1. BPPV and Vestibular Rehab Therapy
Christopher Lambaren, PT, DPT

2. Anatomy of Vestibular System

3. BPPV: signs and symptoms
Vertigo, nystagmus, nausea, and vomiting
Duration generally less than 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

4. 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 hrs then left with impaired balance and possible oscillopsia

5. 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

6. 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

7. 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)

8. 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

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

10. 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)

11. Resources www.dizziness-and-balance.com http://american-hearing.org