DrShreha Pathak_ENTSpecialist

Basic Concept of Balance


Why Vestibular Exercises?

• A problem with balance and equilibrium causes vertigo.

• Vestibular exercises help reduce the symptoms of vertigo and aid to regain balance.

• Vestibular exercises do not treat or regenerate a damaged organ.

• Vestibular exercises improve brain’s compensation for injuries or abnormalities within the balance system, thereby, building up tolerance in brain to overcome symptoms of vertigo.

Aims of Vestibular Exercises

• Relaxing the neck and shoulder muscles.

• To train movement of the eyes, independent of the head.

• To practice head movements that cause dizziness.

• Improving general co-ordination.

• To become accustomed to moving about naturally in daylight and in the dark.

• To encourage the re-building of confidence in making easy, relaxed, spontaneous movements.


• Medical advice/ instructions.

• Safe environment to reduce the risk of injury.

• Slow to begin with, and gradual progression to faster movements.

• Presence of another person during the first few times, to help in case the dizziness becomes severe.

How many times and days?

• 3 times a day / Everyday.

• Work up to doing each movement 20 times.

• If symptoms become too severe, take a break.

• Minimum of 6 to 12 weeks or until the symptoms goes away.

• Exercise can be stopped when no symptoms occurs for two consecutive weeks.

• Can be restarted again at any time if dizziness returns.

Exercises (Cawthorne Cooksey)

1. In bed

• Eye movements: at first slow, then quick


• Head movements: at first slow, then quick. Later with eyes closed.

✦ Turn from side to side
✦ Bend backwards andforwards
✦ Move head diagonally up and down towards right side
✦ Move head diagonally up and down towards left side


2. Sitting

• Eye movement s and head movement s as above.
• Shoulder shrugging. [A]
• Shoulder circling. [A]
• Bending forward and picking up objects from the ground. [B]
• Turning head and trunk alternatively to left and right. [C]

3. Standing

• Eye, head and shoulder movements as above.
• Change from a sitting to a standing position with eyes open, then closed. [D]
• Change from sitting to standing and turn round in between.


More challenging exercises

4. Standing and throwing

• Throw a small rubber ball from hand to hand above eye level.[E]
• Throw ball from hand to hand under one knee.[F]

DrShreha Pathak_ENTSpecialist

5. Walking

• Practice walking in a straight line for 5 minutes with one foot
in front of the other or “heel to toe”. Start with “almost heel to toe” and gradually work to “heel to toe” touching.[G]

• Walking up and down a flight of stairs.[H]

• Walk across the room, first with eyes open, then with eyes closed (at tempt only with assistance).[I]

• Throwing and catching the ball while walking. [J]

Specific Eye Movement (Oculomoter) Exercises

1. Smooth pursuits

• Hold a single target.
• Keep eyes fixed on target.
• Slowly move it while head stays

✦ side-to-side
✦ up-down
✦ diagonally

2. Saccades

• Hold two stationary targets placed inches apart.
• move eyes quickly from target to target as head stays still.

✦ side-to-side
✦ up-down
✦ diagonally

3. Gaze stabilisation

• Keep eyes fixed on single stationary target held in hand.
• Move head side to side.
• Move head up and down.

4. Head/eyes moving in same direction

• Hold a single target.
• Keep eyes fixed on target.
• Slowly move target, head/eyes in same direction
✦ side-to-side
✦ up-down
✦ diagonally

5. Head/eyes moving in opposite direction

• Hold a single target.
• single target, keep eyes fixed on target.
• Slowly move target, head/eyes in opposite direction
✦ side-to-side
✦ up-down
✦ diagonally

Benefits of Vestibular Exercises

• Non invasive.
• Cost effective.
• Returns or restores everyday function.
• Patient friendly.
• May be the best or only management.

Difficulties with Vestibular Exercises

• Not difficult to learn, but to achieve maximum benefit, commitment is needed.
• Exercises can be tedious. Therefore, fixed schedules to incorporate them in lifestyle is important.
• Symptoms may seem to be worse initially. With time and consistent work, symptoms should steadily decrease.
Associated health conditions and medications may affect the recovery. Assessment of such conditions and appropriate management is needed.

Alternatives of Vestibular Exercises

• Active sports
( Basketball, Tennis, Ping-pong, Volleyball)
• Gaming consoles
• VR games
• Yoga
• Tai chi

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