Exercise for Vertigo (spinning) : Epley’s exercises

Source_Wikipedia : Exercise for Vertigo (a whirling or spinning movement)

The Epley maneuver (or Epley’s exercises) is a maneuver used to treat benign paroxysmal positional vertigo (BPPV). It is often performed by a doctor or a physical therapist, but can be performed by the patient at home. This maneuver was developed by Dr. John Epley and first described in 1980.

The procedure is as follows:

  1. Sit upright.
  2. Turn your head to the symptomatic side at a 45 degree angle, and lie on your back.
  3. Remain up to 5 minutes in this position.
  4. Turn your head 90 degrees to the other side.
  5. Remain up to 5 minutes in this position.
  6. Roll your body onto your side in the direction you are facing; now you are pointing your head nose down.
  7. Remain up to 5 minutes in this position.
  8. Go back to the sitting position and remain up to 30 seconds in this position.

The entire procedure should be repeated two more times, for a total of three times.

Vertigo (from the Latin vertō “a whirling or spinning movement”[1]) is a type of dizziness, where there is a feeling of motion when one is stationary.[2] The symptoms are due to a dysfunction of the vestibular system in the inner ear.[2] It is often associated with nausea and vomiting as well as difficulties standing or walking.

The most common causes are benign paroxysmal positional vertigo and vestibular migraine while less common causes include Ménière’s disease and vestibular neuritis.[2] Excessive consumption of ethanol (alcoholic beverages) can also cause notorious symptoms of vertigo. (For more information see Short term effects of alcohol).

Read more at_Vertigo From Wikipedia, the free encyclopedia

Benign paroxysmal positional vertigo (BPPV) is a disorder caused by problems in the inner ear. Its symptoms are repeated episodes of positional vertigo, that is, of a spinning sensation caused by changes in the position of the head.

Vertigo, also called dizziness, accounts for about 6 million clinic visits in the U.S. every year, and 17–42% of these patients eventually are diagnosed with BPPV.[1] Other forms of vertigo include:

[edit] Signs and symptoms

  • Symptoms
    • Vertigo: Spinning dizziness which is not light headed or off balance.
    • Short duration (Paroxysmal): Lasts only seconds to minutes
    • Positional in onset: Can only be induced by a change in position.
    • Nausea is often associated
    • Visual disturbance: It may be difficult to read or see during an attack due to the associated nystagmus.
    • Pre-Syncope (feeling faint) or Syncope (fainting) is unusual.
    • Emesis (Vomiting) is uncommon but possible.
  • Signs
    • Rotatory (torsional) nystagmus, where the top of the eye rotates towards the affected ear in a beating or twitching fashion.

Patients do not experience other neurological deficits such as numbness or weakness, and if these symptoms are present, a more serious etiology such as posterior circulation stroke, must be considered.

[edit] Cause

Within the labyrinth of the inner ear lie collections of calcium crystals known as otoconia. In patients with BPPV, the otoconia are dislodged from their usual position within the utricle and they migrate over time into one of the semicircular canals (the posterior canal is most commonly affected due to its anatomical position). When the head is reoriented relative to gravity, the gravity-dependent movement of the heavier otoconial debris (colloquially “ear rocks“) within the affected semicircular canal causes abnormal (pathological) fluid endolymph displacement and a resultant sensation of vertigo. This more common condition is known as canalithiasis.

In rare cases, the crystals themselves can adhere to a semicircular canal cupula rendering it heavier than the surrounding endolymph. Upon reorientation of the head relative to gravity, the cupula is weighted down by the dense particles thereby inducing an immediate and maintained excitation of semicircular canal afferent nerves. This condition is termed cupulolithiasis.

It can be triggered by any action which stimulates the posterior semi-circular canal which may be:

  • Tilting the head
  • Rolling over in bed
  • Looking up or under
  • Sudden head motion
  • Post head injury

BPPV may be made worse by any number of modifiers which may vary between individuals:

  • Changes in barometric pressure – patients often feel symptoms approximately two days before rain or snow
  • Lack of sleep (required amount of sleep may vary widely)
  • Stress

BPPV is one of the most common vestibular disorders in patients presenting with dizziness and migraine is implicated in idiopathic cases. Proposed mechanisms linking the two are genetic factors and vascular damage to the labyrinth.[3]

[edit] Diagnosis

The condition is diagnosed from patient history (feeling of vertigo with sudden changes in positions); and by performing the Dix-Hallpike maneuver which is diagnostic for the condition. The test involves a reorientation of the head to align the posterior canal (at its entrance to the ampulla) with the direction of gravity. This test stimulus is effective in provoking the symptoms in subjects suffering from archetypal BPPV. These symptoms are typically a short lived vertigo, and observed nystagmus. Rarely, in some patients, the vertigo can persist for years. Assessment of BPPV is best done by a health professional skilled in management of dizziness disorders, commonly a physiotherapist or doctor.

The nystagmus associated with BPPV has several important characteristics which differentiate it from other types of nystagmus.

  • Positional: the nystagmus occurs only in certain positions
  • Latency of onsent: there is a 5-10 second delay prior to onset of nystagmus
  • Nystagmus lasts for 5–120 seconds
  • Visual fixation does not suppress nystagmus due to BPPV
  • Rotatory/Torsional component is present or (in the case of lateral canal involvement)the nystagmus beats in either a geotropic (towards the ground)or ageotropic (away from the ground) fashion
  • Repeated stimulation, including via Dix-Hallpike maneuvers, cause the nystagmus to fatigue or disappear temporarily

[edit] Treatment

Two treatments have been found effective for relieving symptoms of posterior canal BPPV: the canalith repositioning procedure (CRP) or Epley maneuver, and the liberatory or Semont maneuver.[1] The CRP employs gravity to move the calcium build-up that causes the condition.[4] The particle repositioning maneuver can be performed during a clinic visit by health professionals or taught to patients to practice at home. In the Semont maneuver, patients themselves are able to achieve canalith repositioning.[5] Only limited data are available comparing the two treatments, and it is not known which is more effective.[1]

The Epley maneuver (particle repositioning) does not address the actual presence of the particles (otoconia), rather it changes their location. The maneuver aims to move these particles from areas in the inner ear which cause symptoms, such as vertigo, and repositions them to where they do not cause these problems.

Medical treatment with anti-vertigo medications may be considered in acute, severe exacerbation of BPPV, but in most cases are not indicated. These primarily include drugs of the anti-histamine and anti-cholinergic class, such as meclizine and scopolamine respectively. These offer symptomatic treatment, and do not affect the disease process or resolution rate. Medications may be used to suppress symptoms during the positioning manoeuvres if the patient has severe symptoms and may be unable to tolerate them.

Surgical treatments, such as a semi-circular canal occlusion, do exist for BPPV but carry the same risk as any neurosurgical procedure. Surgery is reserved as a last resort option for severe and persistent cases which fail vestibular rehabilitation (including particle repositioning and habituation therapy).

Devices such as a head over heels “rotational chair” are available at some tertiary care centers [6] Home devices, like the DizzyFIX, are also available for the treatment of BPPV and vertigo.[7][8]

Read more_Benign paroxysmal positional vertigo From Wikipedia, the free encyclopedia


See also

External links


Epley’s maneuver

45 sec – 19 Jun 2008 – Uploaded by eyangnarko
for affected left ear, reverse directions.
youtube.comRelated videos
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    41 sec – 27 Mar 2007 – Uploaded by petalfin
    Use this maneuver to treat your Benign Paroxysmal Positional Vertigo (BPPV). Notice the pillow behind the shoulders. Your head
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    1 min – 14 Mar 2010 – Uploaded by wcarender
    Epley Maneuver for Left Ear Instructional Video Wendy Carender, PT University of Michigan Health System Vestibular Testing Center
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  • Dix-Hallpike and Epley Maneuvers for BPPV, in

    1 min – 16 Feb 2007 – Uploaded by webiocosm
    This is a brief claymation video made to serve as a visual aid to show how the Dix-Hallpike test and Epley maneuvers are performed
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  • Epley Maneuver

    20 sec – 2 Aug 2006 – Uploaded by T Hain
    Demonstration of the Epley Maneuver
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  • Modified Epley Maneuver [HQ]

    3 min – 5 Jan 2010
    This video demonstrates how to perform a modified Epley maneuver to treat right posterior canal BPPV canalithiasis. If a left sided
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  • Epley for Dizziness

    1 min – 3 May 2009 – Uploaded by cecfilm
    Positional vertigo is a type of dizziness that occurs when a person rolls in bed, bends over, or looks up. It is caused by crystals in the
    youtube.comRelated videos
  • Health Video on Vertigo (Epleys Maneuver)

    3 min – 22 Nov 2006 – Uploaded by Dr. Malpani
    Full Length High Quality DVD version available. We provide a significant patient and consumer health education library of videos
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  • Epley’s Maneuver.mpg

    2 min – 6 Dec 2009 – Uploaded by tbpt00
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    5 Responses to “Exercise for Vertigo (spinning) : Epley’s exercises”

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