Here is a link to an awesome app for learning

about BPPV and the vestibular system in general:

http://www.psych.usyd.edu.au/news/news20130306-1/

Also can be found by searching "avor" under the apps page.

If you had four hours to learn how to do vestibular rehabilitation

what would be the most important concepts on which to focus?  I believe the following would be the most important:
1.  The most common causes of dizziness are from peripheral vestibular problems.
2.  There are two main types of peripheral vestibular problems:
     a.  vestibular hypofunction
     b.  vestibular hyperfunction
3.  The most common cause of a vestibular hypofunction is neuritis/labyrinthitis (virus).
4.  The most common cause of a vestibular hyperfunction is BPPV.
5.  Understanding how these problems occur will help the individual understand the type of questions to ask their clients when they say they are dizzy.
6.  There are over 320 different ways people describe their dizziness, but there are some very specific questions to ask to help identify neuritis, labyrinthitis and/or BPPV.
7.  There are some simple bedside tests that can be used to identify a hypofunction in room light:
    a. spontaneous and gazehold nystagmus tests as well as the head impulse test
8.  The Dix Hallpike and Roll tests can be utilized to identify BPPV.
9.  Naming nystagmus can improve the likelihood for successful repositioning.
10.  The Epley and Semont Maneuvers are often helpful if done properly and to the correct side.
11.  Other maneuvers may be needed when the Otoconia are rebellious or in other canals.
12.  Repositioning should be done for BPPV and Adaptation should be done for hypofunctions.
13.  Sensory processing disorders may also be present with clients who are dizzy and are common.
14.  Motion sensitivity, visual dependence, neck pain, headaches, imbalance, fear of falls and other forms of anxiety are common.
15.  Other types of therapy and motivational education may be needed to normalize neck strength, ROM and improve nervous system homeostasis.
16.  Clients should be referred to specialists when: the dizziness is acute and/or has not been diagnosed, when the practitioner lacks adequate training, when treatment has not worked or provided any relief within three to six visits, when red flags become apparent during the history or exam.
17.  Beware of the trap of "It."
18   There are often several reasons for the complaints of dizziness a client is experiencing.

Plowing your driveway in the middle of a blizzard is like trying to fix an inner ear

problem before the cause of the inner ear problem has stabilized.  A person who can't stand having snow on their driveway must wait until the snow stops before plowing or shoveling their driveway to yield lasting results.  Trying to fix an inner ear problem, like BPPV, before the cause of the BPPV has stabilized is similar.  You can do repositioning maneuvers all day long, but if the calcium crystals are still in the process of dumping out, the repositioning attempt will likely only provide temporary relief.  I have learned that treating acute BPPV is not the same as treating chronic BPPV.  Sometimes, an inner ear needs time after the calcium crystals have fallen out before repositioning is effective.  On the other hand, I have also noticed repositioning within hours of an individual becoming aware of their BPPV has also been effective.  Different people have different types of BPPV.

Go and Spin No More

Oh how great it would be to miraculously heal people battling dizziness.  So many are suffering and looking for help.  For BPPV, the canalith repositioning maneuvers work so well many think they have received some type of miraculous treatment.  However, many have vertigo from problems other than BPPV.   We learn more each day and new treatment options become available with time.

Vertigo does not mean vertigo

to many people.  Many clients I see come in and tell me they are experiencing vertigo.  They may even be diagnosed with vertigo.  However, nowhere in their history do they describe a sense of spinning, revolving, rotating or any other form of description involving a circular motion.  Yet, they insist they have vertigo.  Upon further questioning, I often find out they never have felt any of the above sensations at any point (outside of playing on a playground).  

Words mean different things to different people.  The given definition of vertigo is spinning.  It is just a symptom.  It is not a diagnosis.   It does not provide the answer to why the individual is spinning.  It simply acknowledges the presence of the complaint of spinning.

Information for review (ACH)

Quick videos:
Skew Eye Deviation (When he uncovers the right eye it moves up)
Left Beat Nystagmus (It was very thoughtful of this young lady to share this video to help others learn)
Mastoid Vibration Test (scroll down and click Movie- Thanks to Dr. Hain for this information)
Right torsion upbeat nystagmus

Here is a nice summary of the four types of Vestibular Rehab-When and how to use them:
Vestibular Rehab Quick Reference

Oculomotor, Positional and Positioning Testing Key

Post maneuver restrictions: Why should they be used?

1. Confirm presence or absence of BPPV (“snow globe” theory)
2. Control symptoms if client has severe nausea (teach to do if BPPV returns)
3. Because “everyone else” is doing it? (Probably not a good reason to use them)
4. Studies that suggest restrictions are not necessary may not cover all etiologies of BPPV (or less common forms of BPPV)
5. Frequently recurring BPPV (hasn't worked without the restrictions)