I first came across the work of Dr. Kimberley Bell, DPT (Creator of The Bell MethodTM) when The Vestibular Disorders Association’s Facebook page shared an interesting blog post titled “Should You Treat Yourself for BPPV? Understanding the Crystals in your Ear”.
My first thought was “this is so great!” I can’t tell you how many patients come in with a clear-cut history of BPPV, but then tried some maneuver they saw on YouTube that resembled a somersault or an Epley, not knowing what the maneuver did or why it might work. As a clinician, raising awareness is awesome and so vital!
Without BPPV education or proper diagnosis, patients are very rarely successful with self-treatment and often even further complicate their situation making their symptoms more difficult to treat. Instead of experimenting with treatment techniques, patients should be encouraged to find help from a clinician with experience treating BPPV or some other vestibular dysfunction. (I should note here that you can locate these specialists through the Vestibular Disorders Association here)
So, right from the beginning, I greatly value Dr. Kimberley Bell’s work and what she had to say. I reached out to her through Facebook to ask if I could send her a Functional Inner Ear. Since then, I have had the opportunity to email back and forth with some “Vestibuloholic Talk”, and she has provided me with some great resources and insight. She sent some articles, videos, and more blogs my way… So I just have to share!
The first resource she sent was a 47-page article which is a 2017 update of the 2008 BPPV Clinical Practice Guidelines from the American Academy of Otolaryngology Head and Neck Surgery Foundation. (Here’s the full text)
Luckily for everyone reading this, Dr. Kimberley Bell also wrote a more concise breakdown of the guidelines:
She states: “My goal is to alert professional physical therapists, physical therapist assistants, physicians, students and dizzy patients of a very important document that represents the evidence-based best practice recommendations and current standard of care for management of patients with dizziness in any clinical practice setting, the 2017 revised BPPV Clinical Practice Guidelines (CPG).
Some of the Key ﬁndings about BPPV include:
- Many patients with BPPV are misdiagnosed or under-diagnosed, due to lack of proper root cause evaluation for patients with complaints of dizziness and vertigo.
- To arrive at a diagnosis of BPPV, the average cost is $2,000.
- Many patients undergo unnecessary diagnostic testing and inappropriate or ineffective treatments, resulting in prolonged delays in care for months.
- Delays in appropriate diagnosis and treatment have a signiﬁcant cost and reduce the quality of life for the patient AND their caregivers.
- Due to the prevalence of BPPV, especially in the elderly, the societal impacts are TREMENDOUS.
- Older people with BPPV have a higher incidence of depression, falls and reduced daily activity levels.
- With the increasing age of the US population, the incidence and prevalence of BPPV is expected to increase.
- Several other disorders may present similarly to BPPV, and should be considered as part of a comprehensive exam. BPPV can also co-exist with these disorders and none of these potential causes should be overlooked.
- The diagnosis and immediate treatment of BPPV can be made based on the clinical history and physical exam by a properly trained clinician without any specialized testing equipment.
- All patients with a history of chronic falls should be evaluated for BPPV as an underlying cause.
- All providers who care for patients with dizziness should have a basic familiarity with BPPV and refer to other specialty providers to prevent the adverse events that are commonly associated with undiagnosed or mismanaged BPPV.
- BPPV is a Bio-Mechanical problem that can be effectively treated with a complete resolution by a properly trained provider in most cases.”
Dr. Bell strongly recommends for ALL healthcare providers who practice in ANY clinical setting where they care for patients with dizziness to read the BPPV Clinical Practice Guidelines.
She also suggests patients, families and caregivers to advocate for themselves by bringing a copy of the BPPV Clinical Practice Guidelines to their physicians or physical therapists, in case the clinicians has not yet seen the revised Guidelines.
You may recall that my last blog post focused on Anterior Canal BPPV. That may also be a good resource for you to share with your clinician since the newly revised 2017 BPPV Clinical Practice Guidelines have excluded that condition.
Dr. Kimberley Bell, DPT is a Licensed Physical Therapist, Vertigo Expert and Laughologist. She owns a private practice in San Diego, CA, specializing in dizziness, vertigo, imbalance and unexplained repeated falls. Dr. Bell has served as the Clinical Leader of the San Diego Fall Prevention Task Force for over 10 years and she now offers multi-media online e-courses for her global audience. Her most recent UCSD Stein Public Lecture, “Dizziness and Vertigo - Research in Aging,” has more than 134,000 views. For more information about Dr. Bell, visit www.BetterBalanceInLife.com or check out her YouTube channel "Kimberley Bell, DPT." Find her on Facebook at Kim Bell PT.
I am so grateful to Dr. Kimberley Bell for her support, her knowledge, and her available online resources. I am excited about our recent connection, and I suspect that us Vestibuloholics will have more to share in the future!
- Bhattacharyya N, Gubbels SP, Schwartz SR, Edlow JA, El-Kashlan H, Fife T, et al. Clinical practice guideline: benign paroxysmal positional vertigo (update). Otolaryngol Head Neck Surg (2017) 156:S1 47.10.1177/0194599816689660 (http://journals.sagepub.com/doi/pdf/10.1177/0194599816689667)
- Blog link: http://www.betterbalanceinlife.com/should-you-treat-yourself-for-bppv-understanding-the-crystals-in-your-ear/
- Dr. Kimberley Bell