Speaker: Shayla Moore, BMR(PT) Relationship with commercial interests: Employee at Creekside Physiotherapy Clinic

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1 Speaker: Shayla Moore, BMR(PT) Relationship with commercial interests: Employee at Creekside Physiotherapy Clinic 1

2 Vestibular Rehabilitation

3 Managing dizziness to maintain mobility in the elderly" Dizziness: is the #1 reason people over the age of 65 visit their doctor, costing > $ 1 billion in 2005 (Worthington, 2001) Is the leading cause of falls vestibular dysfunction leads to a 12-fold increase in the odds of falling (Agrawal, 2009) BPPV is the most common vestibular disorder (von Brevern, 2007)

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5 Vestibular Assessment Subjective: symptoms, past medical history, medications, Dizziness Handicap Inventory, investigative tests (ENG, MRI, CT) Objective: vestibular tests to locate the source of dysfunction BPPV, benign paroxysmal positional vertigo Gaze stability; Vestibular-ocular reflex (VOR) Postural stability/balance Central based tests

6 Vertigo- illusion of movement caused by nystagmus BPPV Unilateral Vestibular Loss (acute) Vertigo lasts seconds, up to 1 min Vertigo lasts hours to days Positional triggers-looking up/down, rolling in bed, getting in/out of bed Not specific to position, worse with head/body movement Fluctuating Persistent

7 BPPV- the plumbing problem

8 Why does BPPV occur? >60 years of age, most common, insidious onset After trauma, eg. MVA, concussion After an ear infection BPPV usually resolves on its own BUT 25-50% report years of recurring bouts

9 BPPV Test: Dix-Hallpike (posterior canal) Treatment: Canalith Repositioning Technique (eg. modified Epley) Frenzel goggles: worn by the patient to magnify the eyes and limit fixation to observe nystagmus

10 Right Posterior Canal BPPV

11 When it s not BPPV Unilateral or bilateral vestibular dysfunction Labyrinthitis, vestibular neuritis Trauma-MVA, vestibular concussion or other TBIs Age-related changes Ménière s Disease Acoustic neuroma Result: gaze and postural instability

12 Unilateral/Bilateral Dysfunction Acute (hours/days) Vertigo Nausea+/-vomiting Severe dysequilibrium?neck/jaw?fatigue?ear pain, tinnitus Chronic (weeks/months) Dizziness with head/body movement Oscillopsia (blurred vision); poor gaze stabilization Imbalance, dysequilibrium?light-headedness?worse with stress or fatigue

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14 Vestibular Physiotherapy for UVLs/BVLs Assess for an acute (eg. Neuritis) vestibular loss or determine the level of function with a chronic loss (eg. Age-related) Assess/rehab for gaze stability (VOR) and balance Design custom exercises including a daily home program Provide education for safety, gait aides

15 Balance/Fall Risk Fallproof This program is based on a model developed and validated at the Center for Successful Aging, California State University, Fullerton. Fullerton Advanced Balance Scale; Berg Balance Scale Interpretation of each task score allows individualization of balance and mobility training Aspects include: Center of Gravity Control, Multisensory, Gait Pattern Enhancement & Variation, Postural Strategy, Strength, Endurance, and Flexibility Training

16 To Serc or not to Serc that is the? Medications are prescribed to reduce/resolve symptoms A diagnosis/reason for the symptoms is needed-vestibular or other Does not resolve BPPV; treatment should be aimed to restore the otoconia to their proper location UVL/BVL: Window of opportunity-the vestibular system has the greatest potential to compensate if it feels bad Vestibular Rehabilitation should be attempted to resolve/reduce symptoms, minimize fall risk and maximize mobility

17 Vestibular Rehabilitation for Senior BPPV patients with dizziness Complement your differential diagnosis of potential inner ear dysfunction (UVL) Patient symptoms: Vertigo Dizziness Feeling off-balance Unexplained inability to focus (blurred vision) with head movement

18 THANK YOU! Creeksidephysio.com

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