1. Rehabilitation for Balance Disorders
Canalith Repositioning Maneuvers
Vestibular Rehab

2. 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.

3. Posterior Canal BPPV

4. The Epley

5. 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?

6. The Semont The “slam dunk” maneuver
Designed with cupulolithiasis in mind
No different in success rate than Epley

7. Horiz. Canal--Barbecue Roll:
Start supine
Rolls toward unaffected ear
in 90 degree steps
2 to 3 times around

8. 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.

9. Casani, et al. (2002) Start sitting facing foward
Lay to affected side head held straight
Turn head toward affected side
Return to sitting.

10. 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.

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

12. Cawthorne-Cooksey Exercises scaled From simple to difficult
From isolated parts (eye movement only, e.g.)
To generalized movement (eye & head, whole body)

13. 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