Cawthorne-Cooksey Exercises

Vestibular compensation

Vestibular compensation is a process that allows the brain to regain balance control and minimize dizziness symptoms when there is damage to, or an imbalance between, the right and left vestibular organs (balance organs) in the inner ear. Essentially, the brain copes with the disorientating signals coming from the inner ears by learning to rely more on alternative signals coming from the eyes, ankles, legs and neck to maintain balance.

The aims of the Cawthorne-Cooksey exercises include 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), improving general co-ordination, and encouraging natural spontaneous movement. You can ask if it is possible for a friend or relative to accompany you during your physical therapy sessions. It can be helpful if someone else learns the exercises and helps you with them. You will be given guidance on how many repetitions of each exercise to perform and when to progress to the next set of exercises. As a general rule, you should build up gradually from one set of exercises to the next.

Eye exercises

• Look up and down 20 times. Start slowly at first, then speed up.
• Look from one side to the other 20 times. Start slowly at first, then speed up.
• Hold up one finger at arm’s length. Focus on it. Move it slowly in towards you and out again 20 times.

Head exercises

• With your eyes open, bend your head forwards, then backwards, 20 times. Start slowly at first, then speed up.
• With your eyes open, turn your head from side to side 20 times. Start slowly at first, then speed up.
• As the dizziness improves, repeat the head exercises with your eyes closed.

Sitting Exercises

• Shrug your shoulders 20 times.
• Turn your shoulders to the right and left 20 times.
• From the sitting position, bend down and pick up objects from the floor, and sit back up again. Repeat 20 times.

Standing exercises

• Move from sitting to standing up, and back again, with your eyes open, 20 times.
• Repeat with eyes closed.
• Throw a small ball from one hand to the other, above eye level, 20 times.
• Throw the ball from hand to hand at knee level, 20 times.
• Turn around 360 degrees on the spot, eyes open.
• Repeat with eyes closed.
• As vertigo lessens, speed up.

Any game or exercise that involves stooping, turning, bending, stretching and hand-eye coordination – for example bowling, tennis – is good for improving your balance.

IMPORTANT NOTES: You may find that your dizziness gets worse for a few days after you start the exercises, but you should persevere with them. Make sure that you are in a safe environment before you start any of the exercises to reduce the risk of injury.