Timothy C. Hain, MD Click here for the main vestibular rehabilitation page. Page last modified: January 8, 2019
|Gaze stabilization exercises.|
An very simple illustration of the "Gaze Stabilization Exercises" is shown above. These are exercises aimed at improving vision while the head is moving, generally while viewing an earth stationary object. They consist of daily practice of exercises such as shown above, with many variants described below.
Why exercise ?
Common sense says that it is a good idea to learn to adapt to conditions that you can't fix.
There is evidence that they help people overcome chronic dizziness. Studies have particularly shown that it is helpful in bilateral vestibular loss (Herdman et al, 2007), and it is our opinion that gaze stabilization is clearly indicated in bilateral loss. Not all agree though -- in a blinded study, strengthening exercises worked as well as more specific exercises (Krebs, 1991). See the main VRT page for a more general discussion of how these exercises work.
Indications for gaze stabilization:
- Gaze stabilization exercises are a reasonable procedure for persons with unilateral vestibular disturbances such as vestibular neuritis or persons who have had tumors of the 8th nerve removed.
- They are also use for bilateral vestibular loss.
- Central vestibular disorders
Conditions in which indications for gaze stabilization exercises are tenuous:
- Usually gaze-stabilization exercises will not be helpful for persons with positional vertigo.
- Gaze stabilization is usually not tolerated by persons with cervical vertigo.
- Intermittent vestibular problems that return to normal such as
- Migraine associated vertigo
- Meniere's disease (some types)
- Nonvestibular problems -- i.e. blood pressure fluctuations, medication induced dizziness
Begin with simpler exercises, progress to harder ones. So what does it mean harder ?
These exercises as incorporate many "dimensions" -- protocol, speed/frequency, target distance (near/far), background, orientation of head on trunk, and orientation of head with respect to gravity. Of course, this defines a gigantic multidimensional treatment space.
The goal is to find the relevant areas in this space which are not working well and practice them. A vestibular physical therapist can be very helpful in selecting the appropriate variation.
These exercises are not "done" just at the (weekly) PT session - - you do them EVERY DAY. We usually recommend doing them for at least 30 minutes (which may be split over several sessions). The duration needs to be carefully adjusted so that it is enough to make a person "dizzy", but not enough to make them "sick".
Other methods of gaze stabilization not necessarily involving a physical therapist:
The procedures above are not the only way to practice seeing with your head moving. There are numerous sports activities that involve seeing, moving the head and balancing all at the same time. Activities such as ping-pong, basketball, pickleball, tennis, racquetball are all effective ways to improve vision during and after rapid head movements.
At home, sometimes toys can be used to good effect. The "boxaball" toy, a boxing reflex ball, was reported by one of our patients to be very helpful. This is a one-person activity, and might be more amenable to daily use than the sports noted above.
Visual acuity while active and subjective symptoms are the main measures. Recently, the "VHIT" test is an excellent method of measuring VOR gain and can be helpful if available.