Answer:

Bridgett Wallace, PT, DPT: “So the bow and lean are what we call differential tests. They’re not the test to say you have horizontal canal, that’s the roll test. But sometimes people are like, which ear is it? I can’t tell which side the nystagmus is stronger. These are differentials. So the bow and lean is you have the patient in sitting and they took the head down and you’re looking to see if they had a geotropic nystagmus, they had a geotropic nystagmus in the roll test in the bow though it’ll create another nystagmus and it’ll be towards the affected ear. So if I go like this and it’s my right ear, I’ll have a nystagmus towards my right ear, and then when I do the lean it’ll switch directions. So bow and lean and then sit to supine and sit to supine follows the rules for lean where they are in sitting and they go back and if it was geotropic nystagmus, it’ll be away from the affected ear and if it’s ageotropic towards. So those are differentials, just like the Null plane test is a differential between horizontal canal and light cupula. So what you do is in the roll test, here’s the middle, you turn the head to the right. If you can’t get the head to the right, because the goal is to get the ear down, roll onto the right side. Because it’s all about getting the ear down. So there’s the roll right, left, middle and then the null point is about 20 to 25 degrees or as Kim said there’s a study that’s 15 to 95, but we’re going to say 20 to 25 degrees. If it’s BPPV, it’ll keep going. If it’s the null point for light cupula, it’ll stop.”

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RESOURCES & LINKS:

• This Q&A is an excerpt from the Vestibular Health Summit Sessions
• The Vestibular Health Summit Sessions are included with 360NeuroGO Enterprise

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FACULTY:

Rudie Spigarelli, PT, DPT, MTC

Rudie Spigarelli has a doctorate in physical therapy and holds a certificate of competency in manual therapy and concussion management. Dr. Spigarelli is a member of the American Physical Therapy Association and Vestibular Disorders Association. Prior to joining the 360 Balance & Dizziness team in 2015, Dr. Spigarelli gained experience working with orthopedic issues Texas PT Specialists in Austin and her love for vestibular disorders began as a physical therapy student while completing an internship at 360 Balance & Hearing. Dr. Spigarelli is the proud graduate of from Texas Woman’s University in Houston. She graduated summa cum laude with a bachelor’s degree in exercise science at Texas State University in San Marcos.

Bridgett Wallace, PT, DPT

Bridgett Wallace, PT, DPT, has a doctorate of physical therapy and holds competency-based certifications in vestibular rehabilitation and concussion management. Dr. Wallace has been treating patients with dizziness and balance disorders for more than 20 years and is the founder and President of 360 Balance & Dizziness – a specialty clinic for the evaluation and treatment of dizziness and balance disorders that includes both audiology and therapy services. She is also the co-founder and Director of Clinical Education for 360 Neuro Health Institute, which provides online, mobile, and live educational offerings for healthcare providers.