The purpose of this case report is to demonstrate using canalith-repositioning maneuvers and balance training as interventions to reduce vertigo and improve balance and gait in a patient with multiple-canal BPPV.https://soar.usa.edu/flsasummer2018/1006/thumbnail.jp

Knights, Nicole

Mallini, Kerry C

English

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Canalith-Repositioning Maneuvers and Balance Interventions on a Patient with Multiple-Canal BPPV: A Case StudyNicole Knights, SPT and Kerry C. Mallini, PT, MPT, NCS The Epley maneuver is a common intervention used to treat benign paroxysmal positional vertigo (BPPV).1 The onset of BPPV can occur following mild head trauma due to lesions in the utricle or saccule macula and multiple canals may be affected in some cases.1,2 BPPV can adversely affect balance secondary to disturbances in vestibular system functioning.3The purpose of this case report is to demonstrate using canalith-repositioning maneuvers and balance training as interventions to reduce vertigo and improve balance and gait in a patient with multiple-canal BPPV. At discharge, post-intervention assessments revealed her Dizziness Handicap Inventory Scale (DHIS) improved from a score of 80 points (severe handicap) to 50 points (moderate handicap). The Berg Balance Scale improved from 27/56 points to 30/56 points (medium fall risk) and the Timed Up-and-Go test improved from 29 seconds to 24 seconds. The Dynamic Gait Index (DGI) score improved from 6/24 points to 10/24 points. Overall, after treatment with the Epley maneuver and balance activities, the patient demonstrated improvement in the DHIS as evidenced by the patient’s ability to perform functional tasks and mobility with less dizziness. Following the intervention, the DHIS and DGI met the minimal detectable change (MDC) and the minimally clinically important difference (MCID). The outcomes of this case report demonstrate that the Epley maneuver with vestibular rehabilitation may have contributed to improvement in dizziness and balance in a patient with multiple-canal BPPV following minor head trauma. Visit Hall-Pike Dix InterventionVisit 1 (+) AC Canalithiasis L Epley Maneuver 1xVisits 2-3 (+) AC CanalithiasisL Epley Maneuver 1xSingle Leg Stance (SLS)/taps Walking with Head Turns Tandem Stance Visit 4 (+) AC CanalithiasisL Epley Maneuver 3xWalking with head turnsObstacle negotiationVisit 5(+) AC CanalithiasisHC Canalithiasis L Epley Maneuver 1xL BBQ Roll 2xVisit 6(+) PC Canalithiasis(-) On 2nd and 3rd assessmentL Epley Maneuver x3SLS Tandem stance Tandem walkingVisit 7(+) PC Canalithiasis(+) HC CanalithiasisL Epley Maneuver x1BBQ x1BBQ x1Visits 8-10 (+) PC Canalithiasis(-) On final assessmentL Epley Maneuver 3x,1x,1xWalking with head turns Tandem stance SLS cone taps Tandem walking/obstacle negotiationCASE DESCRIPTION INTERVENTIONSBACKGROUND & PURPOSE OUTCOMESDISCUSSIONREFERENCES88-year-old female who suffered a fall, hitting her head and subsequently developed vertigo Impairments: -Severe Dizziness with positional changes, bed mobility and ambulation  -LE Weakness -Hallpike-Dix: + downbeating torsional nystagmusActivity Limitations:-Impaired Balance -Difficulty AmbulatingParticipation Restrictions:-Grocery shopping-Community events 1. Suarez H, Alonso R, Arocena M, Suarez A, Geisinger D. Clinical characteristics of positional vertigo after mild head trauma. Acta Oto-Laryngologica. 2011; 131(4): 377-381. doi: 10.3109/00016489.2010.534113. 2. Tomaz A, Gananca M, Gananca C, Gananca F, Caovilla H, Harker L. Benign paroxysmal positional vertigo: concomitant involvement of different semicircular canals. Ann Otol Rhinol Laryngol. 2009; 118(2):113-117. 3. Ribeiro K, Freitas R, Ferreira L, Deshpande N, Guerra R. Effects of balance vestibular rehabilitation therapy in elderly with benign paroxysmal positional vertigo: a randomized controlled trial. Disabil Rehabil. 2017; 39(12):1198-1206. doi:http://dx.doi.org/10.1080/09638288.2016.1190870. 4. Schunke M. Schulte E, Schumacher U. Thieme atlas of anatomy. 2nd ed. New York (NY): Thieme; 2015:558.

Canalith-Repositioning Maneuvers and Balance Interventions on a Patient with Multiple-Canal BPPV: A Case Study

https://soar.usa.edu/cgi/viewcontent.cgi?article=1006&context=flsasummer2018

Canalith-Repositioning Maneuvers and Balance Interventions on a Patient with Multiple-Canal BPPV: A Case Study

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