Kevin,
Interesting comments. I have also read some research (which I do not have to hand to quote) that suggests VBI testing is inadequate and poorly diagnostic of problems. In fact, the position of extension and rotation is also the position for testing BPV (Benign Positional Vertigo), though this is tested off the end of the plinth with the patient supine. Still, I don't see much difference.
I wonder just how much one has to stress the cervical spine to cause injury to the lumen/lamina of the vertebral artery? People who turn their head suddenly to look at something don't die of a stroke. People such as electricians who are looking upwards in combined extension rotation positions also don't appear to have any higher incidence of CVA than any other population.
One can often criticise chiros for not VBI testing, but they do this because they consider it an ineffective premanip screening process.
I can't help but think they might be right.
Just some thoughts......
---
Scott Epsley
PHYSIOTHERAPIST
Northside Sports Injury Centre
Brisbane, Australia.
e-mail: [log in to unmask]
On Sun, 4 Feb 2001 11:48:33
k.reese wrote:
>Dear Henry
>
>I have lost track of the number of patients who present with dizziness, headaches, blurred vision, tinitus etc and it has been coming from musculoskeletal tissues. The reason I can state this with a fair degree of certainty is that their symptoms subsided when these tissues have been addressed.
>
>If not non musculoskeletal the prime suspect on my list would be the autonomic nervous system and its interfaces. These are too numerous to mention but supra scapula soft tissues eg upper traps, lev scap, sub occipital fascia are worth noting post RTA.
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>If the above can be true would it be possible to do VBI and not stress these tissues or any other implicated in the musculoskeletal scenario?. If not VBI does not have much of a diagnostic/differentiation value as you will not be able to tell if the symptoms are from the circulatory or musculoskeletal symptoms, unless they have a stroke afterwards and then you would be farely sure it was circulatory.
>
>Sorry about the flippancy but the later point is valuable. Is it logical to stress delicate tissues like the basilar artery, to determine its integrity?. Unfortunately it is leant to a colleague and never returned but I did have an article once suggesting there are as many serious adverse reponses to VBI as there are with V manips.
>
>So in short the ear symptoms may be musculoskeletal in origin, the best way of finding out is careful and gentle treatment of the interfaces of particularly the autonomic nervous system and monitor the reactions; both processes applying patinet led reasoning. VBI is a strong and potentially dangerous test ot the circulatory system and diagnostically flawed. For the reasons given above I rarely if ever put my patients in combined cervical spine positions without an exceptionally good reason; I also do not V manip the Cx any more.
>
>Hope this helps Kevin Reese PT UK
>
>ps VBI is also a good way of getting rid of difficult patients back to the referrer
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> ----- Original Message -----
> From: Henry Tsao
> To: [log in to unmask]
> Sent: Saturday, February 03, 2001 11:56 PM
> Subject: VBI
>
>
> To all:
>
> I have another question to ask. Recently, I had a patient come in following whiplash to the neck. The doctor has not done any Xrays or scans. He is complaining of pain with rotation, lateral flexion and extension, but also a dizziness and slight blurred vision after performing these movements. He complained of a fullness in the ear (which I can not associate with anything).
>
> I performed a VBI test, and this increased his light headed ness only with extension and combined extension and rotation, but not with rotation. I gently palpated his neck, but as I have never seen someone with VBI, I was very cautious.
>
> My question is if somebody does have VBI, does it give them the fullness in the ear?? I have referred this patient back to the doctor for more examination.
>
> Henry***
>
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