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BPPV Background and Contraindications to Testing

Kathleen Kelley, PT, EdD, NCS

March 19, 2019



Can you discuss BPPV prevalence and any contraindications to testing? 


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

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Editor's Note: Regarding Pennsylvania credits, this course is approved by the PA State Board of Physical Therapy for .5 hour of general and 1.5 hour of Direct Access CE credit.

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