Structures vestibular assessment with positional testing and customized exercise programs. Use when evaluating vestibular disorders, performing Dix-Hallpike testing, or designing vestibular exercise programs.
Structures vestibular assessment including the Dix-Hallpike test, head impulse test, oculomotor examination, and balance assessment with customized vestibular exercise programs for BPPV, unilateral vestibular hypofunction, central vestibular disorders, and persistent postural-perceptual dizziness (PPPD). Aligns with Clinical Practice Guidelines from the Academy of Neurologic Physical Therapy and APTA.
Dizziness is the third most common complaint in outpatient medicine, and BPPV alone affects 2.4% of adults. Vestibular rehabilitation produces complete resolution of BPPV in 80-90% of cases with canalith repositioning and significantly improves function in unilateral vestibular hypofunction. However, vestibular disorders are frequently misdiagnosed, leading to unnecessary imaging, ineffective medication, and prolonged disability. Accurate differential diagnosis between peripheral and central vestibular disorders is critical for patient safety — central causes may indicate stroke or tumor requiring emergent medical management. This skill structures the systematic assessment required to identify the vestibular pathology, select the correct intervention, and document outcomes for a condition where precision directly determines efficacy.
Before beginning vestibular assessment, confirm:
Required clinical questions:
Required documents:
Red flags requiring immediate physician referral (possible central pathology):
HINTS examination (for acute vestibular syndrome):
Oculomotor examination:
Dix-Hallpike test (posterior canal BPPV):
Supine roll test (horizontal/lateral canal BPPV):
Document for each positional test:
Balance assessment battery:
Dizziness measures:
For BPPV — Canalith Repositioning Maneuvers:
Posterior canal BPPV:
Horizontal canal BPPV (geotropic):
Document per treatment:
For unilateral vestibular hypofunction — Vestibular exercise program:
For PPPD and central dizziness:
Reassessment schedule:
Discharge criteria:
Before finalizing vestibular rehabilitation documentation: