The balance exercises were first suggested by Sir Terence Cawthorne and F S Cooksey over half a century ago for people who had undergone surgery which. Cawthorne-Cooksey Exercises. SUPPORTING If your vestibular system (inner ear balance system) is not working properly, you will feel dizzy and off balance. Cawthorne-Cooksey Exercises. The aims of the Cawthorne-Cooksey exercises include relaxing the neck and shoulder muscles, training the eyes to move.

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Assistive devices should especially be considered for persons older than 65 years with bilateral vestibular loss. When nausea or vomiting occurs during exercises, patients are advised to return to the performing the previous exercise on their programs until the nausea becomes prohibitive.

However, not all head movements result in a VOR gain change. Complete functional recovery of vestibular function was observed after streptomycin treatment in chicks, Gallus domesticus.

Vestibular Rehabilitation Therapy: Review of Indications, Mechanisms, and Key Exercises

Maintaining compensation Once all of the exercises can be performed without dizziness, patients should maintain a high degree of physical activity e. The term “decompensation” is adopted to describe a near total relapse.

In this situation the somatosensory cues are more important and could provide the requisite error signals leading to static rebalancing of the vestibular nuclei. Habituation and balance retraining therapy. The hip strategy involves standing in a narrow stance and using rapid torques around the trunk and hips in a top-down control.

Alternatively, it may be that repeated exposure to movements that provoke dizziness symptoms teaches your brain not to listen to the signals it is receiving from the ears as much vestibular compensation. As long as exercises are performed several times every day, even brief periods of exercise are sufficient to facilitate vestibular recovery.

Thus, the use of a cane, which acts as an extended haptic ‘finger’ for orientation to an earth reference, is an important tool for postural rehabilitation.

For most, this would at least involve a graduated walking program. Eye movements occur before the onset of the head rotation when the movement is anticipated. VRT reduces the cost of treating vertigo by reducing unnecessary medications and studies, and by shortening the recovery period.


The environment must be modified to allow a patient to practice the exercises safely and without the continual supervision of a therapist. Patients with panic disorder and other anxiety disorders often seek treatment for ill-defined vestibular symptoms. Enhanced smooth pursuit eye movements in patients with bilateral vestibular deficits.

Substitution by vision or somatosensory cues Patients rely on somatosensory cues from the lower extremities during the acute stage, and on visual cues during the chronic stage.

If the peripheral lesion is extensive, the ipsilateral vestibular nucleus will become responsive to changes in the contralateral eighth-nerve firing rate by activating the commissural pathways. VRT is applicable to patients with stable vestibular lesions whose vestibular function is poorly compensated, regardless of their age, cawthofne cause of their lesion, and symptom duration and intensity.

Exercise modification The exercises can be modified by performing them under various conditions Table 2. In particular, the manoeuvres will not be suitable if you have pain or stiffness in your neck or if you have had a neck injury. Improving activities of daily living The ultimate goal of vestibular recovery should be to enable the patient to return to all of his or her normal activities of daily living.

Treatment of patients with nonvestibular dizziness and disequilibrium. Unilateral vestibular deafferentation produces no long-term effects on human active eye-head coordination.

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Vestibular rehabilitation exercises

The ankle strategy can be practiced by swaying back cawthkrne forth and side to side within small ranges, keeping the body straight and not bending at the hips or knees. This document is one page handout of activities that progress from simple head movement to complex activities such as throwing a ball.

Sitting Eye movements and head movements as above Shoulder shrugging and circling Bending forward and picking up objects from the ground Exerises Eye, head and shoulder movements as before Changing from sitting to standing position with eyes open and shut Throwing a small ball from hand to hand above eye level Throwing a ball from hand to hand under knee Changing from sitting to standing and turning around in between Moving about in class Circle around center person who will throw a large ball and to whom it will be returned Walk across room with eyes open and then closed Walk up and down slope with eyes open and then closed Walk up and down steps with eyes open and then closed Any game involving stooping and stretching and aiming such as bowling and basketball Diligence and perseverance are required but the earlier and more cooksdy the exercise regimen is carried out, the faster and more complete will vetsibular the return to vestibilar activity.


Swaying back and forth. Otolith dysfunction in vestibular neuritis: Saccade and vestibular ocular motor adaptation.

Vestibular Rehabilitation Therapy: Review of Indications, Mechanisms, and Key Exercises

The ankle strategy involves standing in a wide stance and using ankle torques in a bottom-up, inverted-pendulum type of sway. Essentially, the brain copes with the disorientating signals coming from the inner ears by learning to rely more on alternative signals coming from the eyes, ankles, legs and neck to maintain balance.

Once all of the exercises can be performed without dizziness, patients should maintain a high degree of physical activity e.

Visual and somatosensory inputs Recovery is delayed if visuomotor experience is prevented during the early stage after unilateral vestibular loss.

Vestibular rehabilitation therapy VRT is an exercise-based treatment program designed to promote vestibular adaptation and substitution. However, if vestibular function does not recover, dynamic signs will persist for life, leading to blurred vision and imbalance when patients turn their head toward the side of the affected labyrinth. Daily exercise duration Brief periods of unidirectional optokinetic stimulation 30 seconds, ten times daily for 10 days can produce VOR gain changes after unilateral vestibular loss in humans.

Repeat with the other arm. Otolaryngol Head Neck Surg.