The Conventional Head Impulse Test Versus the Suppression Head Impulse Test: A Clinical Comparative Study

Elsherif, Mayada

doi:10.5152/iao.2023.22860

Cited by 7 publications

(5 citation statements)

References 15 publications

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“…This observation was recorded in several studies that had emerged investigating SHIMP ( 17 , 26 – 28 ). The reasons could be multifactorial and uncertain, but proposed theories include a dearth of covert saccades in the SHIMP paradigm and the late onset of VOR suppression at 80–100 milliseconds after the onset of the head impulse ( 24 , 26 ).…”

Section: Discussionmentioning

confidence: 62%

“…When the normal vestibular function group was compared to the abnormal vestibular function group in terms of HIMP and SHIMP VOR gains, there was a significant (p < 0.05) and a near significant difference (p = 0.05) on the right and the left, respectively. This observation was recorded in several studies that had emerged investigating SHIMP (17,(26)(27)(28). The reasons could be multifactorial and uncertain, but proposed theories include a dearth of covert saccades in the SHIMP paradigm and the late onset of VOR suppression at 80-100 milliseconds after the onset of the head impulse (24, 26).…”

Section: Discussionmentioning

confidence: 93%

“…However, there have been studies that had observed covert saccades in SHIMP. These studies observed that covert saccades in SHIMP are far and few in between, and while subjects consistently generated overt saccades (except in acute vestibulopathy), covert saccades are rare ( 12 , 19 , 26 , 27 ). In the current study, a third of the children generated covert saccades in the SHIMP paradigm but they were generated only in 6–10% of the head impulses delivered.…”

Section: Discussionmentioning

confidence: 96%

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Suppression head impulse test in children—experiences in a tertiary paediatric vestibular centre

Dasgupta,

Crunkhorn,

Wong

et al. 2024

Front. Neurol.

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The suppression head impulse paradigm (SHIMP) involves suppression of the vestibulo-ocular reflex (VOR) and anticompensatory saccades generated thereof. SHIMP is gaining importance to understand vestibular compensation with its different parameters (VOR gain/peak saccadic velocity PSV/latency of saccades). SHIMP studies are emerging in adults, but pediatric studies have hardly been performed. This study is a retrospective case note audit over a period of 2 months in a tertiary pediatric vestibular center in the United Kingdom to investigate whether SHIMP is safe/robust to be used in children conforming to existing standards/norms in normal children and whether it yields any meaningful inferences in pediatric vestibular hypofunction. This is the largest pediatric SHIMP study to date. A total of 44 referred children (6–18 years, female children>male children) with a range of complaints from dizziness, imbalance, motor incoordination, postural instability, and hearing loss were included, and their SHIMP parameters were measured. All children underwent comprehensive functional/objective audiovestibular assessments. Two groups were defined—Group A with normal vestibular function and Group B with abnormal vestibular function. The normal population showed an average SHIMP VOR gain of 0.98+/−0.08 and latency of overt saccades at 215.68+/–46.16 milliseconds agreeing with published evidence. The PSV of overt saccades was 315.39+/−56.30/s, and there was a gain asymmetry of 7.42+/−4.68 between the sides. Statistically significant differences with moderate/large effect sizes were observed between the groups in terms of VOR gain and PSV but not in saccade latencies. Covert saccades were rare in SHIMP, while overt saccades were observed in 100% of children. VOR gain difference between the head impulse paradigm (HIMP) and the SHIMP was significant as well. We observed statistically significant differences in side asymmetry of VOR gain between the groups. Furthermore, we identified a group of children with cerebellar lesions where overt saccades in SHIMP were rather low in number. Further research is recommended to investigate pediatric PSV, asymmetry, and inability to generate overt saccades that may suggest useful means to assess compensation and central function. We conclude that SHIMP yields valuable information and is a safe, easy to perform, and a reliable test that should be used in children to supplement HIMP.

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Section: Discussionmentioning

confidence: 62%

Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 96%

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Suppression head impulse test in children—experiences in a tertiary paediatric vestibular centre

Dasgupta,

Crunkhorn,

Wong

et al. 2024

Front. Neurol.

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“…In the vSHIMP protocol, corrective ac-saccade size is also an indicator of VOR gain efficiency: healthy subjects make large saccades, and patients with vestibular loss make very small saccades or no saccades at all [13][14][15][16][17]. A recent study used vSHIMP-generated saccade size as an additional indicator of canal function.…”

Section: Introductionmentioning

confidence: 99%

A Clinical Infrared Video-Oculoscopy Suppression Head Impulse (IR-cSHIMP) Test

Marcelli,

Giannoni

2024

Audiology Research

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Background: We propose a Suppression Head IMPulse (SHIMP) test method that provides for equipment only through the use of InfraRed Video-OculoScopy (IR-VOS) and allows horizontal and vertical semicircular canal function evaluation in bedside mode. We therefore named the test InfraRed clinical SHIMP (IR-cSHIMP). Methods: To check IR-cSHIMP diagnostic efficiency, we studied 22 normal subjects, 18 patients with unilateral, and 6 with bilateral deficient vestibulopathy. Each subject first underwent a vestibular examination and, only later, an IRc-SHIMP test. Results: When the IR-cSHIMP test was performed in the horizontal plane, all normal subjects showed anti-compensatory saccades. When the vertical semicircular canal function was evaluated, the same result was obtained in all normal subjects except three, which were considered false positives. In patients with vestibular deficits, the test performed in the horizontal and vertical planes were always pathological, with 100% agreement between clinical and instrumental tests. Conclusions: Our bedside method proved to be fast, simple, and effective in discriminating between healthy and pathological subjects. It required only the same skill as the better-known cHIT. For these reasons, we believe that the IR-cSHIMP should be part of daily clinical practice as a useful tool in the selection of patients to undergo more sophisticated investigations.

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“…Furthermore, the results of the HIMP and SHIMP tests are highly consistent and complementary in assessing VOR function. [1][2][3] HIMP and SHIMP protocols differ in the presence of catchup saccades, which are considered normal in SHIMP, but abnormal in HIMP. The catch-up saccade in SHIMP, also known as an "anti-compensatory saccade (ACS)", is a rapid eye move-ment that adjusts the compensatory eye movement caused by VOR during head rotation.…”

Section: Introductionmentioning

confidence: 99%

Relation Between Horizontal Saccade Test and Anti-Compensatory Saccade in the Suppression Head Impulse Test Paradigm

Lee,

Yang,

Kim

et al. 2024

Korean J Otorhinolaryngol-Head Neck Surg

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Background and ObjectivesThere is limited study reported on the relationship between horizontal saccades and anti-compensatory saccades (ACS) in the suppression head impulse paradigm (SHIMP). We investigated the relationship between horizontal saccades and ACS in SHIMP in individuals with normal vestibular function and determined the correlation between the associated factors. Subjects and Method Medical records of 79 patients with normal vestibular function and brain magnetic resonance images were retrospectively reviewed. Results ACS and horizontal saccades results were strongly correlated with velocity (R= 0.345, p<0.001) and latency (R=0.547, p<0.001). The latency of ACS was significantly shorter (p<0.001) than that of horizontal saccades. The velocity of ACS was negatively correlated with the latencies of ACS (R=-0.318, p<0.001) and horizontal saccades (R=-0.322, p<0.001). Bilateral ACS latency (R=0.384 and 0.471 in right and left, p<0.001 in both side) and left side ACS velocity (R=-0.263, p=0.019) were significantly affected by age. Conclusion ACS in the SHIMP was strongly correlated with horizontal saccades. However, the latency of ACS was shorter than that of horizontal saccades. Therefore, patient age and results of the horizontal saccades tests should be considered while interpreting the ACS velocity, which reflects vestibulo-ocular reflex function in patients with vestibulopathy.

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The Conventional Head Impulse Test Versus the Suppression Head Impulse Test: A Clinical Comparative Study

Cited by 7 publications

References 15 publications

Suppression head impulse test in children—experiences in a tertiary paediatric vestibular centre

Suppression head impulse test in children—experiences in a tertiary paediatric vestibular centre

A Clinical Infrared Video-Oculoscopy Suppression Head Impulse (IR-cSHIMP) Test

Relation Between Horizontal Saccade Test and Anti-Compensatory Saccade in the Suppression Head Impulse Test Paradigm

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