Depending on the size of the circle, the patient can be asked to make the circle larger or smaller in size.

The circle also be measured by the number of clicks it takes to go around it.

One the patient can easily and gracefully guide the coin through the horizontal circles, change to vertical circles centered at eye level.

When changing the orientation from horizontal to vertical, some may forget to keep their eyes on the coin.

Others may be successful at keeping their eyes on target but lose the shape or struggle to keep the circle centered on the midline at eye level. 

Gentle coaching and questioning can help the patient develop the control needed to make the vertical circle with the same grace and skill as the horizontal.

As the person gains skill, they will be able to orient the circle at 45° or 135°. 

Coin Circles Age Adjustments

Children younger than 5 will often struggle with this activity.  Placing a sticker on their thumbnail will provide a good alternative target while avoiding the difficulties that younger children may have with digital dexterity.

Up through 6-7 years of age, some head movement is common and should be expected based on the patient’s general development.

A gentle downward pressure on the crown of the head will often help stabilize the head and body, so the eyes can  move free of the head and body.

Avoid the use of bean bags or similar weights as they can distract from the process due to the need to balance the bag on the head.

We use a small coin, about 1 to 1.5 cm. 

Hold the coin at the bottom between the thumb and forefinger.

Ask the patient to look at the coin.  See where and how they naturally center the coin.

• How far from them do they hold it?

• Is the coin centered in front of them?

• Where is the coin aligned?  Chin height? Eye height? Chest height?

Ask the patient to hold the coin at eye level and to look at the coin.

Ask the patient to move the coin in a “nice big” horizontal circle while watching the coin with their eyes but keeping the rest of themselves steady and relaxed.

• Watch the size and shape of the circle. 

• Does the circle stay at eye height? 

• Is there head or body movement?

We want to make circles with both the right hand and left hand holding the coin.

We want to make circles both clockwise and anticlockwise.

• Are all the ways to make the circle the same?

• If not, what is different?

Ask the patient if they are happy with their circles.  Encourage the patient to tell you about making the circles. 

Ask the patient what the coin looks like as they move it.

Ask them to tell you what the room looks like as they move the coin.

Ask them to compare how things look as they shift their attention.

How does attention affect the ease of tracing the circle.

How does a different shape affect how they pay attention?

Some patients will have trouble seeing and feeling what a circle is. 

A cardboard cutout, a pizza pan or pot lid can help them get the feel of a circle.

Go big, go slow—smaller quicker circles are much less demanding.

What about using the metronome?

As we notice that the metronome is on most of the time during our in-office VT, we suggest playing with having the person take different counts of beats to move smoothly around the shapes they are working on at the time. More beats requires a slower movement overall and fewer beats to complete the movement requires faster movements. Performing the entire movement at the same graceful speed is the goal.