The Vestibular Ocular Motor Screen

A Screening Tool for Concussions

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If you are experiencing dizzy spells or vertigo after a concussion, you may be a candidate for vestibular physical therapy. This type of therapy involves assessing your vertigo and figuring out how to relieve your dizzy symptoms and prevent future problems. Your physical therapist will use various tests to measure your vestibular function.

One test often used in vestibular physical therapy is the Vestibular Ocular Motor Screen (VOMS). This test can pinpoint what is causing problems after a concussion. It may also help you predict your level of dizziness after a concussion.

What Is Vestibular Therapy?

Vestibular therapy is a type of physical therapy that is done to help people with vertigo, dizziness, or other related symptoms. It is performed by a vestibular therapist. This therapist can assess your balance, ocular function, and vestibular function, and offer you strategies and exercises to help improve your dizzy symptoms.

If you have experienced a traumatic event involving a blow to the head, you may have suffered from a concussion. Symptoms of concussion may include:

If you have suffered a blow to the head, you should see a physician right away; a concussion is nothing to take lightly. Your doctor can assess your condition and get you started on the right treatment.

As many as 50% of all people who have a concussion experience dizziness as a primary symptom. This may lead to movement impairments and difficulty engaging in normal work and recreational activities. Working closely with a physical therapist can help quickly determine the primary cause of your dizziness and can help you recover fully.

Components of the VOMS

The VOMS is a simple test to perform and takes approximately five to 10 minutes to complete. Equipment used for the VOMS is a tape measure, a target (like a pencil tip), and a metronome.

Five domains are measured during the VOMS:

  • Smooth pursuits
  • Saccades (rapid eye movements)
  • Near point convergence
  • Balance vision reflex, also known as the vestibular-ocular reflex (VOR) test
  • Visual motion sensitivity

The goal of each domain during the VOMS test is to make symptoms occur, which the patient records. A baseline recording of headache, dizziness, nausea, and fogginess is recorded before the test begins and after each specific domain is tested. A scale of zero (no symptoms) to 10 (severe symptoms) is used.

Smooth Pursuits

To perform this test, you should be seated in front of your physical therapist. The therapist holds up a finger or pencil about three feet from your eyes. The pencil is then moved right and left about one and a half feet in each direction. Your eyes should follow the pencil tip as it moves side to side while you keep your head still. Two repetitions are performed left and right.

Your physical therapist will then move the pencil tip up and down, about a foot and a half in each direction. Your eyes should follow the pencil tip while you keep your head still. Two repetitions are performed up and down, and then your response is recorded for feelings of headache, dizziness, nausea, and fogginess.

Saccades

Saccades are rapid eye movements. To test this in the VOMS, you and your therapist will be seated across from one another. Your therapist will hold up two fingers about three feet from your eyes and spread apart three feet. You will then move your eyes between the two fingers as quickly as possible for 10 repetitions.

The test will be repeated with your therapist holding their two fingers up and down. Once your eyes move up and down rapidly for 10 repetitions, a score will be recorded for your symptoms.

Convergence

To perform this test, your therapist will sit in front of you. A finger is held up about arm’s length from your nose. The finger is then slowly moved toward your nose and is stopped when you see two fingers (double vision). The distance of the finger from your nose is then measured, and your symptoms are recorded.

An abnormal test is considered when double vision occurs greater than six centimeters from your nose.

VOR Test

The VOR test assesses your ability to keep your eyes focused and steady as your head moves. To perform this test, focus on an object, like a pen tip, about three feet in front of your face. Keep your eyes focused on the object, and then rapidly move your head left and right while keeping your eyes on the pen tip.

A metronome should be used to keep the beat of your head turning. Set the metronome at 180 beats per minute (bpm), and turn your head with each beat of the metronome. Record your symptom response. If you are unable to maintain a speed of 180 bpm, then slow the metronome down and record the maximum beats that you can maintain.

The VOR test is then repeated in the up and down direction, and symptom response is recorded. Record the maximum metronome speed as well.

Visual Motion Sensitivity

This test is performed in the standing position with your feet shoulder width apart. Clasp your hands in front of you and raise your thumbs up. While keeping your eyes on your thumbs, turn your body left and right to a beat of 50 beats per minute.

Keep your eyes on your thumbs; you should see the room swooshing by as you turn. If you are unable to twist at 50 bpm, slow the metronome down and record the maximum speed you can maintain. Record your symptom response as well on a scale of zero to 10.

After the Test

After performing the five domains of the VOMS, your physical therapist will have a baseline idea of the impairments that may be contributing to your dizziness or vertigo. Then, treatment can be tailored to improve upon those impairments.

Research shows that performing exercises specifically like the VOMS domains can improve symptoms and help you return to a symptom-free state.

While the VOMS test is often used specifically for vertigo and dizziness caused by concussions, some physical therapists may use it for non-concussed patients suffering from vertigo with ocular motor changes. The results of the VOMS for these patients may not be as accurate as compared to patients with concussions, but they may serve as a baseline for dizzy symptoms to guide vestibular therapy.

Summary

If you have dizziness, headaches, or fogginess due to a concussion, you may benefit from physical therapy to help your condition. One test that your therapist may perform is the Vestibular Ocular Motor Screen. This simple exam can determine the severity of your problem and can guide your rehab sessions. That way, you can quickly and safely return to your previous level of function.

A Word From Verywell

Dizziness, headaches, and fogginess caused by a concussion can greatly impact your quality of life and ability to perform daily tasks. Physical therapy may be able to help your condition, but it may also not be the right fit for you. Don’t give up hope! Your doctor should be able to recommend other options to ease your symptoms.

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