vestibular rehabilitation 3

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Page 1: Vestibular rehabilitation 3

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• Management of balance disorder cases is challenging and controversial

• A lot of conflicts and unresolved issues raised by A lot of conflicts and unresolved issues raised by clinicians and researchers on the clinicians and researchers on the diagnosis and and treatment of vestibular disorderstreatment of vestibular disorders

• If untreated, the quality of life balance disordered patients can be greatly impaired.

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Selection of appropriate treatment of Central and Peripheral Vestibular Disordered is undoubtedly important to assist them to reach the desired recovery.

Physical exercises have been shown to help

patients with balance disorders especially peripheral vestibular disorders cases

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WHAT IS VESTIBULAR

REHABILITATION?

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Benefits of balance Benefits of balance exerciseexercise

• Reduce the symptoms: dizziness, nausea and

vomiting.

• Increasing postural controlling system.

• Could help patient to accept all weakness or

disease that they faced (familiarized and

adaptation).

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Cont..Cont..

• Prevent from any accident or fall

• Avoid to get psychology signs; palpitation, panic

and others, like those to be faced by chronic

vestibular patient.

• Enhance personal confidence level and increase

quality of life (QOL).

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Indications for therapy Indications for therapy

1. General interventions for vestibular loss - Unilateral loss-vestibular neuritis

or acoustic neuroma (Topuz et al. 2004; Hall et al, 2004; Enticott et al, 2005). - Bilateral loss-gentamicin toxicity and related conditions.

2. Fluctuating vestibular problems. To prepare for anticipated dizziness

rather permanent change in their present vestibular situation. - Meniere's syndrome - Perilymphatic fistula

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CONT..CONT..3. Empirical treatment when the diagnosis is

unclear.

- Post-traumatic vertigo - Multifactorial disequilibrium of the

elderly

4. Psychogenic vertigo for desensitizationPsychological counseling (CBT), with vestibular rehabilitation may be helpful in patients who have no significant emotional disorder that aggravates their vestibular problems (Andersson,

2006; Holmberg, 2006).

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• Vestibular rehabilitation reduces severity of agoraphobia in persons with agoraphobia and vestibular dysfunction (Jacob et al, 2001).

5. Acoustic neuroma

5. A stroke, head injury or concussion

5. A history of inner ear problems

5. Diabetes

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- Mal de Debarquement or "MDD“ or MdDS- Vertigo and imbalance that occurs after getting off of a boat.

http://www.dizziness-and-balance.com/disorders/central/mdd.html

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VIDEO

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Types of balance Types of balance exercises?exercises?

Cawthorne cookseey exercise (CCE) (Adapted from Dix and Hood, 1984 and Herdman, 1994; 2000)

Customised CCE

Bal Ex : Homebased video module for balance exercises = customised CCE +Prayer movement

Wii games

Optokinetic stimulation

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Cawthorne Cooksey ExercisesCawthorne Cooksey Exercises

(Adapted from Dix and Hood, 1984 and Herdman, 1994; (Adapted from Dix and Hood, 1984 and Herdman, 1994;

2000)2000)

• In bed or sitting o Eye movements -- at first slow, then quick

• up and down• from side to side• focusing on finger moving from 3 feet to 1 foot away from face

o Head movements at first slow, then quick, later with eyes closed • bending forward and backward• turning from side to side

• Sitting o Eye movements and head movements as aboveo Shoulder shrugging and circlingo Bending forward and picking up objects from the ground

• Standing o Eye, head and shoulder movements as beforeo Changing form sitting to standing position with eyes open and shuto Throwing a small ball from hand to hand (above eye level)o Throwing a ball from hand to hand under kneeo Changing from sitting to standing and turning around in between

• Moving about (in class) o Circle around center person who will throw a large ball and to whom it will be

returnedo Walk across room with eyes open and then closedo Walk up and down slope with eyes open and then closedo Walk up and down steps with eyes open and then closedo Any game involving stooping and stretching and aiming such as bowling and

basketball

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Customized Cawthorne-Cooksey Customized Cawthorne-Cooksey

Exercise (CCE)Exercise (CCE)

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DISCO DISCO BALLBALL

• A mirrored "disco ball" to provide optokinetic stimulation for patients with vestibular disorders.

• All of these techniques "involve some degree of innovative technology to assess treatment effectiveness, measurement of vestibular function, or reveal behavior in people with vestibular dysfunction," Drs. Schubert and Ryan write.

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Wii gamesWii games• Alternative and recent innovative of vestibular

rehabilitation• Nintendo Wii

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Home-based Video Module for Balance

Exercises

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Arabic

Malay

English

Nigeria

Hokkien

Indonesian

Mandarin Persian Tamil

Japan

France

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Experiences with Experiences with National National Hospital for Neurology and Hospital for Neurology and

Neurosurgery, Central Neurosurgery, Central LondonLondon20062006

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Home-based and video guide Nine different languages (Malay, English, Mandarin, Tamil, Hokkien, Nigeria, Parsian and Arabic) to help patients with various balance disordersConsists of 20 movements (divided into 3 levels) targeting specific functions of balance organsAdaptation from Customized Cawthorned Cookseey Exercise and prayer movement

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- Head & neck- Eye focusing- Heaviness of the

neck

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- Positioning- Daily activities

i.e prayer, up and down

• Return to normal daily activities

LEVEL 1 LEVEL 2

LEVEL 3

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- Postural- Increase the postural control- Return to normal walk, running and use a stair

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TECHNIQUES HOW TO USE BAL EX

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• Under family supervision• Start the exercise according to doctor or

physiotherapist advice or start the Bal Ex exercises from the level 1 till level 3

• Advicely do the exercise 3-4 times per day (morning, afternoon and evenng)

• Repeat the movement 20 times for every movement

• Start the Bal Ex exercises slowly and structuredly according to your capabilities

• Early session patients normally will experience balance disorders symptoms i.e nausea, vomiting, vertigo, unsteadiness and others uncomfort symptoms

• Same exercise ne to be done if the symptom persistancely there till the symptoms resolved

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• Once that exercise success (no symptoms of vertigo, nauea and vomiting), patients can proceed with the second step 1b and so on till the end.

• In the begining please aviod from doing the full step ( 1-20) at the same session.

• Once all the 1-20 movement succussfully done, you can practice the whole 20 movement at the same time.

• This Bal Ex modul can be completed after 2 weeks till 5 months.

• Please don’t do the exercise orsession if you have the symptom of :

- Chest pain - Shortness of breath

- Felling fainting - Severe neck or back injury

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Contraindication for this therapyContraindication for this therapy

• Low blood pressure • Medication reactions (other than ototoxicity) • Migraine associated vertigo (although it has been

reported to be helpful nonetheless, e.g. Whitney et al, 2000)

• Transient ischemic attack -- TIA • Benign Paroxysmal positional vertigo (BPPV)

(chronic cases only)

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Knowledge sharing Malaysia-Pakistan 27

A STUDY OF THE NEUROCOGNITIVE STATUS IN PATIENTSA STUDY OF THE NEUROCOGNITIVE STATUS IN PATIENTS WITH PERIPHERAL VESTIBULAR DISORDERS (PVD) USING WITH PERIPHERAL VESTIBULAR DISORDERS (PVD) USING

SELECTED NEUROLOGICAL TESTSSELECTED NEUROLOGICAL TESTS(BAL EX MODULE & Customized Cawthorne Cookseey (BAL EX MODULE & Customized Cawthorne Cookseey

Exercise)Exercise)

2 year project 2009-2011 (RESEARCH UNIVERSITY GRANT 2 year project 2009-2011 (RESEARCH UNIVERSITY GRANT 99,00099,000

In general, MVVSS and MMSE did not change after the exercise .P300 and late latency response (P1 and N1) did show some improvement after using Bal Ex. It is common that the physiological changes happen first before the patients can actually notice the improvements (as reflected by MVVSS & MMSE).

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VESTIBULAR COMPENSATION

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Patient 1Video before txVideo after txVideo after tx

Patient 2Video before txVideo after tx

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Process occurred during Process occurred during

therapytherapy

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1. Plasticity

2. Formation of internal models

3. Learning of limits

4. Sensory weighting

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Factors that Factors that lead to poor lead to poor compensatiocompensatio

n ?n ?

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-drugs with action upon the central nervous system (importantly including vestibular suppressant drugs), and co-morbid systemic disorders.

PLEASE BE TOO SELECTIVE AND CONFIRM BEFORE YOU THINK TO START ANY MEDICATIONSOMETHING IT NOT HELP.

Luxon LM, Davies RA, eds. Handbook of vestibular medicine. London: Whur Publishers,1997.

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http://bal-exercise.blogspot.com/http://balexstroke2011.blogspot.com/

VIDEO

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Presented by BALEX Researchers

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BALEX Research GroupBALEX Research Group

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Current and future innovationsCurrent and future innovations1. Bal Ex : Home-based Video Module for Balance Exercises2. Bal Ex Stroke: Home-based training Module for Stroke rehabilitation3. Bal Ex Zuraida-shah rotatory chair 4. STAND UP5. Wheelsaver6. Bal Ex Foot7. Bal Ex AUTOFIS

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GOLD MEDAL MALAYSIA TECHNOLOGY EXPO 2012

Bal Ex Homebased Training Bal Ex Homebased Training

Module for Stroke Module for Stroke

RehabilitationRehabilitation

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Home-based Video Module for Balance Exercises

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BAL EX VIRTUAL ROOMBAL EX VIRTUAL ROOM

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Bal Ex Stroke : Home based training Module for Stroke RehabilitationBal Ex Stroke : Home based training Module for Stroke Rehabilitation

MALAYSIA TECHNOLOGY

AWARD 2012(GOLD

MEDAL AWARD)

The ONLY home-based and video guided stroke rehabilitation available in 15 different languages(Malay, English, Mandarin, Tamil, Indonesian, Japanese, Thailand, Korean, Cambodia, Arabic, Persian, France, Russia, Sindhi and Urdu) to help patients with stroke problem

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Bal Ex Stroke – GES 2013 (KLCC)Bal Ex Stroke – GES 2013 (KLCC)

Global Entrepreneurship Summit 2013, Kuala Lumpur Convention Centre, Malaysia.

Visited by: Malaysia Prime Minister

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ZURAIDA-SHAH ROTATORY CHAIR- ITEX 2013 (KLCC)

ZURAIDA-SHAH ROTATORY CHAIR- ITEX 2013 (KLCC)

GOLD MEDAL AWARD - 24TH International Invention, Innovation & Technology Exhibition 2013 Kuala Lumpur Convention Centre, Malaysia.

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STAND UP- Manual Footplate for Balance RehabilitationSTAND UP- Manual Footplate for Balance Rehabilitation

• The ONLY manual footplate balance with structure manual book, protocol and video guided to help patients with various balance disorders

• Was developed by doctors, scientists specializing in the vestibular engineering field

• Consists of 11 movements (divided into 7 steps) targeting specific functions of balance organs (Prayer Movements)

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SPECIAL AWARD BY - Association of Polish Inventors Rationalizes Poland

STAND UP- ACHIEVEMENT

STAND UP- ACHIEVEMENT

PECIPTA 2013PECIPTA 2013

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PECIPTA 2013 – GOLD WINNER AWARD PECIPTA 2013 – GOLD WINNER AWARD

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INNOVATION & INVENTION COMPETITION

On 25 & 26 August, 2013 Perpustakaan Negeri Kelantan. Organized by PETRONAS

Awards:     1) Open Category Special Jury Award     2) Invention Award

STAND UPSTAND UP

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 I-INOVA 2013 - Bronze Awards

STAND UPSTAND UP

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WHEELSAVER- AUTOMATED CONTROLLER FOR WHEELCHAIR

WHEELSAVER- AUTOMATED CONTROLLER FOR WHEELCHAIR

WHAT IS WHEELSAVER?

Wheelsaver is an automatic control device that can be used in any existing wheelchair or a new wheelchair. With low cost, patients are able to own an electric wheelchair or automated to facilitate their movement. As we note an electric wheelchair very high price and some fetch more than RM 10,000.

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ACHIEVEMENT-BIO MALAYSIA 2013

ACHIEVEMENT-BIO MALAYSIA 2013

GOLD WINNER AWARD Bio Malaysia, PERSADA, Johor Bahru, Johor.

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Bal Ex FootBal Ex Foot

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A modified shoes for this stroke patient to improve their gait and avoid further

complication

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ACHIEVEMENT-ACHIEVEMENT-

1. Zuraida Z, Mohd Normani Z, Dinsuhaimi S, Mohd Darimi Y, Zamri H. Silver Medal for BAL-EX; Home based video module for balance exercises in MALAYSIAN TECHNOLOGY EXPO 2010, 26 February 2010 PWTC, KL (INTERNATIONAL)

2. U BALANCE ANUGERAH SANGGAR SANJUNG BAGI KATEGORI KUALITI for BAL-EX; Home based video module for balance exercises 17 March 2010 USM Pulau Pinang

3. Zuraida Z, Mohd Normani Z, Dinsuhaimi S, Mohd Darimi Y, Zamri H. ANUGERAH SANGGAR SANJUNG BAGI KATEGORI PENGKOMERSIALAN for BAL-EX; Home based video module for balance exercises 17 March 2010 USM Pulau Pinang

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4. Winner ( 1st place) for management categories BAL-EX; Home based video module for balance exercises HEALTH CAMPUS ICC CENVENTION 2010

5. Gold Medal award for BAL-EX; Home based video module for balance exercises Konvensyen ICC Wilayah Pantai Timur 2010 di Hotel Renaissance Kota Bharu pada 26 - 27 Julai 2010

6. 2 star for BAL-EX; Home based video module for balance exercises MPC ICC National

Convention 7-9 October 2010 in Genting Highland

7. Silver Medal & 3rd place for the Management category BAL-EX; Home based video module for Balance exercises Bal 7th IPTA ICC Convention hosted by Universiti Putra Malaysia

8. SILVER MEDAL Intelligent balancing system for patients with balance disorder for clinically used EKSPO REKACIPTA DAN PAMERAN PENYELIDIKAN UNIMAP11 JANUARI 2012

 

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9. Gold Medal award for Zuraida z et al. BAL-EX STROKE; Home based training module for stroke rehabilitation Home based video module for balance exercises in MALAYSIAN TECHNOLOGY EXPO 2012, February 2012 PWTC, KL (INTERNATIONAL)

10.Winner ( 1st place) for management categories BAL-EX STROKE; Home based training module for stroke rehabilitation HELATH CAMPUS ICC CENVENTION 2012 Gold Medal award for BAL-EX STROKE; Home based training module for stroke rehabilitation 2012 Gambang Resort City Pahang pada 4 - 5 Julai 2012

11.Gold Medal award with three star for BAL-EX STROKE; Home based training module for stroke rehabilitation KIK National Level KLCC Kuala Lumpur October 2012

12.Top 10 Finalished for ANUGERAH INOVASI NEGARA (Service category) KLCC, Kuala Lumpur 5-7 November 2012

 

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13. ITEX Gold Medal For BAL-EX ZURAIDA-SHAH ROTATORY CHAIR

24th International Invention & technology exhibition ITEX 2013, Kuala Lumpur Malaysia,

9th – 11th May 2013.

14. Jury Awards And Gold Winner For STAND UP- MANUAL FOOTPLATE FOR BALANCE REHABILITATION in Pustaka Negeri Kelantan Innovation and design competition 2013 Organize By Petronas

 15. Gold Winner for AUTOMATED CONTROLLER FOR

WHEELCHAIR, Biomalaysia, Bioeconomy Asia Pacific | 21 – 23 October 2013, Persada Johor International Convention Centre.

16. Bronze Medal Award, For STAND UP- MANUAL FOOTPLATE FOR BALANCE REHABILITATION in I-Innova’13 Ekspo Inovasi Islam 1434 H, Stadium Tertutup Nilai Negeri Sembilan.

 

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17. Gold Winner For STAND UP- MANUAL FOOTPLATE FOR BALANCE REHABILITATION in Pecipta’13 Transforming Research & Innovation Towards Commercialisation, 7- 9 Nov 2013 | Kuala Lumpur Convention Centre Malaysia. 18. Special Awards By Association of Polish Inventors Rationalizes Poland. For STAND UP- MANUAL FOOTPLATE FOR BALANCE REHABILITATION in Pecipta’13 Transforming Research & Innovation Towards Commercialisation, 7- 9 Nov 2013 | Kuala Lumpur Convention Centre Malaysia

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THANK YOUTHANK YOU