vestibilar rehab-cooksey cawthorne..help

hello, I am a physio in Geneva treating a patient with a diagnosis of post ear infection vestibular disorder. She has nystagmus, nausea and can be very affeted in her ability to do any ADLs when worse. She can not travel to UK for testing due to her symptoms but has had a recomendation to do Cawthorne-Cooksey exs.. here I am, english speaking physio but defintely no experience treating this condition. I would love some general tips and words of wisdom ie when to advance to next ex, how to modify and any specific No's.
This lady has no pattern to her symptoms but she has started with very simple gaze work in lying and in sitting and has generally reported a deterioration in her symptoms.

Thank you for your help.

Fiona

One of the first "general" interventions for vestibular problems were the Cawthorne-Cooksey exercises, as shown below. These are a one page handout of activities that progress from simple head movement to complex activities such as throwing a ball.

Cawthorne Cooksey Exercises

In bed or sitting
1. Eye movements -- at first slow, then quick
1. up and down
2. from side to side
3. focusing on finger moving from 3 feet to 1 foot away from face
2. Head movements at first slow, then quick, later with eyes closed
1. bending forward and backward
2. turning from side to side

Sitting
1. Eye movements and head movements as above
2. Shoulder shrugging and circling
3. Bending forward and picking up objects from the ground

Standing
1. Eye, head and shoulder movements as before
2. Changing form sitting to standing position with eyes open and shut
3. Throwing a small ball from hand to hand (above eye level)
4. Throwing a ball from hand to hand under knee
5. Changing from sitting to standing and turning around in between

Moving about (in class)
1. Circle around center person who will throw a large ball and to whom it will be returned
2. Walk across room with eyes open and then closed
3. Walk up and down slope with eyes open and then closed
4. Walk up and down steps with eyes open and then closed
5. Any game involving stooping and stretching and aiming such as bowling and basketball

Diligence and perseverance are required but the earlier and more regularly the exercise regimen is carried out, the faster and more complete will be the return to normal activity.

Apart from Cooksey-Cawthornes' you might consider the following treatment for Benign Paroxysmal Positional Vertigo (BPPV).

http://www.cmaj.ca/cgi/content/full/169/7/681

I researched it to help my father who has had recent episodes of vertigo and nystagmus when turning onto his left side (particularly). I'm not sure if it helping him yet, or even if he is doing the exercises, which involve a whole-body manoeuvre to reposition floating debris that collects in the posterior or lateral semicircular canal of the inner ear.

It might be of interest anyway ........

the cawthorne-cooksey exercises are good to train eye hand coordination for people who have problems with L/R incoordination too.

Cawthorne-Cooksey exercises stand first, of all other protocols for the same

I totally agree with Physiobob and think that apart from presribed medical management ...... follow your patient acc. to suggested exercise (by physiobob) and have some patience..... you will definitely get results.
Good luck