Blog

At North 49, I’ve been incredibly fortunate to learn from many brilliant clinicians throughout my career and I see it as part of my responsibility to share what I’ve learned along the way. My goal is that these blogs are a means of reviewing what I have learned and assist in supporting your journey by offering practical, evidence-based insights.

This blog, however, is a little different.

It’s a summary of a doctoral project by someone I’ve had the honour of working with for several years: Nycole Pataki. Nycole recently relocated from Saskatchewan to Arizona with her family and asked if I’d read her doctoral project. After doing so, I knew this work deserved a broader audience. With her per...

Whether you’re helping a professional athlete, a weekend warrior, an injured worker, or a senior who slipped at home, concussion management is part of your everyday clinical practice. If you’ve been in the field for a while, you’ve seen firsthand how much things have evolved.

Thirty years ago, we relied on grading systems like the Cantu Classification, Colorado Medical Society Guidelines, and AAN Guidelines. These were based largely on loss of consciousness and symptom duration, criteria we now know don’t reliably predict outcomes. Thankfully, modern concussion guidelines for healthcare providers are more evidence-informed and patient-specific.

In this blog, we’ll review three key resou...

Vestibular neuritis is one of the more common causes of acute vertigo seen in emergency rooms and vestibular therapy clinics alike. It is estimated to account for 3.2 to 9% of all vertigo cases seen in specialized dizziness clinics [1], and has an incidence of approximately 3.5 per 100,000 people per year [2]. While many therapists understand its classic clinical presentation of sudden onset of vertigo/dizziness lasting days, often with nausea, imbalance, and spontaneous nystagmus the underlying pathophysiology deserves a closer look.

The Classic Presentation of Vestibular Neuritis

Vestibular neuritis (most commonly due to a viral infection) typically results in an acute unilateral vestibu...

In this blog, I want to share something that over the past couple of years has repeatedly come across my path being Vestibular Paroxysmia. I first remembering hearing about it from Dr. Shepard on the Talk Dizzy to Me podcast, then glanced through it on the Bárány Society website, and more recently it came up during the Advanced Vestibular Physical Therapy cohort I was fortunate to be in through the University of Pittsburgh

I’ve come to realize that, although this condition is not common, it’s certainly out there and as clinicians who work with people dealing with dizziness, we need to keep this one in the back of our minds. My approach is: if I see something once, I park it in the back of m...

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 ...