Early Intervention: The Vestibular System

Many people know the five human senses: sight, sound, touch, smell and taste. However, few have heard about what is widely considered our sixth processing sense: the vestibular sense. This sense controls our visual-motor coordination. The vestibular system constantly provides our brains with information regarding head position and movement, the effects of gravity on our body, and our experiences of acceleration or deceleration. 

Vestibular System Diagram | GentleCare Therapy Early Intervention
Diagram of the Inner Ear, Including the Vestibular Nerve (yellow)

This vestibular sensory input controls much of our physical function, including:

  • Posture
  • Balance
  • Movement
  • Coordination
  • Ability to pay attention
  • Behavior and impulsivity

The vestibular organ is located within the inner ear, deep inside the skull. It communicates with the brain to send signals to the eyes, as well as down the spinal cord to the arms and legs. As you can imagine, this means that our vestibular system helps us maintain balance, posture, coordination, and productive movement. Many people are surprised to learn that our vestibular senses can also affect our ability to pay attention, control our behaviors, and manage impulsivity.

The vestibular sense is the first sense to develop in utero, and by the fifth month of gestation, the vestibular system is typically well developed.  The movement of the mother’s body provides a great deal of information to the growing fetal brain. Unfortunately, when pregnant mothers are placed on bedrest or babies are born prematurely, the babies’ access to this important movement-based information is reduced. These circumstances can delay a child’s development of key vestibular input systems. Luckily, these delays may be improved through physical therapy and early intervention visual-motor exercises. Once babies are born, they continue to develop their vestibular systems throughout adolescence, which offers plenty of opportunity for pediatric early intervention.



Vestibular Functions: What is VOR?

The vestibular system works with the eyes to maintain a very important reflex called the VOR (Vestibular Ocular Reflex). The VOR keeps whatever you are looking at in focus, even when you move your head. To better understand this reflex, clasp your hands together and hold your arms out straight. Focus on your thumbnail. As you move your head left, right, up, or down, notice how your thumbnail stays in focus. This is your VOR at work. For those with vestibular difficulties, an underdeveloped VOR would mean that nothing in the child’s visual focus would stay in place whenever his or her head moved. 

At birth, the VOR is poorly developed. However, if a baby lacks the VOR by 10 months, that is considered abnormal and may require vestibular therapy.

VEstibular Function: What is VSR?

Another vestibular function is the VestibuloSpinal Reflex (VSR). This allows for automatic, reflexive responses in your arms and legs to help keep your overall balance. These responses develop in the arms first; when a baby is first learning to sit, they start to place their arms forward to catch and prevent themselves from falling forward. This forward reflex is first seen around 6 months of age. At about 7 months old, the baby should be able to put his or her arms out to either side to also prevent falling sideways. At about 9 months old, the baby should be able to place hands behind to prevent falling backwards. 

Once these responses are developed, the child is very steady in a sitting position, and parents are no longer worried about needing support behind their child for protection.

Next, a child develops similar VSR responses in their legs. While learning to walk, toddlers develop balancing techniques such as toe raising (ankle strategy), hip movement, or step taking to adjust their balance and prevent falls. Toddlers often experiment with using these balancing techniques as they develop, and these strategies may remain present for longer in children with delayed motor development.  

Vestibular Exercises for Early Intervention with Visual Motor Coordination

If you’re concerned about your child’s visual motor skill development, here are some ideas to help you stimulate his or her vestibular system. Please use caution for safety with any of these ideas and monitor your child for their reaction to the movement. Some children love movement, while others may be very sensitive and want minimal movement. Watch for your child’s response to determine how to proceed. Start slowly and remember that more is not always better. The age ranges are suggestions, as many of these exercises may be used with different age groups.

Vestibular Exercises for Infants Age 0-6 months

  • Infant swing
  • Baby wearing
  • Rocking or cradling
  • Tummy time, time on back, lying on side
  • Limit baby’s total time in “containers” i.e. car seat, bouncy seat to 2 hours maximum each day

Vestibular Exercises for Infants Age 6-12 months

  • Roll baby on tummy over a large play ball or small exercise ball to encourage reaching hands towards floor
  • Encourage rolling on the floor
  • Rocking chair or rocking horse
  • Swinging on lap of parent or in outdoor baby swing
  • Swinging in a hammock

Vestibular Exercises for Toddlers 12-24 months

  • Use of age-appropriate toddler slide
  • Sit and bounce on ball
  • Child-safe mini trampoline with handle
  • Dancing
  • Baby yoga
  • Wheelbarrow walking 
  • Walking outside on grass and gentle slopes

Vestibular Exercises for Toddlers 24–36 months

  • Hopping
  • Skipping
  • Use of Hippity Hop (a sit-on bouncy ball or animal)
  • Rolling across the floor
  • Rolling down a hill
  • Riding push toys

Vestibular Exercises for Toddlers 36+ months

  • Tricycle
  • Scooter (wear helmet and protective gear)
  • Strider bike (wear helmet and protective gear)
  • Sledding
  • Singing songs with motions (i.e. Head, Shoulders, Knees and Toes)
  • Tire swing
  • Playground activities
  • Playing Twister
  • Supervised gymnastics activities

For more information or if you have specific questions about your child?  Ask our physical or occupational therapists for guidance.  

Carol Huegel, Physical Therapist

Carol specializes in in vestibular rehabilitation. She has had the opportunity to practice and develop her skills in a variety of clinical settings ranging from Early Intervention and pre-school, to out-patient clinics, athletic rehabilitation, and neurological rehabilitation research. As a member of the American Physical Therapy Association and Academy of Neurologic Physical Therapy, she has continued to enhance her knowledge, including the completion of the advanced curriculum of the Vestibular Special Interest Group. Carol lectures nationally and internationally on a variety of topics, including vestibular rehabilitation.

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