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.
Mike Studer, PT, DPT, MHS, NCS, CEEAA, CWT, CSST, CBFP, CSRP, FAPTA, has been a PT since 1991, a board-certified neurologic PT in 1995, and a private practice owner since 2005. Dr. Studer has been an invited speaker covering all 50 states, 14 countries, and five continents, speaking on topics ranging from cognition and psychology in rehabilitation, aging, stroke, motor learning, motivation in rehabilitation, balance, dizziness, neuropathy, and Parkinson Disease. Dr. Studer was the founder and operator of Northwest Rehabilitation Associates in Oregon for 18 years and is now a co-founder and co-owner of Spark Rehabilitation and Wellness in Bend, OR. He is an adjunct professor at Touro University and has an additional appointment at UNLV. Dr. Studer also assists the USC-led national network of neurologic PT residencies (Neuroconsortium). In 2011, Mike was recognized as Clinician of the Year in the Neurologic and (in 2014) the Geriatric Academies of the APTA. He received the highest honor available in PT in 2020, being distinguished as a Catherine Worthingham Fellow of the APTA, joining a group of fewer than 300 persons then. Mike’s honors additionally reflect his service as Vice President of the Academy of Neurologic PT, and the Mercedes Weiss award for service to the Oregon chapter of APTA. He holds a trademark in dual task rehabilitation and has a patent pending on the same. Over his career, Mike has authored over 45 articles and seven book chapters, and he routinely has clinical research projects in affiliation with one of many universities. He is a consultant to professional athletes, including Major League Baseball players, competitive divers, and some of the most prolific climbers in world history. As a very fun and lighthearted note, Mike is the four-time and current WR holder for the fastest underwater treadmill marathon, a mark set most recently in January 2022. Mike authored The Brain That Chooses Itself, a practical and application-based guide to increasing healthspan and lifespan for laypersons and medical professionals alike.
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