Effectiveness of Epley Maneuver Versus Semont Maneuver on Dizziness and Balance in Stroke Survivors With Posterior Canal BPPV

Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular disorder and frequently affects the posterior semicircular canal. Stroke survivors with BPPV often experience dizziness, impaired balance, and an increased risk of falls. The Epley and Semont maneuvers are evidence-based repositioning techniques used to treat posterior canal BPPV. However, evidence comparing these two maneuvers specifically in stroke survivors is limited. This randomized controlled trial will compare their effectiveness in reducing dizziness and improving balance over a 4-week intervention period with follow-up assessments. The findings may help guide physiotherapists in selecting the most effective treatment for this population.

• Epley Maneuver (Other): Epley Maneuver: Participants will be randomly allocated to either the Epley maneuver group or the Semont maneuver group. The affected side will be identified using the Dix-Hallpike test before treatment. Participants in the Epley group will receive the canalith repositioning maneuver involving sequential head and body movements to facilitate the movement of displaced otoconia from the posterior semicircular canal into the utricle.
• Semont Maneuver (Other): Participants in the Semont group will receive the liberatory maneuver involving rapid sequential movements between side-lying positions while maintaining the prescribed head rotation.

Primary outcomes

• Dizziness Handicap Inventory [Baseline, 2 weeks, and 4 weeks]: To assess the severity and impact of dizziness and balance in physical aspects of daily life. The questionnaire consists of 25 items scored as 0 (no), 2 (sometimes), and 4 (yes), yielding a total score ranging from 0 to 100. Higher scores indicate greater dizziness-related handicap. Total scores will be interpreted as mild (0-30), moderate (31-60), or severe (61-100) handicap
• Berg Balance Scale [Baseline, 2 weeks, and 4 weeks]: The scale consists of 14 tasks, each scored from 0 to 4, yielding a total score ranging from 0 to 56. Higher scores indicate better balance performance, whereas lower scores indicate greater balance impairment

Sex: All, ages: 18 Years to any

Inclusion Criteria:

* Age: above 18years Diagnosed with stroke survivors Diagnosed with posterior canal BPPV via Dix-Hallpike Test Functional status: Able to sit or walk with/without support, follow instructions, and participate in treatment sessions Willing to participate

Exclusion Criteria:

* Other vestibular disorders (e.g., Meniere's disease (inner ear disorder causing vertigo, hearing loss, and tinnitus)) Diagnosed cognitive impairment (unable to follow instructions) Medically unstable patients Severe cervical spine disorders (e.g., instability, fracture) Spinal conditions restricting head movement Completely bed-bound patients Any contraindication to Dix Hallpike repositioning maneuvers

• Somiya Naz, BSPT, PPDPT, PHD Scholar, Principal investigator, IBADAT INTERNATIONAL UNIVERSITY