The Epley maneuver appears to be a long-term, effective, and conservative treatment for BPPV that has a limited number of complications (nausea, vomiting, and residual vertigo) and is well tolerated by patients. However, study patients who were not provided with any activity restrictions, needed one or two additional treatment sessions to attain a successful outcome. It remains uncertain whether activity restrictions following the treatment improve the effectiveness of the canalith repositioning maneuver. It is important to instruct the patient that horizontal movement of the head should be performed to prevent stiff neck muscles. When doing so, the patient should be encouraged to perform horizontal movements of the head to maintain normal neck range of motion. This is most easily done by using a recliner chair or by using pillows arranged on a couch. This means sleeping with the head halfway between being flat and being upright (at a 45-degree angle). For the next two nights, patients should sleep in a semi-recumbent position. The patient may be instructed to be cautious of bending over, lying backward, moving the head up and down, or tilting the head to either side. During every step of this procedure, the patient may experience some dizziness.įollowing the treatment, the clinician may provide the patient with a soft collar, often worn for the remainder of the day, as a cue to avoid any head positions that may once again displace the otoconia. These steps may be repeated twice, for a total of three times during a procedure.
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