What is the theory against using VOR x 1 and 2 with mTBI?

Answer:

“So we definitely use VOR, VOR cancellation, ocular motor exercises post head trauma. It’s hard for me to say that would be contra-indicative when there’s a VOR deficit. But I get it. I get the conversation because if I’m looking straight ahead and doing VOR, what is my concern about that exercise? It is that I’m becoming too bound, centrally. And I’m feeding into my central vision versus what happens between central and periphery. And what we see with head trauma is decreased visual-spatial processing. So you have to think about… What I was teaching 20 years ago on concussion is in the trashcan. We have to be open. We’re doing the best we can, right?

So it may be that we find, down the road, we were not doing anything in the central visual field, post head trauma because what we need to be doing is having people push out and not becoming too dependent. So I can see where they’re contraindicated. We do a mixture, where five ago… well, I don’t know time anymore, but I know that I did brock string a lot. And then you get in the neuro optometry world, and they’re like, “No. What are you doing?” Then you need to be working on the periphery. So now we do brock string, but not as much.

We do a lot of nasal occlusion to push it out in the periphery. We do a lot of central visual exercises that we’re not becoming too dependent on central vision. So I can see where it’s contra-indicative. But I think that would be the rationale is don’t just do things where the eyes are right here in the middle, because what are your patients do? They just start getting too dependent on central vision and don’t process what’s in the periphery.”

RESOURCES & LINKS:

  • This Q&A is an excerpt from the Vestibular Health Summit Sessions
  • The Vestibular Health Summit Sessions are included with 360NeuroGO Enterprise

FACULTY:

Michelle Gutierrez, PT, DSc

Bridgett Wallace, PT, DPT

Bridgett Wallace, PT, DPT, has a doctorate of physical therapy and holds competency-based certifications in vestibular rehabilitation and concussion management. Dr. Wallace has been treating patients with dizziness and balance disorders for more than 20 years and is the founder and President of 360 Balance & Dizziness – a specialty clinic for the evaluation and treatment of dizziness and balance disorders that includes both audiology and therapy services. She is also the co-founder and Director of Clinical Education for 360 Neuro Health Institute, which provides online, mobile, and live educational offerings for healthcare providers.