Epley and Semont Maneuvers for Vertigo

The Epley and Semont maneuvers are exercises used to treat benign paroxysmal positional vertigo (BPPV). They are done with the assistance of a doctor or physical therapist. A single 10- to 15-minute session usually is all that is needed.

When your head is firmly moved into different positions, the calcium crystal (canalith) debris causing vertigo will slip out of the semicircular canal into an area of the inner ear where it will no longer cause symptoms. Two maneuvers have been used successfully: the Epley maneuver and the Semont maneuver

The Epley maneuver is performed as follows:

  • You are seated, and the doctor turns your head 45 degrees horizontally toward the affected ear. You should hold the doctor?s arms for support.
  • The doctor tilts you backward to a horizontal position with your head kept in place at a 45-degree turn, hanging. An attack of vertigo is likely as the debris moves toward the apex of the canal. You are held in this position until the vertigo stops, usually within a minute.
  • The doctor turns your head 90 degrees toward the unaffected ear. The doctor then rolls you onto the side of the unaffected ear, so that you are now looking at the floor. The debris should move in the canal again, possibly provoking another attack of vertigo. You should remain in this position until the vertigo stops, usually within a minute.
  • The doctor helps you back to a seated position.

The Semont maneuver is performed as follows:

  • You are seated, and the doctor turns your head 45 degrees horizontally toward the unaffected ear.
  • The doctor tilts you 105 degrees so that you are lying on the side of the affected ear with your head hanging and your nose pointed upward. You remain in this position for 3 minutes. The debris should move to the apex of the canal.
  • The doctor then moves you quickly through the seated position, holding your head in place, until you are lying on the side of the unaffected ear with your nose pointed to the ground. You remain in this position for 3 minutes. The debris should move toward the exit of the canal.
  • The doctor then slowly moves you back to the seated position. The debris should fall into the utricle of the canal, where it will not cause vertigo.

Sometimes these maneuvers are done while you wear a vibrating headband. But the vibration may not help any more than the maneuver alone.1

In some cases, your doctor or physical therapist may have you do a modified Epley procedure at home. If your doctor has shown you how and you feel confident, you can try this at home to get rid of your vertigo.

 

Cawthorne-Cooksey Exercises

The aims of the Cawthorne-Cooksey exercises include

  • relaxing the neck and shoulder muscles,
  • training the eyes to move independently of the head,
  • practising good balance in everyday situations,
  • practising the head movements that cause dizziness (to help the development of vestibular compensation),
  • improving general co-ordination, and
  • encouraging natural spontaneous movement.

You should be assessed for an individual exercise programme to ensure you are doing the appropriate exercises. You could ask if it is possible for a friend or relative to accompany you at the assessment. It can be helpful if someone else learns the exercises and helps you with them.

You will be given guidance on how many repetitions of each exercise to do and when to progress to the next set of exercises. As a general rule, you should build up gradually from one set of exercises to the next. You might find that your dizziness problems get worse for a few days after you start the exercises, but you should persevere with them.

Make sure that you are in a safe environment before you start any of the exercises to reduce the risk of injury.

Cawthorne-Cooksey Exercises (rough cut) from Randy Heeren on Vimeo.

Video by Dr Edward Sho of the Home Clinic, courtesy of Randy Heeren, on Vimeo

1. In bed or sitting:

  1. Eye movements (move eyes slowly at first, then quickly)
  2. Up and down
  3. From side to side
  4. Focussing on finger moving from three feet to one foot away from face

 

Head movements (move head slowly at first, then quickly; with eyes open, then closed)

  1. Bending forwards and backwards
  2. Turning from side to side

2. Sitting:

  1. Eye and head movements, as 1
  2. Shrug and circle shoulders

C Bend forward and pick up objects from the ground

3. Standing:

  1. Eye, head and shoulder movements, as 1 and 2
  2. Change from a sitting to a standing position with eyes open, then closed
  3. Throw a ball from hand to hand above eye level
  4. Throw a ball from hand to hand under the knees
  5. Change from a sitting to a standing position, turning around in between

4. Moving about:

  1. Walk across the room with eyes open, then closed
  2. Walk up and down a slope with eyes open, then closed
  3. Walk up and down steps with eyes open, then closed
  4. Throw and catch a ball
  5. Any game involving stooping, stretching and aiming (for example, bowls or skittles)

Gaze stabilization exercises

The aim of gaze stabilization exercises is to improve vision and the ability to focus on a stationary object while the head is moving.

Your therapist should assess you and say which exercises are suitable for you.

  1. Look straight ahead and focus on a letter (for example, an E) held at eye level in front of you.
  2. Move your head from side to side, staying focussed on the target letter. Build up the speed of your head movement. It is crucial that the letter stays in focus. If you get too dizzy, slow down.
  3. Try to continue for up to one minute (the brain needs this time in order to adapt). Build up gradually to repeat three to five times a day.

You can also do this exercise with an up and down (nodding) movement.

Progressions with this exercise can include placing the target letter on a busy background and changing the position of your feet.