New facilitation exercise using the vestibulo-ocular reflex for ophthalmoplegia: preliminary report

Objective: To study the effect of facilitation exercises using the vestibulo-ocular reflex on ophthalmoplegia due to brainstem injury. Design: A single-baseline design (A–B: A without specific therapy, B with specific therapy) across individual subjects. Setting: Inpatient rehabilitation facility. Subjects: Eight patients with ophthalmoplegia (total of 15 affected muscles) due to brainstem injury. Interventions: Basic rehabilitative treatment that included physical therapy, occupational therapy and/or speech therapy for impairments such as hemiplegia, ataxia or dysarthria was administered for two weeks (control treatment). Then, two facilitation exercise sessions (100 times/day, five days/week for two weeks) were administered in addition to the basic rehabilitative treatment for four weeks to the eight patients with ophthalmoplegia. Ophthalmoplegia was evaluated at study entry and at the end of each two-week session. The goal of the facilitation exercises is to facilitate voluntary eye movement using conjugated eye movements in the direction opposite to passive movements of the head. Main measures: To assess ophthalmoplegia we measured the distance between the internal/external corneal margin and the canthus of the affected eye on images recorded on a video tape recorder. Results: After the initial two-week basic rehabilitative treatment, the distance between the corneal margin and canthus decreased slightly. Subsequently, after each of the two facilitation exercise sessions, there were significant reductions in the distance between the corneal margin and canthus compared with that at the beginning of the respective facilitation exercise session. Conclusion: Facilitation exercises significantly improved the horizontal movement of eyes with ophthalmoplegia due to brainstem injury.