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How does an abnormal vestibulo-ocular reflex affect balance? What can I do to address it?

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Senior physical therapist

Answer transcribed from Brightway's interview with Dr. Cristen Gordon (pt.2):


This is one of my favorite things to talk about. Vestibular ocular reflex is the concept that for every degree you turn your head, your eyes have to go in the opposite direction to maintain a stable view of the world. If I turn my head to the right, my eyes have to move to the left and that's how our brain gets information about what's going on around us. When that is impaired, it could be because the eyes physically can't make that movement. Or, it could also be just a coordination issue where the eyes cannot time it with the head movement correctly. What that does is it gives your brain a very skewed view of what is happening in your field of vision. The way our brain works is that your field of vision, which is one of your senses, has to match up with what the rest of your senses in the body are telling the brain. If your ears are telling your brain that your head is turning to the right but your eyes don't match up with that, your brain goes “okay well wait a minute what are we really doing here”. 


When the brain gets those conflicting signals, you could get symptoms like dizziness, nausea, headaches, blurry vision, feeling the loss of balance, and there are probably some other variations of that. A lot of patients have different symptoms that come with that. The biggest place you may see that in this day and age is with driving. When you're back to driving or even just scrolling on your computer, using your cell phone, or watching television, the ability for your eyes to follow what's going on on the screen is part of your vestibular ocular reflex. When it's impaired and you're trying to watch TV, your brain cannot comprehend what is happening on the television versus what's happening with your body, so you might get those symptoms. There are ways to work on it though. There are coordination exercises and training exercises. Again, we'd have to figure out what the cause of the impairment is or why the vestibular ocular reflex is impaired, but there are exercises to work on it as well. It could be a physical therapist, a vision therapist, or it could be a neuro-ophthalmologist that could help with that as well.