Basic post-concussion vestibular and ocular rehabilitation exercises

• Perform the exercises 2 to 3 times per day.
• Do not perform the exercises immediately following school or work or any activity involving a lot of visual stimuli.
• Symptoms will likely increase when performing the exercises. It is okay for symptoms to increase by 2 points on a 0-to-6 point scale but they should reach no higher than 4. If symptoms reach 4, stop the exercises for that session.
• Symptoms should return to pre-exercise levels within 15 to 20 minutes after performing the exercises. If not, decrease the difficulty of the exercises for the next session. If problems persist, check with your clinician.

These exercises are meant to challenge the vestibular and ocular systems until the threshold for provoking symptoms is reached. The expose, recover, and re-engage model for rehabilitation involves slowly increasing the threshold until a normal, asymptomatic state is achieved.^[1]

As patient tolerance increases, so should the difficulty of each exercise, thereby gradually increasing the symptom threshold. Most exercise progressions involve similar movements with added tasks or repetitions, or the introduction of a challenge to the patient's balance. When the initial exercises become easy and provoke only mild symptoms, patients should advance to more challenging exercises as outlined.

As with rehabilitation for other injuries, vestibular and oculomotor rehabilitation follows a few basic principles:

1. Adaptation: Prompt the uninjured parts of vestibular-ocular system to adjust to certain stimuli.
2. Habituation: Reduce symptoms through repeated exposure to noxious stimuli.
3. Substitution: Promote balance by using other sensory stimuli to substitute for reduced vestibular function.