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Rehab Measures: Bow and Lean Test

Link to instrument

 

Title of Assessment

Bow and Lean Test 

Acronym

BLT

Instrument Reviewer(s)

Linda B. Horn, PT, DScPT, MHS, NCS, Karen H. Lambert, PT, MPT, NCS, and the Vestibular EDGE Task Force of the American Physical Therapy Association (2013)

Summary Date

2/17/2013 

Purpose

To determine which side is affected in horizontal canal BPPV (Benign Paroxysmal Positional Vertigo)

Description

  • Head Roll Test is first performed to determine whether the horizontal canal BPPV is canalithiasis or cupulolithiasis
  • In sitting, patient bows head over 90◦ forward and direction of nystagmus is observed (bowing nystagmus). Patient then leans head backwards over 45◦ and direction of nystagmus is observed (leaning nystagmus).
  • For canalithiasis, the affected ear is the same as the direction of the bowing nystagmus and opposite direction of the leaning nystagmus.
  • For cupulolithiasis, the affected ear is the opposite to the direction of the bowing nystagmus and same direction of the leaning nystagmus.

Area of Assessment

Vestibular 

Body Part

Head; Neck 

ICF Domain

Body Structure; Body Function 

Domain

General Health; Sensory 

Assessment Type

Observer 

Length of Test

05 Minutes or Less 

Time to Administer

< 5 minutes

Number of Items

2 after completion of the Roll Test 

Equipment Required

May need electronystagmography, videonystagmography, video recorder, infrared video goggles, or Frenzel goggles to view nystagmus.

Training Required

Yes

Type of training required

Reading an Article/Manual; Training Course 

Cost

Free 

Actual Cost

Free

Age Range

Child: 6-12 years; Adolescent: 13-17 years; Adult: 18-64 years; Elderly adult: 65+ 

Administration Mode

Paper/Pencil 

Diagnosis

Vestibular Disorders 

Populations Tested

Individuals diagnosed with horizontal canal BPPV

Standard Error of Measurement (SEM)

Not Established

Minimal Detectable Change (MDC)

Not Established

Minimally Clinically Important Difference (MCID)

Not Established

Cut-Off Scores

Not Established

Normative Data

Not Established

Test-retest Reliability

Not Established

Interrater/Intrarater Reliability

Not Established

Internal Consistency

Not Established

Criterion Validity (Predictive/Concurrent)

Not Established

Construct Validity (Convergent/Discriminant)

Not Established

Content Validity

Not Established

Face Validity

Not Established

Floor/Ceiling Effects

Not Established

Responsiveness

Not Established

Professional Association Recommendations

Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association’s Multiple Sclerosis Taskforce (MSEDGE), Parkinson’s Taskforce (PD EDGE), Spinal Cord Injury Taskforce (PD EDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (VEDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.

 

For detailed information about how recommendations were made, please visit:  http://www.neuropt.org/go/healthcare-professionals/neurology-section-outcome-measures-recommendations

 

Abbreviations:

HR

Highly Recommend

R

Recommend

LS / UR

Reasonable to use, but limited study in target group  / Unable to Recommend

NR

Not Recommended

 

Recommendations for use based on acuity level of the patient:

 

Acute

(CVA < 2 months post)

(SCI < 1 month post)

(Vestibular < 6 weeks post)

Subacute

(CVA 2 to 6 months)

(SCI 3 to 6 months)

Chronic

(> 6 months)

(Vestibular > 6 weeks post)

VEDGE

LS

 

LS

 

Recommendations based on vestibular diagnosis

 

Peripheral

Central

Benign Paroxysmal Positional Vertigo (BPPV)

Other

VEDGE

NR

NR

LS

NR

 

 

Recommendations for entry-level physical therapy education and use in research:

 

Students should learn to administer this tool? (Y/N)

Students should be exposed to tool? (Y/N)

Appropriate for use in intervention research studies? (Y/N)

Is additional research warranted for this tool (Y/N)

VEDGE

No

No

Yes

Yes

Considerations

Testing prior to performing Bow and Lean Test:

  • Roll Test must be completed prior to performing the Bow and Lean Test to determine if BPPV is canalithiasis or cupulolithiasis
  • Vascular – determine integrity of vertebral artery
  • Orthopedic – determine stability of cervical spine

Determining when to use Bow and Lean Test:

If the Roll Test is positive, this test has good clinical utility to assist in determining side of involvement if the Roll Test is inconclusive .

This tool is not appropriate for differential diagnosis.

Efficacy as determined by remission rates

(Lee, 2010; n = 211; mean age = 50.7 (15.5) years)

  • ·Remission rate (determined by negative Head Roll Test) for horizontal canalilithiasis was 83.1% in the Bow and Lean Test Group compared to 67.4% in the Head Roll Test Group (p = 0.041).

Bibliography

Lee, J. B., Han, D. H., et al. (2010). "Efficacy of the “bow and lean test” for the management of horizontal canal benign paroxysmal positional vertigo." The Laryngoscope 120(11): 2339-2346.

Year published

2006 

Instrument in PDF Format

No 
Approval Status Approved 
 
Attachments
Created at 1/22/2014 1:23 PM  by Jason Raad 
Last modified at 8/29/2014 1:48 PM  by Jason Raad