Brandt–Daroff Exercises
Home provocation exercises intended to relieve BPPV have been used since they were introduced by Brandt and Daroff in 1980. Home treatment has evolved since Brandt-Daroff published their original article promoting a “Physical Therapy” approach thought to promote habituation by repeatedly provoking the positional vertigo. Prior to 1980, many patients with symptoms of BPPV were advised to avoid the offending position.
Brandt and Daroff reported that 66 of 67 patients “experienced complete relief of the positional vertigo within 14 days, with most requiring 7 to 10 days. Positional nystagmus was absent too.” They had great results, but questioned the reason. People were getting better too fast to attribute their improvement to habituation or central compensation. They concluded that “there must be dispersion of otoliths.”
Brandt and Daroff speculated that repeated provocation of the positional vertigo would “promote loosening and ultimate dispersion of the otolithic debris from the cupula.” That is an important point: canalith repositioning, whether in the office or at home, does not involve the classic aspects of vestibular rehabilitation, such as adaptive plasticity and motor learning. It is a mechanical repair for a mechanical problem. Once the particles are mechanically moved from the canal to the vestibule, the condition is essentially “fixed.”
Although recent studies have demonstrated that a home version of the Epley maneuver is more effective than the Brandt Daroff exercises, many physicians still recommend the Brandt Daroff exercises for confirmed or suspected BPPV. We will discuss the home version of the Epley maneuver next week.
The Brandt–Daroff exercises are designed to provoke repeated episodes of BPPV in a controlled, safe manner. Here are links to a patient handout and a YouTube video demonstrating the correct technique.
[This is intended as a discussion among health care professionals and is not intended as medical advice. You should consult with your health care provider before attempting any home treatments]
