A. Cesarani D. Alpini. Vertigo and Dizziness Rehabilitation

Transcription

1 A. Cesarani D. Alpini Vertigo and Dizziness Rehabilitation

2 Springer Berlin Heidelberg New York Barcelona Hong Kong London Milan Paris Singapore Tokyo

3 Antonio Cesarani Dario Alpini Vertigo and Dizziness Rehabilitation The M CS Method With a contribution by c.-f. Claussen Drawings by F. Alpini With 173 Illustrations and 5 Tables Springer

4 ANTONIO CESARANI, M. D. Institute of Otolaryngology University of Sassari Via Mancini Sassari, Italy DARIO ALPINI, M. D. Centro Medico Sociale "S. Maria Nascente" Don Carlo Gnocchi Foundation ENT-Otoneurology Service Via Capecelatro Milan, Italy Dr. Claus-Frenz Claussen President of the Neurotology and Equilibriometric Society Kurhausstrasse Bad Kissingen, Germany ISBN-13: DOl: / e-isbn -13: Library of Congress Cataloging-in-Publication Data Cesarani, A. (Antonio) Vertigo and dizziness rehabilitation: the MCS method / Antonio Cesarani, Dario Alpini; with a contribution by c.-f. Claussen; drawings by F. Alpini. Includes bibliographical references and index. ISBN-13: Vertigo-Patients-Rehabilitation. 2. Dizziness-Patients-Rehabilitation. 3. Equilibrium (Physiology). 4. Vestibular apparatus-diseases. I. Alpini, Dario, II. Claussen, Claus-Frenz. III. Title. RF260.C '41-ddc21 This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilm or in any other way, and storage in data banks. Duplication of this publication or parts thereof is permitted only under the provisions of the German Copyright Law of September 9, 1965, in its current version, and permission for use must always be obtained from Springer-Verlag. Violations are liable for prosecution under the German Copyright Law. Springer-Verlag Berlin Heidelberg 1999 Reprint of the original edition 1999 The use of general descriptive names, registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. Product liability: The publishers cannot guarantee the accuracy of any information about dosage and application contained in this book. In every individual case the user must check such information by consulting the relevant literature. Illustrators: Regine Gattung-Petith and Albert P. Gattung, Edingen-Neckarhausen Cover design: Kunkel + Lopka Werbeagentur GmbH, Heidelberg Typesetting: K + V Fotosatz GmbH, Beerfelden SPIN: / I 0 -

5 Preface This volume opens a new frontier for clinical specialists dealing with vertigo sufferers. As our populations are constantly growing older, we have to deal more and more with degenerative neurosensorial disorders of elderly persons not only from the investigative, but also from the innovative therapeutic point of view. This book's theme of vertigo and dizziness rehabilitation has been chosen in the sense of applied neurootometry and conservative neuroototherapy. The authors describe a new way of utilizing objective and quantitative neurosensorial equilibrium function measurements for special reprogramming and retraining purposes. In the field of diagnosis they place functional investigation of the equilibrium system alongside the other classical techniques which mostly work through inspection and imaging. Consequently, the MCS method of treatment (mechanics, cybernetics, synergetics) has to take into account the basic knowledge on information transfer from the inner ear hair cells to the central nervous system in the regulating centers of the brainstem. With this book an international group of neurootological investigators and clinicians describe in depth the clinical application of exercise therapy in the framework of a general neurootological treatment plan. Starting from theories for vestibular adaptive control mechanisms in patients with vestibular deficits and vertigo, and from vestibular tests which demonstrate the ability of reactional suppression and habituation, various kinds of physical and mental exercises were used to monitor and to stabilize the success of treatment in the long term. Combination of pharmacotherapy with treatment by physical and rehabilitation procedures was also taken into consideration. The volume brings together a well-designed collection of the various basic and clinical experiments regarding the complex sense of the human equilibrium. As shown by the results published here, the MCS method represents a valuable addition to the therapeutic modalities of modern neurootology. It will be an aid both for medical doc-

6 VI Preface tors and those in related professions, especially physiotherapists, who are involved with dysequilibrium disorders. Bad Kissingen, August 1998 Claus- F. Claussen

7 Contents Introduction: Mechanics, Cybernetics and Synergetics of the Equilibrium System MCS Organization of the Equilibrium System Components of the System Eye Movements... 9 Foot Ankle Antigravitational Muscles Neck Lumbar Region Vestibular Reflexes Cybernetics Functional Networks Balance-Ocular Network Balance-Spinal Network Synergetics Integrations Strategies and Synergies: Basis for Motor Coordination Brainstem and Cerebellum: Who Is the Teacher and Who Is the Pupil? Internal Representation of Posture and Orientation Evaluation of the Patient Suffering Vertigo and Dizziness General Approach Anamnesis Qualitative Aspects... 51

8 VIII Contents Quantitative Aspects General Clinical Examination Cranial Nerves Posture Evaluation Specific Approach: Ocular Function Eye Movements Vestibulo-ocular Reflex Otolith Function Specific Approach: Spinal Function Stance Gait Specific Approach: Orientation Using Complex Vestibular Tests To Investigate the Resources of Diseased Equilibrium Function C.-F. CLAUSSEN Introduction Electronystagmography The Caloric Butterfly Test The Rotatory Intensity Damping Test Complex Nystagmus-Based Equilibrium Reactions Vestibular Stimulus Response Intensity Comparison Calorization Pendulum Interference Test Caloric Adaptation Cyclogram Discussion Treatment Mechanics Phase Relaxation Exercises Physiotherapy Ski Training Oscillating Platform Cybernetics Phase Ski Training Oscillating Platform III Vestibular Electrical Stimulation Exercises with the Soft Mattress: The Rettiks Visual Prisms

9 Contents IX 4,3 Synergetics Phase """"""""""""""""", 119 Rettiks """""""""""""""""""""" 120 Daedalus: Labyrinth on an Undulating Platform """"" 120 Visual Feedback Stabilometric Reeducation """"""" 122 The Balance Master,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, " MCS Protocols,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, " 128 Acute Unilateral Vestibular Hypofunction,,,,,,,,,,,,,, " 128 Hospital Treatment """""""""""""""" 129 Home Protocol """"""""""""""""", 136 Uncompensated Unilateral Vestibular Hypofunction """, 141 Exercises in the Gymnasium """""""""""" 142 Mechanics Phase,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, " 142 Meniere's Disease """"""""""""""", 143 Cybernetics Phase,,,,,,,,,,,,,,,,,,,,,,,,,,,,, " 145 Synergetics Phase """"""""""""""", 148 Home Protocol """"""""""""""""", 153 Paroxysmal Positional Vertigo """""""""""", 154 Semont's Maneuver """"""""",,,,,,,,,,,, " 156 Epley's Maneuver,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, " 157 Personal Maneuver for PPV """""""""""", 160 Lempert's Maneuver """"""""""""""", 160 No Resolution Patients """""""""""""", 160 Mechanics Phase,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, " 162 Cybernetics Phase,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, " 163 Synergetics Phase """""""""""""""", 166 Home Protocol """"""""""""""""", 166 Dizziness and Vertigo Following Whiplash Injuries,,,,,, " 168 Exercises in the Gymnasium """""""""""" 171 Mechanics Phase """""""",,,,,,,,,,,,,, " 171 Cybernetics Phase,,,,,,,,,,,,,,,,,,,,,,,,,,,,, " 176 Synergetics Phase """"""""""""""", 182 Home protocol """"""""""""""""", 186 Dizziness in the Elderly """"""""""""""" 188 Exercises in the Gymnasium """""""""""" 190 Mechanics Phase,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, " 190 Cybernetics Phase,,,,,,,,,,,,,,,,,,,,,,,,,,,,, " 195 Synergetics Phase """"""""""""""", 201 Home Protocol """"""""""""""""", 204 Some Suggestions To Ameliorate Lifestyle """""", 207 Dizziness and Structural Fragility Syndrome """""", 210 Exercises in the Gymnasium """""""""""" 211

10 X Contents Mechanics Phase Cybernetics Phase Synergetics Phase Home Protocol Bibliography Subject Index