The Dix-Hallpike Maneuver diagnoses Benign Paroxysmal Positional Vertigo (BPPV) of the Posterior Semicircular Canal.
Less than 5 minutes
Child
6 - 12
yearsAdolescent
13 - 17
yearsAdult
18 - 64
yearsElderly Adult
65 +
yearsInitially reviewed by Jason Raad, MS in 4/2012.Reviewed and Updated by Karen Lambert PT, MPT, NCS and Linda B. Horn PT, DScPT, MHS, NCS of the VEDGE task force for the Neurology section of the APTA in 2013
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
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Abbreviations: |
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HR |
Highly Recommend |
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R |
Recommend |
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LS / UR |
Reasonable to use, but limited study in target group / Unable to Recommend |
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NR |
Not Recommended |
Recommendations for use based on acuity level of the patient:
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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 weeks)
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Vestibular EDGE |
HR |
HR |
HR |
Recommendations based on vestibular diagnosis
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Peripheral |
Central |
Benign Paroxysmal Positional Vertigo (BPPV) |
Other |
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Vestibular EDGE |
LS |
LS |
HR |
LS |
Recommendations for entry-level physical therapy education and use in research:
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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) |
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Vestibular EDGE |
Yes |
Yes |
Yes |
Yes |
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Rates of Benign Paroxysmal Positional Vertigo (BPPV) in young population:
(Kerrigan et al. 2012; n = 198; 99 male, 99 female, aged 18-34, healthy subjects without complaints of dizziness or imbalance)
9% (12% female, 5% male) with positionally induced nystagmus
Rates of Benign Paroxysmal Positional Vertigo (BPPV) in elderly population:
(Ogahali et al. 2000; n = 100; 28 male, 72 female, aged 51-95, patients treated in a geriatric clinic without previous reported
9% with positive dix-hallpike testing
Lifetime prevalence:
(von Brevern et al. 2003; n = 1003)
Lifetime prevalence 2.4% (3.2% female, 1.6% male)
Mean age of onset 49.4 years (SD 13.8)
(Liu 2012; n = 86)
16% patients with dizziness = bppv katsarkas
Adults with a history of vertigo
(Burston et al, 2012)
Excellent agreement between two assessors (Kappa = 0.92; 95% CI: 0.87–0.98)
Predictive Validity
Benign Paroxysmal Positional Vertigo:
(Pollak et al, 2002; n = 58 patients with BPPV who were treated during the past 4 years; mean age = 55.8(14.2) years)
78% of patients (18 of 23) with positive Dix-Hallpike as only sign of vestibular dysfunction in laboratory testing did not demonstrate positional nystagmus after one particle repositioning maneuver
74% of patients (43 of 58 total patients in study) with positive Dix-Hallpike did not demonstrate positional nystagmus after one particle repositioning maneuver
38% (22 of 58 total patients) remained symptomatic despite negative Dix-Hallpike follow-up tests.
Responsiveness:
(Pollak et al, 2002; n = 58 patients with BPPV who were treated during the past 4 years; mean age = 55.8(14.2) years)
Burston, A., Mossman, S., et al. (2012). "Are there diurnal variations in the results of the Dix-Hallpike manoeuvre?" J Clin Neurosci 19(3): 415-417. Find it on PubMed
Cohen, H. S. (2004). "Side-lying as an alternative to the Dix-Hallpike test of the posterior canal." Otol Neurotol 25(2): 130-134. Find it on PubMed
Dix, M. and Hallpike, C. (1952). "The pathology, symptomatology and diagnosis of certain common disorders of the vestibular system." Proceedings of the Royal Society of Medicine 45(6): 341.
Gordon, C. R., Levite, R., et al. (2004). "Is posttraumatic benign paroxysmal positional vertigo different from the idiopathic form?" Arch Neurol 61(10): 1590. Find it on PubMed
Halker, R. B., Barrs, D. M., et al. (2008). "Establishing a diagnosis of benign paroxysmal positional vertigo through the dix-hallpike and side-lying maneuvers: a critically appraised topic." Neurologist 14(3): 201-204. Find it on PubMed
Kerrigan, M. A., Costigan, M. F., et al. (2013). "Prevalence of benign paroxysmal positional vertigo in the young adult population." PM R 5(9): 778-785. Find it on PubMed
Noda, K., Ikusaka, M., et al. (2011). "Predictors for benign paroxysmal positional vertigo with positive Dix-Hallpike test." Int J Gen Med 4: 809-814. Find it on PubMed
Oghalai, J. S., Manolidis, S., et al. (2000). "Unrecognized benign paroxysmal positional vertigo in elderly patients." Otolaryngology - Head and Neck Surgery 122(5): 630-634. Find it on PubMed
Pollak, L., Davies, R. A., et al. (2002). "Effectiveness of the particle repositioning maneuver in benign paroxysmal positional vertigo with and without additional vestibular pathology." Otology & neurotology 23(1): 79. Find it on PubMed
We have reviewed nearly 300 instruments for use with a number of diagnoses including stroke, spinal cord injury and traumatic brain injury among several others.
