Home Epley Maneuver: Performance, Tips, and Tricks (Right Side)

hi my name is Danielle Tate I'm a physical therapist who specializes in the treatment of vertigo and today I wanted to demonstrate how to do a simple repositioning maneuver at home to solve positional vertigo the most common repositioning maneuver we use is the Epley maneuver and this is used to treat for small crystals that are displaced in the posterior canal of the vestibular organ so first all you need is your bed at home and a pillow you're going to take the pillow and put this at the end of your bed and you're going to sit in the middle sitting in the middle of your bed you want the pillow to near your low back so that your head will clear the edge of the pillow to treat the right side or for vertigo cause with your head turn to the right you're going to sit turn your head 45 degrees to the right then you're going to lie back letting your head extend over the pillow keeping it turned about 45 degrees if you start to experience dizziness hold this position and wait for the dizziness to stop wait an additional 30 seconds after the dizziness of stout from here after we've waited 30 seconds after the dizziness has stopped you're going to keep your head on your bed keeping your chin up nice and high and roll it about 90 degrees so now you're looking to your left here you want to wait about 30 seconds to make sure you don't get dizzy from this position you're going to bend your right knee up onto the bed and you're going to turn onto your left side bringing your chin to your shoulder so you're looking down into the mattress so in one motion turn looking down to the mattress at an angle here you may get dizzy wait for the dizziness to stop wait an additional 30 seconds after the dizziness is stopped then you're going to drop your legs off the side of your bed keeping your chin tucked and set up to the starting position so how do you tell which you need to treat right or left there's a very simple test that we can do similar to doing the maneuver at home you're going to start in the middle of your bed with a pillow the pillow should be at your low back to test the right ear you're gonna turn your head 45 degrees to the right you're gonna lie down flat letting your head extend over the pillow and you're gonna wait and see if you get dizzy wait at least 30 seconds to a minute to see if symptoms come on if you're not symptomatic and the dizziness did not start you're gonna sit back up wait a couple of seconds in order to test the left here you're gonna turn your head to the left about 45 degrees you're gonna lie down flat let your head extend over the pillow keeping your head turned left and wait to see if you get dizzy here depending on which side you turn your head will determine which ear is asymptomatic or the involved ear if you get dizzy with your head turn and lying down to the right you want to perform a right of the manoeuvre if you get dizzy with your head turn to the left lying down you want to perform a left at Leman oeuvre now that you've seen how the repositioning maneuvers can be done at home I'd like to explain a couple of key things first of all why does changing positions or going through a certain set of positions fix your positional vertigo well it has to do with all these little crystals that could become too squeezed into one of your canals in your inner ear organ the most common canal we get crystals stuck in is our posterior canal that's when we would use the Epley maneuver so here's a little model a little ring right here represents those crystals that kind of get stuck at the bottom this canal we have to reposition them back up into the top and where they belong down in the utricle in order to stop the positional vertigo so if we're looking at the back of the patient's head their noses up here this sits in your head about a 45 degree angle the first motion that we have to do is turn your head beside that we're going to treat what this does is it lines that canal up with gravity to help pull those crystals through the effectively so that we can get them back to where they belong so our first step in the maneuver and also the way that we can test to see if we have this condition would be to lie back extending your head when we do that that crystals move from the bottom portion of the canal to the middle portion causing that momentary episode of vertigo once your head is turned and extended over the pillow we wait for 30 seconds for all those little crystals to settle a portion of the bigger heavier crystals or debris will settle the middle of the canal but we take some time for little maybe stragglers to finish up by settling down you want to make sure we get them all so that's the purpose of waiting after the dizziness stops from there we transition to turning your head to the opposite side about about 90 degrees here we shouldn't see too much dizziness because we won't see as many crystals moving around but if we see some dizziness or some vertigo in the third position where you turn onto your side tucking your chin that's a good sign that the crystals are moving from the middle portion in the canal back toward they belong now it's important to keep your chin tucked when you go to sit up so that it forces those crystals that are sitting at the top that can help back to the spot where they belong if you were to sit up with your head in a normal position there's a chance those crystals can fall back down into the canal good luck with your maneuvers and I hope they help there are a few things I like to mention that should be brought up with performing maneuvers at home so the first one is it's important to determine which side is making you feel symptomatic performing the maneuver on the correct side could be the way to get you feeling better faster you don't want to do a maneuver on both sides in the same day because if you happen to reposition crystals on the right side first and then go to try the left eppley there's a good chance all those crystals you just replaced can get dumped right back into the canal with that being said I'd like to encourage you to follow some precautions after performing a maneuver at home if you feel like it's gone Cecily the first thing you want to do is not lie flat for 24 hours so there's some research suggesting that we don't need to follow post maneuver precautions but I find that it helps patients we avoid recurrences within the first couple of days by following just for 24 hours so if you were to do the maneuver in the morning I'd avoid taking a nap that day or lying with you on that side that you treated you also want to avoid putting that ear closer to the ground like if you were to bend over and pick something up when it comes to sleeping that night you want to stay a little elevated maybe on a wedge 2 pillows or even in a recliner to avoid lying flat or turning over on to that side that you treated this will help ensure those crystals stay in place and hopefully not go back into those canals causing positional vertigo so how do you know if you've had a successful maneuver at home there are a couple of indications that we can look at to give us an idea the first one being when you turn over into your third position of the Epley maneuver if you get a little dizzy it's a good sign that those crystals are moving from the middle portion of the canal back to where they belong you don't have to get dizzy in this position but it's a good indication that the maneuver is working the second time that you'll have a good idea whether or not it work is when you sit up in the fourth position if you were to sit up and experience vertigo again where the room starts to spin that would mean those crystals are moving back into the canal and the maneuver wasn't successful I'd recommend waiting about 10 minutes before retrying the Epley maneuver again to see if you can get those crystals back to where they belong if you were to sit up from that fourth position and have no dizziness and maybe just I've left with a little bit of light-headed or floating feeling that's a good sign that maneuver worked and is completely normal I would recommend holding off on retesting whether or not you have crystals in those canals at least for ten to twenty minutes but I would even hold off a full 24 hours and follow those post maneuver precautions before trying to change positions again to see if you get vertigo we don't want to run the risk of taking all of those crystals that we just put back where they belong jumping them back into the canal potentially bringing on the positional vertigo again so if you've stuck around for this entire video you've learned how to test which ear to treat how to perform an Epley maneuver at home as well as learn some tips and tricks in order to avoid recurrences and how to be successful in your maneuver I will say that it's really important to seek medical help from a health care professional or vestibular specialists for diagnosis and guidance there are a lot of different causes of vertigo and this application of maneuvers might not be the answer for what you're going through for finding a specialist the vestibular disorders association at wws tubular org has a great provider directory where you can search base on your city or zip code to find a specialist near you also talk to your primary care physician or even your ear nose and throat doctor in your area for additional guidance I hope this has been helpful and we'll see you soon

Channel: Vestibular Today

Views: 1,156,911

Keywords: BPPV, Vertigo, Dizziness, Canalith Repositioning Maneuver, Positional Dizziness, Dizziness Treatment

Id: xTnV3m4bWDg

Length: 9min 37sec (577 seconds)

Published: Tue Mar 24 2020