Rebecca Brown - Vestibular and Face Physiotherapist

Dizziness, Lightheaded, Vertigo, Imbalance…

These words are commonly used by our clients to describe their symptoms.

The goal of a Vestibular Assessment is to figure out if your symptoms are coming from your inner ear balance organ, due to a central cause (something that could be related to the brain/ the pathways within the brain), a proprioceptive issue (this could be dizziness from the neck, imbalance due to altered lower limb sensation/ strength) or a combination of two or more of these.

We allocate one hour for our assessments. They involve a screen of your cranial nerves, oculomotor examination (looking at your eyes and the movement of your eyes in different directions), infrared goggle assessment (we place goggles on you to look at your eyes in the dark), we assess for Benign Paroxysmal Positional Vertigo “The crystals” (this involves us lying you down with your head turned in different directions) and we assess your balance, gait and neck.

Our initial assessments always involve a thorough assessment, explanation and depending on what our assessment shows us we will treat what we find and/ or establish a home program and plan of attack for the future.

If you are ever unsure about what the treatment involves, what you should bring to your assessment or if you need to bring someone with you, please do not hesitate to speak to our friendly reception staff. Our reception staff should be able to answer your questions but if they are unsure they will pass on the message to the Physiotherapists who will personally contact you about your queries.

If you have been given Brandt- Daroff exercises as a handout by anyone without a vestibular assessment or find exercises on the internet to treat BPPV, please FREEZE and read this first!

If these exercises have been prescribed to you by a Vestibular Specialist/ Expert then they may be an appropriate exercise for management of BPPV (crazy crystals - see blog “help I’m dizzy”). Otherwise, there are some more appropriate and effective treatments.

Firstly… hands up who knows what Particle Repositioning Manoeuvre or Brandt Daroff Exercises (bottom are? See the pictures on our Instagram (@thefacialphysio) for what they look like.

Brandt Daroff Exercises were developed in the 1980's. It is a non-specific exercise that usually gives all the canals a “good shake up” without specifically targeting one. It was prescribed to patients because it was thought to be simple enough to do at home alone. Unfortunately, in my experience I have noticed that rather than being simple and easy to do at home; many of my patients have presented feeling worse off, imbalanced and lightheaded.

Why?

- Crystals can end up in other canals

- They may be treating the wrong canal

- Restricted Neck range of movement can result in these exercises aggravating neck pain

- If patients are by themselves at home they may feel very vulnerable and unsafe

- Patients can experience anxiety and fear with making themselves vertiginous

- They may not complete the exercise due to symptom provocation

- Age and comorbidities can play a factor

- People do not have the time to repeatedly do these exercises.

Epley manoeuvre was invented in the 1990s and is best performed by a clinician. The Epley manoeuvre specifically targets the posterior/ anterior canals and usually will only take one to three treatments to move the crystals back home. It is recommended not to do this at home unless it has been prescribed for you and you have a friend or family member there to help.

Dorado et al 2012 did a randomised prospective clinical trial where they reviewed Particle Repositioning Manoeuvre (modified Epley) Versus Brandt-Daroff Exercise for Treatment of Unilateral Idiopathic BPPV of the Posterior Semicircular Canal. The article looked at the short and long term outcomes of these manoeuvres for treating unilateral BPPV.

They concluded that “PRM (Modified Epley manoeuvre) is a more effective treatment and as safe as the Brandt Daroff exercises. It does not reduce the recurrence of BPPV but it may delay the onset of the second recurrence in comparison to the Brandt Daroff”.

The take home message is…before you try the Brandt-Daroff exercises, please see a Vestibular Physiotherapist or someone who specialises in these conditions, who can do a Vestibular Assessment. Dizziness and Vertigo are overly complex symptoms that may not always be due to BPPV. A Dix-Hallpike and Roll Test are the most appropriate assessment tools at identifying the canal and ear involved and guide us on which treatment would specifically target that area.

Bec