Comparison of Half-Somersault Exercise With Brandt-Daroff Exercise in BPPV.
Condition: Vertigo, Paroxysmal
MeSH terms: Vertigo; Benign Paroxysmal Positional Vertigo; Dizziness
Study type: Interventional

Summary: 
      This study is important as there are numbers of BPPV patients presenting to outpatient
      departments which needs more efficient techniques for management of BPPV. Talking about
      literature, there are numbers of studies done on different maneuvers but there is yet no
      study available which compares these maneuvers. So the purpose of this study is to compare
      these techniques to find which one is more effective in treating PC-BPPV.
    

Detailed description: 
      Benign paroxysmal positional vertigo (BPPV) is one of the most common causes in patients with
      vestibular disorders .BPPV has often been described as "self-limiting" because symptoms often
      subside or disappear within six months of onset . BPPV may be characterized by sudden changes
      in the position of the head, such as lying down on one or both sides, looking right or left
      side . Vertigo is defined as illusion of movement which could be spinning, rocking, tilting
      or dropping . Benign paroxysmal positional vertigo (BPPV) is the most frequent vestibular
      disorder and the leading cause of vertigo in adults.BPPV may be divided into 3 types based on
      canal involvement i.e Posterior, Horizontal, and Anterior Semicircular Canal BPPV. BPPV
      clinical findings agree with the hypothesis that semicircular canals with greater incidence
      is posterior canal, have floating particles or debris, which are heavier than the circulating
      endolymph . The vestibular system is located in the inner ear and consists of the utricle,
      saccule and three semicircular canals (i.e. posterior, anterior and horizontal). These canals
      react to rotational movements of the head . Of the types of BPPV, posterior semicircular
      canal BPPV (PC-BPPV) is the most common form, accounting for 85 to 90% of cases Lateral Canal
      BPPV is about 20%, and Anterior Canal BPPV is very rare as it is self-treated due to gravity
      . BPPV accounts for 8% of the subjects with moderate or severe dizziness/vertigo. It may be
      present in child hood but increases with age. The lifetime prevalence is estimated to be 2%.
      It´s reported that the oneyear prevalence is 0.5% in 18-39 years old and 3.4% in people over
      60-years of age . Benign paroxysmal positional vertigo (BPPV) is the paroxysmal transient
      vertigo caused by specific changes in head position, accounting for 60% of peripheral
      vertigo, with an incidence rate of approximately 64/10000 . The average recurrence rate is
      around 50%. BPPV is more common in women than men; and the ratio of women to man population
      is 2:1.BPPV can be caused either by canalithiasis or by cupulolithiasis. Movement of the head
      causes these otoliths to inappropriately trigger the receptors in the semicircular canals and
      send false signals to the brain, causing vertigo and nystagmus . Factors that can be helpful
      in guiding the clinician in the evaluation of the patient with dizziness include the
      characteristics of the dizziness; associated symptoms (ie, hearing loss or tinnitus) duration
      of symptoms; and what, if anything, triggered the symptoms (precipitating factors) .
      Posterior canal BPPV is treated using canalith repositioning procedures, the most common of
      which is the Epley maneuver(EM) , half somersault exercises , Brandt Daroff exercise , Semont
      maneuver, vestibular habituation exercises, balance and eye exercises . Dix-Hallpike test is
      used to diagnose BPPV patients . Paramasivan Mani et al suggested in their study that half
      somersault exercise with Brandt Daroff exercise for 3 weeks showed significantly greater
      improvement in reducing self-perceived handicap among Patients with Posterior Canal Benign
      Paroxysmal Positional Vertigo . Ashok Kumar Gupta et.al concluded that Epley maneuver has
      produced maximum improvement than Semont maneuver and least improvement was produced by
      Brandt-Daroff Exercises . Herman Guild Manayil John et al observed in their study that
      Epley's manoeuvre to be a simple, useful and cost-effective treatment for BPPV . Nevzat
      Demirbilek, conducted a study of Combined Epley and Semont Maneuver in Benign Paroxysmal
      Positional Vertigo and concluded that, the combined maneuvers in our study were found to have
      an increased success rate . Devangi S. Desai et al concluded that, both Epley's maneuver and
      Brandt-daroff treatment approaches are effective in reducing symptoms and improving
      independence level but combined approaches can give better results so modified
      epley'smaneuver should be applied 3 times in one session along with brandt- daroff exercise
      as home exercise .
    

Intervention name(s): Group I Brandt-Daroff Exercises; Group II Half-Somersault Maneuver
Intervention type(s): Other; Other
Intervention description(s): In group I Brandoff Exercises will be performed using standard method, in which the patient is in the sitting position on examination table, the patient moves into the lying position on the affected side on the shoulder, with the head angled upward with about 45. The patient stays in this for 30 s and then goes back to the sitting position, looks forward and remains in this position for 30 s as well. The patient repeats the same procedure for the other side, too.
The patient performs this maneuver 2 times, twice a day. For total 9 days for 3 weeks. Pre, mid and post assessment.; In group II Half-Somersault Maneuver will be done, the patient performs this maneuver 2 times, twice a day. For total 9 days for 3 weeks.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: Half-Somersault Exercise; Brandt-Daroff exercise; Posterior Canal; Benign Paroxysmal Positional Vertigo