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!!