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BPPV Flashcards

1
Q

Subjective Exam

A

-Quality of s/s
-Frequency
-Duration
-Agg/Eas
-Other s/s

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2
Q

Quality: Vertigo

A

-Illusion of movement
-spinning, rocking, swaying, falling

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3
Q

Frequency and Duration: BPPV

A

Short Spells: Canal
Long Spells: Cup

-recurring

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4
Q

Aggs and Eases: BPPV

A

Ag: changing positions or lying or rolling
Eas: holding still for time

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5
Q

Cervical Screen

A
  1. Contraindications
  2. Cervical AROM
  3. Seated Ext/ROT Test
  4. Alar, Transverse leg and VBAI Test
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6
Q

Cervical Screen: Contraindications

A

Ask about Hx of
-neck surgery
-recent trauma
-severe RA, AA or OA instability
-Cervical meylopathy/Radiculopathy
-Carotid sinus syncope
-Chiari malformation
-Vascular dissection

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7
Q

Cervical Screen: Cervical AROM

A

-flx/ext/SB/ROT (Ds and Ns)
-Rot head and ext head and count back from 10

no overpressure

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8
Q

Cervical Lig and ABI Testing

A

-verbalize

“I have checked the transverse and alar ligaments as well as the vertebral basilar artery for insufficiency”

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9
Q

BPPV Exam Order

A
  1. Subjective
  2. Clear C-Spine
  3. Perform Dix-Hallpike (only if cleared)
  4. Roll Test (if -)
  5. Side-Lying Test (if -)
  6. Determine side and canal/cup
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10
Q

Benign Paroxysmal Positional Vertigo: Canalithiasis

A

Canalithiasis (MC):
-otoconia fall off and free float in PSCC
-latent onset of vertico and nystagmus after provoking
-disappears in 1 min

s/s:
-short spells, recurring
-holding still makes it better

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11
Q

Benign Paroxysmal Positional Vertigo: BPPV

A

-BPPV
-most common; age, trauma
-crystals from utricle or saccule (MC) fall from utricle into SCC (PSCC MC)
-heavy crystals cause change in endolymph viscosity and fire nerve signals
-top shelf vertigo
-brief vertigo and nystagmus

s/s:
-short spells, recurring
-holding still makes it better

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12
Q

Benign Paroxysmal Positional Vertigo: Cupulolithiasis

A

Cupulolithiasis:
-otoconia fall off and adhere to cupula of PSCC making cupula denser around endolymph
-immediate vertigo is persistent until head moved
-nystagmus

s/s:
-short spells, recurring
-holding still makes it better

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13
Q

Nystagmus

A

-non voluntary rhythmic oscillation of eyes
-named by fast phase
-can be suppressed by fixation
-viewed with frenzel or infared goggles
-increases toward fast phase (Alexander’s law)

Physiologic: normal stimuli
Pathologic: abnormal; 4 types

Caused by vestib:
-slow phase caused by VOR
-fast corrective by cerebellum

Caused by CNS:
-smooth pursuit and saccades

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14
Q

Nystagmus: BPPV

A

BPPV:
-named by torsion (canal) and rotary component toward the lesion
-Upbeat and rotary for PSCC
-direction fixed

Cause:
-canal stimulation and mixed matched

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15
Q

Vertigo

A

-sensation of the room spinning

BPPV or non-BPPV (anything not canal related)

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16
Q

Determine Canal Involvement

A

-nystagmus present in provoking positions and gone when return to sitting

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17
Q

Canalithiasis

A

-free floating debris
-latent onset of s/s
-short term (<1 min)
-Geotropic

Tx: done slowly

18
Q

Cupulolithiasis

A

-debris stuck on cupula and constantly firing
-immediate onset and long-lasting s/s in position
-Ageotropic

Tx: done quickly

19
Q

Dix-Hallpike Test

A

-for PSSC
-test less affected side first
-Clears VBA first

  1. Use Frenzels
  2. Turn head to ipsi 45 deg
  3. Quickly bring their head down into ext
  4. Hold for 1 min or until dizziness subsides and look at nystagmus

(+) PSC: upbeat
(+) ASC: downbeat

20
Q

Ewald’s 1st Law

A

-for vertical canal BPPV
-eye movements are in the plane of canal stimulated
-opp reaction shown in reversal phase

Posterior Canal: Upbeat
Anterior Canal: Downbeat

Left: Left torsional
Right: Right torsional

21
Q

Ewald’s 3rd Law

A

-for vertical canal BPPV
-deflection of the cupula towards the canal affected creates a stronger excitatory response than away
-positional tests move cupula toward canal

22
Q

Ewald’s 2nd Law

A

-horizonal canal BPPV and VOR
-excitation creates a greater response than inhibition
-flow towards ampulla creates a stronger response than away

Free floating (canal): turning head towards affected side brings cupula away from canal (stronger)

Stuck (cup): turning head towards non-affecred brigns cupula toward canal (strogner)

23
Q

Horizontal Canal

A

-oriented 30 deg upwards and horizontal
-matched with opp HC
-pitch head down 30 to make it parallel to ground

24
Q

Roll Test

A

-for HSC
-if DHP is (-), do it immediately after

  1. Use Frenzels
  2. Pt slides head down until it’s supported
  3. Flex head 30deg and support with pillow
  4. Quickly rotate head to unaffected side first and observe

(+): Geotropic/Canal: ground beating, stronger/faster to affected ear
(+): Ageotropic/Cup: sky beating; stronger/faster to affected ear

25
Sidelying Test
-for PSC/ASC as alternative to DHP or if DHP and RT are negative 1. Pt sitting at edge 2. Rotate head to less affected side 3. Quickly bring pt's head down on affected side with nose up (+) PSC: upbeat, same side of testing side (+) ASC: Downbeat, opp side of testing side
26
Precautions to Treatment of Vestibular Disorders
-sudden loss of hearing -increase in pressure to the point of discomfort -discharge or fluid from the ear -severe ringing in ear
27
Posterior Canal BPPV Treatments
-Canalith Repositioning Maneuver (CRM) (Canal) -Semont Maneuver (cup) HEP: Epley
28
Anterior Canal BPPV Treatments
-Reverse Semont Maneuver (Canal AND Cup) -Yacovino
29
Horizontal Canal BPPV Treatments
-BBQ Roll (Canal) -Gufoni (Cup) HEP: -Forced Prolonged Positioning + BBQ roll -Self-Casani
30
Brandt-Daroff Habituation
-non specific when maneuvers ineffective BPV -given as an HEP *not on practical*
31
Canalith Repositioning Maneuver (CRM)
-PSC canalithiasis 1. Stay in DHP position until the nausea goes away +30s 2. Rotate head slowly to opp side and wait 30s 3. Have Pt move to sidelying and pitch head down in dump position while maintaining rotation, wait 30s 4. Pt slowly sits up maintaining head position, wait 30s 5. Bring head up to neutral, wait 30s
32
Epley Maneuver (Self-CRM)
-HEP for PSC Canal or Cup 1. Pt in long sitting 2. Rotate head slowly to same side of impairment, wait 30s 3. Lay back maintaining rotation and have head off side of pillow, wait 30s 4. Slowly turn head to opposite side, wait 30s 5. Slowly turn body in direction and tuck head inttot dump position, wait 30s 6. Return to sitting, wait 30s *3x/day until s/s stop for 3 days straight*
33
Semont Maneuver
-PSC Cupulolithiasis -2 reps in one session 1. Pt at edge of table, turn head 45 deg in opp direction of affected side, wait 1 min 2. Quickly bring Pt down on affected side with head rotation maintained, wait 1 min 3. Quickly move onto opposite side maintaining rotation and flexing head into dump position, wait 1 min -shake head if no s/s appears and wait 1 min 4. Slowly come up while maintaining head, wait 1 min 5. Head to neutral slowly, wait 1 min
34
Reverse Semont Maneuver
-ASC Canalithiasis OR Cupulolithiasis -2 reps in one session 1. Pt at edge of table, turn head 45 deg in SAME direction of affected side, wait 1 min 2. Quickly bring Pt down on affected side with head rotation maintained and head down into dump position, wait 1 min 3. Quickly move onto opposite side maintaining rotation and tilting head up, wait 1 min -shake head if no s/s appears and wait 1 min 4. Slowly come up while maintaining head turn to affected side, wait 1 min 5. Head to neutral slowly, wait 1 min
35
HEP for ASC and PSC Cupulolithiasis
-Semont or Reverse Semont -3-5 reps until 3 days s/s free
36
BBQ Roll
-HSC Canalithiasis or Geotropic -wait for s/s to dec + 30s 1. Begin in roll test position w/ head turned towards affected and flexed 30 deg, hold for 30s 2. Slowly roll head in opposite direction maintaining flexion, wait 30s 3. Slowly roll body in direction of head into dump position, wait 30s 4. Slowly roll onto Pt stomach while maintaining head position, provide pillow under chest, wait 30s 5. Slowly roll patient onto other side maintaining head position, wait 30s 4. Slowly sit up maintaining position, wait 30s 5. Return to neutral, wait 30s
37
Casani Maneuver
-HSC Cupulolithiasis or Ageotropic -2 reps 1. Pt sitting at mat in neutral 2. Quickly bring patient down onto affected side (opp side of positive testing side), hold for 2 min 3. Quickly rotate head upward away from affected side, hold for 2 min 4. Slowly return to sitting w/ head position maintained, wait 2 min 5. Head to neutral, wait 2 min
38
HEP for HSC Canalithiasis
-Forced Prolonged Positioning for that night followed by BBQ roll in the morning -1x/night and bbq roll in morning, 3 days in a row w/o s/s
39
HEP for HSC Cupulolithias
-Self-Casani -3-5 reps weeks x3 days
40
Forced Prolonged Position
-HEP for HSC Canalithiasis -3 days in a roll 1. Laying on affected ear for 1 min 2. Lie on back for 1 min 3. Quickly roll lying on unaffected ear and sleep in this position (explain way to prop up) 4. In the morning finish BBQ roll

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