Tips for the Dix Hallpike Maneuver 

• If a patient has difficulty achieving adequate extension, a pillow can be used.  Position the pillow so it is near the vertebral level C1, and extend the patient's head over this.  However, if adequate cervical extension is not achieved, there is an increased likely hood for conversion to horizontal canal, and potential decreased in efficacy of technique (Personal opinion not demonstrated by evidence).  

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