Home Program Vestibular Rehabilitation Exercises

Home Program Vestibular Rehabilitation Exercises

Many abnormalities of balance are due to a loss of coordination between the inner ears and the eyes.  Your ability to fix your eyes on a target while moving your head is critical to good balance.  Your vision is critical to this reflex working properly, so be sure that your glasses or corrective lenses are appropriate for your vision.  Often, progressive lenses or bifocals can make these conditions worse. 

What is Vestibular Rehabilitation?

There are three basic concepts of vestibular rehabilitation. The first aspect deals with head-eye coordination exercises which help the eye-ear reflex work in a coordinated manner.  It also stimulates the balance portion of the ear.   It is critical that the head  turn separately from the rest of your body in order for the ear to receive proper inputs.  The second process involves balance retraining exercises which help to reduce unsteadiness and imbalance, by utilizing your vision, sensory system and postural system more effectively. The third aspect deals with habituation.  In other words, continually repeating the actions that bring on the sense of dizziness or vertigo will eventually accustom the body to those actions.  The exercises included below are those that we offer to patients for use at home.  Where there is a chance of falling, we urge you to have a spotter next to you who is stable, and who could support you if you begin to lose your balance.   Often people experience increased dizziness shortly after starting a vestibular therapy program. This can be considered a sign that the brain is appropriately reacting. Please use caution while doing these exercises, especially those that require you to stand (Ankle Sways, Ball Diagonals and Gait With Head Movement).

****These exercises should be performed 2-3 times a day.****

1.  Focusing with Head Turns (Repeat 15-20 times)

Purpose of Activity:  This activity will help you stabilize your gaze with quick, short head movements. This type of movement is used while driving.

 

  • Sit in a comfortable chair and hold a business card with a 1 inch letter “E” written on it approximately ten inches in front of your nose.
  • While keeping your eyes on the “E”   turn your head from side to side approx. 30 degrees.   Try not to let the letter “E” blur.
  • Vary the speed of your head movement to ensure facilitation of the eye-ear reflex.

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2.   Horizontal and Diagonal Head Movements (Repeat 15-20 times)
Purpose of Activity:  This activity will help you keep your vision stable with head movements. This is similar to watching for a break in traffic.

  • Sit in a comfortable chair with your feet flat on the floor and your hands on your thighs.
  • Have a target situated to your right and to your left as well as in the center.
  • Quickly turn only your head and eyes to the right  target pause for 2-3 seconds and then return to the middle target and pause for 2-3 seconds.  Make sure while looking at each target it is in focus and you are moving your head in a sweeping motion. (similar to checking traffic before crossing the street).
  • Focus on the center target for three seconds. 
  • After completing 15-20 repetitions to the right direction, repeat the sequence to the left and center.

3.  Ankle Sways

Purpose of Activity: This activity will help you build good strategies for keeping your balance while standing.  To improve use of your sensory system, actively grip the ground with your toes keeping your weight centered under the balls of your feet. (similar to  a monkey gripping the tree branch)

Stand approx. 4 inches in front of the kitchen counter.

  • Stand with your feet  shoulder width apart with equal weight on both feet and your arms relaxed at your side. Look straight ahead at a focal point.
  • Slowly shift your weight forwards attempting to touch the counter with the front of your thighs as well as your shoulders coming forward.  Return to midline position and repeat. Do not bend at your hips. All movement should be at your ankles. Repeat 10x, then perform with eyes closed 10x.   (use fingertips on counter if needed.)
  • Shift your weight from side to side, placing more weight first to your right side and then to your left side. Do not bend at the hips.

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4.  Ball Diagonals

Purpose of Activity:  This activity will help strengthen the eye-ear reflex, and assist in retraining you to move your body and maintain your balance.

  • Stand with your feet positioned shoulder width apart.   Grip the ground with your toes, keeping weight under the balls of your feet. Hold a large ball or pillow with both hands and your arms straight. Keep your eyes and head following the target.
  • Keeping your arms straight, move the ball in a diagonal pattern starting by your left knee and moving toward the right upper diagonal.  Continue to keep eyes and head following the object as you return to the left lower diagonal.   Make sure at each end range you hold the position until motion sensitivity  is eliminated.
  • Repeat this sequence 10x, and then perform on the other diagonal pattern.

5.  Gait with a Focal Point

Purpose of Activity:   This will help you utilize visual information while walking to prevent staggering or loss of balance.

Have a focal point approximately 20 feet in front of you at eye level.   As you begin walking keep eyes focused on target in front of you.  Periodically briefly look down toward the floor (approx. 5 ft. in front of you)  to check for obstacles and then return eyes to the target.  A hallway is an excellent place for this activity in the beginning.

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6.  Gait with Head Turns

Purpose of Activity:  This activity will help you build stable head movements while walking.  This type of movement occurs when walking down the aisle of the grocery store searching for an object.

  • Begin walking at your regular speed, with eyes focused on a target straight ahead, preferably in a hallway.
  • After 3 steps turn head and eyes to the right 45 degrees, keeping eyes on a new target, (at eye level) while still walking straight ahead.  Do this for 3 steps, then turn eyes and head back to the center finding a target.
  • After three steps, turn your head and eyes to the left (at eye level) while continuing to walk straight ahead finding another target.
  • After three more steps, turn your head back to the center while walking straight ahead.
  • To increase the difficulty of this task, go from a solid floor to a carpeted floor, or walk outdoors on an uneven surface. Thick lawns usually are the most difficult surface.