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Topic: Adult Vestibular Rehabilitation Specific question: Kevin is a 45 year-old male who enjoys surfing. He was recently diagnosed with benign
paroxysmal positional vertigo (BPPV), which is affecting his balance and ability to surf. Would adaptation through Cawthorne-Cooksey balance
exercises be more effective than habituation through Epleys maneuvers in improving his balance so he can enjoy surfing again?
Clinical Scenario: Kevin is a 45 year-old husband and father. When he is not working or spending time with his family, he enjoys surfing. He has
recently noticed that he becomes increasingly dizzy and light-headed throughout the day. He is clumsier than usual, often stumbling and running
into walls when turning corners. He has trouble tracking objects and increased light sensitivity. Occasionally, Kevin experiences ringing in his
ears, which makes it hard for him to focus on tasks. Kevin is worried that these vestibular abnormalities will hinder his ability to surf and care for
his children. Kevin is seen by a physician and learns he has benign paroxysmal positioning vertigo (BBPV). He is referred to an occupational
therapist to improve his balance and symptoms of vertigo through adaptation and habituation interventions.
Issue examined
Balance Rehabilitation by
Moving Platform and
Exercises in Patients with
Neuropathy or Vestibular
Deficits
Efficacy of a Home-Based
Exercise Program on Benign
Paroxysmal Positional
Vertigo Compared with
Betahistine
To determine the
effectiveness of a balance
treatment that uses both a
powered platform that the
patient stands on and
To determine the
effectiveness of a homebased exercises program
compared to the drug,
betahistine, in patients with
BPPV.
Design / Level of
evidence
Participants
Methods /
Intervention /
Measurement tools
underwent powered
platform exercises and
then exercise treatment,
while the other group had
16 participants and
underwent the same
treatment in reverse order.
The balance exercise
intervention was
performed in the hospital
gymnasium, while the
powered platform
intervention was
performed in the posture
and movement laboratory
at the same hospital. Both
treatments administered
by a physical therapist. For
both treatment groups,
patients completed 10
sessions total; 2 thirtyminute sessions a day for 5
sequential days.
Cawthorne-Cooksey
exercises were used with
patients with vestibular
deficits, and Modified
Frenkel exercises were
used with patients with
neuropathy. Powered
platform treatment was
used for both groups. For
this particular treatment,
patients were required to
Threats to internal
validity?
Outcomes / findings
Performance-Oriented
Mobility assessment. 12
patients with vestibular
deficits and 10 with
neuropathy were
evaluated with the
assessment of balance
behavior during sinusoidal
translation of the
supporting surface.
Time constraints for
treatments may have
limited optimal outcomes.
Limitations
Strengths
Both treatment
interventions provided the
desired outcome of
improved balance, which
shows confidence in the
study.
Clinical Implications
Both Cawthorne-Cooksey
exercises and powered
platform activities can be
used as occupational
therapy intervention for
improving balance in
individuals with vestibular
Epleys maneuver is an
effective intervention that
can be administered by
occupational therapists
with patients who have
BPPV and other vestibular
disorders.
Social validity
deficits.
habituation therapy. The other two articles we found using the CINAHL Complete database and the MEDLINE with full text database. For these
two sites, we used key words such as BPPV and Cawthorne-Cooksey exercises, BPPV and balance exercises, and BPPV and balance
rehabilitation. We read several abstracts to sort through articles, which led us to more relevant information and the articles we used for this
assignment.
References
Kulcu, D.G., Yanik, B., Boynukalin, S., Kurtais, Y. (2008). Efficacy of a home-based exercise program on benign paroxysmal positional
vertigo compared with betahistine. Journal of Otolaryngology-Head & Neck Surgery. 37(3):373-379.
Nardone, A. Godi, M. Artuso, A., Schieppati, M. (2010). Balance rehabilitation by moving platform and exercises in patients with
neuropathy or vestibular deficit. Arch Phys Med Rehabil. 91:1869-77.
Pereira, A.B., Santos, J.N., Volpe, F.M. (2010). Effect of Epleys Maneuver on the quality of life of paroxismal positional benign vertigo
patients. Braz J Otorhinolaryngol. 76(6):704-8.
Roa Castro, F.M., Duran de Alba, L.M., Roa Castro, V.H. (2008). Experience with Epleys manoeuvre and vestibular habituation
training in benign paroxysmal positioning vertigo. Acta Otorrinolaringol Esp .59(3):91-5.