Dr. Gans Blog

CASE STUDY: Home-based Vestibular Rehabilitation (VRT) Program: Measuring Outcomes with vHIT and Dynamic Visual Acuity Tests

CASE STUDY: Home-based Vestibular Rehabilitation (VRT) Program: Measuring Outcomes with vHIT and Dynamic Visual Acuity Tests
Vestibular Rehabilitation Therapy (VRT) is well established as the gold standard for the non-medical management of chronic non-compensated unilateral vestibulopathy secondary to acute onset otologic conditions or vestibular migraine. The question often arises whether a home-based program can provide successful outcomes for those patients unable or unwilling to participate in a clinician directed program in an outpatient or hospital rehabilitation services department. A typical clinic-based program requires 2-3 visits per week for 3-4 weeks. Even with the best clinician directed Read More

VIDEO: Video Head Impulse Test (vHIT) with Children

VIDEO: Video Head Impulse Test (vHIT) with Children
The vHIT is easily and reliably performed with children. Vestibular evaluation of children can often be somewhat complicated if the practitioner does not have access to a rotary chair or VEMP. The use of the recently developed vHIT offers a simple, highly reliable, non-invasive and high sensitivity protocol to quickly evaluate children. The use of VNG, particularly calorics, offers a poor option compared to the vHIT. Calorics are not always well tolerated by young children, are of limited sensitivity (.003 Read More

VIDEO- Video Head Impulse Test (vHIT) Has High Diagnostic Sensitivity and Provides VRT Outcome Validation

VIDEO- Video Head Impulse Test (vHIT) Has High Diagnostic Sensitivity and Provides VRT Outcome Validation
  Clinicians and therapists have historically been limited by the constraints of caloric testing, which is a very poor indicator of comprehensive VOR function due to its testing of only the horizontal canals at ultra low-frequency sensitivity (.003Hz). More importantly, caloric testing cannot provide the status of the patient’s compensation. For patients with mid-high frequency non-compensated unilateral vestibulopathy (UVD) secondary to disease or trauma, this has caused many to go undiagnosed, untreated or unable to demonstrate VRT efficacy without an Read More

VIDEO: VRT with Diagnosis Based Strategies using Hybrid Protocols

VIDEO: VRT with Diagnosis Based Strategies using Hybrid Protocols
Vestibular Rehabilitation Therapy (VRT) is recognized as the gold standard for the non-medical, non-surgical management of this often-debilitating condition. Its usefulness has been demonstrated with children to adults, military pilots, and even astronauts, for whom its scientific advancement in the 1980’s was intended. It is most useful for patients who may have experienced any of the following: • Vestibular neuritis or labyrinthitis • mTBI and Labyrinthine Concussion • Presbyastasia – age based disequilibrium • Labyrinthine ablation or end-stage Meniere’s Disease Read More

VIDEO: Basilar Invagination in Osteogenesis Imperfecta or BPPV ?

VIDEO: Basilar Invagination in Osteogenesis Imperfecta or BPPV ?
This charming 14 year-old female with Osteotogenesis Imperfecta (OI), who is pre-pubescent, has a radiographically confirmed basilar invagination for many years. In addition, she has experienced over 50 fractures related to her OI condition. There is neither a history of migraine, nor a familial link with mother and maternal grandmother negative for report of migraine. According to NIH, OI is typically a group of genetic disorders (autosomal dominant) associated with imperfect bone formation. Recently over the past 3-4 weeks she Read More