Figure 2. Video head impulse test of a patient with BVL using SHIMP compared to conventional HIMP.

Typical patient with complete BVL showing a reversed saccadic pattern during HIMP and SHIMP compared to a healthy control (figure 1). (A) During standard HIMP, the patient with BVL elicits mostly overt positive catch-up saccades after the head impulse. (B) During SHIMP, the same patient with BVL shows only very few downward saccades reflecting anticompensatory saccades after the end of the head impulse back to the head-fixed target. Both paradigms give similar but slightly lower vestibulo-ocular reflex gain values during SHIMP compared to HIMP, but a complementary saccade pattern, which is reversed compared to healthy controls. Head velocity = green traces; inverted slow phase eye velocity = blue traces; saccades = red traces. BVL = bilateral vestibular loss; HIMP = conventional head impulse paradigm; SHIMP = suppression head impulse paradigm.