The first step in oculomotor testing is to observe if the patient’s eyes rest in the middle or the neutral position. Following head trauma, the eyes may be mal-aligned in the horizontal or vertical plane. It is also important to be aware of any past medical history of visual deficits, amblyopia (or “lazy eye”) and/or strabismus that may have been pre-existing.
Check smooth pursuit, or slow tracking. Smooth pursuit (or “tracking”) is considered a slower tracking system that allows the eyes to timely and smoothly follow a moving object.
A quick screen for pursuit is typically done in the “H-Pattern” to observe tracking in the horizontal and vertical planes 30 degrees from midline in each direction. The speed is approximately 1 completion from left to right in 2 seconds then right to left in 2 seconds. Perform a minimum of 2 repetitions. It is recommended to make note if tracking was normal: the individual was able to follow the target smoothly and timely and without symptom provocation. An abnormal test is defined by decreased morphology (technique), if the patient made quick corrections of eyes jumping across the visual field in an effort to track the target and/or provocation of symptoms. If the subject shows quick eye corrections (known as corrective saccades) consistently across the visual field then such findings are considered more central in nature.
Remember that it is best to look at a more specific object (e.g., end of a pencil/pen or tracking tool) rather than the tester’s finger. Again, be aware if this test results in an increase in symptoms. A quick subjective tool is a visual analog scale (VAS), a 0-6 scale to be consistent with Graded Symptom Checklist (GSC) scale or the standard 0-10 Visual Analog Scale (VAS). Impairments may be observed in those patients who have notable visual symptoms or sensitivity to visual input and/or in athletes that have a high impact whiplash-like injury. And, remember, the H-pattern technique is considered a screen. To add more complexity, the tester can perform circular patterns as if there was a plate around the subject’s head and perform at the speed above then gradually increase the speed. If the morphology and or corrective saccades increases with faster speeds then such findings are considered more central in nature.
Utilizing the V2FIT® Exercise Videos in Your Clinic
The Smooth Pursuit V2FIT® Exercise Videos are designed to improve the ability to track targets with a variety of backgrounds -- progressing from a blue background to picture background then to a moving background. Some of the exercises will require "dual tasking" -- tracking a primary target while also pointing your finger at other targets that move around a main target.
We currently have 19 smooth pursuit videos and each video is 30 seconds long. These videos are available to purchase on our website. Also keep in mind that all 38 V2FIT® Exercise Videos are FREE with the V2FIT® Certification Course.
Watch Bridgett Wallace, PT, DPT, Concussion Health's Co-Founder and Director of Clinical Education, demonstrate how to utilize the Smooth Pursuit V2FIT® Exercise Videos in your clinic:
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