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. 2024 Oct 16;49(1):51–61. doi: 10.1097/NPT.0000000000000494

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© 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of Academy of Neurologic Physical Therapy, APTA.

This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

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Figure 1. — Useful test positions to identify atypical pc-BPPV-cu and pc-BPPV-ca of short arm. Illustrated for the right membranous labyrinth. Location of debris relative to cupula is adherent (▲) – cupulolithiasis and adjacent to short arm side (●) – short arm canalithiasis. The arrow indicates the line of gravity. (A) Initial position of the Dix-Hallpike Test (DH) and half-Hallpike position (HH) in sitting. To align the plane of right pc in the plane of gravity, rotate the head 45° toward the right – the side to be evaluated. The area of the pc between the common crus (CC) and ampulla is the long arm and between the ampulla and the utricle is the short arm. The pc long arm has two regions, A_PC – proximal segment near the ampulla and N_PC – distal segment near the CC. (B) Contralateral inverted release (IRc) position for the right cupula. In sitting, rotate the head 45° away from the involved side and position the person side lying on the uninvolved side with the neck flexed 20°. If pc-BPPV-cu adherent short or long arm, or pc-BPPV-cu adjacent long arm, in the IRc the longitudinal axis of the cupula is in the earth horizontal plane and maximally deflects towards the ampulla inhibiting (red) the right pc afferent. (C) Ipsilateral Half Hallpike (HHi) position for the right cupula. In the supine recumbent position, the head is rotated 45° toward the side to be evaluated and positioned 30° above earth horizontal plane. (D) Conventional Dix-Hallpike (DH) position for the right cupula and no nystagmus due to absent cupular deflection. In the supine recumbent position, the head is rotated 45° toward the side to be evaluated and extended 20° below earth horizontal plane.16 (E) Augmented Dix-Hallpike (DH) position for the right cupula. In the supine recumbent position, the head is rotated 45° towards the side to be evaluated and extended 40° below the earth horizontal plane.23 (F) Straight Head Hanging (SHH) position for the right cupula. In the supine recumbent position, the head is in neutral rotation and extended 60° below the earth horizontal position. AC, anterior canal; LC, lateral canal; PC, posterior canal; CC, common crus; U, utricle; N_PC, non-ampullary or distal segment of pc; A_PC, periampullary or proximal segment of pc. This figure is available in color online (www.jnpt.org).