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 Canalith Repositioning Maneuvers Vestibular Rehab
Canalith Repositioning • Posterior Canal (85-95% success) • Epley • Semont • Horizontal Canal (100% success) • Barbecue Roll • Appiani • Casani
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
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