OT and BPPV

The Epley maneuver is a 💎 rare gem 💎 in the OT toolkit.

A patient can walk into our treatment room, and they can walk out cured.
They can walk out with instant relief.

(Yes, there is nuance to this. Sometimes the maneuver needs to be repeated. Sometimes it simply doesn’t work. There are important contraindications.) But, the other thing that makes this a GEM is that more so than any other condition we treat there are clear clinical guidelines for treatment of benign paroxysmal positional vertigo (BPPV).

But, despite the amazing power of this treatment, and the swath of research behind it. Many people fail to have their BPPV identified and treated in a timely manner.

In today’s article, we get to learn about a trauma center that trained their therapists in managing BPPV after TBI, and were able to reduce their referrals to neurology.

You are going to have so many questions after reading this article, and that’s why I am so thankful to welcome to the podcast, Jeff Walter, a PT who has devoted much of his career to treating and teaching on this condition.

1. You will be able to identify red flags during your OT provision that would merit further assessment for BPPV.

2. You will be able to recognize which populations should be considered for BPPV assessment, with or without dizziness.

• Intro

• Breakdown and analysis of journal article

  • Intro to BPPV and TBI

  • What were their methods

  • What were their results?

  • Article discussion/conclusion

• Discussion on practical implications for OTs

  1. Jeff, can you tell me how you became interested in dizziness and how that has intersected with your PT career?

  2. Can you tell me about your current work—and what you are passionate about right now related to BPPV?

  3. What were your impressions of this article?

  4. Why are patients with BPPV so underserved still? It seems like we have great research to back intervention.

  5. How do these crystals get dislodged? (And what do we need to know about idiopathic versus trauma-induced BPPV?)

  6. The article mentioned “vestibular agnosia” what do OTs need to know about this—and why are subjective complaints not enough in a screening approach for BPPV.

  7. This article mentioned these are red flags (post trauma)  that should merit vestibular assessment with out with dizziness. Do you agree with the list?

     • Skull fractures

     • High energy trauma

     • Vomiting

     • Gait Disturbance

     • Nystagmus during bedside assessment

  8. Here’s what the article outlined as training. Would your recommend for an aspiring vestibular therapist?

     • 2 hours theory based on anatomy and physiology of post-traumatic BPPV.

     • Training to identify and treat posterior and horizontal canal BPPV using standardized treatment guideline

     • 90 minute practical training session with a member of the visiting vestibular team

     • Opportunities over 2 months to complete a joint sessions

  9. How do we maintain contemporary practice standards for BPPV intervention for rehab and keep up to date?

  10. What do you see as the benefit training both OT and PT?

  11. What do you see on the horizon for BPPV?

Primary

• Does training therapists to manage benign paroxysmal positional vertigo in patients with acute traumatic brain injury reduce vestibular neurology referrals?

Additional

• We should be screening for benign paroxysmal positional vertigo (BPPV) in all older adults at risk of falling: a commentary on the World Falls Guidelines

• Clinical Practice Update Part II: Considerations for Treatment and Management of Benign Paroxysmal Positional Vertigo

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OT Potential pays guest speakers an honorarium for their participation, either directly or to an institution of the speaker's choosing at their request. We invite guests whose expertise often comes from practices, programs, or building products in their field. Where a speaker has a financial interest in the subject of a course, we disclose it below so you can weigh it for yourself.

OT Potential's interest in this topic: We have no financial stake in this topic.

Speaker interests: Jeff Walter has no financial interest in this topic to disclose.