How we use ‘The Orbital’ (a multi-axis rotating chair)
Firstly, ‘The Orbital’ was developed to stimulate the vestibular system which leads to modulation of the ‘out of balance’ or poorly integrated sensory motor part of the nervous system. This procedure improves the functional performance of the sensorimotor system. That is, the ‘information’ from the muscles, ligaments, skin, eyes, ears and the vestibular organs must be accurately mixed up and delivered to the brain so it can make good use of it. In this way, the brain rapidly understands the current environment and responds accordingly in fractions of a second. The vestibular system is extremely complex and is a major contributor to the sensorimotor system.
To understand how to achieve vestibular system stimulation we must be familiar with the terms of Pitch, Roll and Yaw.
Yaw is just being upright and spinning on the spot. Either done standing or on a swivel chair will achieve this. With the ‘the Orbital’ we add a bit of sophistication by tilting the patient forwards 25 degrees to isolate the Lateral Semicircular Canals to achieve a greater level of stimulation. This Off Vertical Axis Rotation (OVAR) is a ‘step up’ on just spinning. .
Various parameters are measured when doing this activity, such as Heart Rate, Heart Rate Variability and Optokinetic Nystagmus, which is the jerky eye movements that occur with suddenly stopping after repeated rotations.
When the patient can easily tolerate repeated 30sec trials of the yaw movement we progress to Forward Rolls to further stimulate the vestibular system. If this is well tolerated, we will continue with Backwards Rolls. Progression at this point will be to combine the forward or backward rolls with the sideways yaw movement. This further stimulates the vestibular system in a controlled manner.
This progression of stimulating the vestibular system from the simple movements to more complex movements proceeds depending on each individuals tolerance to the combination of movements.
Rolling sideways is the most stimulating of the three; Yaw, Pitch and Roll movements that can be produced with the ‘The Orbital’ and involves parts of the vestibular system called Otoliths. It is actually a unique vestibular stimulation previously unattainable without this type of equipment.
Initially the sessions are 20 seconds long progressing to 30 and 60 seconds as tolerated. It is important to ensure the patient does not experience discomfort or nausea as that will diminish the therapeutic effects of the procedure and waste valuable consultation time.
Continuous monitoring of the various biomarkers ensure improved vestibular ‘robustness’.
At various times, with some patients, their particular dysfunction may require even more precise controlled stimulation where it may be necessary to isolate the semicircular canals further into the Left Anterior Right Posterior and Right Anterior Left Posterior semicircular canal configurations. For this ,the chair is positioned in such ways as to further maximise the stimulation to the Vestibular system.
A more complex explanation.
Injuries causing concussion, advanced age, some illnesses, trauma and abuse all have the potential to create a neuro-inflammatory cascade within the brain which remains active our entire lives. Our brain function will be adversely affected to various degrees. It’s a silent disease state preventing our full potential to be expressed and can produce symptoms like dizziness, motion sensitivity, headaches, migraine, nausea, brain fog, insomnia, sensitivity to light and sound. Many other symptoms can occur to a greater or lesser degree.
Stimulating the Vestibular system gives the brain a chance to sort itself out.
Likewise neuro-developmental conditions may also respond well to increased vestibular stimulation as the intervention again increases sensory motor integration.
An application of ‘The Orbital’ in this regard (neurodevelopmental) is when the symptomatology aligns with a retained Tonic Labyrinthine Reflex.
The Tonic Labyrinthine Reflex (TLR) is a primitive reflex that is normally found in infants and is expected to be integrated (i.e. become less pronounced) as the child develops. This reflex is thought to help with the birthing process and also plays a role in the development of head control and spatial orientation. It is stimulated by the position of the head in relation to gravity and affects muscle tone throughout the body.
There are two components to the TLR:
TLR Forward: When the head tilts forwards, the arms and legs flex.
TLR Backward: When the head tilts backwards, the arms and legs extend.
In a typical developmental process, the TLR becomes integrated during the first year of life. It should not remain active (unintegrated) beyond infancy, in adults, the presence of an unintegrated TLR can be addressed through specific exercises and therapies aimed at promoting neurodevelopmental integration. The goal of these interventions is to help the nervous system develop more mature ways of responding to sensory input, thereby reducing the incorporation of the reflex for balance, coordination, and daily activities.
The signs of a retained Tonic Labyrinthine Reflex in an adult can include:
Poor Balance and Coordination: Difficulty in maintaining balance, especially in the dark or on uneven surfaces. Coordination issues might also manifest in activities that require precise movements.
Postural Problems: An individual may have poor posture, possibly slouching or leaning forward excessively. This can lead to back and neck pain.
Motion Sickness: Adults with a retained TLR may be more prone to motion sickness due to the continued impact on the vestibular system.
Spatial Awareness Difficulties: Difficulty in judging distances or spatial relationships, leading to clumsiness or frequent minor accidents, like bumping into things.
Visual Perceptual Skills: Problems with tracking moving objects, focusing on stationary objects, and possibly difficulty reading, as eye movements may be affected.
Difficulty with Bilateral Integration: Challenges in coordinating both sides of the body, which can impact activities such as swimming, riding a bicycle, or even walking smoothly.
Hypotonia or Hypertonia: Muscle tone may be affected, leading to either hypotonia (reduced muscle tone) or hypertonia (increased muscle tone).
Foot Placement Issues: Problems with gait, including how the feet are placed while walking, can be a sign of a retained TLR. This might manifest as overly cautious walking or difficulty with activities like running.
Fear of Heights: A heightened fear of heights or depth perception issues may be more pronounced due to the ongoing influence on the vestibular system.
Anxiety and Stress: Increased levels of anxiety, particularly in situations that challenge balance or spatial orientation.
‘The Orbital’ has potential to assist in many conditions like this as it is a generalised method of stimulating the entire nervous system.
Long term stroke rehabilitation, neurodegeneration, post concussion syndrome, migraine, vertigo and dizziness often respond well to improved sensory motor integration.
The video below is performing at a velocity appropriate to this patient. Each patient’s ability is different throughout their therapeutic journey and we always begin slowly and well within the ‘comfort zone’ of the patient.