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.

11/12/2025

👁️ 🔃 Can you see the torsion? This patient demonstrated ~5 seconds of LEFT torsional nystagmus in the left Dix-Hallpike test.

🌀 Is it due to posterior canal BPPV? In this case, yes! How do we know? After a repositioning maneuver (left modified Epley), and 10 minutes rest, a re-test of the left Dix-Hallpike showed no nystagmus and resolved positional vertigo symptoms.

👁️ "BPPV nystagmus is primarily torsional when the gaze is directed ipsilateral toward the side of lesion whereas the nystagmus is primarily vertical when the gaze is directed contralateral toward the side of lesion" (Barin, Petrak, Cassidy and Whitney, 2025). So if we wanted to see the upbeat element better, we could ask the patient to gaze to the RIGHT (away from the affected side) in this case.

📚 Want to learn more about eye movements in vestibular pathology? Check out our popular on-demand course: v1st.co/EyePath

11/11/2025

🍯💎 Sticky, stubborn posterior canal BPPV? Not sure which side is the affected side? You could try a version of the Bow-and-Yaw maneuver.

📝 This maneuver is not tolerated by all patients so should be selected very carefully by a clinician only when appropriate.

🧰 This was designed to treat short-arm posterior canal BPPV by using deep forward head flexion (“bow”) combined with side-to-side rotations (“yaw”) to facilitate movement of otoconia from the short arm of the canal into the utricle.

✅ Effectiveness: In a prospective study of 171 posterior canal BPPV patients, Bow-and-Yaw alone resolved symptoms in ~40% of cases with possible short-arm canalithiasis (Ping et al., 2022). A 2023 case report confirmed its success in resolving a case of atypical posterior canal BPPV after traditional maneuvers had failed (Ludwig & Schubert, 2023).

📝 STEP-BY-STEP PROTOCOL (choose seated OR quadruped depending on patient’s mobility and comfort level).

SEATED VERSION:

1. Start seated with feet firmly planted on the ground.
2. Bend down with the head towards the feet and point the top of the head towards the floor (45 degrees cervical flexion, creating 135 degrees total flexion angle from upright).
3. Shake the head 45 degrees right and left continuously without pausing in center.
4. Complete 10 full rotations (1 rotation = left + right).
5. Slowly return to upright with head in neutral.

QUADRUPED VERSION:
1. Start on hands and knees on a mat table, bed, or floor.
2.Bend the head down 45 degrees toward the support surface, creating 135 degrees total flexion angle from upright.
3. Shake the head 45 degrees right and left continuously without pausing in center.
4. Complete 10 full rotations (1 rotation = left + right).
5. Slowly return head to midline → transition to side-sitting.
Carefully come to full sitting with head in neutral.

⚠️ IMPORTANT: Always consult a qualified vestibular specialist before attempting any BPPV maneuvers. This is for educational purposes only.

Post created in collaboration with Sonia Vovan, PT ()

Have you seen upbeat nystagmus in positional testing and/or at rest? Here are some tips for differentiating brain (centr...
11/10/2025

Have you seen upbeat nystagmus in positional testing and/or at rest? Here are some tips for differentiating brain (central) issues from peripheral (inner ear) causes. Register v1st.co/IP25 for a FREE amazing International Pediatric Balance Network Virtual Seminar!

Lab day - Conquering BPPV!!
11/08/2025

Lab day - Conquering BPPV!!

11/06/2025

👗🎄🌶️ Dizzy when reaching to hang clothes, string holiday lights, or cooking in the kitchen? Here’s a vestibular rehab progression to work on decreasing sensitivity to various head/body turns and when reaching.

🪑 🛏️ ⏰ Remember to modify speed and distance of movement as well as duration of the activity to avoid elevating symptoms by more than 2 units from baseline. Starting seated or supine (add rolling) are options as well!

📊 Progression options:
⭕️🍦 Reach forward to move matching colored rings onto colored cones.

🦶🪴 🏋🏼‍♀️ Step forward and laterally for controlled weight shifts while moving rings to cones. Encourage planting each foot to establish firm base of support. Consider adding wrist or ankle cuff weights for increased somatosensory input.

⬅️ ➡️ Clinician calls out left or right to direct which side the patient needs to start to reach behind and move a ring onto a cone. Alternate or randomize the direction of the turns.

⛳️🪨 Stand on a foam pad with reaching. Progress to placing a foam pad or river stone underfoot as you step forward and laterally onto another foam pad or river stone.

💁🤩 Don’t forget to sign up for our FREE November Journal Club v1st.co/JT25 on “Treating Oculomotor Disorders after mild TBI” with Dr. Jacqueline Theis, OD, FAAO, FNAP to learn more!

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

11/05/2025

⬇️ Do you see the downbeat nystagmus? This was provoked with the straight head hang test (and I'd seen similar but more mild persistent downbeat in the left Dix-Hallpike test in the same patient).

⏰ Symptoms: mild off-feeling. Duration of nystagmus: persistent. It could be atypical BPPV or a central positional nystagmus (brain issue)!

🙃 I trialed a modified Yacovino, 10 minutes rest, then re-test of the straight head hang showed no nystagmus and no symptoms.

👂 Likely diagnosis: (left?) short arm posterior canal BPPV!

📝 Check out this free resource on vestibular testing: v1st.co/freetests and learn more!

Congratulations to our giveaway winner Rae Teffo, a physiotherapist born and trained in South Africa, who provides essen...
11/05/2025

Congratulations to our giveaway winner Rae Teffo, a physiotherapist born and trained in South Africa, who provides essential physio services in Belgium. For those who did not win, consider signing up for the awesome Iowa Vestibular Symposium at v1st.co/IVS26, and enter to win a free membership to the American Balance Society at v1st.co/freeabs25 (winner will be announced in December). Iowa Vestibular Symposium American Balance Society Wijkgezondheidscentrum Vierkappes vzw

11/04/2025

🍁 🍏 Dizzy or imbalanced when trying to enjoy fall activities? Try these ideas in vestibular rehabilitation!

Activity ideas:
🔵🛻 Hayride prep: Start seated on a large physioball to increase core strength and seated balance. Progress with gentle bouncing and/or optokinetic video of riding in a truck to increase tolerance to self-motion and visual motion respectively. Add gaze substitution (2 targets) and/or gaze stabilization activities if/when appropriate.
🧺🍎 Apple picking prep: Use theraband resistance for proprioceptive input during reaches and items placed up high (we use Squigz in this video) then place them in a basket or bucket. Remember to pace your movements and spot objects in your environment as you reach and turn.
🪨🌳 Walking in the pumpkin patch: Practice walking over uneven surfaces and stepping over hurdles, taking time to shift your weight from one foot to the other and keeping your feet shoulder width apart. Try to gently shift your gaze between the ground and the environment ahead of you.
🎃🌿 Pick up and carry a pumpkin: Work on bend, lift, and carry for weighted objects. Start with picking up lighter objects placed on a stool or table before progressing to heavier objects and/or lifting from the floor. Keep your feet shoulder width apart, gently squat, and spot with your eyes (keep head upright rather than tipping it toward the ground).

⏰ Remember to modify speed of movement and duration of the activity to avoid elevating symptoms by more than 2 units from baseline. Start slowly and gently, and progress on days that you are able.

⚠️Close supervision by a trained vestibular clinician is recommended to ensure safety with balance activities as well as to ensure the correct challenge level and type of vestibular rehab activities for you individually.

11/03/2025

JUST Published: rapid bilateral sitting-up maneuver for atypical posterior canal BPPV by Dr. Haider Alsarhan! Also, catch a free webinar on "Recognizing Eye Movements and Nystagmus" on Tuesday, November 4, 8 PM Eastern. Join the ABS email list at v1st.co/emailabs to get the link!

11/02/2025

Proud to support vestibular instruction by providing a free Trainer Toolkit to Dr. Jennifer Nash at the recent APTA Nevada Conference! Teaching a vestibular course in the US in 2026? Sign up for your loaner toolkit at v1st.co/toolkit!

Share these vestibular jokes with your favorite someone, and wishing a Happy Halloween to those who celebrate! Want to w...
10/31/2025

Share these vestibular jokes with your favorite someone, and wishing a Happy Halloween to those who celebrate! Want to win a vestibular model treat? v1st.co/JT25 to register for our upcoming Journal Club, and you're entered to win!

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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.