BPPV and Vestibular Rehab Therapy

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Presentation transcript:

BPPV and Vestibular Rehab Therapy Christopher Lambaren, PT, DPT

Anatomy of Vestibular System

BPPV: signs and symptoms Vertigo, nystagmus, nausea, and vomiting Duration generally less than 30-40 seconds Typically described as being brought on by very specific head movements (looking up, rolling over in bed, etc) Can also cause dizziness, lightheadedness, and general imbalance

Vestibular Weakness: signs and symptoms Acute onset of prolonged vertigo, spontaneous nystagmus, imbalance with tendency to fall towards affected side, and nausea/vomiting Hearing loss might be involved Usually lasts 48-72 hrs then left with impaired balance and possible oscillopsia

BPPV: exam/special tests Dix-Hallpike test: Patient begins in long sitting Rotate head 45 degrees towards side being tested Quickly bring them back onto table with head off edge of table (~20 degrees of ext) still rotated Positive if nystagmus is upbeating and torsional towards downward ear

BPPV: exam/special tests Supine roll test Supine, head flexed 20 degrees Head turned to one side quickly and observed for nystagmus Head slowly returned to neutral position. Repeat to other side Positive if horizontal nystagmus beating downward towards affected ear

Vestibular Weakness: exam/special tests Caloric testing (VNG) VOR testing Balance assessment, Fukuda Step test HINTS exam (hrs/days of vertigo and spontaneous nystagmus) Head Impulse (abnormal is good) Nystagmus (unidirectional-good, bidirectional-not) Test for Skew (no vertical skew)

BPPV: interventions Epley manuever Same start position as Dix Hallpike test Head turned towards affected ear Lie pt. back quickly with head into extension off table (20 degrees) keeping head rotated Rotate head slowly to opposite side Roll onto side opposite affected ear keeping head rotated Sit up from sidelying with head rotated and chin tucked into shoulder

BPPV: interventions Log roll maneuver Begin with pt. supine with head turned so affected ear is down Slowly turn head to neutral (hold 15-30 sec) Slowly continue rolling head until affected ear is up (hold 15-30 sec) Continuing rolling head and body until their face is down (hold 15-30 sec) Continuing rolling same direction until back to starting position

Vestibular Weakness: interventions Initially vestibular suppressants and bed rest After initial onset then: Compensation (brain) Habituation (dizziness from movement or visual stimuli) Adaptation (change activity/lifestyle)

Resources www.dizziness-and-balance.com http://american-hearing.org http://vertigotreatment.org http://bppv-treatment.com http://vestibular.org