VOR Training Dosage: A Sensory Strategy Approach
A Deep Dive for Vestibular Professionals
In vestibular rehabilitation, the 'sensory strategy approach' is a powerful tool that can guide clinical decision-making. This Substack delves into the nuances of VOR exercise duration, empowering you to find the 'sweet spot' in VOR training dosage.
Beyond Symptom Reduction: A Functional Perspective
While reducing dizziness and vertigo is a primary goal, VOR training should ultimately aim to restore functional capacity. This means considering how well patients perform daily activities like walking, turning, and navigating their environment, a perspective that keeps you engaged and interested in the process.
Sensory Strategies: Guiding Your Dosage Decisions
A sensory strategy approach considers how patients utilize sensory inputs (visual, vestibular, somatosensory) to maintain balance. This framework can inform your exercise selection and progression.
Vision-Dependent Patients: These individuals rely heavily on visual cues for stability. Progress them from static to dynamic exercises, gradually reducing visual reliance:
Supine → Sitting → Supported Standing → Unsupported Standing
Walking with a wide base of support → Narrow base of support → Firm surface → Compliant surface
Sitting on a stable surface → Swiss ball
Standing with a normal base of support on a firm surface → Compliant surface → Narrow base of support on a compliant surface
The Challenge: Integrating VOR, Vision, and Somatosensory Input
The real challenge lies in effectively integrating VOR training with exercises that challenge other sensory systems. Here's how to approach it:
Eyes Closed Exercises: These exercises force reliance on vestibular and somatosensory inputs. Intersperse them with VOR training to enhance multisensory integration.
Start with static exercises (standing with feet together, eyes closed) and progress to dynamic tasks (walking with eyes closed, head turns with eyes closed).
Altering the support surface (firm to compliant) or reducing the base of support gradually increases the difficulty.
Vision-Stable Exercises: These exercises challenge the vestibular system while minimizing visual conflicts.
Use stable visual targets or backgrounds during static head changes (AKA: 7 Head Positions).
Dosage Considerations: Duration and Progression
Individualized Approach: There is no one-size-fits-all answer. Consider the patient's specific needs, symptoms, and functional limitations.
VOR Exercise Duration:
Start with shorter durations: For individual exercises, particularly those that are more intense or provoke symptoms, begin with 30 seconds to 1 minute.
Gradually increase: As tolerated, progress to 1-2 minutes per exercise.
Monitor closely: Watch for signs of dizziness, fatigue, or avoidance, and adjust duration as needed.
Total Session Time: Aim for 20-45 minutes per session, including warm-up, VOR exercises, balance training, and cool-down.
Frequency: Initially, daily practice is often recommended. As the patient improves, reduce the frequency to 3-4 times per week, then to a maintenance level of 1-2 times per week.
Key Takeaways
A sensory strategy approach can guide your VOR training dosage decisions.
Integrate VOR exercises with eyes-closed and vision-stable exercises to challenge different sensory systems.
Individualize the duration and intensity of exercises based on the patient's response.
Regularly assess progress and adjust the program accordingly.
By understanding the nuances of VOR training dosage and incorporating a sensory strategy framework, you can optimize patient outcomes and facilitate a triumphant return to function.