Cooksey-Cawthorne exercises for BPPV: Treatment, symptoms, advice and help

The following exercises were developed to encourage and hasten restoration of balance that had been upset by a disorder in the inner ear.

Any sudden impairment of the inner ear function, whether due to injury or other causes, is followed by giddiness, which in the first few days may be very intense. Fortunately this giddiness diminishes as compensation takes place, but usually there remains a residue of dizziness that is particularly provoked by sudden turning or bending movements of the head. These exercises are designed to bring about a variety of head movements and encourage the patient to master the disturbing effect of any dizziness. They have been particularly helpful for the dizziness that follows concussion, and after operations on the labyrinth for Menieres Disease or otosclerosis, but can be equally well employed when there is residual giddiness as a result of partial or complete loss of function of one labyrinth.

The Scheme of Exercises

Aims:

1. To loosen the muscles of the neck and shoulders – to overcome the protective muscular spasm and tendency to move “in one piece”.
2. To re-train eye movements independently of the head.
3. To practise balancing under everyday conditions with special attention to developing the use of the eyes and muscle joint sense.
4. To practise eye/head movements that provoke giddiness and thus gradually overcome the problem.
5. To become accustomed to moving about naturally in daylight and in the dark.
6. To encourage the restoration of self-confidence with spontaneous movement.

In addition to head moving exercises, practise in balancing when walking with the eyes open and close, up and downhill and up and downstairs is necessary to restore confidence in balancing under everyday conditions. Patients with vertigo tend to fix the eyes on a stationary object straight ahead and keep the neck as still as possible. This causes excessive muscle tension and a tendency to turn the trunk instead.

Progression:

On initial assessment, the provocative movements should be graded on a scale of 1 to 3 depending upon the symptoms produced, i.e.:

0 – None, 1 – Mild, 2 – Moderate, 3 – Severe

The exercises that provoke the symptoms are then used as the basis of the home programme. All the exercises are performed in slow time and progressed gradually to quick time.

The first exercise should be performed 3 times daily and repeated 10 times. Once this exercise can be consistently graded 0 or 1 over several days thus demonstrating an improvement in symptoms, the patient should progress on to the next exercise as instructed, and the same process repeated.

The rate of progression through the exercises is totally dependent upon the individual. This process may take several months.

NB: If the symptoms do not settle following an exercise the patients are advised to rest until they feel well enough to continue.

Cooksey-Cawthorne Exercises

Exercise Table:

Eyes

Movements at first slow, then quickly:

• Up and down, side to side.
• Focusing on finger moving from 3 ft to 1 ft from face.

Head
Movements at first slow, then quick. Perform with eyes open and then closed:

• Bending forwards and backwards
• Turning from side to side.

Trunk
Perform with eyes open and then closed:

• Bending forwards to touch the floor.
• Bending forwards to touch the floor and twist the body, first to left, then to right.
• Drop shoulder and head sideways to left and to the right.
• Throw and catch ball to the side and above the head.
• Pas