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BPPV Background and Contraindications to Testing

Kathleen Kelley, PT, EdD, NCS

March 19, 2019

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Question

Can you discuss BPPV prevalence and any contraindications to testing? 

Answer

Demographics & Prevalence

BPPV is probably something most of us have seen.  It's one of the most common vestibular disorders. To make sure we are all understanding, BPPV stands for benign paroxysmal positional vertigo.  Benign meaning "non-threatening" which is very important to teach your patients. People are afraid when they're dizzy. It is really important to teach them about it being benign.  Paroxysmal meaning "sudden; sudden and intense" and positional meaning related to the position of the head. Finally, vertigo and if it's true BPPV  the complaint of spinning is the hallmark sign. 

BPPV is the most common cause of dizziness seen by otolaryngologists and the most common adult vestibular disorder.  The age of onset is 50 to 70 but anyone can get BPPV.  It is more common in women and the recurrence rate after the first treatment is 10-18%.  Lifetime population prevalence is 2.4%.  There's two kinds of BPPV.  Canalithiasis where the otoconia are free-floating and cupulolithiasis where the otoconia adhere to the cupula.  BPPV of the posterior canal in canalithiasis accounts for 80-90% of all cases of BPPV.  

Contraindications to Testing

Why wouldn't you test someone even if the history suggests it?

  • OA instability
  • History of aneurysm clipping
  • Arnold Chiari Malformation
  • Vertebrobasilar insufficiency
  • New onset SAH or SDH
  • Presence of a V-P shunt (unless cleared by neurosurgery) 
  • BP greater than 145/90
  • cervical spondylosis

This Ask the Expert is an edited excerpt from the course, Series: Physical Therapy Examination and Treatment of the Vestibular System, by Kathleen Kelley, PT, EdD, NCS


kathleen kelley

Kathleen Kelley, PT, EdD, NCS

Dr. Kelley is an associate professor of physical therapy at Quinnipiac University. She has taught in the areas of neurologic rehabilitation, neurologic pathology, balance, falls and vestibular dysfunction for 22 years. Dr. Kelley received her BS in physical therapy from the University of Connecticut, her MS in neurology from Boston University and her Doctorate in education from the University of Sarasota. She is also a board certified neurological clinical specialist. Dr. Kelley is also an avid teacher and practitioner of yoga and meditation and applies these teachings to both her life and her work.

 


Related Courses

Series: Physical Therapy Examination and Treatment of the Vestibular System
Presented by Kathleen Kelley, PT, EdD, NCS
Recorded Webinar

Presenter

Kathleen Kelley, PT, EdD, NCS
Course: #3338Level: Intermediate4 Hours
  'clear explanations'   Read Reviews
This series will describe and demonstrate common examinations and treatment for vestibular dysfunction in adults. Examination and treatment of dysfunctional oculomotor control, hypofunctioning VOR, and BPPV will be included.

Editor's Note: Regarding Pennsylvania credits, this course is approved by the PA State Board of Physical Therapy for 2.5 hours of general and 1.5 hours of Direct Access CE credit.

Vestibular System Anatomy and Physiology: An Update
Presented by Kathleen Kelley, PT, EdD, NCS
Recorded Webinar

Presenter

Kathleen Kelley, PT, EdD, NCS
Course: #2977Level: Intermediate1.5 Hour
  'I liked how the instructor would summarize intermittently'   Read Reviews
The purpose of this course is to provide physical therapists with a review of anatomy and physiology of the vestibular system. External and internal anatomy, anatomy of the 8th cranial nerve; ascending and descending tracts that carry information from the vestibular apparatus and the physiology of the Vestibular Ocular Reflex (VOR) will be discussed. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT and PTA.

Physical Therapy Examination of the Vestibular System
Presented by Kathleen Kelley, PT, EdD, NCS
Recorded Webinar

Presenter

Kathleen Kelley, PT, EdD, NCS
Course: #3285Level: Intermediate2 Hours
  'Very informative'   Read Reviews
This presentation will describe and demonstrate common examinations for vestibular dysfunction in adults. Examinations will include Oculomotor control, VOR X 1, VOR X 2 and VORc assessment, and general standing balance and postural control assessment.

Physical Therapy Treatment of the Vestibular System
Presented by Kathleen Kelley, PT, EdD, NCS
Recorded Webinar

Presenter

Kathleen Kelley, PT, EdD, NCS
Course: #3286Level: Intermediate2 Hours
  'Combined with the anatomy and assessment courses this course is a fantastic refresher or starting point for anyone seeing patients with vestibular challenges'   Read Reviews
This presentation will describe and demonstrate common treatments for vestibular dysfunction in adults. Treatment of dysfunctional oculomotor control, hypofunctioning VOR, and BPPV will be included.

The Use of Therapeutic Yoga for the Prevention of Falls in Community Dwelling Older Adults
Presented by Kathleen Kelley, PT, EdD, NCS
Recorded Webinar

Presenter

Kathleen Kelley, PT, EdD, NCS
Course: #3486Level: Intermediate2 Hours
  'Great examples/pictures'   Read Reviews
This course will provide an evidence-based approach to applying yoga asana (postures) to the prevention of falls in older adults. Examples of application of asana in the treatment of older adults will be provided. This course is directly related to the practice of physical therapy and athletic training and is therefore appropriate for the PT/PTA and Athletic Trainer