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#Post#: 4--------------------------------------------------
Vertigo!
DIR By: CardioFlexTherapy
Date: August 2, 2018, 10:08 am
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Over the past 6 years CardioFlex Therapy has successfully
treated hundreds of vertigo patients, and assisted them in
eliminating their dizziness. I want to share some concepts of
how to use Vestibular Rehabilitation to get maximum results for
Benign Paroxysmal Positional Vertigo (BPPV) patients.
Diagnosis
The first step in getting rid of dizziness begins with a solid
diagnosis. Does the patient have a peripheral or a central
problem? What causes the patient to get dizzy? Is there any
spinning vertigo with the dizzy episodes? Patients that have
Meniere’s Disease or other chronic conditions will get recurring
bouts of dizziness, so helping them resolve each episode quickly
will be the best case scenario for those individuals.
Central Vertigo involves brain and spinal cord lesions such as
tumors, cysts, surgeries, scar tissue, and degeneration.
Neuromuscular disorders such as Multiple Sclerosis, Ataxia,
Stroke, & Parkinson’s Disease can affect the cerebellum in the
brain, causing gait and balance disturbances as well as severe
vertigo. Peripheral Vertigo is typically considered to be caused
by anything not in the central nervous system (brain and spinal
cord). Much of the time, Peripheral Vertigo is synonymous with
Positional Vertigo (BPPV).
To truly diagnose the vertigo as peripheral, the patient must
have a brain MRI to rule out central involvement. A Hallpike Dix
test and a Supine Roll Test are performed to see if the patient
has Positional Vertigo on the left side, the right side, both
sides, or not at all. Positional Vertigo (BPPV) is caused by
displaced otoconia, commonly called crystals, which tend to get
stuck in the 3 semicircular canals. The Hallpike Dix Test will
be positive if crystals are stuck in either the Anterior or
Posterior canals. The Supine Roll Test will be positive if
crystals are stuck in the Horizontal canals.
Eye tests need to be conducted with and without head movement to
see if there is a visual sensory-in component. In other words,
if a patient gets dizzy from visual tests with or without head
movement, then there is probably a visual sensory-in pathway
which can trigger the symptoms at any time, usually seen with
severe vertigo. If the patient gets any nystagmus (spinning
vertigo), then they have a sensory-out component through their
eyes, and are more likely to have a sensory-in component as
well.
Treatment
At CardioFlex, we believe in a concept that we call “Repetitive
Maneuvers.” We believe that several maneuvers should be
performed in each treatment session in order to clear the
crystals out of the semicircular canals, and become free flowing
like they were before getting stuck. There are several maneuvers
that we like to use in our sessions to clear the crystals, such
as the Brandt-Daroff Maneuver, the Semont Maneuver, Epley’s
Maneuver, and the Barbeque Roll Maneuver.
Vestibular Rehabilitation at CardioFlex Therapy
The Brandt-Daroff Maneuver is the best maneuver to give to
patients for a Home Exercise Program (HEP), because it’s the
simplest maneuver to execute. In our clinic, we will have the
patient do this maneuver first to get the crystals flowing, and
get their vestibular system ready to handle more intense
stimuli. After this maneuver, we will do eye exercises in
sitting with the patient, if they have any sensory-in problems.
If they don’t have any sensory-in dizziness, then we will
proceed to static and dynamic balance exercises, with and
without head movements. The head movements are either very small
rapid movements, or slow full range movements, which are meant
to disturb balance and aggravate the dizziness symptoms. After
these balance exercises are done, we may decide to do some
functional activities with head movements, such as squats,
lunges, and different directional walking exercises. The goal of
each therapy session is to aggravate the dizziness and clear the
displaced crystals.
Which exercises we choose for the patient is based on a
progressive loading pattern, starting off very easy then
progressing to very difficult exercises by the end of therapy.
At the end of each treatment session, we will do 1 power
maneuver, such as the Semont Maneuver, Epley’s Maneuver, or the
Barbeque Roll. Once they can handle a power maneuver without any
adverse dizziness symptoms, then we will change the order of the
maneuvers to enable as many as 4 maneuvers per session. The
ideal order becomes: Brandt-Daroff Maneuver, Semont Maneuver,
balance exercises, functional exercises, and lastly the Epley’s
Maneuver.
The Brandt-Daroff, Semont, and Epley’s Maneuvers clear crystals
in the Anterior and the Posterior semicircular canals, but not
in the Horizontal (Lateral) canal. The Barbeque Roll Maneuver
clears crystals in the Horizontal canal, so it’s really not
needed unless the other maneuvers are not able to completely get
rid of the vertigo, or if the patient tested positive for the
Supine Roll Test (Horizontal BPPV test). When the Barbeque Roll
test is incorporated, it should either be the last maneuver, or
the 2nd to last maneuver performed, to get maximum results. If
the Barbeque Roll test is either too violent for the patient to
handle (gets sick, nystagmus, etc.) or the patient cannot
physically do it (rolling over), then another Horizontal
Maneuver can be used such as the Log Roll Maneuver or the Gufoni
Maneuver.
At CardioFlex, we have used our “Repetitive Maneuver” method on
hundreds of vertigo patients with tremendous success. Due to the
volume of patients who have had rapid results from our methods,
we are very confident in our expertise treating patients with
vertigo, dizziness, and balance disorders.
For more info, please visit www.cardioflextherapy.com
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