This document discusses vestibular rehabilitation therapy exercises for treating vertigo and balance issues associated with inner ear problems. It defines vestibular disorders as inflammation of the inner ear, nerves connecting the inner ear to the brain, or both. It then describes several exercises including: Cawthrone-Cooksey exercises involving eye and head movements; gaze stabilization exercises focusing on a target while turning the head; canalith repositioning exercises repositioning debris in the ear canals; and Brandt-Daroff exercises involving lying on each side for 30 seconds. The goal of these exercises is to improve eye-head coordination and balance.

1. Mr. Manikandan.T,
RN., RM., M.Sc(N)., D.C.A .,(Ph.D)
Assistant Professor,
Dept. of Medical Surgical Nursing,
VMCON, Puducherry.

2. DEFINITION
• Inflammation of ear the inner ear or the
nerves that connect inner ear to the brain

3. CAUSES /RISK FACTORS
• Upper respiratory infection – common cold, flu
• Virus
• bacteria
• Middle ear infection
• Meningitis
• Head injury
• Smoking
• Alcohol
• Stress
• Allergy

4. CLINICAL FEATURES
• Dizziness
• N/V
• Hearing loss
• Vertigo
• Tinnitus
• Loss of balance (Nytagmus)
• Hearing problem

5. DIAGNOSIS
• H.C
• P/E
• CT
• MRI
• EEG
• Electronystagmography (eye movement)
• Audiometry

6. MANAGEMENT
• IV - Antibiotics
• Vomiting – ondensatron - ante emetics
• Vertigo – Tab. Cinnerazine (Calcium channel
blocker)
• Anxiety - benzodiazepines
• Depression – SSRI (Citalopram, fluoxetine)
• Allergy – diphenhydramine (anti histamine)
• Antiviral
• Fluid replacement

7. vestibular rehabilitation therapy
• Cawthrone – cooksey exercise
• In bed or sitting
– Eye movements -- at first slow, then quick
• up and down
• from side to side
• focusing on finger moving from 3 feet to 1 foot away from face
– Head movements at first slow, then quick, later with eyes
closed
• bending forward and backward
• turning from side to side.
• Sitting
– Eye movements and head movements as above
– Shoulder shrugging and circling
– Bending forward and picking up objects from the ground

8. • Standing
– Eye, head and shoulder movements as before
– Changing from sitting to standing position with eyes open and shut
– Throwing a small ball from hand to hand (above eye level)
– Throwing a ball from hand to hand under knee
– Changing from sitting to standing and turning around in between
• Moving about (in class)
– Circle around center person who will throw a large ball and to whom it
will be returned
– Walk across room with eyes open and then closed
– Walk up and down slope with eyes open and then closed
– Walk up and down steps with eyes open and then closed
– Any game involving stooping and stretching and aiming such as
bowling and basketball

9. GAZE STABILIZATION
• Seated on a chair
• Focus on a small target or your thumb at eye
level in front
• Look at the target, turn your head to the left
and continue to look at the target
• Now turn your head to the right while still
focusing on the same target
• Repeat turning your heard left and right for 1
minute

11. CONT.,
• Seated on a chair
• Raise two small targets or thumbs to eye level
and move them slightly apart
• Focus on the target on your left with your eyes,
then turn your head towards the same target
• Then focus on the target on your right with your
eyes, then turn your head towards the same
target
• Repeat the same steps for 1 minute

13. CANALITH REPOSITIONING EXERCISE
• Step 1. First you move from a sitting to a reclining
position with your head turned to the affected side by
45 degrees. Your health provider will help extend your
head over the edge of the table at a slight angle.
• Step 2. With your head still extended over the edge of
the table, you'll be prompted to turn your head slowly
away from the affected side by about 90 degrees.
• Step 3. Roll onto your side. Your head should be slightly
angled while you look down at the floor.
• Step 4. Finally, you return carefully to a sitting position
with your head tilted down and returned to the center
position.

15. brandt-daroff exercises
• Start in an upright, seated position.
• Move into the lying position on one side with
your nose pointed up at about a 45-degree
angle.
• Remain in this position for about 30 seconds
(or until the vertigo subsides, whichever is
longer). Then move back to the seated
position.
• Repeat on the other side.