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NIH Toolbox Dynamic Visual Acuity Test (DVA)
Availability
Please visit this website for more information about this instrument:
Classification
Supplemental: Sport-Related Concussion (SRC) and Acute Hospitalized, Concussion/Mild TBI, Epidemiology, Moderate/Severe TBI: Rehabilitation; Traumatic Brain Injury (TBI)
Short Description of Instrument
This NIH Toolbox Dynamic Visual Acuity (DVA) test is a measure of gaze stability, which helps identify individuals who may have a deficit of the vestibular system (which regulates internal balance). The NIH Toolbox Visual Acuity Test must be administered followed by the DVA Test.
 
Participants are seated 12.5 feet from a computer monitor at eye level. For the DVA Test, participants wear lightweight headgear that contains a rate sensor, and are asked to move the head back and forth, as if saying “no.” Once the head is measured to be moving at greater than 180 degrees per second, an optotype flashes on the monitor, and the participant is asked to identify it. Smaller optotypes are displayed as the participant correctly identifies letters, and larger ones are displayed if the participant cannot correctly identify the letter shown, until the computer has calculated the smallest size that the participant can see with the head moving. This is calculated separately for head rotation leftward and rightward from center (though the participant continues shaking the head both ways), and this performance is compared to the participant’s visual acuity when the head was stationary (the NIH Toolbox Visual Acuity Test score, sometimes referred to as “static” visual acuity in the context of the DVA test).
 
The difference between “static” and dynamic visual acuity represents the vestibular contribution to gaze stability.
 
The DVA Test takes approximately six minutes to administer and is recommended for ages 3–85.
 
Sport-Related Concussion Specific: Advantages: The DVAT has been used before to classify vestibular problems. For example to distinguish patients with deficient bilateral vestibular function from healthy individuals during walking in place (Grossmann & Leigh, 1990). It has been reported as an easy-to-administer, cost- and time-efficient test of vestibular and visual function (Li et al., 2014).
 
Limitations: Scores are worse in male and elderly subjects (>50 years of age) (Li et al., 2014).
Scoring
Please visit this website for more information about scoring and interpretation of the DVA:  NIH Toolbox Scoring and Interpretation Guide
References
Gottshall K, Drake A, Gray N, McDonald E, Hoffer ME. Objective vestibular tests as outcome measures in head injury patients. Laryngoscope. 2003;113(10):1746–1750.
 
Grossman GE, Leigh RJ. Instability of gaze during locomotion in patients with deficient vestibular function. Ann Neurol. 1990;27(5):528–532.
 
Grossman GE, Leigh RJ, Bruce EN, Huebner WP, Lanska DJ. Performance of the human vestibuloocular reflex during locomotion. J Neurophysiol. 1989;62(1):264–272.
 
Herdman SJ, Tusa RJ, Blatt P, Suzuki A, Venuto PJ, Roberts D. Computerized dynamic visual acuity test in the assessment of vestibular deficits. Am J Otol. 1998;19(6):790–796.
 
Hillman EJ, Bloomberg JJ, McDonald PV, Cohen HS. Dynamic visual acuity while walking in normals and labyrinthine-deficient patients. J Vestib Res. 1999;9(1):49–57.
 
Li C, Beaumont JL, Rine RM, Slotkin J, Schubert MC. Normative Scores for the NIH Toolbox Dynamic Visual Acuity Test from 3 to 85 Years. Front Neurol. 2014;5:223.
 
Reuben DB, Magasi S, McCreath HE, Bohannon RW, Wang YC, Bubela DJ, Rymer WZ, Beaumont J, Rine RM, Lai JS, Gershon RC. Motor assessment using the NIH Toolbox.  Neurology. 2013;80(11 Suppl 3):S65–S75.
 
Rine RM, Roberts D, Corbin BA, McKean-Cowdin R, Varma R, Beaumont J, Slotkin J, Schubert MC. New portable tool to screen vestibular and visual function--National Institutes of Health Toolbox initiative. J Rehabil Res Dev. 2012;49(2):209–220.
 
Rine RM, Schubert MC, Whitney SL, Roberts D, Redfern MS, Musolino MC, Roche JL, Steed DP, Corbin B, Lin CC, Marchetti GF, Beaumont J, Carey JP, Shepard NP, Jacobson GP, Wrisley DM, Hoffman HJ, Furman G, Slotkin J. Vestibular function assessment using the NIH Toolbox. Neurology. 2013;80(11 Suppl 3):S25–S31.
Schubert MC, Herdman SJ, Tusa RJ. Functional measure of gaze stability in patients with vestibular hypofunction. Ann N Y Acad Sci. 2001;942:490–491.
 
Schubert MC, Migliaccio AA, Clendaniel RA, Allak A, Carey JP. Mechanism of dynamic visual acuity recovery with vestibular rehabilitation. Arch Phys Med Rehabil. 2008;89(3):500–507.
 
Shumway-Cook A, Horak FB. Assessing the influence of sensory interaction of balance. Suggestion from the field. Phys Ther. 1986 Oct;66(10):1548–1550.
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