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, diagnostic test results, and a physical examination by a qualified doctor.
Vestibular Exercise Program to Overcome Dizziness AIMS OF EXERCISE: 1. To loosen up the muscles of the neck and shoulders, to overcome the protective muscular spasm and the tendency to move “in one piece.” 2. To train movement of the eyes, independent of the head. 3. To practice balancing in everyday situations with special attention to developing the use of the eyes and the muscle senses. 4. To practice head movements that cause dizziness, and thus gradually overcome the disability. 5. To become accustomed to moving about naturally in daylight and in the dark. 6. To encourage the restoration of self-confidence and easy spontaneous movement. All exercises are started in exaggerated slow time and gradually progress to more rapid time. The rate of progression from the bed to sitting and then to the standing and walking exercises depend upon the dizziness in each individual patient’s case. A. SITTING POSITION – without armrests 1. Eye exercises – at first slowly, then quickly a) Up and down. b) Side to side. c) Repeat a and b, focusing on finger at arm’s length. 2. Head exercises – head movements at first slow, then quick 3. Shrug shoulders and rotate, 20 times 4. Bend forward and pick up objects from the ground, 20 times 5. Rotate head and shoulders slowly, then fast, 20 times 6. Rotate head, shoulders and trunk with eyes open, then closed, 20 times B. STANDING POSITION 7. Repeat Number 1 8. Repeat Number 2 9. Repeat Number 5 10. Move from a sitting to standing position, with eyes open, then closed. 11. Throw ball from hand to hand (above eye level)
12. Throw ball from hand to hand under knees 13. Move from sitting to standing, and turn around in between. 14. Repeat Number 6 C. WALKING 15. Walk across room with eyes open, then closed, 10 times 16. Walk up and down slope with eyes open, then closed, 10 times 17. Play any game involving stooping, or stretching and aiming, such as bowling, shuffleboard, etc. 18. Stand on one foot with eyes open, then closed 19. Walk with one foot in front of the other with eyes open, then closed Cawthorne’s Head Exercises Exercises are to be carried out for 15 minutes twice a day, increasing to 30 minutes. EYE EXERCISES Look up, then down – at first slowly, then quickly, 20 times. Look from one side to the other – at first slowly, then quickly, 20, times. Focus on your thumb at arm’s length, moving it one foot toward you and back again, 20 times. HEAD EXERCISES Bend head forward then backward with eyes open – slowly, later quickly, 20 times. Turn shoulders to right, then to left, 20 times. Bend forward and pick up objects from the ground and sit up 20 times. STANDING Change from sitting to standing and back again, 20 times with eyes open. Repeat with eyes closed. Throw a small rubber ball from hand to hand above eye level. Throw ball from hand to hand under one knee. MOVING ABOUT Walk across the room with eyes open, then closed, 10 times. Walk up and down a slope with eyes open, then closed, 10 times. Walk up and down steps with eyes open, then closed, 10 times. Any game involving stooping or turning is good.
Vestibular rehabilitation therapy (VRT) is an exercise-based program designed to promote central nervous system compensation for inner ear deficits. VRT can help with a variety of vestibular problems, including benign paroxysmal positional vertigo (BPPV) and the unilateral or bilateral vestibular hypofunction (reduced inner
ear function on one or both sides) associated with Ménière’s disease, labyrinthitis, and vestibular neuritis. Some of the exercise and activities may at first cause an increase in symptoms as the body and brain attempt to sort out the new pattern of movements. Because of this, people sometimes give up on VRT, thinking it is making their vestibular disorder worse. However, in most cases balance improves over time if the exercises are correctly and faithfully performed. Muscle tension, headaches, and fatigue will diminish, and symptoms of dizziness, vertigo, and nausea will decrease or disappear. Many times, VRT is so successful that no other treatment is required. After the brain has learned to compensate for vestibular dysfunction, events such as a bad cold or flu, minor surgery, or even anything that interrupts normal activity for a few days can cause the brain to “forget” what it learned and symptoms to reoccur. This is called decompensation. Most people are able to quickly recover from decompensation by immediately returning to the home-based exercise program developed during their initial course of VRT. However, if symptoms persist or are severe, it is important to get a diagnosis and medical treatment because this suggests that additional vestibular damage has occurred.
New Dizziness Therapy
If you suffered from dizziness, you were probably told, "You'll have to live with it." That's not the case today.
Three sensory systems gather information regarding your body's position and movement in space: the visual, vestibular (semicircular canals and otoliths), and somatosensory (touch, joint and muscle receptors) systems. These systems transmit information to your brain's central processor, the cerebellum. The balance response is carried out by the motor system located here - the right and left vestibular systems, which are key to maintaining balance because they provide the brain with information about your head movement and position. Disease in one vestibular system will send erroneous information to your brain and cause vertigo or imbalance. Vision helps orient the body in space by referencing vertical and horizontal axes of objects around you. The somatosensory system gives your brain information regarding support surfaces and the motion of your body's parts in relation to one another. Balance can be maintained if you suffer a loss of one of these three sensory systems, but when more than one system is lost balance difficulties like dizziness occur. And this is where vestibular rehabilitation comes in.
The vestibular system is housed in our middle ear near the cochlea that is responsible for our balance. Most people stop there but in fact the strength of the vestibular system affects how many of our sub-systems work such as proprioception, sight and many others.
Three methods of vestibular rehabilitation: The first is habituation, which means that by continually repeating the actions that bring on dizziness or vertigo you will eventually accustom your body to those actions. The second process involves balance retraining exercises that help reduce unsteadiness and imbalance. The third aspect deals with head-eye coordination exercises that help reduce gazeinduced dizziness.
A physician will diagnose your particular problem by performing a complete medical history, a neurologic examination, and tests of hearing and balance function. Blood tests for allergies, autoimmune inner ear disease (allergies to your own ear tissue), or hormonal imbalance may also be necessary. A vestibular rehabilitation therapist with create a therapy program specifically for you.
Vestibular rehabilitation (VR) is a well-accepted exercise program intended to remedy balance impairment caused by damage to the peripheral vestibular system. Alternative therapies, such as Tai Chi (TC), have recently gained popularity as a treatment for balance impairment. Citation: BMC neurology. 2005 Feb 18 ;5(1): 3.
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