Benign Paroxysmal Positional Vertigo in the Acute Hospital Setting

Abstract

Introduction: Dizziness is a common and nonspecific complaint leading to a growing number of emergency department visits and hospital admissions following trauma associated with a fall. Otovestibular conditions constitute a significant proportion of dizziness cases. Common treatable peripheral vestibular disorders, including benign paroxysmal positional vertigo (BPPV), that may go unrecognized may be diagnosed using inexpensive bedside tests. Case Description: Two patients were consulted to have a vestibular rehabilitation therapy evaluation performed by physical therapy in the acute care department as both subjectively described BPPV. The first patient was treated using conventional techniques and application of evidence-based guidelines for BPPV intervention. However, orthopedic/pain limitations restricted traditional examination techniques for the second patient allowing consideration of a novel approach to carrying out the examination. Discussion: The first patient was treated successfully for BPPV remission using emerging clinical practice guidelines. The clinical evaluation of the second patient was nonsignificant; however, the presentation illustrates how traditional vestibular assessment techniques can be modified in a novel way in the acute care setting based on recent biophysical scientific evidence. Conclusion: This case study found that evidence-based practice guidelines as well as application of a biophysical scientific knowledge base can be applied into the acute care vestibular rehabilitation examination using primarily different configurations of a hospital bed only. Positive outcomes hold the unique potential of physical therapist consultation services throughout acute and inpatient environments, as well as setting a clinical precedent for future patients presenting with previously unrecognized BPPV.