Seeing the Unseen: How Vestibular Rehab Can Transform Your Recovery w/ Dr. Helena Esmonde (Vestibular First) | E40 - Life After Impact: The Concussion Recovery Podcast

Episode Transcript
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SPEAKER_02 (00:00):
And what's really fascinating is that both
enjoyment and just having a dualtask, meaning something else to
think about, time and again hasbeen shown to improve balance
better than uh just like whatI'll call a more straightforward
balance activity by itself, aswell as to reduce dizziness.

SPEAKER_01 (00:18):
Welcome to Life After Impact, the concussion
recovery podcast.
I'm Dr.
Ayla Wolfe, and I'll be hostingtoday's episode where we help
you navigate the oftenconfusing, frustrating, and
overwhelming journey ofconcussion and brain injury
recovery.
This podcast is your go-toresource for actionable
information.
Whether you're dealing with arecent concussion, struggling

(00:40):
with post-concussion syndrome,or just feeling stuck in your
feeling process.
In each episode, we dive deepinto the symptoms, testing,
treatments, and neurologicalinsights that can help you move
forward with clarity andconfidence.
We bring you leading experts inthe world of brain health,
functional neurology, andrehabilitation to share their

(01:01):
wisdom and strategies.
So if you're feeling lost,hopeless, or like no one
understands what you're goingthrough, know that you are not
alone.
This podcast can be your guideand partner in recovery, helping
you build a better life afterimpact.
All right, Dr.
Helena Esmande, thank you somuch for coming onto the Life

(01:23):
After Impact podcast.
Thank you so much for having me.
It's really a pleasure to bewith you.
Well, I have been a big fan ofall of the content that you put
out through Vestibular First,which is a company that you are
the founder, the creator of.
And the um you have createdthese infrared goggles, which

(01:45):
many people are maybe familiarwith them, but I think you
really brought a particulardesign to market that was
affordable for many cliniciansthat had small clinics.
So thank you for doing that.

SPEAKER_02 (01:57):
Oh, well, it's it's it's funny because it's not only
is it my joy to do so, uh, but Ihave to say that it was really
initially a very um personalthing because I had worked at a
clinic that had infrared videogoggles, and before that, I
worked at a hospital thatdidn't.
So I was like, all right, um, Iknow the difference from my own

(02:18):
experience in addition to what'sin the literature.
I'm not going back.
And then I needed to change jobsfor for family reasons.
And so I found a clinic that wasa great fit, but of course, uh,
they had never had a vestigialtherapist.
So, of course, they didn't havegoggles.
And I said, Well, this is amust-have.
And they're like, Well, how muchare they?
And so I, you know, priced outdifferent choices, and they're

(02:38):
like, none of these can weafford, um, which is fair
because that was gonna bepart-time, especially, and and I
understand that.
So uh luckily, my husband is atinkerer, he's been uh taking
apart VCR since he was threewith his dad and such.
So he's like, I think I can makeyou a pair.
I'm like, go for it.
Like, I'm in.
Uh, and luckily he was able torepurpose a VR goggle for our

(03:01):
first kind of prototype version.
And we had no intent to have amedical device company, but then
uh I had other clinician friendsof mine saying, What are you
using?
Can you make us a pair?
And I'm like, I'm not gonna makea bunch of kind of um not that
ours were unsafe, but just youknow, that initial prototype was
not anything officially FDAcleared or anything like that.

(03:21):
So, you know, my husband and Isat down and we said, All right,
are are we gonna do this?
Like, is this like gonna be athing?
Like, can this work?
Like, you know, like many of usover the years that maybe have
uh gone on a limb, right, invarious times of life for
personal or professionalreasons.
And so this is my limb.
Uh, but so far it's holdingsteady.

(03:43):
So great gratitude for that andand to help so many people has
always been my life goal.
So it's it's a pleasure.

SPEAKER_01 (03:50):
Amazing.
Well, the the goggles I I'veI've had with the kind of the
initial prototype that I thenhad to like send back in once
the other prototype came in.
So I've been with you from thebeginning.
And uh I also, you know, I'm soexcited to have you on the show
because you are an absoluteexpert when it comes to
vestibular disorders, which is,I think, one of the most comp

(04:12):
complicated aspects with peoplewho have concussions, but also
people who don't too.
Uh I can't tell you how manypeople come into my clinic and
they say, I've got dizziness orvertigo, and they've been to
numerous doctors, and they don'thave a clear diagnosis.
They don't know if it's comingfrom the peripheral vestibular
apparatus or if it's a centralissue.

(04:32):
They don't know the difference.
And so there's still so muchconfusion in this field.
And I think you're you're reallyshedding light on how to do
proper diagnostic workup.
And so I wanted to talk to you,you know, in for our listeners
who are dealing withconcussions, who maybe also are
dealing with dizziness, vertigo,rocking, swaying, bobbing, all

(04:54):
these symptoms anddisequilibrium.
Maybe we can kind of talkthrough some of the work that
you're doing to try to helppeople figure this out so that
they're having clearerdiagnosis, which leads to
obviously clearer treatmentstrategies.
Absolutely.
Absolutely.

SPEAKER_02 (05:11):
No, I I'm uh totally uh empathetic.
I think that's the right wordwhen I haven't had a concussion.
Um, but I certainly have hadmany patients, unfortunately,
who have dealt with this.
And uh there's no question thatuh because concussion involves
the brain, which I thinkeverybody's on board with that,

(05:31):
uh it it becomes extremelychallenging because there is a
lot of individuality to ourbrains.
Um so I have you know patientscertainly that uh will say to
me, Oh, well, I feel this set ofsymptoms.
That must mean this, or doesthat mean this?
And I'm like, I care about yoursymptoms because I care about
how you're feeling, but um veryfew symptoms give us a very

(05:54):
clear directive of what is theroot cause of that symptom.
Is that the brain talking, whichis how I kind of characterize
like um sensations that reallycome from the brain perhaps
struggling to process sensoryinformation, things like that.
Or, like you said, is it theperipheral inner ear vestibular
system, you know, also having anissue that could be related or

(06:17):
unrelated to the initial traumaof the concussion?
Um, and then other secondaryissues that can come up
post-concussion, such aspost-concussion migraine, um,
which is a pretty challengingsituation uh for most patients,
if they have no history ofmigraine in particular, because
then they're really this is newterritory.

(06:38):
Um and the really challengingfact that there are types of
migraine essentially that do notnecessarily involve much in the
way of headache.
And this I find that my patientsget very confused by because
historically I think migraineand headache have pretty much
been used synonymously, but uhin fact it's it's not so
clear-cut, although certainlysome people with migraine do

(07:00):
primarily have headache.
But uh because I like to callmigraine the cranky brain, uh
it's it's just uh sensoryprocessing challenges and
hypersensitivity to sensorystimulation.
And uh because people withmigraine again may not have the
same uh triggers or things thatkind of tend to kind of make the

(07:20):
brain more cranky, um, it can beconfusing because it's like,
well, you know, I read that youcan't drink red wine, but I can
drink it and I don't feel anydifferent.
Well, that's just not it's notit for you.
Um but it's both the the coolthing about the brain, but also
the challenging thing from likea treatment perspective, even
more so than blood pressure,which I understand from

(07:41):
physicians also sometimes youhave two patients with high
blood pressure and onemedication works well and
another patient doesn't respondto that.
So I think looking at our ourindividuality of being human
again is super cool, but alsofrom a medical standpoint, super
challenging.

SPEAKER_01 (07:58):
Absolutely.
And you know, I just got anemail in my inbox from from you
the other day that was talkingabout atypical benign paroxysmal
positional vertigo.
And it, you know, it just reallystruck me of how neurology is
really the field where it's it'salmost like when someone comes
in and they fit a textbookdescription, you're kind of

(08:20):
like, oh, thank you.
Because so often people come inand they don't fit these
textbook descriptions of whatyou learn and what you would
expect to see.
And then you've got to figureyour your way through that.
And uh so neurology, I somebodyjust once said like biology is
messy.
I feel like neurology is evenmessier.

SPEAKER_02 (08:40):
Yes, yes, yes.
And so again, I'm so empatheticto the patients because on their
end, you know, understandablythey're like, oh, the advanced
science, we should, you know,have all these answers.
And uh I think that is becomingmore true than it ever has
before.
Uh, but yet, because of thecomplexity and individuality of

(09:00):
the brains, we're definitely notall the way there.
You know, whether that's um agiven treatment, is this gonna
help?
And there has to be,unfortunately, uh sometimes some
trial and error.
And so, you know, I always tryto establish like a really kind
of open communication with mypatients.
I set certain parameters likesymptom level.

(09:20):
Um, I tried very hard if we'regoing to, you know, try some
different ways to stimulate thesystem to try to work as a
better team between the eyes andthe vestibular system in the
brain or what have you, that Idon't want the symptoms to
increase by more than two unitsfrom baseline.
So it's comes that at a two outof ten dizziness.
Um, I don't want their dizzinessto exceed a four out of ten as

(09:42):
we're trying to train the brainto process movement better.
And, you know, I'm always tryingto look at the big picture, you
know, if we're not makingprogress, what maybe hasn't been
assessed that needs it?
And it might not be somethingthat's my specialty, and that's
okay.
I really believe concussion inparticular, and I'm sure you've
had many guests on that are ofdifferent disciplines uh for
that reason, you know, whetherthey need neuroautometry, you

(10:03):
know, maybe specialized glasses,prism lenses, things like that
might be great for one patient,not needed for another.
So, you know, is one personreally more neck issues than
anything else?
I've definitely had patientsthat I have provided neck care,
but also gladly handed patientsoff to me, uh, folks in the
chiropractic world uh toprovide, you know, more

(10:24):
specialized manual care than ummaybe would be appropriate for
me to do.
Um, you know, so I think that ifwe all kind of are comfortable
in our disciplines, in ourtraining, and always trying to
learn, uh, we can continue tohelp these patients with the, I
like to say, layers to the onionthat are often present.
Um, you know, because sometimeswe just get stuck where we just

(10:46):
can't make progress becausesomething really needs to be
addressed.
Um, and that could be emotionaluh support is needed because
there's the brain also processesemotions.
I try to remind patients of thatbecause sometimes they're like,
why do I feel so irritable orwhy do I feel so you know
frustrated?
I normally am so like, you know,can can I handle, you know, like

(11:09):
what's going on in my life, evenif it's really chaotic, and now
it's just like the littlestthing sets me off.
I'm like, you have to recognize,like, yes, we have some
management of our emotions andwhatnot and some control over
them, but ultimately, um, Iremember hearing a talk a while
ago, and it really stuck with meabout a patient who had had a
concussion and you know wassignificantly felt like they

(11:32):
were and the family felt thatway, uh, more irritable, and you
know, that, you know, it it wasliterally years, like 10, 15
years before they got adequatecare for the emotional piece.
And once that happened, it waslike a turning point for like
all their other symptoms, um,which doesn't mean that that's
always the answer.
But again, like I think it'sgood to try to look at like what

(11:54):
piece or pieces maybe need to beaddressed.
Is it sleep?
That's a big one, right?
Um, so you know, when I thinkabout dizziness, you know, I
like to say the crystals puttingthem back, it's like the easy
part, like, oh, I'm just gonnaplay the game with the plastic
ball and the plastic maze andmove you around and you know,
use your eye movements and tellme where the where the crystals
are out and I'll put them back.
And like um, really, if you'rewell trained in that, like that

(12:17):
is straightforward because it'sa physical issue, it's a
mechanical problem.
I just gotta put the crystalsback.
But uh, when it comes to theseother layers, the the brain
layer, you know, and how longwe've had symptoms, that means
the brain has kind of learnedthat when I turn my head right,
that means dizziness, and so howwe kind of have to retrain that,
for example.
And so, you know, I'm just verypassionate about like um I I

(12:41):
attribute it to being at gradschool at Marquette University,
and their motto is curapersonalis, which in Latin uh it
means care for the whole person.
Um, and I know that those in thechiron and functional neurology
world also are that way.
So that's one reason I thinkthat what you guys do is also
super cool um because you'reyou're willing to look at things

(13:03):
like nutrition and you know,whatever else might be kind of
playing into, you know, what'sgoing on with the symptoms and
how can we help?

SPEAKER_01 (14:22):
Yeah.
And now I I imagine in yourpractice, you are obviously
looking at people's eyes all daylong with these infrared goggles
on.
And so people who aren'tfamiliar, what we're talking
about are these goggles, almostthey look like scuba got scuba
goggles, but when the patientputs them on, they can't see
anything.
They're in the dark.

(14:43):
But the little infrared camerasallow us to look at a computer
screen and see the eyes.
And so talk a little bit aboutuh this idea that when somebody
has their eyes open and they canfixate on a target, that can
inhibit a lot of pathology.
It can shut down a lot ofpathology.
As soon as you put the goggleson and somebody cannot fixate on

(15:06):
anything, we kind of get to seewhat this connection is between
the eyes and the vestibularsystem.
And sometimes you can see somepretty immediate pathology.
Uh, and so talk to me a littlebit about what what you do often
see or what it is that you'reyou're either looking for or
observing when you pop thesegoggles on and are looking at

(15:27):
somebody's eyes for kind of thefirst time as part of your
evaluation.
Absolutely.
Yes, yes.

SPEAKER_02 (15:32):
I like to joke that uh it's all the eyes looking,
but not all the romance.
Um so, you know, um again, it'sreally cool that there's
something called the vestibuloocular reflex, which is this
great um fastest reflex in ourbody, uh, connection between our
inner air vestibular system andour eyes.
Um, and that is mediated uh at abrainstem level as well.

(15:55):
So we do have the brain in thegame.
So we've got all three there.
Um and this is really a helpfulreflex uh from a vestibular
assessment standpoint, an ocularmotor assessment standpoint,
because uh when there'sdifferent pathologies present,
whether it's inner earpathology, brain pathology, um,
we can get certain eye movementsuh that some are spontaneous,

(16:19):
just sitting at rest, I can seesomething.
Sometimes I can provoke it withsomething, like uh I want you to
look with your eyes to the rightor left.
So that's kind of a gaze-evokedtype test.
Then I can do um avibration-induced nystagmus test
where I put a vibration tool onthe mastoid behind the ear and
stimulate uh the peripheralsystem this way.

(16:40):
And there's a few differentthings I look for, and depending
on what you might be going at onat that level, we might see a
different direction of eyemovement.
So we're just looking at um whattype of movement is it
persistent or is it uh kind ofbrief?
Uh, we're looking at thedirection that the eyes are
going, and uh we're looking ateverything.
So it's not one test by itselfthat gives me all the answers.

(17:02):
I really have to do a full examto get the full picture, which I
know some patients findfrustrating because they often
uh comment online on our postson social media.
Well, you know, I feel dizzywhen I turn to the right.
Does that mean that I have aproblem in my right ear?
And unfortunately, I don't knowbecause until you get that full
exam from someone who's trained,you know, turning your head to

(17:24):
the right and feeling dizzycould be due to a neck issue, uh
vascular issue in the neck,blood flow not going right, um,
something going on in the rightinner ear, something going on in
the left inner ear, but it justhappens turning right kind of
got things moving on the left,um, something going on with the
brain processing movement goingthat direction.
So it the symptoms again,although I I want to hear about

(17:46):
them because sometimes they giveme a clue, um, by themselves are
not particularly diagnostic.
Um, and yet that's what thepatient's feeling all the time.
So they're pretty aware of thesymptoms, um, which is
understandable, but also, again,not as helpful as I'd like.
So uh we're gonna do differentuh positional tests, things like
that to stimulate the vestibularsystem and the brain in

(18:08):
different ways and see how theeye movements respond.
So there's normal responses, um,and then there's abnormal
responses, and the types ofabnormal response could say,
yep, everything's saying thatthe brain's not processing well,
or I see one eye, as soon asyou're in the dark, it deviated
laterally.
That means their eyes are havingtrouble working as a team.

(18:29):
Um, so you know, again, there'ssome treatment I might apply for
that, and there's some referralI might do for certain cases
because it might need moreintervention than I have
available as a physicaltherapist.
So, you know, it's how do Isummarize years of training?
Um, but that's what we're doing.
We're we're we are doing ascience.
Um, it's certainly not exactbecause again, individual

(18:51):
variation.
So the good news is there areusually patterns.
So if I start to see kind of apatient who has a bunch of eye
movements that are fitting acertain pattern of crystal being
out of crystals being at a placein the inner ear, which we all
have these crystals, butsometimes they go in the wrong
part of the inner ear, versus,you know, this pattern is really
fitting someone who has a mixedpresentation where they have
clear, you know, issues withcoordinating their eye movements

(19:14):
and things like that, which ismore of a brain level issue.
But then also they have signs ofdamage to a vestibular nerve on
one side.
So sometimes, unfortunately,someone has multiple issues,
which might have happened at thesame time or might be, you know,
happened one thing happenedbecause you had an ear infection
as a kid.
Um, and that's just gonna affectmaybe your progress and what
kinds of rehab we need to applyto help get everything back on

(19:38):
track.

SPEAKER_01 (19:39):
Yeah, yeah.
So the kind of take-home messageis, you know, for for people
listening, is that your yoursymptoms are not necessarily
always the clear path towardsthe diagnosis.
You really need to go throughall the testing, uh, both with
your eyes kind of without fixingit, fixating, and then also
obviously with fixation and uhlooking for differences and

(20:02):
looking for normal versusabnormal responses to things to
really just allow the clinicianto go through that differential
diagnosis of it isn't this, it'snot that, it's not this, but
this, it is this.
Right.

SPEAKER_02 (20:15):
And to understand things can change.
So I've certainly had a patientpost-concussion who had no signs
of crystals being in a place,definite signs of you know, some
difficulty with eyes working asa team and things like that.
We were applying rehab for thosethings.
Patient was making goodprogress, we're all happy.
Uh, and then we're about fourweeks in, and she comes in,

(20:36):
she's I feel different, I feeloff.
Yes, very, very vague languagein this case, but that happens,
and that's not to judge that.
And that's what's her physicalexperience of what's going on.
So I think to myself, okay, I'mgonna do some screening and
compare to the first day,anything different or the same.
So I didn't do my full, fullexam for the first day, but I

(20:56):
picked out some key elementsthat I thought could be
involved.
Okay, nope, that looks the same.
Okay, goggles on.
Um, you know, your brain againwants to suppress some of these
abnormal eye movements to try tomake you feel less symptom,
which is very nice at the brain.
Good job.
But as a clinician, yeah, I needto see these eye movements.
So I'm gonna put you in the darkso I can see them better so they
don't get suppressed.
And actually, the patient didend up having a certain type of

(21:18):
BPPV in the horizontal canalwhere it can get stuck.
So it's kind of a stubborn type,um, notorious for um being more
difficult to clear.
So, you know, some BPV willactually clear itself, which is
nice for the patient.
They don't necessarily alwaysneed a maneuver, but in this
case, that wasn't likely.
So we were able to apply, youknow, proper treatment for that
and um have her rest and thenretest after the treatment.

(21:43):
And that eye movement that I wasseeing that was telling me that
autoconia were stuck, that wentaway.
And so that's an indication thatwe've cleared that.
So it's a really nice kind ofbefore and after uh testing that
we can do in a case like that.
Um, but to speak also to somepatients feel like, oh, you
know, I feel these symptoms, Imust have crystals out.

(22:03):
Unfortunately, again, symptomsnot always being a good report
or a good helper here.
Um, you know, there are manypatients who are doing maneuvers
or even having clinicians domaneuvers on them.
And because the crystals aren'tout of place, it's not harming
them, but it's not going to helpthe symptom.
We have to, again, always betrying to look back to one or
more root causes of why we'refeeling this way and kind of

(22:25):
work on those.
And some of them take a lot oftime, unfortunately, especially
brain changes can take time.
Um, if you ever try to learnSpanish uh or any foreign
language, you'll know that youknow the brain is a wonderful
learning machine, but it cantake time to make changes.
So yeah.

SPEAKER_01 (22:42):
Well, and you bring up a good point.
There are lots, there's lots ofinformation now online about how
to do different at-homemaneuvers if people have uh a
benign paroxysmal positionalvertigo.
And I know you guys also havesome great handouts that you
give to people.
Um it seems like there's like anew maneuver coming out

(23:02):
constantly.
So what's up with that?

SPEAKER_02 (23:04):
Yeah, no, that's a great question.
So, you know, it's interestingbecause although I totally
understand why um patients orpeople with symptoms of various
types might look at our materialfrom vestibular first or follow
us or make comments, you know,the reality is I do build uh
what we create primarily withclinicians in mind.
And as far as the number ofmaneuvers, um having tried to

(23:28):
move crystals uh back where theybelong for 20 years, uh I have
learned that many respond to acouple of my kind of key uh kind
of well-studied maneuvers,certainly modified uply very
popular.
And we know that from multiplestudies, it's between 91 to 93
percent effective for a certaintype of BBBV, which is the
posterior canal where it'sfloating, uh canal with thiasis.

(23:51):
So I use that maneuver, butthere are patients where that's
not gonna work.
First of all, because I said 91to 93, not 100.
So even if it is floating andeverything fits as far as like
it should work, I think this isa maneuver for this issue.
It's just not, you know, becausethe particular person's anatomy

(24:11):
shape or whatever it is, it'snot hitting it.
So this is where many cliniciansand and researchers I would say,
usually they're both, um, ifthey're doing research on PVP,
many of them are alsoclinicians, but they're
researchers.
And so they'll say, Oh, what ifwe try this variation?
Or what if we tried, you know, atotally different approach, you
know, in case the canal isshaped this way or angled this

(24:32):
way, um, and the anatomy is alittle bit different, which
there's multiple studies on thatshowing that there are there is
some variation betweenindividuals.
So this is part of why we needdifferent maneuvers to address
those.
And then on top of all of that,we have again individual patient
bodies.
So some patients lying on theirback and rolling a certain way,

(24:54):
it really hurts their shoulderto lay on that side.
So I can always go through mymental catalog of maneuvers, uh,
which I don't have all of themmemorized, but I'm getting
there.
Um and I'll say, oh, I couldtry, you know, the um universal
maneuver, because then we don'thave to be on that shoulder for
more than a minute, or you know,something where I think it's
gonna work for that individualperson's um, you know, body type

(25:15):
or if they're pregnant orwhatever it is that might change
what I choose to consider that.
And not the least of is acervical range of motion.
So we have people in hospitalsor in collars, and then we even
have patients who just have veryum limited range of motion in
their neck, fusion from surgery,whatever it is, right?
So I might have to kind ofchange up uh how we're gonna

(25:39):
move to try to get thesecrystals clear because I don't
have the um interesting and coolbut very, very much uh large
machine where you can putsomeone in a chair and bring
them all directions, which Ithink could clear crystals
really well.
But you know, some patientsmight also not tolerate that
motion as well.
So it's always pros and cons toevery choice.
And um I try to give a lot ofmaneuvers so that clinicians

(26:04):
can, as they grow more and moreexperienced, say, oh, like, oh
my gosh, I have this toughpatient.
I would normally try A, B, or Cmaneuvers, but none of those can
work.
What else is out there?
Um, so I like to provide backupsand as much information as I can
about efficacy because somemaneuvers are known over time as
we get more research to be kindof more effective.

(26:25):
So I was like, say bang for mybuck.
I want to, and really for mypatient's buck, I want them to,
you know, get the best outcomepossible if we can.
So I'm trying to choose thosemaneuvers that you know are
upping our odds of gettingclearance with not having to do
10 maneuvers because that's notfun for anyone.
So, you know, we're trying to beefficient as well.
So there's a lot of variables inthis one area of just clearing

(26:48):
crystals that I like to takeinto account.
So I know in the end, uhhopefully more and more
research.
There's probably a couplemaneuvers that'll kind of just
fall into like, hmm, they reallyaren't useful enough and they
don't really fit any cases, youknow, these other five or six or
ten work.
So, you know, but for right now,it it's still there's only a few

(27:08):
maneuvers where we have multiplestudies.
So the rest we're still tryingto sort out what's gonna end up
being the best um for certaincases, or even just in general,
the best efficacy and things.
So I'm open-minded.
Yeah.

SPEAKER_01 (27:21):
Yeah.
And I know in your clinic too,you use a lot of really fun and
creative kind of therapies tohelp people in terms of
rehabbing their balance andtheir trust in their own ability
to just move through the world.
Um, I think one of the ones Iloved was if you had different
colored felt on the floor andthen you'd toss little silks at

(27:41):
people.
They have to like catch theyellow silk and then touch the
yellow felt on the floor.
And um, I love that.
And I went out, I bought, I hadto buy like the silks and the
they're not that expensive.
It's pretty good.
Yeah, yeah, yeah.
But I was like, oh my gosh, Ilove that.
What a fun thing to, you know,just have somebody in like a
safe environment be able topractice, you know, some
hand-eye coordination, and thenhaving to move their foot

(28:04):
according to the color.
So I just I love your creativitythat you bring to your clinic.
And I'm sure your patientsprobably end up having fun as
part of their rehab.

SPEAKER_02 (28:13):
They're like, is this like some of them, uh, you
know, my older gentlemen inparticular, they'll be like, I'm
not a kid, but then they're likelaughing as they're playing.
I'm like, I know, but and what'sreally fascinating is that um
both enjoyment and just having adual task, meaning something
else to think about, time andagain has been shown to improve

(28:34):
balance better than uh just likewhat I'll call a more
straightforward balance activityby itself, um, as well as to
reduce dizziness, which I'msuper big on for many of my
patients that have um somelearned or other brain type of
dizziness, will say, crystalsare crystals, we got to move
those.
But you know, for a lot of theother dizziness out there, or
from inner ear vestibular nervedamage even, um, you know, we do

(28:58):
want to be moving our head.
We want to kind of getting somestimulation and uh again, used
to still follow my two-unitrule.
But uh, you know, I have foundthat if I give a patient a
simple, okay, I want you to justkind of um turn left and turn
right and grab, you know, just acone and it's kind of boring,
you know, all my dizziness isup.
But if I'm like engaging withthem and we're like, all right,

(29:20):
now you gotta put the ring onthat cone.
Oh, nope, that's a yes, that's ano, go, no, go.
We're like, oh no, no, you can'tput it on that cone.
And like all of a sudden it'slike 15 minutes later, and
they're like, oh yeah, I'm not.
Maybe when they stop, they'relike, I feel a little more
dizzy, but like, and so it'sboth in the research and in my
personal experience, um, thatthe more I can get creative, um,
make it salient, which is like,how is this can be similar to

(29:43):
some issue you're having,whether it's um, you know, a
task at home, like movinglaundry um into the dryer from
the washer, or it's somethingyou enjoy, like, oh, I want to
be able to bend down and youknow, pick up that fish hook I
dropped when I'm going fishingor whatever.
So just trying to kind of figureout how to relate that to also
their goals.
I always tell my patients thatyour goals are my goals.

(30:05):
So I really want you, you know,to meet those.
And so um that's also a kind ofpart of when I think of
activities, uh, what I'm tryingto get out of it.
So there's really a lot ofpieces to, you know, sometimes
it's just something fun, butreally honestly, there's usually
uh several reasons I've chosento try that with somebody.
Um, and you know, noteverything's a hundred percent

(30:25):
win.
Like sometimes I'm like, yeah,okay, we're done with this one.
Let's great job, let's move on.
And that's okay, you know, uh,because you're you are trying to
again individualize it, whichmeans you're not always gonna
hit the marper out gate, butjust pick something else and
move on, and that's good.

SPEAKER_01 (30:39):
Yeah.
And, you know, you mentionedlike the laundry thing.
I have so many patients thatsay, Oh, I get really dizzy when
I have to unload the dishwasher,or I have to move the laundry,
or I have to bend over and putwater in my dog's bowl.
It's like it's those dailyactivities that are those
triggers.
And so the more you can kind ofrecreate similar types of things

(31:00):
in the clinic, and then also,like you said, bring in a
cognitive component wherethey're also having to focus on
something else cognitively whilethey're moving through these
types of things.
Yeah, is so important for peopleto start to have that trust that
they can now move through lifewithout feeling dizzy and
anxious about it.

(31:21):
Right.
And then I like to have mybridges.

SPEAKER_02 (31:24):
So a really big bridge that works really well
for anyone who has visualability is to fix their gaze as
they move.
So a lot of patients at firstneed that bridge.
So if we're going to bend downand come up instead of just
bending down and coming up andhoping that if we keep repeating
that, it'll feel better.
Sometimes it helps to both slowit down and then also to say,
okay, I want you to look at thatfire extinguisher and then the

(31:47):
doorknob and then that blackspot on the carpet that we
probably need to clean.
And you know, as you come backup, same deal.
So you're really allowing thevision to be a bit substitutive,
but in a helpful way to help thebrain, because otherwise the
brain, if the vacuum system ishaving trouble, whether it's on
a brain level or an inner earlevel, it always says, wait,
where are we?

(32:07):
And the wait, where are wefeeling is probably going to
feel like dizziness oroff-feeling.
And so if we can kind of givethat vision to be a little bit
helpful and say, you're here,you're here, you're here, the
brain's like, oh, up and down.
I think I know where we're at.
And what I find is often thenthe brain is able to kind of
rewire itself.
So eventually we don't need thatbridge.
You know, we'll do less spots orwe can move more quickly with

(32:29):
just one or two, you know, kindof points to look at.
And, you know, ice skaters dothis.
I don't know if you guys knowwhen they're spinning, they kind
of fix their gaze.
Um, so it's it's I think one ofmy jobs as a collision is
definitely to try to figure outwhat bridge do you need.
Um so it's not just, oh, just dothe movement and hopefully it'll
feel better.
Like it's really like groundingis another big one, like feel

(32:49):
where your body is, plant yourfeet, really using our
appropriateception orsomatosensory as much as we have
it, hopefully, um, you know, toagain give information to the
brain, say, oh, this is where weare.
And there's really cool researchthat comes out all the time
about the brain and how a lot offolks who have brain issues and
even inner ear issues that arecreating dizziness is it's

(33:11):
craving good sensoryinformation.
And because the vestibularsystem is trying to heal, but
it's just not there yet, um, youknow, we want to do some sensory
reweighting, which is reallykind of using our vision and
like most importantly, our bodyand our body information.
But I'm I allow both because inthe beginning we just got to use
what we got, and now we canstart to maybe decrease visual

(33:32):
dependence, you know, with someactivity.
Um, maybe eventually eyesclosed, but maybe not right
away.
Like there's a lot of ways tobridge to eyes closed.
Um sunglasses.
I mean, there's so many choices.
I'm always putting up stuffabout that stuff.
So hopefully people pick up allmy tips.

SPEAKER_01 (33:48):
But yeah, yeah.
I'm always amazed at sometimeshow powerful it can be just to
like reach out and just kind ofhold on to somebody's ankles for
a moment.
And then all of a sudden they'relike, oh, okay, yes, I do have
feet.
I am grounded, and that takesaway or like takes our symptoms
way down by just reminding themlike you've got feet, you've got

(34:10):
ankles.
Like don't forget to don'tforget the.
Yeah.

SPEAKER_02 (34:13):
So we can we can use our hands to help guide.
And I've also, in some patients,that actually's not everybody,
to put a little bit of um, wehave like cuff weights, which is
uh weight that you don't need tohold, but you can loop around a
wrist or an ankle.
Um, and sometimes just atwo-pound cuff weight on each
wrist or each ankle.
I found I have one lady uh whois a pretty involved vestibular

(34:35):
migraine situation, and and shecan't walk her dog um really
without the cuff weights on herwrist.
But as long as she wears thosetwo-pound cuff weights, she
still has some symptoms, butthey really seem to kind of give
her body a little extrasomatosensory input that the
brain's like, oh yes, I gotthis.
You know, maybe she won't needthem forever, and that would be
great.
But for right now, it's awonderful way so that she can at
least get outside.

(34:56):
We know that being outdoors,really good for the brain.
You know, they call it like theforest bath or whatever, but
like, you know, just kind ofgetting that green nature,
oxygen, um, sunshine, vitamin D,all that stuff.
Um, you know, we try not to havepeople kind of be um stuck in a
cave in a in their house becausethe you know, the stimulation.

(35:16):
And if she's light sensitivethat day, she's got you know her
special lenses now that thatreally help her to like have
that not be a big stimulant forher brain.
So it's kind of finding theseways to kind of hopefully
bridge, you know, yes, we'd loveto have no symptoms and have
nothing bother us, but you know,we might get there, but we might
take some time with that, ormaybe we always need a little

(35:36):
bit of help.
Um, and I think that's okay.

unknown (35:39):
Yeah.

SPEAKER_01 (35:40):
Maybe give some advice to people if they're
looking for somebody to helpthem with their symptoms.
A lot of times, you know,patients are kind of at the
mercy of whatever insurancecompany they have or who's in
their network and all thosethings.
But um, maybe you can just givepeople some ideas of like what
questions to ask when they docall and uh look for somebody

(36:00):
who might be a good fit whenthey're dealing with these kinds
of vestibular issues.
Absolutely.

SPEAKER_02 (36:06):
So I'll start by saying there's a couple great
resources for the US, and thereare some for other countries
that if people need that, I canreach out and we can uh let them
know what's there for somecountries, not every country,
unfortunately, but um in the US,it's the easiest because I
definitely have those memorized.
So uh one that's just about tobe released uh is owned by

(36:27):
myself and my husband.
It's called Disney Care Network,and um essentially we have a
questionnaire that uh wascreated by a Mayo Clinic, and
it's pretty detailed, uh, but itallows folks to know kind of
what they should do next.
So, like for example, thepatient fills it out, and part
of their symptom profile is alot of hearing symptoms.

(36:49):
Um, it's probably gonnarecommend pretty early on you
should have a hearing test ifyou haven't already.
So it's gonna help kind ofsuggest some kind of next steps.
And sometimes that's like, oh,you need to be matched with
someone who really knows how tocheck if you have crystals out
of place or not, because yoursymptoms sound like it might be
that.
No, if it's not that, then atleast the person can screen

(37:10):
that, right?
So that's the idea.
Um, and so um we're about to doa local launch here in the
Philly area first, make sure itworks well, and then it'll be
launched naturally nationally.
So if anyone wants to learnmore, that's Dizzy.care.
Vestibular.org, which is thevestibular disorders
association, also has a find-upprovider.
Um, so folks can go on there,put in where they live, um, and

(37:32):
it'll suggest clinicians.
Now, unfortunately, sometimesit's like the next closest
clinician that's on our networkis, you know, 50 miles away.
So that's not ideal.
Um, there are sometimestelehealth options, which is
also good, um, particularly forcertain issues where um the
guidance the person couldbenefit from the most doesn't

(37:53):
need to be as physical.
Um, so that's why it's stillworth looking to see on these
networks whether they haveanyone who's doing hello health
that's um licensed in the statethat you're in.
Um and a lot of PTs now at leastcan have like it's called
compact, which means likemultiple states recognize the
license of the other state,which is cool.

(38:15):
Um, so those are definitely twooptions off the top of my head
on finding a trained clinician.
And then the questions you canask are really, to me, if you
have had symptoms for a whileand have seen several
practitioners, whichunfortunately is the case for
several patients I've seenpost-concussion in particular,
uh, I think if you know you'reyou're not the easy one, you're

(38:39):
not the one that like kind ofgot better on their own, or with
just, you know, the firstpractitioner you saw and some
time and a little bit of youknow rehab, you you got all the
way better.
That's awesome.
Uh but for those who are not inthat bucket and who are not that
lucky, um, I think you want tolook for someone who has quite a
bit of experience.
So um I'm gonna say experienceisn't really age, but it's

(38:59):
definitely years of practice.
So, you know, someone who has 20years of practice, um chances
are they at least have seen morepatterns.
Um and so that's like a piece ofthe puzzle to me for a complex
patient.
Um, you know, I don't know whatthat line is 10 years, 15 years,
20 years.
Um, you know, just see what youcan find for sure.

(39:21):
And then the second thing is ifthe clinician says, Oh, I
absolutely can fix you noquestion, you probably should
step away, which sounds likeodd.
Yes, that's exactly what I wantto hear.
Uh, but unfortunately, that'susually an indication of uh
possible um kind ofoverpromising something.

SPEAKER_01 (39:44):
But I would agree with you, like if somebody, if a
clinician hasn't even evaluatedthe patient and then they're
acting super confident they canfix them, I would also say
that's probably a red flag.
It's one thing to go through acomprehensive exam, have a fair
understanding of what you'reseeing, and then say, okay, I'm
pretty sure I can help you.
But when you're telling, whenyou're making those promises

(40:06):
before you've even seen theperson, I would say that's a bit
of a red flag.

SPEAKER_02 (40:10):
Yes.
Yes.
And so a person who's saying,look, let's take a look.
Here's what I know.
Um, you know, this is what I'llrule in or out.
You know, based on what I see, Ithink it's this, or if I was
you, I would go see thisclinician next.
And, you know, like that kind oflanguage is much more reassuring
to me because it means, youknow, I kind of can hear them

(40:30):
problem solving.
Like, what are they seeing?
What are they thinking?
You know, this is what we'lltry, you know, and so you really
have like a good sense of likewhy, um, the what and the why,
you know.

SPEAKER_01 (40:42):
Yeah.
Well, and you know, you youbrought up acupuncture too.
And what I always say to people,like you you need to choose the
right tool for the job.
So when someone's coming in withBPPV, acupuncture is not the
right tool.
Like you need a maneuver tocorrect that.
But if somebody's dizziness ismaybe coming from their neck,
well, then yes, maybeacupuncture will help with that

(41:03):
dizziness if you're working ontheir neck and improving their
joint position sense.

SPEAKER_02 (41:07):
Or is it stress because you have, you know, a
stress-related dizziness thatmight be a piece of a migraine
condition?
And so if your major trigger isstress and you find things that,
you know, really relieve yourstress, and you know, as much as
I think meditation is great,some people either struggle with
it or this just not doesn't seemto really kind of fit the bill
for them.

(41:28):
Like it's good to kind of lookat what are really my options
that are are safe and reasonableand and in my budget and so
forth, you know, kind of fittingthose variables, hopefully.
Um, you know, and that's kind ofwhere I think the problem
solving comes in.
And the other thing I'd say isthat having a clinician with
certain tools, I do think isimportant.

(41:50):
So, you know, I know that I owna company that makes infrared
video goggles, but it's notbecause I sell them, it's
because the research is there tosay that there's eye movements
you would miss in room light.
So if you want a full vestibularexam and the clinician does not
uh have goggles for whateverreason, maybe they couldn't have
that, you know, even though I'vetried to make them more
affordable, maybe it's still notin their budget or what have

(42:10):
you.
I'm not saying don't go to them,but just understand that their
information set is going to bemore limited.
And so again, especially ifyou're a more complex patient,
maybe that's not the right uhfit for you.
So it's just kind of looking atthose kinds of variables and
saying, like, okay, like what isright for me?

SPEAKER_01 (42:26):
Yeah, absolutely.
I mean, I just had somebody comein this week who's had vertigo
episodes for I think four years,and she had seen a PT and she
had seen a nurse practitioner,and um neither of them had
infrared goggles.
And so they kind of did theirexams and were like, Well, uh,
you don't have BPPV, and thenkind of left it at that.

(42:47):
And then as soon as she came inand I popped the goggles on, she
had a continuous right-beatingnystagmus.
And it, you know, when she whenher eyes are in the dark and she
can't fix it on anything.
And so right away, I was like,Okay, well, you absolutely that
have there's a reason why you'rehaving vertigo.
I guess this is pretty clear.
Yeah.

SPEAKER_02 (43:06):
Yeah.
And it's really validating forthe patient.
I actually will show them theirvideos sometimes because they're
like, oh, you know, because it'sit's hard having a symptom um
that's not obvious, I guess.
Like, oh, if I have a broken armand I have an x-ray that shows,
look, there's my fracture and Ihave a cast, like everyone's
like, oh, okay, broken arm, weget it.
But when we're talking about umdizziness and imbalance and off

(43:26):
feeling and headaches and thingsthat are kind of hard to
pinpoint, um, you know, becausethey seem like more vague
symptoms.
Oh, I've had dizziness.
Well, maybe you're justdehydrated.
Like, unfortunately, there'slike, you know, lots of reasons
to be dizzy.
Um, and so it's it's it'sdefinitely a little bit more
challenging uh to you know, havesomeone who hasn't experienced
it, that particular type ofdizziness will say, uh, to

(43:49):
understand.
Um, and so a lot of patients andthey want me to show their their
spouse or whatnot, like, look,honey, I'm not crazy.
Like, Helena found this, andthis is what we're gonna do
about it.
And, you know, that's uh reallycan be very helpful.
And even if we don't findabnormal eye movements, which
does happen sometimes, but theirhistory is pretty much sounding

(44:12):
like they had a vestibular issuethat probably resolved itself.
So for example, the crystalsmaybe were out of place and they
dissolved or found their wayback, which we know can happen.
Sometimes the brain will thenunfortunately learn to be dizzy
uh because of when the crystalswere there and they'll still
kind of think they're there, andso we have to reteach the brain.
And so, you know, you have tofit certain criteria to have

(44:34):
what I'm describing, which iscalled persistent postural
perceptual dizziness, and havingcrystals out of place and then
having them go back is just onepossible cause of that issue.
But it is a basically a learneddizziness in the brain, and
they've been able to find it's avery expensive machines called
functional MRIs that you knowthere are real changes to the
brain in those folks thatexperience that condition.
Um so for me, since I do nothave those really expensive

(44:57):
machines, and you're not goingto probably be able to get a
doctor to run you through thattest just to confirm that per
se.
So uh we do have criteria.
There's there's uh clinicalpractice guidelines and criteria
that um, you know, the expertsin the field that our
researchers have set forth tohelp us clinicians to say, okay,
have I have I done all thethings that allows me to say,

(45:19):
wow, it really seems like you'refitting this criteria.
And we've done a good job ofruling out other competing
causes and not just jumping tothis condition uh right away.

SPEAKER_01 (45:28):
Yeah.
And you know, that that's kindof interesting.
You talk about that people hadBPPV and then it went away, but
they're like their brain isstill kind of almost remembering
that I had this one episodewhere I had gotten off an
airplane, I walked into the air,you know, the airport bathroom,
and I walked into the stall andI immediately had a moment of

(45:50):
just vertigo that kind of cameout of nowhere and then it
passed.
But then ever since that, everytime I walk into airport
bathrooms, it happens.
Yeah, totally.
It's ridiculous.
I'm like, okay, brain, like ithappened one time.
You don't need like, let's moveon, let's get over this.
And it just I think that speaksvolumes.

SPEAKER_02 (46:09):
Totally legitimate.
I like to say the brain is abeautiful learning machine, and
that's good, and that we canretrain the brain.
So it if we wanted to reallywork on that, there would be
strategies, you know, to get thebrain to reset itself from that
uh bad learned pattern or not auseful pattern to a more useful
pattern.
Um, but you know, I think again,like retraining the brain, not

(46:33):
only can it take time, uh, butit can take uh doing your
homework.
So some patients understandablythey're busy, they're tired.
You know, I totally get it.
Busy, you know, life, there's alot going on.
It's hard to do the homework,but um, that's why I care to
keep the homework tight.
Like we're talking like threeexercises max in my book.

(46:53):
Um, and then we might change it.
Like, okay, we're not gonna dothat one anymore, you don't
really need it.
Let's, you know, upgrade to thisone or whatnot.
So um that's another good signof a good clinician, is that not
every condition needs homework,but um many uh I'd say in the
vestibular world benefit fromsome some kind of homework.

SPEAKER_01 (47:11):
So yeah, yeah.
And you know, I've always beenkind of amazed at how many
people will come into my clinicand basically kind of they've
reached a point where they'relike, yeah, I have all these
symptoms and I just kind of livewith them.
And it's like, well, like, haveyou done this?
Have you have you looked intothat?
Have you tried this?
Have you had have you gottenthis diagnosis?
And it's kind of like, no, no,no, no, no.

(47:32):
And so I do think that there's alot of people out there that are
probably suffering fromsymptoms, but they're not even
aware that there are treatmentoptions or that there are these
like ways of kind of diagnosingit and looking into it deeper.
And so I almost feel like thisworld of vestibular PT is you
know still kind of unknown to alot of people.

SPEAKER_02 (47:53):
Absolutely.
And, you know, I think one of myfavorite stories about a patient
uh after concussion, justbecause I think it's really
instructive to clinicians, butalso to patients perhaps, um, is
I had a woman who was a nurseand she was downtown Philly and
she was walking across thestreet and she tripped on the
curb or something because youknow the curbs are a mess.

(48:16):
And this is the real thing.
And unfortunately, she didn'treally catch her balance, so she
ended up hitting her head.
Um, and she's a nurse, so she'slike, Oh, I'm pretty sure I had
a concussion.
So she already kind of knew herdiagnosis out the gate.
Um, so she saw the rightclinicians, uh, a physician at
the concussion clinic.
They suggested pesticid rehab oryou know, physical therapy.

(48:37):
And so, you know, she happenedto see me.
And so I do my full screening.
I found BBV right away.
I'm like, okay, well, let'sclear that.
So got that cleared early,because you know, the longer
it's there, the more confusedthe brain can get.
So we're gonna get that square.
Uh, but she still had somedizziness, which could be kind
of a brain-level dizziness.
She definitely had some ocularmotor and kind of sensory

(48:58):
processing issues a little bit.
And she had a history ofmigraine, which we know can just
make it harder to recoverbecause the brain is already a
bit sensitive.
Um, so it's like, now what?
Fair enough, brain, fair enough.
Um, so she was reading reallywell.
And uh just towards the end, Ifelt like of a rehab where she
almost had really gonna go backto baseline during, you know,

(49:18):
kind of before the concussion,which is what we all want.
Um, she had this little residualdizziness, but it wasn't really
provoked by movement.
It was kind of there all thetime.
And I'm like, hmm, what elsecould it be?
So we went back through hermedication list, and I'm like,
oh, like remember they addedthis headache medication.
She already had one on boardfrom her migraines, but they'd
added a bonus headachemedication after the concussion

(49:39):
because her headaches had beenelevated at that time.
Now they were really, you know,resolved or at least back to
whenever she got the occasionalmigraine before, which was again
back to baseline.
Um, I'm like, you know, you wantto check with your doc and see
if you can come off this med.
And so they did wean her offover like a week or two as they
should for that particularmedicine, and that residual
dizziness went away.
So in her case, that wasbasically a side effect of that

(50:01):
medication.
So I think there's tempting onthe clinician's side to say, I
can fix all dizziness.
Um, right?
Oh, we just didn't do the rightvestibular exercise.
Maybe I just need more scarves.
Like, no, this patient didn'tneed more scarves, although we
had a nice time with you know,tossing the ball and stuff when
we needed it, but like that hadkind of done what it needed to
do.
And I just needed to sit backand say, okay, like what is

(50:23):
this?
What else could it be?
And it's being willing to alwayskind of come back to the table,
re-examine what am I kind ofseeing?
What uh, you know, what have Inot looked at yet or not
re-looked at?
Um, you know, again, I alwayscheck on other big ones, date
hydration, nutrition, sleep.
You know, look at all thesethings that like could come into
the symptom uh onion layers.

(50:46):
Um and I encourage patients tokind of think that way too.
Like, you know, I mean it mayyou feel like you've tried
everything and you've seeneveryone, and I totally get that
because some patients reallyhave gone above and beyond.
Um I totally my heart goes outto y'all that you know are just
like, I feel like I've doneeverything and seen every
specialist possible and flown toDubai or something.

(51:06):
But like, you know, maybe itneeds a fresh pair of eyes.
Maybe, you know, it is worth.
I have had a few patients,sadly, I feel, um, drive from
like, you know, two hours awayjust for me to like take another
look.
Um, you know, because a freshset of eyes.
And sometimes that's helpful.
And sometimes I'm like, well, Iruled out this.
Like, at least I can listen andmaybe suggest like some other

(51:29):
piece that might not have beenlooked at.
So you are absolutely worth atwo-hour drive.
Oh, thank you.
Well, I try.
I like to joke, oh, no pressure,Helena.
Like, that's you know, what do Igot to offer here?

SPEAKER_01 (51:40):
Uh, but you know, I'm always gonna be honest as to
what I find and what I don't,you know, I'm not gonna well,
and I think that medicationpiece is also uh an interesting
one because I often have toremind people who maybe they've
been on medications before theirconcussion, and then they get
their concussion, they get allthese symptoms, and then we, you
know, we're getting peoplebetter, but then there's still

(52:02):
like these lingering things.
Well, um people can responddifferently to medications after
a brain injury.
And just like alcohol, right?
So many people say, well, Icould have a glass of wine with
dinner before my concussion, andnow after my concussion, I take
two sips of wine and I feel likeI'm drunk.
And so it's the same thing.

(52:23):
It's like your brain isdifferent after a concussion,
you can't process alcohol thesame way you used to, and you
might also be having troublewith some of the medications
that you used to be totally finewith.
So we have to take that intoconsideration if at the end of
the day people are stillsymptomatic and you're trying to
like, gosh, all these exams lookfine and this looks fine and
that looks good.
And it's like, what else isgoing on?

(52:45):
I think that that medicationreview is is always an important
one that that can get missedbecause they will say, Well,
I've been on this for 10 years.
Like, um, yeah, no, a hundredpercent.

SPEAKER_02 (52:57):
Yes, I agree.
And I think to even something assimple as like um the type of
exercise you do, you know, likeyou might need to kind of
transition that or adjust that.
Uh, you know, it's it'sdifficult because you, you know,
sometimes you just feel likeyou're like scatter shot, but
like I think the goal, eventhough it's slower, is to be a

(53:20):
bit methodical and say, okay,I'm just gonna change this one
thing.
Um, and let's see over like afew weeks, two to four weeks,
maybe, depending on the change.
Uh, how because we might seelike if that has an impact,
positive or negative.

SPEAKER_01 (53:34):
Yeah, absolutely.
Well, thank you so much for yourtime tonight.
Uh, why don't you let peopleknow where they can find you and
all of your great information?
And absolutely.

SPEAKER_02 (53:44):
No, happy to help.
So um you can always find us atvestibularfirst.com.
That's our website.
And then uh we are on severalsocial medias at Vestibular
First.
Uh, nice and simple.
And I have no problem withpeople email me emailing me
directly.
Um, so that's my first name,Helena H-E-L-E-N-A at

(54:06):
vestibularfirst.com.
So just let me know what youguys need, you know, clinicians,
patients.
I I like to think of a wealth ofresources.
I try to point people directionsand be a connector as much as I
can because I I feel as much asI haven't had a lot of uh
vestibular issues so far in mylife, um, I really have a huge

(54:29):
amount of compassion, both forthe patients who are really, you
know, often struggling andfrustrated and have fluctuant
symptoms, and that's a lot goingon, and I know that's tough.
Um and then on the clinicianside, you want to do your best
job, and sometimes it's unclearlike what's the next right step
for this patient.
And so, you know, whether that'sa a bit of information you need,

(54:53):
uh, maybe another referralsource that's near you, to kind
of have them take a look at theeyes or something, or a course
that you might need to help youwith something like atypical
BBPV, which can be very, verytricky in my experience.
And if I knew now, if I knewback when I started vestibular,
what I knew now, man, there's somany more patients that would
have not that they weren'thelped, but they would have been

(55:14):
helped even faster and evenmore.
But that's that's the wealth ofexperience, right?
So, you know, I try toaccelerate everybody else's
experience so that it doesn'ttake them as long as I feel like
it's taken me uh to get where weare today.
So, you know, we're alwaystrying to learn, always trying
to improve, and just, you know,keep trying to do your next
right thing, be kind toyourself, be patient.

SPEAKER_01 (55:34):
Yeah, yeah.
Well, thank you so much.
You're doing so much for justclinicians in general with all
of your information and yourexpertise that you are sharing,
so that uh hopefully we can allhelp get patients feeling better
and feeling more like themselvesas fast as possible.
So thank you again.
And uh I look forward to uhconsuming all your future

(55:54):
content.

SPEAKER_02 (55:55):
Sounds good.
And I yours, thank you for allyour important work as well.
Thank you.

SPEAKER_01 (56:00):
All right, have a great night.
You too.
Bye.

Medical disclaimer (56:07):
this video or podcast is for general
informational purposes only anddoes not constitute the practice
of medicine or otherprofessional healthcare
services, including the givingof medical advice.
No doctor-patient relationshipis formed.
The use of this information andmaterials included is at the

(56:27):
user's own risk.
The content of this video orpodcast is not intended to be a
substitute for medical advice,diagnosis, or treatment, and
consumers of this informationshould seek the advice of a
medical professional for any andall health related issues.
A link to our full medicaldisclaimer is available in the
notes.

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Seeing the Unseen: How Vestibular Rehab Can Transform Your Recovery w/ Dr. Helena Esmonde (Vestibular First) | E40

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.css-14f5ked{margin:0;word-break:break-word;display:-webkit-box;-webkit-box-orient:vertical;box-orient:vertical;-webkit-line-clamp:2;overflow:hidden;}Seeing the Unseen: How Vestibular Rehab Can Transform Your Recovery w/ Dr. Helena Esmonde (Vestibular First) | E40