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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...

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...

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...

We’re excited to share an assessment technique that has significantly enhanced our ability to evaluate patients with vestibular hypofunction: the Skull Vibration Induced Nystagmus Test (SVINT). After hearing about it a few times over the past few years, we decided to investigate further and are glad we did. Given our access to infrared goggles, implementing SVINT was quite affordable since portable handheld massage devices can be picked up at places like Walmart.

Clinically, the test has helped us pick up vestibular hypofunctions when our other battery of tests such as looking for gaze evoked nystagmus, head impulse test, head shaking nystagmus test, and dynamic visual acuity tests were unr...

At North 49, the three common questions we get asked about infrared goggles are:

1. Can we get a discount rate on goggles through North 49?
2. Do I really need goggles?
3. Which goggles do you recommend?

Can we get a discount rate on goggles through North 49?

The answer to the first question is, unfortunately no. That being said, we would really appreciate that if you end up buying a pair of goggles from Vestibular First that you use: https://vestibularfirst.com/?referredby=507 as it allows us to collect points that we redeem to purchase anatomical models that we give out as draws at our weekend courses. From time to time we also have give-away draws for our monthly newsletter subscribers. 

As a healthcare provider, seeing patients with various medical conditions is part and parcel of our daily routine. However, there are certain conditions that are relatively rare, but require keen attention and understanding for effective management should they occur. One such condition is an acoustic neuroma, also known as vestibular schwannoma. In this blog, I will provide insights into what an acoustic neuroma is, its prevalence, clinical presentation, conservative treatment principles, and indications for surgery. Then, if you want to take a deeper dive, I'll provide some of my favourite resources at the end of the this blog. 

Understanding Acoustic Neuroma:

Acoustic neuroma is typicall...

Do you ever struggle distinguishing between different types of nystagmus, such as end point nystagmus (EPN) and gaze evoked nystagmus (GEN)? If so, you're not alone. Working closely with therapists in vestibular therapy over the years we've found this to be a common issue. Given such, let's review three practical tips when assessing patients that we have found helpful.

Actually, before we get too far, we need to remember that end point nystagmus is a normal physiological response, while a true positive gaze evoked nystagmus finding is indicative of a central or peripheral vestibular disorder.

As we will see in this blog, end point nystagmus is a bit of a misnomer as it can be seen prior to...

With going to vestibular therapy courses have you found that learning how to treat BPPV affecting the anterior canal is often overlooked. This is understandable to some extent given that other vestibular conditions are more prevalent. Specifically with BPPV, according to Bhattacharyya, it only affects the anterior canal up to 3% of the time. Not nearly as common as the other two canals, where much of the training focuses on.

With that being said, BPPV affecting the anterior canal is rare, but it does happen. So, if you are treating patients with dizziness it is just a matter of time until you may see this form of BPPV. When you do it will be good to have a treatment technique up your sleeve...

Ever heard of Ewald's Laws?

If not, with assessing BPPV do you ever wonder why:

• With BPPV affecting the posterior canal, going into the Dix-Hallpike Test is more provocative than sitting up after?
• With BPPV affecting the lateral canal, going into the Supine Roll Test the side that is more provocative is not always the affected side?
• With cupulolithiasis affecting the lateral canal, the nystagmus beats towards the affected ear with the Lean Test?

Maybe you have not, but understanding the WHY behind these will help us treat the atypical forms of BPPV. It will also help us determine if there is another vestibular condition at play, mimicking BPPV.

What are Ewald’s Laws?

There are thr...

A recent Instagram post caught my eye as it indicated that given a particular study, clinicians should not repeat positional testing after performing a canalith repositioning technique for BPPV. The reason for this, I believe, was due to the risk of causing the loose otoconia to fall right back into one of the canals.

To be honest this post surprised me. I just assumed that it was common practice now-a-days to repeat positional testing to see the effect of treatment. Don’t we want to evaluate the effect of our treatment? Then, when I went back to find that post and hopefully get the study they were referring to, it was buried deep in the social media abyss.

I was a bit disappointed that I ...