Specific Interventions

Description/Progressions

Rationale

Patient education

Education regarding relationship between visual, vestibular, and somatosensory systems.

Increase patient confidence in physical therapy and compliance with HEP.

VOR oculomotor exercises

Therapist holds pen out in front of patient and moves pen horizontally within 60-degree arc from patient’s visual field while patient tracks pen with only eye movement. Progressed to vertical and diagonal patterns and different speeds.

Enhance vestibular adaptation.

VOR X1 gaze stabilization exercises

Therapist holds pen out in front of patient while patient fixes eyes on pen and slowly but continuously rotates head horizontally 60-degrees to either side. Progressed to vertical and diagonal patterns and different speeds.

Encourage dissociation of eye/head movement.

VOR X2 exercises (eyes/head opposite)

Therapist holds pen out in front of patient and moves pen horizontally within 60-degree arc from patient’s visual field while patient tracks pen with eyes and slowly but continuously rotates head in opposite direction of pen. Progressed to vertical and diagonal patterns and different speeds.

Enhance vestibular adaptation by improving optokinetics and inducing retinal slip.

Walking with horizontal head turns, eyes fixed ahead on target

Patient ambulates straight ahead linearly while slowly and continuously turning head 30-degrees to either side. Progressed with various speeds of gait and head turning.

Enhance vestibular adaptation during dynamic activity.

Walking with vertical head nods, eyes fixed ahead on target

Patient ambulates straight ahead linearly while slowly and continuously nodding head 30-degrees up and down. Progressed with various speeds of gait and head movements.

Enhance vestibular adaptation during dynamic activity.

Walking with eyes looking left/right

Patient ambulates straight ahead linearly while moving eyes horizontally. Progressed with various speeds of gait.

Utilize all sensory inputs to improve dynamic postural control.

Walking with eyes looking up/down

Patient ambulates straight ahead linearly while moving eyes vertically. Progressed with various speeds of gait.

Utilize all sensory inputs to improve dynamic postural control.

Standing balance (dynamic surface)

Dynamic surface used was Airex pad. Progressed to unilateral stance, eyes closed, perturbations.

Promote increased utilization of somatosensory system in postural control.

Tandem balance (eyes open)

Standing with feet in tandem stance. Progressed to Airex pad, eyes closed, perturbations.

Promote increased utilization of somatosensory system in postural control by altering base of support.