Table Of ContentA. Cesarani D. Alpini
Vertigo and Dizziness Rehabilitation
Springer
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London
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Paris
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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
ANTONIO CESARANI, M. D.
Institute of Otolaryngology
University of Sassari
Via Mancini 5
17100 Sassari, Italy
DARIO ALPINI, M. D.
Centro Medico Sociale "S. Maria Nascente"
Don Carlo Gnocchi Foundation
ENT-Otoneurology Service
Via Capecelatro 66
20148 Milan, Italy
Dr. Claus-Frenz Claussen
President of the Neurotology and Equilibriometric Society
Kurhausstrasse 12
97688 Bad Kissingen, Germany
ISBN-13: 978-3-540-64084-4 e-ISBN -13: 978-3-642-59875-3
DOl: 10.1007/978-3-642-59875-3
Library of Congress Cataloging-in-Publication Data
Cesarani, A. (Antonio)
Vertigo and dizziness rehabilitation: the MCS method / Antonio Cesarani, Dario Alpini; with a contri
bution by c.-F. Claussen; drawings by F. Alpini.
Includes bibliographical references and index.
ISBN-13: 978-3-540-64084-4
1. Vertigo-Patients-Rehabilitation. 2. Dizziness-Patients-Rehabilitation. 3. Equilibrium (Physiology).
4. Vestibular apparatus-Diseases. I. Alpini, Dario, 1958- . II. Claussen, Claus-Frenz. III. Title.
RF260.C47 1999
616.8'41-ddc21
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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 disor
ders 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 neu
roototherapy. 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 sys
tem 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 ac
count 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 investiga
tors and clinicians describe in depth the clinical application of exer
cise therapy in the framework of a general neurootological treatment
plan. Starting from theories for vestibular adaptive control mecha
nisms in patients with vestibular deficits and vertigo, and from ves
tibular 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 var
ious 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 modali
ties of modern neurootology. It will be an aid both for medical doc-
VI Preface
tors and those in related professions, especially physiotherapists, who
are involved with dysequilibrium disorders.
Bad Kissingen, August 1998 Claus-F. Claussen
Contents
Introduction: Mechanics, Cybernetics and Synergetics
of the Equilibrium System ............................. .
2 MCS Organization of the Equilibrium System . . . . . . . . . . . . . . . . 9
2.1 Components of the System . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Eye Movements ..................................... 9
Foot .............................................. 12
Ankle. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Antigravitational Muscles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Neck. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Lumbar Region ..................................... 18
Vestibular Reflexes .................................. 18
2.2 Cybernetics Functional Networks ...................... 20
Balance-Ocular Network. . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 21
Balance-Spinal Network .............................. 26
2.3 Synergetics Integrations .............................. 33
Strategies and Synergies: Basis for Motor Coordination .... 33
Brainstem and Cerebellum:
Who Is the Teacher and Who Is the Pupil? .............. 36
Internal Representation of Posture and Orientation . . . . . . .. 40
3 Evaluation of the Patient Suffering Vertigo and Dizziness . . . . .. 49
3.1 General Approach ................................... 49
Anamnesis ......................................... 49
Qualitative Aspects ................................ 51
VIII Contents
Quantitative Aspects ............................... 51
General Clinical Examination . . . . . . . . . . . . . . . . . . . . . . . . .. 54
Cranial Nerves . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 54
Posture Evaluation ................................ 55
3.2 Specific Approach: Ocular Function .................... 55
Eye Movements ..................................... 55
Vestibulo-ocular Reflex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 58
Otolith Function .................................... 70
3.3 Specific Approach: Spinal Function . . . . . . . . . . . . . . . . . . . .. 71
Stance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
Gait .............................................. 75
3.4 Specific Approach: Orientation ........................ 81
3.5 Using Complex Vestibular Tests To Investigate the
Resources of Diseased Equilibrium Function
C.-F. CLAUSSEN ..................................... 86
Introduction ....................................... 86
Electronystagmography .............................. 86
The Caloric Butterfly Test . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 88
The Rotatory Intensity Damping Test ................... 89
Complex Nystagmus-Based Equilibrium Reactions ........ 91
Vestibular Stimulus Response Intensity Comparison ..... 91
Calorization Pendulum Interference Test . . . . . . . . . . . . . .. 93
Caloric Adaptation Cyclogram . . . . . . . . . . . . . . . . . . . . . . . 94
Discussion ......................................... 95
4 Treatment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 101
4.1 Mechanics Phase ............ . . . . . . . . . . . . . . . . . . . . . . .. 106
Relaxation Exercises ................................. 107
Physiotherapy ...................................... 107
Ski Training Oscillating Platform . . . . . . . . . . . . . . . . . . . . . .. 107
4.2 Cybernetics Phase . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 110
Ski Training Oscillating Platform . . . . . . . . . . . . . . . . . . . . . .. III
Vestibular Electrical Stimulation ....................... 112
Exercises with the Soft Mattress: The Rettiks . . . . . . . . . . . .. 115
Visual Prisms ...................................... 119
Contents IX
4,3 Synergetics Phase """"""""""""""""", 119
Rettiks """""""""""""""""""""" 120
Daedalus: Labyrinth on an Undulating Platform """"" 120
Visual Feedback Stabilometric Reeducation """"""" 122
The Balance Master, , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , " 123
4.4 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
X Contents
Mechanics Phase ................................ 211
Cybernetics Phase . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 216
Synergetics Phase ............................... 217
Home Protocol ................................... 219
Bibliography ............................................ 227
Subject Index ........................................... 237
