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Benign Paroxysmal Positional Vertigo

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Vertigo Rehabilitation Protocols

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Abstract

Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo, and it is recognized to be a pure inner ear problem that results in short-lasting, but severe, room-spinning vertigo generally provoked by movement of the head or changing position in bed. Cupulolithiasis and canalolithiasis have both been proposed as pathophysiologic biomechanical models underlying BPPV. On the basis of these models, manoeuvres aimed to the “liberation” of the cupula or the canal have been proposed, and most cases of BPPV can be treated using Semont’s liberatory manoeuvre in the case of cupulolithiasis or Epley’s canalith-repositioning procedure (CRP) and Lempert’s “barbecue manoeuvre” in the case of canalolithiasis. These manoeuvres are sometimes unsuitable for patients with cervical or back disorders, especially for older patients. In this kind of patients, it is thus better to use more conservative procedures like the supine to prolonged lateral position (SPLP) or the rolling over manoeuvre (ROM). The treatment proposed in this chapter combines different steps: (1) high-velocity low-range epigastric supported manipulation of the middle thoracic joint (Th7–8 segment), (2) high-velocity low-range sternum supported manipulation of the cervicothoracic (C7–Th1–2 segment), (3) treatment of the cervical soft tissues and (4) proper liberatory manoeuvre.

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Authors and Affiliations

  1. “Don Carlo Gnocchi” Foundation, Milano, Italy

    Dario Carlo Alpini

  2. UOC Audiologia Dip. Scienze Cliniche e Comunità, Università degli Studi di Milano, Milano, Italy

    Antonio Cesarani

  3. Istituto Auxologico Italiano, Milano, Italy

    Guido Brugnoni

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  1. Dario Carlo Alpini
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  2. Antonio Cesarani
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  3. Guido Brugnoni
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Alpini, D.C., Cesarani, A., Brugnoni, G. (2014). Benign Paroxysmal Positional Vertigo. In: Vertigo Rehabilitation Protocols. Springer, Cham. https://doi.org/10.1007/978-3-319-05482-7_8

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  • DOI: https://doi.org/10.1007/978-3-319-05482-7_8

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