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.
-Geotropic nystagmus: Beating towards the ground when head is turned
-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.
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.
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).