Treating benign paroxysmal positional vertigo (BPPV) in brain injury cases

As a serious injury lawyer, it's not unusual to come across head injuries of different severity in clients who have suffered traumatic and at times high velocity accidents. 

Anecdotally, and in my experience, one of the issues many head injury sufferers experience are balance or tinnitus issues, however the NICE Guideline for the assessment and early management of a head injury doesn't contain any reference to vestibular assessments or follow ups. 

What is BPPV?

Benign paroxysmal positional vertigo (BPPV), in particular, has affected many of my clients. BPPV as a condition can lead sufferers to experience, in various intensities, symptoms such as dizziness, vertigo, unsteadiness and nausea. Such clients rarely seem to have been assessed or treated at the time I'm instructed, when in fact such conditions can be debilitating and greatly affect the quality of life of clients I've acted for.

This is despite a study confirming that “benign paroxysmal positional vertigo (BPPV) affects approximately half of acute, moderate-severe traumatic brain injury (TBI) patients.”

It came to the conclusion that specialist therapist-led assessment and treatment are effective for resolving benign paroxysmal positional vertigo (BPPV) due to acute traumatic brain injury (TBI). 

Repositioning manoeuvres carried out by professionals also seem to be more effective than the generic standard exercises or advice, which many of my clients receive instead of referral to an appropriately qualified professional (such as vestibular physiotherapists or similar). The study states that specialist therapists safely and accurately delivered the interventions based on monitoring criteria, with no serious adverse events reported.

Key study findings

The study found:

• Overall, 60% of the patients achieved resolution of their BPPV at 12 weeks.
• The resolution rate was 78% in the repositioning manoeuvres group, 53% in the advice group acting as a control group, and 42% in the Brandt-Daroff exercises group (a further control group). 
• Patients with resolved BPPV had a significant improvement in gait speed, whereas patients with unresolved BPPV did not.
• Among the group achieving resolution of BPPV, 29% subsequently had a recurrence. The majority of those experiencing recurrence initially had skull fractures (80%) and/or bilateral or mixed BPPV (70%).

Support available

As someone who deals with brain injury cases, this is another development to bear in mind.

Find out more about Irwin Mitchell's expertise in supporting people impacted by serious injury at our dedicated section on the website.