Rehabilitation for Balance Disorders Canalith Repositioning Maneuvers Vestibular Rehab.
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Transcript of Rehabilitation for Balance Disorders Canalith Repositioning Maneuvers Vestibular Rehab.
Rehabilitation for Balance Disorders
Canalith Repositioning Maneuvers
Vestibular Rehab
Canalith Repositioning• Posterior Canal (85-95% success)
– Epley– Semont
• Horizontal Canal (100% success)– Barbecue Roll– Appiani– Casani
Posterior Canal BPPV
The Epley
Epley Issues
• Speed of maneuver:
fast isn’t necessarily good.
• Is vibration necessary?
• Follow up movement restrictions?
• Follow up exercises?
The Semont
• The “slam dunk” maneuver
• Designed with cupulolithiasis in mind
• No different in success rate than Epley
Horiz. Canal--Barbecue Roll:
• Start supine
• Rolls toward unaffected ear
• in 90 degree steps
• 2 to 3 times around
Appiani:
• Start sitting
• Lay toward unaffected side w/ head elevated and facing straight ahead. Remain 1 minute after nystagmus disappears
• Turn head toward table – 3 min post-nyst
• Return to sitting
• Lay on affected side to double check.
Casani, et al. (2002)
• Start sitting facing foward
• Lay to affected side head held straight
• Turn head toward affected side
• Return to sitting.
Vestibular Rehabilitation
• Habituation
• Adaptation
• Substitution
Brandt-Daroff Exercises
Cawthorne-Cooksey
• Exercises scaled– From simple to difficult– From isolated parts (eye movement only, e.g.)– To generalized movement (eye & head, whole
body)
Assessing Progress
• Symptom amelioration• Scales
– Dizziness Handicap Inventory (Jacobson)– Vestibular Disorders Activities of Daily Living
Scale– Vestibular Symptom Index (Black)
• Tests– Berg Balance Scale– Timed Up and Go Test