4/3/2024 0 Comments Epley maneuver for vertigo pdfHerdman and Tusa 2 Report some controversies regarding canal repositioning maneuvers. His conclusions are that these maneuvers efficacies are not yet satisfactorily determined. Van der Velde 15 analyzed other conservative and non-pharmacological physical treatments besides repositioning maneuvers. Some papers have shown little effect of canal repositioning maneuvers as to long lasting symptoms improvement, as well as weak evidence when compared to other therapeutic resources (physical therapy, medical or surgery related) for posterior semicircular canal BPPV, especially due to a lack of good quality clinical studies 6, 14. Habituation exercises are used for milder residual complaints 2. We typically use canal repositioning treatment or releasing maneuvers. Efficacy studies state that all three facilitate recovery. There are three basic BPPV treatments, each with its own use indication: canal repositioning, releasing exercises and habituation exercises. Head position exercises attempt to reach central nervous system adaptation and compensation mechanisms, trying symptom recovery. The main goal of these maneuvers is to take the free debris from the semicircular canal back to the utricle, where they presumable adhere1. This therapy involves head position changes in a series of repetitions, as proposed by Brandt and Daroff 8, Semont´s releasing maneuver, Epley's canalicular repositioning 1, 9, among others 10, 11, 12, 13. As we repeat the maneuver, fatigue ensues, reducing nystagmus intensity until it totally recedes in the third or fourth repetition.īPPV clinical findings agree with the hypothesis that semicircular canals, with greater incidence on the posterior canal, have floating particles or debris, which are heavier than the circulating endolymph 5.Īlthough the exact mechanism by which these debris cause BPPV and nystagmus is still unknown 1, it is broadly accepted that a canal lithiasis phenomenon be responsible for this condition 6.Įach free debris point require a different treatment strategy, through maneuvers comprised of head movements, in order to restore normal semicircular canal function and thus eliminate vertigo and positional nystagmus 7. Rotational nystagmus is typical: four to five second latency and duration of 30 to 40 seconds. We have a positive maneuver when it triggers vertigo and nystagmus when the patient changes posture from sitting to laying down with his/her head hanging downwards horizontally, with a 45° head turn towards the tested side 3, 5, 6. However, some patients experience recurrent symptoms months or even years later, which may vary from short spells to decades of suffering, with short remission spans 5.ĭix-Hallpike maneuver aids in diagnosis. Symptoms tend to spontaneously resolve after a few weeks or months. Because of its clinical characteristics, patients feel fearsome, and both vertigo as well as triggering head movements might considerably limit their daily activities 5. The interview reveals a typical history with short vertigo spells at head movements 4. It is clinically characterized by recurrent vertigo spells, usually triggered by certain head movements or patient's change in posture 3.ĭiagnosis is clinical. Benign paroxysmal positional vertigo (BPPV) is one of the most frequent vestibular disorders 1, 2.
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