(Vestibular Compensation Exercises)

The Cawthorne-Cooksey Vestibular Exercises were designed. to gradually retrain the eye and body musculature to use vision and proprioceptive signals to compensate for the lost or disrupted vestibular signals (which cause poor balance and coordination). The eye and head movements listed under A are started as soon as possible after the acute vertigo (dizziness), nausea and vomiting subside. The exercises under B thru D are then gradually introduced as the patient recovers. Three (3) exercise sessions per day for at least 6 minutes are recommended. The patient should seek out the head positions and movements that cause vertigo, as fast as can be tolerated, since the more frequently vertigo is induced, the more quickly compensation occurs.

Vestibular Compensation Exercises
A. In bed
1. Eye movements, at first slow, then more quickly:
a. Up and down.
b. From side to side.
c. Focusing on fingers moving from 3 feet to 1 foot away from head.
2. Head movements, at first slow, then quick. Later with eyes closed.
a. Bending forwards and backwards.
b. Turning from side to side.

B. Sitting
1. Eye movements. as above.
2. Head movements as above.
3. Shoulder shrugging and circling.
4. Bending forwards and picking up objects from the floor.

C. Standing
1. A-1 & A-2 & B-3 as above.
2. Changing from sitting to standing position with eyes open and with eyes shut.
3. Throwing a small ball from hand to hand, above eye level.
4. Throwing ball from hand to hand, under knee.
5. Change from sitting to standing and turning around in between.

D. Dynamic
1. Circle around center person who will throw a large ball and to whom it will be returned.
2. Walk across room with eyes open and then eyes closed.
3. Walk up and down slope with eyes open and then closed.
4. Walk up and down steps with eyes open and then closed.
5. Any games involving stooping and stretching such as frisbee, catch or basketball.

Benign Paroxysmal Positional Vertigo usually subsides in weeks or months: rarely does it persist for years. Mechanical therapy that includes inducing the vertigo by positional exercises has been the most effective way to treat this condition. It is speculated that such exercises would promote loosening and ultimate dispersion of the degenerated otolithic material from the posterior semi-circular canal (the inner ear).

For positional exercising, the patient sits with eyes closed and tilts laterally to the side to the precipitating position, with the lateral aspect of the head resting on the bed to insure that the ear is stimulated. The patient remains in this position until the positional vertigo subsides, and then returns to the sitting position for 30 seconds before assuming the opposite head-down position. This sequence of positions is repeated until the positional vertigo fatigues. The positional exercises are carried out by the patient every three (3) hours while awake and are terminated after 2 consecutive vertigo free days.