A 52-year-old male experienced an acute onset of vertigo immediately following a Valsalva maneuver when he was performing a bench press. His primary physician referred him to outpatient physical therapy because his symptoms have been persistent for more than 3 weeks despite taking meclizine (a common drug for vertigo) for the past 5 days. He has been purposefully limiting his cervical range of motion because he reports that movement of his head up and to the right causes his vertigo. He is still able to work as a mechanical engineer, which involves working at a desk and computer to view drawings. However, he has been taking frequent rest breaks throughout the day. He has also limited his driving because he experiences symptoms when he turns his head to change lanes. Currently, his coworker transports him to and from work. The patient is married and has three school-aged children and lives in a two-story home. His spouse is becoming quite frustrated at his limited assistance with caring for the children and household chores since the onset of his vertigo.
What is his rehabilitation prognosis?
What are the most appropriate physical therapy interventions?
What are the examination priorities?
What are the most appropriate examination tests?
- AMPULLA: Widened portion of semicircular canal (SCC) that is near the utricle and contains the sensory hair cells
- BONY LABYRINTH: Bony shell filled with perilymphatic fluid, which is similar in composition to cerebrospinal fluid (high sodium, low potassium); includes the three semicircular canals, the cochlea, and the vestibule
- CANALITH REPOSITIONING PROCEDURE/EPLEY MANEUVER: Clinical technique used in treating the canalithiasis form of benign paroxysmal positional vertigo
- CANALITHIASIS: Type of benign paroxysmal positional vertigo in which otoconia are floating free in the semicircular canals
- CRISTA AMPULLARIS: Sensory structure (including hair cells) that senses angular movement within the semicircular canals
- CUPULA: Bulbous, gelatinous mass that surrounds hair cells of cristae within semicircular canals
- DIX-HALLPIKE MANEUVER: Clinical test for diagnosing benign paroxysmal positional vertigo in the anterior and/or posterior semicircular canals
- MEMBRANOUS LABYRINTH: Structure filled with endolymph that is suspended within the bony labyrinth by fluid and connective tissue; contains membranous portion of the three semicircular canals, utricle, and saccule
- NYSTAGMUS: Involuntary back-and-forth or cyclical eye movements; movements may be rotary, horizontal, or vertical
- OTOCONIA (OTOLITHS): Calcium carbonate crystals in utricle and saccule that cause stimulation of the hair cells when the otoconia are stimulated by linear acceleration
- SACCULE: Otolith structure in inner ear that detects vertical translation motion of head
- SEMICIRCULAR CANALS: Three fluid-filled loops in the inner ear that measure angular acceleration; includes anterior (superior), posterior (inferior), and horizontal (lateral) canals
- UTRICLE: Otolith structure in inner ear that detects horizontal translation and tilt of head
- VERTIGO: Illusion of movement; a sense of spinning
Describe basic vestibular anatomy.
Describe benign paroxysmal positional vertigo (BPPV) ...
Log In to View More
If you don't have a subscription, please view our individual subscription options below to find out how you can gain access to this content.
Want remote access to your institution's subscription?
Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.
If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.
AccessPhysiotherapy Full Site: One-Year Subscription
Connect to the full suite of AccessPhysiotherapy content and resources including interactive NPTE review, more than 500 videos, Anatomy & Physiology Revealed, 20+ leading textbooks, and more.
Pay Per View: Timed Access to all of AccessPhysiotherapy
24 Hour Subscription $34.95
48 Hour Subscription $54.95
Pop-up div Successfully Displayed
This div only appears when the trigger link is hovered over.
Otherwise it is hidden from view.