Dix-Hallpike

The safety of the patient should be prioritized when completing this test virtually, and the examiner should avoid putting the patient in a position where a fall may occur. Floor (or bed) Dix-Hallpike: this test can be used for patients who are fully mobile and able to get down to the floor and up again without assistance. Instruct the patient to sit upright on the floor and place a pillow directly behind them (which will align to their mid-back when lying supine). Then have the patient turn their head 45o to the right/left and lie back quickly, with proper placement of the pillow allowing the head/neck to extend slightly as they lie back. The patient should hold the camera in front of their eyes throughout the maneuver. Assess for nystagmus and symptom provocation. If dizziness is provoked, allow the patient sufficient time to recover before instructing them to sit up. Have the patient keep the camera on the eyes as they sit up to see if there is reversal of the nystagmus (see example in PC-BPPV - https://collections.lib.utah.edu/ark:/87278/s6ng8nbm). When the test is positive for posterior canal benign paroxysmal positional vertigo [https://collections.lib.utah.edu/details?id=1281863&q=dix+hallpike&fd=title_t%2Cdescription_t%2Csubject_t&facet_setname_s=ehsl_novel_gold], the nystagmus 1) typically begins with a short latency (sometimes as long as 30 secs) after change in head position, 2) lasts less than 1 min, 3) fatigues with repeated testing, and 4) often reverses direction (downbeat-torsional towards the left ear with right PC-BPPV) when the patient sits up again [https://collections.lib.utah.edu/details?id=1281864&q=dix+hallpike&fd=title_t%2Cdescription_t%2Csubject_t&facet_setname_s=ehsl_novel_gold].