BackgroundBell's palsy (idiopathic facial paralysis) is commonly treated by various physical therapy strategies and devices, but there are many questions about their efficacy.
ObjectivesTo evaluate physical therapies for Bell's palsy (idiopathic facial palsy).
Search methodsWe searched the Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials (The Cochrane
Beni gn Paroxysmal Positional Vertigo (BPPV) is one of the most frequent diseases of the vestibular system and it is characterized by episodes of recurrent vertigo triggered by head movements or position changes. There are several approaches for treatment, but efficacy is still being discussed. Aim: To asses the effectiveness of the specific maneuvers available to the treatment of BPPV. Methodology: An electronic search at the main databases, including MEDLINE, LILACS, PEDro, Cochrane Collaborations Database was performed, and we selected only randomized clinical trials studying adults with diagnosis of BPPV confirmed by the Dix-Hallpike test. The trials should have included physical maneuvers such as Epley and Semont. The main outcome was Dix-Hallpike negative test and the changes to subjective complaints. The trials were assessed using Jadad's scale and only studies with quality scores equal or above 3 were pooled on a meta-analyses to assess their effectiveness. Results: We found five controlled clinical trials phase I comparing the Epley's maneuver with controls or placebo. The metaanalysis showed positive evidence of Epley's maneuver to the posterior semicircular canal (effect size = 0.11 [CI 95% 0.05, 0.26]
Introduction Telehealth consists in the application of technology to provide remote health service. This resource is considered safe and effective and has attracted an exponential interest in the context of the COVID pandemic. Expanded to dizzy patients, it would be able to provide diagnosis and treatment, minimizing the risk of disease transmission. Benign paroxysmal positional vertigo (BPPV) is the most common vestibular disorder. The diagnosis typically rests on the description of the symptoms along with the nystagmus observed at a well-established positional testing.
Objectives The aim of the present study was to propose a teleconsultation and teletreatment protocol to manage patients with BPPV during the COVID-19 pandemic.
Methods Specialists in the vestibular field met through remote access technologies to discuss the best strategy to manage BPPV patients by teleconsultation and teletreatment system. Additionally, several scientific sources were consulted. Technical issues, patient safety, and clinical assessment were independently analyzed. All relevant information was considered in order to design a clinical protocol to manage BPPV patients in the pandemic context.
Results Teleconsultation for BPPV patients requires a double way (video and audio) digital system. An adapted informed consent to follow good clinical practice statements must be considered. The time, trigger and target eye bedside examination (TiTRaTe) protocol has proven to be a valuable first approach. The bow and lean test is the most rational screening maneuver for patients with suspected positional vertigo, followed by most specific maneuvers to diagnostic the sub-variants of BPPV.
Conclusion Although with limited evidence, teleconsultation and teletreatment are both reasonable and feasible strategies for the management of patients with BPPV in adverse situations for face-to-face consultation.
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