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.

02/20/2026

Grateful to be surrounded by so many amazing and talented people at - I’m inspired to keep doing the hard work to learn and share life-changing clinical insights every chance I get.

Couldn’t make it? See you next year in Philadelphia (and clinical pearls incoming next week)!

02/19/2026

🧲🔓 Stubborn horizontal canal BPPV? It might be cupulolithiasis — and the Gufoni maneuver (apogeotropic variant) could help!

🧰 Unlike canalithiasis, cupulolithiasis involves otoconia stuck to the cupula, jammed in the canal like a blocked pipe, or trapped in the short arm of the horizontal canal. The Gufoni for cupulo uses rapid positional changes to generate momentum to detach the debris, then guides it back toward the utricle.

🟡 If nystagmus remains unchanged after this treatment, try alternative treatments like the Kim, square wave, or forced prolonged positioning maneuvers, and consider a central (such as vestibular migraine) cause of the nystagmus.

⁉️ Effectiveness remains debated. Kinne et al. (2023) reported 100% resolution in individual studies after a single session. Correia et al. (2021) found 71.4% short-term success. Lee et al. (2021) observed lower immediate resolution, with improvements occurring later.

📝 STEP-BY-STEP (example in video is treating the right side):

Patient sits on the edge of the bed.
Quickly lie patient down on the RIGHT (affected) side — head parallel to floor, looking straight ahead, legs up on bed. Hold 30 sec.
Quickly turn head up to the LEFT (unaffected side - nose toward ceiling). Hold 1–2 min.
Drop legs off the bed, slowly sit up. Wait 60 sec before standing.
🔁 For LEFT ear, mirror.

📌 Variation: Head turned toward the ground 45–60° instead of toward the ceiling, sometimes called the “Casani.”

⚠️ For cupulolithiasis (apogeotropic), lie onto the AFFECTED side — opposite from geotropic BPPV. Always consult a vestibular specialist. Educational purposes only.

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

02/17/2026

👟✏️ Dizzy bending down to put on shoes or pick up an object? Try this vestibular rehab move, with its bonus challenge of working on tolerance to visual motion!

⏰ 🐢 Remember to pace the activity and scale to an easier activity if you’re having a more symptomatic day.

🪑💪 Start seated, keeping aware of your posture. Be sure to screen the neck, core, and scapular muscles to see if they also could benefit from strengthening to increase a sense of stability during this activity.

🪩🚗 To build tolerance to visual motion, viewing the moving treadmill is an added challenge. Start with a very slow-moving treadmill before increasing speed.

v1st.co/DK26 to register for our free March Journal Club on positional nystagmus beyond BPPV. So much to learn - don’t miss it!

📝 Guidance by a trained vestibular clinician is recommended to ensure the correct challenge level and type of vestibular rehab activities for you individually.

Love ❤️ seeing our co-founder and our company featured by her PT Alma Mater!
02/15/2026

Love ❤️ seeing our co-founder and our company featured by her PT Alma Mater!

Last chance to see us at Booth 1312 at CSM - exhibit hall is open until 3 pm. Come say hi!!!
02/14/2026

Last chance to see us at Booth 1312 at CSM - exhibit hall is open until 3 pm. Come say hi!!!

Will you be our Vestibular Valentine? v1st.co/resource to find SO many continuing ed courses, free printable pdfs, speci...
02/13/2026

Will you be our Vestibular Valentine? v1st.co/resource to find SO many continuing ed courses, free printable pdfs, special topic information, and more!

02/12/2026

❄️ Dizzy or unsteady when walking in winter? Here are some vestibular rehab ideas to build confidence for navigating snowy, slippery surfaces.

📝 Don’t forget: individualized vestibular rehab is best — Work with a vestibular specialist to tailor the exercises to you!

⏰ Start with short durations (10s) and try not to let symptoms increase by more than 2 units from baseline.

Gaze Stabilization on Unstable Surfaces 👁️⚡️ Gaze stabilization on a BOSU ball or foam pad challenges the vestibular system to maintain visual clarity as the surface shifts, just like walking on uneven, snow-covered ground.

Sliding Disc Single-Leg Balance 🧊🦶 A sliding disc under one foot simulates the unpredictable slip of icy snow. This trains the vestibular system to detect and respond to sudden surface shifts, critical for winter walking safety.

Weighted Marching on Uneven Surfaces 🥾🏋️ Ankle weights simulate the heaviness of winter boots, altering proprioceptive feedback and increasing motor planning demands. This builds the coordination needed for real-world winter terrain.

Obstacle Navigation & Surface Variability 🪨🌨️ Stepping over obstacles and across different surfaces mimics snow-covered sidewalks — hidden curbs, snowbanks, and ice patches. This trains the brain to integrate visual, vestibular, and proprioceptive input under changing conditions.

🥇 The goal is vestibular rehab that translates to real-world winter mobility, safety, and independence!

Stay balanced — don’t let winter catch you slipping!

Are you in Anaheim, home of Disneyland, for  ?  Come say hi at Booth 1312 in the exhibit hall. Not here? No worries! We’...
02/12/2026

Are you in Anaheim, home of Disneyland, for ? Come say hi at Booth 1312 in the exhibit hall. Not here? No worries! We’ll be posting clinical pearls and highlights, so stay tuned!

02/10/2026

🌹⏫ Off balance or dizzy when reaching or stepping? Here are some options to improve these skills, with strong use of VOR cancellation training.

⁉️🧠 What is VOR cancellation and why does it matter? VOR cancellation means that the brain overrides the vestibulo-ocular reflex (VOR) to keep the eyes fixed on a target (like a ball, or a cup you’re putting on a shelf) moving with the head, rather than stabilizing the gaze against head movement.

🔑📝 The key instruction to provide to patients with this activity is to keep their eyes fixed on the object (ball in this video, although you can use a daily object like a cup, or a light hand weight is great for increased proprioceptive input) throughout the movement.

🤓🐢 Training VOR cancellation may improve cerebellar function, enhance tolerance to self-motion, and promote multisensory integration with task-relevant and saliant movements. Start with slow movements and short duration (30 seconds) activity before progressing as able.

📈🧩 Do not allow symptoms to exceed 2 units from baseline (if resting dizziness is 3/10 on a 0-10 scale, dizziness should not exceed 5/10 for example). Use grounding (feel your body) and paced breathing to bring symptoms back toward baseline level.

📝 Guidance by a trained vestibular clinician is recommended to ensure the correct challenge level and type of vestibular rehab activities for you individually.

v1st.co/StrokeVR for a free Journal Club video with TONS of vestibular rehab treatment ideas for stroke and other neuro issues, and v1st.co/education for our on-demand continuing education course “Interventions for Vestibular Disorders.”

What does Apogeotropic nystagmus mean in BPPV? v1st.co/atypical for free information on this, and v1st.co/JH26 to refer ...
02/09/2026

What does Apogeotropic nystagmus mean in BPPV? v1st.co/atypical for free information on this, and v1st.co/JH26 to refer patients with bilateral vestibular loss for a study at Johns Hopkins on vestibular implants to improve balance and quality of life! Johns Hopkins Medicine

Goggles cameo 🤩 and we ❤️ all those neuroplasticitians!
02/06/2026

Goggles cameo 🤩 and we ❤️ all those neuroplasticitians!

Address

Philadelphia, PA

Alerts

Be the first to know and let us send you an email when Vestibular First posts news and promotions. Your email address will not be used for any other purpose, and you can unsubscribe at any time.

Contact The Practice

Send a message to Vestibular First:

Share

Share on Facebook Share on Twitter Share on LinkedIn
Share on Pinterest Share on Reddit Share via Email
Share on WhatsApp Share on Instagram Share on Telegram

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.