Vestibular Rehabilitation Exercises To Help Improve Your Balance

Falls are the leading cause of fatal and non-fatal injuries for people over 70 years of age. A majority of these individuals report chronic problems of dizziness and imbalance. After consulting with a physician, a patient may be referred to a physical therapist for vestibular rehabilitation. VRT exercises will help the muscles, joints, eyes, and inner ears learn to compensate for vestibular imbalance and/or weakness. The exercises described in this article can be done at home to supplement physical therapy. Always get medically cleared by a physician before starting any exercise program.

The following exercises may cause dizziness. The first attempt should be done with great caution. Always be prepared to stop and rest if the exercise causes dizziness or lightheadedness. For standing exercises, always stand close to a strong support, such as the back of a very sturdy chair, leaving room for movement but standing close enough to hold if needed.

Ankle sways: Stand holding on to a stable support. Without locking the knees, but keeping them fairly straight, lean slightly forward from ankles (not hips or waist). Hold for five seconds. Stand up straight. Do the same thing leaning left, back, and right, holding each for five seconds and straightening up in between.

Heel-to-toe rolls: Stand holding onto a stable support. Without locking the knees, but keeping them fairly straight, sway from the ankles (not hips or waist) 360 degrees (in a complete circle), first one direction, then the other direction. Stand up straight. Repeat up to five times.

Tracing the alphabet: Stand holding onto a stable support. With the right foot, draw an imaginary letter A on the floor. Continue through the rest of the alphabet, then do the same thing with the left foot. For a challenge, follow with the lower case alphabet on each side.

The following exercises may be done sitting, standing with support, standing without support, or even walking in some cases (depending on comfort level).

Saccades (pronounced "suh-KAHDZ"): Tape four targets (pieces of paper or cards, for example) on a wall approximately 30 degrees apart in a diamond pattern (one right, one left, one high, one low). One arm's length from the wall is about 20 inches apart. To be further from the wall, the targets will need to be further apart. Without moving the head, look back and forth between the right and left targets for about one second each, approximately 25 times. Repeat with the high and low targets.

V.O.R. (Vestibulo-Ocular Reflex) exercise: The V.O.R. is a reflex which normally makes the eyes move equal and opposite of how the ears move. This allows vision to remain clear while the head is moving, such as when walking. To stimulate this reflex, look at a target directly in front (not too close nor too far away) and while keeping the eyes focused on the target, move the head right and left in one second intervals while keeping the target in focus. Complete the cycle approximately 15 times, depending on comfort level. Repeat the cycle with up and down head movements, always trying to keep the target in focus. For a challenge, try this with diagonal head movement (like the lines of an X). The goal is to keep the eyes trained on the center target at all times. The faster the head moves, the harder this will be, so slow down or speed up as needed.

Head circles: Move the head as if drawing a circle on the wall with the nose. Hold onto a support if needed. Follow this pattern: Clockwise (CW) with eyes open 5-10 times, Counterclockwise (CCW) with eyes open 5-10 times, CW with eyes closed 5-10 times, and CCW with eyes closed 5-10 times.

Sinusoidal tracking: Hold a card, pen, or just a finger out at arm's length. Hold the head still and move the arm right and left 10 times while keeping the eyes focused on the object (just the eyes will move right and left together with you arm). Change hands and repeat. Ask someone else to help if the arm gets tired.

Head movement: While sitting or standing, turn the head to look over the right shoulder, turn back to look in front, turn to look over the left shoulder, then turn back to the front. Only turn as far as comfort allows. Repeat the cycle approximately 10 times. As confidence is gained, try turning to look up and down or at diagonals, increase the pace, and/or do these while walking.

Recreational activities can also be excellent for vestibular rehabilitation. In general, activities should involve using the eyes while the head and/or body are in motion. Of course, many activities require this: golf, bowling, tennis, racquetball, ping-pong, dancing, martial arts, swimming, etc. The trick is to find one that is fun, safe, and stimulating. Just walking around the block looking from side to side is a useful activity. Always be aware of physical limitations, and be safe!

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