Vestibular Treatment Ideas

Heidi's Vestibular Activities for Treatment:  please work with your therapist on appropriate treatments!  

For the hyper-vestibular registering child (greater than 12-14 nystagmus in either eye, gets sick easily, gravitationally insecure, poor balance, avoids movement challenges often)

1. Start out session with deep pressure touch and calming input, such as brushing and joint compressions, weighted tasks, weighted blanket or vest options.  Calm the system down with lots of deep pressure touch and joint input before doing any vestibular input.  Combine deep pressure touch with movement, like wearing a weighted vest or using a weighted blanket while laying down on platform swing with gentle rocking movements. 

2.  Try activities that are grounded and a little vestibular in nature before bombarding their system with suspended swinging. Such as: jumping with medicine ball in hand or weighed vest on, trampoline activities, twisting and turning head while jumping, figure eight walk, rolling or bouncing on a therapy ball, gentle flips and rolling to a target, and head turning like figure eight walking first. 

3. Once they are comfortable with head swings, jumping on a trampoline, rocking on the air pillow, and activities such as that, then try the suspended swinging. This may take a few sessions.  

4. Work on integration of all primitive reflexes!  If you do not know how to evaluate and treat primitive reflexes, then contact me and I can give you information on some great educational courses! 

5. Integration of the MORO, Fear Paralysis and other reflexes are essential to making progress with gravitational insecurities. 

6. When ready for vestibular suspended input, do it slow, calm, and put a weighted vest on them or weighted blanket to calm if needed.

7. Many times they will lay down to feel more "grounded" but this actually can create a stronger input to the canals, causing them to get sick easier. Try to have them sit up with eyes open at first.

8. Be slow and calm in the movement, do not turn the swing or rotate them. Linear movement without a lot of stops and starts is best at first.

9. When they can tolerate simple linear rocking from a single point swing for about for 15 minutes, then gradually start to add in stopping and starting, climbing the rope ladder, throwing balls or bean bags at a target, and other movement/eye hand coordination activities while swing is in linear motion.

10. Gradually add in fun activities that encourage half spins, head swings, and stop and start the swing, as well as get faster in the movements of the swing over time.

11. DO NOT do Therapeutic Listening or other listening therapies right away on the swing with a hypervestibular child! Therapeutic Listening is a type of intense vestibular input, so if you swing them at the same time, you are doubling the input, this is often way to much for their system to handle. 

12.  Your goal is to have a hyper registering child, be able to tolerate swinging with all different head positions (side lying, prone, supine, sitting, etc. while doing an intense eye hand coordination task), they should also be able to tolerate rotary input and fast input without getting ill.

13. The final goal to reach of course is a normal 7-10 second nystagmus response!

Hypo-registration of Vestibular input (less than 7 seconds of nystagmus, craver, seeks all kinds of movement, can't sit still, often poor balance, hyperactive, etc.)

1. The main issue with the hypo issues is to isolate the vestibular system and try to "wake it up". This means that you often have to do activities that have the child close their eyes while receiving balance or vestibular information. This isolates the vestibular system.

Example of ideas with eyes closed: use a bandana or play peek a boo with a younger child while swinging, stand on one foot with eyes closed, walk balance beam with eyes closed, swing with eyes closed in rotary input, and jump on trampoline with eyes closed!

2. Rotary input is the key for children with hypo- or under registration of vestibular issues. Still watch out for them being too hyper afterwards and/or even sick, their systems will wake up without warning and all of sudden they start to get sick after movement, this is actually a good sign that the therapy is working and their system is getting closer to normal!  Change the treatment protocol at this point to normal registration activities and decrease spinning with eyes closed. 

3.  Remember when giving rotary input, 10 rotations to each side, such as 10 spins to the left, stop watch for nystagmus, wait until they give you the go ahead,  then 10 rotations to the right.  You can repeat with a break in between each direction, but never keep going without the child's ok and a break to feel the movement.  Do equal spinning to each direction always. 

4. Swinging from a single suspended point doing rotary input with eyes closed is the strongest vestibular sensation for hypo child.

5.  Other activities for when you can't swing include:  figure eight walk, jumping in circles, jumping on trampoline in circles, leaning over to pick up ball to throw at a target,, jumping and falling on a large trampoline, walking in a figure eight pattern, running in a figure eight pattern, running in a circle, using a scooter board or snow saucer to do spins (great motor planning and proprioceptive activity as well), spinning on an office chair that spins, and again any of these with eyes closed is best!

6.  Just like a child with low muscle tone it takes 9 times more the effort to do a motor task, a child with hypo or under registration of vestibular input, they may need 9 times more the movement to feel it!

If we can "wake up" their vestibular system and challenge it more with intense movement experiences, then we can calm down their excessive need to move while seated and help their systems get the "fix" it needs from recess or gym time.  

The following are activities that I have found to incorporate more hand-eye coordination, visual skills, tracking, head swings, and overall more connections between the visual, proprioceptive, and vestibular systems while swinging.

The importance of connecting and doing activities that include all three of these systems is very important to quicker results therapeutically and functionally!

We need to make sure that therapy is not just spending 15 minutes swinging, it needs to be more therapeutic such as incorporating more cognitive and visual tasks.

These are listed from easiest to hardest:

1. Throw a bean bag or medicine ball at a target while swinging. For the hypo-registering child, have them get on and off the swing to get the ball or missed bean bag, this will increase the stop and start input, which is the strongest input. Of course you can make this more challenging such as telling them to, "pick up the bean bag and throw it with your right hand at the red bucket", or "hold the medicine ball above your head with arm straight and spell ball, then throw into the target". You can add crossing midline of course by having them reach for the bag or ball across midline, then throw. Don't forget to do this in different positions such as supine and prone as well!

2. Popping bubbles while swinging! This simple activity can be a great way to get head turns and swings, finger isolation (tell them which finger you want them to pop the bubbles with such as "have middle man pop the bubble") use the bubble tongs, and of course counting them as they pop them is a great way to motivate! Don't forget to let them blow using the no spill containers! You can also have them hold a spoon in their mouth for lip closure skills and have them pop the bubbles with the spoon! That is a fun one!

3. Crossing midline and position in space awareness while swinging ideas: attach items with links to the ropes all around them, tell them to take off items from the back right rope, and link to the front left rope, or use right left directions!  

4. Visual tracking: do visual tracking activities while swinging using flashlights in a dark room, black light fun, bright colored toys, reaching for objects while in motion and making targets while in motion.  Have them do visual tracking in the same progression as the VMI shape formations such as vertical, horizontal, circles, diagonals, cross, X, square, etc.

5. Laterality and directionality skills: have them look up at a distance such as 5-10 feet away at an arrow chart and then have them hold a medicine ball and do movements with arms only to arrow chart directions while swinging. Can also do this with just holding one arrow that you change the direction of to represent what position for them to move the ball.

6. b,d,p,q,a,m,w, ball: have them read a ball with all different letters that are commonly reversed on it, you turn to different letters ask them to state which letter they see on the ball while swinging. Keep it at least 3-5 feet away.

7. Body Awareness on the swing: have the child do activities with eyes open or closed is best such as,"flex or bend your right wrist", "touch your right knee with your left thumb", "flex your right thumb", "point your left ring finger"

8. Balance code charts on the swing! Do b,d,p,q code charts while swinging in tall kneeling! Yes it can be done! Great balance work too!

9. Prone work: laying on belly to climb rope while on swing, picking up medicine ball and placing in appropriate bucket, throwing at targets while prone, and picking up bean bags working on auditory memory skills! 

10. SUPINE! Don't forget to try them on their backs while swinging! You can do reaching, rope climbing, and medicine ball activities while on their back which is a great Moro and STNR reflex integrator!

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