Brandt Daroff exercises video in Russian

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Friday, July 22, 2021 15:03 + to quote book
Brandt-Daroff exercises for benign paroxysmal positional vertigo

Brandt-Daroff gymnastics is a set of special exercises for benign paroxysmal positional vertigo (BPPV), which the patient does at home independently after the Epley-Hughes rehabilitation maneuver has been performed in the clinic. Methodology:

1. Starting position - sit on the bed and keep your head straight, then lie down on your right side, placing your right arm bent at the elbow under your head, your palm holding your head. 2. Remain in this position for 30 seconds or until the dizziness stops completely. 3. Return to the starting position while sitting. Hands on knees. Sit for 30-40 seconds. 4. Perform the exercise in the opposite direction (see points 1-3).

General principles of physical therapy

Special gymnastics for dizziness is an effective way to normalize the condition

Gymnastics for the vestibular apparatus for dizziness should begin as early as possible. Patients can do exercises after the first signs of improvement. Physical therapy is indicated during drug treatment. The function of the vestibular organ is restored much faster if the patient constantly stimulates it with various movements.

Scientists and doctors have conducted research on the effect of physical exercise on restoring the functioning of the vestibular system. It has been proven that with regular exercise, 50-80% of patients experience positive dynamics. At the same time, in a third of patients the balance apparatus was completely restored.

Exercises should be as varied as possible, since the vestibular apparatus quickly adapts to the load. The patient constantly needs to complicate tasks so that the receptors of the balance apparatus are constantly in good shape. This helps to quickly restore neural connections between the brain and the auditory organ.

The gymnastics complex should be adapted for patients with vestibulopathies. The selection of exercises depends on the severity of the disease. In many patients, the balance apparatus is severely damaged. This increases the risk of falls during exercise. Patients are allowed to train with their eyes open and perform tasks with support. Bedridden patients after a stroke undergo physical therapy (physical therapy) in bed, helping them to rise and sit down.

When performing exercises to train the vestibular apparatus for dizziness, stressful situations and overwork should be excluded. It has been scientifically proven that anxiety and depression slow down rehabilitation measures. Patients with depression show signs of vestibulopathies for a long time, even after a long recovery period.

Drugs for the treatment of dizziness

When prescribing a set of exercises, the effect of medications should be taken into account. Some medications improve the functioning of the balance organ. These drugs include Betaserk, Tanakan. Studies were conducted on the effectiveness of Tanakan in a clinic setting on patients with primary vestibulopathies. The patients took the drug in conjunction with physical exercise. All patients showed positive dynamics.

Drugs that inhibit the restoration of vestibular function are: antipsychotics, sedatives, tranquilizers. During the rehabilitation of vestibulopathies, patients are tried to stop these medications. If you stop taking neurotropic drugs, the effect of treatment is much higher.

Patients should exercise in a well-ventilated area. All sharp objects should be removed. The carpet should not have folds, as this may cause the patient to fall.

There must be mats in practice rooms. Patients should be trained in well-lit areas. If the patient cannot complete the task, then they try to help him. This reduces the likelihood of falling, especially at the initial stage of treatment.

Indications for gymnastics for dizziness:

Meniere's disease;
vestibulopathies caused by osteochondrosis, stroke, impaired cerebral blood flow;
benign positional paroxysmal vertigo;
vestibular neuronitis;
vestibular migraine.

When is vestibular gymnastics recommended?

To enhance sensitivity, it is worth doing vestibular exercises for older people.

Gymnastics for the vestibular apparatus is a set of simple exercises that older people can do at home.

It is worth remembering that such exercises are aimed at concentrating your attention, and not at training the muscles of the body.

All older people are allowed to practice this type of gymnastics to correct their balance.

Human vestibular organ

But exercises are directly indicated for people who suffer from:

Post-stroke period.
Positional paroxysmal vertigo.
General disturbances in coordination of movements.
Osteochondrosis.
From damage to the spinal column.
Discirculatory encephalopathy.
Pathologies of the ear area.

Devices and exercises for patients with vestibulopathies

Biofeedback trainer for balance restoration

Several types of gymnastics have been created for the rehabilitation of patients with balance disorders. To facilitate exercise, as well as to adapt the load of physical exercise, various devices are used.

Computer programs with special feedback platforms are used for patients. The most popular of them is the “Target” program. The patient stands on a special support. A monitor is fixed in front of the patient, on which there is a cursor reflecting the position of the center of gravity. The patient, moving his body, must hit the target. In this case, the patient needs to be prevented from falling if the body is strongly tilted. The doctor who performed this procedure may make the task more difficult by reducing the area of support.

For patients after a stroke, there are special suits that help perform exercises and protect the patient from falling. Costumes consist of several elements: shorts, vest, knee pads, shoes. Equipment for patients after a stroke has 2 categories: for patients who are unable to move independently even on a flat surface, for patients who need support when moving on uneven surfaces (stairs, descents, sharp ascents). Vestibular exercises for vertigo for elderly patients are often performed using suits if the person is not fully capable.

Exercises for vestibulopathies

Exercises for dizziness have basic directions that are used in almost all proprietary methods. Patients are included in exercises for head and body movements, exercises to improve static and dynamic balance, and walking training with eyes closed or open. They actively use breathing exercises, yoga, and Tibetan techniques to improve the functioning of the vestibular apparatus.

The Brandt-Daroff technique is actively used. You can do it yourself. The patient should sit down, straighten his back, and place his hands on his knees. After this, lie on your left side, turning your head 45° to the right. You need to stay in this position for half a minute, and then sit down again. After the initial position, the patient lies on his right side and turns his head to the left. The task should be repeated 5 more times. If an attack of dizziness occurs, treatment is stopped until you feel better.

Treatment

At the moment, the treatment of otolithiasis often involves actions that facilitate the extraction of the otolith from the semicircular canal back into the vestibule. This allows you to relieve existing symptoms, but does not guarantee that the attack will not recur.

In situations where removal of the otolith is impossible, specialists resort to the method of repeated provocation of dizziness, which makes it possible to reduce the severity of symptoms (or even get rid of them altogether) thanks to central compensation.

After the attending physician has carried out the necessary actions, it is usually necessary to reduce vestibular excitability. For this purpose, special vestibulolytic drugs are used.

Most often, specialists prescribe betahistine dihydrochloride (Betaserc) to patients. The medication affects histamine receptors located in the inner ear and the vestibular nuclei of the central nervous system.

Betaserc improves blood flow and normalizes lymphatic pressure inside the cochlea and labyrinth. In addition, the drug helps increase serotonin levels, which also makes the vestibular nuclei less active. The optimal dosage of the drug is 24 mg twice a day.

In addition, the doctor may prescribe additional medications that will help eliminate nausea, dizziness and emotional stress, and will also help normalize blood circulation in general.

One of the most significant points regarding overcoming a disorder of the vestibular system is associated with performing sets of exercises that represent special vestibular gymnastics.

It is equally important to begin treatment as early as possible, as well as to provide rational psychotherapy, since in some cases (as, for example, with phobic pastural vertigo), the main cause of the disease can be psychological disorders, without eliminating which the entire process will be meaningless. It should also be taken into account that patients may require not only medication, but also surgical treatment

Health-improving gymnastics

First of all, we are talking about rotatory (facing the affected ear) tilts of the head. A lying or bending person holds the position for 10-15 seconds. Then he sits down, simultaneously turning his head in the direction opposite to the painful area.

You can also make turns by vertically rocking forward and backward. The desired result is felt already 1-2 days later in approximately 75% of patients.

Next, you should switch to specially designed therapeutic exercise programs:

Epley maneuver.

You need to sit on the couch in a sitting position and turn your head approximately 45° towards the sore ear. The specialist fixes the resulting position and places the patient on his back, also tilting his head to 45°. After this, you need to turn it in the opposite direction, and the entire body on the side where the healthy ear is.

The last step is to take the starting position, tilt your head and turn to where you feel dizzy. Repeat the entire complex 3-4 times.

Semont maneuver.

While sitting, keep your legs perpendicular to the ground. Turn your face 45° towards the ear that does not hurt. Fix the pose with your hands and lie on the side opposite to the side in which you turned your face.

You must remain in this position until the attack completely passes, and then, with the help of a doctor, lie on the other side without changing the position of your head. Wait until the attack is over again, then take the starting position. Repeat as needed.

Lempert maneuver.

Sitting on the couch, turn your head at the standard angle for such exercises in the direction where the pathological area is located. The physician must hold the patient's head throughout the maneuver. The person needs to be placed on his back and his face turned in the opposite direction. Then turn your head to where your ear is great.

Next, the body of the person who came to the appointment is turned so that he lies on his stomach. The head should be turned so that the nose points perpendicularly downwards. Turn the patient on the other side, and place the head so that its painful side is facing down. Return to the starting position through the healthy side.

Such techniques are usually quite sufficient to overcome the disease, so you should not resort to independently obtained folk recipes for treating dizziness, especially without obtaining the approval of a specialist.

Classification of forms of BPPV

Depending on the location of pathological changes in the ear, several forms of BPPV are distinguished. Particles of the otolithic membrane move freely relative to each other along the structure of the semicircular canal. There is also a classification based on the mechanism of development of the pathology.

Cupulolithiasis

Cupulolithiasis of benign paroxysmal positional vertigo is rare. It is characterized by the fixation of fragments in the ampoule on the cupule.

The fragments are otoliths that constantly irritate the receptors when the head changes.

Canalolithiasis

More common than cupulolithiasis is BPPV canalolithiasis. In this case, the otoliths in the form of a clot move freely along the endolithm. They also irritate the receptors in the inner ear and cause dizziness.

The anterior canal is affected

Damage occurs in 2% of all cases. This is due to its position, which prevents otoliths from remaining in the anterior canal.

Posterior semicircular canal

In patients with benign paroxysmal vestibulopathy, damage to the posterior canal is more common because the otoliths are fixed there under the influence of gravity.

Canalolithiasis of the left posterior semicircular canal (rarely anterior) occurs in 30-40% of all cases of this disease. This is due to the fact that it is the longest channel - about 20 mm.

Outer form

The external semicircular canal is the shortest, 12-15 mm. Its lumen is wider than the posterior and anterior canals. It forms an angle of 30° with the horizontal plane.

The external canal is more susceptible to inflammation due to infectious diseases.

Folk remedies

Toning infusions of lemongrass, mint or lemon balm will help reduce signs of dizziness. A collection of clover, hawthorn and sage flowers effectively smoothes out attacks of faintness. You can also mix essential oils: camphor (10 drops), fir (3 drops) and juniper (1 drop). Rub the resulting mixture into the temple area. A few spoons of pomegranate or grape juice will help relieve nausea.

Rubbing will help relieve the condition:

earlobes;
fingertips, starting with the little finger;
the upper edge of the eyebrow arches;
areas between the nose and lip.

To eliminate symptoms, infusions and decoctions of herbs that have sedative properties are used.

Chamomile infusion can be prepared from 3 g of dry herb and 300 ml of boiling water. After infusion for 20 minutes, the product is ready for use. It is worth taking 150 ml 2 times a day for 7 days.

A decoction of lemon balm and linden also helps eliminate dizziness and accompanying symptoms. For 500 ml of water you will need 5 g of each herb, cook for 3 minutes, leave for 40 minutes. Take 100 ml 3 times a day.

Mint infusion is the most popular remedy. You can get it from 3 g of dry leaves and 250 ml of boiling water. After infusion for 20 minutes, you can use the medicine. It's better to do this before bed. Repeat 7-10 days in a row.

Causes of otolithiasis

Otolithiasis is attack-like (paroxysmal) dizziness. Its characteristic feature is the factor that provokes dizziness - this is a change in the position of the head. Otoliths in the ear, namely the inner ear, irritate the receptors, causing the patient to experience various ailments.

Unidentified causes

In 40-50% of cases, it is not possible to establish the exact cause of dizziness. This is due to the fact that there are many diseases that cause dizziness.

Meniere's disease

It is a non-inflammatory process in the inner ear. It most often occurs in people aged 30-50 years and is unilateral in nature, which usually becomes bilateral.

Dizziness occurs systematically with severe attacks, accompanied by nausea and sometimes vomiting. If the patient tries to change the position of the body, the condition worsens.

Taking ototoxic antibiotics

Ototoxic antibiotics affect the functioning of the vestibular apparatus and hearing. The destructive property of such drugs is their destructive effect on the cells of the ear and auditory nerve. The disease begins with hearing impairment, and then attacks of dizziness occur.

Viral inflammation of the vestibular apparatus

Viral diseases include vestibular neuronitis, when the vestibular nerve becomes inflamed. It occurs against the background of some previous infection. Inflammation affects the superior branch of the vestibular nerve.

Alcohol intoxication

Alcohol intoxication is a poisoning of the body that affects all its functions. Dizziness appears already in the middle stage of intoxication, when alcohol begins to affect neurological functions and organs. Alcoholic drinks disrupt the transmission of impulses between neurons.

Symptoms

BPPV is characterized by specific clinical features that form the basis for the diagnosis of this disease. So, BPPV is characterized by:

sudden attacks of severe dizziness that occur only when changing body position, that is, dizziness never appears at rest. Most often, an attack is provoked by a transition from a horizontal to a vertical position after sleep, or by turning in bed during sleep. The leading role in this case belongs to the change in the position of the head, and not the body;
dizziness can be felt as the movement of one’s own body in space in any plane, as the rotation of objects around, as a feeling of falling or lifting, swaying on the waves;
the duration of the dizziness attack does not exceed 60 seconds;
sometimes dizziness may be accompanied by nausea, vomiting, slow heart rate, diffuse sweating;
An attack of dizziness is accompanied by nystagmus - oscillatory involuntary movements of the eyeballs. Nystagmus can be horizontal or horizontal-rotational. As soon as the dizziness stops, the nystagmus immediately disappears;
attacks of dizziness are always the same, never change their “clinical coloring”, and are not accompanied by the appearance of other neurological symptoms;
attacks are more pronounced in the morning and in the first half of the day. Most likely, this is due to the dispersion of crystals in the fluid of the semicircular canals during constant head movements. The crystals break down into smaller particles in the first half of the day (motor activity is much higher during the waking period than during sleep), so in the second half, symptoms practically do not occur. During sleep, the crystals “stick together” again, leading to increased symptoms in the morning;
upon examination and thorough examination, no other neurological problems are ever detected. There is no tinnitus, no hearing loss, no headache - no additional complaints;
Spontaneous improvement and disappearance of attacks of dizziness are possible. This is probably due to the spontaneous dissolution of detached calcium bicarbonate crystals.

BPPV is more common in people over 50 years of age. Perhaps by this time the natural processes of resorption of calcium bicarbonate crystals are slowing down, which is the reason for the more frequent occurrence of the disease at this age. According to statistics, women suffer from BPPV 2 times more often than men.

Diagnosis of the disease

Diagnosing a disease with such a symptom as dizziness is difficult due to the fact that it occurs in many diseases: osteochondrosis, vegetative-vascular dystonia.

However, modern diagnostic methods for BPPV make it possible to detect the disease in any form. The need to undergo them is determined only by an otoneurologist.

Instrumental examination

Instrumental examination methods can reveal not only the diagnosis of BPPV. MRI and CT scan of the brain evaluates its condition and reveals the slightest pathologies.

Physical examination

The Dix-Hallpike test allows you to test for benign positional vertigo. The patient is asked to sit on the couch and turn his head in a certain position. Then he is placed on the couch, holding his head.

At this time, the patient reports the moment of dizziness. A positive Hallpike test allows for postural dizziness.

Differential diagnosis of the disease

The differential method identifies diseases of the inner ear. It is performed for pathology of the posterior cranial fossa, multiple sclerosis, and central positional nystagmus.

Complications of benign paroxysmal positional vertigo

BPPV itself has a favorable course, but if an attack of systemic dizziness occurs when a person is at great heights, depths, or while driving, then it can be dangerous. For example, such dizziness can cause a fall and injury.

The main complications and discomfort with BPPV are associated with the vestibular system. Autonomic disorders such as sweating and tachycardia are often observed. Patients experience prolonged minor instability both after an attack and after successful treatment.

Multichannel BPPV is one of the most severe complications. It can develop either after a head injury or after repositioning techniques—removal of otoliths and their particles from the canals. Crystals fall not only into the affected channel, but also into neighboring ones. This leads to severe irritation of the vestibular apparatus.

Do not forget that BPPV itself is a complication of other diseases, most often traumatic brain injury. It can be disguised as clinical manifestations of other diseases and injuries - vestibular neuronitis, heart attack or labyrinthine hydrocele. To distinguish BPPV from these disorders, it is necessary to take a competent approach to diagnosis.

How to get rid of dizziness?

Dizziness is only a symptom of many diseases. Treatment for BPPV will be effective only after identifying other factors that trigger vertigo and diagnosing BPPV.

Then it will become clear how to treat benign paroxysmal vertigo. Incorrect therapy will aggravate the course of an undetected pathology. Medicine recognizes the high effectiveness of gymnastics treatment.

Positional gymnastics

Benign positional vertigo can be treated with special exercises designed to influence the movement of otoliths. Only in 2% of cases does it not help.

Gymnastics are prescribed by a doctor depending on the location of pathological changes in the ear.

Semont maneuver

It is better to carry out this exercise only in the presence of a specialist. An exceptional feature of the maneuver is the rapid movement of the patient at a certain angle. To avoid nausea or vomiting, take antiemetic medications.

Brandt-Daroff

Brandt Daroff gymnastics is performed several times a day: the first approach is done immediately after waking up. Each of them includes tilts in both directions at a certain angle.

Vestibular gymnastics by Brandt Daroff is always selected individually depending on the nature of the disease. Before starting, it is recommended that you familiarize yourself with the techniques in the video of the Brandt-Daroff exercises.

Epley exercises (video)

The Epley maneuver is effective for pathology of the posterior semicircular canal. There are quite a lot of nuances in performing the Epley Maneuver exercise, so it should be entrusted to a doctor.

The specialist will turn the patient’s head in a certain direction, depending on the location of the pathology, then change the position of the patient’s body.

Dix-Hallpike gymnastics

Gymnastics is based on different movements of the body, head and eyes. The effectiveness of a gymnastics regimen depends on factors such as age, one- or two-sided pathology, and duration of the disease. Positive changes are already observed in 50-80% of cases.

Lempert method

The method is used for benign paroxysmal vestibulopathy of the horizontal semicircular canal. The head is turned 45 degrees in the horizontal plane towards the pathology.

After which the patient is placed on the couch and the head and body are turned in a certain sequence. The method involves a series of sequential maneuvers, which can be found in the video in Russian.

Drug treatment

Treatment of BPPV with drugs was the mainstay of treatment until about 15 years ago. Today, gymnastics and maneuvers performed by doctors are effective. Medicines should only be used to treat inflammation or relieve symptoms.

Vasodilators

Vasodilators are vasodilators in nature and are prescribed to improve blood circulation. To treat benign paroxysmal vertigo, medications such as:

Vestibulolytic drugs

Drugs in this group affect the pathogenesis of vestibular disorders of vascular etiology and the treatment of otolithiasis. After therapy, blood supply to the brain tissue improves:

Herbal nootropics

Nootropics improve brain activity, increase mental performance, and reduce fatigue. Some believed that treatment with folk remedies, to which they were previously classified, gives a temporary effect, but depending on the duration of treatment, a positive result also appears.

Bilobil	1 capsule 3 times a day for adults, course of treatment – at least 3 months
Ginko biloba extract	1-2 capsules 1-2 times a day, course of treatment – 3 months
Ginseng	Tincture – 15-25 drops, tablets 0.15-0.3 mg before meals 3 times a day

Antihistamines

Antihistamines are designed to suppress the effect of the allergen.

Antiemetic drugs

Drugs in this group relieve attacks of nausea and vomiting that occur against the background of postural dizziness.

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.

A similar technique is used for the Lempert maneuver. The difference is that the person rotates completely around the axis. After this exercise, you should not bend your head and torso for several days. You need to sleep on a hard, high pillow.

Prevention of cupulolithiasis

There are many reasons for the occurrence of BPPV; without provoking them, you can avoid an unpleasant disease. Dizziness of any etiology is not scary if you follow a healthy lifestyle, do exercises in the morning and hardening. Benign positional vertigo syndrome is more complicated, since the causes of its occurrence are not always clear. However, a general set of actions will help avoid not only DDZ:

If the patient has already had the disease, then therapeutic maneuvers should be performed several times a week so as not to provoke a relapse.
Maintaining a daily routine that requires 7-8 hours of sleep.
Active lifestyle, training to strengthen the body.
Proper nutrition with a minimum content of salty, fatty, spicy foods.

Recommendations from Dr. Myasnikov

Training according to the method of Dr. Myasnikov
To avoid dizziness, it is necessary to train the vestibular apparatus and perform special exercises.

Run in a circle until you feel slightly dizzy, then change direction.
Run backwards, sideways at a slow pace.
Spin the “Health” dial left and right.
Standing on one leg, bend over, move your free leg to the side, keep your balance.
Walk along the curb or drawn line with your face and back.

By performing a set of exercises for benign positional vertigo, you can quickly and safely eliminate tinnitus, attacks of nausea, and not be afraid of falling. All the techniques are quite simple, the main thing is not to rush, listen to your feelings, and practice regularly. You can start doing gymnastics only after an examination, since vertigo can be a sign of multiple sclerosis and other dangerous diseases.

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.

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.

Gymnastics should be performed twice a day with a break of at least 8 hours. The movements are smooth, increase the load gradually. Start with 5-7 times, increase the number of repetitions to 10-15 times. The average duration of classes is 30 minutes.

Basic principles of diagnosing and treating dizziness

There are four main types of dizziness: true (or vestibular) dizziness, a feeling of lightheadedness, a feeling of impending loss of consciousness, and unsteadiness. True or vestibular vertigo is a sensation of imaginary rotation or movement of objects around the patient or the patient himself in space. This dizziness in most cases is caused by damage to the peripheral or central parts of the vestibular analyzer. Other types of dizziness, as a rule, are not associated with damage to the vestibular system, but are a symptom of other conditions, such as orthostatic hypotension, polyneuropathy or anxiety disorder. The main goal of diagnostic measures for vestibular vertigo is to determine which part of the vestibular apparatus is damaged: central (vestibular nuclei of the brain stem, vestibular connections and vestibular centers of the brain) or peripheral (vestibular nerve and labyrinth). In 93% of cases, the cause of dizziness is one of three diseases: benign paroxysmal positional vertigo, Meniere's disease or vestibular neuronitis. All of these diseases represent damage to the peripheral vestibular apparatus. In other cases, dizziness may be caused, for example, by exposure to toxic substances and drugs (alcohol, aminoglycosides, phenytoin, barbiturates, furosemide), cerebrovascular disease, migraine, acute labyrinthitis, multiple sclerosis or a tumor. It should be noted that the importance of cerebrovascular diseases in the development of dizziness is significantly overestimated. Recurrent isolated vestibular vertigo is extremely rarely caused by cerebrovascular disease. Among the causes of such dizziness may be vestibular migraine, vestibular neuronitis and vestibular paroxysmia (irritation of the vestibular nerve root by a vessel). Meniere's disease and perilymphatic fistula may also initially manifest as attacks of isolated dizziness, but soon hearing loss and tinnitus join vestibular disorders. The role of pathology of the cervical spine is also overestimated. Dizziness with dorsopathy is apparently possible, but it is not vestibular in nature, is rare and is characterized by a feeling of instability. Despite the huge variety of causes of dizziness, the correct diagnosis in most cases can be made based on a detailed questioning of the patient, analysis of complaints and medical history, as well as examination and examination of the neurological status, without resorting to instrumental examination. Complaints and anamnesis Some general patterns established when collecting complaints and anamnesis of the disease help to differentiate central and peripheral vestibular disorders. Dizziness in the form of a sensation of objects rotating around the patient is characteristic of damage to the peripheral part of the vestibular analyzer, especially in cases when it is accompanied by nausea and vomiting. The time of onset of dizziness is also of differential diagnostic significance. One study showed that dizziness that occurs in the morning upon waking in most cases is of peripheral origin. Peripheral dizziness usually begins faster than central dizziness and immediately reaches its maximum intensity. The only exceptions are stroke and transient ischemic attack, which are also characterized by the sudden onset of severe dizziness. Duration of dizziness Vestibular dizziness lasting up to several seconds is characteristic of diseases of the peripheral vestibular analyzer with unilateral vestibular hypofunction and occurs in late stages of Meniere's disease or vestibular neuronitis. An attack of benign positional vertigo, vestibular paroxysm and dizziness with a perilymphatic fistula continues from several seconds to several minutes. Dizziness lasting from several minutes to an hour occurs with a transient ischemic attack. Dizziness may continue for several hours due to Meniere's disease, perilymphatic fistula, or migraine. Dizziness persists for several days with a stroke in the vertebrobasilar system, multiple sclerosis, and sometimes with vestibular neuronitis. Complaints of dizziness that last for weeks or months almost always indicate the psychogenic nature of the disease. Provoking factors A change in head position provokes an attack of benign paroxysmal positional vertigo. In many other diseases (such as acute labyrinthitis, perilymphatic fistula, multiple sclerosis), dizziness also increases with changes in head position. However, unlike benign positional vertigo, it does not go away with rest. Dizziness that occurs when straining, sneezing, coughing, or loud noises indicates a perilymphatic fistula. The latter is formed as a result of a rupture of the round or oval window, as a result of which pressure in the middle ear cavity is directly transmitted to the inner ear. Dizziness that develops after an acute respiratory viral infection may indicate vestibular neuronitis. Immunodeficiency (for example, when taking immunosuppressants) can cause herpetic lesions of the geniculate ganglion of the facial nerve (Hunt syndrome), including dizziness and unsteadiness. Stress can provoke psychogenic dizziness. Associated symptoms The combination of dizziness with hearing loss almost always indicates damage to the inner ear or, less commonly, to the vestibulocochlear nerve. Only occasionally the cause of vestibular vertigo and acute sensorineural hearing loss is a stroke in the anterior inferior cerebellar artery or labyrinthine artery. Attacks of vestibular vertigo, accompanied by progressive hearing loss, mainly in low frequencies, and noise in the ear, indicate Meniere's disease. Dizziness, combined with other focal neurological disorders (diplopia, cerebellar ataxia, hypoesthesia, paresis, dysarthria or dysphagia), may be due to damage to the brain stem or cerebellum (for example, due to stroke, transient ischemic attack or tumor). The combination of dizziness with headache, sensitivity to light and sound, nausea and vomiting is characteristic of migraine. Attacks of dizziness accompanied by parenchymal keratitis and hearing loss indicate an autoimmune disease (Cogan syndrome). Past diseases Cardiovascular diseases (arterial hypertension, atherosclerosis, heart disease, atrial fibrillation), hyperlipoproteinemia and diabetes mellitus are risk factors for stroke and, therefore, increase the likelihood of dizziness caused by damage to the central vestibular structures. Neurological Examination The purpose of the neurological examination is to determine whether dizziness is accompanied by other focal neurological symptoms. Identification of focal neurological disorders in a patient suffering from dizziness indicates damage to the brain stem or cerebellum and requires the exclusion, first of all, of a stroke or a tumor of the brain and the cerebellopontine angle. In such cases, it is necessary to immediately perform a CT or MRI of the brain. Nystagmus analysis is of important diagnostic value during a neurological examination of a patient suffering from dizziness. Dizziness in peripheral vestibular disorders is accompanied by horizontal and/or rotatory nystagmus, which does not change direction when looking in different directions. Vertical nystagmus in 80% of cases indicates damage to the vestibular nuclei or cerebellar vermis. Nystagmus when looking down (“downward nystagmus”) occurs with craniovertebral anomalies (Arnold-Chiari syndrome, platybasia). It has also been described in brainstem and cerebellar stroke, lithium or anticonvulsant drug poisoning, and multiple sclerosis. Nystagmus during upward gaze is caused by damage to the tegmentum of the pons as a result of a stroke, tumor, or demyelinating disease. In addition to analyzing nystagmus, some special tests help determine the cause of dizziness. The Dix-Hallpike test has high sensitivity and specificity for benign paroxysmal positional vertigo. Since this disease is the most common cause of vestibular vertigo, the Dix-Hallpike test should always be performed during a neurological examination of a patient with vertigo. To perform this test, the patient, sitting on a couch with his head turned 45° to the side, is quickly placed on his back so that his head is thrown back over the edge of the couch. If, after a short (several seconds) latent period, vestibular dizziness develops, accompanied by horizontal rotatory nystagmus and lasting 20–40 s, then this test can be considered positive. If, when performing this test, dizziness and nystagmus (usually vertical, directed downward) occur immediately after transition to a horizontal position, without a latent period, and continue all the time while the patient is lying down, then it is necessary to exclude a space-occupying formation in the posterior cranial fossa. The appearance of nystagmus and dizziness when pressing on the tragus (Hennebert's symptom) is a sign of a perilymphatic fistula. Another symptom of a perilymphatic fistula is dizziness during the Valsalva maneuver (forced exhalation with a closed glottis). Treatment of dizziness To reduce vestibular dizziness, drugs of several groups are used: H1 blockers, anticholinergics, benzodiazepine tranquilizers and phenothiazines. H1 blockers For vestibular vertigo, only those H1 blockers that have a central anticholinergic effect are effective. These drugs include dimenhydrinate, diphenhydramine, promethazine, meclozine, cyclizine. These drugs significantly reduce dizziness and associated nausea and vomiting. The main side effect of these drugs is sedative or hypnotic effects. It is more pronounced in dimenhydrinate and diphenhydramine. In addition, H1 blockers can cause dry mouth and impaired accommodation. Long-term use of these drugs (more than 2-3 days) is not recommended because they slow down vestibular compensation. Anticholinergics These drugs inhibit the activity of the central vestibular structures. Scopolamine patches are used, releasing 0.5 mg of scopolamine into the blood over 72 hours. Side effects of scopolamine are caused mainly by blockade of M-cholinergic receptors and include dry mouth and drowsiness. In addition, amnesia and hallucinations are possible. Scopolamine should be prescribed with great caution to the elderly due to the risk of developing psychosis or acute urinary retention. Benzodiazepine tranquilizers The inhibitory transmitter of the vestibular system is GABA, and benzodiazepines enhance the inhibitory effects of GABA, which explains the effect of these drugs on dizziness. A common side effect is drowsiness. Phenothiazines Thiethylperazine is mainly used to relieve dizziness. Side effects of this drug include drowsiness and extrapyramidal disorders. Treatment of certain diseases accompanied by dizziness Benign paroxysmal positional vertigo - for this disease, drug treatment is not indicated. Special treatment maneuvers have been developed, for example, the Epley maneuver or the Semont maneuver, which can eliminate dizziness in the vast majority of cases. The effectiveness of a single Epley maneuver is 80%, and the effectiveness of a repeated maneuver is close to 100%. As an alternative to the rehabilitation maneuver for benign paroxysmal positional vertigo, special exercises are used (for example, Brandt-Daroff exercises), which patients can do at home on their own. Meniere's disease To prevent attacks of Meniere's disease, a diet with salt restriction to 1–2 g per day, diuretics (acetazolamide or combination drugs containing hydrochlorothiazide and triamterene) and Betaserc at a dose of 48 mg/day are prescribed. Betaserc is a synthetic histamine analogue that is active when taken orally. Acts mainly on histamine H1- and H3-receptors of the inner ear and vestibular nuclei of the central nervous system. Through a direct agonistic effect on H1 receptors of the vessels of the inner ear, as well as indirectly through an effect on H3 receptors, it improves microcirculation and capillary permeability, thereby normalizing endolymph pressure in the labyrinth and cochlea. At the same time, it increases blood flow in the basilar arteries. Betaserc also has a pronounced central effect, being an inhibitor of H3 receptors in the nuclei of the vestibular nerve. Normalizes neuronal transmission in polysynaptic neurons of the vestibular nuclei at the level of the brain stem. The clinical effect of the drug is manifested by rapid (from several hours to a day) relief of acute attacks of Meniere's syndrome. In the presence of repeated attacks of vestibular disorders, as well as in chronic cases, the best results are achieved with long-term (4 weeks or more) use of the drug. The drug normalizes both vestibular disorders and cochlear disorders, relieves noise and ringing in the ears, and prevents the development of deafness. Betaserc is used for a long time, for several months in a row, because the drug does not have an adverse effect on the organs and tissues of the body (in particular on liver function, the cardiovascular system, etc.), and also does not show the development of tolerance and addiction. Vestibular neuronitis In addition to symptomatic medications that reduce dizziness, nausea and vomiting, corticosteroids are prescribed for vestibular neuronitis. Prednisolone at a dose of 0.5–1 mg/kg has been shown to accelerate vestibular compensation in vestibular neuronitis. In addition, to accelerate vestibular adaptation, Betaserc is used at a dose of 48 mg/day. In experimental studies, vestibular compensation occurred twice as quickly when taking Betaserc. Vestibular gymnastics is important for vestibular neuronitis. It has been proven that it accelerates vestibular compensation, which makes it an essential part of the treatment during the recovery period of vestibular neuronitis. Vestibular migraine To prevent attacks of dizziness during vestibular migraine, beta-blockers, tricyclic antidepressants and calcium antagonists are used. During an attack, triptans, such as sumatriptan, can be used. Vestibular paroxysmia For vestibular paroxysm caused by compression of the root of the vestibulocochlear nerve by a vessel, carbamazepine is used. Treatment begins with small doses (100 mg/day), gradually increasing them until a therapeutic effect is achieved. Thus, diagnosis of most diseases manifested by dizziness is possible based on a thorough collection of complaints and anamnesis, a neurological examination, including several special tests, such as the Dix-Hallpike test and the Valsalva maneuver. For most diseases of the vestibular system, effective treatment has been developed, including drug therapy, rehabilitation maneuvers and vestibular exercises. Literature 1. Weiss G. Dizziness // Neurology / Ed. M. Samuels. – M., 1997. – P. 94–120. 2. Dizziness. Ed. M.R. Dixa, D.D. Huda. M.; 1989. 3. Zamergrad M.V., Melnikov O.A. Dizziness in the elderly. Wedge. gerontology. 2003; 9(10):13–16. 4. Melnikov O. A., Zamergrad M. V. Benign positional vertigo // Attending physician. – 2000. – No. 1. –p.15–19. 5. Parfenov V.A., Zamergrad M.V. Dizziness in neurological practice // Nevrol. magazine – 2005. – No. 1. – P. 4 – 11. 6. Shtulman D.R. Dizziness and imbalance. In the book: Diseases of the nervous system. Ed. N.N. Yakhno, D.R. Shtulman. M., 2001: 124–128. 7. Baloh RW Vertigo. // The Lancet. –1998. –v.352. –p.1841–1846. 8. Brandt T. Vertigo. Its Multicensory Syndromes. – 2nd Ed. – London, 2000. 9. Dieterich M., Brandt T. Episodic vertigo related to migraine (90 cases): vestibular migraine? // J Neurol. –1999. –v.246. –No. 10. –p.883–892. 10. Labuguen RH Initial evaluation of vertigo. // American Family Physician. –2006. –v.73. –No. 2. –p.244–251. 11. Minor LB, Schessel DA, Carey JP. Meniere's disease. // Curr Opin Neurol. –2004. –17(1). –p.9–16 12. Suzuki AR, Herdman SJ, Tusa RJ Diagnosis and therapeutic options in benign paroxysmal positional vertigo. // Acta Otorrinolaryngology Esp. –1999. –v.50. –No. 2. –p.106–117. 13. Swartz R., Longwell P. Treatment of vertigo. // American Family Physician. –2005. –v.71. –No. 6. –p.1115–1122. 14. Vannucchi P, Giannoni B, Pagnini P. Treatment of horizontal semicircular canal benign paroxysmal positional vertigo. // J Vestib Res. –1997. –No. 1. –P.1-6 15. Wolf JS, Boyer KP, Manokey BJ et al. Success of the Modified Epley Maneuver in Treating Benign Paroxysmal Positional Vertigo. // laryngoscope. –1999. –V.109. — No. 6. –p. 900–903.

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.

If examination reveals a nystagmus that differs from that described above, as well as other neurological symptoms, it is necessary to exclude other lesions of the nervous system.

Lying on your side with the affected ear facing up for 12 hours,

Barbecue method

The “barbecue” method - turning the patient 360˚ - the patient in a lying position is successively turned towards the healthy ear by 90˚ until he takes the starting position.

The patient's head is rotated 270˚ from the affected ear to the healthy one.

Special studies have shown the sufficient effectiveness of exercises performed by patients. There were no differences in the effectiveness of the maneuver in specialized clinics and in primary care settings.

IP – LYING ON YOUR Stomach

Stretch your arms forward without lifting your chin from the floor, raise your legs, spread them, connect them, then lower them. Repeat 4-6 times.
“Swimming” - raise your upper body and perform a movement with your arms as if swimming, without touching the floor with your hands. 4-6 repetitions of 4 movements on each hand.
Hands in a “lock” behind your head, bend over 4-6 times.
“Wings” - raise your arms and torso above the floor, spread your arms to the sides and swing them up and down 6 times
Rest.

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