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• Prerequisites and learning objectives
• Lesson
  • Content
    • 1 - How to prescribe speech therapy
      • 1.1 - Introduction
      • 1.2 - Indication of the speech and language assessment
      • 1.3 - Speech therapy for hearing loss
      • 1.4 - Impairment in written language
      • 1.5 - In the case of children with multiple disabilities
      • 1.6 - Speech therapy in pharyngolaryngeal disorders, including dysphonia
      • 1.7 - Speech therapy in dysphagia
      • 1.8 - Speech therapy and velo-palato-pharyngeal and buccal conditions
      • 1.9 - Speech therapy and neurological disorders
    • 2 - How to prescribe physiotherapy
      • 2.1 - Introduction
      • 2.2 - Maxillofacial physiotherapy and re-education
      • 2.3 - Physiotherapy and facial paralysis
      • 2.4 - Physiotherapy and vestibular re-education
        • 2 . 4 . 1 - Benign paroxysmal positional vertigo
        • 2 . 4 . 2 - Other vertigo-inducing situations
      • 2.5 - Physiotherapy and cervical carcinological surgery
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2 . 4  -  Physiotherapy and vestibular re-education

Balance is a complex function. It uses three sensory afferents (vestibular, visual, and proprioceptive). Their symmetry depends on unconscious and normal functioning of balance. Damage to the vestibular apparatus causes a balance disorder, which entails, among other things, dizzy spells.

Vestibular re-education has two objectives depending on the origin of the disorder :

• In the case of benign paroxysmal positional vertigo, to restore normal vestibular function;
• In other cases, to develop visual and proprioceptive substitution as well as decrease subjective consequences of dizzy spells.

2 . 4 . 1  -  Benign paroxysmal positional vertigo

Treatment for benign paroxysmal positional vertigo (the most frequently encountered cause of vertigo) is not, strictly speaking, a re-education technique but a therapeutic technique. It uses a liberating maneuver to move otoliths that have often migrated to the posterior semicircular canal.

In certain positions, such as the lateral position or during flexion and extension of the head, the patient feels intense and brief episodes of dizziness.

The maneuver that can be carried out by a physiotherapist, following medical advice, is to induce the dizzy spell on the patient in a lying position and then quickly turning the patient to the other side in order to move the otoliths and make them 'leave' the posterior semicircular canal (Semont maneuver).

2 . 4 . 2  -  Other vertigo-inducing situations

The intended objectives are :

• decrease the intensity, duration, and frequency of the dizzy spells;
• improve standing/walking balance;
• decrease the associated symptoms (nausea).

Re-education is indicated in the following situations :

• unilateral vestibular impairment such as vestibular neuritis, section of the vestibular nerve (e.g., after acoustic neuroma);
• bilateral vestibular impairment;
• balance disorder in the elderly characterized by a lack of use of the vestibular information often associated with a decrease in other sensory information (vision, proprioception, motion sickness, or travel sickness).

The techniques used include :

• stimulation using a rotating chair that acts on the reflexivity of the two vestibules;
• optokinetic reflex stimulation (projection of moving dots of light with a standing patient). This technique decreases a possible visual dependence and favors the use of somatosensory information;
• proprioceptive platform. The patient stands on a mobile platform. The objective is to develop proprioception by favoring the use of somatosensory information.

These techniques are combined with psychological treatment and care so as to lessen the impact of the situation.

2 . 5  -  Physiotherapy and cervical carcinological surgery

A lymph node dissection combined with radiation therapy is likely to lead to trophic disorders and lesions in the area of the accessory nerve (11^th cranial pair). This trauma leads to shoulder pain and difficulty in arm abduction. Upon examination, a shoulder shrug is impossible, and there is abnormal detachment of the scapula.

Treatment combines the use of a pain-relieving shoulder splint as well as compensation techniques that use other muscles. The result is often only partial recovery.