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ADVANCE Perspective: Physical Therapy & Rehab Medicine

Rocker Boards, Parallel Bars and Eye Tests Galore

Published October 4, 2011 11:48 AM by Rebecca Mayer

During my second session of PT for vestibular issues related to motion sickness, my therapist Mark LeBoeuf, MSPT, asked for a progress report of the home exercise program he had given me two weeks earlier.

Yes, I have been doing my vestibular exercises two times a day as he suggested. The program includes exercises to challenge my vistibulo-occular reflex, cervico-occular reflex and depth perception.

An example of a vistibulo-occular exercise: while standing on an uneven surface (to challenge my vestibular system), I am instructed to hold an object in front of me at arm's length. While focusing my gaze on the object, I shake my head up and down and side to side.

To challenge my body's perception of depth, I stand with my arms against a wall and do a push-up while looking at a fixed object in front of me, such as a penny taped to the wall. Mark feels that this exercise ought to help when I occasionally feel off-balance/slightly dizzy when walking down stairs or on escalators.

I explained to Mark that, on some days, doing my exercises in the mornings was more difficult than in the afternoons and evenings because I felt the symptoms come on more quickly. He suggested that I do both sessions later in the day when I feel more comfortable. He reminded me that the point of the exercises is to bring on the symptoms at about a 3 on a scale of 1 to 10. The point is not to make me feel like I'm actually on a boat, during or after the exercises.

Speaking of boats, I guess you are wondering how my trip to Provincetown went? Well, it was a beautiful sail and an incredible wedding extravaganza with good friends, but I was not myself. I had pre-medicated the day before the trip with Meclozine and continued to take it throughout. I was well rested, was consuming low-sodium whole foods, and exercising daily (Provincetown is a beautiful place to take a nice, long leisurely run, if you are interested!). I was tired from the medication the whole weekend and by the third day, I was very nauseous.

So, come on, exercises, I need you to start making a difference! In the meantime, I am happily dedicating my time and energy to the physical challenges brought by the home program.

After we discussed my progress, Mark performed the BPPV tests again just to see if there had been any changes. There were not. Then he took me through a set of more advanced vestibular tests.

While standing between a set of parallel bars (in case I lost my balance), Mark had me perform a series of eye tests in which I followed a cue card he was holding while balancing on one foot, then on a rocker board, and finally on one foot while standing on a trampoline.

We discovered that when he moved the cue card diagonally, rather than vertically or horizontally, I had the greatest onset of symptoms. In the future, he thinks that I should modify the exercises at home to have someone else move the cue card for me, rather than moving the card myself.

I also learned that I need to challenge my balance with a more difficult surface while performing my home exercise program. I had been using a rolled up towel but he suggested a pillow or a seat cushion.

Mark also suggested adding an additional exercise to my list. He would like me to sit on the edge of a bed or couch and quickly lie to one side, ear down on a flat surface, and stay there for 30 seconds. Sit up to start and then do it on the other side. He suggested I repeat this exercise several times daily on each side.

Check back in two weeks after my next, and final, PT session with Mark!


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