Rehabilitation of Vertical Gaze Palsy and Impaired Eye Proprioception Following Bilateral Thalamic Infarcts: A Case Report

IntroductionThalamic infarctions, which account for .6% of all ischemic strokes, are characterized by altered mental status, vertical gaze palsy, and memory impairment. There is only one other case report on the rehabilitation of a vertical gaze palsy due to thalamic lesions. Although rehabilitation strategies for vertical gaze palsy have been documented, the role of eye proprioception in this condition was not discussed.Case ReportA man in his late 50 s presented to outpatient occupational therapy following bilateral thalamic infarcts with bilateral vertical gaze palsy, preserved vestibular ocular reflex (VOR), and cognitive impairments. These impairments impeded his performance of functional activities including feeding, dressing, driving, and navigating obstacles during functional ambulation. During rehabilitation, it was revealed that he was unable to identify his line of sight creating the potential for impaired eye proprioception. Interventions included oculomotor exercises, VOR cancellation strategies, and functional adaptations.DiscussionThis case discusses the potential impact of eye proprioception in the rehabilitation of vertical gaze palsy following thalamic infarcts. Two theories for impaired proprioception are explored: damage to thalamic structures and impaired proprioceptive input from the extraocular muscles. Interventions to address eye proprioception led to improved vertical eye movements and functional abilities.