9 Effective Exercises for Vestibular Hypofunction

Vestibular hypofunction can be a challenging condition for patients, with symptoms such as balance issues and dizziness that can dramatically impact quality of life. Research shows that vestibular rehabilitation programs that promote head and body movement are crucial for patient recovery. This article focuses on nine evidence-based vestibular hypofunction exercises designed to offer patients a structured, effective approach to rehabilitation.

What Is Vestibular Hypofunction?

This condition occurs when the balance part of the inner ear, the vestibular system, is not working properly, either from nerve damage or an insult on one side or both sides of the inner ear(s). The vestibular system works with the eyes and body (muscles and joints) to keep us balanced and tell us where we are in space. It is also highly integrated with the autonomic nervous system and limbic system, so symptoms can vary and give rise to anxiety and fear avoidance patterns if not addressed.

Important Vestibular Hypofunction Exercise Considerations

While guiding patients through the exercises described below, it’s important to let them know that it’s normal to experience some level of dizziness (as the brain is working to reintegrate systems), and to help them set boundaries that feel safe as they go through the exercises. Aim for a slight challenge to provoke symptoms, but after stopping, exercise symptoms should dissipate within 10-15 minutes post-exercise (shorter recovery time means progress). If dizziness persists, it might indicate overexertion. In such cases, reduce the intensity or duration of the exercise and gradually build tolerance.

Encourage patients to breathe and try to stay relaxed while doing the exercises to keep the nervous system calm. Please also teach them to employ grounding strategies after the activities or when they participate in their own movement throughout the day so that the brain is supported by stabilizing somatosensory input while recovering from vestibular insult.

Retraining the Brain with Targeted Exercises

Vestibular rehabilitation exercises are tailored to retrain the brain to recognize and process signals from the vestibular system more efficiently, helping to improve balance and reduce dizziness. For individuals with vestibular hypofunction, these exercises are essential components of a comprehensive treatment plan. They are designed to promote adaptation and compensation for the loss of vestibular function and to enhance gaze stability, balance, and general mobility.

Walking Exercises

Walking with head turns

Have the patient start by walking 20-30 feet while swinging their arms and gently turning their head left and right, like they are walking through a museum. Start slowly and then increase the speed as tolerated. Perform this exercise for one to two minutes, twice a day. This exercise aims to improve balance and coordination by integrating head movements with walking, which is fundamental for daily activities. Encourage patients to breathe and shake out any tension in their body regularly during the exercise to ensure they are comfortable while performing the activity.

Vertical head movements

This exercise is similar to the one above, but with the head moving up and down while walking and swinging the arms. Perform this exercise for one to two minutes, twice a day.

Diagonal head movements

While the patient is walking a length of 20-30 feet and swinging the arms, have them turn their head diagonally (up to the left and right). Perform this exercise for one to two minutes, twice a day. This exercise further challenges the vestibular system by introducing more complex head movements.

Gaze Stabilization Exercises

Gaze stabilization with static objects

Have the patient focus on a thumb or a letter on a card (such as “E”), then turn the head left and right (shaking the head “no”) for 30 to 90 seconds while maintaining eye contact with the object. You may need to adjust the speed of the head turns and/or the duration of time to accommodate the patient’s symptoms. They should proceed with head turns as fast as they feel comfortable, eliciting some dizzy symptoms, while keeping the object in focus. If the object goes out of focus or they feel two to three notches above a baseline level of dizziness, have them slow their head speed down. Progress by trying up, down, and diagonal head movements while maintaining fixation on the target.

This exercise strengthens the vestibulo-ocular reflex (VOR), which is crucial for improving visual focus and stability during head movements. The patient should perform short 30- to 90-second sessions, five times each day, trying to total at least 10-15 minutes a day. Increase duration of time and intensity as tolerated. See below to progress the VOR exercises.

Progressive gaze stabilization

The patient starts with the basic gaze stabilization exercise and gradually progresses to performing it while standing, walking forwards and backwards, and finally, against a busy background like a checkerboard. These progressions aim to enhance gaze stability in increasingly challenging contexts.

Balance and Strength Exercises

Outdoor walking

A 15 to 20-minute walk outside, three to four times a week, can significantly benefit individuals with vestibular hypofunction. Have the patient incorporate gentle head turns to look around the environment, swing their arms, and use walking poles if necessary. This exercise promotes general fitness, balance, and mental health benefits. The patient should bring a friend or their phone and have a plan if they don’t feel safe doing this at first.

Standing balance practice

The patient practices standing with their eyes closed for 30 to 60 seconds, twice a day. They should start with a wide base of support and gradually narrow their stance or try a semi-tandem stance then to a tandem stance to increase difficulty. This exercise helps in enhancing postural stability and balance. Encourage the patient to breathe and relax (not fight the sway) during the exercise. If the patient doesn’t feel secure, they should choose an easier stance or be near the wall or counter for safety.

Balance on a foam pad or beach towel

Standing on a foam pad or folded beach towel, the patient performs gentle head turns in various directions five to ten times with eyes open and five to ten times with eyes closed, once or twice a day. This activity adds a proprioceptive challenge, aiding in balance and coordination.

Ankle strengthening

Have the patient rock onto the toes and heels 10 to 20 times, once or twice a day, to build ankle strength, which is foundational for stable walking and balance.

A Structured Path Toward Rehabilitation

For individuals with vestibular hypofunction, these exercises offer a structured path towards rehabilitation, focusing on improving balance, stability, and overall mobility. Guiding our patients through these exercises with patience and care can make a substantial difference in their recovery journey. It’s important to monitor progress and adjust the exercises as needed, ensuring a personalized approach that meets each patient’s unique needs and capabilities. With dedication and the right strategies, improvement in vestibular function and quality of life is achievable.