For patients who either fail or cannot tolerate canalith repositioning procedures (CRP), self-administered exercises may be used. They may be performed safely at home, and do not require a skilled practitioner.
For patients with recurrent BPPV, patients are treated with a canalith repositioning procedures, and then are asked to perform Brandt-Daroff exercises daily, each morning, for prophylaxis against further episodes. These exercises are also useful in habituating the phobic responses, which commonly develop in patients with an associated anxiety disorder1.
Self-administered CRP: The Epley and Semont manoeuvres have both been modified for self-administration by patients for the treatment of BPPV; the Epley appears to be more effective.
Self-administered CRP appears to be more effective than self-treatment with Brandt-Daroff exercises2.
Brandt-Daroff exercises
The patient sits upright on the edge of the bed, with the head turned 45 degrees to one side. The patient is instructed to move rapidly down into the side-lying position, keeping the head turned in the same direction. This position is maintained until the precipitated vertigo subsides, or at least for 30 seconds. The patient then returns to the upright position, and holds this position for an additional 30 seconds. The head is then turned in the opposite direction, and the same procedure is repeated on the other side. Patients repeat the whole sequence until vertigo is no longer experienced with changes in position. These exercises may be performed several times each day, and should continue until at least one full day after no symptoms of vertigo are experienced3.
