brandt-daroff exercises
TRANSCRIPT
Brandt-Daroff Exercises Use for recurrent BPPV sufferers or any chronic vertigo
Some recommend doing straight after Epley but goes against Cochrane advice.
Can make them feel sick
Ideally have some one with you
Suggested schedule – for 2 weeks
o Morning 5 repetitions
o Afternoon 5 repetitions
o Evening 5 repetitions
Cawthorne-Cooksey exercises Vestibular compensation – essentially teaches the
brain to ignore disorientating signals coming from the ear and to rely more on other senses.
Refer to vestibular rehab (physio via ENT)
Patients should do each exercise daily
eg. Sit and move eyes - at first slow, then quick up and down
from side to side
focusing on finger moving from 3 feet to 1 foot away from face
Standing
Eye, head and shoulder movements as before Changing form sitting to standing position with eyes open and shut Throwing a small ball from hand to hand (above eye level) Throwing a ball from hand to hand under knee Changing from sitting to standing and turning around in between Moving about
Circle around center person who will throw a large ball and to whom it
will be returned Walk across room with eyes open and then closed Walk up and down slope with eyes open and then closed Walk up and down steps with eyes open and then closed Any game involving stooping and stretching and aiming such as
bowling and basketball
BPPV When to Refer Recurrent and frequent - ? Needs vestibular training.
Any suspicion of central disorder
Still significantly symptomatic after a month, for confirmation of the diagnosis.
More specific or 'customized' exercises may be needed, preferably supervised by a specialist physiotherapist
Red flag symptoms associated with vertigo that require 'prompt' referral Unilateral hearing loss
Unilateral otorrhoea
neurological symptoms or signs
nystagmus has central features
spontaneous nystagmus persists after 48 hrs
positional vertigo/nystagmus which does not have all the features of posterior semi circular BPPV
significant vertigo/ imbalance persist after a month
positive fistula sign: pressure on the tragus reproduces symptoms (suggests endolymphatic fistula)
Any Questions?
What 4 questions helps you differentiate “dizziness”
1. Does the room spin around?
2. Do You feel like you may faint?
3. Do you feel unsteady?
4. Do you feel lightheaded?
What are the three most commonest vertigo presentations in primary care?
1. BPPV
2. Vestibular Neuronitis
3. Menier’s
What’s the Capital of? Iceland
Norway
Canada
South Africa
Reykjavík
Oslo
Ottawa
Pretoria (executive)
Blomefontein (judicial)
Cape Town(legislative
What percentage of primary care vertigo presentations do those 3 make up?
93
Which Vertigo? Most common after 40
years (50-70 commonest)
10% have Family Hx
Woman 2:1 Men
well young or middle aged adults (usually between 20 and 40 years old).
BPPV
Menieres
BPPV
Vestibular neuronitis
What 3 questions differentiate vertigo?
1. Duration of vertigo
2. Precipitation of vertigo?
3. Is hearing affected
Which countries and what leaders fought at: Waterloo
Trafalgar
France (Napoleon)
Combined forces of GB, NL, Prussia (Wellington and Von Blucher)
GB (Nelson)
France and Spain (Vielleneuve)
What percentage of BPPV will Epley cure?
80
What are Cawthorne-Cooksey exercises good for? Vestibular rehabilitation
Chronic vertigo and disequilibrium.
What are Brandt-Daroff Exercises good for Recurrent BPPV
Dr Corrigan What is Corrigan’s sign?
What is Corrigan’s door?
Waterhammer pulse in aortic regurgitation
Secret door he had made in his outpatient room to escape the never ending work.
I.e. Look after yourselves to look after them!!