Eye Exercises for Visual Field Loss

Often a stroke survivor, or survivor of traumatic brain injury, has a loss of visual field perception, often termed Hemianopsia.  They may be unable to see to one side, or they may have blind spaces in their visual field.  Many eye doctors still believe that this visual field neglect never improves after a stroke. However, in my experience, exercises that promote eye, neck and inner ear coordination do in fact help reduce the visual deficit.

Below are some exercises that I frequently use with patients in the clinic.


Exercises should be completed at least 3x/day for a minimum of 10 days. It is important to have adequate water/hydration before and after each exercise set.

The GOAL OF THESE Exercises is to maintain your visual focus on the target, despite either the target or the head moving. Exercises should first be done SITTING. After all exercises are easy to complete in sitting – be sure to do the full 10 days – then you can progress to doing them in STANDING.

 Briefly close the eyes and rest between each Exercise Set. If they cause extreme dizziness (greater than 5/10 intensity) then a reassessment should be done. All exercises are initially done for 10 days with only horizontal or vertical movements. Diagonal patterns should not be added until the other directions are easy and cause no dizziness.

* IF the stroke survivor cannot hold the card(s), then another person can hold the card(s)*


Hold a playing card or small object arms length from your eyes, nose height. Keeping your head completely stationary, move the card/object slowly from Right -> Midline -> Left -> Midline -> Right (repeat 3x) .

While the card/object is moving keep your eyes focused on it , but your head still.

After a brief rest, keep your head completely stationary, move the card/object slowly

Up -> Midline -> Down – Midline (repeat 3 x)



Hold a playing card or small object arms length from your eyes, nose height. Keeping the card/object completely stationary, move your head slowly from Right -> Midline -> Left -> Midline -> Right (repeat 3x) .

While your head is moving keep your eyes focused on the card/object.

After a brief rest, Keep the target completely stationary, move your head slowly Up -> Midline -> Down – Midline (repeat 3 x)



Hold a playing card or small object in each hand, arms length, nose height with approx. 3 feet spread between hands. Keeping your head still, rapidly look from left to right focusing on the card/object on one side then the other (10x each side)



ReLearning to Walk After A Stroke

I recently presented at a Stroke Symposium for the Pacific Stroke Association and several members of the audience asked me to post my slides.  They are posted here for educational purposes only. Not all of the slides are self-explanatory, so if you have questions please feel free to contact me.

Just a reminder:  IF you are holding onto anything with your hands, or if a therapist is holding onto you during your “balance exercises”  you are NOT working on balance.  One must not have contact with anything when learning to balance on their own, therefore it is very important that you practice only in safe confine with another person guarding for safety. I recommend standing with your back very near but not touching a corner, then placing a walker or chair or person in front of you for safety. 

ReLearning to Walk 09.17

Fact or Fiction: Understanding recovery of movement after stroke

Last week, I presented a talk for stroke survivors affiliated with The Pacific Stroke Association.  Several attendees asked me to post my slides.  I am doing so, but some of the slides may not be entirely self explanatory.

Feel free to contact me with questions.

PSA 3-17

The Subluxed Shoulder – stage one

The subluxed shoulder is a common problem post stroke and often treated only with a sling, that really does not offer much support.  I think we need to change the way we treat the subluxed shoulder.  Historically, weight bearing through the paretic arm has mostly resulted in a painful shoulder.  Often the paretic hand is bound / tied to the handle bar of machine that does reciprocal pedaling/rowing/etc.  This is really not good for the subluxed shoulder. Every revolution of the handle bar is essentially pulling the arm out of the shoulder joint again.

In my book “Highs, Lows, and Plateaus: a path to recovery from stroke” I talk about the stages of recovery following a stroke.  Not everyone goes through these precise stages but it provides a framework.  Early on the arm is often flaccid and the shoulder joint becomes subluxed, i.e. the upper arm bone literally slips out of the shoulder socket.  A few DO and DO NOT lessons that I have learned:


  • Use a sling to keep the arm safe when walking
  • Electrical stimulation to the muscles of the shoulder joint is helpful when used daily on a set protocol.
  • All exercises for the arm should be done while lying on your back.  This provides stability to the shoulder blade and also allows the upper arm to gently glide back into the joint.
  • The first exercise is to bring the weak arm gently over head (with help from your strong arm) so that with your hands together, both arms are vertical to the body (90 flexion) and the elbows are straight.  Then  make TINY little circles with the hands allowing a gentle motion of the shoulder joint. This allows the joint to gently settle into the socket and stimulate the sensory receptors that then excite the muscles around the joint.


  • DO NOT Use any type of reciprocal exercise machine for the weak arm!
  • DO NOT Put weight through the weak arm – not until the shoulder joint is no longer subluxed out of the socket
  • DO NOT Overstretch the arm by having any motion that brings the arm overhead or out to the side.  If an overhead motion is made, then the shoulder blade MUST also be rotated to prevent the arm bone from pinching into the front of the shoulder socket

As you do the first exercise the muscles around the shoulder joint will begin to activate again. As the subluxation resolves, the exercises are advanced.



Cross-Brain Exercises

I was giving a talk over the weekend to a group of stroke survivors when a woman in the audience reminded me to talk about “cross-brain exercises.”  She had used these types of exercises to help her own post-stroke recovery.

There are lots of websites, You Tube videos, and books about exercises that encourage the two halves of your brain to communicate with each other. This is especially important when one half has been injured!   Historically, these exercises have been used for children to aid in neuromuscular development, but they are great for any brain ~ young, old, or injured.

Just a few ideas:

1. Reach for bean bags, balls, stuffed animals, or other objects across midline, then throw them at a target. You can use your sound or affected hand to do this exercise.  You can also use your feet to kick rather than throw across midline.

2. Draw large Figure Eights (the infinity sign or an 8 turned on its side) on paper or in the air with a finger. While drawing the Figure Eight follow the path closely with your eyes, but do not allow your head to move.  Then try it again, keeping your eyes quiet while allowing your head to move as you follow the Figure Eight.

3. Strength and coordination training of the sound hand or leg has been shown to be beneficial for affected / weak side. Practice lifting a weight with one hand and then placing it on the opposite side of the body without switching hands. Or lift a weight on your ankle and cross your leg over to the other side.

4. Touch the opposite elbow and to knee. You can begin by touching your elbow the the strong side to the knee of your weak side, and then vice versa.

5. Cross one foot over while sitting, then alternate.  To make this more difficult, cross one foot over the other while standing against the wall, or if you are doing really well over the other while walking sideways.

6. Windmills-Stand with feet spread apart and arms extended out to the sides. Bend over at waist and tap right hand to left foot or knee. Stand back up and then bend and tap left hand to right foot or knee.

Those are a few ideas.  You can also do cognitive exercises such as:

  1. Working puzzles.  Start with a 32 piece puzzle and work your way up to a 500 piece puzzle as you get better at it.
  2. Work on “hidden word puzzles”
  3. Play card games

The basic idea is to use your brain daily. If movement is limited, do the best you can to cross body, cross brain. Be creative!!

Human Standing

I see so many clients post-stroke who have poor standing balance yet have already begun to “walk”. They don’t actually walk, they “hobble”. Thing is that I have also noticed a lot of people who have never had a stroke also “hobble”, due to back pain.

I think that we have been ignoring the amazing features of the human brain and physiology that allow us to walk upright on two very small bases of support.  It is really kind of crazy that two little feet can keep us upright!  Well, we have more going for us than our feet…

Balance and upright posture is controlled by sensory interactions within our brains.  We do not “think” about balance, we simply balance. This requires that our brain be able to continuously compare input from our EYES, our INNER EAR, and SENSORY RECEPTORS in our MUSCLES.  After a stroke…or even an injury to the back… this sensory comparison is all out of whack! It is imperative to recalibrate the brain and the sensory signals it is utilizing.

A simple daily exercise will make a huge difference:

Stand against a wall with your heels touching the baseboard, hips touching the wall, shoulders touching the wall, head touching the wall.  Close your eyes.  Hold this position for 2 minutes with your eyes closed!  It will feel strange. Perhaps difficult and occasionally it may not seem possible. Stick with it.  After 2 minutes, open your eyes and then slowly turn your head to the left and then to the right, three times. Returning the head to midline each time.

Do this exercise 3 times per day every day for 2 weeks.

Once this is easy, the do the same exercise while standing in the corner of the kitchen. You will no longer be touching the wall, but instead free-standing as if you were against a wall.

*Always have supervision when doing any kind of balance training* Never try the exercise alone the first time*

May is “Stroke Awareness Month”

When I was actively lecturing on the warning signs of stroke and the need for immediate medical attention, I would get letters from people.  Lots of letters.  Letters that said thank you for teaching the warning signs of stroke.  It is so important to know when to call 911 – because everyday heroes are the ones that can change the outcome for a person having a stroke.

An excerpt from my book “Highs, Lows, and Plateaus: a path to recovery from stroke”

“It is very important for everyone to recognize the signs of stroke, because stroke strikes anywhere, anytime, across age, ethnicity, and socio-economic groups. I have never known anyone who planned on having a stroke. But, I know a lot of people who survived with minimal deficit because someone else recognized the signs and sought help. Unfortunately, in my field of work, I also know a lot of people whose symptoms of stroke went unrecognized. Remember, according to our national statistics, fewer that 7 percent of stroke victims get to the hospital in time for emergency intervention.

The odd thing about a stroke is that the person having a stroke often does not fully realize that anything is wrong. When asked if they are o.k. the person having the stroke quite often says they are fine or makes up a reason to explain their behavior. Remember, it is the brain that is under attack – and this is the same brain that is supposed to be identifying that something is wrong! A brain under attack is going to have to rely on someone else to identify the problem and seek help.”