Living Your BEST LIFE with Superficial Siderosis
Our readers living with Superficial siderosis should be aware that living your best life means looking beyond simply treating the symptoms. Both your physical and mental health will benefit. Moving towards a healthier diet, exercising to your limits, and managing other coexisting medical issues increases your chance of positively affecting your well-being. Conversely, smoking, an unhealthy diet, and little exercise increase the risk of aggravating your SS symptoms and speeding the disorder’s progression. This is the sixth installment of our BEST LIFE Series. Updated 05.25
What is Vestibular Therapy
Vestibular therapy is a specialized form of physical therapy that focuses on improving balance, coordination, and spatial orientation by addressing dysfunction in the inner ear and vestibular system. It’s particularly beneficial for people experiencing vertigo, dizziness, unsteadiness, and other symptoms linked to vestibular nerve damage, common in patients with superficial siderosis.
This therapy works by retraining the brain to better interpret signals from the inner ear and eyes, helping to restore equilibrium even when nerve damage is permanent.
Therapy exercises are customized to meet the patient’s current level of function and may include:
- Walking in a straight line
- Standing on one foot
- Turning the head while walking
- Gaze stabilization exercises (keeping vision focused while moving)
- Balance challenges on uneven surfaces
Over time, these activities help:
- Reduce vertigo and dizziness
- Improve eye movement control and focus
- Enhance stability and confidence during motion
- Decrease the risk of falls
Vestibular therapy isn’t a one-size-fits-all approach. It requires consistent practice and progressive adjustments, often under the supervision of a physical therapist trained in vestibular rehabilitation.
Understanding the Vestibulocochlear Nerve
The eighth cranial nerve, or vestibulocochlear nerve, is essential for two critical functions: hearing and balance. It splits into two distinct parts:
- The cochlear nerve, which carries sound signals to the brain
- The vestibular nerve, which transmits information about head movement and spatial orientation
Hemosiderin (iron) deposits from chronic bleeding can accumulate on the cranial nerves, especially the vestibulocochlear nerve, in patients with superficial siderosis. This often results in progressive hearing lossOverview In approximately 95% of superficial siderosis patie... More, imbalance, and chronic dizziness, some of the condition’s most disabling symptoms.
What Happens When Signals Are Disrupted?
Damage to the vestibular portion of the nerve prevents the brain from correctly interpreting signals about the body’s position and motion. As a result, the brain may misinterpret stillness as movement, leading to symptoms such as:
- Vertigo (a spinning sensation)
- Dizziness
- Nausea or vomiting
- Disorientation and loss of spatial awareness
Over time, the body compensates for this disruption, but symptoms can remain persistent or worsen without targeted support.
Vision and Eye Movement Issues
The vestibular system also plays a critical role in stabilizing vision. The vestibulo-ocular reflex (VOR) helps coordinate eye movements with head position. When the vestibular nerve is impaired, patients may experience:
- Difficulty tracking objects or focusing
- Oscillopsia (a sensation that the environment is moving)
- Double visionOverview Diplopia, commonly known as double vision, happens ... More
- Blurred vision, especially during motion
How Vestibular Damage Affects Balance
The inner ear helps regulate our center of gravity through fluid movement in the semicircular canals. When this system is compromised, patients may:
- Be more prone to falls, especially in low-light environments or on uneven surfaces
- Lose their ability to balance confidently
- Walk with a widened gait
- Require walking aids
Vestibular Therapy: A Tool for Retraining the Brain
Vestibular rehabilitation therapy (VRT) is a physical therapy that promotes central nervous system compensation for inner ear deficits. These custom-tailored exercises help retrain the brain to interpret and respond to vestibular signals more effectively, even if the vestibular nerve is permanently damaged.
Common goals of VRT include:
- Reducing vertigo and dizziness
- Improving balance and stability
- Enhancing gaze control
- Regaining confidence in movement
Patients with superficial siderosis often benefit from early intervention and ongoing adaptation of exercises as their condition progresses.
Exercises You Can Do at Home
to download the
MedBridge GO app
and log in
Thanks to the SSRA MedBridge partnership, patients can now access home-based vestibular training programs via:
- A web browser (on computer or a Smart TV)
- The MedBridge Go mobile app
These programs are structured in three levels of difficulty and include activities targeting:
- Functional movement (e.g., turning, bending).
- Gaze stabilization
- Balance training
- Important Safety Note:
If you are unsteady, use a gait belt and have a spotter present at all times. Do not attempt exercises that challenge your balance alone. - Take breaks if you feel dizzy or nauseated, and always follow your provider’s guidance on when to progress to more challenging routines.
Home Vestibular Exercise Program
Level One
Seated Vestibular, Balance, and Leg Strength Exercises
Estimated Time: 14 minutes
Access Code RNKLMVHP
2 x daily – 7 x weekly – 2 sets – 10 reps each set
- Seated Gaze Stabilization with Head Nod
- Seated Gaze Stabilization with Head Rotation
- Seated Head Nod Vestibular Habituation
- Seated Horizontal Smooth Pursuit
- Seated Vertical Smooth Pursuit
- Seated Small Alternating Straight Leg Lifts
- Seated Heel Raise
- Seated Hip Adduction Isometrics with Ball
- Proper Sit-to-Stand Technique
- Standing Hip Abduction
Level Two
Vestibular, Balance, and Leg Strength Exercises
Estimated Time: 16 minutes
Access Code 34VENAAN
2 x daily – 7 x weekly – 2 sets – 10 reps each set
- Standing on Foam Pad – 1 x daily – 7 x weekly – 1 sets – 5 reps
- Seated Nose to Left Knee Vestibular Habituation
- Seated Nose to Right Knee Vestibular Habituation
- Supine to Long Sitting Vestibular Habituation
- Supine to Left Sidelying Vestibular Habituation
- Right-Sidelying to Left-Sidelying Vestibular Habituation
- Narrow Stance with Head Nods and Counter Support
- Sit to Stand Without Arm Support
- Standing Hip Abduction with Ankle Weight
- Seated Long Arc Quad with Ankle Weight
Level Three
Vestibular, Balance, and Leg Strength Exercises
Estimated Time: 11 Minutes
Access Code T2RN8NAE
2 x daily – 7 x weekly – 2 sets – 10 reps each set unless noted
- Standing Gaze Stabilization with Head Rotation
- Standing VOR Cancellation
- Standing with Slow Head Nod
- Standing Horizontal Head Rotation Vestibular Habituation
- Standing with Fast Head Nod
- Sitting Swiss Ball Gaze Stabilization with Head Nod
- Sitting Swiss Ball Gaze Stabilization Head Rotation
- Sit to Stand Without Arm Support – 2 x daily – 7 x weekly – 2 sets – 15 reps
- Wide Stance with Head Rotation on Foam Pad – 2 x daily – 7 x weekly – 2 sets – 5 reps
- Romberg Stance – 1 x daily – 7 x weekly – 2 sets – 5 reps
Thank you for this great work. In addition to weekly equipment pilates this is helpful.
Question:
Are the eye excercise to be made with or without eye glaases. I have souble vision in my left eye.
Hi Kaija,
I’m not a therapist, but my husband was put into this same program and told to keep his glasses on.