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RehabMeasures Instrument

Side-lying Test for BPPV (Semont Diagnostic Maneuver)

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Purpose

The Segmont Diagnostic Maneuver diagnoses Benign Paroxysmal Positional Vertigo (BPPV).

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Instrument Details

Acronym  

Area of Assessment

Vestibular

Cost

Free

Cost Description

Test is free; electronystamography, videonystagmography, video recorder, video goggles, or Frenzel goggles cost > $1000

Diagnosis/Conditions

  • Vestibular Disorders

Key Descriptions

  • Examination procedures:
    1) The patient begins seated at side of an examination table.
    2) The head is turned 45 degrees away from side being tested to align the posterior semicircular canals with the plane of movement; patient is quickly laid onto the table onto the side being tested.
    3) The clinician observes the patient’s eyes for one minute.
  • Diagnosis criteria:
    1) Benign paroxysmal positional vertigo of the posterior canal is diagnosed if an upbeating and rotational nystagmus (fast phase towards the ear being tested) is observed with the patient in this test position.
    2) The nystagmus should begin after a brief latency (5-10 seconds), last less than one minute, and should correlate with symptoms of vertigo.

Equipment Required

  • Examination table
  • electronystamography
  • videonystagmography
  • video recorder
  • video goggles or Frenzel goggles to view nystagmus

Time to Administer

5 minutes

5 Minutes or Less

Required Training

Training Course

Instrument Reviewers

Karen Lambert, PT, MPT, NCS, Linda B. Horn, PT, DScPT, MHS, NCS and the Neurology Section Vestibular EDGE Task Force of the American Physical Therapy Association.

ICF Domain

Body Structure

Considerations

The side-lying test can be used as an alternative to the Dix-Hallpike maneuver when the patient cannot tolerate the latter due to postural restrictions, medical precautions, or discomfort. There have been very few studies looking specifically at the Side-Lying Test. As with any positional test, true BPPV may be missed due to the transient nature of this diagnosis among other reasons.

  • “Subjective” BPPV accounts for about one-fourth of patients suspected of BPPV (Noda 2011) 
  • Prevalence of BPPV (Bhattacharyya 2008) 
    • Prevalence of BPPV reported between 10.7-64 per 100,000 individuals
    • Lifetime prevalence of 2.4%
  • Prevalence of BPPV (Ogahali 2000) 
    • 9% of patients undergoing a comprehensive geriatric assessment (not related to complaints imbalance) were found to have BPPV

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Vestibular Disorders

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Criterion Validity (Predictive/Concurrent)

Vestibular Disorders

 

Concurrent Validity - (Cohen, 2004, n = 61; 14 males, 47 females; mean age = 56.2 (16) years; all subjects reported experiencing vertigo when looking up, down, or rolling over in bed)

  • 61 subjects with history consistent with BPPV underwent Dix-Hallpike and Side-Lying Test for BPPV 
  • Group 1 performed Dix-Hallpike followed by Side-Lying Test, Group 2 performed Side-Lying Test followed by Dix-Hallpike 
  • Mann-Whitney U tests showed no significant difference between the two maneuvers (results of Mann-Whitney U test not reported) 

(Halker, 2008, performed a critical appraisal of diagnostic maneuvers for BPPV and further analyzed Cohen, 2004 article)

 

 

Side-Lying Value

(95% CI)

Prevalence

87.9%

Sensitivity

89.7% (78.6-100)

Specificity

75.0% (32.6-100)

Positive predictive value

96.3% (89.2-100)

Negative predictive value

50.0% (10.0-90.0)

Overall accuracy

87.9% (76.7-99.0)

Positive likelihood ratio LR+)

3.59 (0.65-19.67)

Negative likelihood ration LR-)

0.14 (0.04-0.46)

 

Concurrent Validity - (Cohen, 2004) 

  • Comparison of the Side-Lying and Dix-Hallpike tests found no significant difference between the two techniques (results of the Wilcoxon matched-pairs signed ranks tests were not reported)

Bibliography

Cohen, H. S. (2004). "Side-lying as an alternative to the Dix-Hallpike test of the posterior canal." Otology & Neurotology 25(2): 130-134. 

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." The neurologist 14(3): 201-204.

Helminski, J. O., Janssen, I., et al. (2008). "Daily exercise does not prevent recurrence of benign paroxysmal positional vertigo." Otology & Neurotology 29(7): 976-981. 

Helminski, J. O., Zee, D. S., et al. (2010). "Effectiveness of particle repositioning maneuvers in the treatment of benign paroxysmal positional vertigo: a systematic review." Phys Ther 90(5): 663-678. Find it on PubMed

Lee, S. H. and Kim, J. S. (2010). "Benign paroxysmal positional vertigo." Journal of Clinical Neurology 6(2): 51-63. 

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

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