Vestibular Ocular Motor Screen: What to Expect?

Introduction

The vestibular and ocular system is essential in maintaining posture, balance, and vision. The ear and eyes connect with the brainstem and cerebellum to provide information about the position and motions of the body. The system decides the head in the space. It detects a shake or nods in the head called angular acceleration. It positions the head and neck according to the sensory inputs.

What Is the Significance of the Vestibular System?

The significance of the vestibular system is:

• The two main components of the vestibular system are the central processor and motor output.

• The system consists of the eye and head movements by receiving information from the sensory inputs of vision and proprioception.

• It orients the movements of the head and eyes by receiving information from the sensory inputs of vision and proprioception.

• Three semicircular canals in the inner ear detect angular and linear acceleration.

• The vestibular system is a set of structures carrying many functions.

• It deals with the sense of proprioception and equilibrium.

• The functions are oriented to the surrounding by screening and receiving sensory inputs from the eyes and ears. Based on which the head movements are introduced.

• The body's response includes movement of the head in any direction associated with eye movement and posture change.

• The reflexes are called as vestibulo-ocular and vestibulospinal reflexes. Learning, navigation, spatial memory, cognitive functions, and consciousness are essential functions.

What Are the Functions of the Vestibular System?

The functions of the vestibular system include the following:

• The system's two components are centrally located, and the other is peripherally located in the inner ear. The centrally located vestibular system involves neural pathways in the brain.

• They respond to the afferent signals from the inner ear and give back the efferent signals that result in head and eye orientation according to the ecosystem.

• The vestibular system creates awareness of the position of the head and the body in orientation to the surrounding.

• The system's peripheral portion in the inner ear consists of the vestibular labyrinth, vestibular ganglion, and vestibulocochlear nerve (cranial nerve VIII).

• The vestibular labyrinth comprises semicircular canals containing cells that detect the head's angular acceleration.

• The utricle and saccule contain cells that detect the linear acceleration of the head and position of the head in space (spatial orientation).

• The vestibular ganglion perceives the responses from the receptors of the vestibular labyrinth. The reaction from the ganglion is carried to the nerves of the vestibular portion, called the vestibulocochlear nerve, which is located centrally.

• The vestibular nuclei transmit these signals to the spinal cord, cerebellum, and thalamus, by this mechanism, the head, eyes, and whole body, orient to the space.

What Is Vestibular Ocular Motor Screen (VOMS)?

The vestibular ocular motor screen is explained as follows:

• VOMS is used for treatment in people with sports-related concussions.

• A concussion is a severe brain injury that is caused due to a blow or hit to the head while playing sports. This blow or movement to the head can cause changes in the skull, such as bouncing or twisting around the skull, that leads to chemical changes in the brain. It affects the brain cells and can damage them.

• It is a traumatic event where the pain and headaches can be temporary, but over time, they can cause problems with memory, concentration, vision, self-analysis, and consciousness. However, most people recover completely after a traumatic event.

• After sports-related concussions, vestibular and oculomotor impairment causes detrimental symptoms.

• A proper concussion assessment involves vestibular ocular motor screening (VOMS). The main feature of the VOMS test is the assessment of balance, vision, and movement.

• VOMS is an effective tool that helps to find the issues through the assessment. It determines the signs and symptoms of concussion.

• It judges the vestibular ocular system responsible for integrating balance, vision, and movement. It is combined with other tests such as computerized neurocognitive test batteries, cognitive testing, and neurological examination.

• The duration of the VOMS test is five to ten mins. It provides an understanding of the oculomotor and vestibular functioning of the body after the concussion.

• A vestibular therapist carries out vestibular therapy. First, the therapist assesses the balance. The equipment used for VOMS includes a tape measure, a target (pencil tip), and a metronome (a device that produces a steady pulse).

What Are the Components of VOMS Testing?

There are five components in VOMS testing. They are:

• Smooth Pursuits - The eyes can slowly follow an object along a pathway with the head in a straight position.

• Saccades - The ability of the eyes to turn from one object to another with focus.

• Convergence - It is the ability to view a closer object without double vision.

• Vision Motion Sensitivity (VMS) - The eyes can stop movement when the vestibular system is working.

• Vestibular-Ocular Reflex (VOR) - The ability of the eyes to maintain focus on the object while the head is moving.

What Is Smooth Pursuit in VOMS Screening?

The smooth pursuit is explained as follows:

• The person is made to sit in front of the vestibular therapist. The therapist holds a pencil about three feet from the person’s eyes.

• The pencil is then moved right and left about one and a half feet in each direction.

• The therapist notices whether the eyes follow the pencil tip as it moves side to side.

• The patient is advised to position the head still. Then, the left and right movement is performed two times.

• Then the therapist moves the pencil up and down about a foot distance in each direction. The patient is advised to follow the pencil while the head is straight and still. Two repetitions are performed.

• The patient’s response to the feelings of headache, dizziness, vomiting, and fogginess is recorded.

What Are Saccades in VOMS Screening?

The saccades in VOMS are explained as follows:

• The next test is saccades. Saccades involve rapid eye movements.

• The therapist and the patient are seated across from one another.

• The therapist will hold two fingers about three feet from the patient’s eyes and spread them three feet apart.

• The patient is asked to move their eyes between the two fingers. It is done quickly, about ten times. Then, the same test is repeated with fingers up and down.

• After ten times, the score is recorded for the symptoms.

What Is Convergence in VOMS Screening?

The convergence test is explained as follows:

• The patient is made to sit in front of the therapist in this test. The therapist holds a finger about arm’s length from the nose.

• The finger is slowly moved towards the nose and stopped when the patient can see two fingers simultaneously, called double vision.

• The finger's distance from the nose is then measured, and the symptoms are recorded.

• The test is abnormal when double vision occurs over six centimeters from the nose.

What Is Visual Ocular Reflex Test (Vor Test) In VOMS Screening?

The visual ocular reflex test is explained as follows:

• The visual ocular reflex test examines eye ability.

• In this test, the therapist places an object like a pen or pencil about two feet from the face, and the patient is advised to focus on the thing while moving the head left and right. A metronome is used to record the beat of the head-turning.

• The metronome is set at 180 beats per minute, and the patient is asked to turn the head with each moment of the metronome.

• The symptom response is recorded. For example, if the patient considers 180 beats very high, the speed is adjusted accordingly.

• The same procedure is repeated in the up and down direction, and symptom response is recorded. In addition, the maximum metronome speed is recorded.

What is Visual Motion Sensitivity in VOMS Testing?

The patient is advised to stand with feet and shoulder width apart. The hands are clasped in front of the body, and the thumbs are raised. While keeping the eyes on the thumbs, the patient is asked to turn the body right and left for 50 beats per minute. The eye focus should be on the thumbs. The symptoms response is recorded on a scale of zero to ten.

What Are the Observations After the VOMS Test?

After all the levels, the physical therapist will get a baseline idea of the impairments contributing to symptoms. The treatment is tailored accordingly. Performing exercises can improve symptoms. The person can soon turn into a symptom-free state. The VOMS test is used specifically for symptoms caused by concussions. Sometimes physical therapists may use it for non-concussed patients suffering from vertigo with ocular motor changes.

Conclusion

Physical rest and mental rest are essential for quick recovery. Slow-sensitive activities can be carried out because too much rest can slow the process of healing. Physical activity, playing video games, reading books, and watching television can help. Gradually these activities can be increased, and the doctor makes the final decision.