Dizzy Diagnostics
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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.
Some fun exercise ideas for all you clinicians out there.
As a friendly reminder, if you are not a clinician please work with a professional before trying any of these on your own.
*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.
Your patient isn’t HIDING things from you, they may just not see the connection.
Things patients rarely volunteer because they don’t know they’re relevant:
👉🏼Motion sickness: boats, cars, amusement rides, video games
👉🏼Hx of stomach issues as a child
👉🏼Habits that may have quietly changed (avoiding big grocery stores, wearing sunglasses more often, not driving long distances, not going to public events because of the crowds)
👉🏼hormonal changes. Menstrual cycle, birth control changes, pregnancy/postpartum, perimenopause
👉🏼Life happenings. Stressful events, sicknesses, change in routines
👉🏼Changes in sleep quality
👉🏼Changes in diet or hydration
👉🏼Medication changes
👉🏼 Other symptoms: neck pain, nausea, pre-syncope, sensation changes, other ear symptoms, visual changes, etc
This takes time and we usually aren’t getting through all of these topics in one visit.
What would you add??
09/11/2026
If you’re new to us, hi! We are so glad you’re here!
We are using part 2 to highlight some of the not-so-obvious questions that need to be asked during a vestibular eval.
💤 Sleep quality: avg hours slept, frequency of waking, history of sleep apnea, daytime fatigue
🍔 Diet: frequency of eating, nutritional density of foods, eating enough?
💧Hydration: total amount of water, water distribution during day
☕️ Caffeine: how much, how often
🚶🏿Activity levels: sitting for long periods? Activity avoidance?
🏋🏽♀️Exercise: type, frequency, symptom response to exercise
Some of the questions that can be harder to ask:
😓 Psychological history: anxiety, depression, PTSD
😓 Stress levels: personal, work, financial, etc
😓 Life events: job loss, death in family, etc.
These things may seem unrelated, but when dealing with dizziness (especially chronic!), it all matters.
Build these topics into your evaluation template so you never miss a detail that could make a difference!
09/07/2026
Is it BPPV or could it be vestibular migraine?!
START YOUR SUBJECTIVE STRONG!
Here are some of our top questions about dizziness we ask every patient:
Quality: “What does it feel like? Describe your dizziness without saying dizzy.”
Frequency: “Is is always there, or does it come and go?”
Timing: “How long does it last? Seconds, minutes, hours, days?”
Triggers: “Do you notice any triggers? Movements, visual input, diet, weather, stress, etc?”
Relieving factors: “What makes it better? Holding still, gentle movement, medication, etc?”
Other otologic symptoms: hearing changes, aural fullness, tinnitus, otalgia
Specific questions we ask to differentiate between BPPV and vestibular migraine:
- History of migraine
- Family history of migraine
- History of motion sickness
- Sensitivity to light, sound, smell
- Headaches or other sensations
Presence of these means it’s likely not JUST BPPV!
Use these questions to build a solid subjective history.. this will make differential diagnosis MUCH easier!
Do you follow a template for subjective history during a vestibular eval, or do you wing it???
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
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Baton Rouge, LA