Thank you to COVD for this piece.
Today’s guest blogger is Dr. Alicia Groce. She recently graduated from Nova Southeastern University College of Optometry and is currently doing a residency in Pediatrics and Binocular Vision at Nova Southeastern University College of Optometry. In her free time she likes to play with her dogs, run and listen to music.
At the COVD Annual Meeting in San Diego, Dr. Baxtrom presented a lecture entitled “How to Vestibularly Make Optometric Vision Therapy More Effective.” In therapy, many of us incorporate the vestibular system without even thinking about it. Dr. Baxtrom shared the science behind the visual and vestibular systems and how to enhance the connection to improve therapy.
The vestibular system provides information related to movement and head position. Upright posture requires humans to balance body mass on a relatively small area of support (the feet). It is the vestibular system that carries the burden of keeping us balanced as we move through our environment. It is extremely important for the development of balance, coordination, eye movements and a stable visual world. One way the visual and vestibular systems work together is via the vestibular-ocular reflex (VOR). When motion of the head is sensed by the vestibular sensors in the inner ear, the information is processed by the central nervous system. Signals are sent to the eye muscles which cause our eyes to move in the opposite direction. The result is a stable image on the retina. Manipulation of the vestibular system can enhance eye movements and bilateral integration. This can be extremely productive when working with patients with strabismus and other binocular vision disorders. Many of us have had this experience…. a child with a strabismus starts jumping on a trampoline and when he or she looks up, the eyes are straight…amazing, right? The connection between the visual and vestibular systems explains why this happens.
There are two types of acceleration: linear and rotational. Activities such as swinging, jumping on a trampoline, rocking or walking on a rail are examples of linear acceleration; they are often helpful when working with patients with exotropia. Activities such as spinning and turning are examples of rotational acceleration; they are often helpful when working with patients with esotropia. Vestibular input can also be helpful to change the mood of a patient during therapy. How many parents have told you that putting a fussy baby in a car puts them right to sleep? This is an example of the calming effect of linear acceleration. So, patients that come into the office very anxious, agitated or hyper might benefit from a dose of linear acceleration (do you have a swing in your office?). A patient who has low tone or is falling asleep doing activities might benefit from adding rotational acceleration. Imagine how happy your patients will be if you allow them to spin on chairs and stools in the therapy room! These simple additions to therapy could change a patient’s mood and make the session more productive.
Integrating vestibular aspects into visual therapy is simple. A balance board or walking rail can be added to activities involving charts to introduce linear acceleration or the child can stand on a balance board while doing a bean bag toss. Putting a child on a swing while doing therapy activities is also a good way to integrate linear acceleration and also work on peripheral awareness as the periphery will be moving. Turn and clap activities, spinning on a swing or spinning in a computer chair are ways to add rotational acceleration to therapy.
So, next time you are stuck in therapy or wish there was some way you could help change a patient’s mood, try integrating vestibular input into your therapy.
*”Child swinging” by US Environmental Protection Agency – Climate Change & Children’s Health. EPA, December 2009. Back cover.. Licensed under Public domain via Wikimedia Commons –http://commons.wikimedia.org/wiki/File:Child_swinging.jpg#mediaviewer/File:Child_swinging.jpg