Square Wave Maneuver for Apogeotropic Horizontal Canal BPPV

The square wave maneuver is designed to treat individuals with horizontal canal cupulolithaisis and is commonly used when individuals have cervical restrictions and the affected side is not well identified at baseline. 1. The patient begins in the supine position with the head 20 to 30 degrees above the horizon. 2. The patient rolls 90 degrees and lies on their side until the elicited nystagmus has reached it maximum intensity. 3. The patient rolls 180 degrees towards the other side as quicky as possible. This position is held until the elicited nystagmus has reached it maximum intensity. 4. 180-degree rolls from one side to the other are performed until there is nystagmus resolution, vertigo resolution and/or conversion into geotropic nystagmus (up to 10 times in a single session).