PURPOSE: The purpose of these activities is to help the patient develop understanding of how the eyes move, the ability to control these movements in a coordinated and effortless manner, and the ability to visually anticipate movement or change. Precise and predictable eye movements direct the purposeful movement of the body.
In all eye movement control activities the patient is encouraged to a) feel the eyes moving, and b) to maintain awareness of the peripheral surroundings (“side vision”). Moving the eyes to extreme positions of gaze can be uncomfortable, so watch for signs of fatigue and take a break if necessary. Repeat this exercise over no more than two or three training sessions.
ACTIVITY 1 – EYE STRETCH
1. The patient sits or stands in balanced posture, looking straight ahead with eyes open.
2. The home assistant asks the patient to move his/her eyes to the extreme right and to hold them there for a count of five. The patient is encouraged to stretch the eyes to their maximum limit, without moving or turning the head, and to feel the movement of the eyes.
3. The eyes then return to the straight-ahead position.
4. The following movements are practiced, always holding for a count of 5 in each position. (“Right, 2,3,4,5,” etc.) The home assistant should monitor carefully for head movement, fatigue, dizziness or nausea. Effort should be made to move the eyes only, and not the head.
When these are mastered, do obliques:
ACTIVITY 2 – CLOSED EYE MOVEMENTS
1. The above procedure is repeated with the eyes closed.
2. When the patient believes that the eyes are in the desired position, they are opened for verification.
ACTIVITY 3 – THUMB TRACKING
1. The patient sits or stands in a balanced posture, both eyes open.
2. One arm is held out, elbow slightly bent, fingers gently clenched, thumb erect (hitchhiker sign).
3. Fixating the thumbnail (a dot or sticker may be added to enhance stimulation and awareness), the patient moves his/her arm slowly:
side to side
up and down
upper left to lower right
upper right to lower left
clockwise and counterclockwise
in a figure eight
4. Effort should be made to move the eyes only and not the head. Do this with both eyes open, then with each eye closed, then with both eyes open again. Try to vary the speed as well.
ACTIVITY 4 – FOLLOW THE BUG
1. The patient sits or stands in a balanced posture.
2. The patient is asked to track an imaginary bug as it walks along the side of a door, edge of the table, etc. Use regular shapes with smooth featureless edges. You could, for example, print off a large ‘o’ on a sheet of paper, or simply draw a shape.
3. As ability improves, the home assistant can ask the patient to stop, start, and reverse movement.
ACTIVITY 5 – EYES CLOSED THUMB TRACKING
1. The patient performs the thumb tracking procedure above, but with the eyes closed.
2. He/she attempts to keep the arm and eyes rotating together.
3. Occasionally the eyes should be opened to verify that they are aimed at the thumbnail.
4. If necessary the patient may rub the thumb and index finger together while moving the arm to enhance awareness of thumb position.
ACTIVITY 6 – HEAD SWING
1. The patient sits or stands in balanced posture fixating a straight-ahead target at eye-level. With the eyes remaining fixed on the target, the patient slowly moves the head from side to side, as if gesturing “No.” Then the head is moved up and down, as if gesturing “Yes.” Diagonal, clockwise and counterclockwise movement is added as ability improves. While the head is moving the eyes must remain fixed on the target. The home assistant should monitor carefully for eye movement, fatigue, dizziness or nausea. You can also: Move the target as the client moves his head; have the client sit in a swivel chair and maintain fixation while keeping the head steady (relative to the chair) and swiveling back and forth, up and down.
ACTIVITY 7 – HEAD ROTATIONS IN THE MIRROR
1. The patient sits or stands in a balanced posture in front of a mirror, approximately 16 inches away.
2. A colored dot, sticker or other target is placed on the mirror straight-ahead, at the patient’s nose-level.
3. Keeping both eyes aligned on the target at all times, the patient slowly moves his/her head:
- side to side
- up and down
- upper left to lower right
- upper right to lower left
- clockwise and counterclockwise
- in a figure eight
4. The assistant should monitor carefully for eye movement, fatigue, dizziness or nausea.