Physical therapy for dizziness(feeling of unsteadiness or light-headedness) and imbalance is called as vestibular rehabilitation or balance rehabilitation.

Symptoms of vestibular dysfunction include but are not limited to imbalance, nausea, dizziness, true vertigo, blurry vision, poor depth perception, loss of balance when walking, falling, confusion, and disorientation. 

Vestibular rehabilitation therapy (VRT) has been a highly effective modality for disorders of the vestibular or central balance system. It includes combined specific head and body movements with eye exercises. If the exercises are correctly performed, muscle tension, headaches, and fatigue will diminish, and symptoms of dizziness, vertigo, and nausea will decrease. Most VRT exercises involve head movement. Head movements are essential in stimulating and retraining the vestibular system.

Goals of VRT (Vestibular Rehabilitation Therapy)

• Improve balance 
• Minimize falls 
• Decrease subjective sensations of dizziness 
• Improve stability during locomotion 
• Reduce overdependence on visual and somatosensory inputs
• Improve neuromuscular coordination
• Decrease anxiety and somatization due to vestibular disorientation

These conditions can benefit from Vestibular Rehabilitation Therapy:
• BPPV (Benign Paroxysmal Positional Vertigo)
• Bilateral & Unilateral dysfunctions
• Otolith Dysfunction
• Vestibular Labyrinthitis
• Acoustic Neuroma or vestibular neuritis.
• Ototoxicity
• Meniere’s Syndrome
• Neurologic Disorders (stroke, brain injury, multiple sclerosis)

Gaze stabilization Exercises

Gaze stabilization is the ability to hold the visual world steady while the head and/or body are moving. The vestibulo-ocular reflex (VOR) helps to provide gaze stability when the head moves.

Fix your gaze at one point in front of you at eye level, then move your head from side to side (45 degrees to each side) while keeping the gaze fixed. Similarly, it can be done by moving head vertically up and down while keeping the gaze fixed at the target.

Balance exercises

Static balance activities used for training include Standing straight with feet close together and standing on one leg. Exercises are made more challenging by altering the surface on which the person stands on, like foam, trampoline, tilt board. Maintaining static positions with eyes closed and lastly incorporating head motions while maintaining balance.

Dynamic balance is trained by performance of activities including walking with head turns, full body turns and marching in place. Dynamic activities are made more challenging by altering the surface (e.g.- balance beam, treadmill), and performance with eyes open and eyes closed.

Cawthorne Cooksey Exercises

Cawthorne-Cooksey exercises helps in relaxing the neck and shoulder muscles, training the eyes to move independently of the head, practicing good balance in everyday situations, practicing the head movements that cause dizziness (to help the development of vestibular compensation), and in improving general co-ordination.

1. In bed or sitting 

• Eye movements -up and down, from side to side and diagonally. At first slow, then quickly. Focusing on finger moving from 3 feet to 1 foot away from face.
• Head movements- first with eyes open and later with eyes closed. Bending forward and backward, turning from side to side, tilting from side to side and moving diagonally.

2. Sitting 

• Eye movements and head movements as described above.
• Shoulder shrugging(try to touch your shoulders to your ears) and shoulder circling(rotate your shoulders).
• Bending forward and picking up objects from the ground. 

3. Standing 

• Eye, head and shoulder movements as described above. 
• Changing from sitting to standing position with eyes open and then eyes closed.
• Throwing a small ball from hand to hand above eye level.
• Throwing a ball from hand to hand under knees.
• Changing from sitting to standing and turning to one side and then to another.

4. Moving about 

• Walk across room with eyes open and then eyes closed. 
• Walk up and down the slope with eyes open and then eyes closed. 
• Walking up and down the steps with eyes open and then eyes closed.
• Sit up and lie down in bed.
• Sit down in a chair, then stand up. 
• Recover balance when pushed in a specific direction. 
• Throw and catch a ball. 
• Engage in any game involving stooping or stretching and aiming, such as bowling, volleyball, or shuffleboard.

Spend 1-2 minutes on each of these exercises.

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