Novel Treatment of Subjective BPPV in the Medically Complex Geriatric Patient

Background and Purpose: Peripheral vestibular disorders such as benign paroxysmal positional vertigo (BPPV) are a common, yet costly health care burden. In the older adult population, BPPV may go undiagnosed and contribute to a poorer quality of life and increased risk for falls and secondary injury. The presence of both acute and chronic medical complexities increases the challenge clinicians face in examination and evaluation. The purpose of this article is to present a case report of the treatment of subjective BPPV in an older adult with acute contraindications to traditional intervention techniques. Case Description: A geriatric patient presented to acute inpatient rehabilitation with multiple comorbidities and orthopedic restrictions after falling down a flight of stairs. The patient described vertiginous symptoms consistent with BPPV. Intervention and Outcome: In absence of objective nystagmus, the diagnosis of subjective BPPV was established and the patient was treated using a novel intervention method to accommodate orthopedic restrictions. Positional symptoms were absent during remaining hospital stay and at a 1-week phone follow-up. Discussion: In acute settings of practice, therapists are frequently presented with many restrictive factors preventing conventional performance of BPPV diagnosis and treatment. With increased knowledge regarding modification factors, new techniques can be developed to improve clinical outcomes.