Vestibular First

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

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

How can we help decrease sensitivity to visual patterns/motion? In addition to training increased use of proprioception,...
10/17/2025

How can we help decrease sensitivity to visual patterns/motion? In addition to training increased use of proprioception, here are great ideas! v1st.co/JT25 to register for an upcoming Journal Club on treating oculomotor issues after mild TBI with the brilliant Dr. Jacqueline Theis.

We need your help - are there TWO maneuvers both called the Reverse Epley? Which if any did you learn? Thanks to Brian W...
10/15/2025

We need your help - are there TWO maneuvers both called the Reverse Epley? Which if any did you learn? Thanks to Brian Werner, PT, for bringing this challenge to our attention! v1st.co/bppvMN to register for an awesome in-person (not virtual and not recorded) intermediate BPPV course in January 2026 in St. Paul, MN! M Health Fairview

10/14/2025

🌖 🌌 Dizzy in the dark? This patient reported recent onset of dizziness, worse with head and body movement, as well as an off-balance feeling, worse in the dark to the point of immediate loss of balance with eyes closed.

🌪️📚 But research indicates that symptoms aren’t the best indicator of the root cause of dizziness or imbalance.

🔑 🔎 Key exam findings in infrared video goggles:
👁️ Spontaneous right beating nystagmus in the dark (suppressed with the visual fixation lights on);
😒 Gaze-evoked nystagmus: increase strength of right beating with right gaze, decreased strength of right-beating with left gaze;
🫨 Horizontal head-shake with ongoing right beating nystagmus

👀 Also, in room light, the head impulse test to the left showed a corrective saccade (abnormal), and the Dynamic Visual Acuity had a 6 line loss or difference.

👂 As a clinician, we should also ask about hearing symptoms (may need a hearing test), as well as past medical history (history of cardiovascular risk factors, diabetes, inner ear infection, chemo, etc.).

❓ Do you think this is a unilateral or bilateral vestibulopathy? What other test results could be beneficial to clarify?

Learn more - take our intro online course series “Foundations for Vestibular Rehab” at v1st.co/intro

Are there any contraindications to BPPV testing? Learn more about BPPV testing - check out v1st.co/freeLDH for a free in...
10/13/2025

Are there any contraindications to BPPV testing? Learn more about BPPV testing - check out v1st.co/freeLDH for a free info page on the very helpful updated option of Loaded Dix Hallpike by Dr. Jeff Walter et al. (2020).

What BPPV maneuver do you think they’re learning? Thanks to Danny Ludwig, PT for this great photo of  PT students gettin...
10/12/2025

What BPPV maneuver do you think they’re learning? Thanks to Danny Ludwig, PT for this great photo of PT students getting insights with our vestibular headband!

In honor of National Physical Therapy Month: Enter to win our giveaway of 1 free registration (virtual or in-person) to ...
10/10/2025

In honor of National Physical Therapy Month: Enter to win our giveaway of 1 free registration (virtual or in-person) to the intro/intermediate level multi-disciplinary Iowa Vestibular Symposium on January 17-18, 2026. v1st.co/IVS25 to learn more and to enter to win! Iowa Vestibular Symposium Vestibular Rehab SIG

How do you know a BPPV maneuver worked? Number 1: Positional nystagmus resolved upon re-test (recommend 10 minute rest f...
10/08/2025

How do you know a BPPV maneuver worked? Number 1: Positional nystagmus resolved upon re-test (recommend 10 minute rest first) of positional testing such as Dix-Hallpike. Check out a wonderful PT job opportunity at Sandpoint PT in northern Idaho - call 208.265.0610 option 1 to learn more and apply! Cornerstone Physical Therapy & Aquatics

10/07/2025

💈🪩 🚗 Dizzy when viewing moving vehicles or moving patterns/lights? Here’s a handy treatment idea to use equipment that many homes and clinics already have (playing cards and a treadmill!) to work on decreasing sensitivity to visual motion.

🧠 🐢 Remember to modify speed of the treadmill (visual motion level) and self-motion as well as modifying duration of the activity to avoid elevating symptoms by more than 2 units from baseline.

💃🪩 This activity works on a mix of functional eye and head movements, including active eye and head movements, VOR cancellation, and tolerance to visual/self-motion overall. It could be useful as a progression for those with persistent postural perceptual dizziness, visual vertigo, or post-concussion, for example.

📈🪜 Progression options:

🪑🧎 👁️ Start seated or kneeling. Look at a card in front of you and then visually track and follow that playing card as it “takes a ride” on the treadmill track. Adjust frequency of card placement to tolerance.

🫱♠️♥️ Clinician placed 2 cards on the track. Pick up the card that is called out, example: “Pick up the Queen of Hearts.”

🛞🔄 Add a 90 degree head/body rotation position to the “pick up the card that is called out” activity above.

👯♦️♣️ Add body turns alternating left/right to reach and match cards by number or suit.

💁🤩 Don’t forget to sign up for our FREE November Journal Club on “Treating Oculomotor Disorders after mild TBI” with Dr. Jacqueline Theis, OD, FAAO, FNAP to learn more!

📝 Guidance by a trained vestibular clinician is recommended to ensure the correct challenge level and type of vestibular rehab activities for you individually.


Job opportunity near gorgeous Florida beaches!
10/06/2025

Job opportunity near gorgeous Florida beaches!

Fyzical provides Physical Therapy, Physiotherapy, Physiotherapy, Athletic Therapy, Chiropractic, Natural Therapy, Manual Therapy, Massage Therapy and Accupuncture in Decatur

Do you see light sensitivity with vestibular migraine? v1st.co/dizzycook for a great article on optical tint lens option...
10/06/2025

Do you see light sensitivity with vestibular migraine? v1st.co/dizzycook for a great article on optical tint lens options, and v1st.co/BB25 to learn more about a fantastic upcoming online guided chronic dizziness care program led by Dr. Emily Kostelnik.

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Philadelphia, PA

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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.