Rehabilitation for Balance Disorders - PowerPoint - PowerPoint

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					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