Smooth Pursuit, Fast Saccades, Gaze Stability Part 2 of 4

- Our first maneuver is smooth pursuit, where we have the patient track a single object, our finger in the horizontal plane, with their eyes while keeping their head still. We'll do this for five repetitions, increasing speed as we end, and stopping in the middle of the patient's visual field. There are two kinds of abnormalities to look for. Abnormal signs, which can include either jerky or jumpy eye movements or multiple beats of nystagmus, or symptom provocation, including headache, dizziness, nausea, eye fatigue, or eye pain. Second and third are fast saccades, where we had the patient rapidly look back and forth between two fixed objects. For horizontal saccades, we hold our fingers approximately shoulder-width apart and ask the patient to rapidly look back and forth between them. We'll do this for up to 20 repetitions, again assessing for symptom provocation, and stopping if they become symptomatic before 20 reps. We'll then move to the vertical plane, holding our fingers between their forehead and approximately their sternal notch, again, asking them to rapidly look back and forth between them, and stopping if they become symptomatic or at 20 repetitions. You'll notice I'm wiggling my fingers towards the end and that can help pace the younger children, who are having trouble following instructions. Fourth and fifth are gaze stability, or the vestibular ocular reflex. This involves the eyes fixed while the head is moving. For horizontal gaze stability, our patient will stare at our thumb while shaking their head no for, again, up to 20 repetitions. And then we'll move to the vertical plane where they'll fix their eyes on our thumb while nodding their head yes, again, for up to 20 repetitions. You'll notice I flip my thumb towards the end, and that's because it's easier to fix your eyes on an object that is perpendicular the plane in which you're moving your head.