Faculty Advisor(s)

Amy J. Litterini

Document Type

Course Paper

Publication Date



© 2017 Clare Roeder


Background & Purpose: Benign Paroxysmal Positional Vertigo (BPPV), the most common vestibular disorder, is treated via a canalith repositioning maneuver (CRM), often providing rapid and lasting resolution of symptoms. However, 31% to 61% of patients experience residual dizziness (RD) post-treatment. For these cases, known as BPPV treatment failures, vestibular rehabilitation (VR) is recommended. Limited evidence exists for the specifics of treatment. This report documents VR of an older patient following BPPV treatment failure. Case Description: The patient was a 77 year-old male referred to outpatient physical therapy with a diagnosis of peripheral vertigo. He reported unsteadiness and dizziness during gait and sit to stand transfers. A positive Dix-Hallpike test indicated posterior canal BPPV. Despite a successful CRM, his symptoms persisted. A VR program consisting of static balance, dynamic gait, and gaze stabilization was implemented to decrease RD, improve functional mobility, and reduce fall risk. Outcomes: The patient demonstrated improvements in all outcome measures: the Dizziness Handicap Index score (58/100 to 30/100); the Mini Balance Evaluation Systems Test (20/26 to 24/26); condition 4 of the Modified Clinical Test of Sensory Integration on Balance (6.3s to 30s); vestibular ocular reflex (VOR) testing (3/10 to 0/10 dizziness); and strength testing of the lower extremities (increased ½ to 1 manual muscle testing grade throughout). Discussion: A VR program implementing gaze stabilization, static balance and dynamic gait training appeared to be successful in treating this patient with BPPV treatment failure. This case report suggests that improvements in functional mobility, balance, and VOR function may be possible in patients with RD. Future research should investigate effective interventions for older patients with BPPV treatment failure.


The case report poster for this paper can be found here:




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