Cawthorne-Cooksey Exercises 

Timothy C. Hain, MD •Last update: July 30, 2022Spanish translation of CC exercises (courtesy of Maria Busso).

One of the first "general" interventions for vestibular problems were the Cawthorne-Cooksey (CC) exercises, as shown below. Although some authors state that the CC exercises are outmoded, this is not true. The CC exercises are still in common use (see numerous references at bottom of the Vestibular Rehab page). The CC exercises are mainly used as a home program

This document is one page handout of activities that progress from simple head movement to complex activities such as throwing a ball. There are some small adaptations from the original. One should gradually progress through these exercises. For persons who find these activities easy, move on to a harder one in the group(usually the next one).

Cawthorne Cooksey Exercises

  1. In bed (if unable to sit)
    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. Sitting (if possible)
    1. Eye movements as above.
    2. Head movements at first slow, then quick, later with eyes closed
      1. bending forward and backward
      2. turning from side to side.
    3. Shoulder shrugging and circling
    4. Bending forward and picking up objects from the ground
  3. Standing (might need some assistance)
    1. Eye, head and shoulder movements as in the sitting protocol.
    2. Changing from 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
  4. Moving about (best in a class, as assistance may be needed)
    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. Ideally these activities should be done with a supervised group. Individual patients should be accompanied by a friend or relative who also learns the exercises.

(Adapted from Dix and Hood, 1984 and Herdman, 1994; 2000)

References:see the vestibular rehabilitation page for a detailed list