Epley Maneuver & Brandt-Daroff Drills: How Physiotherapists Treat Vertigo

The Mechanical Logic of the Epley Maneuver

The Epley maneuver is a four-step canalith repositioning procedure designed by Dr. John Epley to treat posterior canal BPPV. It leverages gravity and head rotations to shepherd loose otoconia debris through the arch of the posterior semicircular canal.

Performing the maneuver accurately requires knowing which ear is affected. A physiotherapist first conducts a Dix-Hallpike test to observe the direction and duration of rotational eye nystagmus to pinpoint the symptomatic side.

• Position 1: Patient seated, head turned 45 degrees toward the affected ear, quickly laid flat with neck extended 20 degrees.
• Position 2: Head rotated 90 degrees toward the opposite (unaffected) ear, held until nystagmus ceases.
• Position 3: Patient rolls onto their side, head turned another 90 degrees looking down at the floor.
• Position 4: Patient carefully brought back up into a seated position with chin tucked.

Brandt-Daroff Exercises for Habituation and Recurrence Prevention

When residual dizziness lingers after an Epley maneuver, or for patients with mild recurring vertigo, Brandt-Daroff exercises serve as home vestibular habituation therapy. They accelerate central nervous system adaptation to sensory mismatch.

Exercises involve sitting upright, quickly lying down onto one side with head turned upward, waiting 30 seconds, sitting back up, and repeating on the opposite side.

• Performed in sets of 5 repetitions on each side, twice daily for two weeks.
• Mild dizziness during the exercise is expected and indicates the vestibular system is adapting.
• Discontinue and seek clinical reassessment if neck pain or severe nausea occurs.

Safety Precautions and In-Home Clinical Guidance

Attempting self-administered Epley maneuvers without knowing which canal is involved can displace crystals into the horizontal canal, worsening symptoms into violent lateral spin. Professional assessment ensures accurate diagnosis.

CareMotion's qualified home-visit physiotherapists provide expert vestibular testing, gentle repositioning maneuvers, and supportive balance retraining across Kolkata.

• Keep eyes open during the maneuver so the clinician can observe diagnostic nystagmus beats.
• Sleep with two pillows for the initial day post-repositioning to keep the head slightly elevated.
• Avoid extreme dentist-chair neck extension or washing hair backwards at beauty salons immediately after.

Useful next steps

• Balance and coordination training
• Meet our licensed team
• Book an assessment visit

Further reading

• Vestibular Disorders Association: BPPV and Epley Maneuver