The "360 Maneuver" is done in the special chair that turns people
upside-down. It uses the same concept of standard CRP.
INTRODUCTION 
As
canalith repositioning becomes more accepted in the treatment of benign
positional vertigo, straightforward cases are readily treated and cured using
standard particle repositioning manuvers. (1-8) Difficult cases, and those
refractory to standard treatment, are often referred. Thus referral centers may
begin to see a skewed population of more difficult BPPV cases.
It seems that in some of these cases, the standard Epley maneuvers either
cannot be physically done or fail to solve the problem.
These difficult cases require a different approach. (9-11)
A multiaxial positioning device has been developed to treat the more
difficult patients.
Difficult patients are represented by those who are unable to physically tolerate body position manipulation, patients who are prone to panic, patients who have canal particles in more than one canal, and patients in whom standard repositioning maneuvers are ineffective.
Some patients have back problems that are exacerbated by flexion, extension or torsion, and are therefore unable to physically tolerate the body position manipulation. Both the Epley and Semont maneuvers inherently require some degree of torsion, extension and flexion. Patients who have had strokes or some sort of paralysis also have a difficult time facilitating the maneuver. The multiaxial positioning device allows the patient to be secured in a chair and immobilized. All positioning is done externally with the body as a unit. There are no elements of flexion, extension or torsion involved. The patient does not have to move a muscle.
Patients who are prone to panic attacks are also difficult to reposition. Some will not allow themselves to be placed in a Dix Hallpike position. Those who allow the practitioner to start the maneuver often find themselves fighting violently and uncontrollably to recover to the upright position. The multiaxial positioning device allows the patient to be strapped securely to the seat. There is security in knowing that they cannot fall. Since they are physically restrained, they cannot flail about. This allows the procedure to be done while preventing the patient from physically harming himself and others.
Patients who fail the standard repositioning maneuvers may simply require a pure 360 degree rotation. The multiaxial positioning device may actually help distinguish certain conditions such as canal jam, cupulolithiasis or involvement of multiple canals. (9,10,11)
In patients who have canal particles in multiple canals, the multiaxial positioning device allows canal specific repositioning. In other words, in theory, the left posterior semicircular canal can be treated independently of the right posterior semicircular canal and also independently of the horizontal semicircular canals. The multiaxial positioning device allows easy transition between each of the maneuvers.
The Device:
The
multi-axial position device consists of two concentric rings in a stabilizing
frame. In the center ring, a bucket
seat with padded metal shoulder and torso harness (similar to that used in
modern-day roller coaster rides) is used to secure the patient snugly in the
seat. Two DC motors were mounted to
drive the rotation about the vertical and horizontal axes. In order to get electrical current to the inner ring, two
slip rings were incorporated into the two axes.
Concept to reality
Conclusions:
The 360 degree maneuver can be effective in treating benign positional
vertigo. Its rate of success is
comparable to the rate of success of the standard Epley maneuver. This success
is not surprising given that careful analysis shows that the positions of the
Epley maneuver as well as the Semont maneuver correlate with positions reached
using the 360 maneuver and thus are quite similar. The procedure itself is generally not uncomfortable and
fairly well tolerated by patients. Validation
of the 360 maneuver opens the doors for further research in the treatment of
difficult vertigo patients.
