The Dynamic Relationship Between Vision and Balance
Overview:
Do you ever experience a weird sensation like the room is spinning or dizziness/blurred vision that is triggered with head movements such as turning to say hello to a friend or nodding your head “yes” or no”? Do you feel nausea or unsteadiness when turning your head while driving? Your eyes provide visual information that the body uses to maintain balance along with proprioceptive information from your muscles and joints and vestibular information from your inner ear that helps to keep the body in a state of equilibrium. There is a reflex called the Vestibular Ocular Reflex (VOR) that allows a person to keep their eyes fixed on a target while they are changing their head position. When you have damage to the inner ear, this reflex can be disrupted, making it difficult to focus your vision while the head is moving. Damage to the ear can include things such as an inner ear infection, head injury (concussion, whiplash, TBI), high doses of certain antibiotics, and viral infections as well as the general aging process that can deteriorate this reflex.
The good news is that this reflex can be trained which means your symptoms can improve! If your doctor or physical therapist diagnoses you with a VOR hypofunction, physical therapy can be used to challenge the vestibular system and can produce improvement in VOR function rather quickly! It works by retraining the brain to use the information correctly as the exercises force the brain to process the information being sent by the inner ear and use it to keep the eyes fixated on a target. Keep reading to learn some exercises you can try at home to improve your symptoms!
VOR x 1
- Start in a seated or standing position. Hold out a piece of paper with an “x” written on it in approximately 12-point font (option to tape paper on the wall and stand/sit arm’s length away). Make sure the wall or environment behind the letter is plain.
- Move your head in a small range while keeping focus on the X as fast as possible while keeping the letter “x” in focus
- Left to right like you are shaking your head “no”
- Up and down like you are shaking your head “yes”
- Do this for 5x for 30 seconds each or until your symptoms are 4/10. Perform 1x daily
- Rest for 30 seconds in between repetitions or until your symptoms reach your baseline level
- PROGRESSIONS: always start in a seated position and progress as follows: standing;; standing and decreasing the distance between your feet; perform in tandem stance or single leg stance
- SAFETY: always perform near the countertop surface if standing to provide support if you lose your balance or in a corner of the room with a chair in front of you
VOR x 2
- Set up is the same as VOR 1.
- Move your head in the OPPOSITE direction as the letter/card in a small range and as fast as possible while keeping the letter “x” in focus
- Left to right like you are shaking your head “no”
- Up and down like you are shaking your head “yes”
- Do this for 5x for 30 seconds each or until your symptoms are 4/10. Perform 1x daily
- Rest for 30 seconds in between repetitions or until your symptoms reach your baseline level
- REMINDERS: Don’t forget to blink. Any symptoms (nausea, dizziness, unsteadiness) should decrease to baseline levels within 15 minutes after cessation of exercise. Always discuss with your therapist if you have any other questions or concerns
Smooth Pursuits
- Hold up a target such as a pen, sticky note with an “x” on it, spoon, etc and keep your eyes fixed on the target
- Slowly move the target left to right, up to down, and diagonally while keeping your eyes on the target with the movement
- Perform for a total of 5 minutes or until your symptoms reach 4/10
Book Target
- While seated, grab a book and hold approximately arms length away (but ensure the words stay in focus)
- Move your head side to side as quickly as possible while still being able to read the words on the page
- 5 x for 30 seconds each or until your symptoms are 4/10. Repeat twice daily
Balance
- Select one of the following positions:
- Romberg stance (feet close together)
- Tandem stance (one foot in front of the other in a “heel-to-toe” stance)
- Single leg stance
- Focus on an object 6 to 8 feet in front of you
- Perform 3 x 30 seconds
- SAFETY: always perform near the countertop surface to provide support if you lose your balance or in a corner of the room with a chair in front of you
Please call (260)739- 0300 to schedule an appointment with ProTailored Physical Therapy at one of our 4 locations in Fort Wayne!
References:
Somisetty S, M Das J. Neuroanatomy, Vestibulo-ocular Reflex. [Updated 2023 Jul 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK545297/