Question
What do you do for a geriatric patient who does not have the cervical range in order to do the maneuvers to test for vestibular issues?
Answer
If you are looking at the Epley maneuver, it is not necessary that you take that individual back into a position of cervical extension past 10 degrees. One of the things that I like to do is actually lift the body up. It is important that the semicircular canals are inverted or in a Trendelenburg position. When I lay the patient back, I will usually put one or two pillows underneath the thoracic spine so that their head can be supported on the mat behind them, and they do not have to lie back over the edge. Remember that what we want to do is line up the vestibular apparatuses, specifically the semicircular canals, such that we can reposition the otoconia. To do that, we need the whole body back in the Trendelenburg 10 degree position.
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