Half Somersault Maneuver

Posterior canal BPPV

The key points regarding using the Foster maneuver to treat posterior canal BPPV (PC BPPV)

1. The Foster maneuver, described by Dr. Carol Foster in 2012, is a self-treatment method for posterior canal BPPV. It involves a series of head and body positions similar to the Epley maneuver but with the head far forward instead of far backward.

2. Home treatment maneuvers like the Foster have advantages - they are quick, often effective, and free. However, there are potential problems: - If BPPV is not definitively diagnosed, positional exercises may be inappropriate and delay proper treatment. - Determining the affected side can sometimes be tricky. - Complications like canal conversion or severe vomiting are better handled in a doctor's office. - Rarely, neurological symptoms can occur due to vertebral artery compression during the Epley.

3. Analysis using the Teixido BPPV viewer suggests the Foster positions are biomechanically logical for moving otoconia out of the posterior canal:

- Position A (head 45° back): Moves otoconia 1/3 around the posterior canal. May affect lateral but not anterior canal. - Position B (head upside down): Moves otoconia 2/3 around. May move anterior canal otoconia halfway. - Position C (head turned 45° right while inverted): Does not further move posterior canal otoconia. - Position D (head rotated 90° up): Helps move otoconia near the common crus. Not helpful for anterior canal. - Position E (upright): Debris should fall out of canals into the vestibule, but could re-enter posterior canal.

4. The Foster maneuver requires more strength and flexibility than some other home maneuvers. There is a falling risk when dizzy in positions B-E.

5. It is unlikely to be effective for anterior canal BPPV, as the head is not optimally positioned.

6. Though possibly less effective than the Epley, patients may prefer the Foster maneuver. Biomechanically, it is similar to other recent home BPPV treatments.

Overall, the Foster maneuver seems to be a reasonable self-treatment option for posterior canal BPPV, with the caveats that an accurate diagnosis and identification of the affected side are important, and the first treatment is safest in a medical setting. Patients should be aware of the potential risks and limitations. Further research comparing the effectiveness of various home maneuvers would be helpful to guide patients' choices.

Anterior Canal BPPV

the key points regarding using the Foster maneuver to treat Anterior Canal BPPV (AC BPPV):

1. The Foster maneuver, as originally described, is intended to treat Posterior Canal BPPV (PC BPPV), not Anterior Canal BPPV.

2. Analysis using a BPPV viewer model suggests the Foster maneuver positions are not optimal for moving otoconia out of the anterior canal:

- Position A (head tilted 45° back) does not affect debris in the anterior canal.

- Positions B and C (head inverted) are good for moving debris in the anterior canal towards the vestibule. However, there is a risk it could cause anterior canal BPPV if there was pre-existing loose otoconia in the vestibule. Only one inversion position is needed.

- Position D (head turned 45° to the right on a horizontal trunk) does not help clear either anterior canal. The debris may fall back to the original position.

3. A modified maneuver is proposed that may work better for right AC BPPV:

- Start upright - Move to the inverted position (Foster position B or C) - Instead of position D, move into a left Dix-Hallpike position to move otoconia close to the vestibule - Return to upright, allowing otoconia to settle in the vestibule

4. Compared to other AC BPPV treatments, this modified maneuver requires less neck extension which may be better tolerated. The inversion step may also be more effective than partial inversions in other techniques.

5. If unsure which side has the AC BPPV, there is a 50% chance of picking the wrong side. The other side can be tried next time if needed.

In summary, the original Foster maneuver is not recommended for AC BPPV, but a modified version incorporating the Dix-Hallpike position may be an option worth further investigation. Accurate diagnosis of which side and canal is affected remains important for optimal treatment.

References Foster CA, Ponnapan A, Zaccaro K, Strong D. A comparison of two home exercises for benign positional vertigo: Half somersault versus Epley Maneuver. Audiol Neurotol Extra 2012;2:16-23 Furman, J. M. and T. C. Hain (2004). ""Do try this at home": self-treatment of BPPV." Neurology63(1): 8-9. Radtke, A., et al. (1999). "A modified Epley's procedure for self-treatment of benign paroxysmal positional vertigo." Neurology 53(6): 1358-1360. Radtke, A., et al. (2004). "Self-treatment of benign paroxysmal positional vertigo: Semont maneuver vs Epley procedure." Neurology 63(1): 150-152.

https://dizziness-and-balance.com/BPPV/Foster.pdf

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