Vestibular rehabilitation, BPPV, Dix Halpike, Dix Halpike, Dizziness, Disequilibrium, Lightheadedness, Nonvestibular dizziness

1. VESTIBULAR
REHABILITATION
DR. SHILPA M
J

2. VESTIBULAR REHABILITATION
HISTORY
 Cawthorne and Cooksey – First
clinicians to offer exercises for
dizziness and vertigo.
 Harold Schuknecht – Cupulolithiasis
theory.
 John Epley – Canalithiasis theory –
Revolutionized treatment for BPPV.

3. DIFFERENTIAL DIAGNOSIS FOR
DIZZY PATIENT
 LIGHT HEADEDNESS – Feeling that
fainting is about to occur
 .(Causes – Hypotension, Hypoglycaemia, or
anxiety)
 DISEQUILIBRIUM – Sensation of being
off balance. (Causes – nonvestibular
problems – decreased somatosensation or
weakness in the lower extremeties)
 VERTIGO – Illusion of movement. (Causes-
pathology within the vestibular periphery or
along the vestibular pathways)
 OSCILLOPSIA – Experience that objects
in the visual environment that are known to
be stationary are in motion.(Cause
 – Vestibular hypofunction)

4. DIAGNOSTIC TECHNIQUES
 Careful history
 Clinical examination – Assessment of eye
movements, posture and gait
 HEAD IMPULSE TEST – Assess
semicircular canal function.
• HEAD SHAKING INDUCED
NYSTAGMUS – Diagnosis of people with
asymmetry of peripheral vestibular input to
central vestibular regions.

5. POSTIONAL TESTING –
To identify whether otoconia have been
displaced into the SCC BPPV. The Dix –
Hallpike test commonly used to verify
displaced otoconia.
DYNAMIC VISUALACUITY –
Measurement of visual acquity during self
– generated horizontal motion of the head.
POSTURE & BALANCE TESTING –
Determination of a patient’s functional
status. Testing includes static balance,
weight shifting, automatic postural
responses and ambulation.

6. PHYSICAL THERAPY
INTERVENTION
 Vestibular Rehabilitation refers to
interventions such as repositioning techniques,
vestibular adaptation exercises, habituation
excercices, and general exercise to improve
muscle force, gait or balance.
 BENIGN PAROXYSMAL
POSITIONAL VERTIGO – Nystagmus
is generated when SCC with displaced
otoconia are placed into gravity – dependent
positions, as in the Dix-Hallpike test.

7. TREATMENT DIAGNOSIS
Canalith
Repositioning
Maneuver (CRM)
BPPV due to
Canalithiasis
Liberatory
Maneuver
BPPV due to
Cupulolithiasis
Brandt-Daroff
Exercises
Persistent BPPV
unresolved with
CRM/Liberatory
Residual vertigo
without
nystagmus
Maybe useful for
the patient who
cannot tolerate
CRM.

8. UNILATERAL VESTIBULAR
HYPOFUNCTION
 Recovery time upon initiating vestibular
rehabilitation averages 6 to 8 weeks.
 Primary focus – gaze and gait stability exercises.
 The two primary paradigms of vestibular adaptation
are X1 (times 1) and X2 execises (times 2).
 X1 – Patient is asked to move the head horizontally
(and vertically if appropriate) as quickly as possible
while maintaining focus on a stable target.
 X2 – Patient to move the head and target in opposite
directions.

9. BILATERAL VESTIBULAR
HYPOFUNCTION
 Designed to address the primary complaints of
gaze instability during head motion,
disequilibrium, and gait ataxia.
Other recommended activities – execises in a
pool and Tai Chi.
Habituation exercises do not work for the
patient with a bilateral vestibular loss.

10. CENTRAL VESTIBULAR LESION
 Time to recovery will be 6 months or more and
may be incomplete.
Though vestibular rehabilitation offers promise
for treating persons with Traumatic brain injury,
it may not always be the treatment of choice due
to its irritative nature

11. NON VESTIBULAR DIZZINESS
 Vestibular rehabilitation techniques similar to
those patients with true vestibular pathology.
CONCLUSION
The vestibular system requires movement to
recover from most lesions

12. THANK YOU