The purpose of the Vestibular Ocular Reflex (VOR) is to maintain stable vision during movement. The VOR controls eye-head coordination. It is important in daily activities, especially those that are more dynamic. The VOR is of particular importance in sports related activities. The clinical implications of a VOR impairment can result in movement related dizziness, blurriness, concentration problems and even nausea. In the video below, Bridgett Wallace, PT, DPT demonstrates how to assess the VOR - seated with single object*:
*This is the first video in the VOR treatment progression series. Attention Premier Members: the entire series is located in the member-only area.
Clinical Implications: Dysfunction in the VOR can result in movement-related dizziness, blurriness, concentration problems and even nausea. Symptoms are commonly exacerbated by head movement, walking, riding in a car and or busy visual environments.
Functional Testing of the VOR: Seat the patient at the appropriate distance from the eye chart (e.g., a 10x10 is 10 feet from the eye chart) and ask him or her to read the lowest line possible on the chart. The tester stands behind the patient and places hands firmly on either side of the patient’s head. The tester starts shaking the head from side to side in about a 30-40 degree arc (15-20 degrees to each side) and after 3 seconds the tester asks “What is the lowest line you can read on the eye chart while I am moving your head?” The patient ideally should be able to read the same line or the line above with the head moving as when it was still AND without an increase in symptoms. The test is considered positive if the patient cannot read the same line, states that the letters are moving, and/or it is making them dizzy or nauseous. Record the line difference and if any provocation of symptoms per a symptom scale. It is also recommended to perform vertically but overall, is less reliable objectively.
It is strongly recommended to test the VOR. The test should be done every time someone reports dizziness unless there are contraindications for moving the head. The test can provide valuable insight to their symptoms of movement related dizziness, blurriness and even nausea.
The VOR coordinates eye and head movement and is of particular importance in daily activities and especially in sports-related (or more dynamic) activities. VOR impairments can result in dizziness, blurriness and even nausea. VOR impairments are very common post-concussion and should be part of the examination.
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As you well know, concussions, from various causes, impact millions of children and adults of all ages. As national awareness grows, so does the need for concussion health experts, like yourself, to provide best practices care to those in need.
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Bridgett Wallace, PT, DPT
Co-Founder & Director of Clinical Education
Vestibular symptoms can occur immediately following traumatic brain injury (TBI) and can be some of the most problematic sequelae, which contribute to a prolonged recovery. Assessment of the vestibular system post TBI generally focuses on sensory organization or balance testing, while testing the vestibulo-ocular reflex (VOR) continues to be largely overlooked. The literature is particularly sparse in incorporating VOR exercises into a rehabilitation program post injury, or articulating the importance of peripheral versus central vestibular involvement.
We are going to publish a video a week discussing the inclusion of visual, vestibular, and cervicogenic symptoms in TBI assessment and management. Join our mailing list and build on your knowledge of comprehensive diagnosis and management of concussion.
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