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