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