Rehabkurser

Hem
Sverige
Sturefors
Rehabkurser

Rehabkurser är ett utbildningsföretag & drivs av leg. sjukgymnast Daniel Petersson. Ej patientkontakt

06/03/2026

🌪️ BPPV affects more than just vertigo, it disrupts your balance system too
A new systematic review and meta‑analysis (2025) shows that benign paroxysmal positional vertigo (BPPV) doesn’t just cause spinning sensations; it affects several deeper components of postural control that help keep you upright and safe.

🔍 Key findings
People with BPPV have impaired perception of verticality; their brain literally misjudges what “upright” is.

Sensory orientation is significantly disturbed, meaning the body struggles to integrate visual, vestibular and somatosensory input.

Gait stability is reduced, which helps explain the higher fall risk seen in these patients.

Older adults show reduced limits of stability, making balance even more vulnerable.

✅ The good news
After repositioning maneuvers, both verticality perception and sensory orientation improve significantly. This means the treatment doesn’t just stop the spinning, it helps restore the underlying balance mechanisms that prevent falls.

🧠 Why it matters
BPPV is often dismissed as “just dizziness,” but this review shows it affects the entire postural control system. Treating it promptly can reduce fall risk, improve confidence, and restore functional stability.

📖 Source: Pauwels S, Casters L, Meyns P, Lemkens N, Lemmens W, Meijer K, van de Berg R, Spildooren J. Several components of postural control are affected by benign paroxysmal positional vertigo but improve after particle-repositioning maneuvers: A systematic review and meta-analysis. Clin Rehabil. 2025 Jan;39(1):3-22. doi: 10.1177/02692155241292662. Epub 2024 Nov 5. PMID: 39501612; PMCID: PMC11776354.

04/03/2026

🤝 Varför bråkar vi när vi egentligen jobbar för samma sak?
Då jag i över 10 års tid har föreläst för tusentals vårdgivare från en rad olika yrkeskårer kan jag konstatera att jag har haft fördomar om naprapater och kiropraktorer som inte alls stämde.

Jag vet att det finns en märklig och i många fall helt onödig rivalitet mellan fysioterapeuter, naprapater och kiropraktorer. Tre professioner som alla arbetar med smärta, funktion och rörelse… men som ändå ofta hamnar i varsin ringhörna.

Fördomarna är välkända:
”Kiropraktorer bara knäcker....”
”Naprapater gör samma sak fast mjukare...”
”Fysioterapeuter tränar bara sina patienter...”

Men de här bilderna är inte bara fel; de gör vården sämre. De reducerar hela professioner till karikatyrer och skapar avstånd där det borde finnas samarbete.

🔍 Sanningen? Den är både enklare och mer utmanande. Det finns fantastiska terapeuter inom alla tre yrken. Och det finns mindre bra terapeuter inom alla tre.

Det är inte titeln som avgör kvaliteten. Det är kompetensen, omdömet, nyfikenheten och förmågan att möta människan framför sig.

När vi fastnar i rivalitet missar vi det viktigaste: patienterna bryr sig inte om våra revir. De bryr sig om att få hjälp.

🌍 Tänk om vi istället såg varandra som kollegor?
Tillsammans täcker vi ett enormt spektrum av kunskap. Tillsammans kan vi ge bättre vård. Tillsammans kan vi minska fördomar och öka kvaliteten.

💬 Kanske är det dags att släppa rivaliteten och börja prata med varandra istället för om varandra?
För i slutändan handlar det inte om vem som ”har rätt”. Det handlar om att människor ska få den hjälp de behöver, av en kompetent terapeut, oavsett titel.

Vad skulle hända om vi började samarbeta mer öppet mellan professionerna?

03/03/2026

🌟 Region Örebro storsatsar på yrsel- och balansutbildning för fysioterapeuter!
Den 27–28 augusti genomför Region Örebro en betydande satsning tillsammans med Rehabkurser på att stärka fysioterapeuters kompetens inom yrsel och balansrubbningar, ett område som ofta är både komplext och underprioriterat i primärvården.*

Det här är mer än en utbildning. Det är en investering i framtidens vård. 💡

🎓 Vad satsningen betyder för fysioterapeuter
🔍 Skärpt klinisk kompetens i att bedöma och behandla yrselpatienter.

🧭 Trygghet i manöverbehandlingar, inklusive att upptäcka vanliga fallgropar.

🤝 Stärkt roll i primärvårdens flöden, där fysioterapeuter tar större ansvar för första linjens yrselbedömning.

⚡ Effektivare vårdkedjor, där rätt behandling ges direkt, utan onödiga remisser.

💚 Vad satsningen betyder för patienterna
⏱️ Snabbare och mer träffsäker bedömning, vilket minskar oro och lidande.

🎯 Effektiv behandling, särskilt vid BPPV där rätt manöver ofta ger omedelbar lindring.

🛡️ Minskad risk för långvariga besvär och fallolyckor.

🚪 Ökad tillgänglighet, när fler fysioterapeuter kan ta emot yrselpatienter direkt.

Det betyder att fler patienter får rätt hjälp, vid rätt tid och av rätt kompetens. 🙌

🌍 Ett gott exempel för andra regioner:
Region Örebro, och flertal regioner sedan tidigare, visar vägen för hur en riktad kompetenssatsning kan stärka både professionen och patientnyttan. Den här modellen kan inspirera andra regioner i Sverige att göra liknande satsningar och därmed bidra till en mer jämlik och evidensbaserad vård över hela landet. 🇸🇪✨

Intresserad av ett samarbete? Kontakta info@rehabkurser.se

*Det går inte att boka plats på kursen via Rehabkurser. Kontaktperson på Region Örebro är Patrik Genberg

01/03/2026

To everyone who believes post-restrictions after BPPV treatment still have a place, are you being consistent?

This isn’t a post arguing for or against restrictions. My position is clear: I never prescribe them. This post is about logical consistency.

If you tell patients to follow restrictions after you perform, for example, the Epley maneuver (sleeping semi‑upright, avoiding the affected side, limiting head movements, etc.), then shouldn’t the exact same rules apply when the patient performs the maneuver at home?

Think about it:
If a patient does a home Epley today…
Should they then sleep upright for example, 1–3 nights before they’re “allowed” to do another one? Should they avoid the affected side between each home treatment?
Should they wait days before repeating the maneuver?

Do you actually tell them that?
Or do you suddenly think differently when the patient performs the maneuver themselves?

If restrictions are truly essential to “keep the crystals in place" and to prevent recurrence, then doing multiple home Epleys in the same 24–48 hours should be a big problem, yet many clinicians who believe in restrictions still encourage daily (or even multiple daily) home treatments.

So the question isn’t whether restrictions work.
The question is, are you consistent in your reasoning?

19/02/2026

There are people in the world of healthcare who are genuinely passionate about sharing knowledge. And then some are passionate about sharing themselves. The difference isn’t always obvious at first glance, but you can feel it, like a faint but persistent background hum. That hum that says: “Look at me. Listen to me. I know things.”

It’s fascinating how some manage to build an entire persona around being the one who “dares to speak the truth,” while the content they deliver is often as hollow as an empty glove. When their statements are examined more closely, much of it turns out to be borrowed, sometimes stolen, and sometimes just sloppily retold from someone who actually did the work. It’s like watching someone paint over an old canvas and then call themselves an artist.

And when the criticism comes, because it always does, something peculiar happens. The confident voice, the one that just spoke with authority about evidence, guidelines, and “what the research really says,” suddenly softens like an overcooked noodle. Responsibility? No, thank you. Those were someone else’s words, someone else’s interpretation, and someone else’s fault. “I was just sharing,” they say, as if sharing itself were a shield against consequences.

It’s a strange paradox: the desire to be seen is enormous, but the willingness to stand by what they say is microscopic.

In healthcare where words actually matter, where people listen because they must, not because they want to, this becomes especially problematic. Because when someone builds their credibility on borrowed ideas and half‑truths, they risk pulling others down with them. Patients, colleagues, and students. People who don’t have the time or opportunity to double‑check every claim.

And perhaps that’s what stings the most: that the subject matter, the medicine, and the people actually affected are reduced to props in someone else’s personal brand‑building. That the complexity of healthcare is boiled down to soundbites, that research becomes decoration, and that responsibility becomes something you hand off to the next person in line.

Because in the end, being wrong isn’t dangerous.
Pretending to be right is.

16/02/2026

When patients seek help for dizziness or balance problems, it is understandable that both clinicians and patients want clear answers. But in vestibular medicine, more testing does not mean better diagnosis. Many commonly ordered investigations are expensive, time‑consuming, and, most importantly, can provoke significant symptoms without improving clinical clarity.

The most accurate diagnostic information almost always comes from a structured clinical history and targeted bedside examination. This is where the “what” of the problem is identified. Most advanced vestibular tests do not answer that question.

🎯 Tests answer “how much,” not “what.”
Vestibular tests quantify function, how much asymmetry, how much nystagmus, how much vestibular loss, etc., not the underlying cause. When used without a clear clinical hypothesis, they often produce ambiguous or incidental findings that do not change management.

⚠️ Symptom‑provoking tests can make patients worse
Several vestibular tests are known to trigger intense dizziness, nausea, and fatigue, especially in patients who are already symptomatic. Examples include:

VNG (Videonystagmography)

Caloric irrigation
Rotational chair testing
Motion‑provocation or sensory conflict protocols
Unnecessary positional testing

These tests have value when used appropriately, but when ordered routinely or without a diagnostic rationale, they can provoke symptoms far out of proportion to the clinical benefit.

False positives: Broad testing increases the chance of incidental abnormalities that lead to further unnecessary investigations.

❗ Potential risks
✅ Delayed treatment: Time and resources shift away from interventions that actually help, such as education, reassurance, vestibular rehabilitation, and targeted maneuvers.

✅ Increased anxiety: Patients may misinterpret incidental findings as a serious disease.

✅ Higher healthcare costs: Both for the system and the patient, without improving outcomes.

🔎 In short
Good vestibular care is not about doing many tests. It’s about doing the right tests, for the right reasons, at the right time.

12/02/2026

9–10 april håller jag en 2‑dagarskurs i Sundsvall om yrsel och balansrubbningar.
Det är första gången jag föreläser i just Sundsvall, vilket är lite extra roligt att få uppleva staden och naturen runt omkring. 🌲🏙️

Det finns fortfarande några platser kvar tills kursen är helt fullbokad. Ta chansen att ta del av två dagar som kommer att göra dig till en bättre kliniker. 🎓✨

🎯 Kursens mål
🧠 Ökad kunskap om yrseldiagnoser
Du får en tydlig förståelse för diagnostik och behandling av de vanligaste yrseltillstånden och när du ska remittera vidare.

🗣️ Ta en grundlig yrselanamnes
Du lär dig välja rätt undersökningsmetoder utifrån anamnesen.

👂 Innerörats anatomi & fysiologi
En stabil grund som gör kliniska beslut enklare.

🔄 Diagnostik och behandling av BPPV posterior och horisontell båggång, inklusive vanliga felkällor och hemträning.

⚠️ Röda flaggor
Du lär dig känna igen när något inte stämmer.

🏋️ Vestibulär rehab
Kännedom om träningsprinciper och utvärderingsmetoder.

💤 PPPY – den ”sovande jätten”
Förstå patofysiologi och behandling.

✅ Cervikogen yrsel
Hur du ställer diagnosen och vad du ska tänka på.

Mer information och anmälan hittar ni via hemsidan:
👉 www.rehabkurser.se

12/02/2026

Jag har haft många examinerade naprapater och kiropraktorer på mina kurser genom åren och igår fick jag chansen att undervisa en heldag på Nordens största högskola inom manuell teknik. En bladning av teori och praktik bland duktiga kliniker.

Tack för förtroendet och lycka till alla blivande naprapater ute i arbetslivet.

06/02/2026

New Evidence on Acute Vertigo Triage — Key Takeaways
🔍 What They Tested
A new integrated algorithm combining TiTrATE + STANDING + HINTS Plus — the first attempt to merge all three into one ED‑friendly tool.

📊 Bottom Line
The algorithm is very good at catching stroke (90% sensitivity)…
…but not good at ruling it out (57.9% specificity).
➡️ Nearly half of all non‑stroke patients were misclassified as stroke.

⚡ The Big Problem: Vestibular Migraine
Vestibular migraine was the most common false positive.
The authors argue that migraine features must be added to future versions to avoid unnecessary stroke activations.

🎯 Other Findings
Excellent specificity for BPPV and PVD

Moderate sensitivity for both

No management guidance for migraine, PVD, or chronic vascular causes

Stroke pathway triggered too often due to “continuous symptoms” rule

🧠 What Needs to Change
The authors recommend:

Adding vestibular migraine criteria (history, triggers, motion sickness, photophobia/phonophobia)

Clearer Rule Out Stroke pathways

Management guidance for all diagnostic categories

Ongoing validation in real ED settings

📌 Final Verdict
A promising step toward safer acute vertigo triage — but not ready for clinical use.
High sensitivity protects patients, but the false‑positive rate is too high, especially for migraine.
More refinement is essential before this can guide real‑world ED decisions.

30/01/2026

❗️❗This post focuses on general dizziness experiences. It does not cover other medical conditions, such as migraine, vestibular migraine, anxiety disorders, or neurological conditions, that can make dizziness more intense or more frequent. Everyone’s body is different, and individual factors can change how dizziness is felt.

Dizziness isn’t a threshold; it’s an experience.”
People often say things like “I have a high pain threshold” as if it’s a fixed, measurable fact. But here’s the thing: most of us have no way of actually knowing our “threshold.” What we do know is how we’ve reacted in the past, and we turn those reactions into a story about who we are.

I think it is the same thing that happens when you experience dizziness.

Some patients say they’re “super sensitive to dizziness,” while others proudly claim they “don’t get dizzy easily.” It sounds like a stable trait, but dizziness doesn’t work like that. There’s no built‑in “dizziness meter” in the brain.

Dizziness is shaped by a mix of many things for example:
✅ Past experiences
✅ Attention and focus
✅ Stress and body awareness
✅ Expectations (“this movement always makes me dizzy.”)
✅ How safe or unsafe a situation feels

So when someone says, “I’m very sensitive to dizziness,” they’re not always describing a biological fact; they’re describing a personal interpretation of their experiences.

And that interpretation matters.

If you expect dizziness, you’re more likely to notice it. If you fear it, it often feels stronger. If you feel safe and in control, the same sensation might barely register.

This self‑perception can have clinical consequences. It could influence how patients move, how they interpret symptoms, how they approach examinations, and what they expect to feel after treatment. During procedures such as the Epley maneuver, a patient who sees themselves as “sensitive” may become more tense, more vigilant, and more likely to interrupt movements, while someone who believes they are “tolerant” may push too far or overlook important signals. In other words, it is the self‑image that drives the behavior, not the actual vestibular function.

27/01/2026

TRV Chair, luxury gadget or real clinical value?
This post applies to all mechanical repositioning chairs, but since I’ve worked with the TRV chair since 2018, that’s the one I’ll refer to.

I was one of the first clinicians in Sweden to purchase the chair and to this day, I’m still among those with the most hands‑on experience in both diagnostics and treatment using it.

So… what does all that experience tell me?
Is the chair actually needed, or is it just an expensive bragging tool?

After thousands of assessments and treatments, here’s some of what I’ve learned.

✨ The Upsides
✔ Standardized examinations
Regardless of a patient’s anatomy or mobility, I can almost always examine and treat them in the chair. Very few patients fall outside its range.

✔ Less symptom provocation
The chair allows me to follow a specific algorithm that minimizes symptoms during testing. This creates a calmer experience for both me and the patient.

✔ Continuous nystagmus monitoring
Videofrenzel goggles can stay on in every position without disturbing the patient, making it easier to observe nystagmus even during treatment.

⚠ The Downsides
✖ It’s expensive
And it requires a room that can handle significant weight and movement.

✖ Not ideal for severe claustrophobia
A small number of patients simply can’t tolerate the setup.

✖ Not plug‑and‑play
No matter how “fancy” these chairs look, they require experience and deep vestibular knowledge. You’ll see more nystagmus, not because of pathology, but because of videofrenzel + extreme positioning, and you need to know how to interpret that.

So… who should invest in a repositioning chair?
Right now, most chairs in Sweden are found in hospitals and ENT departments.
But honestly? I see even greater value in primary care.

Not because everyone needs chair‑based diagnostics; most BPPV cases can be handled perfectly well on a regular treatment table with the right skills and equipment. But looking ahead, with an aging population and increasing mobility limitations, the chair is fantastic for older patients. That’s where it truly shines.

26/01/2026

Today I met a patient who reminded me why dizziness is one of the most fascinating (and frustrating) areas in medicine.

👉 50+ years old
👉 Previous BPPV (fully recovered 1 year ago)
👉 Migraine
👉 Significant anxiety and fear of movement

She described 4 weeks of “my crystals are back” but the symptoms didn’t match at all:

❌ no clear positional vertigo
❌ unsteady walking
❌ discomfort in supermarkets
❌ a “weird” feeling in the head
❌ symptoms mainly when upright

Everything pointed toward:
🔹 PPPD?
🔹 Migraine‑related dizziness?
🔹 Anxiety‑driven hypervigilance?
🔹 Visual motion sensitivity?

But then comes the twist…

👇
👇
👇

🔍 On examination: a textbook BPPV.
This is exactly why the history of dizziness can be so misleading.
When migraine, anxiety, and fear of movement mix together, the patient’s experience becomes completely “colored” and even classic BPPV can sound like something entirely different.

This is also why we ALWAYS perform positional tests.
Even when the history points in a completely different direction.

💬 QUESTIONS FOR YOU
🔸 Have you ever had a patient where the history and the findings didn’t match at all?
🔸 How often do you “accidentally” find BPPV in patients with anxiety/migraine/PPPD‑like symptoms?
🔸 What’s your strategy when the story points one way but the body points another?

Share your experiences in the comments; the dizziness world needs more conversations about these grey zones.

Adress

Hjortronvägen 7
Sturefors
58961

Telefon

+46736754786

Webbplats

http://www.rehabkurser.se/

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Om Rehabkurser

Rehabkurser drivs av leg. sjukgymnast Daniel Petersson. Fröet till Rehabkurser sattes omkring 2012. Jag behövde dock ett par år på mig att skriva och bearbeta det material som jag nu stolt kan erbjuda er. Rehabkurser vänder sig framför allt till vårdpersonal och organisationer som vill lära sig mer om undersökning, differentialdiagnostik och behandling inom områdena yrsel och balansrubbningar. Yrsel och balansrubbningar är, i mina ögon, områden där patienter allt för ofta riskerar falla mellan stolarna inom vården. En anledning till detta kan vara att personalen inte har tillräckligt fördjupad kunskap inom dessa områden vilket medför att det blir svårt att få rätsida på både anamnes och att kunna prioritera vilka undersöknings- och behandlingsmetoder som är relevanta för patienten.Jag vill att fler patienter ska få möjlighet till rätt diagnos inom en rimlig tid utan att patienten skall behöva handläggas på specialistklinik. Jag hoppas att jag snart får chansen att träffa just dig och berätta vad jag kan inom dessa områden.

Vänliga hälsningar

Daniel Petersson

leg.sjukgymnast och yrselnörd