Patient Information BrandtDaroff Exercises Innovation and excellence in health and care Page of Addenbrookes Hospital l Rosie Hospital Audiology Department Home treatment of Benign Paroxysmal Posit
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Presentation on theme: "Patient Information BrandtDaroff Exercises Innovation and excellence in health and care Page of Addenbrookes Hospital l Rosie Hospital Audiology Department Home treatment of Benign Paroxysmal Posit"â€” Presentation transcript:
Page 1 Patient Information Brandt-Daroff Exercises Innovation and excellence in health and care Page 1 of 4 Addenbrooke’s Hospital l Rosie Hospital Audiology Department Home treatment of Benign Paroxysmal Positional Vertigo (BPPV) Brandt-Daroff Exercises Who is the leaflet for? What is its aim? This leaflet is for patients who have been diagnosed with Benign Paroxysmal Positional Vertigo (BPPV). It aims to describe how to perform Brandt-Daroff exercises so that you are able to carry out the exercises yourself. Brandt-Daroff exercises are usually used as a home trea tment where it is di fficult to carry out other types of treatment manoeuvre, or where these manoeuvres have not been successful. Please see the BPPV leaflet for more information on BPPV in general. How to carry out the exercises The Brandt-Daroff exercises should be performed for two or three weeks and a suggested schedule is as follows: (one repetition = manoeuvre done to each side in turn [taking two minutes]) Time Exercise Duration Morning 5 repetitions 10 minutes Noon 5 repetitio ns 10 minutes Evening 5 repetitions 10 minutes Brandt-Daroff exercises are carried out as fo llows, and as shown in Figure 1 below: 1. Sitting comfortably sideways on, in the middle of your bed (position 1), turn your head 45 degrees to one side. 2. Keeping your head 45 degrees to one side, lie down sideways on the bed in the opposite direction to the way your head is turned. For example, if your head is turned to the left then lie down onto your right side (position 2). 3. This movement may provoke a brief sensat ion of dizziness or vertigo. Stay in this position for 30 seconds or until the dizziness has passed if this is longer. 4. Return to the sitting position (position 3), staying there for 30 seconds. 5. Turn your head 45 degrees in the opposite direction to previously and go through the same routine but to the other side. This means keeping your head turned 45 degrees to one side and lying down sideways on the bed to the side opposite to the way your head is turned. For example, if your head is turned to the right then lie down onto your left side (position 4). Page 2 Patient Information Brandt-Daroff Exercises Innovation and excellence in health and care Page 2 of 4 Addenbrooke’s Hospital l Rosie Hospital 6. Again this movement may provoke a brief sensation of dizziness. Stay in this position for 30 seconds or until the di zziness has passed if this is longer. 7. Return to the sitting position (position 1), staying there for 30 seconds. 8. Repeat, as according to your schedule. 9. On completion of your set of exercises ensure you stay sitting on the side of your bed until any dizziness has pass ed and you feel safe to stand up. Figure 1. Brandt-Daroff Exercises , with permission, from Hain TC. http://www.dizziness-and-balance.com/disorders/bppv/bppv.html , 02/08/2013. 1 Benefits Brandt-Daroff exercises are carried out to try to reduce or resolve your dizziness associated with BPPV. This may occur by either: repositioning the chalky crystals that have broken free in your balance organ back to their normal position dissolving or dispersing the crystals in the fluid of the balance canal, or exposing your brain to the unpleasant dizzy sensations on a repeated enough basis that it no longer recognises these sensations and the dizziness subsides (this is a recognised phenomenon called habituation). Research studies have suggested that Brandt-Daroff exercises are effective in ¼ to ½ of patients. 3,4,5,6 Overall, Brandt-Daroff exercise s are considered less effective than other treatment manoeuvres for BPPV, but sometimes are still worth trying especially when other manoeuvres are not suitable. Page 3 Patient Information Brandt-Daroff Exercises Innovation and excellence in health and care Page 3 of 4 Addenbrooke’s Hospital l Rosie Hospital The Brandt-Daroff exercises are relatively easy to carry out at home. As a home treatment they enable you to perform frequent repetitions of the manoeuvre yourself, giving the treatment a better chance of resolving your BPPV without frequent visits to the clinic. It may also help to know how to carry out the procedure if you have a recurrence of BPPV. The Brandt-Daroff manoeuvre requires a turn but not extension of the neck and so may be more suitable for you than other manoeuvres if you have neck problems in particular, especially when exercises ar e being carried out at home without the supervision of a clinician. An advantage of Brandt-Daroff exercises ov er some other treatment manoeuvres is that you do not need to know which ear is affected by BPPV in order to carry it out correctly. Risks Only attempt the Brandt-Darof f exercises at home if you have been advised to do so by your audiologist or other healthcare professional. The procedure is not always recommended if you have a known neck or ba ck problem, or any difficulty breathing when lying down. If you are in any doubt about your suitability then speak to your audiologist or healthcare professional. It is always recommended that you have someone with you when performin g the Brandt-Daroff exercises. Brandt-Daroff exercises require repetitive movements that are likely to provoke dizziness in individuals with BPPV. Some dizziness cannot be avoided in order to carry out the manoeuvre correctly. If you ar e finding it difficult to cope with this dizziness then change your schedule of ex ercises to fewer repetitions per day or take a break from the exercises for a day or more before recommencing your schedule. If the exercises are provoking severe dizziness then stop your schedule and speak to your audiologist or other healthcare professional. Some patients may not be able to tolerate the repetitive provocation of their dizzy symptoms by these exercises and will have to stop the schedule entirely. There is a chance that the Brandt-Daroff exercises can lead to BPPV in a different part of the balance organ. If this happens then alternative treatments should be available. Alternatives If you prefer not to carry out home exercises for BPPV or your clinician has advised you not to, then you may be able to receive suitable treatments from the vestibular audiologists or other healthcare professional in clinic instead. Contacts/Further information Vestibular Audiologists, Audiolog y Department, Tel: 01223 217797 Page 4 Patient Information Brandt-Daroff Exercises Innovation and excellence in health and care Page 4 of 4 Addenbrooke’s Hospital l Rosie Hospital References/ Sources of evidence 1. Brandt T, Daroff RB. Physical therapy for benign paroxysmal positional vertigo. Arch Otolaryngol 1980; 106: 484-5. 2. Hain TC. Benign Paroxysmal Positional Vertigo. Chicago Dizziness and Hearing. http://www.dizziness-and-balance.com/disorders/bppv/bppv.html , 02/08/2013. 3. Soto Varela A, Bartual Magro J, Santos Perez S, Velez Regueiro M, Lechuga Garcia R, Perez-Carro Rios A, Caballe ro L. Benign paroxysmal vertigo: a comparative prospective study of the effi cacy of Brandt and Daroff exercises, Semont and Epley maneuver. Rev Laryng ol Otol Rhinol (Bord) 2001; 122: 179- 83. 4. Radtke A, Neuhauser H, von Brevern M, Lempert T. A modified Epley’s procedure for self-treatment of benign paroxysmal positional vertigo. Neurology 1999; 53: 1358-60. 5. Helminski JO, Zee DS, Janssen I, Hain TC. Effectiveness of particle repositioning maneuvers in the treatment of benign pa roxysmal positional vertigo: a systemic review. Phys Ther 2010; 90: 663-78. 6. Amor-Dorado JC, Barreira-Fernandez MP, Aran-Gonzalez I, Casariego-Vales E, Llorca J, Gonzalez-Gay MA. Particle repositioning meneuver versus Brandt-Daroff exercise for treatment of unilateral idiopa thic BPPV of the posterior semicircular canal: a randomized prospective clinical trail with short- and long-term outcome. Otol Neurotol 2012; 33: 1401-7. We are currently working towards a smoke free site. Smoking is only permitted in the designated smoking areas. For advice and support in quitting, contact your GP or the free NHS stop smoking helpline on 0800 169 0 169 Help with this leaflet: If you would like this info rmation in another language, large print or audio format, please ask the department to contact Patient Information: 01223 216032 or email@example.com Document history Authors Richard Knight Department Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ www.cuh.org.uk Contact number 01223 217797 Publish/Review date January 2014/January 2017 File name Brandt_Daroff_Exercises.doc Version number/Ref 1/PIN3464