About Visual Therapy
Visual (eye) exercises are designed to improve the patient's ability to see clearly during movement, allowing for an overall increase in balance and stability while moving. Eye exercises are included as a portion of vestibular therapy, which is a very specialized form of physical therapy. A vestibular therapist, under the direction of a physician, will develop a set of individualized exercises to address the needs of each patient. As a result, no two patients will have the same exercises or respond to the exercises in the same manner. The goal of visual exercises is to retrain the eyes, and the movements of the eyes, to more effectively communicate with and respond to vestibular, somatosensory, and central nervous system (CNS) changes. A better coordination between the four different sensory systems will increase the likelihood of alleviation of symptoms.
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Exercises
The exercises listed below are only an example exercises and non-specific to any person or condition, they are only examples for discussion purposes only. The following exercises are helpful for some patients with dizziness. DO NOT use them unless the therapy program has been prescribed by a physician and carried out by a physical therapist. The exercises listed below are only some exercises that will help provide a natural progress to improve visual
coordination.
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Head Rotation and Gaze Stabilization Exercises
Gaze stabilization exercises, or vestibulo-ocular reflex training, is used to train the eyes to remain fixed on an object as the patient moves. This is a very practical exercise that correlates with real world activities. As a person moves
from one place to another, their head also moves. In a perfect world our eyes will move in an opposite direction of our head to keep our vision stable. However, when the vestibular system or inner ear is not functioning correctly, it is impossible to keep your vision stable, resulting in the symptoms associated with dizziness and other vestibular disorders. Through diagnostic testing, EIT physicians can objectively evaluate the vestibulo-ocular reflex, allowing very specific and individualized exercises to be prescribed to retrain the vestibular system to properly communicate with the eyes. These exercises are generally done with the head moving in two specific directions, either up-and-down or side-to-side, while the eyes remain focused on a target. The speed of the movement is progressive, meaning that one would progress from a slower to faster speed as they can tolerate. Generally movements start at about 2 Hz (2 rotations per second) and progress up to 5-6 Hz (5-6 rotations per second). The number of repetitions and proportion of the exercises will vary based on the specific abnormalities.
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Eye and Head Coordination Exercises
***The exercises listed below are designed to stimulate the balance sensors within the inner ear. As a result of this stimulation, the inner ear becomes challenged, and, as a consequence, will usually give you the sensation of being dizzy or not balanced. Therefore, these exercises should be done while sitting in a chair or other safe place so that one will not fall if they do become dizzy. The key to these exercises is to keep your eyes open and focused on an object. This exercise should be "progressed" to a more difficult level as a person begins to correctly adapt and adjust to the exercises.***
This exercise is designed to improve the coordination between eye movements and head movements. The goal is to practice enabling the brain to remember where a target is with the eyes closed. Practice for about 2 - 3 minutes three times a day.
1. Pick two objects in the room that are far apart but close enough that you can see them without moving your head. It is best if one of these objects is high and the other low. (Suitable objects may be a plant, light switch, doorknob, picture on the wall, or other object).
2. Next, move your head and eyes so that you are looking directly at one of the objects. Now, close the eyes and move the head so that when you open the eyes they will be perfectly positioned on the second object.
3. Then, open your eyes and look at the second object. Pay careful attention to where your eyes "looked" at the moment you opened them and note if the eyes have to move to "find" the second object.
Continue this exercise over and over by going back and forth between the two objects. The goal of this exercise is to train the brain so that no corrective eye movements are required to "find" the object when the eyes are opened. You should choose other objects as well. Some of these should be close, others far away, some high, and some low in the room.
When you are getting better at this exercise try using objects that you must move your head to see. These of course will be further apart then the first set of objects.
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Hallpike Exercises
***The exercises listed below are designed to stimulate the balance sensors within the inner ear. As a result of this stimulation, the inner ear becomes challenged, and, as a consequence, will usually give you the sensation of being dizzy or not balanced. Therefore, these exercises should be done while sitting in a chair or other safe place so that one will not fall if they do become dizzy. The key to these exercises is to keep your eyes open and focused on an object. This exercise should be "progressed" to a more difficult level as a person begins to correctly adapt and adjust to the exercises.***
These exercises are similar to movements that you may have done in the clinic while being evaluated for dizziness. They are done lying down with your head hanging over the end of a couch, bed, or other safe surface.
1. With your head hanging back over the end of the bed or couch, turn your head so that the right ear faces the floor. Hold this position for 10 or 20 seconds or until the dizziness subsides.
2. Move your head back to the initial position.
3. Rotate your head so that the left ear points towards the floor. Hold this position for 20 seconds or until dizziness subsides.
These exercises should be repeated two to three times in each of three to four sessions per day.
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Visual Dependence Exercises
***The exercises listed below are designed to stimulate the balance sensors within the inner ear. As a result of this stimulation, the inner ear becomes challenged, and, as a consequence, will usually give you the sensation of being dizzy or not balanced. Therefore, these exercises should be done while sitting in a chair or other safe place so that one will not fall if they do become dizzy. The key to these exercises is to keep your eyes open and focused on an object. This exercise should be "progressed" to a more difficult level as a person begins to correctly adapt and adjust to the exercises.***
Visual dependence exercises are used when an individual relies heavily on their visual system for balance. Therefore, removal or incorrect sensory input from the visual system will force
the body to rely on other systems, such as vestibular or somatosensory senses. The vestibular therapist may propose treatment maneuvers that will take away visual dependence, such as making it difficult for person to see by wearing dense, unclear glasses, or completely covered glasses. The rationale is to reduce "visual dependency", by not allowing a steady reliance on visual input. This challenges other balance systems in the body and makes the patient rely on a multitude of situations where it might be better to use somatosensory or vestibular inputs.
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