Rehabilitation for Balance Disorders

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Presentation transcript:

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 Success in dealing with benign paroxysmal positional vertigo has been impressive. The liberatory or repositioning procedures have been successful in over 80% of the cases.

Posterior Canal BPPV

The Epley

fast isn’t necessarily good. 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 An area that has really grown in last decade or two. Focusing on: Habituation Adaptation Substitution Either as primary management technique or as adjunct. Rehab has been used in an exploratory capacity as well, in for example, cases of suspected perilymph fistula. The true fistula case should not benefit from therapy.

Brandt-Daroff Exercises Brandt-Daroff exercises are rather aimed at getting the CNS to adapt to the peripheral disorder.

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 Tests Dizziness Handicap Inventory (Jacobson) Vestibular Disorders Activities of Daily Living Scale Vestibular Symptom Index (Black) Tests Berg Balance Scale Timed Up and Go Test