Effects of Combined Cervical and Oculomotor Exercises on Dynamic Balance in Elderly

Frequency: 3 sessions/week | Duration: 30-45 min

* Week 1-2: Eye exercises 10-12 reps, VOR x1 (30-40 sec), basic balance training, walking 5-12 min

* Week 3-4: Eye exercises 12-15 reps, VOR x1→x2 (1 min), moderate balance training, walking 12-15 min

* Week 5-6: Eye exercises 15-20 reps, VOR x1+x2 (1-2 min), advanced balance training, walking 15-20 min

Smooth pursuit exercises, where the eyes follow a moving target horizontally, vertically, and diagonally while keeping the head still.

Saccadic eye movements, involving quick shifts of gaze between two stationary targets.

Gaze stability (VOR x1 and VOR x2) exercises, involving head movements while maintaining focus on a target, and moving the head and target in opposite directions.

All participants will perform the Otago exercise program, a well-established, evidence-based fall prevention program focusing on lower limb strengthening and dynamic balance. It includes:

• Strengthening exercises (e.g., knee extensions, hip abduction, calf raises).
• Static and dynamic balance exercises (e.g., tandem stance, backward walking, sit-to-stand without using hands).
• A progressive walking plan to improve endurance and confidence during ambulation.

• Frequency: 3 sessions/week | Duration: 30-45 min
• Week 1-2:

Cervical ROM 10-12 reps, chin tuck 5-7 sec ×10, isometrics 5-6 sec ×5-6, eye exercises 10-12 reps, VOR x1 (30-40 sec), walking 5-12 min * Week 3-4: Cervical ROM 12-15 reps, chin tuck 8-10 sec ×12, isometrics 7-8 sec ×8-10, eye exercises 12-15 reps, VOR x1→x2 (1 min), walking 12-15 min

* Week 5-6: Cervical ROM 15-20 reps, chin tuck 10-12 sec ×15, isometrics 10 sec ×10-12, eye exercises 15-20 reps, VOR x1+x2 (1-2 min), walking 15-20 min

Cervical range of motion exercises in flexion, extension, rotation, and side bending (gentle, controlled movements).

Chin tuck exercises in supine or sitting positions to activate deep cervical flexors.

Isometric neck strengthening exercises (flexion, extension, lateral flexion), focusing on controlled, static holds.

Occulomotor Exercises:

Smooth pursuit exercises, where the eyes follow a moving target horizontally, vertically, and diagonally while keeping the head still.

Saccadic eye movements, involving quick shifts of gaze between two stationary targets.

Gaze stability (VOR x1 and VOR x2) exercises, involving head movements while maintaining focus on a target, and moving the head in opposite direction Otago exercises Strengthening exercises (e.g., knee extensions, hip abduction, calf raises). Static and dynamic balance exercises (e.g., tandem stance, backward walking, sit-to-stand without using hands).

A progressive walking plan to improve endurance and confidence during ambulation.

The Timed Up and Go Test (TUG) was used

Cut-off Values:

less than 10 seconds → Normal mobility 10-19 seconds → Good mobility 20-29 seconds → Mild impairment

• 30 seconds → Severe impairment > 13.5 seconds → Increased risk of falls (important clinical cutoff)

Interpretation:

Lower time indicates better performance

Four Square Step Test was used to evaluate dynamic balance

Cut-off Values:

< 15 seconds → Normal performance > 15 seconds → Increased risk of falls

Interpretation:

Lower time indicates better balance

4. Dizziness Handicap was used

Cut-off Values:

0-30 → Mild handicap (used in inclusion criteria) 31-60 → Moderate handicap 61-100 → Severe handicap

Interpretation:

Higher score indicates greater dizziness-related disability