Sungacha Epley does not include vibrations of the mastoid process originally indicated by Epley, as the vibration procedures have been proven ineffective. The modified procedure has become that now described generally as the Epley maneuver. Effectiveness. An Epley maneuver is a safe and effective treatment for BPPV, although the condition recurs in approximately one third of cases. Sequence of positions. The following sequence of positions describes the Epley maneuver: These steps may be repeated twice, for a total of three times during a procedure. During every step of this procedure, the patient may experience some dizziness. Post-treatment phase. Following the 	Epley maneuver
6677793	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. 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. For the next two nights, patients should sleep in a semi-recumbent position. This means sleeping with the head halfway between being flat and being upright (at a 45-degree angle). This is most easily done by using a recliner 	Epley maneuver
6677794	chair or by using pillows arranged on a couch. The soft collar is removed occasionally. When doing so, the patient should be encouraged to perform horizontal movements of the head to maintain normal neck range of motion. It is important to instruct the patient that horizontal movement of the head should be performed to prevent stiff neck muscles. It remains uncertain whether activity restrictions following the treatment improve the effectiveness of the canalith repositioning maneuver. However, study patients who were not provided with any activity restrictions, needed one or two additional treatment sessions to attain a successful outcome. The Epley 	Epley maneuver
6677795	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. Background information. The goal of an Epley maneuver is to restore the equilibrium of the vestibular system, more specifically, to the semicircular canals, in order to treat the symptoms associated with BPPV. There is compelling evidence that free-floating otoconia, probably displaced from the otolithic membrane in the utricle are the main cause of this disequilibrium. Recent pathological findings also suggest that the displaced otoconia typically settle in the 	Epley maneuver
6677796	posterior semicircular canal in the cupula of the ampulla and render it sensitive to gravity. The cupula move in relation to acceleration of the head during rotary movements and signal to the brain via action potentials about which way the head is moving in relation to its surroundings. However, once a crystal becomes lodged in the cupula, it only takes slight head movements in combination with gravity, to create an action potential, which signals to the brain that the head is moving through space, when in reality, it is not, thus creating the experience of vertigo associated with BPPV. When 	Epley maneuver
6677797	a therapist is performing an Epley maneuver, the patient's head is rotated to 45 degrees in the direction of the affected side, in order to target the posterior semicircular canal of the affected side. When the patient is passively positioned from an upright seated posture down to a supine (lying on the back) position, this momentum helps to dislodge the otoconia (crystal) embedded in the cupula. Steps 3–10 in the above-mentioned procedure are intended to cause the newly dislodged crystal to be brought back to the utricle through the posterior semicircular canal so that it can be re	Epley maneuver
6677798	-absorbed by the utricle. In 1957, John M. Epley received his M.D. degree from the University of Oregon Medical School (now Oregon Health Sciences University). While a resident at Stanford Medical School he conducted original research on the first multichannel cochlear implant. He developed his BPPV technique in 1979. He died July 31, 2019. Epley maneuver The Epley maneuver or repositioning maneuver is a maneuver used by medical professionals to treat one common cause of vertigo, benign paroxysmal positional vertigo (BPPV) of the posterior or anterior canals of the ear. The maneuver works by allowing free-floating particles, displaced otoconia	Epley maneuver
6677799	Sungacha Sungacha The Sungacha or Songacha ( Sungacha" or Сунгач "Sungach", ) is a river marking part of the border between the Russian Federation and the People's Republic of China. It is a left tributary of the Ussuri, and the only outflow of Khanka Lake. The -long Sungacha's length fluctuates, as the stream bed changes every year. The area of its basin is approximately , of which within Russia. The river supports a rich diversity of flora and fauna, including "Nelumbo nucifera" in its basin. The Sungacha's waters come from rain, snow and springs. Sungacha The Sungacha or Songacha ( "Sungacha" or