The Role of Vestibular Screening Technology in Modern Clinics


No matter what field you work in, there are always going to be new technologies out there that will help you do your job more efficiently. Take it from Dr. Danielle Gross, a doctor of physical therapy who specializes in vestibular examination and rehabilitation. As the Balance Program Director at FYZICAL Therapy & Balance Center of Rockville, she is a huge proponent of modern technologies that screen the vestibular function, and believes that they set her practice apart from her competitors.

I had the honor of speaking with Dr. Gross about the technologies she uses in her day to day and how they help with screening and treating dizzy patients.

Can you tell me more about yourself and FYZICAL Therapy & Balance Center of Rockville?

I am a physical therapist. I graduated from school in December of 2014 and took a special interest in vestibular rehabilitation therapy. I studied for an entire clinical rotation with a specialist in Danville, PA at a vestibular and balance center, where I got a little more hands-on training. It was really cool to have that experience and see the different types of diagnostic equipment like VNG goggles, as well as other methods used to diagnose patients.

As for FYZICAL Therapy and Balance Center, it’s a growing national franchise that helps clinics get more into needed areas of physical therapy, like vestibular therapy, testing, and rehab. One of the things they push and encourage is using technology to better diagnose severe dysfunction, as well as track progress of therapy. So we have different types of goggles, and even partner with ENT and otolaryngologist offices to send patients over for videonystagmography testing and different things along those lines.

Are you seeing other clinics in your area using technologies like this?

As far as vestibular is concerned, there are a few. As physical therapists, we have a general knowledge of positional testing and repositioning maneuvers, like an Epley maneuver for BPPV. But as far as really getting into more concussion testing and rehab, few in the area, aside from some of the larger organizations, have an outpatient setting that does vestibular rehab.

What products are you using to screen the vestibular function?

We use the Micromedical xDVR goggles more than anything. We have the monocular model that goes right into the computer, which allows us to record all of our sessions with the image of the eye and a view of the room. This allows us to see what the therapist is doing with the patient as they take them though evaluation. They’ve been very useful in enabling us to go back and review the test position itself and other factors, which has been helpful in terms of differentiating between eye movements, as well as diagnosing other abnormalities like acoustic neuroma.

The goggles themselves, because we can remove fixation and still see the patient’s eye move during a test, give us an advantage to look at things we might have missed without them. It’s been a huge help to add them to our evaluation techniques.

How long have you been using the goggles for?

I would say close to two years now.

Can you think of an example in which this technology helped diagnose a significant problem?

Big time. We had a patient that came to us in December of 2015 with balance issues, and his neurologist wasn’t quite sure what was going on. They tested him for peripheral neuropathy, and he had little of that, but he was insisting that it was something different. So they pulled me in to check him out and do a quick bedside examination. We did some positional testing, but found nothing too crazy until we had him perform a hyperventilation test.

I removed fixation with the goggles and I had him breathe, in and out of his mouth, one breath per second for 30 seconds. With that test, we were able to see this robust nystagmus. That raised a red flag because hyperventilation-induced nystagmus can mean a few different things. It’s highly suggestive of patients that have an acoustic neuroma or a small, benign growth that comes from the cerebellum into the auditory canal. So this explained his issues with hearing and balance because it was slowly cutting off the inner foundation of the vestibular organ itself.

We asked him to go back to his doctor and get an MRI, and it was clean, so he left us for a little while. But he came back about six months later because he was having a significant number of falls. He even had hospitalization and lost all the hearing in his right ear. So, again, we used the goggles to do a more thorough examination. We had a strange feeling we knew what was going on, so we went back to his doctor and asked for a specific type of MRI. And, sure enough, he had acoustic neuroma.

When the doctor re-examined the first MRI, they saw that they just missed it. Because we were able to use the goggles, because we were able to block fixation and see what was going on throughout the test, we already had a hunch of what the issue was. It’s a great example of how this type of vestibular screening technology can be very useful, especially when other types of tests may not be able to pick up something significant.

How is that patient doing today? Is he still in treatment?

He is still in treatment. He’s a bit of a complicated patient because he has some other issues going on as far as cerebellar degeneration and other things are concerned. However, he did undergo radiation therapy for the tumor in his ear and it actually reduced his symptoms a little bit. He’s had significantly fewer falls, and he’s doing pretty well. He just continues with us for some balance therapy so he can feel confident in what he’s doing.

Do your patients ever comment on any of the technology you’re using?

Absolutely! It’s funny, some patients, who probably saw an ENT who did a VNG on them, will say, “Hey! My doctor does this to me. That’s awesome!” And they see what we can do with our technology, and it amazes them that they can see changes with us. We record a lot of the videos and show them what their eyes looked like beforehand and how they’ve improved.

I think they appreciate the technology because it allows them to see the difference and become more educated on what we are talking about. They see the goggles we use and go, “What are those!?” And they become more inquisitive. They want to learn more about what we’re looking for and why. So I think it’s a great way to show the patient how they’re progressing, and it opens the door to more communication and education. It also gives them more assurance that we’re not eyeballing things; we have a better, closer look to make better decisions as opposed to making an educated guess.

I’m sure they appreciate that you have this technology that’s going to help pinpoint what’s going on.

Yeah, it helps set us apart from other clinics in the field as well. They may do the same exact things we do, but if they don’t have that technology, it does leave a lasting impression on the patient. If a patient were to come here and see that we’re using technology that the other clinics they’ve gone to aren’t, it gives them a little more confidence in us.

Are there any new technologies that your practice is considering adopting in the near future?

Well, there is always computerized dynamic posturography, which there are all different types of versions for. Some of the newer versions coming out include virtual reality. There are some studies that have come out recently supporting the use of VR for vestibular rehabilitation therapy, which I think is super cool. I’m hoping we can get our hands on that to help guide patients through different things like vestibular rehab or concussion rehab, and see if we can use this technology to move people along the treatment process quicker.

Anything else you would like to add?

I think that this technology is something that is very useful, and it’s awesome to see that it’s still growing and that it does have a place for helping patients with dizziness and balance issues. I look forward to seeing more innovation because there can only be better things from here on out!