If your vestibular system (inner ear balance system) is not working properly, you will feel dizzy and off balance. The purpose of this graduated set of simple habituation exercises is to reduce dizziness and imbalance. Habituation exercises work by gradually training your brain to tolerate the faulty information coming from damaged inner-ear balance sensors. The exercises can be done at home.

The exercises were originally developed to help with a stable vestibular loss in one ear (unilateral) such as following acoustic neuroma surgery, vestibular neuritis, labyrinthitis or advanced stage (burn-out) Ménière's disease. They are also helpful for dizziness associated with concussion, BPPV (benign paroxysmal positional vertigo), and PPPD (persistent postural-perceptual dizziness).

Cawthorne-Cooksey exercises will not help patients with spells of acute, active, recurrent, spontaneous vertigo (spinning sensation) – for example, acute vestibular migraine or Ménière's disease – because the brain cannot adjust to the fluctuating nature of these disorders.

Cawthorne-Cooksey exercises are done for time, not number of repetitions.

Try to do the exercises 2 or 3 times every day. Begin with Set A. As a general rule, try to gradually build up from one set of exercises to the next. You may need to start with just a few seconds and gradually work up to 1 to 2 minutes for each exercise.

You might get dizzy when you first start. Do not worry - this means an exercise is working. Do an exercise until you provoke moderate symptoms (4 to 6 on a scale of 10), then stop until your symptoms settle down.  Move on to the next exercise once the current exercise no longer provokes symptoms (0 on a scale of 10).

Diligence and perseverance are required despite any discomfort and passing dizziness brought on by the exercises – this dizziness should go away no more than 20 minutes after you stop an exercise. If an exercise provokes severe symptoms right away, or your symptoms do not settle down within about 20 minutes, it is too hard and should be reserved for later in the process. Exercises that do not provoke symptoms can be skipped.

The earlier and more regularly the exercise program is carried out, the faster and more complete will be your return to normal activity. You may find that your dizziness symptoms worsen for a few days after you start the exercises but do your best to persevere with them.

Diligent practice of the exercises should bring some improvements in about 6 to 8 weeks. You will know you are improving when you are able to repeat the same movement with ease.

If you have no improvement, seek professional advice. You may have a condition that is not a good candidate for these exercises, or you may need different exercises.

It is important to:

• Check with your doctor or vestibular physiotherapist before starting.
• Stop immediately and seek medical attention if any of the exercises seem to cause any of the following symptoms: sharp, severe, or prolonged pain in your neck, head or ear; a feeling of fullness in the ear; deafness or noises in the ear; fainting with loss of consciousness or blacking out; double vision, numbness, weakness or tingling in your arms and legs.
• Stay safe – have someone, or at least a sturdy handhold, within arm’s reach, especially when doing the standing exercises.
• Relax during all of the exercises.