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Bow and Lean Test (also known as Head Pitch Test, Head Yaw Test, and Pagnini-Mc-Clure technique)

Image adopted from Choung, Shin, Kahng, Park, & Choi, 2006).

 

 

Steps to Perform (Choung, Shin, Kahng, Park, & Choi, 2006)



1.  Down-pitch:  Patient begins in the sitting position.  Flex their head forward, and observe for nystagmus (Choung, Shin, Kahng, Park, & Choi, 2006 describe bowing head over 90 degrees, however it is my opinion that this amount may be excessive).  

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-Observe for nystagmus.  



2.  Up pitch:  Extend patient's head at least 45 degrees.

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-Observe for nystagmus.   

 

 

Geotrophic Variant 



Up-pitch:  Horizontal nystagmus away from the side of involvement

Down-pitch: Horizontal nystagmus towards the side of involvement

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Apogeotrophic Variant 



Up-pitch: Horizontal nystagmus towards the side of involvement

Down-pitch: Towards the side of involvement



Evidence:

Low sensitivity value and high false-negative rate (Riga, 2013).

 













 

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