Epley maneuver
The Epley maneuver (or canalith repositioning maneuver) is a maneuver used to treat benign paroxysmal positional vertigo (BPPV).[1] It is often performed by a doctor, chiropractor, or a physical therapist, after confirmation of a diagnosis of BPPV using the Dix-Hallpike test. This maneuver was developed by Dr. John Epley and first described in 1980.[2] Physiotherapists and some chiropractors now use a version of the maneuver called the "modified" Epley that does not include vibrations of the mastoid process originally indicated by Epley, as they have since been shown not to improve the efficacy of the treatment.[3]
The following sequence of positions describes the Epley maneuver:
- The patient begins in an upright sitting posture, with the legs fully extended and the head turned 45 degrees towards the affected side.
- The patient then quickly lies down backwards with the head held approximately in a 30 degree neck extension (Dix-Hallpike position) where the affected ear faces the ground.
- Remain in this position for approximately 30 seconds.
- The head is then turned 90 degrees to the opposite direction so that the unaffected ear faces the ground, all while maintaining the 30 degree neck extension.
- Remain in this position for approximately 30 seconds.
- Keeping the head and neck in a fixed position, the individual rolls onto their shoulder, in the direction that they are facing.
- Remain in this position for approximately 30 seconds.
- Finally, the individual is slowly brought up to an upright sitting posture, while maintaining the 45 degree rotation of the head.
- Hold sitting position for up to 30 seconds.
The entire procedure should be repeated two more times, for a total of three times.
During every step of this procedure the patient may experience some dizziness.
Following the treatment, the clinician may provide the patient with a soft collar, often worn for the remainder of the day, as a cue to avoid any head positions that may once again displace the otoconia. The patient may be instructed to be cautious of bending over, lying backwards, moving the head up and down, or tilting the head to either side. The soft collar is removed prior to bed. When doing so, the patient should be encouraged to perform horizontal movements of head to maintain normal neck range of motion.[4]
It is important to instruct the patient that horizontal movement of the head should be performed to prevent stiff neck muscles
It is still uncertain in the research literature whether activity restrictions following the treatment improve the effectiveness of the canalith repositioning maneuver. However, patients who were not provided with any activity restrictions needed one or two additional treatment sessions in order to attain a successful outcome.[5]
See also
External links
- Video demonstration - "Epley maneuver" (no sound) (0:40 Flash Video)
- Video demonstration - "Epley's maneuver" (with narration) (0:45 Flash Video)
References
- ^ Hilton M, Pinder D (2004). "The Epley (canalith repositioning) manoeuvre for benign paroxysmal positional vertigo". Cochrane Database Syst Rev (2): CD003162. doi:10.1002/14651858.CD003162.pub2. PMID 15106194.
- ^ Epley JM (1980). "New dimensions of benign paroxysmal positional vertigo". Otolaryngol. Head Neck Surg. 88 (5): 599–605. PMID 7443266.
- ^ Parnes LS, Agrawal SK, Atlas J. (2003.) "Diagnosis and management of benign paroxysmal positional vertigo (BPPV)".CMAJ.169(7):681-93.PMID 14517129,
- ^ Schubert, M. C. (2007). Vestibular disorders. In S. O’Sullivan & T. Schmitz (5th edition), Physical Rehabilitation pp. 999-1029). Philadelphia: F.A. Davis Company.
- ^ Herdman, S. (2000). Vestibular rehabilitation (3rd edition), Physical therapy diagnosis for vestibular disorders (pp. 228-308). Philadelphia: F. A. Davis Company.