If the results of the rotary chair examination indicate a deficit of the VOR, particularly decreased gain or a significant asymmetry, we may start the patient on a series of exercises known to enhance the function of the VOR. Like most exercises, the goal is to push the limit of your performance to gradually increase your limit.
Below, you will find the handout that we usually give to people who have no other issues beyond a peripheral vestibular disorder. There are many other VOR exercises not listed here, but we try to keep it simple so the patient does not get frustrated and quit.
These are done at home, but we also frequently refer to Physical Therapy if there are any complicating factors. The main advantage of offering home exercises is that people will do them. Too often, a recommendation to go to a Physical Therapist is not followed through.
Vestibular-Ocular-Reflex (VOR) Exercises
The primary role of the inner ear and vestibular system is to allow you to keep your eyes stable and focused on objects as you move your head around.
VOR exercises are integral to vestibular rehabilitation, a therapy designed to improve the stability and focus of your vision while moving your head. They aim to enhance the communication between your inner ears and your eyes. The inner ear provides crucial information to the brain, which, in turn, uses this data to determine the necessary eye movement for maintaining a fixed gaze on an object during head movements.
As you practice these exercises, your brain becomes adept at interpreting the information from the inner ear and adjusting your eye movements accordingly. With time, your ability to move rapidly while maintaining visual stability will improve. It’s essential to vary the speed and direction of eye movement to replicate real-life situations effectively. These exercises are instrumental in the recovery process from most inner ear disorders.
The ideal outcome of a session is a slight feeling of uneasiness, indicating that the system has been adequately challenged to facilitate progress. Feeling perfectly fine may imply that you are moving too slowly, while pronounced nausea may suggest you are moving too quickly. Thus, VOR exercises serve as a crucial component of vestibular rehabilitation, aiding in your journey to regain stability and visual focus.
- Take an item to read, hold it in front of you, move your head back and forth, up and down, around in circles both directions, as fast as you can and still be able to read the words on the page. Do each direction for about one minute, mix up the direction.
- Hold two items about arms length apart, move head quickly from one to other, up/down, side to side, for about one minute. Stay only long enough to establish focus, then move your head quickly back to the other object.
You should spend about 5 minutes, 2 to 3 times a day, performing the above exercises.
**Interested readers can also check out this very informative video from VEDA that provides a great overview and examples of VOR from Dr. Beth Wagner:
About the author
Alan Desmond, AuD, is the director of the Balance Disorders Program at Wake Forest Baptist Health Center, and holds an adjunct assistant professor faculty position at the Wake Forest School of Medicine. He has written several books and book chapters on balance disorders and vestibular function. He is the co-author of the Clinical Practice Guideline for Benign Paroxysmal Positional Vertigo (BPPV). In 2015, he was the recipient of the President’s Award from the American Academy of Audiology.
**this piece has been updated for clarity. It originally published on June 9, 2013