Vestibular (Vertigo) Rehab

By: Carla Hernandez, SPTA

BPPV -Benign Paroxysmal
Positional Vertigo:

Episodes of dizziness and head

spinning, triggered by
specific changes in the heads
position.
 Dix-Hallpike Test:
Eye Nystagmus directions:

Positional testing looking for

nystagmus (eye flutters) going
in certain directions. Patient
turns head to 45 degrees
towards ear being tested, then
brought to supine and extends
neck to 30 degrees.
Up= opposite side displacement
Down= same side displacement
Eply’s Maneuver:
A simple and noninvasive
approach of a series of head
movements to treat and relieve
symptoms of vertigo.

This maneuver places the

displaced otoconia in its
correct position within the ear.

Left affected ear to ground 45

deg, then rotate 90 deg. It is
important to keep the neck ext
30 deg.
PPPD- Persistent Postural Perceptual Dizziness:
Chronic dizziness and unsteadiness
left after treatment.

Described as: Constant floating or

rocking.

Physical therapy helps to relieve

balance and unsteady deficits.
Who is at risk for BPPV: People
aged 50 and older but can occur at
any age.

Women more susceptible than men.

 Peer review article #1
Goal of the article: Is Vestibular
rehabilitation superior to usual physical
therapy on balance and mobility?

Experiment: 1,876 male and females aged

above 65 in 20 randomized and 2 non
randomized trials. Computer-assisted
(CAVR) in 5, Tai Chi (TCVR) in 3, canal
repositioning maneuvers (CRM) in 1, and
manual therapy (MT) in 1 study.

Results: VR is moderately proven superior

to the usual care of improvement on
balance and mobility.

Conclusion: To treat older individuals

with vertigo, CRMs seem to be more
effective.
 Peer review article #2
Goal of the article: Does VRT (Vestibular
Rehabilitation Therapy) reduce symptoms of
PPPD?

Experiment: Two groups with PPPD: Group 1,

treated with VRT. Group 2, treated with
VRT placebo.

Results: VRT showed significant reduction

of symptoms and those who did not benefit
had more complex cases.

Conclusion: VRT reduced symptoms and

improved quality of life in the subjects.
Demonstration and instructions of exercises:

https://www.youtube.com/watch?v=a3ARx7d_NOo
Questions? - Thank you!
 References:
P;, R. V. S. E. M. M. B. (n.d.). Physical therapy
interventions for older people with vertigo, dizziness
and balance disorders addressing mobility and
participation: A systematic review. BMC geriatrics.
Retrieved November 7, 2022, from
https://pubmed.ncbi.nlm.nih.gov/33228601/

MR;, N. E. H. I. O. A. H. (n.d.). Vestibular

rehabilitation therapy outcomes in patients with
persistent postural-perceptual dizziness. The Annals
of otology, rhinology, and laryngology. Retrieved
November 7, 2022, from
https://pubmed.ncbi.nlm.nih.gov/30607985/

Jacobson GP,CW: The development of the dizziness

Handicap Inventory. Arch Otolaryngol Head Neck Surg
1990;116: 424-427