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Purpose

The BLT determines which side is affected in horizontal canal BPPV (Benign Paroxysmal Positional Vertigo).

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Instrument Details

Acronym BLT

Area of Assessment

Vestibular

Assessment Type

Observer

Administration Mode

Paper & Pencil

Cost

Free

Diagnosis/Conditions

  • Vestibular Disorders

Key Descriptions

  • Head Roll Test is first performed to determine whether the horizontal canal BPPV is canalithiasis or cupulolithiasis.
  • In sitting, patient bows head over 90 degree forward and direction of nystagmus is observed (bowing nystagmus). Patient then leans head backwards over 45 degree and direction of nystagmus is observed (leaning nystagmus).
  • For canalithiasis, the affected ear is the same as the direction of the bowing nystagmus and opposite direction of the leaning nystagmus.
  • For cupulolithiasis, the affected ear is the opposite to the direction of the bowing nystagmus and same direction of the leaning nystagmus.

Number of Items

2

Equipment Required

  • electronystagmography
  • videonystagmography
  • video recorder
  • infrared video goggles or Frenzel goggles to view nystagmus

Time to Administer

less than 5 minutes

Required Training

Reading an Article/Manual

Age Ranges

Child

6 - 12

years

Adolescent

13 - 17

years

Adult

18 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

Linda B. Horn, PT, DScPT, MHS, NCS, Karen H. Lambert, PT, MPT, NCS, and the Vestibular EDGE Task Force of the American Physical Therapy Association (2013).

Body Part

Head
Neck

ICF Domain

Body Structure
Body Function

Measurement Domain

General Health
Sensory

Professional Association Recommendation

Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association’s Multiple Sclerosis Taskforce (MSEDGE), Parkinson’s Taskforce (PD EDGE), Spinal Cord Injury Taskforce (PD EDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (Vestibular EDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.

For detailed information about how recommendations were made, please visit: http://www.neuropt.org/go/healthcare-professionals/neurology-section-outcome-measures-recommendations

Abbreviations:

HR

Highly Recommend

R

Recommend

LS / UR

Reasonable to use, but limited study in target group  / Unable to Recommend

NR

Not Recommended

Recommendations for use based on acuity level of the patient:

 

Acute

(CVA < 2 months post)

(SCI < 1 month post)

(Vestibular < 6 weeks post)

Subacute

(CVA 2 to 6 months)

(SCI 3 to 6 months)

Chronic

(> 6 months)

(Vestibular > 6 weeks post)

VEDGE

LS

 

LS

Recommendations based on vestibular diagnosis

 

Peripheral

Central

Benign Paroxysmal Positional Vertigo (BPPV)

Other

VEDGE

NR

NR

LS

NR

Recommendations for entry-level physical therapy education and use in research:

 

Students should learn to administer this tool? (Y/N)

Students should be exposed to tool? (Y/N)

Appropriate for use in intervention research studies? (Y/N)

Is additional research warranted for this tool (Y/N)

VEDGE

No

No

Yes

Yes

Considerations

Testing prior to performing Bow and Lean Test:

  • Roll Test must be completed prior to performing the Bow and Lean Test to determine if BPPV is canalithiasis or cupulolithiasis
  • Vascular – determine integrity of vertebral artery
  • Orthopedic – determine stability of cervical spine

 

Determining when to use Bow and Lean Test:

If the Roll Test is positive, this test has good clinical utility to assist in determining side of involvement if the Roll Test is inconclusive .

This tool is not appropriate for differential diagnosis.

Efficacy as determined by remission rates

(Lee, 2010; = 211; mean age = 50.7 (15.5) years)

  • ·Remission rate (determined by negative Head Roll Test) for horizontal canalilithiasis was 83.1% in the Bow and Lean Test Group compared to 67.4% in the Head Roll Test Group (p = 0.041).

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Bibliography

Lee, J. B., Han, D. H., et al. (2010). "Efficacy of the “bow and lean test” for the management of horizontal canal benign paroxysmal positional vertigo." The Laryngoscope 120(11): 2339-2346.