BPPV Flashcards
What is BPPV and how do you test for it
Benign Paroxysmal Positional Vertigo mechanical disorder caused by utricular otoconia displacement into SCC’s
How do you test for BPPV
- Hallpike-Dix Test
- Roll Test
Hallpike-Dix Test examines for
BPPV in vertical SCC’s;
Hallpike-Dix Test
patient long-sits on table with head rotated 30-45 degrees; clinician stands behind patient supporting neck and trunk while assisting patient into supine with head slightly below horizontal plane; position maintained for 60 seconds; return to long sit and repeat to other side
Hallpike-Dix Test positive test what = + BBPV
vertigo and torsional jerk-nystagmus beating in plane of involved SCC (Ewald’s 1st Law); fast phase beats toward offending SCC
Nystagmus upbeat=
P-SCC
Nystagmusdownbeat=
A-SCC
vertical or direction changing nystagmus
may suggest CNS problem
Hallpike-Dix Test Canalithiasis (BPPV)
otoconia free-floating in SCC
latency period of several seconds
torsional jerk-nystagmus
symptoms fatigue in less than 60 seconds
Hallpike-Dix Cupulolithiasis (BPPV)
otoconia adhered to cupula in SCC
no latency period
torsional jerk-nystagmus
symptoms persist beyond 60 seconds
Roll Test examines
for BPPV in horizontal SCC’s
Roll Test is performed how?
patient long-sits on table with head neutral; clinician stands behind patient supporting neck and trunk while assisting patient into supine with neck flexed 30o; head passively rotated to one side and position maintained for 60 seconds; return to neutral and repeat to other side
Roll Test what indicates a positive?
typically positive to both sides (Ewald’s 2nd Law: direction changing nystagmus) and side producing strongest nystagmus is involved side for canalithiasis but uninvolved side for cupulolithasis; vertical nystagmus may suggest a CNS problem
What is the 1 intervention for anterior and posterior canalithiasis
Canalith Repositioning Maneuver (CRM).
Vertical Canalithiasis: Canalith Repositioning Maneuver (CRM)
1) Patient placed into + Hallpike-Dix position for 60 seconds.
2) Patient’s head then rotated into opposite Hallpike-Dix position for 60 seconds.
3) Patient then assisted onto side towards uninvolved ear, patient should be looking toward floor with neck flexed 20 degrees towards floor for 60 seconds.
4) Patient then assisted into sitting and head returned to neutral.
What is 1 intervention for anterior and posterior cupulolithiasis?
Liberatory Maneuver.
Liberatory Maneuver for Posterior SCC:
1) Patient begins in sitting position with head turned 45 degrees towards Uninvolved side.
2) Patient moved into involved side for 60 seconds.
3) Patient then moved through sitting position to opposite sidelying position while maintaining same head alignment for 60 seconds.
Liberatory Maneuver for Anterior SCC:
1) Patient begins in sitting position with head turned 45 degrees towards Involved side.
2) Patient moved into involved side for 60 seconds.
3) Patient then moved through sitting position to opposite sidelying position while maintaining same head alignment for 60 seconds.
What are 2 interventions for horizontal canalithiasis?
Canalith Repositioning Maneuver (CRM)
Appiani Maneuver:
Canalith Repositioning Maneuver (CRM) :
- Patient placed into + Roll test position for 60 seconds.
- Patient’s head is then rotated into neutral for 60 seconds.
- Patient’s head is rotated into opposite Roll test position for 60 seconds.
- Patient is assisted into prone looking straight at floor and head flexed 30 degrees for 60 seconds.
- Patient is assisted into supine with head flexed 30 degrees and rotated approximately 45 degrees towards involved side for 60 seconds.
- Patient is assisted into sitting and head returned to neutral.
Appiani Maneuver:
- Patient is sitting with head neutral.
- Patient is moved to uninvolved side for 60 seconds.
- Patient’s head is rotated approximately 45 degrees towards table for 60 seconds.
- Patient is assisted into sitting and head returned to neutral.
Differences betwwen (CRM) and Appiani Maneuver:
The Appiani Maneuver is the optional test that can can be conducted if the client can not tolerate the CRM. There is a lot of moving and holding head for 60 secs in CRM and that may be just to much for some clients. So the Appiani is a shorter version.
What is the 1 intervention for horizontal cupulolithiasis?
Horizontal Cupulolithiasis: Casani Maneuver
- patient sitting with head neutral
- patient’s moved onto involved side for 60 seconds
- patient’s head then rotated approximately 45º towards table for 60 seconds
- patient then assisted into sitting and head returned to neutral
Home Program (all types of BPPV)
- avoid lying down for remainder of day
- avoid bending or turning your head for 24 hours
- ask for help in activities like tying shoes, feeding pet, or picking something up from floor for 24 hours
- the day treatment, sleep in a slightly elevated head position by using an extra pillow and avoid lying on your affected side until your follow-up visit with clinician
- follow-up clinician visit within 2 days if possible
Interventions for General Motion Sensitivity
Brandt-Daroff Exercises
neck neutral or neck rotated as per clinician instructions
sit on edge of couch then lie on right side for 60 seconds
sit up and remain in that position for 60 seconds
lie down on left for 60 seconds
sit up and remain in that position for 60 seconds
symptoms should increase 1-2 points during exercise
symptoms should return to baseline within 1-5 minutes
perform 1-5 repetitions per session as able
perform exercise 1-3 times per day as able
A patient has a primary complaint of vertigo that she rates as 0-9/10. The clinician performs a right Hallpike-Dix test which produces brief right torsional down-beating nystagmus and the patient’s symptoms reach a 2/10 before subsiding. What should the clinician do next?
perform a left Hallpike-Dix test
A patient’s initial mVAS was 0-7/10 during the Hallpike-Dix test. Following the CRM, a subsequent Hallpike-Dix test, during the same session, produces right torsional down-beating nystagmus that fatigues in 15 seconds. What should the clinician do next?
canalith repositioning maneuver
