The goal of all healthcare providers and dizzy patients themselves is clearly combined in a participative intervention to prevent falls. We know that there is a very great neuronal complexity of what goes into the perception of "balance." We know that there are age-related conditions that intercede with balance in the way of orthopedic, visual, and other neurological circuit problems. While we are discussing these situations, there are certain concepts that must be understood in the reading of this text.

"Peripheral" does not primarily indicate peripheral nervous system such as those nerves which come out and go into the spinal cord at various levels. Indeed, there are inputs into the ascending spinal cord from the "periphery", (i.e. nerve endings that bring in messages from joint position sensors. External changes are also registered in the muscles as they contact and relax the speed of that activity, which is in a constant flow into the brain and the cerebellum. There are also skin touch receptors that are entering into this neuronal equation at all times. Indeed, however for the most part, in our discussion, we have used the term peripheral as synonymous with vestibular end organs, (semicircular canals), and cranial nerve (8) inputs into the pontomedullary junction vestibular nuclei. Again, terminology has to be utilized cautiously because the eighth nerve is of course the "auditory" nerve, but it also carries within it vestibular messages, which is what we are really concerned about for balance assessment.

It is crucial to understand that when we say "control" area, we mean "central" this being CNS, (i.e. the vestibular nuclei at the pontomedullary junction and their connections to the third, fourth, and sixth nerve nuclei, which are located in the mid brain and pons (CNS) themselves. We also have to realize that they are in play with brain frontal eye field control centers and parietal eye field control centers in an ongoing manner. The receptive areas in the occipital cortex, and the parietal cortex are interwoven in this ongoing split second process that involves literally millions of neurons. These circuits enable us to perceive balance and to accept the visual and auditory information inputs that we have, to identify where we are in space, and how we are moving in space. It is vastly complex physiology, one that we plan to make easy and understood. It is extremely important to keep the terminology correct.

If we are successful, we can indeed prevent falls and relieve our patients of pain and suffering from these falls. Ultimately, this is our goal.

It is our goal to help you to correctly interpret the video ENG and balance data collected in the vertiginous and dizzy patient. Noting that this is a clinical problem, which causes are often multiple, and the etiology may in fact be physiological as opposed to structural, careful attention to the details is very important. The patient's clinical information must always be reviewed to aid in the interpretation of the test results, so that you make the correct diagnosis.

We are going to point out what each and every test you do means, and what the abnormalities are (if any). In some occasions, unfortunately, we will not be able to comment on the full test battery, because of the patient's inability to complete the entire testing batter, and on occasion, technical difficulties may intervene as well. We will try to point to you how to decide whether the problem is within the central nervous system (brain stem and brain) or the peripheral input system, i.e., the vestibular apparatus and eighth nerve as they come into the brain stem vestibular area. We will typically base a decision on the clinical data that is present as we view the test results.

Our goal in quality assurance is to teach you how to ask the right questions, how to read the complete testing protocol correctly, and how to understand and diagnose the patient's problem. Then, you can effectively direct individualized rehabilitation programs for each patient.