Background: A 20-year-old male professional hockey player presented with headache, neck pain fogginess, fatigue, instability, and decreased performance in his sport. No reports of vertigo or lightheadedness. Upon examination the patient had aberrant biomechanics during gait, with subtle left lateropulsion and adduction of the shoulder during the left midswing phase of gait. Nystagmus was not present, nor were symptoms produced or exacerbated in either Dix-Hallpike position, or side-lying positions.
Methods: A rightward Lempert (BBQ) Maneuver was performed, modified by combining successive rightward Halmagyi head thrust, and leftward optokinetic stimuli, as the maneuver was performed. The maneuver began with the patient on his back, continued 450 degrees in rightward yaw pausing every 90 degrees to perform the head thrusts and optokinetic stimuli. The patient concluded by laying on his right side. He maintained this position for 2 minutes before sitting up.
Results: Following the intervention, the patient reported an immediate feeling of “lightness, stability, and clarity.” He reported that his headache, neck pain, and fogginess had completely resolved. His gait biomechanics had completely normalized.
Conclusion: Positional maneuvers for benign paroxysmal positional vertigo may have a central, lasting effect on central vestibular projections, which can be exaggerated using optokinetic stimulation. This may affect cognition, blood flow, balance, and gait. Performance of peripheral repositioning maneuvers combined with optokinetic stimulation should be investigated as a central vestibular rehabilitation therapy.
Acknowledgments: Dr. Freddys Garcia, Claude Martinet, Dr. Yanick Pauli