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If you want to learn how to grow a vestibular therapy practice and make a real impact in your community, there are key strategies that can help. At North 49, we are a physical therapy clinic that has built a thriving vestibular therapy practice where we now see more vestibular patients than all musculoskeletal conditions combined. Given such, I want to share the five key factors that helped us grow—so you can reach success faster and meet the growing need for vestibular care.

1. Stop Doubting and Set Up a Niche Service

Many clinicians hesitate to commit to a niche because others already offer similar services. To that, I say—"so what?" There’s more than one restaurant in your city and more...

Gaze stabilization exercises, such as X1 and X2 exercises, are essential in vestibular rehabilitation for patients with unilateral vestibular hypofunction (UVH). Standard progressions typically involve increasing the duration, transitioning from a plain to a busy background, adding balance challenges, and advancing to X2 exercises. However, beyond these standard progressions, there are additional strategies that can further enhance a patient's recovery.

In this post, we will review three additional progression options that have proven useful in clinical practice. 

Gaze Stabilization Progression #1: Bringing the Target Closer

How to Perform:
Patients perform the X1 gaze stabilization exerci...

Persistent Postural Perceptual Dizziness (PPPD or 3PD) is a chronic functional vestibular condition that can be a challenge to manage. While it isn’t caused by structural damage or psychiatric disorders, it’s one of the most common reasons people experience long-term dizziness. This condition is especially prevalent in specialized dizziness centers, where understanding PPPD can make a big difference in patient care. Let’s take a closer look at its symptoms, history, and what healthcare providers need to know. We hope that in sharing what we have found, this helps you better understand this challenging condition and improve patient outcomes.

What Does PPPD Look Like?

Patients with PPPD ofte...

In an effort to better understand the Storage Velocity Mechanism (SVM) and its clinical significance—something that isn’t talked about much in courses—I decided to dive deeper into what it is, why it matters, and what I should know as a vestibular therapist. Here’s what I found.

What is the Storage Velocity Mechanism?

As we know, the semicircular canals detect angular acceleration. However, with motion at a steady speed the cupula in the semicircular canal returns to its resting position within 7 seconds. Despite this, we can maintain visual stability during sustained rotations, thanks to the Storage Velocity Mechanism (SVM).

The SVM essentially integrates and "stores" velocity informa...

Managing sports-related concussions requires a structured, evidence-based approach and often a multidisciplinary team to ensure a safe return to play. Tools like the SCAT6 (Sport Concussion Assessment Tool) and SCOAT6 (Sport Concussion Office Assessment Tool) play pivotal roles in the  assessment and management of sports related concussion. Developed as part of the 2023 Concussion in Sport Group (CISG) Statement, these tools offer standardized methods for evaluating sport related concussion symptoms and guiding recovery.

In this blog, we outline the roles of the SCAT6 and SCOAT6, when to use them, their similarities and differences, strengths and weaknesses, and how to optimize them when ti...

As vestibular therapists, we often focus on assessing the function of the semicircular canals in the inner ear. However, the otolithic organs—the utricle and saccule—play a crucial role in maintaining balance and spatial orientation and are not routinely assessed. Two electrophysiological tests, Cervical Vestibular Evoked Myogenic Potentials (cVEMPs) and Ocular Vestibular Evoked Myogenic Potentials (oVEMPs), provide valuable insights into otolithic function. I often forget the difference between the two VEMPs tests, so hopefully writing this blog will make it stick. If not, at least I have a quick resource to refer back to!

If you are like me, these tests may not be readily available in ...

This fall, Guardian Caps are appearing more frequently in football, including on professional fields. As someone with experience with rugby and wakeboarding, I immediately noticed how these caps resembled scrum caps used in rugby or impact vests for wakeboarding.

Guardian Caps are soft-shell helmet covers designed to reduce the force of impacts during collisions. With concussions continuing to be a significant issue in contact sports, especially football and hockey, these caps offer a fresh approach to an old problem. Let's face it, over the past few decades, helmet designs have not changed much while concussions have remained a persistent issue.

How Do Guardian Caps Work?

The principl...

Maintaining mobility and activity levels in patients with balance issues is essential for their overall well-being. Falls are a leading cause of losing independence in older adults, making fall prevention a key priority. As healthcare providers, we must balance the need to reduce fall risks with keeping patients active. This is where ambulatory aids like walking, Nordic, and trekking poles can make a significant difference. In this post, we’ll review the benefits, differences, and sizing of these poles, and how to determine which is the best option for your patients.

1) Walking Poles: Stability and Confidence on the Go

Designed to provide stability, they can help patients maintain balance ...

In the field of vestibular therapy, taking a thorough vestibular history is crucial. Accurate diagnosis of vestibular conditions (i.e. vestibular migraines) often depends solely on the patient’s history. When I first entered this field years ago, I was advised to focus on three primary elements during vestibular history-taking: symptoms, tempo, and circumstance. Over time, this approach has proven invaluable in my practice.

In this post we'll cover these three elements along with a useful acronym that will help gather all of the pertinent information.

Key Components of a Vestibular History

1. Symptoms

To begin, determining the nature of the patient’s symptoms is essential. Is our patient...

As healthcare providers, we occasionally encounter patients with dizziness that does not fit the usual patterns of vestibular disorders. One such condition is Third Window Syndrome (TWS), which most commonly presents as Superior Semicircular Canal Dehiscence (SSCD). There are other presentations of TWS aside from SSCD and TWS itself was first described by Minor in 1998. 

In this blog, we will cover what TWS is, its causes, symptoms, triggers, diagnosis, and treatment options.

What is Third Window Syndrome?

Third Window Syndrome (TWS) encompasses a group of inner ear disorders characterized by an abnormal opening or thinning in the bony structures of the inner ear. The most well-known form...