Positional testing: Dix Hall Pike Test, Eplei, BPPV

Question 1

What is Dix Hall-pike testing for?

Answer 1

he Dix-Hallpike test is valuable in patients with complaints of positioning vertigo. For example, in patients that get dizzy when they sit up quickly or roll over in bed.
test for BPPV.
By looking at rotatory nystagmus - tortional is what we are looking for, to see if they are positive or negative.

Question 2

Contraindications of doing DHP:

Answer 2

1. neck pain
2. back pain
3. lack of consent
4. eyes shut
5. some type of movements can cause issues in the beck and the veins (idk man)
6. recent eye surgery (cataracts)

Question 3

How to do a DHP test?

Answer 3

1) Begin with the patient sitting length-wise on the examination table.
2) Place the Frenzel/VNG goggles on the patient.
3) Have the patient turn their head to a 45-degree angle toward the side that you suspect to be affected.
4) While maintaining the 45-degree head position, guide the patient in a continuous motion from sitting to lying with the head hanging off the table at approximately 20 degrees. It is imperative to provide cervical support during this part of the procedure.
5) Hold this position for 30 to 60 seconds or until nystagmus has subsided.
6) Guide the patient back into a sitting position.
7) Allow 30 to 60 seconds in the sitting position for the patient to recover.
8) Have the patient turn their head 90 degrees toward the unaffected side, so that the head is at a 45-degree angle toward the unaffected side.
9) While maintaining the 45-degree head position, guide the patient in a continuous motion from sitting to lying with the head hanging off the table at approximately 20 degrees. It is imperative to provide cervical support during this part of the procedure.
10) Hold this position for 30 to 60 seconds or until nystagmus has subsided.
11) Guide the patient back into a sitting position.
12) Maintain postural support until the patient is stable.

Question 4

Patient instruction for DHT:

Answer 4

“I am going to place a mask over your goggles. I need you to cross your arms over your chest and turn your head toward me. At the count of three, I want you to lie back while keeping your head turned and your eyes open. Once you are lying down, your head will be slightly hanging down. I will help to support you through the entire process.”

Question 5

Normal and Abnormal results:

Answer 5

lookout iPad

Question 6

What is the treatment if the patient has been tested for BPPV using the DHT and it comes back positive?

Answer 6

You do the eplei manoeuvre

Question 7

How do you do an employ manoeuvre?

Answer 7

Begin with the patient sitting length-wise on the examination table.
Place the Frenzel/VNG goggles on the patient.
Have the patient turn his head to a 45º angle toward the side that you are going to treat (the affected side).
While maintaining the 45º head position, guide the patient in a continuous motion from sitting to lying with the head hanging off the table at approximately 20º. It is imperative to provide cervical support during this portion of the procedure.
Hold this position for 30-60 seconds.
Maintain the 20º head extension and rotate the patient’s head 90º toward the unaffected side so that the patient’s head is approximately 45º toward the unaffected side.
Hold this position for 30-60 seconds.
While still maintaining the 45º head position, guide the patient into a side-lying position on the shoulder of the unaffected side. The patient’s nose should be pointed toward the floor.
Hold this position for 30-60 seconds.
Instruct the patient to tuck his chin and maintain the 45º head position.
Guide the patient back into a sitting position while ensuring that the patient’s head remains at the 45º angle and the chin remains tucked.

CAN DO WITHOUT GOGGLES

Question 8

Results of Eplei Manoeuvre?

Answer 8

It is important to watch for changes in the nystagmus upon completion of the procedure: a reversal of nystagmus indicates that the otoconia fell back into the canal; an upbeat nystagmus indicates that the otoconia fell back into the cupula.

Question 9

what are the 2 BPPV results?

Answer 9

The type of BPPV can be identified by whether
or not the nystagmus is delayed.
▪2 forms of BPPV:
▪ Delayed onset – canalathiasis
▪ Immediate onset – cupulolithiasis

torsional nystagmus lasting up to a minute
▪ Fatigues when the manoeuvre is repeated
▪ Other peripheral vestibular lesions: horizontal positional nystagmus
▪ Central lesions: horizontal, vertical or direction-changing nystagmus

Question 10

memorise the conditions worksheet

Answer 10

MEMORISE

Question 11

which SSC is affected during BPPV results:

Answer 11

The direction of the nystagmus can identify which SSC is
affected:
▪ Posterior canal: up-beating torsional nystagmus
towards the affected ear
▪ Anterior canal: down-beating torsional nystagmus
towards the affected ear
▪ Horizontal canal: horizontal nystagmus beating either
towards or away from the ground