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Dizziness from Vestibular Disequilibrium

By Debbie Batjer


Dizziness is a common occurrence after stroke. It is particularly common with brainstem stroke. Many survivors struggle with dizziness. It is often caused by a problem with the Vestibular system.

Within the first year after my brainstem stroke in 1993, my PT wanted me to consult with a specialist in “Vestibular Equilibrium Disorders.” I had complained of seemingly constant dizziness. Initially, I couldn’t even move without everything spinning, so I didn’t care what she was known for; I just wanted to get rid of the constant sense of nauseating imbalance.

She asked me questions about when and where I felt dizzy. Up until then I had not analyzed the problem. It was an instructive exercise, though, because I realized for the first time, for example, that I was not dizzy whenever I was sitting. I also learned that I had developed lots of techniques to compensate. These included moving only my eyes instead of turning my head to focus, wooden-like, because it was more comfortable. She asked about my sleeping patterns, and told me that my habit of sleeping only on my back with several pillows under my head was my way of compensating in bed. She said that dizziness is a common problem for brainstem stroke survivors.

Testing my tolerance, she told me to watch as she twirled a huge black-and-white checkered poster in front of me. She then asked me to lie on a hard examining table, first on my stomach and then on my back with no pillows. These were awful experiences, but she assured me that the empty wastebasket nearby could be my vomit receptacle. When I didn’t lose it despite the discomfort, she suggested that I would likely drive again one day (highly doubted up until then).

She proceeded to teach me exercises to perform daily both with my physical therapist and on my own with the hope of habituating my responses enough that my dizziness would substantially diminish. They worked in time with a lot of repetitive practice. I remember that I did each about 10 minutes daily over several months, gradually increasing complexity as I mastered the first exercises. I detail them here in the hopes that they might give others some relief for a similar cause, but I can only claim that they helped me.

The specialist couldn’t explain whether these exercises would work or, if they did, why. Her caution, though, was unequivocal: always to err on the side of SAFETY in attempting anything. These exercises sound easy to someone who does not experience discomfort moving the head, but they were at first very difficult for me.



1. Move head, left/right, up/down, diagonally while standing. For safety, stand in a corner facing the back of a high-backed substantial chair, holding onto the chair back while moving head around, repeat.

2. Move head, left/right while walking. For safety, do with someone at your side or holding onto your therapy belt. Practice moving the head side to side while slowly walking. As this gets easier, naturally swing arms. As you feel more comfortable, do this while walking up/down stairs, always holding on to the railing.

3. Move head, left/right, up/down while lying in bed. Using one finger, move it from 1 to 3 feet away and back again. Repeat.

4. Move head from side to side, leaving body facing forward, while sitting.

5. Stand up/sit down, repeat. Sit/stand/turn upper torso to one side, repeat turning upper torso to other side.

6. Turn head toward ceiling/down to floor, while sitting. Repeat.

7. Bend from waist/extend arms over head, moving head up/down with body while sitting or standing. Repeat.

8. Stoop, reach with big ball between hands, moving head with ball, up/down/diagonally. Repeat.

Always, stroke survivors should begin any treatment by finding out what may be causing their dizziness or imbalance. It may be a common problem, but it may also be more complicated. Also there are lots of web sites (keywords: vestibular equilibrium, balance, dizziness) and past newsletter articles that may also help.

For me, 14 years after my stroke, my dizziness is thankfully only a memory. And, yes, I drive. I also do low-impact water exercises daily to help maintain balance, which I highly recommend.

From the StrokeNet archive:
Balance: A View From A Survivor, May 2005


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