On Friday February 24, 2023, I attended an outstanding lecture on Treatment Techniques for BPPV at a national physical therapy conference (CSM) called:

Beyond Posterior Canal BPPV: Clinical Decision Making and a Critical Appraisal of Treatment Techniques for Anterior & Horizontal Canal BPPV
Presented By: Richard Alan Clendaniel PT, PhD, FAPTA and Laura Olsen Morris, PT

This lecture was excellent for vestibular physical therapists at all levels of skill, from beginner to intermediate and even advanced.

The presenters reviewed the anatomy of anterior and horizontal canal BPPV, along with various treatment techniques for BPPV. They described maneuver options for each type of BPPV and the effectiveness of each maneuver.

I think it’s so important for vestibular PT clinicians to be aware of multiple maneuver options for each type of BPPV because some treatment techniques for BPPV do not necessarily work for every patient.

Also, some patients may not be able to move into certain positions due to their other health issues and comorbidities, so another maneuver or treatment technique for BPPV may be needed to accommodate that patient’s mobility limitations or restrictions.

One specific maneuver / treatment technique for BPPV they discussed takes 15 minutes! Most medical doctors don’t have time for that during a normal clinic visit.

This powerful lecture makes the case that vestibular PTs are the practitioners of choice for patients with BPPV!

My favorite comment during this presentation came from Dr. Richard Alan Clendaniel PT, PhD, FAPTA. He said that vestibular PTs do a little dance in their head when they hear a patient say they get dizzy lying down or rolling over in bed. That’s so true!

However, he then cautioned that we don’t get too excited or assume that is always BPPV, because central nervous system lesions can create symptoms that mimic BPPV.

This is why vestibular health care providers need the skill to differentiate between different types of BPPV and vertigo caused by the central nervous system.

After this lecture, I felt so validated knowing that my two esteemed colleagues agree with me about the existence of anterior canal BPPV.

I just saw and cleared a case of anterior canal two weeks ago, but its existence remains controversial within standard health care today.

Since I see anterior canal BPPV on an infrequent but regular basis, I was so upset after the American Academy of Otolaryngology removed anterior canal BPPV from their revised BPPV clinical practice guidelines, published in 2017.

Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update)

At that time, I wrote an article about that which you can find here:

Anterior Canal BPPV: Does it Exist?

And I was interviewed for an article which you can find here:

https://www.vestibular.today/blog/anterior-canal-bppv-it-exists

This lecture is a clear demonstration of the fact that there’s a lot more to successfully treating BPPV than just trying Epley maneuver.

Thank you Dr. Clendaniel and Dr. Morris for being so awesome!

Disclaimer

This blog is provided for informational purposes only. The content and any comments by Dr. Kim Bell, DPT are not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. The details of any case mentioned in this post represent a typical patient that Dr. Bell might see and do not describe the circumstances of a specific individual.

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