Effectiveness of Customized Vestibular Rehabilitation (CVR) on balance in adults with Benign Paroxysmal Positional Vertigo

Arm 1: one intervention group who will receive both customized vestibular rehabilitation (CVR) +canalith repositioning maneuver (CRM) . Once per week for one hour , One treatment per week over 6 weeks. (30 min CVR followed by 30 min CRM) .A trained physiotherapist will administer the sessions. Arm 2: one control group who will receive only canalith repositioning maneuver (CRM). Once per week for half an hour One treatment per week over two weeks .A trained physiotherapist will administer the sessions. canalith repositioning maneuver (CRM).Treatment: The therapist moves the patient through a series of head position change. I. Place subject into positive dix-hallpike position. Supporting subject’s neck, head rotation 45 degree and quickly assist subject into supine and head hanging position with head extension 20 degree. II. Without lifting the subject’s head, turn the subject’s head to the opposite dix-hallpike position. III Supporting subject’s head , asked subjects to turn body until subject is lying on side and nose is pointing to the floor. IV. Maintaining head position from procedure iii, assist subject to a seated position. V. Centered subject’s head and asked subject to tilt head down 20 degree. Customized vestibular rehabilitation (CVR) TREATMENT: CVR involves performing the vestibular exercises. Adaptation exercises includes vestibular ocular reflex X1(VOR X1) and vestibular ocular reflex X2 (VOR X2) viewing exercises as described by Herdman (1998) and Shumway cook, & Horak (1990) Substitution are to Synthesize the use of all sensory input from visual, vestibular and somatosensory system .Subject were taught to substitute vision and somatosensory for the deficit of the vestibular system. Balance exercises: Using alternative strategies and sensory information to compensate for the defective vestibular input (Shumway-cook 1997; Horak 1986). Balance exercises were designed to integrade variety of sensory environment such as vision, vestibular and somatosensory input to improve co-ordination of muscles responses and postural balance.. Such exercises includes for example, changing from sitting to standing, turning around or reaching for an object. Gait exercises: The exercise were designed to improve functional activiites or dynamic balance related to vestibular function.eg. The subjects begin walking and suddenly stopped at physiotherapist command. The progression to increase task difficulty were to increase walking speed or alter walking speed at physiotherapist command before stopping. To ensure adherence to the intervention, a call rem. inder for attendance will be made once a week before the next appointment.