Capitol Ear, Nose and Throat P.A.

VESTIBULAR EXERCISE PROGRAM

Goals of Exercise

  1. To loosen up the muscles of the neck and shoulders in order to overcome the protective muscular spasm and tendency to move "in one place."
  2. To train movement of the eyes, independent of the head.
  3. To practice balancing in every day situations with special attention to developing the use of the eyes and the cutaneous and kinesthetic senses.
  4. To practice head movements that cause vertigo or giddiness, and thereby gradually overcome the disability.
  5. To improve ability to move about comfortably in the dark, as well as in the light.
  6. Generally, to encourage the restoration of self confidence and easy spontaneous movement.

The Exercise Program

The exercises are to be performed slowly at first, then more rapidly. The rate of progress depends on how much vertigo or other distress you feel. Be patient and stay at the same level until you can easily do the exercises 15-20 times rapidly. Then move onto the next level. Do exercises three times each day for five minutes. Always begin five minute sessions at Exercise #1 and proceed through the higher levels.

  1. Seated, on/in bed
    1. Immobile, eye movements - at first very slow, then quickly.
      1. Up and down
      2. Side to side
    2. Repeat a and b, focusing on finger
      1. Focusing on finger moving from about three feet to two inches away from face and back.
  2. Sitting position without arm rests
    1. Shrug shoulders and rotate
    2. Bend forward and pick up objects from the ground
    3. Rotate head and shoulders slowly, then fast
      1. Rotate head with eyes open, then closed
    4. Rotate head, shoulders and trunk with eyes open, then closed.
  3. Standing
    1. Repeat exercises 1, 2, and 5
    2. Change from a sitting to standing position, with eyes open, and then shut
    3. Throw a ball from hand to hand (above eye level)
    4. Throw a ball from hand to hand under knees.
    5. Change from sitting to standing and turn around in between
    6. Repeat exercise 6
  4. Moving about
    1. Walk across the room with eyes open, then closed
    2. Walk up and down a slope with eyes open, then closed
    3. Do any games involving stooping or stretching and aiming, such as bowling, shuffle boarding, etc.
    4. Stand with one foot in front of the other with eyes open, then closed

Suggestions:

  1. It is often extremely valuable to have the patient carry a light cane, not for support but to provide additional information to aid in tactile and proprioceptive orienting input.
  2. Optimal visual correction should be achieved. Cataract surgery; however, should be avoided if possible, since it carries a major risk of further impairment of balance because of the visual distortions induced by the lenses that must be worn. If the patient has already undergone such surgery, the use of contact lenses (which avoid such distortions) may be advisable.
  3. In walking, the patient should be advised not to look down, but to select a distant point for fixation, using peripheral vision to avoid nearby objects.
  4. A night light and bathroom light should always be left on in the patient's room.
  5. Group exercises have been found to encourage a steady rate of progress