Vincent Cumberworth BSc FRCS Consultant Ear, Nose and Throat Surgeon
Clementine Churchill Hospital Sudbury Hill Harrow Middlesex HA1 3RX
Private Secretary: Tel: 020 8872 3866 Fax: 0208872 3861

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Cawthorne-Cooksey Exercises: Principles

Instructions for patients

The balance parts of the two ears complement each other sending equal impulses to the brain, which are essential for the maintenance of equilibrium of the head and body.  If either, or both balance centres are damaged, equilibrium is upset.  The result of this is vertigo or giddiness, which may be accompanied by nausea and vomiting.  Although this condition may be very frightening, it is not serious in that it does not, in itself, threaten life.  It can, furthermore, be overcome by carrying out special exercises.

The purpose of the exercises is to build up a tolerance mechanism in the brain which compensates for the unequal balance of the two ears.  The exercises stimulate the development of this tolerance mechanism and the more diligently and regularly they are performed, the sooner the vertigo will disappear.

The exercises should be carried out persistently for at least five minutes, three times daily, and for as long as vertigo persists.  This may be for one to three months.  A conscious effort should be made to seek out the head positions and movements that cause vertigo, in so far as can be tolerated, because the more frequently vertigo is induced, the more quickly the brain compensation mechanism is built up.

Certain medications help to control the vertigo while brain compensation is being achieved, and any such tablets should be taken regularly during the course of the exercises.

Meanwhile, as normal a life as possible is to be recommended.  An early return to work and sport are helpful in rehabilitation.

Diligence and perseverance will be required, but the earlier and more regularly the balance regime is carried out, the faster and more complete will be recovery to normal activity.

The exercises are listed below:

Exercises 

Standing

Eyes: 

Movements at first slowly, then quickly.

  1. Up and down, side to side.
  2. Focusing on finger moving from 3 feet to 1 foot from face.

Head

Movements first slow, then quick (also with eyes closed)

  1. Bending forwards and backwards
  2. Turning from side to side

Trunk

Movement (eyes open and closed, except d)

  1. Bending forwards to pick up objects from the floor.
  2. Bending forwards to pick up ball from floor, and twist body to put ball behind, first to left, then right.
  3. Drop shoulder and head sideways to left and right.
  4. Throwing and catching ball to the side and above head.
  5. Pass ball between legs and above head.
  6. Change from sitting to standing with eyes open and closed, also turning round in between.
  7. Turning on the spot to left and right, eyes open and closed (will require supervision).
  8. Walk with another person, throwing and catching ball in a circle and straight line.
  9. With another person’s help, walk, eyes open and closed, backwards and forwards, sideways, turning head, looking in all directions to avoid fixating with eyes.
  10. Walking in a circle forwards and backwards with head turned to left and right, eyes open and closed.

Lying Down 

(Eyes open and closed)

  1. Rolling head from side to side, also over edge of bed.
  2. Rolling whole body from side to side.
  3. Sitting up straight, forwards and from side lying.

Each exercise should be done about 5 times with 2 repeats
5 – 10 minute sessions (including rests)
3 – 4 sessions per day

The Cawthorne-Cooksey Vestibular Exercises  –

(rehabituation exercises) – alternative description

Each exercise should be carried out ten times.  In Section A, all ten should be carried out with the eyes open.  In all other sections, exercises should be carried out five times with the eyes open, five times with eyes shut.

SECTION A:

  1. Keeping head still, move eyes up and down;
  2. Keeping head still, move eyes to left and right;
  3. Focus on your index finger as you bring it from arm’s length away up to your nose, and then out again.

SECTION B:

  1. Holding a soft ball, touch it down in front of you, then stand up again;
  2. As above, but twisting round to left and right before you stand up again;
  3. Throw the ball from one hand to the other, watching the ball all the time;
  4. Pass the ball between your knees and then right up over your head, watching the ball all the time;
  5. Drop your head and shoulders down to the left and to the right, and touch the outsides of your knees;
  6. *  Sit down, then stand up and turn round on the spot, Then sit down, stand up and turn round in the opposite direction;
  7. *  Without sting down, turn on the spot in both directions;
  8. *  If space permits, walk round in a circle with a partner, throwing the ball to each other as you move round;
  9. *  Link arms with your partner and walk round each other in a circle. (You might both feel dizzy!)

SECTION C:

(lying down):

  1. Turn your head from left to right;
  2. Roll your whole body from left to right;
  3. As above, but sitting up in between rolling from one side to the other.

Ideally, the exercises should be carried out 3 or 4 times a day, but this may not always be possible for you.  Basically, try to do them as often as you can.  Some of the exercises, especially Section A, can be practised wherever you are, whilst those marked with an asterisk (*) should only be carried out with somebody else present, at least to start with.

DON’T BE AFRAID TO STOP WHEN YOU’VE HAD ENOUGH!  In any case, you should stop if you start to feel sick.  You can always carry on later.  Don’t hesitate to contact me if you need to.