Lab 3: BPPV interventions Flashcards
CNS involvement prognosis: recovery will be ____
possible slower recovery
and quicker plateau than peripheral
vestibular involvement
which is harder to recover from: bilateral or unilateral vestib loss?
bilateral
which is harder to recover from? chronic or acute
chronic
which diagnosis is most responsive to treatment?
BPPV
what is a medical emergency?
SUDDEN HEARING LOSS
if patient has sudden hearing loss
Pressure increase
Discharge
Ringing that is new
Call PT/MD and stop ex
who is at higher risk for BPPV?
older, female
what can you do for management of vestibular disorders?
medications
lifestyle change: avoid
surgery: eliminate symptoms
rehab: MANAGE symptoms
types of Vestib dysfunction:
- uni or bilateral hypofunction
- BPPV
- central vestibular dysfunction
- motion sensitivity
treatment for peripheral non BPPV: unilateral or bilateral hypofunction
adaptation or substitution
treatment for peripheral BPPV
canal repositioning maneuver*
semont or liberatory maneuver
BBQ roll or lempert maneuver
casani maneuver
(Gufoni to affected side); Yacovino
Maneuver, and Brandt-Daroff Habituation Exercises
surgery in rare cases (singular nerve avulsion, bone plug to block endolymphatic flow)
CVD treatment
Oculomotor Exercises, Habituation exercises
Motion Sensitivity treatment
Habituation exercises (use MST results)
interventions for gaze stabilization: working on VOR
eye-head coordination exercises
interventions for dizziness provoked by specific stimuli (Cawthorne-Cooksey exercises)
habituation exercises
interventions for postural control
motor coordination activities
interventions for orientation of body in space
sensory organization training
red flags for treatment of vestibular disorders
- sudden hearing loss, fluctuations in hearing
- increased pressure/fullness
- discharge of fluid from ear
- severe ringing
STOP EXERCISES, CONTACT DR
for canalithiasis, repositioning maneuvers are done ___
SLOWLY (pin ball)
cupulolithiasis: repositioning maneuvers are done
FAST (knock otoconia from cupula)
treatment maneuvers for posterior canal
CRM (Epley)
Semont
treatment maneuver for horizontal canal:
log/BBQ roll
gufoni (casani/appiani)
treatment maneuver for anterior canal
reverse semont
yacovino
CRM for POSTERIOR canalithiasis
+ Dix-Hallpike or sidelying test
1. Dix-hallpike position until 30s
2. rotate to opposite dix hallpike, until 30s
3. patient roll to side-lying slow…head 45 deg rotation, then DUMP (tuck chin) until 30 s
4. examiner holds patient’s head in same position, pt SLOWLY SIT UP + 30 sec
PSCC Home Epley Maneuver
- use two pillows
- turn head, lie down
- turn head to other side
- sidelying, smash nose into mat
- come to sitting w/ head down
If any of those cause dizziness, do it again the next morning. 3 reps every morning until no symptoms for 3 DAYS IN A ROW
semont (FAST, LIBERATORY) maneuver for PSC cupulolithiasis
what do you do for PSC cupulolithiasis?
semont maneuver (2-5 reps)
GOT TO BE FAST
*can do for canal if patient can’t get to supine or can’t extend/rotate neck well/COMPLEX PATIENTS
what do you do to fix canalithiasis PSC
CRM or Epley
what do you do for ASC canalilthiasis or cupulolithiasis?
REVERSE semont maneuver
What do the AA practice guidlines say about the semont maneuver?
more effective than no treatment, placebo, or Brandt-Daroff exercises for PSCC
HEP for ASC and PSC cupulolithiasis
no definite guidelines
1. give semont or reverse semont as HEP: 3-5 reps daily until vertigo is gone 3 consec days
what could happen when patient does semont/reverse semont maneuver as HEP?
Canal conversion to PSC canalithiasis! Then, treat with Epley/CRM and self CRM
What is the treatment for horizontal canal canalithiasis?
BBQ/log roll
what is treatment for horizontal canal cupulolithiasis?
casani (Gufoni to other side)
For Semont/Reverse semont, how long do you wait in each position?
1 minute
(total 4 minutes long for 1 rep)
-quick sidelying
-quick dump
-SLOW sitting
How many times do you repeat Semont?
2-5 times in ONE SESSION
(2 times on practical)
Perform Semont ___reps daily as HEP until vertigo free ___consecutive days
3-5 reps daily as HEP until vertigo free x3 consecutive days
After treating ASC/PSC cupulolithiasis, what could happen?
Canal conversion to PSC canalithiasis may occur
(treat with Epley)
BBQ roll for HSC Canalithiasis: how long should you hold each position?
until symptoms cease + 30 seconds
Should head be pitched in BBQ roll test?
YES 30 degrees flexion
What are 3 names for the HSCC canalithiasis maneuver
BBQ roll
log roll
Lempert Maneuver
What is the maneuver for HSCC cupulolithiasis
Casani (aka Gufoni to affected side, nose up)
How long should you hold each position in Casani maneuver?
2 MINUTES
*cupulolithiasis
*quick movements until SLOW sitting up
HEP for HSC canalithiasis
forced prolonged positioning (FPP)
*every night followed by finishing BBQ roll upon waking the next morning
until vertigo free for 3 days in a row
HEP for HSC cupulolithiasis
instruct patient to perform self Casani
*quick sidelying,
*quick rotation
*slow sitting up
*slow head back to neutral
3-5 times daily until vertigo free 3 days in a row
What are Brandt-Daroff Habituation Exercises?
non-specific, habituation
(not as effective)
after treating BPPV (vertigo),
1-2 weeks after it is gone,
if vestibular imbalance PERSISTS,
incorporate ____ training
VOR and postural stability training
non-BPPV peripheral hypofunction
