Vestibular Positioning Assessments and Interventions

This is a series of videos and links I use when teaching students different positioning manoeuvres in the assessment and intervention of Benign Paroxysmal Positional Vertigo (BPPV). These videos are not intended for the home-treatment of dizziness by patients. The wrong positioning manoeuvre can actually make things worse sometimes, so please seek professional help.

Case history taking for your diagnostic approach to dizziness is covered well here. Figure 2 is great:

Initial assessment of a patient’s dizziness (Post & Dickerson 2010)

When history indicates an episodic positional vertigo, or if you want to exclude BPPV, it’s then time to move to the positioning test. Check for contraindications first.

Assessments

Assessing the Anterior and Posterior canals: the Dix Hallpike test

An alternative assessment of the Anterior and Posterior canals for when the patient has back/ neck problems: the side-lying test (from 1:33)

Assessing the Horizontal canal: the supine roll test

If you have observed nystagmus, it is then time to figure out what is causing it: Cupulolithiasis, Canalithiasis and Vestibulithiasis

Interventions

The Epley and Lempert manoeuvres are used in the treatment of canalithiasis. Brandt-Daroff home exercises are often given for home treatment with patients who suffer from recurrent BPPV.

Treating Posterior and Anterior Canal Canalithiasis: the modified Epley manoeuvre

Treating Horizontal Canal Canalithiasis: the Lempert (BBQ roll) manoeuvre 

Home treatment of Posterior and Anterior Canal Canalithiasis: Brandt-Daroff home exercises

The Sermont and Rahko manoeuvres are used in the treatment of cupulolithiasis. 

Treating Posterior Canal Cupulolithiasis: the (liberatory) Semont maneuver

Treating Anterior Canal Cupulolithiasis: the Rahko manoeuvre

 

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