Vestibular First

Vestibular First Our mission is to create simple, effective, affordable, and ubiquitous vestibular technologies.
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Our mission is to create simple, effective, affordable, and empowering vestibular technologies to help improve the lives of those suffering from vestibular disorders.

Is the Dix-Hallpike or side-lying test more sensitive? A surprising Q&A on positional testing...plus v1st.co/DK26 to reg...
03/16/2026

Is the Dix-Hallpike or side-lying test more sensitive? A surprising Q&A on positional testing...plus v1st.co/DK26 to register for this week's free Journal Club. Then you're entered to win a free vestibular model!

Are you an ED/Acute Care PT in the United States? v1st.co/Win for a research survey on your confidence in vestibular ass...
03/13/2026

Are you an ED/Acute Care PT in the United States? v1st.co/Win for a research survey on your confidence in vestibular assessment/management REGARDLESS of how often you work with vestibular cases. Help research AND get entered to win a $20 Starbucks gift card - win, win! The ED DPT APTA Acute Care

Have you seen nystagmus in the Dix-Hallpike that wasn't due to BPPV? It happens more than you might guess - about 12% of...
03/12/2026

Have you seen nystagmus in the Dix-Hallpike that wasn't due to BPPV? It happens more than you might guess - about 12% of nystagmus seen in positional testing is due to central (brain) issues like vestibular migraine. v1st.co/DK26 to learn more at our next Journal Club!

03/11/2026

🐶 👠 Dizzy bending down/turning to care for a pet or put on a shoe? Try some of these bending/turning vestibular rehab options!

👁️ 🐢 A key technique here is move slowly at first and move your eyes from one stationary object to another as you bend or turn.

🦶👤 Bonus: feel your feet/body (somatosensory input) and keep aware of your posture.

Want to learn more? Check out our latest free info page on concussion rehab updates at v1st.co/concussion!

👏 🎈 Great dual task idea!
03/10/2026

👏 🎈 Great dual task idea!

03/10/2026

🥸👁️ Is right torsional upbeat nystagmus in the 3rd position/part of a right modified Epley maneuver (nose down position, treating right posterior canalithiasis) usually a good or a bad sign for success of treatment?

😇🎉 Good! Right torsional upbeat nystagmus (fancy term: “orthotropic”) in the 3rd position/part of the right modified Epley (nose down position) is 88.9% sensitive for indicating that a successful maneuver has been completed (Lou et al., 2020).

💎🚛 Orthotropic nystagmus in position 3 of the Epley means that the otoconia are moving AWAY from the cupula (ampullofugal) which excites it, and so they are moving TOWARD the utricle, which is exactly where we want those otoconia to go!

🤨⛔ On the other hand, a “reversal” with left torsional downbeat nystagmus (not shown in this video) in position 3 would suggest a possible failure of the modified Epley maneuver, where otoconia move TOWARD the cupula (ampullopetal) which inhibits it.

📚🧠Want to learn more about BPPV nystagmus and its mimickers? v1st.co/DK26 for a fantastic FREE Journal Club on “Positional Nystagmus: Beyond BPPV” with the brilliant Dr. Diego Kaski!

👯‍♀️ Vestibular besties! We’re so grateful for our customers who also make the best of friends. Cheers to you all!
03/09/2026

👯‍♀️ Vestibular besties! We’re so grateful for our customers who also make the best of friends. Cheers to you all!

Have you tried the Sleep Maneuver for posterior canal BPPV? It's a gentle and easy follow-up option for a home maneuver ...
03/09/2026

Have you tried the Sleep Maneuver for posterior canal BPPV? It's a gentle and easy follow-up option for a home maneuver after an in-clinic Epley, Semont, etc. v1st.co/sleep to get a free printable pdf handout!

03/05/2026

🎯🚧 Unsteady or dizzy while walking over uneven ground like grass or cobblestones? Try this!

🌈🌍 Variety for real world application is the key here!

The progression options here involve:
1️⃣ adding heads turns,
2️⃣ half step back with diagonal head turns,
3️⃣ head turn with one foot on a harder surface and the other on a softer surface.

v1st.co/resource to access so many free vestibular articles and printable pdfs, and check out our YouTube channel for many free vestibular rehab ideas!

03/04/2026

❄️🛑 Dizzy with snow shoveling? Here are key tips:

🏋🏼‍♀️ 🛗 Squat a bit with your head forward rather than head down to bring the shovel to the ground. If possible, look with your eyes down rather than tipping your head down.

💞🔁 Turn with your body (step your feet) rather than twisting your back. Look from object to object (trees, light poles, etc.) in your environment as you turn.

⏰🧠Pace yourself and rest as needed to avoid increasing dizziness by more than 2 units from baseline. Remember that barometric pressure shifts can trigger vestibular migraines so be sure to stay hydrated, nourished, and get adequate sleep to improve your migraine threshold.

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How do you provide patient education for those with dizziness? v1st.co/DF26 for PTs and PTAs to complete a quick survey ...
03/04/2026

How do you provide patient education for those with dizziness? v1st.co/DF26 for PTs and PTAs to complete a quick survey to support research on this important topic! Whitworth University Vestibular Rehab SIG

03/03/2026

🙏 The Farouk Praying Maneuver — a novel alternative to the Bascule maneuver for refractory posterior canal BPPV, especially cupulolithiasis (Farouk, preprint).

📝 This should only be performed by a trained clinician after confirming posterior canal BPPV that has not responded to standard repositioning maneuvers like the Epley.

🧰 Like the Bascule, this maneuver uses forward bending, but in a stable, controlled prostration (sujood) posture with optional mastoid vibration. Gravity + vibration promote otoconial detachment from the cupula; slow return reduces re-adherence; salutation head turns facilitate migration toward the utricle.

📝 STEP-BY-STEP:

Patient starts seated upright.
Move into full prostration (sujood/praying posture). Hold ~30–60 sec. Apply mastoid vibration to the affected ear (continuous device preferred; tuning fork 128–256 Hz or manual tapping acceptable).
Slowly return to upright sitting.
Salutation head turns: rotate toward the AFFECTED side first, then the other side.
Repeat steps 1–4 once (total = 2 prostrations with vibration).
⚠️ Supervise posture transitions. Use knee support for elderly/obese. Monitor for cervicogenic pain. Educational purposes only.

Post created in collaboration with Sonia Vovan, PT, PhD(c) ()

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Our Story

When Helena Esmonde transitioned from a large hospital-based outpatient vestibular clinic to a small, privately owned clinic, she found herself without the use of the infrared video goggles she had become accustomed to using for her patients’ care. Her new workplace was an independent, PT/PTA co-owned physical therapy clinic that could not afford the minimum $8500 price tag for a pair among the current ones on the market. She brought this problem to her husband Patrick Esmonde, and he said, “Tell me more about the goggles.” After an explanation and research, he said, “I can build that.” And so necessity once more became the mother of invention and Patrick developed infrared video goggles that not only did what a vestibular therapist would need them to do, but he built them at a much lower cost. When Helena discovered that this was possible, she asked (perhaps nearly demanded) that they make these infrared video goggles available to countless other researchers, clinicians, and educators whose organizations could not afford such useful but costly technology. For this reason, Vestibular First came to be!

Our future is now resting on our community of therapists and educators to help refine and perfect the technology through our new customer offer. We hope you feel the same and will join our company in providing infrared goggles to all trained clinicians and educators to help more patients who suffer from vestibular disorders regain their safety and quality of life.