Masato Kobayashi
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Kasey, I agree with you. At first I thought the patient would be appropriate for a KAFO but if we were to get really granular, KAFOs are recommended for individuals with less than (not less than or equal to) 3+/5. Since the patient has 3+/5 strength in the quads, an AFO would be warranted.
Hi Cally. I wanted to chime in on this topic so we can problem-solve it together since this is a topic I’m refining as well. I would say clinically, even if a patient demonstrates knee extension in stance there is still a chance for them to buckle anteriorly particularly due to PF weakness – eccentric control from the gastroc-soleus complex is needed in stance. So if a patient demonstrates the criteria of PF weakness (4 or less) and/or excessive DF/PF in stance, this could warrant a DF stop to prevent buckling through stance.
Wondering if this makes sense to you or others reading? Happy to hear from others!
Hi Kristin! This references back to the mnemonic COWS (Cold-Opposite, Warm-Same). Cold and warm water will induce different patterns of nystagmus due to the inhibition and excitation of the vestibular system, respectively. “Decreased left-beating nystagmus when the right ear is irrigated with warm water” is incorrect because introduction of warm water would induce right-beating nystagmus not left-beating nystagmus. And in the case of this patient with a right hypofunction, a reduced right-beating nystagmus compared to a normal reference point would be observed. Hopefully that clarified your question – happy to expand!
I second Karen’s post about Permobil’s PDF on WC seating and positioning. Medbridge also has a series on WC prescription.
Vestibular nerd here, so I want to give this a shot. Chrissy and the rest of the NCS Advantage community – correct me if I am wrong!
Cally, totally understandable to be confused about which CRMs are appropriate for each type of BPPV. There are so many variations/types of CRMs!
For horizontal canalithiasis, both the BBQ roll and the Gufoni maneuver can be used.
For horizontal cupulolithiasis, the Kim maneuver can definitely be used but be aware that there is a version of Gufoni maneuver that can also be used to treat this type of BPPV (this is where some confusion can arise).
Really important to be able to identify the involved side with horizontal canalithiasis so you know which CRM to ultimately use – another area that can stump clinicians.
I would recommend being familiar with the BPPV CPG – Bhattacharyya, N., Gubbels, S. P., Schwartz, S. R., Edlow, J. A., El-Kashlan, H., Fife, T., Holmberg, J. M., Mahoney, K., Hollingsworth, D. B., Roberts, R., Seidman, M. D., Steiner, R. W., Do, B. T., Voelker, C. C., Waguespack, R. W., & Corrigan, M. D. (2017). Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update). Otolaryngology–head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 156(3_suppl), S1–S47. https://doi.org/10.1177/0194599816689667.
Just be aware – the more you deep dive into vestibular literature, the more you may get confused with all the variations of CRMs! I would start with this CPG and know the foundational/highly researched maneuvers. Hope this helps! Happy to expand if needed.
