Modified (Chair) 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. Modified (chair) Dix-Hallpike:(1) this test can be used for patients who may not be able to safely undertake the traditional Dix-Hallpike. Instruct the patient to sit at the front of the chair, turn their head 45o to the right/left and sit back quickly, allowing their neck to extend slightly over the back of the chair. 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. When nystagmus is provoked, continue to observe the eyes after returning to an upright seated position to evaluate for reversal. 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].