dizzyness following ortho tx

Moderators: kwyss, Sillevis

dizzyness following ortho tx

Postby kwyss » Wed Sep 14, 2011 11:55 am

Patient has head trauma and is seen for dizzyness as well as cervical dysfunction. RR and SBR as well as ext. or fast movement will cause dizziness. Cervical dysfunction: OA 2/6, C5-6, C6-7 on R 2/6; Right sided hypertonicity of paraspinals and levator with guarding in the ant muscle group.
A: positional restrictions for treatment?
B: should this patient be seen back to back for the vestib and orthop component and why/why not?
C: restrictions towards the ortho component to avoid interference with the vestib. component.
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Re: dizzyness following ortho tx

Postby Sillevis » Sat Sep 24, 2011 12:32 am

As a non-vestibular therapists I can't answer some of your questions, but how about an of the wall approach (not really..) manipulate her upper TSA (symapthetic related to the head and cervical region)and see how her symptoms alter..
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Re: dizzyness following ortho tx

Postby DCandy » Sat Oct 15, 2011 1:44 pm

What sort of testing has this patient had done? That is, do we truly know that the dizziness is vestibular in nature?

Differentials:
1) Vestibular dysfunction
2) Cervicogenic dizziness
3) Vertebrobasilar arterial compromise

With head trauma, any of these could be a cause. Holding the head still and having the patient rotate the body on a stationary head would be a good start. If dizziness occurs, it's not vestibular its either 2 or 3. If no dizziness after this position is maintained for a few minutes, it's more likely vestibular.

If the dizziness is ortho in nature, I think starting with the T-spine as mentioned before is probably a good starting place. Be very cautious with cervical mobilization/manipulations (especially rotational) until vertbral artery can be sufficiently ruled out.
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Re: dizzyness following ortho tx

Postby Paula » Sun Oct 23, 2011 9:52 pm

If the patient demonstrated dizziness with isolated RR, SBR and ext then combined motions(Vertebral Artery Test and Dix Hallpike Test) will surely increase her symptoms. Must assess carefully if she has only complaints of dizziness or dizziness combined with slurred speech, confusion etc. I know there is much debate as to whether a VA test should be done for cervical assessment. I feel that the clinician should use his/her best judgement for this based on symptoms, history etc. I would however refrain from upper cervical mobilization/manipulation if patient is symptomatic secondary to head trauma. Has there been any diagnostic imaging to rule out VA dysfunction. Since patient had head trauma I would expect this should be done. In vestibular therapy, a majority of patients are routinely put into the VA test position but for vestibular assessment it is known as the Dix Hallpike Test to determine if symptoms are positional(BPPV) and is utilized as part of the treatment in the Epley maneuver. Also, I would expect that dizziness associated with head trauma is most likely to be a result of both cervicogenic and vestibular issues. Patient should be able to have treatment for ortho and vestibular back to back unless the patient is very acute at which time may be best to have on alternating days untils symptoms begin to improve.
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Re: dizzyness following ortho tx

Postby kwyss » Thu Nov 03, 2011 11:29 pm

Problem appears to be that the vestibular exercises involving cervical rotation increase the patients upper cervical symptoms. Upper cervical segmental limitation effects the patients mobility. Midrange mobilization seems very effective but if Vestib Tx follows all is irritated. It appears that this patient benefits most when treatments are performed on different days. Thoracic manipulation has improved his symptoms.
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Re: dizzyness following ortho tx

Postby fred » Wed Feb 29, 2012 3:23 pm

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