Exam 2: Vestibular, BPPV Flashcards
what are the two methods of treating BPPV?
● REPOSITIONING MANEUVERS
● HABITUATION EXERCISES
Presentation of BPPV (6)
- ● POSITIONAL
- ● TORSIONAL NYSTAGMUS MOST COMMON
- ● LATENCY TO ONSET
- ● LIMITED DURATION
- ● REVERSAL ON RETURN TO UPRIGHT
- ● RESPONSE DECLINE WITH REPETITION
what is the test where we lay the pateint back called?
Dix-hallpike
Pt Exclusion Criteria for Dix Hallpike test (10)
- ● Cervical stenosis
- ● Severe kyphoscoliosis
- ● Limited cervical ROM
- ● Down syndrome
- ● Severe RA
- ● Cervical radiculopathies
- ● Pagets disease
- ● Ankylosing spondylitis
- ● Spinal cord injuries
- ● Morbid obesity
Names for the two tests for Repositioning Offensive Otoconia
- ● CANALITH REPOSITIONING MANEUVER, formerly called Epley Manuver, (for canaliathis)
- ● SEMONT MANEUVER or Libratory Manuver (for cupuloliasis)
What is the name of the habituation exercises we learned?
BRANDT DAROFF HABITUATION EXERCISES
Principles and follow up for Canalith Repositioning Manuver
- PRINCIPLES
- TARGET SCC CO-PLANAR WITH GRAVITY
- TRACK BY MONITORING NYSTAGMUS INDUCED BY CANALITH MIGRATION
- USE VIBRATION IF NEEDED
- REPEAT UNTIL CANAL CLEAR
- RETURN VISIT IN APPROXIMATELY ONE WEEK, RE EVALUATE FOR HALLPIKE, AND ANY REMAINING SYMPTOMS
How to perform Semont Maneuver
- ● IDENTIFY PROVOKING SIDE
- ● MOVE QUICKLY INTO SIDE LYING WITH THE PROVOKING SCC EARTH VERTICAL
- ● MAINTAIN POSITION 2 TO 3 MINUTES
- ● RAPID MOVEMENT INTO SITTING AND DOWN INTO OPPOSITE SIDE LYING WITH HEAD DOWN AND MAINTAIN FOR 3 TO 5 MINUTES
- ● HEAD SHAKING ADVOCATED BY SOME (not recommended)
Information/characteristics of Habituation Exercises
Called BRANDT DAROFF HABITUATION EXERCISES
- ● Reccomends PATIENTS PERFORM 3 TO 4 TIMES DAILY
- ● 3 REPS EACH SESSION
- ● POOR COMPLIANCE
- ● SYMPTOMS PROVOKED EACH SESSION
- decrease frequency of exercises after pt experiences 3 DAYS WITH NO VERTIGO DURING EXERCISES
These exercises sound awful!!
What direction should we expect Nystagmus to be for Posterior canal problem?
What percentage of BPPV pts have posterior BPPV?
POSTERIOR
- UPBEAT AND TORSIONAL
- 85 PERCENT
What direction should we expect Nystagmus to be for anterior canal problem?
What percentage of BPPV pts have anterior BPPV?
ANTERIOR
• DOWNBEAT AND TORSIONAL
• 12 PERCENT
What direction should we expect Nystagmus to be for horizontal canal problem?
What percentage of BPPV pts have horizontal BPPV?
HORIZONTAL
- • HORIZONTAL
- • 2.5 PERCENT
Summary of BPPV
- MOST COMMON PRESENTATION WITH SUDDEN ONSET VERTIGO
- POSTERIOR CANAL MOST COMMONLY AFFECTED
- SYMPTOMS MAY GO ON FOR YEARS
- BPPV DOES NOT EXCLUDE PTS FROM OTHER VESTIBULAR PATHOLOGIES
- RECOGNIZE EVALUATION FLAGS (things we expect to see if pt is positive for BPPV)
- CANAL PLUGGING ONLY SURGICAL OPTION
Evaluation Flags for BPPV (6)
- ● SHORT DURATION
- ● POSITIONAL
- ● CHARACTERISTIC NYSTAGMUS IN HALLPIKE
- ● LATENCY OF ONSET OF SYMPTOMS IN HALLPIKE
- ● RESPONSE DECLINE WITH REPETITION
- ● OFTEN REVERSES ON RETURN TO SIT
These are all things we should expect to see if pt is positive for BPPV
