BPPV

Question 1

What is BPPV and how do you test for it

Answer 1

Benign Paroxysmal Positional Vertigo mechanical disorder caused by utricular otoconia displacement into SCC’s

Question 2

How do you test for BPPV

Answer 2

• Hallpike-Dix Test

- Roll Test

Question 3

Hallpike-Dix Test examines for

Answer 3

BPPV in vertical SCC’s;

Question 4

Hallpike-Dix Test

Answer 4

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

Question 5

Hallpike-Dix Test positive test what = + BBPV

Answer 5

vertigo and torsional jerk-nystagmus beating in plane of involved SCC (Ewald’s 1st Law); fast phase beats toward offending SCC

Question 6

Nystagmus upbeat=

Answer 6

P-SCC

Question 7

Nystagmusdownbeat=

Answer 7

A-SCC

Question 8

vertical or direction changing nystagmus

Answer 8

may suggest CNS problem

Question 9

Hallpike-Dix Test Canalithiasis (BPPV)

Answer 9

otoconia free-floating in SCC
latency period of several seconds
torsional jerk-nystagmus
symptoms fatigue in less than 60 seconds

Question 10

Hallpike-Dix Cupulolithiasis (BPPV)

Answer 10

otoconia adhered to cupula in SCC
no latency period
torsional jerk-nystagmus
symptoms persist beyond 60 seconds

Question 11

Roll Test examines

Answer 11

for BPPV in horizontal SCC’s

Question 12

Roll Test is performed how?

Answer 12

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

Question 13

Roll Test what indicates a positive?

Answer 13

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

Question 14

What is the 1 intervention for anterior and posterior canalithiasis

Answer 14

Canalith Repositioning Maneuver (CRM).

Question 15

Vertical Canalithiasis: Canalith Repositioning Maneuver (CRM)

Answer 15

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.

Question 16

What is 1 intervention for anterior and posterior cupulolithiasis?

Answer 16

Liberatory Maneuver.

Question 17

Liberatory Maneuver for Posterior SCC:

Answer 17

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.

Question 18

Liberatory Maneuver for Anterior SCC:

Answer 18

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.

Question 19

What are 2 interventions for horizontal canalithiasis?

Answer 19

Canalith Repositioning Maneuver (CRM)

Appiani Maneuver:

Question 20

Canalith Repositioning Maneuver (CRM) :

Answer 20

1. Patient placed into + Roll test position for 60 seconds.
2. Patient’s head is then rotated into neutral for 60 seconds.
3. Patient’s head is rotated into opposite Roll test position for 60 seconds.
4. Patient is assisted into prone looking straight at floor and head flexed 30 degrees for 60 seconds.
5. Patient is assisted into supine with head flexed 30 degrees and rotated approximately 45 degrees towards involved side for 60 seconds.
6. Patient is assisted into sitting and head returned to neutral.

Question 21

Appiani Maneuver:

Answer 21

1. Patient is sitting with head neutral.
2. Patient is moved to uninvolved side for 60 seconds.
3. Patient’s head is rotated approximately 45 degrees towards table for 60 seconds.
4. Patient is assisted into sitting and head returned to neutral.

Question 22

Differences betwwen (CRM) and Appiani Maneuver:

Answer 22

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.

Question 23

What is the 1 intervention for horizontal cupulolithiasis?

Answer 23

Horizontal Cupulolithiasis: Casani Maneuver

1. patient sitting with head neutral
2. patient’s moved onto involved side for 60 seconds
3. patient’s head then rotated approximately 45º towards table for 60 seconds
4. patient then assisted into sitting and head returned to neutral

Question 24

Home Program (all types of BPPV)

Answer 24

• 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

Question 25

Interventions for General Motion Sensitivity

Answer 25

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

Question 26

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?

Answer 26

perform a left Hallpike-Dix test

Question 27

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?

Answer 27

canalith repositioning maneuver