Vestibular First

Vestibular First Our mission is to create simple, effective, affordable, and ubiquitous vestibular technologies.

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

04/06/2026

Have you seen the rare acute inferior vestibular neuritis? How did you differentiate it from a central vestibular issue? Learn more: v1st.co/EP26 to register for next month's free Journal Club on VEMP testing updates!

Should we speak up when we see information that seems inaccurate on vestibular topics? YES - there is a way to have resp...
04/03/2026

Should we speak up when we see information that seems inaccurate on vestibular topics? YES - there is a way to have respectful dialogue. We support this! Dizzy Diagnostics All In Your Head Balancing Act Rehab Dr. Arryn Gamble The Vertigo Doctor

Do you use the Modified Yacovino maneuver for anterior or short arm posterior canal BPPV? Did it work? v1st.co/YMclinic ...
04/02/2026

Do you use the Modified Yacovino maneuver for anterior or short arm posterior canal BPPV? Did it work? v1st.co/YMclinic for a free printable handout (clinican assist version)! Balancing Act Rehab

04/01/2026

👁️🚙Have you seen nystagmus that varies in speed during BPPV? Typical otoconia move at a rate of 0.2 mm/s, or about 1% of the circumference of the canal each second. We must be patient but observant during our Dix-Hallpike tests!

🎯✅ Here are a few possible reasons why nystagmus speed can vary in BPPV:

⏰🚦 Latency - “viscous drag” inertia before particles start moving;

🤏 🪨 Size and number of particles - larger chunk can create “burst” while smaller dispersed particles can make nystagmus milder;

💎⭕ Individual anatomy - variability of canal shape affects how quickly the debris moves through narrow canal segments.

🐢🏃Speed of testing: Moving quickly into a Dix-Hallpike test can increase the intensity of nystagmus, which is helpful if only a few otoconia are displaced. HOWEVER, the speed of a maneuver should also consider patient tolerance to symptom provocation; faster is not always necessary, especially when using infrared video goggles to visualize nystagmus!

Get your free resource on BPPV here: v1st.co/bppv

Have you had patients with dizziness after concussion? Screen for BPPV and dysautonomia, and be sure to intervene as ear...
03/30/2026

Have you had patients with dizziness after concussion? Screen for BPPV and dysautonomia, and be sure to intervene as early as possible to reduce the chance of developing PPPD. Calling all Canadian physios: v1st.co/can26 with code DYLRYHTAP for a quick survey on concussion care! All In Your Head

A classic - the BBQ or Lempert roll for horizontal canalithaisis BPPV. Particularly good for home and hospital settings ...
03/27/2026

A classic - the BBQ or Lempert roll for horizontal canalithaisis BPPV. Particularly good for home and hospital settings where sitting up can be limited by nausea or mobility issues. Get your free handout at v1st.co/bbqhandout today! Balancing Act Rehab

Does type of dizziness lead to diagnosis? Not usually! dizzy.care is the best place for a free questionnaire to learn wh...
03/26/2026

Does type of dizziness lead to diagnosis? Not usually! dizzy.care is the best place for a free questionnaire to learn what best steps are needed for exam, as well as a way for clinicians to get matched to patients they are likely to be able to help. Win win! Dizzy Care Network

Free live-only (not recorded) webinar on Anxiety, Stress and Fear in Vestibular Patients TODAY (Wednesday, March 25) at ...
03/25/2026

Free live-only (not recorded) webinar on Anxiety, Stress and Fear in Vestibular Patients TODAY (Wednesday, March 25) at 8 PM Eastern. Use this Zoom link at the time of the event: v1st.co/VSIG26. See you there! Vestibular Rehab SIG

03/25/2026

🛑 STOP doing an Epley maneuver just because your patient feels symptoms in a Dix-Hallpike test. Instead, look at the EYES!

👁️🥸 Can you tell which direction the nystagmus is going? The ability to visualize and identify the direction of nystagmus is CRTICAL when trying to determine which type of BPPV may be present.

🚦🙋 Knowing the type of BPPV is ESSENTIAL to selecting a repositioning maneuver that might actually work for a patient. Eye movement direction and quality can also clue us in on whether the nystagmus and symptoms are caused by BPPV or by a different issue (e.g. vestibular migraine) mimicking BPPV.

📚📈 Level up your knowledge - v1st.co/ceu for efficient and brilliant courses on identifying types and directions of nystagmus, differential diagnosis, atypical BPPV, and more as well as our upcoming in-person intro courses. Plus, get free info on vestibular exam techniques and nystagmus here: v1st.co/freetests

03/24/2026

🚩🌲 Unsteady stepping over sticks in the yard or cracks on a sidewalk, especially if distracted or needing to look down/up to check for other pedestrians, cyclists, etc.?

💦 Here’s an early/intermediate progression flow for single limb balance using toe taps to a target.

🎯 Adjust various elements (target distance from the standing position, movement speed, range of head movements, duration of reps etc.) to individualize variables for each patient and stage of recovery.

⏰Pacing, dual task, and progress the challenge when ready to reduce dizziness and improve daily balance!

Ever have a patient with facial droop due to damaged facial nerve after a vestibular schwannoma? v1st.co/face26 for a ve...
03/23/2026

Ever have a patient with facial droop due to damaged facial nerve after a vestibular schwannoma? v1st.co/face26 for a very affordable 2 hour con ed course next weekend - will be recorded so watch it later if you like! Dizzy Diagnostics

Big thanks to all those who want to learn more about best practices treating dizziness and balance problems. You make it...
03/20/2026

Big thanks to all those who want to learn more about best practices treating dizziness and balance problems. You make it all worth it.

(Yes, that’s a Dino toy from the Flintstones. Dinosaurs had vestibular systems too!)

v1st.co/resource for our FREE educational library, printable BPPV maneuver handouts, and more!

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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.