Download Speaker: Shayla Moore, BMR(PT)

Speaker: Shayla Moore, BMR(PT)
Relationship with commercial
interests: Employee at Creekside
Physiotherapy Clinic
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Vestibular Rehabilitation
Shayla Moore BMR (PT)
“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)
Shayla Moore BMR (PT)
Shayla Moore BMR (PT)
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
Shayla Moore BMR (PT)
Vertigo- illusion of movement caused by nystagmus
BPPV
 Vertigo lasts seconds,
Unilateral Vestibular Loss
(acute)
 Vertigo lasts hours to days
up to 1 min
 Positional triggers-looking
 Not specific to position,
up/down, rolling in bed,
getting in/out of bed
worse with head/body
movement
 Fluctuating
 Persistent
Shayla Moore BMR (PT)
BPPV- the “plumbing problem”
Shayla Moore BMR (PT)
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
Shayla Moore BMR (PT)
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
Shayla Moore BMR (PT)
Right Posterior Canal BPPV
Shayla Moore BMR (PT)
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
Shayla Moore BMR (PT)
Unilateral/Bilateral Dysfunction
Acute (hours/days)
 Vertigo
Chronic (weeks/months)
 Dizziness with head/body
 Nausea+/-vomiting
 Severe dysequilibrium
 ?neck/jaw


 ?fatigue
 ?ear pain, tinnitus
Shayla Moore BMR (PT)


movement
Oscillopsia (blurred vision);
poor gaze stabilization
Imbalance, dysequilibrium
?Light-headedness
?worse with stress or fatigue
Shayla Moore BMR (PT)
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
Shayla Moore BMR (PT)
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
Shayla Moore BMR (PT)
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
Shayla Moore BMR (PT)
Vestibular Rehabilitation for Senior
patients with dizziness
 BPPV
 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
Shayla Moore BMR (PT)
THANK YOU
!
 Creeksidephysio.com
 832-6603
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