Vertigo training according to Epley

The Epley maneuver is designed to remove the causative trigger for benign paroxysmal postural vertigo. Free-moving otoliths in the archways transmit misleading information to the brain. They do not match those of the other sensory organs.

With the help of a fixed sequence of different movement maneuvers, one tries to move the ear stones into a static position with the help of gravity. The procedure is as follows: The patient sits on an examination couch with stretched legs and turns his head by 45 degrees to the affected side. Now the patient moves quickly into a lying position with the head slightly protruding over the top of the couch.

The affected side touches the support. Even if dizziness and a nystagmus should occur, stay in this position for one minute. Then the patient moves the head quickly by 90 degrees and remains in this position for one minute.

Then the patient turns his entire body 90 degrees in the direction of the head for one minute. The eyes look towards the floor. Finally, the patient quickly straightens up into the sitting position.

Already 50% of the patients show a clear improvement after the first treatment. In the remaining cases, it is recommended to repeat the procedure up to three times a day, in which the duration of the individual head positions can be reduced to 30 seconds. Quick head movements in space are crucial for the success of the maneuver.

Exercises

It is recommended to do the vertigo training two or three times a day and to repeat each exercise frequently. Although certain drugs suppress the dizziness symptoms, they counteract the learning process of cerebral structures. In this sense, medication should be avoided as far as possible and should only be resorted to in the case of severe nausea and vomiting.

The training should be increased gradually. Only when the exercises in the sitting posture are successful, do you switch to standing. The same applies to the transition from standing to walking.

In a sitting position: Standing: While walking:

You start by slowly moving your eyes up and down. After ten repetitions, the same exercise is done with a now rapid movement from top to bottom. Similarly, the eyes are then moved ten times slowly, then quickly from left to right.
The exercise for head movement is similar.
The practitioner tilts the head slowly forward so that the chin approaches the sternum. He then moves the head at the same speed in the opposite direction and stretches the neck. After ten repetitions, the exercise is performed in the same way with one quick movement.

The same principle is then applied when turning the head from left to right.
Another sitting exercise is the bending of the torso towards the floor, just as if the practitioner were lifting an object. The exercise should be performed ten times slowly and ten times quickly.
At the end of the sitting exercises, the upper body is rotated ten times, initially with open eyes on both sides. Then the same exercise is done ten times with closed eyes.
The exercises in standing position are similar.
First, the eye movements, head movements and slow rotation are repeated ten times in the standing position.
Now the practitioner provides a chair from which he or she moves ten times from a sitting position to an upright posture with stretched legs. In the first ten repetitions the exercise is done with open eyes, in the second with closed eyes.
For the following exercise a small ball is needed. It is thrown ten times from the right hand to the left hand and vice versa.
Make sure that the hands are at eye level.
Following the exercises in standing position, dynamic tasks can be performed while walking. First the practitioner walks ten times through a room with open eyes for about half a minute. He does the same with his eyes closed.
The one-legged stance is practiced alternately five times on the right foot, then five times on the left foot.
The eyes remain open.
Performing the same exercise with eyes closed is a challenge. It may take some time before it is successful. At the beginning, fixed holding aids can be used.
The last two exercises train the so-called tightrope walk.
The practitioner sets one foot in front of the other on an imaginary rope with open eyes. He repeats this five times. If he can do the tightrope walk with his eyes open, he can do the same exercise five times with his eyes closed.

A swivel chair is often used initially in the diagnosis of dizziness.

The person affected is placed on the chair and must also wear so-called Frenzel glasses. These have such strong lenses that nobody can see clearly through them. This means that the brain cannot rely on the information from the eyes when turning, but only on the signals from the organ of equilibrium.

The affected person is turned in a circle on the chair. So-called nystagmus, or rapid eye movements, should be observed. In vertigo training, a swivel chair can only be used at the very end of the therapy.