VOR stimulation exercises

The VOR maintains stable gaze and visual focus during active and passive head motion. VOR exercises are
performed to improve the gain and accuracy of the VOR.
For head movements in phase with a target (X1 viewing), hold a card with lettering at arm's length with eyes
focused on the letters. Move the head from side to side, increasing speed with progressions. Repeat the entire
cycle 20-30 times. The head can also be moved vertically and diagonally. Progress from sitting to standing with
the feet shoulder width apart to standing with the feet together to standing partially pointed (ie, one foot half
way ahead of the other) to standing pointed (ie, one foot completely in front of the other). Progress from
standing on a firm surface to standing on a compliant surface. Post the card on the wall with a plain background
and progress to posting on a wall with a busy patterned background.
For head movement out of phase with target (X2 viewing), hold a card with lettering at arm's length with eyes
focused on the letters. Move the head to the right and the card to the left, keeping the eyes focused on the
letters. Then move the head to the left and the card to the right, keeping the eyes focused on the letters. Begin
slowly and increase speed as the test progresses, but keep the letters in focus. Repeat the entire cycle 20-30
times. This test can also be performed in a vertical direction. Progress from sitting to standing to a sharpened
stance as described above.
Ocular motor exercises
As an exercise to increase pursuit gain, hold a card with lettering at arm's length. Move the card left and right
across the visual field, tracking with eye movement and keeping the head still. Repeat the full cycle 20-30
times. Perform the test in the vertical and diagonal directions as well, increasing speed but being certain to keep
the letters in focus. Progress from sitting to standing to a sharpened stance as described above (see VOR
stimulation exercises above).
As an exercise to improve saccade latency, velocity, and accuracy, hold a card with lettering in each hand
approximately 15 inches apart at arm's length. Keeping the head still, move the eyes back and forth from card to
card, 1 second per card. Repeat 20-30 times for the complete cycle. This test also can be performed in the
vertical and diagonal planes. Progress from sitting to standing to a sharpened stance as described above (see
VOR stimulation exercises above).
Balance exercises
Stand with feet together, maintaining balance by reaching out and touching the wall (in front of the patient).
Take the hands off the wall for progressively longer periods. Begin by taking 1 hand at a time off the wall,
alternating hands. Sharpen the stance. Stand with feet shoulder width apart, looking at a target on the wall.
Narrow the base of support by sharpening the stance. Perform first with arms outstretched, then close to the
body, then folded across the chest. Perform exercises by sitting, then standing with the head bent forward 30°,
and finally standing with the head bent backward 30°. Reach up as though for an object over the head. Bend
over as though picking up an object from the floor. Progress from sitting to standing to a sharpened stance.
Perform exercises with the room lights lowered and then with eyes closed. Progress to standing on foam or
pillow and then to standing on 1 leg.
Another exercise is making a circle with a ball. Focus the eyes on the ball. Move it in a circular fashion in both
directions with increasing speed. Move the head and body with the ball. Progress from sitting to standing to a
narrowed stance.
Gait exercises
In walking exercise 1, begin by walking next to a wall, with the hand out for support, and gradually increase the
number of steps without support. Narrow the width of the gait, and progress eventually to heel-to-toe walking.
In walking exercise 2, walk with the head in motion, left and right, with increasing speed. Narrow the width of
the gait. Move the head in the vertical direction (ie, nodding up and down) as well. Practice turning when
walking, first with large circles, then with gradually smaller turns, in both directions.
In walking exercise 3 (sit to stand), with 2 chairs approximately 10 feet apart, walk from one to the other. Upon
reaching the first chair, sit without using the hands, and, after 5 seconds, rise without using the hands. Go to the
second chair, touch it, and, with support, practice standing on 1 leg for 5 seconds. Repeat the entire cycle 10
times. Add head movements as the exercise progresses, increase walking speeds, and decrease width of gait.
Combined category exercises
For an obstacle course, step over objects and around furniture. Perform activities such as bending over, picking
up objects, throwing and catching objects, bouncing them off walls, and walking on differing compliance
surfaces.
To walk at the grocery store, practice with minimal and then no support from the cart. Begin with slow, small
head movements, increasing speed and degree. Go when few people are shopping and then when the grocery
store is busy.
To walk at the mall, walk slowly, stay near the walls, and go with flow of the crowd. Increase speed, move away
from the walls, and go against traffic. Window shop with head movements.