-120°/s, HS-SOT5-15°/s, and HS-SOT5-60°/s). Average equilibrium scores decreased as condition difficulty increased (SOT2, HS-SOT2-60°/s, HS-SOT2-120°/s, SOT 5, HS-SOT5-15°/s, and HS-SOT5-60°/s) for each group; as expected, a lower decline was noted for controls (slope = -6.59) compared to patients (slope = -11.69). The HS-SOT5-15°/s condition was superior for identifying peripheral vestibular asymmetry (AUC = 0.90 sensitivity = 70%, specificity = 100%), with the strongest correlation to caloric UW% (rs = -0.743, p = 0.000006). HS-SOT5-15°/s appears to be a promising screening measure for peripheral vestibular asymmetry.

Original languageEnglish (US)
Pages (from-to)67-72
Number of pages6
JournalGait and Posture
StatePublished - Sep 1 2016


  • Caloric weakness
  • Calorics
  • Head-shake
  • Head-shake posturography
  • Peripheral vestibular
  • Peripheral vestibular asymmetry
  • Posturography
  • Sensory organization test
  • Unilateral weakness

ASJC Scopus subject areas

  • Biophysics
  • Orthopedics and Sports Medicine
  • Rehabilitation


Dive into the research topics of 'Modified head shake sensory organization test: Sensitivity and specificity'. Together they form a unique fingerprint.

Cite this