lab 3: BPPV treatment maneuvers Flashcards
what treatment is done if u have unilateral hypofunction
adaptation
what treatment is done if u have unilateral complete loss for peripheral non BPV treatment
adaptation substitution
what treatment do u do if u have bilateral peripheral non BPV complete loss
subsitution
what treatment do u do if u have bilateral peripheral non BPV hypo function
adaptation
what are treatments for central vestibular problems
oculomotor exercises and habituation exercises
what are the peripheral BPV treatments
Canalith Repositioning Maneuvers
(CRM);
Semont (or liberatory) Maneuvers;
BBQ Roll or LempertManeuver;
Casani Maneuver (Gufoni to affected side);
what are the red flags for precautions to treatment of vestibular disorders
Sudden loss of hearing or fluctuations in hearing
Increases pressure &/or fullness to the point of discomfort
Discharge of fluid from the ear (s)
Severe ringing in the ear (s)
for BPPV intervention how are teh resptioning maneuvers done for canal and cupulo
canal is done slowly
cupulo is done fast
what is the BPPV treatment maneuver done for postieror canal
CRM (Epley), semont
what is the BPPV treatment maneuver done for horizontal; canal
Log/BBQ Roll, Gufoni(Casani/Appiani)
what is the BPPV treatment maneuver done for anterior canal
Reverse Semont, Y acovino
if vertigo + nystagmus elicited during Dix-Hallpike or Side-lying test, immediately take the patient through what
CRM (canalith repositioning maneuver, aka epley) using Frenzel or IR goggles
how to perform the Canalith Repositioning Maneuver (CRM) for Canalithiasis PSC
remain in DHT position on affected side until nystagmus , vertigo and/or nausea ceases + 30 secs
rotate patients head SLOWLY (wiht neck in 30° extension) to opposite dix hallpike position (unaffected side; away from invovled ear) patient remains in position until symptoms stop + 30s ; if no symptoms remind in the postion for 30s
have patient roll to side lying (unaffected side ; away from invovled ear) slowly while maintaining head in 45° rotation , then tuck pt chin so nose is point to mat (dumped position) patient remains in postition until symptoms stop + 30s ; if no symptoms remain in position for 30s then move to next position
PT hold pts head in same position (head turned 45° and flexed 30°) as pt slowly sits up and remains sitting until symptoms stop = 30 s ; if no symptoms then remain in position for 30s before moving head slowly to neutral and wait for symptoms to stop + 30s
when should the patient perform the self CRM
at home the next morning after treatment and if they experience vertigo then repeat it ever morning until vertigo free for 3 days in a row!!!!
if the pateint is unable to perform self CRM at home then what will u give them
Brandt-Daroff Habituation
Exercises
how will u instruct the pateint HEP for self CRM to home epley maneuver
sit in head with pillows behind middle of back , turn head to affected side then lie down with head turned to affected side and extend over the pillows with head resting on bed not the pillows… then turn head slowly to the unaffected side and then turn body slowly to the unaffected side while tucking chin in and pointing nose into bed then slowly return to sitting
stay in each postion for 30 s or until symptoms go away + 30 secs
perform 1 rep every morning until no symptoms tom’s for 3 days in a row
how to perform the Semont (liberatory) Maneuver for PSC Cupulolithiasis R PSC
pt sits at edge of plinth with head turn 45 ° to oppsite direction of affected PSC (So left) then pt quickly moved to side lying towards affected or invovled side (R) while the PT keeps head positioned turned 45 ° so patients nose is up towards ceiling
after 1 minutes , pt asked to quickly move in an upward arc thru sitting to opposite side with PT holding head alignment so that the pt is looking down (nose down) with head flexed at least 30° (dumped)
nystagmus and vertigo shoudl reappear in that position if not shale head 1-2x to free debris and have pt stay in position for 1 minutes
pt slow moves to sitting position while PT keeps head in 30° of flexion (dump position) wait 1 minutes then return head to neutral and wait 1 min
repeat 2-5 times in 1 session , symptoms should faitgue or lessen in intensity w reps
how to perfomr the Reverse Semont (liberatory) Maneuver for ASC Canalithiasis or Cupulolithiasis
pt sits at edge of linth with head turned 45° towards affected ACS side
pt moved quickly onto the affected or invovled side while PT keeps head positions os pt is looking down
after 1 min, pt asked to quickly move in upward arc to oppside side with PT hold head alignment so now the patient is looking up
nystagmus and vertigo should reappear if not then shake head 1-2x to fre debris and have pt stay in this position for 1 min
pt slowly moves to sitting initially keeping head turned 45° towards affected side then after 1 min moves it slow back to neutral and wait 1 min
reappear 2-5 times in 1 session , symptoms should faitgue or lessen
what is the HEP for PSC and ASC cupulolithiasis
semont or reserve semont maneuvers
perform 3-5 reps daily until vertigo free from 3 days in a. row
have pt record symptoms intensity and duration each day
how do u perform the BBQ or Log Roll for HSC Canalithiasis
pt begins in Roll Test position of affected side (supine w head flexed 30 deg & rotated 90 deg towards the affected ear (side that causes more nystagmus & vertigo during roll test). Remain
here x 30s or until symptoms cease + 30s
PT slowly rolls pt head 90° away from afffected ear to face up (maintaining 30° of neck flexion) and holds here from 30s or until symptoms stop + 30s
PT slowly rolls pt head 90° towards unaffected side with affected ear facing up and holds here from 30s or until symptoms stop + 3ps
Pt asked to slowly roll head and body in same direction away from involved ear onto unaffected side while PT miaintains head position in 30° of flexion
Pt asked to slowly roll onto stomach until face is down (dump position) as PT maintain main position (neck flexed to 30°) and holds here for 30s or until symptoms stop +30s
ePT slowly rolls pt head 90° towards affected side w unaffected ear facing up
pt asked to slowly roll head and boyd in same direction onto affected side while PT maintains head position (30° of neck flexion ; dump)
pt slowly sits up keep head flexed and holds for 30s or until symtoms stop + 30s and then return head to neutral and wait for symtoms to stop + 30s
how to perform the Casani (aka Gufoni to affected side, nose up)
Maneuver for HSCC Cupulolithiasis
start w pt sitting at edge of mat w head in neutral and nose forward supported by examiner
ask pt to quickly lie down not he affected side (side of weaker apogeotropic nystagmus) while u maintain neutral head positions for 2 minutes or until vertigo stops
PT then quickly rotated pts head 45 ° away from affected side (nose up) and hold for 2 mins
slowly return to sitting head in same position and wait for 2 mins then slowly bring head to neutral
repeat 2-5 times or as needed
what is the HEP for HSC canalithiasis
assume the forced prolonged positioning for that night followed by finishing the BBQ roll u[on walking the neck morning
perform the forced prolonged position once ever night followed by finishing the BBQ roll in the morning until vertigo free from 3 days in a row
what is the HEP for HSC cupulolithiasis
perfor the self casani
perform 3-5 reps daily until vertigo free for 3 days in a row
what is the Forced Prolonged Position as
HEP for HSC Canalithiasis
start by lying on affected side for 1 min , then lie on ur back for 1 mins then quickly roll down that ur lying on ur unaffected ear and sleep in this position for the night
in the morning finish the self BBQ roll
when should u use frenzels
to observe direction and rotation of nystagmus
when would u use reverse semont for
canalithiass or cupuloithias of ASCC or if residual symtoms after PSCC CRM or if no tolerance for head hanging position for PSC CRM or if mixed peripheral and central vestibular dysfunction
