Inter-individual Variability in Processing of the Sémont Liberatory Manoeuvre

Czech version

Authors: M. Stehlíková ¹; O. Čakrt ¹; I. Bodlák ²; Z. Čada ³; R. Černý ⁴; J. Jeřábek ⁴
Authors‘ workplace: Klinika rehabilitace a tělovýchovného lékařství 2. LF UK a FN v Motole, Praha ¹; Princip a. s., Praha ²; Klinika otorinolaryngologie a chirurgie hlavy a krku 1. LF UK a FN v Motole, Praha ³; Neurologická klinika 2. LF UK a FN v Motole, Praha ⁴
Published in: Cesk Slov Neurol N 2015; 78/111(1): 38-43
Category: Original Paper
doi: https://doi.org/10.14735/amcsnn201538

Overview

Aim:
Sémont liberatory manoeuvre is used in the treatment of posterior semicircular canal in patients with benign paroxysmal positional vertigo. The aim of the study was to determine the inter-individual and intra-individual variability in the processing of the manoeuvre and to define the parameters that affect it the most.

Methods:
Three experienced therapists applied the manoeuvre bilaterally in 10 healthy probands. Inertial measurement unit consisting of the accelerometer and gyroscope recorded the trajectory and speed. Angle changes were placed in the coordinate reference system. Accuracy of the manoeuvre was evaluated based on the deviations from the projected sensory plane.

Results:
Parameters affecting the accuracy of the manoeuvre included height of a proband (p = 0.0252), phase of the movement (p < 0.0001), therapist and the side of the movement. The effect of these factors is the most pronounced when combined. We assessed interactions of the phase of the movement and the height of the probands (p = 0.0130), the therapist and the phase of movement (p = 0.0001), the therapist and the height of the probands (p < 0.0252). The largest magnitude of deviation from the sensory plane was in the range of –37.17° to 31° with a standard deviation of 16.6°.

Conclusions:
The data highlight high variability in the implementation of the Sémont liberatory manoeuvre, whether measurements by a single therapist or inter-individually between the therapists are compared. Analysis of the impact of these deviations on therapeutic efficacy in patients with benign paroxysmal positional vertigo and detailed analysis of influencing parameters should be the subject of further research.

Key words:
benign positional paroxysmal vertigo – variability – Sémont liberatory manoeuvre

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.

Sources

1. Fife TD. Positional dizziness. Continuum (Minneap Minn) 2012; 18(5): 1060– 1085. doi: 10.1212/ 01.CON.0000418376.80099.24.

2. von Brevern M, Radtke A, Lezius F, Feldmann M, Ziese T, Lempert T et al. Epidemiology of benign paroxysmal positional vertigo: a population based study. J Neurol Neurosurg Psychiatry 2007; 78(7): 710– 715.

3. Dagan E, Wolf M, Migirov LM. Why do geriatric patients attend otolaryngology emergency rooms? Isr Med Assoc J 2012; 14(10): 633– 636.

4. Parnes LS, Agrawal SK, Atlas J. Diagnosis and management of benign paroxysmal positional vertigo (BPPV). CMAJ 2003; 169(7): 681– 693.

5. Radtke A, von Brevern M, Tiel‑ Wilck K, Mainz‑ Perchalla A, Neuhauser H, Lempert T. Self‑ treatment of benign paroxysmal positional vertigo: Sémont maneuver vs Epley procedure. Neurology 2004; 63(1): 150– 152.

6. Cohen HS, Kimball KT. Effectiveness of treatments for benign paroxysmal positional vertigo of the posterior canal. Otol Neurotol 2005; 26(5): 1034– 1040.

7. Toupet M, Ferrary E, Bozorg GA. Effect of repositioning maneuver type and postmaneuver restrictions on vertigo and dizziness in benign positional paroxysmal vertigo. Scientific World Journal 2012; 2012: 162123. doi: 10.1100/ 2012/ 162123.

8. Brandt T, Huppert D, Hecht J, Karch C, Strupp M. Benign paroxysmal positioning vertigo: a long‑term follow‑up (6– 17 years) of 125 patients. Acta Otolaryngol 2006; 126(2): 160– 163.

9. Semont A, Freysse G, Vitte E. Curing the BPPV with a liberatory maneuver. Adv Otorhinolaryngol 1988; 42: 290– 293.

10. Cavaliere M, Mottola G, Iemma M. Benign paroxysmal positional vertigo: a study of two manoeuvres with and without betahistine. Acta Otorhinolaryngol Ital 2005; 25(2): 107– 112.

11. Moon SJ, Bae SH, Kim HD, Kim JH, Cho YB. The effect of postural restrictions in the treatment of benign paroxysmal positional vertigo. Eur Arch Otorhinolaryngol 2005; 262(5): 408– 411.

12. Massoud EA, Ireland DJ. Post‑treatment instructions in the nonsurgical management of benign paroxysmal positional vertigo. J Otolaryngol 1996; 25(2): 121– 125.

13. Papacharalampous GX, Vlastarakos PV, Kotsis GP, Davilis D, Manolopoulos L. The role of postural restrictions after BPPV treatment: real effect on successful treatment and BPPV’s recurrence rates. Int J Otolaryngol 2012; 2012: 932847. doi: 10.1155/ 2012/ 932847.

14. Li S, Tian L, Han Z, Wang J. Impact of postmaneuver sleep position on recurrence of benign paroxysmal positional vertigo. PLoS ONE 2013; 8(12): e83566. doi: 10.1371/ journal.pone.0083566.

15. Shigeno K, Ogita H, Funabiki K. Benign paroxysmal positional vertigo and head position during sleep. J Vestib Res 2012; 22(4): 197– 203. doi: 10.3233/ VES‑ 2012‑ 0457.

16. Shim DB, Kim JH, Park KC, Song MH, Park HJ. Correlation between the head‑ lying side during sleep and the affected side by benign paroxysmal positional vertigo involving the posterior or horizontal semicircular canal. Laryngoscope 2012; 122(4): 873– 876. doi: 10.1002/ lary.23180.

17. Imai T, Ito M, Takeda N, Uno A, Matsunaga T, Sekine K et al. Natural course of the remission of vertigo in patients with benign paroxysmal positional vertigo. Neurology 2005; 64(5): 920– 921.

18. Chen Y, Zhuang J, Zhang L, Li Y, Jin Z, Zhao Z et al. Short‑term efficacy of Sémont maneuver for benign paroxysmal positional vertigo: a double‑blind randomized trial. Otol Neurootol 2012; 33(7): 1127– 1130. doi: 10.1097/ MAO.0b013e31826352ca.

19. Faldon ME, Bronstein AM. Head accelerations during particle repositioning manoeuvres. Audiol Neurootol 2008; 13(6): 345– 356. doi: 10.1159/ 000136153.

20. Blanks RH, Curthoys JS, Markham CH. Planar relationships of the semicircular canals in man. Acta Otolaryngol 1975; 80(3– 4): 185– 196.

21. Hashimoto S, Naganuma H, Tokumasu K, Itoh A, Okamoto M. Three‑ dimensional reconstruction of the human semicircular canals and measurement of each membranous canal plane defined by Reid’s stereotactic coordinates. Ann Otol Rhinol Laryngol 2005; 114(12): 934– 938.

22. Della Santina CC, Potyagaylo V, Migliaccio AA, Minor LB, Carey JP. Orientation of human semicircular canals measured by three‑ dimensional multiplanar CT reconstruction. J Assoc Res Otolaryngol 2005; 6(3): 191– 206.

23. Cox PG, Jeffery N. Geometry of the semicircular canals and extraocular muscles in rodents, lagomorphs, felids and modern humans. J Anat 2008; 213(5): 583– 596. doi: 10.1111/ j.1469– 7580.2008.00983.x.

24. Levrat E, van Melle G, Monnier P, Maire R. Efficacy of the Sémont maneuver in benign paroxysmal positional vertigo. Arch Otolaryngol Head Neck Surg 2003; 129(6): 629– 633.

25. Bhattacharyya N, Baugh RF, Orvidas L, Barrs D, Bronston LJ, Cass S et al. Clinical practice guideline: benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg 2008; 139 (Suppl 4): S47– S81. doi: 10.1016/ j.otohns.2008.08.022.

26. Rajguru SM, Ifediba MA, Rabbitt RD. Three‑ dimensional biomechanical model of benign paroxysmal positional vertigo. Ann Biomed Eng 2004; 32(6): 831– 846.