Epley and Semont maneuver: Brandt-Daroff exercises in the treatment of vertigo

Symptoms

BPPV develops more often in women. The most likely cause of the disease is the deposition of calcium salts (otoliths) in the inner ear canal. Head movements (tilts, turns, tilts) provoke short-term attacks of dizziness. Between episodes, the patient may experience nausea, fluctuations in blood pressure, loss of balance, and impaired thermoregulation. Regular intense attacks can cause such great inconvenience that the question of what to do with dizziness is in the first place for the patient. With timely treatment, BPPV does not cause lasting harm to health; the benign nature of the disease implies a decrease in the severity of the episodes.

Surgical intervention

In some cases, the use of maneuvers does not lead to recovery. Then the doctor may consider it necessary to use surgery. But, as a rule, it is used only as a last resort, as a “last resort”.

During the operation, to achieve the desired effect, nerve fibers can be cut, the semicircular canal can be sealed, or the vestibular apparatus can be removed completely.

If you notice symptoms of BPPV, you should immediately consult a doctor, namely a neurologist. Most often, the prognosis is favorable; in most cases, cure is achieved using the techniques described above. Sometimes self-healing is observed, apparently when the otoliths independently return “to their place.”

Dizziness - causes, symptoms, diagnosis, therapeutic methods

The illusion of rotation that occurs in a person with dizziness is accompanied by eye movement (nystagmus). During diagnosis, the doctor uses certain methods to induce an attack in order to determine the direction of the nystagmus. This can be done using a device (a more accurate and reliable method) or visually when a feeling of rotation occurs.

There are 2 main therapeutic methods used for dizziness:

Exercises. A special system of exercises is used to adapt the vestibular system to an unhealthy state. But this method is long-term (months of treatment), and also does not address the problems that cause dizziness.
Maneuvers. For dizziness, positional therapeutic movements (maneuvers) are used. They (in particular, Epley's maneuvers) involve the doctor changing the position of the patient's head. With the help of maneuvers, it is possible to move the otoliths from the semicircular canals to the healthy part of the system, eliminating irritation. There is no pain during the maneuver and it usually lasts up to 30 minutes. It is often possible to get rid of dizziness after the 1st session of the maneuver; sometimes it is necessary to repeat the procedure.

Diagnostics

In addition to a good medical history (occurrence of dizziness with typical movements) and a standardized neurological examination, the presence of characteristic nystagmus on the Dix–Hallpick test is a key factor in the diagnosis of BPPV.

Physical examination

The survey includes the following measures:

internal (blood pressure measurement, heart rhythm disturbances, heart defects, anemia, orthostatic dysregulation: Schelling test);
neurological (examination of cerebellar symptoms, sensory polyneuropathy with loss of position perception, damage to the trigeminal or facial nerve):
gait study - falling on one side (on the affected side - vestibular causes, on the healthy side - cerebellar causes);
Romberg test - positive (in the case of proprioceptive and sensory ataxia), negative (in the case of cerebral vertigo);
Unterberger test – positive (for cerebral and vestibular damage);
nystagmus (with the vestibular type - nystagmus in one direction, never vertical; with the central type - complex, changing direction);
ear examination with an otoscope (herpes zoster, otitis media, perforation);
hearing test (one-sided deafness is usually of vestibular etiology).

Instrumental studies

This method includes the following approaches:

ECG – if there is a suspicion of heart rhythm disturbances;
laboratory examination - blood test, glycemia, creatinine, liver tests, basal TSH (with a targeted examination, all studies are not necessary);
if necessary, examination by an ENT specialist, neurologist, ophthalmologist, orthopedist.

What exercises can you do at home?

You need to start classes with a warm-up - perform 5-7 bends and turns of the head.

A set of exercises for BPPV at home:

In a sitting position, fix your gaze on an object at a distance of 1 m, relax your lower jaw and tongue. Turn your head from side to side, up and down, without taking your eyes off the object
While sitting, fully extend your arm with a pencil. Slowly bring the pencil closer to the tip of your nose, constantly watching the object with your eyes. Return to starting position. Fix your gaze on the pencil, turn your head to the side, move your hand with the object in the opposite direction. But continue to follow the object with your eyes.
Arrange the book so that it is convenient to read. Turn your head from side to side, up and down, while reading the text out loud.
Place 2 objects with an interval of 1 m at a distance of 1.5 m from the eyes. Look straight ahead. Then look at the left target with one eye, fix your gaze, and turn your head to the left. Without changing position, look at the right object, after fixing your gaze, turn your head to the right.
Sit on a chair. Place the ball on the side of the chair with your right hand and straighten up. Bend over, pick up the ball, return to the starting position.
Toss the ball from hand to hand at eye level.
Bend over, transfer the ball from hand to hand behind your knees.
In a standing position, legs together, arms extended in front of you, turn your head to the sides. Then open and close your eyes on the count of 3.
Stand on one leg for 10 seconds. Gradually increase the duration to 30 seconds.
In a standing position, put one leg forward, arms crossed, palms resting on your shoulders. Change the position of your legs, fixing the position for 10 seconds.
Feet shoulder-width apart, arms along the body. Tilt your torso slightly forward, tilt it back, move it from side to side. Repeat with eyes closed.
Walk at your usual pace, turning your head to the right and left.
Walk along the line facing forward, then backwards for 1 minute.

Symptoms

Indications for use

The Epley maneuver is prescribed by a doctor only after examination, examination and an accurate diagnosis. It is also worth remembering that these exercises can only be recommended for stable, non-progressive illness.

Among these pathologies:

period after a stroke;
benign positional paroxysmal vertigo;
violation of movement coordination;
osteochondrosis;
recovery period after injury to the spine or brain;
ear diseases;
infectious pathologies.

Gymnastics does not affect muscle function in any way

Its main goal is to teach a person to control attention, so regular use does not cause any unwanted manifestations

Vestibular exercises for dizziness

The best workout is the swing. Vestibular gymnastics for dizziness must necessarily include swing riding. In this case, you need to start gradually, with rocking with a small amplitude. Each time it is necessary to increase the training time and the amplitude of the swings. Each person benefits from riding about 15 minutes a day.

Another possible way to simply train the vestibular system is to walk along a curb. We've all done this as children, trying to maintain balance for as long as possible. In adulthood, this exercise will help rid the body of seasickness. It is worth saying that vestibular gymnastics should be regular and progressive. After you have reached the limit, you need to rest for a week or two so that your body gets used to training, and then start exercising again.

The third simple exercise of vestibular gymnastics for dizziness is turning around yourself. It is necessary to turn around its axis in both directions about 10 times. After this you need to walk along a straight line. With each workout, you should increase the number of turns and the length of the straight line. Training the vestibular apparatus will quickly affect the general condition of the body, and dizziness will go away.

Vestibular gymnastics goes well with yoga. In order to get rid of nausea, it is enough to learn to breathe correctly

You need to study with trusted masters and in good centers, so that attention is paid not only to exercises, but also to breathing techniques and adjusting your way of thinking

In yoga there is one very good vestibular gymnastics breathing exercise that will quickly bring you back to normal. This technique does not require any special skills other than concentration. The exercise is performed with a completely straight back. It is necessary to exhale deeply with great effort, as if expelling the air from yourself. As you inhale, you should lower the diaphragm, inflate your stomach and fill the lower sections of your lungs with air to the limit. After this, you need to forcefully expand the chest, letting air into the middle sections of the lungs. Finally, due to the movement of the neck, the upper sections of the lungs are filled. Exhalation should be smooth, occurring in the same order: first the stomach, then the chest and neck. Remember to inhale through your nose and exhale through your mouth.

Vestibular gymnastics for the elderly has its own characteristics. They should avoid riding on swings, walking on curbs, and breathing too deeply. In various diseases, this can cause unpleasant or painful sensations in the body. Vestibular gymnastics after a stroke can be carried out only after examination by a doctor and his permission to practice. Therapeutic and preventive gymnastics under the supervision of an experienced specialist is the best solution for older people.

Vestibular gymnastics at home should be structured as follows:

The first week you need to practice turning your head in different directions, in circular movements. Do not be afraid of nausea, because this is quite normal. The main thing is to continue studying. The second week should be devoted to bending your torso back and forth and left to right.

At the same time, it is important to monitor your breathing and remember that you exhale when bending over. After 20 days, the training is supplemented with light boxing

You need to clench your fists and bend your elbows and box with an invisible opponent. Remember that your torso should also turn after your hand. The hand throw should be done with force. After this you should add walking. Step forward and then, without looking back. 10-15 repetitions will be enough.

At the same time, it is worth knowing that people who move little often get motion sickness.

This is why it is so important to play sports and run more. Great for active ball games

Disease prevention

Since the exact causes of this disease have not been established, prevention can only consist of general measures. You should devote more time to physical activity, monitor the condition of your vestibular apparatus, and do exercises to strengthen it. It is recommended to give up bad habits and spend more time outdoors.

Older people are not recommended to get out of bed abruptly, since after 50 years the risk of otolith rejection increases significantly. You should start the day with a slight shake of your head and a slow rise, which will allow the vestibular system to “wake up” faster and keep your body in balance.

Vestibular gymnastics exercises

In such diseases, where there is tinnitus and various hearing impairments, gymnastics for the vestibular apparatus should be a mandatory attribute of treatment. If you experience dizziness, again, it would be a good idea to consult a specialist to identify the true cause of this phenomenon.

In any case, before performing the next set of exercises, you should consult with a specialist, and if severe pain occurs during the exercise, then the exercise should be stopped. Almost all exercises are performed 5-7 times and before performing them, do a little exercise in the form of arm swings, rotation of the shoulder girdle and squats.

The starting position of the body is to stand straight, with your heels and toes together. The back is straight, the arms are lowered, and the stomach is slightly retracted. In this position, you need to raise your arms straight and close them above your head. This pose is held for five to seven seconds, after which you can return to the starting position and repeat.
Standing straight on your feet, you need to alternately raise your left and right legs, holding for five seconds. Then, after successfully completing these actions, the exercise is complicated as follows: the raised leg is pressed against the other leg so that the heel is closer to the groin area and the toe is pointing down. In other words, the leg bent at the knee needs to be pressed against the other leg, while clasping it with both hands. Make sure that the bent leg is in the same plane with the other leg. Balance must also be maintained in this way for five to seven seconds.
The essence of the exercise is to turn your head to the side and fixate at the extreme point for five seconds. At the same time, be careful and do not allow pain to arise in the neck.
The head is tilted and raised: the top of the head is pulled up, after a delay at the extreme point for several seconds and returned to the starting position. Head tilts are performed in the same way.
Tilt your head to the side - try to press your ear to your shoulder, without moving your shoulders. Fixation at the extreme point is also necessary here.
Grab yourself by the shoulders and lean forward, trying to stretch the ligaments and muscles of the spine as much as possible.

Physician Epley Method

This exercise was developed by doctor Epley, after whom this exercise is named. It is also prescribed as vestibular exercises for BPPV (benign positional paroxysmal vertigo). Starting position: lying on the bed, arms along the body. The head must be turned 90 degrees in any direction and held in this position for 30 seconds. After waiting the allotted time, turn your head in the other direction and hold again for 30 seconds. Then, without changing the position of your head, turn to your side, while looking down. Again we delay for half a minute.

How to understand that a person has BPPV

People aged 50 years or older are more likely to experience this type of dizziness. Moreover, this disease occurs 2-3 times less often in males than in females.

The list of diseases that are accompanied by dizziness is huge. But there are basic clinical features characteristic of this disease, according to which the doctor can make the correct diagnosis even during the initial examination.

Let's look at the symptoms of this difficult disease:

when a person changes body position, he may feel a sudden onset of dizziness. Moreover, most often it appears precisely when turning the head. Very often, an attack occurs when people suddenly sit up in bed after sleep. Benign positional vertigo can also be triggered by head movements made during sleep. The symptom cannot occur in a state of complete relaxation and rest;
sudden unexpected attacks can be caused by performing simple and seemingly safe exercises, such as raising and lowering the head and squats;
As a rule, the attack lasts about one minute. Although there are cases in which dizziness lasts much longer, up to several hours;
often dizziness can be felt as a movement of the body in weightlessness, as a feeling of rising and falling, similar to the state while riding on a swing;
nystagmus is unregulated eye movements. It is a symptom often present in BPPV. Nystagmus disappears immediately after the dizziness stops;
often paroxysmal positional vertigo is accompanied by a feeling of heat, pallor, sweating, nausea and vomiting, changes in heart rate (in particular, its slowdown); as a rule, with benign positional paroxysmal vertigo, other neurological symptoms are not observed, the attacks are similar to one another;
BPPV attacks most often occur in the morning and early afternoon; when benign dizziness occurs, symptoms such as deafness and tinnitus, pain in the head, generally do not appear;
attacks can spontaneously disappear, which leads to a sudden improvement in the patient’s condition, after which he feels like a completely healthy person.

It will not be difficult for a doctor to identify paroxysmal positional vertigo and distinguish it from other types of vertigo.

How is the diagnosis made?

So, in order to timely and correctly diagnose the disease, the doctor collects in great detail information from him about his feelings during attacks of dizziness, the time and frequency of attacks, and the symptoms accompanying this painful condition. If there are no other complaints besides those described above, then, as a rule, the patient is asked to undergo the Dix-Hallpike test, since it is the easiest to identify BPPV.

To begin with, the patient is seated on the couch, asking him to look at the center of the doctor’s forehead. After this, his head begins to turn first to the right, then to the other side. The rotation angle should be about 45 degrees. After the turns are completed, the person lies on his back. At the same time, your head should be thrown back, slightly over the edge of the couch.

It is fixed in this position. The doctor then begins to carefully study the patient's eye movements. 25-35 seconds are enough if nystagmus is not observed, and a little more if it makes itself felt.

After this, the patient is seated again, turning his head to one side, and the same observation is carried out. Then the same actions are performed when turning the head in the other direction. The side on which the nystagmus appeared is the affected side. During this procedure, the doctor uses special glasses to detect nystagmus.

To exclude abnormalities in the functioning of the brain and the presence of tumors, the patient is prescribed MRI and CT. It should be noted that paroxysmal dizziness is accompanied by a complete absence of neurological signs.

Diagnostic methods

The study of equilibrium functions is carried out through a comprehensive examination.

Physical examination

Physical examination methods:

Detailed anamnesis. The nature and type of equilibrium disorder is determined.
Study of spontaneous vestibular phenomena: standing, when walking, deviation of the limbs (the patient should stand straight, walk in a straight line for several steps, etc. - this allows you to control which side he is leaning towards, what feelings of dizziness he has). The examination provides important information about the external manifestations of balance disorders.

Instrumental studies

Instrumental research methods:

If an organic cause is suspected, X-rays, CT, MRI (damage to the brain stem and cerebellum) are performed.
Orientation study of brain nerve function to compare the functions of the right and left equilibrium apparatus.
Stimulation testing of equilibrium functions (electronystagmography) usually requires special devices.
Audiometric examination.

Damage to the lateral semicircular tubule

A lesion of the lateral RCC is detected with the patient lying down by turning the head in the plane of the canal from right to left and vice versa (roll test). Horizontal nystagmus occurs, with a clonic component directed downward, mainly when the affected ear is turned downward; if the healthy ear is located below, nystagmus also occurs, the clonic component of which is directed downward, but less pronounced.

In a quarter of patients, canalolithiasis in the lateral RCC is combined with canaloliasis in the posterior RCC. In contrast to downward-directed nystagmus, the clonic component of evoked nystagmus is directed toward the overlying ear. This form is combined with the location of otoliths in the anterior part of the lateral ACC or the otolith fixed to the cupula, while with freely moving otoliths, nystagmus occurs directed towards the underlying ear.

Test results may be influenced by cervical spinal canal stenosis, radiculopathy of the cervical segments of the spinal cord, severe kyphosis, restrictions of movement in the cervical spine: rheumatoid arthritis, ankylosing spondylitis, Paget's disease, spinal cord injury, morbid obesity, Down syndrome. In this case, it is possible to use a Barany swivel chair.

If the test results are negative, a preliminary diagnosis of BPPV is made based on complaints of positional vertigo and is confirmed by successful performance of vestibular maneuvers.

Visits are conducted by our neurologists:

Shekhovtsov Daniil Georgievich, neurologist, doctor of manual therapy

Certificate: "Neurology"

Education: St. Petersburg State Medical University University named after I.P. Pavlova General Medicine 2004 Residency: St. Petersburg Medical Academy of Postgraduate Education Neurology 2006 Specialization: St. Petersburg PMA Manual Therapy 2006 Advanced training: St. Petersburg MAPO Autonomic pathology vascular diseases of the nervous system 2011; CHOU DPO "Higher School of Medicine "Eco-Safety" Neurology 2015

Neurologist D. G. Shekhovtsov is a certified specialist in the field of otoneurology and a participant in the All-Russian program for the diagnosis and treatment of dizziness.

Vestibular gymnastics for benign positional paroxysmal vertigo

Benign paroxysmal positional vertigo (BPPV) is a disorder of the inner ear that causes paroxysmal dizziness in certain head positions. The main method of treating BPPV is to carry out the so-called rehabilitation maneuver - a special complex of vestibular gymnastics.

It should be noted that self-medication is possible only after a doctor has reliably diagnosed BPPV, since in cases of tumor or ischemic brain damage, as well as a high probability of compression of the vertebral artery, self-medication can complicate the provision of timely professional medical care and worsen the patient’s condition. The most adapted for the patient to perform independently are the Brandt-Daroff and Epley-Simon gymnastics.

Brandt-Daroff gymnastics

1. In the morning, after sleep, sit on the bed, straightening your back (Position 1) 2. Then you need to lie on your left (right) side with your head turned up at 45° (to maintain the correct angle, it is convenient to imagine the person standing next to you at a distance of 1 .5 meters and keep your gaze on his face) - Position 2 3. Stay in this position for 30 seconds or until the dizziness disappears 4. Return to the starting position while sitting on the bed 5. Then you need to lie on the other side with your head turned up 45 ° — Position 2 6. Stay in this position for 30 seconds 7. Return to the starting position while sitting on the bed (Position 1) 8. Repeat the described exercise 5 times

If dizziness does not occur during the exercise, it is advisable to perform it only the next morning. If dizziness occurs at least once in any position, then you need to perform the exercises at least two more times: in the afternoon and in the evening.

Epley-Simon Gymnastics

1. Sit on the bed with your back straight (Position 1) 2. Turning your head towards the affected labyrinth, stay in this position for 30 seconds (Position 2) 3. Lie on the bed with your head thrown back 45°, stay in this position for 30 seconds (Position 3) 4. Turn your head in the opposite direction, stay in this position for 30 seconds (Position 4) 5. Turn on your side with your head turned with your healthy ear down, stay in this position for 30 seconds (Position 5) 6. Return in a sitting position on the bed with legs down

The correct execution of the complex is shown in the following video clip:

It should be noted that independent implementation of the Epley-Simon complex is difficult at first due to the patient’s ignorance of the side of the diseased labyrinth; in addition, the opposite side may also be involved in the pathological process. In this regard, it is highly advisable to only continue the classes started by the doctor, and not self-medicate.

Patient reviews

Anzhelika Rogonova, 35 years old:

Frequent dizziness began and it was impossible to get out of bed. I sinned on the blood vessels, but after Dix Hallpike’s test, the doctor revealed the diagnosis. I’ve been going to physical therapy for a month now and doing exercises for BPP, the Brandt Daroff method, and I feel positive changes.

Alesya Rumyantseva, 28 years old:

She suffered from the flu very badly, and began to have heart problems, which also caused dizziness. But it turned out that it was otolithiasis and inflammation of the inner ear. I do Brandt Daroff vestibular gymnastics, go to the pool, treatment has just started, but I feel like life is easier.

Step by step guide

The physician performing the Epley maneuver manually moves the person into a series of positions. This can also be done at home by a person who is experiencing symptoms of CDB. The steps for both versions are detailed below.

Steps of the Epley maneuver performed by a physician.

When a doctor performs the Epley maneuver, he or she does the following:

Have the person sit upright on the examination table with their legs fully extended in front of them.
Turn the patient's head at a 45-degree angle to the side of the dizziness where they experience the worst dizziness.
Quickly move the person back so that their shoulders are touching the table. The person's head is pointed in the direction most susceptible to dizziness, but now at an angle of 30 degrees, so that it is raised slightly from the table. The doctor holds the patient in this position for 30 seconds to 2 minutes until the dizziness stops.
Rotate the person's head 90 degrees in the opposite direction, stopping when the opposite ear is 30 degrees away from the table. Again, the doctor holds the patient in this position for 30 seconds to 2 minutes until the dizziness stops.
They then turn the person in the same direction they are facing, onto their side. The side they experience the worst dizziness on will be facing upward. The doctor holds the patient in this position for 30 seconds to 2 minutes until the dizziness stops.
Finally, the doctor returns the patient to a sitting position.
The entire process is repeated up to three times until the patient's symptoms disappear.

Steps of the Epley maneuver performed at home.

It is best to have a doctor perform the Epley maneuver if the person experiencing BPSD has not previously used this technique.

After the doctor performs the Epley maneuver, the patient may want to repeat the procedure at home if they experience other symptoms.

A person experiencing HPV symptoms can follow these steps to get relief at home:

Sit in bed with their legs extended in front of them and turn their head 45 degrees to the side where they feel most dizzy.
Lie down with your head turned to the side and raised at a 30-degree angle from the bed. They should remain in this position for 30 seconds to 2 minutes until the dizziness stops.
They should then turn their head 90 degrees to the other side and stop when it is 30 degrees away from the bed on the other side. Again, the person should hold this position for 30 seconds to 2 minutes until the dizziness stops.
They should now roll onto their side towards the head, maintaining this position until the dizziness stops.

Epley maneuver

The essence of the Epley maneuver is to position your head so that the dizziness stops.

To treat dizziness, the exercise therapy complex includes the Epley maneuver or maneuver. You can perform the exercise yourself, but a specialist should show all the basic techniques.

The essence of the Epley method for dizziness is to place your head at an angle so that gravity stops making you dizzy. Improvements occur after the first implementation of the complex, but provided that the person follows all the doctor’s recommendations for several days.

Indications: BPPV, period after a stroke, loss of coordination, osteochondrosis. Gymnastics speeds up the recovery process after head or spinal injuries and helps with ear diseases. Contraindications – confusion, disorientation, problems with breathing, heart, blood vessels. You will have to abandon the complex if after performing the maneuver your health deteriorates significantly.

The Epley maneuver is used as a diagnostic method if it is not possible to accurately diagnose BPPV, but there are all signs of pathology. The exercise can only be done with negative Hallpike tests.

Studies have shown that with regular performance of the Epley maneuver for dizziness, unpleasant symptoms quickly disappear. The technique is considered simple and safe. When performing exercises, the otoliths do not dissolve, but change their position in the inner ear and do not irritate the organ of balance. Relapses occur in only 20% of patients.

How to do it correctly

When changing body position, the head must be kept at an angle of 45 degrees.

Exercises must be performed quickly, but without jerking. The neck should be straight so that calcium salts do not enter the semicircular canal again. The appearance of slight dizziness is a sign of correct execution of the maneuver. The duration of the gymnastics is 10 minutes.

Technique for performing the Epley method for dizziness:

Sit up straight with your feet on the floor.
Turn your head to your ear at an angle of 45 degrees.
Don't turn your head at the right angle, lie down on the couch, tilt your head back a little. Remain in this position for at least 1 minute.
Turn your head the other way 90 degrees. Hold the position for half a minute.
Turn your body and head in the same direction another 90 degrees, your face should be pointing down. Stay in this position for 30 seconds.
Return to original position.

After the maneuver, you need to sit quietly for a quarter of an hour so that the otoliths do not move. For the rest of the day, you need to wear a neck or travel pillow to limit head movements and record the results of the gymnastics. For the next 2-3 days you need to sleep with your shoulders back and your head turned at an angle of 45 degrees. During the day after performing the exercise, you should not throw your head back.

Exercises are performed in a bright room without sharp, dangerous objects. Clothes and shoes are comfortable, the surface is smooth and soft. It is not recommended to do the maneuver alone, as you may feel very dizzy, feel nauseous, and will need help. Doctors recommend taking 100 mg of Dramamine half an hour before classes.

The lack of the desired result when performing exercises for dizziness may be due to insufficient neck extension, with blockage of the posterior semicircular canal. The therapeutic effect does not appear if the diagnosis is incorrect or if BPPV transforms from the posterior canal to the anterior one.

Treatment

Treatment always depends on the cause. Mostly, vestibular rehabilitation, multifunctional psychotherapy, and drug therapy help.

Non-pharmacological treatment

The therapeutic basis is special exercises that can eliminate the problem for benign positional vertigo. In practice, 2 maneuvers are used to displace irritating stones (otoconia) in the inner ear away from the area of receptor cells and into a non-sensitive area. The maneuvers are also suitable for benign paroxysmal vertigo of childhood.

Brandt-Daroff maneuver

Balance exercises work on several levels. Their essence is to increase the supply of stimuli to the nerve cells of the central part of the vestibular system located in the brain stem.

Principles of therapeutic exercises:

While lying down, move your eyes to the sides in horizontal and vertical directions, bringing your eyes closer together (looking at the tip of the approaching finger).
In the next stage, add slow, gradually accelerating head movements, first with your eyes open, then with your eyes closed.
Add head movements while sitting - turns, bends, again with eyes open and closed.
Then add throwing the ball from hand to hand, more complex maneuvers (throwing the ball under a raised knee, etc.).
Gradually try bending your entire body with your eyes open and closed.
On the next one, sit down and stand up, first with your eyes open, then with your eyes closed. Once you become good at the exercise, add a twist of your torso when standing up.
Walk with your eyes open on a level surface, then add walking with your eyes closed; walk along the drawn line, add a turn of your head as you walk, again with your eyes open and closed.

Semont maneuver

Although this maneuver is demanding, it is most effective in practice. The method is used to distinguish canal damage. Using a maneuver, the patient can get rid of the problem after the first exercise, but sometimes it needs to be done several times. The maneuver is not used in patients with organic back pain; it is rarely used for dizziness in children (due to the difficulty of performing). The method consists of quickly turning the patient on his side with his head turned 45º. Performed exclusively by a doctor!

Epley and Lempert maneuver

In terms of complexity, the Epley and Lempert maneuvers are similar to the Semont method, however, they are performed for vertigo in children.

The basis is a position on the back with the head turned, after which a turn is carried out on the side, after a few seconds - taking a sitting position. All these movements are performed with open eyes, 2 times a day, 3 times in a row.

If the maneuver is performed correctly and all prescribed rules are followed, the success of the treatment manifests itself quickly. Patients are recommended to sleep in a semi-sitting position for 24 hours after exercise.

Pharmacological treatment

Today, there is no pharmacological therapy for benign positional vertigo. But, if the patient suffered from hearing loss before benign positional vertigo was detected, it is recommended to supplement the exercises with vasodilators

The importance of this therapy is to stop or slow down hearing loss. In pharmacological therapy, drugs containing betahistine hydrochloride are used

This active ingredient increases blood flow in the inner ear. Other effects include reducing the frequency and intensity of dizziness and suppressing tinnitus. In an acute condition, relief of vegetative symptoms is necessary: nausea, vomiting. For this purpose, antiemetics are used, in particular Torekan (Thiethylperazine).

For central and peripheral vertigo, vasoactive (vasodilator) drugs are used:

Agapurin, Trental, Pentoxifylline (active substance pentoxifylline);
Duzodril, Enelbin (naftidrofuryl);
Xanidil (xanthinol);
Oxyphylline (etophylline);
Cavinton (vinpocetine).

Surgical methods

Surgical methods for treating dizziness:

labyrinthomia - used in advanced stages of Meniere's disease;
ototoxic antibiotics – drop attacks in Meniere’s disease;
neurovascular decompression – for vestibular paroxysm;
elimination of canal blockage – with BPPV;
decompression operations with hydrates – for Meniere’s disease;
neuroma surgery;
perilymphatic fistula surgery.

Essence and basic principles

The Epley maneuver or exercises are a special maneuver used to treat benign paroxysmal positional vertigo (BPPV).

This procedure is often carried out in a physiotherapy office, but it can also be done at home after a specialist shows all the basics of the technique. This maneuver was developed by Dr. John Epley, after whom it was named. The first time it was talked about was back in the 80s of the last century.

The Epley maneuver is a series of exercises that help relieve symptoms of dizziness. Numerous studies have proven that this technique is the simplest, safest and most effective in the treatment of dizziness caused by the deposition of calcium salts in the inner canal of the ear.

All these exercises do not eliminate the presence of otoliths, but only change their location. Such manipulations cause them to move to other areas of the inner ear that do not cause dizziness.

As a result, it turns out that this maneuver relieves all symptoms, but you need to do the set of exercises several times. The thing is that the first time the crystals can move a small distance.

There are a number of rules that must be followed:

classes should take place in a well-lit room;
there should not be any objects with sharp corners, carpet paths, or objects that could cause a person to fall near the patient;
It is better to perform the exercise on a soft surface; a couch, yoga mat, or thick-pile carpet are suitable for this;
the clothes a person wears should be loose, not restricting movements, so that he can move easily and freely;
shoes on feet should be without heels;
while performing exercises, someone must be present next to the person; it is unknown how his body will react to the exercise; someone needs to provide backup;
if a person feels unwell or has symptoms of other diseases, then therapy is postponed until the person feels better;
Even after the Epley maneuver is successfully performed, when the results sought are obtained, you will need to visit the doctor several more times to prevent a relapse.

Experts who recommend the Epley maneuver to their patients for symptoms such as dizziness note that after the first use of a set of exercises, serious changes are observed. The symptoms go away, but only if you follow all the prescribed recommendations for several days after them.

Treatment

The disease can be treated at home by periodically visiting the doctor. No hospitalization required. Treatment methods for BPPV can be either conservative or surgical. However, the latter are preferable in especially severe cases, when conservative treatment methods do not have a satisfactory effect.

The type of conservative treatment depends on the type of positional vertigo. In cases where curulolithiasis is diagnosed, Semont exercises are indicated. If the symptoms are mild and do not cause much discomfort, gymnastic exercises aimed at training the vestibular apparatus can maintain a normal state.

Semont maneuver

Taking medications is advisable during exacerbations. For example, Sibelium. Although some studies question the effectiveness of drug therapy, it can be an addition to individually selected exercises and techniques (for example, the Elpi or Semont maneuver), but not the basis.

Surgical intervention is indicated if there is no satisfactory effect from the above methods. Involves filling the semicircular canal and other techniques.

Etiological factors in the development of functional dizziness (causes)

Benign paroxysmal positional vertigo (BPPV), a very complex condition in etiology, in some cases it is not possible to establish the true cause of the disease.

The most common causes of BPPV include:

traumatic injuries of the skull and concussions;
inflammatory processes in the labyrinth of the inner ear;
undergone surgical interventions in the head area.

Features of symptomatic manifestations

Symptomatically, benign paroxysmal vertigo manifests itself in the form of a feeling that objects around are rotating, this feeling appears after a sudden change in body position.

Paroxysmal dizziness usually manifests itself in the morning after sleep; it is difficult for a person to navigate in space after getting out of bed.

The duration of the paroxysmal period is, as a rule, no more than three minutes, then it goes away on its own without the use of auxiliary techniques.

An important aspect in diagnosing the disease is that benign positional vertigo is not accompanied by syndromes of organic disorders of the nervous system.

With this pathology, no pathologies develop in the organs of hearing, vision or smell. Thus, the disease does not pose a particular threat to human life, but causes some discomfort.

Clinic of the disease

According to the patient's complaints, positional vertigo occurs with sudden turns of the head, and the pain is severe. Basically, the disease is unilateral, so in such a situation, treatment and exercises are prescribed only on one side. It is easy to determine which side needs to be treated; you need to tilt and turn your head.

This condition may cause vomiting and nausea in the patient. The state of constant swaying is painful. If you are in a state of complete rest, your head stops spinning. Also, with positional vertigo there is no tinnitus, deafness or severe headache.

As for the danger of the disease, it is insignificant. If timely treatment is provided, the risk of complications is minimal. Unconditional remission may occur, but symptoms appear after a couple of years with more frequent relapses.