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.

🎉 Please join us in wishing our cofounder Dr. Helena Esmonde, PT a Happy Birthday! It was a very special year for her as...
12/10/2025

🎉 Please join us in wishing our cofounder Dr. Helena Esmonde, PT a Happy Birthday!

It was a very special year for her as she won the APTA Pennsylvania Neuro Physio Award for 2025. (Bonus: she got a picture with a dinosaur. Fun fact: As a kid, Helena wanted to be a paleontologist.)

So thankful for all of the kind support from our vestibular community!

What is Visual Snow Syndrome and how is it addressed? v1st.co/freeabs25 to enter to win a free membership to the America...
12/08/2025

What is Visual Snow Syndrome and how is it addressed? v1st.co/freeabs25 to enter to win a free membership to the American Balance Society - we'll be choosing a winner this week! American Balance Society

Got unexpected vestibular migraine symptoms? Check out this free vestibular migraine info resource at v1st.co/freemigrai...
12/04/2025

Got unexpected vestibular migraine symptoms? Check out this free vestibular migraine info resource at v1st.co/freemigraine and watch our Journal Clubs on vestibular migraine topics with Drs. Shin Beh and Jeffrey Sharon at our Vestibular First YouTube channel.

12/03/2025

🧠😶‍🌫️ Brain fog making it hard to find your words while walking or slowing your reaction time to avoid tripping over a pet? Here are a few ideas to start training reaction time, dual task, and balance!

⏰ 🦺 Remember to pace yourself, keep feet under shoulders (not too narrow), and scale to an easier activity if you’re having a more symptomatic day. Start seated if necessary, focusing on the manual parts of the tasks (like catching the Heco stick).

🎲 🅾️ Start by catching and throwing a 20-sided oversized dice (search for “giant foam 20 sided dice” on Amazon). Find the number called out by the clinician or a family member/friend.

☘️ 🎲 Add catching a “hand eye coordination trainer” (one brand name is HECOstix) to the above 20-sided dice task. Bonus if you can catch the side of the stick with a specific color as called out by the clinician or a family member/friend.

🏄 💃🏻 Upgrade your dice and coordination trainer tasks above with a balance challenge, such as standing on foam pad or taking a step over a cane, hurdle, or shoebox. Ensure adequate leg lift to clear the obstacles safely with each leg, with close supervision for safety.

♻️ 🤚 Try spinning one item (coordination tool, ball, dice) in one hand while catching an item with the other hand (athlete level)!

v1st.co/freeabs25 to enter to win a FREE membership to the American Balance Society, which has many more educational resources for you!

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

💯 agree - please be sure the testing is accurate before using a particular treatment for dizziness, vertigo, or imbalanc...
12/03/2025

💯 agree - please be sure the testing is accurate before using a particular treatment for dizziness, vertigo, or imbalance. Precision with infrared video goggles, with testing done by a trained vestibular clinician - this is the way!

12/02/2025

😳 Do you use the (horizontal) head shake test, also known as head shaking nystagmus?

🧰 How to perform:
1. Patient is seated.
2. With the head tilted 30° forward, the clinician oscillates the patient’s head side-to-side (2 Hz speed) for about 20 seconds while fixation is removed by infrared video goggles.
3. Stop moving the head and ensure that the patient’s eyes are open to observe any nystagmus.

✅ A normal finding is 3 beats of horizontal nystagmus or less (often no nystagmus is present).
❌ An abnormal finding is either:
👂 Inner ear problem: more than three beats of horizontal nystagmus are observed after shaking typically indicates inner ear vestibular nerve damage. The fast beat of the nystagmus beats toward the non-damaged or “stronger” side).
💎 There may also be a head shaking nystagmus in lateral canal BPPV, being more common in the apogeotropic (horizontal cupulolithiasis) form.
🧠 Vertical nystagmus (if present/provoked by the test) suggests a central lesion such as stroke, multiple sclerosis, etc. and would need further testing to clarify the root cause.

🫆🧩 In this case, the fast beat of the nystagmus was beating toward the patient’s left, consistent with a right peripheral vestibulopathy (damage to the right peripheral vestibular system). Given this patient’s history, it was determined that they likely had a recent infection (vestibular neuritis) that damaged the right vestibular nerve.

⏰ ‼️ Can this test show chronic (old) damage? Sometimes, yes! Head shaking nystagmus persists over 1 year in more than 30% of patients with vestibular neuritis. After 2 years of follow-up, head shake nystagmus intensity in compensated patients reaches the level of the control group, but poorly compensated patients often have a well-detectable head shake nystagmus throughout 2 year follow-ups! (Kim 2020; Striteska et al., 2022).

🎯 v1st.co/freetests for a free resource on more vestibular testing, and register v1st.co/AT26 for our January Journal Club on diagnosing acute dizziness!

Sources: Porwal et al., 2021; Sun et al., 2022; Kim 2020; Striteska et al., 2022

What works best for suspected anterior canalithiasis (which more recent studies suggest as being short arm posterior can...
12/01/2025

What works best for suspected anterior canalithiasis (which more recent studies suggest as being short arm posterior canalithiasis in most cases)? Submit an abstract for the American Balance Society meeting at v1st.co/abstract25 this week - we can't wait to see you there! American Balance Society

Ready to get infrared video goggles for your vestibular practice? Please purchase or make a quote soon if you can! Due t...
11/30/2025

Ready to get infrared video goggles for your vestibular practice? Please purchase or make a quote soon if you can! Due to rising costs of production, Insight Pro+ goggles will be $2800 starting Jan 1, 2026. Thank you for your support as we strive to keep our prices as affordable as possible!

Do you see patients with diabetes and dizziness? Be sure to check for BPPV and vestibulopathy! v1st.co/AUVP for more det...
11/28/2025

Do you see patients with diabetes and dizziness? Be sure to check for BPPV and vestibulopathy! v1st.co/AUVP for more details on vestibulopathy, and v1st.co/videos to watch some great Journal Clubs on vestibulopathy topics.

11/28/2025

These rehab ideas 🥰

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Philadelphia, PA

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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.