Pearls of Wisdom

 

September is Fall Prevention Awareness Month #FightTheFall

 

It's no secret that the Boomer's are aging out. In general, we live a much more active life longer than generations that came before us. And that means that we most definitely need to take fall prevention seriously. Healthcare in the United States is volitie, and as services/reimbursements become more limited taking a proactive approach, rahter than a reacitve approach is definitey the prudent thing to do.

.

 

2005-2014, United States Unintentional Fall Death Rates per 100,000 All Races, Both Sexes, Ages 65+  Source: www.cdc.gov/injury/wisqars 2005: 43.12, 2006: 44.8, 2007: 48.47, 2008: 50.91, 2009: 51.54, 2010: 53.76, 2011: 55.36, 2012: 56.07, 2013: 56.96, 2014: 58.48

  • One out of five falls causes a serious injury such as broken bones or a head injury
  • Each year, 3 million older people are treated in emergency departments for fall injuries.
  • Over 800,000 patients a year are hospitalized because of a fall injury, most often because of a head injury or hip fracture.
  • Each year at least 300,000 older people are hospitalized for hip fractures.
  • More than 95% of hip fractures are caused by falling, usually by falling sideways.
  • Falls are the most common cause of traumatic brain injuries (TBI).
  • In 2015, the total medical costs for falls totaled more than $50 billion. Medicare and Medicaid shouldered 75% of these costs.
  • Falls are preventable.

A little known fact is that every year Medicare has a set value of Physical Therapy (PT) dollars that you have. Use them or not, they are there. Take the time to invest in your health and independance, before the fall happens.

 

To learn more visit: https://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html

 
By Hearing & Balance Center of Austin
September 17, 2018
Category: Hearing Aids
Tags: hearing aid  

Since it happens slowly over a long period of time, you may not realize you have hearing loss until it has progressed to an advanced state.hearing aids Luckily, your audiologist can help you fully understand your options for hearing aids, how hearing loss can affect your daily life, and how you can overcome this diagnosis and take back your life. Find out more about your hearing aid options with Dr. Paige Peterson and Dr. Taryn Shelton at Hearing & Balance Center of Austin in Austin, TX.

Do I need a hearing aid? 
There are some subtle yet common ways to tell if you are suffering from hearing loss. If you feel as though those around you mumble or if your housemates often tell you the TV or radio is very loud but you feel as though it is at a normal level, you may have hearing loss. Having difficulty hearing others, especially in a crowded place like a restaurant, or struggling to understand the other end of a phone conversation can also indicate hearing loss. If you begin to notice these instances occurring frequently, you should consult with your doctor to talk about your hearing aid options.

Hearing Aid Options in Austin, TX

  • Behind-the-Ear: BTE hearing aids fit inside the ear and wrap up and around the backside of the outer ear. These common hearing aids are affordable and readily available.
  • In-the-Ear: ITE hearing aids have smaller components, allowing them to fit into the ear without wrapping up the back of the ear. These aids are smaller and more compact, making them less noticeable at first glance.
  • In-the-Canal: ITC hearing aids rest in the ear canal itself, almost completely out of sight to others and unnoticeable to those around you.
  • Completely-in-Canal: CIC hearing aids fit completely in the canal with no visible parts on the outside of the ear.

If you think you can benefit from a hearing aid, your doctor can help you determine the best style and fit for you. For more information on hearing aids or your options, please contact Audiologists Dr. Paige Peterson and Dr. Taryn Shelton at Hearing and Balance Center of Austin in Austin, TX. Call 512-258-2300 to schedule your appointment with your audiologist today!

Signia Styletto Hearing Aid Review | Hearing & Balance Center of Austin

 

Introducing The Signia Styletto

 

Signia Hearing Instruments (aka Siemens for those who have been around a long time) has released Styletto. A sleek, rechargeale hearing aid that reminds us of something that Steve Jobs would have debuted with a lazer show as it came up out of the stage to a fanfare of trumpets. It makes you want to bust out your iPhone and color coordiante with your Apple watch, head phones and maybe even your fashion jewelry. But as the dust settles, what is left?

 

So Is The Styletto a Hearing Aid?

 

Yup. Every inch of this is in fact an amplification device. It has Signia's new Nx chipset (which in all reality is one of the more novel things to come out of the hearing aid world in awhile). It's slim design and lack of buttons make this look more like an accessory than a hearing aid, so I can see where the confusion is coming from. It is significantly thinner and a skosh longer than a normal hearing aid. Like with everything it has Pros and Cons, but at the end of the day it's all about what you NEED. So let's see what makes Signia’s Syletto stand out.

 

Styletto’s Slim Design and Rechargability

While the industry standard in rechargability uses either a lithium ion, rechargeable interchangeable or zinc-air button battery, Styletto is the first to use the slim-pin design. This is what allows the aid to be much thinner (think the diameter of a regular water straw) than your typical hearing aid. To accomplish this slimmer design, the device itself is in fact longer than your typical hearing aid. It has a brushed metal plate that faces outward from the ear without any push buttons or on ear manipulations. Don’t worry, you can still change your volume and programs from the phone app OR the little key fob remote control (this has a name, but right now it has left me).

Here is where, the road warrior - I hate changing batteries or plugging something in every night - individual is going to get excited. Like the Apple Air Pods, the Styletto’s carrying case IS THE CHARGER. Yup, you can get 3 - 4-ish charges off of the case itself. All of the spec sheets say 19 hrs of wear time. If your day takes you to a dinner meeting, after hours happ-hour or all night sales schmooze-a-thon, putting the devices in the case for 30 min will get you an extra 5 hours of run time. So think, driving in the car to get to your meeting, or sitting in the salon getting your hair done, put the Styletto in the case, and presto, 5 more hours of play time.  The case fits easily in your purse or pocket and can be recharged using an external power bank. So if you REALLY had to, you could honestly not plug anything into a wall for about a week if needed. This is honestly, from my perspective the best feature about this hearing aid. 

 

 

Does Syletto Have Direct Connectivity to iPhone or Android via BlueTooth?

 

Sadly, no. With everything in technology, there is a give and take with everything. Getting the slim design, cool charging capabilities AND Signia’s Nx chip came with a price, direct connectivity. I would hope in the next 3-5 years that will happen, but right now that is not an option. You CAN in fact have a program built into the aid where you can have the phone calls go into both ears. BUT to do this you have to either go to the app and change programs before you call, OR once you pick up the call say “Oh, can you please wait?” And then go to the app, change programs and go. Now this will work with landline OR phone, so that is something. For those who need the hands free streaming, this won’t be the hearing aid for you. But for those with the mild-moderate hearing loss, where this isn’t a problem, working in an office where phone calls aren’t part of your every day, this is still a viable option.

Because it does not connect via BlueTooth, changes to volume and programs are made via a high frequency tonal signal. This is standard within the hearing industry and is of no surprise here.

 

Does the Styletto use Signia’s New Own Voice Processing (OVP)?

 

Why yes, yes it does. Hinting to how long I’ve been in this industry, every now an again Siemens (now Signia) comes out with something that truly changes how the hearing aid world functions. When their e2e (ear to ear) processing started back in the day, I can remember being in Topeka, KS at the VA Medical Center thinking “Holy ____, this just changed the game.” This my friends is one of those times. Outside of hearing conversation in noise & hearing the television, the complaint I hear the most is “my voice is too loud” or “I don’t like the echo in my voice.”  This is due to a few things, and I won’t bore you with the physics (if you really want to know, call me or make and appointment and we’ll have a chat) but Signia has developed within their algorithm an ability to genuinely combat this. You may not get streaming, but you DO get Own Voice Processing, and that isn’t bad.

 

Tele-Audiology To the Rescue

 

As you may know, I have quite a background in Telehealth, it’s kinda my passion, which is why we have a Tele-Audiology clinic at the hearing & Balance Center of Austin. Of the main six manufacturers only a few have the capability of functioning in a tele clinic. Signia’s first instance for this delivery model was limited, but effective. With Telecare 3.0 they have stepped up the game, and Syletto comes equipped with this capability.

 

So Is There Anything You Don’t Like About the Syletto?

 

Actually, yes. From an audiological standpoint I really don’t like the fact that the receiver is not interchangeable. You read that correctly. The component that goes from the hearing aid to the speaker in your ear is part of the whole thing. Part of the beauty of a RIC (receiver in the canal) is that if anything happens to the receiver (moisture, you need to change the receiver, change length, someone breaks it) you can just change it right then and there like a LEGO block. Believe me I do this a lot. You can’t do that with Syletto. Now, Signia has come up with this quick replacement system. That sounds good, but environmentally I’m not a fan and it seems like a huge waste.

 

Overall, I think that this is a solid, out-of-the-box solution. I think this has the possibility of being and accessory and moving us past the stigma associated with hearing loss. This is NOT grandma’s hearing aid. But let’s be real here, I like to look into the future, and what Signia has done here is create something that they can market test and then I think, de-feature for the OTC classification that will drop in 2020. OTC aids will be for mild to moderate loss, like the Styletto, which honestly is a brilliant idea. For the mild to moderate hearing loss crowd, this is really something to look into.

 

To find out more, or to see if Syletto is a fit for you, call (512) 258-2300 to schedule an appointment with our Audiology staff today.

 

Signia Styletto Fashion Hearing Aid Austin, TX

Fall Prevention Specialists Austin, TX

 

Fall Prevention: When Does this Apply to You?

 

-Feeling unsteady

-Currently using a walker/cane or another form of walking aide

-Have muscle weakness or decreased sensation in the feet or legs

-Have poor vision

-Recently had a lower extremity surgery

-Feeling dizzy or light headed

-Had a fall within the past few months to a year

-Fearful of falling

-On a ton of medications

 

Well then this if for you!

 

Falls...the one thing that everyone is afraid off especially when over the age of 65. Falling is the number one reason for fatal and nonfatal injuries in persons 65 and older. Falls are also the most common cause of traumatic brain injury ¹. According to the CDC (Centers for Disease Control and Prevention),  1 in 4 elderly adults 65+ yrs old fall each year ¹. One in five falls will result in a serious injury such as head trauma or a broken bone ¹. “Over 800,000 people a year are hospitalized due to a fall that resulted in injury of either head trauma or hip fracture. More than 95% of hip fractures are a result of a fall. ¹” In addition, ¹ “every 20 minutes an older adult dies from a fall in the United States”. Yikes!!

 

 

Prevention is Better Than a Cure

Some of the things that contribute to falls especially in the elderly population are impaired vision, medication, decreased balance, leg weakness, chronic health conditions and home hazards.  The key is figuring out which one or ones are a problem for you so that you may seek help to decrease these risk factors and lower your chances of having a fall.

 

Problem: Impaired Vision

People with visual deficits such as glaucoma or cataracts are definitely at risk for falls as their visual acuity and depth perception are altered. Lighting can also play a role as if walking out at night or when getting up from bed to walk to use the bathroom; if adequate lighting is not available the visual field will be altered thus increasing risk of falls.

 

Solution: If you notice you have trouble looking at objects either far or near or often misjudge your step when coming on/off an escalator or stair case, you might have a visual deficit. Get your eyes tested frequently. If you were prescribed glasses, make it your duty to always wear them. Update your glasses if need be. The CDC recommends: “If you have bifocal or progressive lenses, you may want to get a pair of glasses with only your distance prescription for outdoor activities, such as walking. Sometimes these types of lenses can make things seem closer or farther away than they really are. ²” Also utilize night lights throughout your home to ensure adequate lighting when going to restrooms and always give yourself a few minutes to adjust upon getting up from bed to walk to restroom to ensure your eyes have adjusted from your awaked slumber.

 

Problem: Medication

Certain meds have side effects of dizziness, altered mental state, muscle fatigue and sudden drop in blood pressure including but not limited to blood pressure medication, antidepressants, sleeping pills and some pain meds and muscle relaxers. Not to mention if on more than one of these medications the drug interactions can cause issues with gait and balance and increase risk of falling.

 

Solution: Have your primary care provider look over ALL your medications to screen for the side effects and drug interactions. Report a list of all your medications to your health care providers. It is important to keep all your health care clinicians in the loop with your list of meds because if one prescribes a medication unaware that you are currently taking a drug for a certain condition he/she might end up prescribing you another medication treating the same condition but with more severe side effects when interacting with that drug. Thus putting you at risk for falling. As a Physical Therapist, I ran out out of fingers and toes to count the amount of times I had patients coming in for gait and balance treatment, with a long list of meds to treat similar or exactly the same conditions in which the physicians prescribing these drugs had no clue the patient was already taking Drug XYZ prescribed already from Doctor A. So I can’t emphasize enough the importance of having your healthcare provider monitor the medications you are on and their interaction with other drugs.

 

Problem: Decreased Balance/ Leg Weakness

If you have had numerous falls in the past, frequently feel unbalanced when walking, often grab onto the nearby person/wall/furniture when walking then you may have a balance impairment.  Many factors can play into why someone has decreased balance for example whether or not you may have decreased sensation in your feet due to Diabetes, or have an inner ear issue such as vertigo, or recently had a stroke and have difficulty moving the limbs due to extreme weakness. Decreased mobility/inactivity can also affect balance because when we are inactive our muscles become deconditioned and if the muscles are weak, they will affect our ability to stay upright thus putting us at increase risks for falls. Not to mention if you do trip, the ability for you to catch yourself or to correct your footing is less likely if the muscle strength is not there.

 

Solution: Consider using a walking aid whether cane or walker. A Physical Therapist can assess you for the proper assistive device needed to give you more stability when walking and can train you on how to properly use the device. Talk to your health care physicians about falls prevention classes or referrals for physical therapy to work on gait and balance training and/or strength conditioning. Also, stay active! You are never too “old” to exercise. The body is made up of many muscles and like the saying goes “use it or lose it”. It doesn’t mean you have to sign up for the next marathon but just keeping moving, maybe even a gentle daily walking program to build up endurance. You can even join a gym! The American Heart Association, AHA, recommends about 30 minutes of moderate intensity exercises at least 5 days a week to improve overall health ³.

 

AHA Recommendation

For Overall Cardiovascular Health:

  • At least 30 minutes of moderate-intensity aerobic activity at least 5 days per week for a total of 150

 

OR

  • At least 25 minutes of vigorous aerobic activity at least 3 days per week for a total of 75 minutes; or a combination of moderate- and vigorous-intensity aerobic activity

 

AND

  • Moderate- to high-intensity muscle-strengthening activity at least 2 days per week for additional health benefits.


 

Problem: Chronic Health issues

Patients with comorbidities and chronic illness such as Diabetes, Arthritis, Heart Disease, COPD, Parkinsonism, Multiple Sclerosis, Alzheimer’s, history of stroke, and etc are at increased risk to falls due to the general weakness, impaired muscle tone, reduced sense of position in relation to gravity, altered mental state, decreased cardiovascular endurance and decreased oxygenation.

 

Solution: Follow up with health care provider regarding treatment interventions and exercise regimens to ensure optimal functioning despite health conditions. Routinely check blood pressure if feeling lightheaded, check glucose levels, use assistive device of need be for conditions that can impact gait and take prescribed meds at routine time of the day.  

 

Problem: Home hazards

As we often like to think we are the most safe in our homes, that is not always the case. Clutter can lead to tripping and falling. Incorrect placement of furniture may narrow spaces and increase risk for falling. Throw rugs and small pets are very easy to trip over or get your walking aides caught up over. Poor lighting can affect your visual field and depth perception. Cracked stairs and loose carpet, lack of or shaky railing can also increase your risk of falling. The bathroom can become a complete nightmare without grab bars or a shower stool. High kitchen cupboards may prove difficult to reach and can lead to a safety issue if you are constantly trying to climb up onto the counter. Step stools are helpful but if unsteady can be very dangerous.

 

Solution: Remove the clutter from your home. Wires, stacks of books, that step stool you refuse to place under the table or in a closet can all lead to clutter and increase risk of falling. Furniture placement is also essential making sure everything is strategically placed so that you are able to maneuver around your home without sliding through the corners or stumbling around your furniture. Even more so, if you use an aide whether cane or walker to move around; it can easily get caught in the clutter causing you to misstep and fall down. Get rid of or properly secure throw rugs to the floor especially if you notice the ends curling upwards.

 

Be mindful of pets when walking about in your home; they love to lay near your feet. As lovable as they are, they are very easy to trip over if not paying attention!

 

Be mindful of steps especially if you already had visual issues. Depth perception and busy colors can really impact the way we see our stairs. Also if living in an older home make sure the railing is secure and if steps are slanted revealing wear and tear, maybe time to revamp as this can all lead to falls. Make sure to hold onto railing when ascending or descending stairs and be aware of foot placement to ensure you don’t misplace your feet at the edge. You may even consider installing rails on both sides if need be for safety. Don’t forget having a step stool in the kitchen can be very helpful. Ensure the step stool is leveled before using.

 

Grab bars and/or shower stool are also neat for bathrooms especially in showers where it tends to get slippery. May even consider anti-slip bath mats. Also grab bars near the toilet as to assist with transfers on and off.

 

Lighting is essential in both daytime and especially at night. Broken bulbs?? Replace it! Make sure your home always has adequate light to ensure that you can see where you are going especially at night time walking down hallways to get a glass of water or use the bathroom. Night lights tend to come in handy for that or if you are feeling fancy, motion sensor lights can also do the trick. Also make sure there is adequate light over staircases. Is the light switch only at the bottom or top of the staircase? You may need both to ensure safety.  

 

Image result for falls prevention checklist

 

References

 

  1. “Home and Recreational Safety.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 11 Oct. 2016, Accessed on 20 July 2018 at www.cdc.gov/homeandrecreationalsafety/falls/index.html.

 

  1. “Home and Recreational Safety.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 10 Feb. 2017, Accessed on 20 July 2018 at www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html.

 

  1. American Heart Association Recommendations for Physical Activity in Adults. (2017, December 14). Retrieved July 23, 2018, from http://www.heart.org/HEARTORG/HealthyLiving/PhysicalActivity/FitnessBasics/American-Heart-Association-Recommendations-for-Physical-Activity-in-Adults_UCM_307976_Article.jsp#.W1Ydo-gvxD8

 

  1. Yoshida, Sachiyo. “A Global Report of Falls Prevention: Epidemiology of Falls.” Retrieved July 24, 2018 Http://Www.who.int/Ageing/Projects/1.Epidemiology%20of%20falls%20in%20older%20age.Pdf

 
By Collette Rhoden, PT, DPT
July 25, 2018
Category: BPPV
Tags: Austin   Vertigo   dizzy   spinning   BPPV   doctor  

BPPV: Understanding the Crystals in My Ear


 

Inner Ear Cochlea, Semi-Circular Canals Hearing & Balance Center of Austin

Picture retrieved from

http://dynamicsportspt.com/mobileservices/bppvvertigo/


What Is BPPV?

BPPV-Benign Paroxysmal Positional Vertigo is the most common vestibular disorder that causes a false sense of room spinning dizziness. This issue is due to the disruption of the crystals in your inner ear. This occurs when the otoconia (calcium carbonate crystals) get dislodged from the utricle, where they are normally embedded, and migrate into one or more of the 3 semicircular canals also known as “canalithiasis” ¹. During head movement, the free floating otoconia crystals shift disrupting the normal fluid movement in the semicircular canals thus causing the brain to send signals of false movement in relation to gravity ¹. The information perceived by the brain does not match what the eyes are seeing and what the body muscles are doing nor what the other ear is sensing therefore causing the person to feel an imbalance or false sense of spinning ¹.

 

What Causes BPPV to Happen?

 

There is no known exact cause as to why this happens but research has shown that risk factors that may influence the occurrence of BPPV are: direct trauma to the head, prolong periods of inverted head positions, inner ear infections or diseases, migraines, reduced blood flow, sickness causing prolonged periods of lying in bed and or inactivity, and one’s preferred sleep position ¹.

 

Am I Making This Up? Is BPPV all in My Head? Why Me?

 

You are not alone nor are you going crazy! BPPV has an estimated incidence of 107 people per 100,000 per year ¹. BPPV has a recurrence rate of about 15% per year with a high of 56% ² of individuals having a recurrence of BPPV.  It is more prevalent in people 50 and older and more likely prevalent amongst females ³. At least 20% of patients that have symptoms of dizziness are diagnosed with BPPV by their physician ². Other symptoms that can also occur due to this condition other than the routine nausea, room spinning dizziness and vomiting are high levels of anxiety, frustration, anger, fatigue and depression. It is completely normal to feel helpless and frustrated and depressed when dealing with BPPV due to the functional limitations that occur as a result of this condition but please seek counselling if symptoms worsen as the emotional component can actually make the symptoms persist.

 

Who Do I See if I Think I Have BPPV?

After visiting your family doctor or general practitioner and upon diagnosis of BPPV, you may be referred to a more specialized physician for treatment or further assessment such as an Audiologist, ENT (Ear Nose and Throat Doctor), and/or Physical Therapist (specifically trained to rehab patients with vestibular disorders) ¹. Beware that not all Doctors are familiar with vestibular rehabilitation and may fail to refer you to a Physical Therapist for treatment, which has been proven highly effective for recovery, so don’t be afraid to bring up the idea of seeing a Physical Therapist for treatment to your doctor if have been diagnosed with BPPV.

 

How is BPPV Diagnosed?

 

BPPV is diagnosed through symptom clustering and checking the semicircular canals via the Dix Hallpike and Supine Horizontal (Roll) tests. During your assessment  your Physical Therapist may ask you question in regards to positions and whether or not they tend to elicit your symptoms. BPPV is commonly triggered by activities such as getting in and out of bed, rolling over in bed, tipping the head back to look up, bending over forward, and quick head movements ¹ (i.e turning your head when someone calls your name). After collecting a list of activity provokers, the Therapist and/or other healthcare professional trained in vestibular assessment will perform the Dix Hallpike [Figure 1] ⁴ to check for loose floating otoconia in the posterior semicircular canals which tend to be the most common area of BPPV.

 

The Supine Horizontal test will also be performed to assess the horizontal canals for BPPV. Positive test is the presence of rapid eye movement whether torsional or up or down beating on the side that is tested which is noted as “nystagmus”. The rapid eye movement is triggered when the free floating otoconia is moving in the canal and should last in short duration under 30 seconds ¹. This can last longer if the otoconia are stuck to the cupula (organ in inner ear that senses spatial orientation) instead of free floating in the canals which is called cupulolithiasis, another form of BPPV where the rapid eye movement nystagmus will occur as long as the patient is held within the testing position. Since the otoconia are stuck on the cupula, the brain perceives constant input of movement therefore causing constant nystagmus when in the tested position but symptoms should subside once taken out of the tested position with head in neutral positioning in relation to gravity. In addition, a series of visual and vestibular test will also be performed to rule out other pathologies.

Dix Hallpike Testing for BPPV Austin, TXFigure 1: Dix Hallpike

[Picture retrieved from http://epomedicine.com/clinical-medicine/vestibular-examination-dix-hallpike-maneuver-for-bppv


 

Ahhhh Yes! The Good Part: How is BPPV Treated?

 

Upon assessment and determining whether or not it is canalithiasis or cupulolithiasis and determining which canal is affected. The Physical Therapist will perform evidence based highly effective corrective maneuvers to clear the crystals from the canal. The maneuvers utilize head on body movement along with gravity to transfer the crystals back into their rightful place in the inner ear. One of the maneuvers that can be performed is called the Epley maneuver [Figure 2] ⁵ or also known as the Canal Repositioning Maneuver which is performed to clear the otoconia out from the posterior semicircular canal. This maneuver can also be self performed for the individual to treat at home ONLY IF your Therapist recommends it, however, caution should be

taken because if performed wrong can make symptoms worse. The maneuver that can be used to clear the crystals in the horizontal/lateral canals is called the Lempert Roll Maneuver or “BBQ roll’. Both maneuvers can be modified for patients that may have neck injuries or postural deformities that may affect their ability to get into some positions. If the therapist suspect cupulolithiasis, then he/she will perform the Liberatory Maneuver which incorporates rapid head movement to dislodge the crystals from the cupula.

 

Epley Maneuver Diagram BPPV Dizziness Treatment Austin,TX

 

Figure 2: Epley Maneuver

[Picture retrieved from https://athenatech.us/epley-maneuver-diagram/epley-maneuver-diagram-unique-check-your-balance]

References

 

  1. Benign Paroxysmal Positional Vertigo (BPPV). (2018, January 26). Retrieved July 10, 2018, from https://vestibular.org/understanding-vestibular-disorders/types-vestibular-disorders/benign-paroxysmal-positional-vertigo

 

     2. Pérez P, e. (2018). Recurrence of benign paroxysmal positional vertigo. - PubMed -   

        NCBI. [online] Ncbi.nlm.nih.gov. Accessed July 11, 2018, Available at:

        https://www.ncbi.nlm.nih.gov/pubmed/22388730  

 

     3. Patient.info. (2018). Benign Paroxysmal Positional Vertigo; BPPV information. Patient.  

         [online] [Accessed July 16. 2018]. Available at:

         https://patient.info/doctor/benign-paroxysmal-positional-vertigo-pro  

 

     4. Vestibular examination : Dix-Hallpike Maneuver for BPPV. (2014, August 27). Retrieved

        July 12, 2018, from           

http://epomedicine.com/clinical-medicine/vestibular-examination-dix-hallpike-maneuver-for-bppv

 

     5. Athenatech.us. (2018). Epley Maneuver Diagram Unique Check Your Balance - Diagram

         Inspiration. [online] [Accessed 16 Jul. 2018].Available at: https://athenatech.us/epley-maneuver-diagram/epley-maneuver-diagram-unique-check-your-balance

 

 

 

 

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