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Vertebrobasilar Insufficiency (VBI) and Wallenberg's Position

Vertebrobasilar Insufficiency (VBI) is a medical condition that results from reduced blood flow to the cerebellum, brain stem, and occipital lobes. It is often caused by an underlying spinal cord injury, cerebrovascular accident, or vascular disease. Symptoms of VBI include dizziness, nausea, blurred vision, delays in response time, and difficulty balancing and coordinating motions.Wallenberg's position is a maneuver used to test for V

Transcript

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This in Brent of the Brookbush
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Institute, and in this video we're going to go
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over the Wallenberg's position and vertebral basilar insufficiency or
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ischemia testing, commonly known as VBI testing. I'm going to have my friends Sonya
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come out, she's going to help me demonstrate this. Now of course if we were doing this
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test we would have some reason to believe that Sonya here had cervical
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complaints, or maybe some neurological signs accompanying her orthopedic
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cervical complaints. Or we're trying to clear Sonya here for us to be able to do
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high-velocity manipulations. Although I'm going to get back to that in a second
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because there is some weirdness with that. Now the tests themselves are not
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that hard; however, you do have to memorize some symptoms that you're
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looking for. The test goes like this, I'm going to test the extreme of rotation with
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the extension to see if Sonya here still gets good blood flow to her brain
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essentially. Alright that's that vertebral basilar ischemia, we're trying
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to make sure that we don't cut off her vertebral artery when she goes back into
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rotation and extension. So I'm going to have her rotate as far as she can to look at
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me, and then she's going to go back into extension and now I need to start
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testing her for various symptoms. So I'm going to look her in the eyes and
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see if she has nystagmus. I might go hey do I have two faces? No I
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only have one face right, double vision would be another thing that we were
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looking for. Can she speak clearly? So usually what I'll have somebody do
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rather than go talk to me, right which gets people a little on edge, I'll go hey
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can you just tell me that tell me the alphabet real quick (ABCD), and I'll be
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listening to see if there's any slurred speech any stuttering. Another
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thing that we might want to look for is does she have problems swallowing, can
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you just take a gulp for me. Make sure swallowing is okay, everything's cool
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there, nauseous? No. Of course we know she's not having a
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drop attack, we know that she's not having any other strange symptoms,
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lightheadedness, no none of that right cool. So that was the list of symptoms I
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just went down, and noticed they're just they're
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neurological symptoms that might be related to this insufficiency of these
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arteries. So now I'm going to have her do it to the other side, good right so she'd
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rotate and then tilt back, and I go through the same thing. Look her in the
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eyes: ask her if she's seeing two of me, ask her to say her alphabet, ask her to
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take a quick swallow, make sure I'm watching her for a nystagmus. Is she
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going to pass out on me? Is she losing her balance? Is she having a hard time
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sitting here? These are the symptoms that were looking for to make sure that she's
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still getting good blood flow via the vertebral arteries. Now this is the
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Wallenberg's position, the other thing you could do is just commonly referred
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to as VBI testing which I'm going to go ahead and have Sonya spin around and
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she's going to lay down for me, she's going to back up off the table, alright. Now this
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test is kind of convenient because usually this would be the position that
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we did a cervical manipulation in. So it's very common for people to
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state that you should do these tests before to doing a cervical manipulation.
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All I'm going to do is rotate, drop her head back and now I can do the same thing
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right, swallow for me, good, tell me your
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alphabet. She has nice clear speech I'm looking her in the eyes to make her
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absolutely uncomfortable and be creepy, no I'm looking her in the eyes for a
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nystagmus, and then of course I can ask her you know do you see two of me or am
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i blurred at all? No and you're fine, you don't feel like you're going to
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pass out? No not dizzy in this position, and you're
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not nauseated? Cool and then I could do the other side and
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then if I was going to do a cervical manipulation of course I could go ahead
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and do that. Now you can go ahead and sit up Sonya. The one thing I want to mention,
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and this is important, there are a couple practice acts that talk
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about doing these upper-cervical spine stability tests and things like the VBI
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tests before we do cervical manipulations. But this particular test
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has zero sensitivity. I'm not kidding, so far the studies show that this test is
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not sensitive it is specific. Now if you are following along in
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our special test courses, you know that screens actually need to be highly
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sensitive, and specificity matters less So this test is absolutely backwards.
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Does that mean we shouldn't do it? I don't totally know in the sense that I
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guess if we caught one person it would be worth it, because obviously damaging
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somebody's vertebral artery can be very serious. But we also don't have any
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evidence to suggest that this would catch anybody who had vertebral artery
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insufficiency, and I think we need more research on that before we start
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dictating to practitioners what they should be doing as far as their
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assessments so keep that stuff in the back of your head. If you'd rather play
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it safe than sorry then do the assessment, but if you see people doing
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manipulations for people who are relatively asymptomatic for neurological
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symptoms, and they're young and they're healthy and they don't have a history of
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smoking or artherosclerotic disease and they've done us good subjective exam,
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don't judge them too harshly We don't have enough data on these
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particular special tests for us to dictate what should and shouldn't be
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done. If you have any questions or comments please leave them below. I