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Vestibular Rehabilitation: When to Consider the Epley Maneuver for TBI Patients

Vestibular Therapy for TBI

Are you facing the unnerving symptoms of vertigo as the result of a traumatic brain injury? Make an appointment with a neurologist in NYC at Neurodiagnostics Medical, P.C., and see what vestibular rehabilitation therapy (VRT) can do for you.

Any time you hit your head, there’s a real risk you could sustain a traumatic brain injury. If you’re in a car accident, sustain a blow to the head at work, collide with someone on the field, or slip and fall, you need to take it seriously. In fact, even when you think it’s a mild bump, seeing a neurologist in New York for a head injury might be critical to preventing life-altering symptoms.

The CDC defines a TBI as any injury that affects how your brain works, and this includes concussions. Even a mild concussion affects your memory, concentration, and problem-solving. Aside from this, one of the most common side effects of any TBI is vertigo or feelings of dizziness and imbalance. 

The Journal of Neurology’s study revealed that 50% of people under age 40 who experience a concussion will develop vertigo within five years. These symptoms are also a leading reason for disability that keeps many of these people from working. Thankfully, one option worth exploring for TBI patients living with a specific type of vertigo is vestibular rehabilitation, which helps to manage and improve symptoms. 

Could a vestibular specialist help you alleviate the effects of vertigo to improve your balance, vision, and more? Absolutely. Here’s more about methods such as the Epley Maneuver if you’re wondering about rehabilitation therapy after a TBI.

The Basics of Vestibular Rehabilitation Therapy

To explain how vestibular rehabilitation therapy works, it’s helpful to understand what happens during a TBI

While the human brain is soft and pliable, your skull and surrounding membrane provide ample protection from most hazards. However, any time your head sustains a sudden impact, the brain can move and hit against your skull. This impact alone can stretch and even break neurons, which directly affects your brain function.

These injuries cause problems with critical systems like your vestibular system. This controls your balance, and when it struggles, you might experience:

  • Dizziness
  • Problems focusing your gaze
  • Feeling of an imbalance while standing or walking

The vestibular network comprises neural pathways and structures inside the brain, which respond to signals that come from your inner ear. Vestibular disorders, or issues with balance and dizziness, can come from within your ear or from disruptions to your brain pathways. That’s why vestibular rehabilitation therapy focuses on treating issues such as: 

  • Benign paroxysmal positional vertigo, which can cause mild to severe dizziness 
  • Meniere’s syndrome, which can cause hearing loss and ringing in the ears 
  • Vestibular migraines 
  • Concussions

Vestibular rehabilitation is also a common treatment for people with Multiple Sclerosis or recovering from a stroke.

Vestibular Therapy for TBI 

When you see a neurologist in New York for a vestibular rehabilitation program, it may include several types of therapy, but all of these programs are quite effective.

According to a review in the British Journal of Medicine, vestibular therapy reduced symptoms in patients with sports-related concussions faster. They were three times as likely to return to play within eight weeks of the therapy than those who didn’t go through the treatments.

So, while much vestibular rehabilitation runs parallel to regular physical therapy, there’s value in the additional equipment or devices your therapist will use to address visual, sensory, and balance issues. They may also introduce specific exercises, like the Epley Maneuver. 

What Is the Epley Maneuver?

What Is the Epley Maneuver?

The Epley Maneuver is a buzzword in the world of TBI therapy, but it’s just a simple exercise to treat benign paroxysmal positional vertigo. This very specific form of vertigo is quite common after a TBI. It is also associated with: 

  • Age
  • Ear infections
  • Changing positions too quickly
  • Intense exercise

To understand the Epley Maneuver, let’s look at the inner ear a little closer.

As a critical part of your vestibular system, the inner ear contains semicircular canals. These canals send signals about motion and movement to your brain, which helps you remain upright and feel balanced. The nearby utricle, another part of the inner ear, also contains calcium crystals (canaliths), which detect motion and power those other signals.

When you experience an impact TBI, these canaliths in the utricle can dislodge and move into the semicircular canals. When this happens, the ear sends incorrect signals to your brain and makes you feel dizzy. You might also experience nausea, a headache, a whooshing sensation, or vision-related issues.

With the Epley Maneuver, the simple movement aims to move wayward canaliths back into the utricle where they belong. The effect should alleviate your dizziness and other symptoms. Plus, if BPPV is the source of your symptoms, then the Epley Maneuver will provide lasting relief (the Cleveland Clinic reports a success rate of over 80%, and Canadian Family Physicians reports that one out of every two or three patients experience complete symptom relief).

If your vertigo symptoms are due to a different vestibular injury, this exercise won’t help much.

How a Neurologist in NYC Diagnosis BPPV 

Because the Epley Maneuver is only effective for BPPV, your neurologist or physical therapist will want to rule out other reasons for your symptoms first. The Epley Maneuver is safe for most people, but not for anyone with a neck or back injury or retinal detachment.

We’ve seen that a head injury is a common cause of BPPV, so it’s critical that you seek a diagnosis as soon as possible. Imaging tests like an MRI or CT scan may apply.

However, to determine whether you have this type of vertigo, the doctor will take a complete medical history and gauge how well you can keep your eyes focused. They’ll also look for unusual jerking movements in the eyes. This test for “nystagmus” involves the doctor moving your upper body around quickly to bring on vertigo. 

If the doctor diagnoses BPPV, then the Epley Maneuver will likely be the first course of treatment. During vestibular rehabilitation, BPPV generally responds well to the Epley Maneuver, and you will also learn to do the move at home to alleviate symptoms as they arise. Doctors from Johns Hopkins Medicine note that it’s very common for symptoms of BPPV to lessen over time and eventually resolve on their own.

Make Your Appointment With a Neurologist in New York for TBI Treatment 

Any time you experience a hard blow to your head, it’s wise to seek immediate medical treatment. You’ll want to rule out a severe TBI and prevent ongoing health issues, and that’s what professionals like Neurodiagnostics Medical P.C. do for people in the New York Metro area. The comprehensive neurological care includes care for concussions, headaches, chronic migraines, and more. 

Regardless of whether you’ve sustained a TBI, you don’t have to let the symptoms of vertigo disrupt your life. Our neurologist in NYC at Neurodiagnostics Medical, P.C. is just a call away at (347) 602-9530. Our doctors accept most insurance plans, including workers’ compensation, no-fault, and PIP (personal injury protection), and same-day appointments may be available.

Effective vestibular injuries treatment begins with a prompt and accurate diagnosis, so even if you don’t think your accident caused a problem, it’s imperative that you schedule a visit with a neurologist. Undiagnosed problems cause debilitating symptoms months or even years later, so don’t wait.

Frequently Asked Questions 

The Epley Maneuver is a safe and effective way of improving symptoms of a concussion, but you likely have a few questions. Common patient queries include the following:

Is There Anything You Should Not Do After the Epley Maneuver?

There are one or two things you should not do after the Epley Maneuver, even if it has reduced your symptoms of vertigo immediately. For example, for the rest of the day after treatment, you should avoid bending over. You also shouldn’t sleep on the side where you had symptoms for a few days.

Why Didn’t the Epley Maneuver Help With My Vertigo?

If the Epley Maneuver didn’t help with your vertigo, it might be because this vestibular therapy technique does not help all vertigo or balance problems. It can even make things worse if the issue isn’t due to canaliths in the posterior semicircular canal. For example, if your symptoms stem from the otolith organ or a neurological issue, the Epley Maneuver will be ineffective.

How Many Times Should You Perform the Epley Maneuver?

You can perform the Epley Maneuver whenever you have symptoms of vertigo. If the ear is your source of vertigo, you’ll visit a healthcare provider or physical therapist to learn the technique during vestibular rehabilitation sessions. Most people experience immediate relief; others repeat it up to three times to experience the full effect.

What Happens If You Perform the Epley Maneuver Incorrectly?

If you perform the Epley Maneuver incorrectly, such as with the wrong ear, the only effect will be vertigo symptoms that remain. However, if you don’t follow the vestibular rehabilitation therapist’s instructions, doing the move could cause a neck injury or exacerbate your symptoms.

About The Author

Picture of Ashwin Malhotra, M.D.

Ashwin Malhotra, M.D.

Ashwin Malhotra, M.D. is a highly respected neurologist based in New York City. With over 20 years of experience in the field of neurology, he has earned a reputation as a leading expert in the diagnosis and treatment of neurological disorders and traumatic brain injuries. In addition to his clinical work, Dr. Malhotra is also a dedicated educator and researcher. He has published numerous articles in peer-reviewed medical journals and has presented his research at national and international conferences.