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Vestibular Testing in Patients Lacking Cervical Range

Mike Studer, PT, DPT, MHS, NCS, CEEAA, CWT, CSST, CBFP, CSRP, FAPTA

October 23, 2013

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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.  

 

mike studer

Mike Studer, PT, DPT, MHS, NCS, CEEAA, CWT, CSST, CBFP, CSRP, FAPTA

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, 17 countries, and 6 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 assists the USC-led national network of neurologic PT residencies (Neuroconsortium) as well.  

Mike holds the distinction of being the only PT in the US to be recognized as Clinician of the Year in the Neurologic and 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.  Mike’s honors additionally reflect his service as the  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. Throughout his career, Mike has authored over 50 articles, seven book chapters, and two books, and has routinely led clinical research projects in affiliation with various 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 that was set most recently in January 2022. Most recently, Mike authored The Brain That Chooses Itself: Personalized Strategies to Extend Your Healthspan, a practical and application-based guide to increasing both healthspan and lifespan for laypersons and medical professionals alike. Dr. Studer followed this by authoring My Face Book: Looking Beyond What the Mirror Tells Us in Crisis.

 

 

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