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.
Dr. Studer, a Physical Therapist (PT) since 1991 and a Board-Certified Clinical Specialist in Neurologic Physical Therapy since 1995, co-founded and co-owns Spark Rehabilitation and Wellness in Bend, Oregon. Additionally, he serves as an adjunct professor at Touro University and is an instructor at UNLV. Actively engaged as a practicing clinician, researcher, author, and presenter in DPT programs and continuing education, Mike was honored as the 2011 Clinician of the Year in the Neurologic Academy and, in 2014, in the Geriatric Academy of the APTA.
Dr. Studer has presented invited lectures in all 50 states and 12 countries across four continents. In 2020, he received the highest honor in PT, being distinguished as a Catherine Worthingham Fellow of the APTA. Over his 33-year career, Mike has authored over 35 articles and six book chapters and is a consultant to Major League Baseball.
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