Vestibular impairment

The measurement of vestibular impairment for medicolegal purposes represents a challenge. In the United States, the most widely employed system is that described in the American Medical Association's (AMA's) Guides to the Evaluation of Permanent Impairment. The fourth edition, published in 1993, represented a major step forward at that time, but room for improvement still exists. The problem areas in the Guides are discussed and appropriate modifications are suggested. Briefly, balance disorders are divided into two general categories, constant and recurrent (episodic). Using this novel approach, scales for quantification of the symptoms and signs (and laboratory tests for each), in increasing order of severity, are suggested. In this manner, an overall score may be derived for any individual with a permanent medicolegal balance impairment.