Dizzy Diagnostics

This is not to say a vestibular evaluation is easy — it takes knowledge and practice. But too often we hear therapists say they just didn’t assess the vestibular system because they didn’t know where to start.

Here’s a general framework for a good vestibular evolution.

1. Subjective history (symptom quality, time pattern, triggers)
2. Oculomotor exam (ocular ROM, spontantous &gaze nystagmus, smooth pursuit, saccades, etc.)
3. Balance assessment (tons of options here - our go-tos are mCTSIB and FGA)
4. Positional assessment (Dix Hallpike, supine roll test, etc.)

A systematic approach makes all the difference.

We have tons of stuff coming up to help you navigate vestibular rehab. Give us a follow & if you want in the inner circle join our newsletter club! Link below 🤩

What do you think?!

What’s REALLY cool is that these dots are mimicking our otoconia (the “crystals” of the inner ear)

We can thank our otoconia for detecting gravity and linear acceleration. They sit on top of a gelatinous matrix inside the otolith organs (utricle and saccule). When linear acceleration or static tilt occurs, the crystals shift relative to gravity, creating a shearing force on that matrix and the hair cells beneath.

The way we explain it to patients: imagine a pan of Jell-O with mini chocolate chips scattered across the top. Tilt or wiggle that pan, and the chips slide; they’re moving relative to gravity while the Jell-O underneath deforms. That deformation is exactly what bends the hair cells and tells your brain about the motion or position that is occurring.

Pretty cool right?!