Dizzy Diagnostics

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Baton Rouge, LA
Dizzy Diagnostics

Evidence-based resources for assessment and treatment of the vestibular system. NOT medical advice.

All exercises should be performed under the supervision of a qualified clinician. We are Sara and Sydney, two physical therapists with a combined 20 years of experience working with patients with vestibular disorders. With a shared passion for vestibular rehab, we aim to equip fellow clinicians with evidence-based resources to provide high quality care to patients with vestibular disorders.

09/04/2026

Happy Friday!

We had a doozy of a positional vertigo case today & 2 brains are better than 1, so here we are brainstorming a case of atypical posterior canal BPPV

Here’s what happened:

Left Dix Hallpike: down beat - persistent, but reduced with fixation

Right Dix Hallpike: down beat followed by a burst of upward right torsion that lasted about 20 seconds, then more down beat

👉 treated with R Epley

On reassessment of Right Dix Hallpike, only down beat was noted. BUT!! Upon return to sit she exhibited a STRONG burst of upward right torsion lasting about 30 seconds.

⁉️Where could the crystals be?! What maneuver would you try next?!

Of note, she has a clear brain MRI and no other central findings on exam.

09/03/2026

A few lessons I’ve learned 😊

08/27/2026

We try not to let our patients lose interest, so here are some treatment tools we use to keep rehab fun and salient!

*Please note that all content posted by Sara & Sydney I Vestibular Physical Therapists is for educational purposes only and is not to be used as medical advice. This platform is designed to serve as a resource for healthcare professionals. Sara & Sydney I Vestibular Physical Therapists assumes no responsibility for any misuse or reliance on the information provided on this page.

Spot it - visual search to find matching symbols on cards
👉🏼👉🏼 tandem walk with head turns to find matching symbol between cards in hands

Cards - endless possibilities for gaze stability, balance, and habituation!
👉🏼👉🏼 holding a stack of playing cards face down. Flip one at a time and turn right if red, left if black to place card on surface behind you (habituation, balance)

Balls ⚾️ 🏈 🏀
👉🏼👉🏼 toss tennis ball and catch with other hand while walking (visual tracking, balance)
👉🏼👉🏼 back facing wall, turn to tap ball on wall in various directions (habituation, balance)
👉🏼👉🏼 single leg stance, bounce ball to targets on wall (I.e. playing cards) on command (balance, cognitive dual task)

Blankets, pillows, towels
👉🏼👉🏼 crumple up blanket and march on it to practice walking in uneven grass
👉🏼👉🏼 stepping onto/off of pillow while reading words on wall (gaze stability, functional balance)

Colors!
👉🏼👉🏼 toss 3 scarves and have patient grab one color on command while telling you an object that color (visual habituation, dual taask)
👉🏼👉🏼 bean bags on ground, patient bends forward to grab one with R or L hand on command (red & blue = right hand, yellow & green = left hand). Stand up and toss into a basket (balance, habituation to bending, dual task)

Motion Guidance reaction pods

The options here are endless. You can set them to respond to either touch or laser (helloooo cervical proprioceptive training!)

They can be set to light up AND make a sound, which is great for patients who have difficulty localizing sound due to hearing loss

Thank you Motion Guidance for this amazing system!

We ❤️ our Bertec. We know we are sp

08/10/2026

These test variation can be a roadmap to determining the best treatment for your patient.

Otoconia can be loose in various places in the canal or stuck to the cupula. These tests will help you narrow down where!

We will break these down in more detail coming up, so follow along for more Sara & Sydney I Vestibular Physical Therapists

*Please note that all content posted by Sara & Sydney I Vestibular Physical Therapists is for educational purposes only and is not to be used as medical advice. This platform is designed to serve as a resource for healthcare professionals. Sara & Sydney I Vestibular Physical Therapists assumes no responsibility for any misuse or reliance on the information provided on this page. Patients have consented to videos used.

08/07/2026

Half Dix Hallpike - if it’s not part of your BPPV toolkit, add it!! Such a useful test for narrowing down where otoconia are in the canal

I know some of you have used this test. Has it helped you manage any tough cases of BBPV?

08/03/2026

✨ our current vestibular rehab essentials ✨

Colorful scarves are so dynamic. Need a visual distraction? Need a cognitive dual task? So many options

Wrist weights and hand weights. Can’t emphasize enough how big of a difference these can make for a patient with dizziness

Wrapping papers for visual complexity

Cards, balls, bands, and beanbags. The treatment options here are never ending.

Motion Guidance headcount laser and reaction pods ‼️ this system elevates rehab in a special way (not an ad)

Spot it! An OG of our clinic. Great for functional gaze stability training 👀

What’d we miss?!

08/02/2026

A vestibular evaluation involves a lot more than most clinicians expect. Here is a look at the tools we use every single day and what they actually tell us.

The vestibular models are up first because patient education starts as soon as your eval does. If someone can see what the inner ear looks like and how it works, the rest of the session makes a lot more sense to them.

The Maddox rod and tongue depressor with the letter card and tape measure are for oculomotor testing. Small tools that give you a lot of information when you know what you are looking for.

The Airex foam is for the modified Clinical Test of Sensory Interaction on Balance (mCTSIB), an absolute staple of every vestibular eval!! It will really help you start to understand how your patient is using their sensory systems for balance.

Vitals are soooo important in this population. The vestibular system is highly susceptible to vascular changes and we want to know what we are working with from the start.

The Vestibular First goggles are how we see what the vestibular system is doing in real time. Easily the most valuable tool in the room!! Not an Ad - just love our goggles 😉

And the balance systems poster is on the wall at all times because education is part of every single session.

07/28/2026

Here are a few real situations that led me to send patients to the ED. Some of them were clear calls, but some of them required more assessment and critical thinking.

My patient from yesterday is stable and still being worked up.
He has a history of migraine associated positional vertigo. New onset of “different” dizziness over the last two weeks after prolonged work in cervical extension. During the first Dix-Hallpike, he developed severe dizziness with down beat nystagmus, nausea, significant imbalance, and numbness in both hands. Blood pressure jumped to 170s/100s from a normal reading at the start of the session. Downbeat positional nystagmus can be migraine in some cases, but with associated hypertensive crisis and sensation changes?!? 🚩

Some other examples:

Male in his 80s, previous patient, classic posterior canal BPPV history. Called in asking to be seen. What I found in the assessment was severe gait impairment, direction changing nystagmus, and downbeat positional nystagmus on top of multiple cardiac comorbidities. This was not a crystal readjustment situation. This was an ED visit!! 🚩

Healthy 60 year old female, new onset dizziness and severe imbalance. She came in by wheelchair and could barely walk (and she was normally fully independent) ‼️ Downbeat positional nystagmus and elevated blood pressure. Neurology found a small pontine stroke.

Male in 50s, sudden onset hearing loss, vertigo, and ataxia four days prior, referred to PT with a diagnosis of labyrinthitis. HINTS exam came back positive for central findings; normal head impulse test, direction changing nystagmus, vertical skew. That is not the ear!!! Immediate ED referral. 🚨

Female in her 70s, positional dizziness with characteristic nystagmus on Dix-Hallpike. She had a syncopal episode during the Epley maneuver. This one is obvious.. We called 911. 🏥

All of these cases were referred as typical “vertigo”!!!

Address

Baton Rouge, LA

Website

https://www.advancedneurotherapyed.com/, https://linktr.ee/dizzydiagnostics

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