Vestibular First

Vestibular First Our mission is to create simple, effective, affordable, and ubiquitous vestibular technologies.
(1)

Our mission is to create simple, effective, affordable, and empowering vestibular technologies to help improve the lives of those suffering from vestibular disorders.

👯‍♀️ Vestibular besties! We’re so grateful for our customers who also make the best of friends. Cheers to you all!
03/09/2026

👯‍♀️ Vestibular besties! We’re so grateful for our customers who also make the best of friends. Cheers to you all!

Have you tried the Sleep Maneuver for posterior canal BPPV? It's a gentle and easy follow-up option for a home maneuver ...
03/09/2026

Have you tried the Sleep Maneuver for posterior canal BPPV? It's a gentle and easy follow-up option for a home maneuver after an in-clinic Epley, Semont, etc. v1st.co/sleep to get a free printable pdf handout!

03/05/2026

🎯🚧 Unsteady or dizzy while walking over uneven ground like grass or cobblestones? Try this!

🌈🌍 Variety for real world application is the key here!

The progression options here involve:
1️⃣ adding heads turns,
2️⃣ half step back with diagonal head turns,
3️⃣ head turn with one foot on a harder surface and the other on a softer surface.

v1st.co/resource to access so many free vestibular articles and printable pdfs, and check out our YouTube channel for many free vestibular rehab ideas!

03/04/2026

❄️🛑 Dizzy with snow shoveling? Here are key tips:

🏋🏼‍♀️ 🛗 Squat a bit with your head forward rather than head down to bring the shovel to the ground. If possible, look with your eyes down rather than tipping your head down.

💞🔁 Turn with your body (step your feet) rather than twisting your back. Look from object to object (trees, light poles, etc.) in your environment as you turn.

⏰🧠Pace yourself and rest as needed to avoid increasing dizziness by more than 2 units from baseline. Remember that barometric pressure shifts can trigger vestibular migraines so be sure to stay hydrated, nourished, and get adequate sleep to improve your migraine threshold.

ess

How do you provide patient education for those with dizziness? v1st.co/DF26 for PTs and PTAs to complete a quick survey ...
03/04/2026

How do you provide patient education for those with dizziness? v1st.co/DF26 for PTs and PTAs to complete a quick survey to support research on this important topic! Whitworth University Vestibular Rehab SIG

03/03/2026

🙏 The Farouk Praying Maneuver — a novel alternative to the Bascule maneuver for refractory posterior canal BPPV, especially cupulolithiasis (Farouk, preprint).

📝 This should only be performed by a trained clinician after confirming posterior canal BPPV that has not responded to standard repositioning maneuvers like the Epley.

🧰 Like the Bascule, this maneuver uses forward bending, but in a stable, controlled prostration (sujood) posture with optional mastoid vibration. Gravity + vibration promote otoconial detachment from the cupula; slow return reduces re-adherence; salutation head turns facilitate migration toward the utricle.

📝 STEP-BY-STEP:

Patient starts seated upright.
Move into full prostration (sujood/praying posture). Hold ~30–60 sec. Apply mastoid vibration to the affected ear (continuous device preferred; tuning fork 128–256 Hz or manual tapping acceptable).
Slowly return to upright sitting.
Salutation head turns: rotate toward the AFFECTED side first, then the other side.
Repeat steps 1–4 once (total = 2 prostrations with vibration).
⚠️ Supervise posture transitions. Use knee support for elderly/obese. Monitor for cervicogenic pain. Educational purposes only.

Post created in collaboration with Sonia Vovan, PT, PhD(c) ()

How do you treat vestibular migraine and Mal de Débarquement? Do you have tough vestibular patient cases like these? v1s...
03/02/2026

How do you treat vestibular migraine and Mal de Débarquement? Do you have tough vestibular patient cases like these? v1st.co/LBmentor to sign up for remote vestibular clinical mentorship with Dr. Lisa Brekke, PT, DPT!

Check out this free patient-focused vestibular education event!. Register v1st.co/veda2026. Vestibular Disorders A...
02/27/2026

Check out this free patient-focused vestibular education event!. Register v1st.co/veda2026. Vestibular Disorders Association (VEDA) Balancing Act Rehab

02/26/2026

⏬👁️Have you seen downbeat nystagmus (DBN) in infrared video goggles in response to a horizontal head shake test? What types of diagnoses can demonstrate such nystagmus?

📌Downbeat nystagmus induced by horizontal head shaking, known as “perverted head-shaking nystagmus” (pHNS), is a rare response that can occur after shaking the patient’s head in the yaw (horizontal) plane at 2 Hz for ~20 seconds.

What might pHNS mean?
(1) 🚩Usually indicates central vestibular dysfunction (e.g., cerebellar lesion, MS, stroke)
(2) ✅Rarely may indicate posterior canal BPPV

Differential diagnosis:
❓Is there a typical posterior canalithiasis response to the Dix-Hallpike for this patient, and if so, do the nystagmus/symptoms resolve with 1-3 appropriate maneuvers? If yes, posterior canal BPPV is more likely. However, watch for “difficult to resolve BPPV,” which more likely indicates a central brain lesion.
👀 Are there any central signs (abnormal saccades, abnormal smooth pursuit, abnormal VOR cancellation, etc.) on the oculomotor exam? If yes, it is more likely to be central.
🧠 Imaging (MRI/MRA head) and other neurologic work-up are very often recommended to clarify the diagnosis, particularly if any nystagmus/symptoms in Dix-Hallpike do not completely resolve quickly with treatment for posterior canal BPPV.

🏅Want to learn more about downbeat nystagmus? Check out this free resource at v1st.co/downbeat and check out our con ed course “Eye Movements in Vestibular Pathology” at v1st.co/education too!

(Yang et al., 2017; Lee and Kim, 2021)

How do you maximize success with the Epley? v1st.co/Den26 to get your official Vestibular First certification, taught by...
02/25/2026

How do you maximize success with the Epley? v1st.co/Den26 to get your official Vestibular First certification, taught by Drs. Jen Stoskus, Sara Oxborough, and Helena Esmonde!

So proud of Sara MacDowell and Sydney Duhe, two talented vestibular and concussion specialists featured using our Insigh...
02/24/2026

So proud of Sara MacDowell and Sydney Duhe, two talented vestibular and concussion specialists featured using our Insight Pro+ infrared video goggles to maximize patient assessment for best outcomes!

Address

Philadelphia, PA

Telephone

+12156678990

Website

Alerts

Be the first to know and let us send you an email when Vestibular First posts news and promotions. Your email address will not be used for any other purpose, and you can unsubscribe at any time.

Contact The Practice

Send a message to Vestibular First:

Shortcuts

Share

Share on Facebook Share on Twitter Share on LinkedIn
Share on Pinterest Share on Reddit Share via Email
Share on WhatsApp Share on Instagram Share on Telegram

Category

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.