The Gans Repositioning Maneuver GRM, developed in 2000, has been described in the literature and textbooks as a hybrid maneuver; particularly useful with individuals with poor or limited mobility and for those that neck hyperextension is contraindicated. An additional technique of use of a sheet or towel to facilitate a smooth and effortless bed roll, used with back patients has proven highly efficacious.

In this video, an 88 year-old male patient with left PC-BPPV, and physical co-morbidities limiting his mobility, is treated with a GRM with the bed roll. The initial position is that of left side-lying (nystagmus can be clearly observed). After waiting one minute, the patient is smoothly and effortlessly rolled to his right side. This is immediately followed by a controlled passive head-shake. Wait time is one minute post head-shake. Patient is then seated upright with a head tilt. As is the AIB protocol, patient is then immediately re-checked and retreated. This has resulted in a success rate of 97% in one visit. The patient was successfully cleared and was seen one-week post treatment. At the follow-up visit he was clear of any positional vertigo and nystagmus, and was most pleased to return to his routine activities.

References:

Roberts, R.A., Gans R.E., & Montaudo, R. (2006) Efficacy of a new treatment maneuver for posterior canal benign paroxysmal positional vertigo. Journal of the American Academy of Audiology, 17, 598-604

Roberts, RA, Gans, RE (2008) Nonmedical Management of Positional Vertigo in
Jacobson and Shephard (Eds.) Balance Function Assessment and Management,
Plural Publishing, San Diego

Dispenza, F., Kulamarva, G., & De Stefano, A., (2012) Comparison of repositioning maneuvers for benign paroxysmal positional vertigo of posterior semicircular canal: advantages of hybrid maneuver, American Journal of Otolaryngology-Head and neck Surgery, Vol. 33, Issue 5, pages 528-532