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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.

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rehabilitation for balance disorders

Rehabilitation for Balance Disorders

Canalith Repositioning Maneuvers

Vestibular Rehab

canalith repositioning
Canalith Repositioning
  • Posterior Canal (85-95% success)
    • Epley
    • Semont
  • Horizontal Canal (100% success)
    • Barbecue Roll
    • Appiani
    • Casani
epley issues
Epley Issues
  • Speed of maneuver:

fast isn’t necessarily good.

  • Is vibration necessary?
  • Follow up movement restrictions?
  • Follow up exercises?
the semont
The Semont
  • The “slam dunk” maneuver
  • Designed with cupulolithiasis in mind
  • No different in success rate than Epley
horiz canal barbecue roll
Horiz. Canal--Barbecue Roll:
  • Start supine
  • Rolls toward unaffected ear
  • in 90 degree steps
  • 2 to 3 times around
appiani
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
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
Vestibular Rehabilitation
  • Habituation
  • Adaptation
  • Substitution
cawthorne cooksey
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
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