How to perform the Brandt-Daroff Exercise

First part of the exercise being shown with assistance

Second part of the exercise shown without assistance

Helpful hints

• Before recommending any form of positioning maneuver, it is important to ascertain whether the patient has current or past injuries of the neck or spine
• If possible neurological symptoms occur during the execution of positioning maneuvers, discontinue the procedure immediately and refer for the patient for a neurological evaluation. These symptoms might include blurred vision, numbness, weakness of the arms or legs or confusion
• In order for the exercise to be successful, the patient must remain in each position until the vertigo subsides plus an additional 30 seconds and the patient must perform all 10 revolutions of the This is time consuming and often challenging for the patient due to intense vertigo. Therefore, it is important that the patient is educated on what to expect during the exercise and has agreed to full compliance
• It is practical, if possible, to have another person there to assist the dizzy person with the exercise
• Without the patient's commitment to full compliance, performing the Brandt-Daroff exercises might be counter-productive in that otoconia may travel to different parts of the vestibular system and cause a worsening of symptoms
• You should instruct the patient that if they are doing the exercise properly, their symptoms will likely lessen in severity with each repetition. However, they should always do the full set of 10 complete revolutions

Procedure

1. Begin with the patient sitting upright on the edge of his bed
2. The patient will turn his head 45o toward either side, or as far as is comfortable
3. The patient moves from sitting position to side-lying position while maintaining the 45o angle of the head (the patient's nose should be pointed upward)
4. The patient lies in this position until his symptoms have subsided plus an additional 30 seconds
5. The patient returns to the sitting position and waits for symptoms to subside plus an additional 30 seconds
6. The patient should turn his head in the opposite direction and repeat the exercise

** The above description constitutes one revolution of the exercise. It is recommended that the patient perform ten complete revolutions of the exercise, three times daily.

References

• Brandt T, Daroff RB. Physical therapy for benign paroxysmal positional vertigo. Arch Otolaryngol 1980 Aug;106(8):484-485
• Fife TD, et al. (2008). Practice parameter: Therapies for benign paroxysmal positional vertigo (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology, 70(22): 2067-2074.

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