The vestibular ocular reflex system consists of semicircular canals and organs that work much like a gyroscope to communicate to your brain which way up you are. Vestibular Otolith Repositioning exercises (VOR exercises) are a series of graduated movements intended to relax neck and shoulder muscles, train eye movement independently from head movement, promote good balance in everyday situations, practice dizzy-causing head movements for compensating vestibular compensation purposes (providing dizziness relief), improve general co-ordination, promote general co-ordination while encouraging natural unprompted movements.
1. Turn your head to the right
Vestibular rehabilitation exercises aim to restore the functionality of your vestibular ocular reflex (VOR). A properly functioning VOR allows you to keep visual targets in focus as you move your head; in contrast, when its function becomes compromised it may cause your surroundings to appear blurry and give the sensation that everything is spinning out of control.
Exercise are designed to test your balance and may initially cause dizziness. It’s important to push through these sensations, but if they become overwhelming it’s advisable to slow down or stop. Furthermore, these exercises should always be completed in a safe environment with chairs or countertops available as support if required.
Cawthorne-Cooksey exercises are a series of head and eye movements that gradually accelerate, to teach the brain how to compensate for missing inner ear signals that normally provide balance information by using alternative signals from ankles, legs, neck, eyes and even independently moving head movements as alternative sources.
These exercises not only serve to maintain balance and stability, but they can also significantly enhance quality of life. By engaging in more household tasks, leisure activities, driving or sports participation as well as aiding balance and coordination during everyday movements they provide tremendous benefit to overall quality of life.
Begin the exercise by standing up straight and holding out a finger at arm’s length in front of your face at arm’s length. While gazing upon this finger, slowly rotate your head from side to side while looking at it – repeat this movement 40 times before switching your direction for 40 more repetitions on the other side.
2. Turn your head to the left
When we move our head, an intricate system of semicircular canals and organs within the inner ear send signals to our brain telling it which way is up. These signals are sent to a pair of three neurons known as vestibular nerves, which then relay this information to muscles and joints that control posture and balance. When these systems are functioning efficiently, we are able to quickly and effortlessly adjust our gaze in response to head or body movement – a process known as gaze stabilization or VOR. When vestibular systems fail to quickly compensate for head movement, symptoms like dizziness may arise and in severe cases lead to functional loss necessitating rehabilitation services.
When performing VOR exercises, it is key to keep both eyes focused on one object. This can be accomplished by gazing upon something stationary like a thumb or an X on the wall before moving your head from left to right for one second each way and repeating for up to two minutes per day – this should take about one second per time! It may cause dizziness; however, persist through it as this exercise helps with recovering VOR.
An alternative way of performing VOR exercises is walking down a hallway or open space while turning your head and eyes left and right with every other step (i.e. when walking with left foot look left; similarly when switching sides look right). This exercise should last up to 20 feet.
3. Extend one arm forward with the thumb raised
When the vestibular system is working well, the brain communicates automatically with the eyes to keep them steady while moving the head. Unfortunately, communication becomes impaired when an inner ear disorder such as vertigo or vestibular neuritis disrupts this communication, leading to dizziness, nausea, or falls. Vestibular Rehabilitation Training (VRT) helps retrain eye, inner ear, and brain systems so they work correctly together and avoid symptoms of dizziness.
One common VRT exercise entails extending one arm forward with its thumb raised, to improve gaze stability and decrease vestibular symptoms. It should be performed in a safe environment since these exercises may induce dizziness; start slowly before speeding up over time.
Carefully pull downward and backward to stretch each arm for 30 seconds each, using your thumb. This should be repeated on both arms.
Strengthen the muscles in the hand while expanding range of motion in finger joints with this exercise. Place one hand palm-down on a flat surface with its knuckles facing each other; with your other hand make a fist and wrap thumb across fingers until a slight stretch at base of thumb occurs.
By rhythmically turning your head left to right and back again, repeat this sequence a few times before moving your head sideways while maintaining focus on an objective, you will reestablish the ocular reflex while improving balance and coordination overall.
4. Move the thumb from side to side
When the vestibular system is injured or an imbalance develops between right and left vestibular systems, the brain must compensate by turning to different signals from eyes, ankles and legs in order to maintain equilibrium – this process is known as vestibular compensation and often leads to dizziness symptoms.
Vestibular Ocular Reflex Exercises, commonly known as VOR exercises, aim to enhance the brain’s interpretation of vestibular system information. VOR exercises will challenge this system and can cause dizziness; however, repeated practice allows your brain to adapt quickly.
The vestibulo-ocular reflex (VOR) comprises two components, with its rotational component driven by signals from semicircular canals and translational component driven by signals from otoliths. Signals from otoliths synapse in two places in the brainstem: vestibular nuclei and abducens nerve. Vestibular nuclei send inhibitory signals to extraocular muscles while excitatory signals reach lateral rectus muscle of eye, prompting these two muscles to produce compensatory movements of head that prevent visual target from shifting.
VOR training typically begins by looking at a fixed point in space and quickly rotating one’s head in rapid succession. To ensure safety, this exercise should begin at an extremely slow speed before gradually increasing in speed over time.
VRT exercises require patients to rate their dizziness throughout the exercises to assess whether its intensity increases or decreases over time. Once reaching certain speeds of head-turning, their therapist may add more dynamic balance activities requiring the patient to move from sitting to standing on different surfaces and view targets of various sizes and colors.
5. Place two objects on a horizontal surface
The Vestibulo-Ocular Reflex (VOR) is an integral component of balance rehabilitation. This reflex increases communication between your inner ears and eyes in order to help maintain gaze stability during head movements, thus helping maintain steady gaze during any head motions. If it fails to function optimally, dizziness may result when moving your head or walking or running.
To improve your vestibular ocular reflex (VOR), engage in vestibular ocular reflex exercises that present your system with challenges. While these may cause dizziness symptoms, this is normal. If any VOR exercise makes you nauseated or lightheaded, discontinue immediately and inform a physical or occupational therapist so they can modify its difficulty level to meet your needs.
To activate VOR, it is necessary to observe two stationary objects placed on a horizontal surface and close enough together so that you can view both without moving your head. You then move your eyes from one object to the other either sideways, vertically, or diagonally – these exercises are known as head motion and eye movement coordination exercises.
Performing these exercises will help relax your neck and shoulder muscles, train your eyes to move independently of the head, enhance postural stability, practice vertigo-causing head movements, and promote natural unprompted movement. To gain more information on these graduated set of balance exercises presented here, watch Balance & Dizziness Canada’s 35-minute video.
