Benign Paroxsysmal Positional Vertigo (BPPV): An algorithm for clinicians
Dalton Gilligan, PT, DPT
Supine Roll Test
Image retrieved from google images, April 12th, 2013 from http://ars.els-cdn.com/content/image/1-s2.0-S0196070911001633-gr4.jpg
​Nystagmus will present one of two ways when the horizontal canal is involved.
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-Geotropic nystagmus: Beating towards the ground when head is turned
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-Apogeotropic nystagmus: Beating towards the sky when head is turned​

To determine affected ear, both sides must be examined. Both sides likely will elicit nystagmus.

Determine if the nystagmus is apogeotropic, geotropic, and note the side with stronger nystagmus and symptoms.
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The above variables will dictate course of treatment.
1: Patient begins in long sitting position.
2: Patient is brought to supine, with their head elevated 30 degrees.
3: Quickly rotate the patient's head 45 degrees to one side, and observe for nystagmus and symptoms.
4: Return their head to the neutral position, and wait for any symptoms or nystagmus to resolve.
5: Rotate patient's head 45 degrees to opposite side.
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Determining the horizontal canal involved can often be difficult. Additionally, incorrect diagnosis can lead to poor treatment outcomes. There are a number of secondary tests that can be performed to help confirm a diagnosis of the horizontal canal. In order to use these tests, variant of nystagmus must be identified (geotrophic or apogeotrophic).