Vestibular Rehabilitation Therapy (VRT) is the process of teaching and habituating your brain how to process signals sent from your eyes and inner ear. This will help you maintain your balance, manage head and positional changes, and overall decrease your dizziness. An event that caused a lesion or injury to the vestibular nerve will make you dizzy, events like vestibular neuritis, vestibular migraine, or concussion can impact your vestibular system negatively. The process of Vestibular Rehabilitation Therapy is based on a concept called neuroplasticity. Your brain exhibits neuroplasticity by rerouting and rebuilding damaged neuronal pathways from your vestibular system to your brain.  VRT is a series of specific exercises that will help your vestibular system reorient itself, and get you back to feeling like yourself.

These exercises may cause your symptoms, and that is actually the intention of them. Vestibular Rehabilitation Therapy should be performed with precise steps before, during, and after exercise.

Before:

Take a baseline of your symptoms. Your symptoms of your vestibular disorder probably fluctuate, sometimes feeling good and some days are not as great. Consider your symptoms on a 0-10 scale. 0/10 is no symptoms at all, feeling completely normal. 10/10 is the worst day of dizziness. Consider your symptoms, and decide a number out of 10. This is the number you will aim to return to after each exercise.

During: 

During your exercises, you will be somewhat dizzy throughout the time you’re performing them. The intention is to make you a little bit dizzy, but not so dizzy you can’t bring your symptoms back down to your baseline. The baseline number is important to  return to between each exercise, as you don’t want to make your symptoms worse for more than 5 minutes at a time.

After:

After you finish the exercise, either one set or repetition, or if you’re finished for the day, you don’t want to feel dizzier because of your exercises for long term. If it takes more than 15 minutes to feel like yourself again, or back to baseline then stop for the day. The intention is to increase your symptoms mildly, bring your symptoms back down to baseline, and then begin again. VRT is like strength training for your brain – you become tired or sore from strength straining at the gym, and you become a little bit dizzy from brain training.

VORx1 (VOR Times One)

Your vestibulo-ocular reflex is the reflex that keeps your eyes and ears paired during movement. This reflex helps your eyes stay steady while your head is moving, and your head stay still when your eyes are moving. It is important to retrain this reflex if you or your patient have complaints of gaze instability. Gaze instability is the kind of dizziness that occurs with movement. This could happen if you’re walking and feel like the horizon is jumping around, if you move your head and feel like the view is following you, or like nothing is staying still quite like it should. If this sounds like you, you probably need gaze stability training.

The purpose of VORx1 is to keep an object in your visual field still, while you move your head.

  1. Place a focal point on the wall, either the letter B, or use this pineapple worksheet.
  2. While keeping your eyes on the focal point, shake your head right and left quickly, in a small range of motion (as if you’re shaking “no”), while keeping the focal point still & in focus the entire time — If the point jumps or becomes blurry, slow down.
  3. Shake your head as directed for 15 seconds. Repeat 3 times, waiting at least 1 minute between each 15 second repetition (not 45 seconds)
  4. If this increases your symptoms, wait until the symptoms subside before beginning again.

If the focal point moves or becomes blurry as you’re doing this exercise, slow down. The intention of the exercise is to make you slightly dizzy [less than 5/10 over your BASELINE], but nothing that you cannot bring back down to your baseline in under 5 minutes.

If it takes more than 5 minutes to bring down the symptoms, or the symptoms are greater than 5/10 over your baseline, you’ve done too much. In this case, symptoms include: the focal point jumping, becoming blurry or moving. Additionally, nausea, disequilibrium, or lightheadedness can be experienced with this exercise – if you experience these lasting less than 5 minutes, that’s the correct response to the exercise. If you experience these symptoms for more than 5 minutes, or more than a 5/10 over your baseline, you’ve done too much, and should start again tomorrow when you’re feeling better.

Here’s a link to a fun focal point, and instructions, on a printable PDF for you to practice at home!

 

VOR Cancellation (VORcX)

As much as we use the vestibulo-ocular reflex, we also frequently suppress it, like when we move our bodies and eyes at the same time; this is called VOR cancellation. VORcX is helpful in teaching your brain and eye what’s happening around you while simultaneously focusing on a single focal point. If you become motion sick, or watching the scenery pass you by in a train or car makes you nauseous, this exercise is a great test and exercise for you.

The test for VORcX should be performed in the following way:

  1. Set a metronome for 50BPM.
  2. Stick your thumbs out in front of you, and focus on them at eye level.
  3. Rotate left and right, about 80 degrees each way, to the beat of 50BPM. Your whole trunk should rotate with your arms, left and right, your eyes staying fixed on your thumbs.
  4. Complete 10 rotations total in this standing position

Record your symptoms. Results that represent a positive test include: dizziness, lightheadedness, nausea, fogginess, inability to stay focused on your thumbs (they become blurry, jump around, or you lose track of them.

Exercise:

Perform this exercise the same way, however if 50BPM gives you any symptoms, slow down. You can even do this without a metronome, or seated if your symptoms are too severe.

The intention of the exercise is to make you slightly dizzy [less than 5/10 over your BASELINE], but nothing that you cannot bring back down to your baseline in under 5 minutes.

If it takes more than 5 minutes to bring down the symptoms, or the symptoms are greater than 5/10 over your baseline, you’ve done too much. In this case, symptoms include: lightheadedness, loss of balance, disequilibrium, dizziness, nausea or symptoms you experience.

Walking With Head Turns

When we walk down the streets, we observe our surroundings, we people watch, stare at cars, or just enjoy the outdoors. However, if you have a vestibular disorder, you may find it more difficult to turn your head in general, especially if you’re walking. Not only is it generally uncomfortable not to feel like you can move your head, but its safer to be able to, and an important part of life. If you feel dizzy, uncomfortable, or nervous about walking while turning your head, this exercise is for you!

To test if you need to perform this exercise, I use the 4-Item Dynamic Gait Index, or 4-Item DGI. This tests for more than just walking with head turns, but it’s a great measure in general to know how you are walking.

Score each section with the lowest category that applies. 

1. Walking in a straight line: walk 20’ on a level surface, you may use an assistive device if necessary.

  • (3) Normal: Walks 20′, no assistive devices, good sped, no evidence for imbalance, normal gait pattern
  • (2) Mild Impairment: Walks 20′, uses assistive devices, slower speed, mild gait deviations.
  • (1) Moderate Impairment: Walks 20′, slow speed, abnormal gait pattern, evidence for imbalance.
  • (0) Severe Impairment: Cannot walk 20′ without assistance, severe gait deviations or imbalance.

2. Walking with differing gait speeds: begin walking at your normal pace (for 5′), then ” walk as fast as you can (for 5′). Lastly, walk as slowly as you can (for 5′).

  • (3) Normal: Able to smoothly change walking speed without loss of balance or gait deviation. Shows a significant difference in walking speeds between normal, fast and slow speeds.
  • (2) Mild Impairment: Is able to change speed but demonstrates mild gait deviations, or not gait deviations but unable to achieve a significant change in velocity, or uses an assistive device.
  • (1) Moderate Impairment: Makes only minor adjustments to walking speed, or accomplishes a change in speed with significant gait deviations, or changes speed but has significant gait deviations, or changes speed but loses balance but is able to recover and continue walking.
  • (0) Severe Impairment: Cannot change speeds, or loses balance and has to reach for the wall or be caught.

3. Walking with horizontal head turns: begin walking at your normal pace. Then, look “look right,” keep walking straight, but turn your head to the right. Next, “look left,” and keep walking straight and turn your head to the left. Repeat 1 more turn to each side, while trying to maintain a straight line.

  • (3) Normal: Performs head turns smoothly with no change in gait.
  • (2) Mild Impairment: Performs head turns smoothly with slight change in gait velocity, i.e., minor disruption to smooth gait path or uses walking aid.
  • (1) Moderate Impairment: Performs head turns with moderate change in gait velocity, slows down, staggers but recovers, can continue to walk.
  • (0) Severe Impairment: Performs task with severe disruption of gait, i.e., staggers outside 15” path, loses balance, stops, reaches for wall.

4. Walking with vertical head turns: begin walking at your normal pace. Then, “look up” while you keep walking straight. Next, “look down,” and keep walking straight with your head down. Repeat 1 more time up and down.

  • (3) Normal: Performs head turns smoothly with no change in gait.
  • (2) Mild Impairment: Performs head turns smoothly with slight change in gait velocity, i.e., minor disruption to smooth gait path or uses walking aid.
  • (1) Moderate Impairment: Performs head turns with moderate change in gait velocity, slows down, staggers but recovers, can continue to walk.
  • (0) Severe Impairment: Performs task with severe disruption of gait, i.e., staggers outside 15” path, loses balance, stops, reaches for wall.
  • Score these tests out of 12. If you can walk quickly and slowly on an even surface with perfect score, but left and right cause balance impairments, a zig-zagged line, loss of balance, sway, dizziness, lightheadedness, or nausea, you need practice with these exercises.

Exercise:

The test, once again, becomes the exercise here! If up and down, or left and right, head turns made you dizzy, it’s time to practice those!

  1. Find a long hallway or room without obstacles where it is safe to perform this exercise.
  2. Find a point directly in front of you but at the other end of the room/hallway, this is the spot where you are going to try and end up. Alternatively, if you have tile or hardwood, find a straight line that you are going to try and follow through the duration of the exercise
  3. Begin walking at your normal pace, and turn your head one direction (right, left, up, or down) while walking, and then back to center.
  4. Be sure you’re still in a straight line. If you are not, that’s okay, but get back on your line and try again. If you cannot stay in a straight line, make some adjustments:
    1. Walk more slowly, but still maintain a good heel-toe gait pattern.
    2. Use fewer head turns.
    3. Walk with more “centered” steps in between head turns.

The intention of the exercise is to make you slightly dizzy [less than 5/10 over your BASELINE], but nothing that you cannot bring back down to your baseline in under 5 minutes.

If it takes more than 5 minutes to bring down the symptoms, or the symptoms are greater than 5/10 over your baseline, you’ve done too much. In this case, symptoms of imbalance, walking in a crooked line, feeling dizzy or lightheaded, overwhelmed, or nausea are all symptoms. Wait for your symptoms to return to baseline before beginning again.

Standing with Head Turns

If turning in a circle, moving around corners, or general head movements are difficult for you even when you’re standing still, practicing standing head turns is a great exercise to practice. This can be completed on firm or foam (even or uneven surface), and with a wide or narrow base of support.

  1. Stand with feet hip width apart.
  2. Slowly turn your head right and left, and then return to the center.
  3. Repeat 10 times.

Progressions if this is too easy:

  1. Turn your head more quickly.
  2. Narrow your base of support (feet together)
  3. Stand on an uneven or foam surface

The intention of the exercise is to make you slightly dizzy [less than 5/10 over your BASELINE], but nothing that you cannot bring back down to your baseline in under 5 minutes.

If it takes more than 5 minutes to bring down the symptoms, or the symptoms are greater than 5/10 over your baseline, you’ve done too much. In this case, symptoms of dizziness, lightheadedness, nausea, disequilibrium, or loss of balance are symptoms signaling to stop, wait, and begin again.

Walking on Uneven Surfaces

Surfaces including grass, gravel, and uneven asphalt are difficult for those with vestibular disorders. Your vestibular system is responsible for pairing your proprioception (way you feel the floor) and vision together to keep you upright when you’re walking on an uneven surface. If uneven surfaces are difficult for you, practice is the answer here.

Find a grass, gravel, or foamy surface. It can be any length or distance, but it should be near an even surface, in case you need a break.

  1. Begin by standing still on the uneven surface of your choice.
  2. Stand for at least 1 minute and keep your equilibrium throughout that time.
  3. Then, when you’re feeling comfortable, take a few steps forward on the uneven surface.
  4. Walk about 20’, staying in a straight line, making sure you don’t lose your balance.

The intention of the exercise is to make you slightly dizzy or imbalance, not to to fall or lose your balance, [less than 5/10 over your BASELINE], but nothing that you cannot bring back down to your baseline in under 5 minutes.

If it takes more than 5 minutes to bring down the symptoms, or the symptoms are greater than 5/10 over your baseline, you’ve done too much. In this case, loss of balance or disequilibrium, nausea, walking in a cooked line, or becoming overwhelmed and anxious are are symptoms; be sure to decrease your symptoms before beginning again.

Source:
Dynamic Gait Index, the 4-item Dynamic Gait Index, and the Functional Gait Assessment show sufficient validity, responsiveness, and reliability for assessment of walking function in patients with stroke undergoing rehabilitation, but the Functional Gait Assessment is recommended for its psychometric properties[10].

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1 thought on “Best Exercises for Dizziness”

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