REFERENCE · RECOVERY TECHNIQUE

Using Gaze-Stability Exercises Only When They Fit

When this may fit: When assessment identifies a problem keeping vision clear during head movement that a gaze exercise is intended to address. [Adjacent vestibular-hypofunction guideline; not mandatory PPPD treatment]

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For the Person With FND

“Look at a letter and turn your head” sounds simple. It is still a specific exercise, and it is worth knowing why it has been prescribed. Dizziness alone does not tell you whether this is the right practice.

What is gaze stability?

Gaze stability means keeping the image of something reasonably steady while your head moves. One contributor is the vestibulo-ocular reflex (VOR): signals from the inner ears help the eyes move in the opposite direction to the head. When that system is impaired, the world may blur or appear to bounce during movement. Other eye or neurological problems can also affect vision. [1]

PPPD does not itself prove a weak VOR. A clinician may find a coexisting vestibular problem and select exercises for it, but a gaze exercise should have an explained purpose. [2]

If a therapist prescribes it

Ask what the exercise is meant to improve and which assessment supports using it.
Have the therapist demonstrate the target, position, head direction and speed. Tell them about neck pain, visual problems or symptoms provoked by the demonstration.
Obtain a written or otherwise accessible plan for the amount and what to do if the target will not stay clear.
Review whether it helps the activity you care about, rather than increasing speed because an online programme says to.

Do not invent a dose from this description. Moving just the eyes, following a moving object and keeping a fixed target clear during head movement are different tasks. Their names can sound similar, so ask the therapist to check that the instructions are clear. [1]

Limits to keep in mind

Do not push through neck pain, new double vision, severe headache, near-fainting or unsafe balance. Prescribed glasses and a stable seated position may be appropriate. If repeated practice makes function worse, request reassessment instead of assuming more repetitions must be the answer.

During a familiar flare

Follow the agreed adjustment or pause the exercise. Staring at a target is not a universal rescue technique for every dizzy episode; use the strategy your own plan identifies.

When to stop and seek assessment

Stop unsafe activity. Sudden or distinctly different dizziness with new weakness, double vision, speech trouble, inability to walk, severe headache, fainting or chest pain needs urgent assessment. Sudden hearing loss, head injury or persistent vomiting also needs prompt medical attention. Increasing falls or progressive loss of function warrants reassessment. Existing PPPD does not explain every new symptom. See the diagnostic and differential-assessment page.

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Help arrange the prescribed target only if asked. Do not move it unexpectedly, hold the person’s head or increase the speed. Repeating the instructions is useful support, not a reason to test their memory.

During a familiar flare, follow the agreed support and safety plan. Ask before taking over. New or substantially different symptoms need their own assessment; an exercise should never delay that care.

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For Clinicians and the Care Team

Clarify whether the target is VOR adaptation, substitution or another goal. The Hall guideline addresses peripheral vestibular hypofunction and should not be presented as a PPPD-specific dosing rule. Assess visual, cervical and neurological limits. Record the impairment and functional outcome supporting selection, and discontinue or revise when the rationale or response does not fit.

Agree an accessible next step and review point. Consider meaningful activity, safety, access, effort and delayed effects alongside dizziness severity. Limited improvement is not grounds to withdraw assistance or infer lack of effort.

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Research and Sources

This page expands original entry 5, Gaze-stability exercise when indicated. Examples and practical prompts are educational adaptations, not patient quotations or a reproduced treatment protocol. Original-entry numbering does not imply thirteen independently validated treatments.

The guideline offers strong recommendations for its defined hypofunction population. That evidence cannot be transferred to every person with PPPD. This page explains how to discuss an indicated prescription rather than providing one.

Citation	Source	What it supports and its limits	Figure
1	FND-CIT-0193 — Hall CD, Herdman SJ, Whitney SL, et al. Vestibular Rehabilitation for Peripheral Vestibular Hypofunction: An Updated Clinical Practice Guideline From the Academy of Neurologic Physical Therapy of the American Physical Therapy Association. Journal of Neurologic Physical Therapy. 2022;46(2):118–177. DOI.	Guideline for peripheral vestibular hypofunction; adjacent evidence, not a PPPD exercise prescription.	—
2	FND-CIT-0027 — Staab JP, Eckhardt-Henn A, Horii A, et al. Diagnostic criteria for persistent postural-perceptual dizziness (PPPD): consensus document of the Committee for the Classification of Vestibular Disorders of the Bárány Society. Journal of Vestibular Research. 2017;27(4):191–208. DOI.	Diagnostic consensus; defines PPPD and differential assessment, not treatment efficacy.	—

Sources checked: September 22, 2026 · Vestibular, neurological, lived-experience and accessibility review pending

For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
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