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A few months ago we reviewed how gait speed is not only a great test to measure mobility, but why it should also be considered a vital sign (link). But have you ever wondered about assessing your patient’s ability to walk backwards? This is a more complex task needed for tasks such as backing up to a chair, opening a door, or avoiding a sudden obstacle. Or,  have you ever wondered if there was a standardized testing protocol for backwards walking with normative data? 

The study by Carter in 2017, called “The 3m Backwards Walk & Retrospective Falls: Diagnostic Accuracy of a Novel Clinical Measure” looked at walking backwards and falls. The study reviews:

1. ...

The other day we had a patient whose history seemed like pretty straight forward BPPV. On examination, I anticipated there being nystagmus and the patient tightening their grip on my arm with Dix-Hallpike testing, but to my surprise Dix-Hallpike testing was negative when tested to the right and left. This was a bit anticlimactic and somewhat disappointing.

Have you ever been in this situation? Testing tells you one thing, but your gut says otherwise, so now what do you do? If you are not sure what to do next or are curious what we do at North 49, then this post is for you. In this post we will cover 7 things we consider to help us rule in/out BPPV when the initial testing is negative....

The Dilemma With Getting Infrared Goggles

Are you a busy clinician who has ventured out in the field of vestibular therapy, but find it hard to justify the cost of purchasing infrared goggles? You know they would really help with your assessment, take out some of the guess work, and improve your outcomes.  As most things, it can come down to the "budget". Maybe you do not see enough dizzy patients to justify the expense or the owner of the clinic you work at does not understand their value. 

Our Journey To Find Infrared Goggles

We get it as we have been there, but fortunately over the years we have been able to gradually purchase infrared goggles. We actually have...

Have you ever had headaches or dizziness slow you down? With vestibular migraines individuals can unfortunately have a recurring problem with both.

What are Vestibular Migraines?

A vestibular migraine (aka migrainous associated vertigo) is a condition involving the brain that causes symptoms of dizziness.

Are vestibular migraines a neurological disorder?

Yes, vestibular migraines are considered a neurological disorder, but structurally the brain is fine. Rather, a vestibular migraine is thought to be due to the brain having an adverse reaction or sensitivity to a certain stimuli.

What causes a vestibular migraine, or why do I get vestibular migraines?

That is a great question that no...

Do you ever find it difficult to see the torsional component of nystagmus with the Dix-Hallpike test? At times we have, and it can be concerning given the possibility of the  vertical nystagmus being indicative of a central vestibular disorder. There is, however, a clinical trick to help tease out any torsional component. 

It's All About Semicircular Canal Orientation

As the video in this blog reviews, the nystagmus with BPPV is in the same plane as the semicircular canal that is affected. So, with being able to understand the orientation of the canals we can bias the nystagmus to reveal the torsional component and if need be the vertical component.

To see more of the...

Over the past decade, there has been a significant increase in research published regarding concussions. This information has allowed care providers to better understand the pathophysiology and natural history of concussions. Treatment protocols have also been published to assist care providers in the management of concussions.

As with anything, with this increase in published information, there is a corresponding increase in misinformation and/or poor quality research. This has lead to conflicting information and confusion for both the health care provider and the patient.

Given this, we have decided to clear up some of this confusion in regards to concussions by getting “back to...

We are all familiar with vital signs such as heart rate, blood pressure, blood oxygen levels, respiration rate, and body temperature. How accurate are these signs at determining health or predicting future health? Are there other signs that we should consider as a vital sign? If you could add another vital sign what would it be? Mine would definitely be, with no reservation, “gait speed”.

What Is Gait Speed?

The time one takes to walk a specified distance on a level surface.

Why Gait Speed Should Be Considered a Vital Sign?

The reason I believe gait speed should be considered a vital sign is that it packs more information than just determining the need for a...

When you get to shore after a long day of boating with the family or friends do you ever feel like you are still in motion despite you are sitting or standing totally still? Then when you move this feeling is less noticeable? This sensation is called Mal de Débarquement and is a normal experience that resolves rather quickly. Mal de Débarquement Syndrome on the other hand presents in a similar manner, but lasts at  least 48 hours. 

Clinically, at North 49 we never see individuals with Mal de Débarquement, but will see those with Mal de Débarquement Syndrome. In this blog we will cover the 5W’s of Mal de Débarquement Syndrome (MdDS). I...

This past fall we were asked by a university program in the USA to help them deliver an online course for their students in regards to vestibular therapy. Traditionally this course and the labs were taught by faculty or guest lecturers in person, but COVID-19 has made this a challenge. 

To address this, we thought that our Understanding Dizziness 101 online course would be the best fit. This course was initially created with the clinician in mind. However, given the demand for online training this course seemed the best option to help students with their board exams and eventual life in the clinical setting as it builds a framework, for the course...