I recently made a bold claim: You cannot holistically assess vestibular dysfunction without understanding ocular motility. Today, we start building that foundation. Part 1 of our 5-part series begins where all eye movement understanding must begin: How do the eyes actually move together? We’re building toward understanding why posterior canal BPPV creates “upward” nystagmus when […]

Click here to get the ‘Part 5: BPPV Nomenclature is Canal-Based — NOT Muscle Based’ handout The posterior canal connects to the ipsilateral Superior Oblique (SO) and contralateral Inferior Rectus (IR) — muscles that pull the eye DOWN. So why does posterior canal BPPV produce UPbeating nystagmus? If you’ve ever paused mid-explanation, trying to reconcile muscle […]

Click here to get the ‘PIVC Activation Paradox’ handout A colleague called a couple of nights ago to discuss an article she was reading and brainstorm about activities that activate versus suppress the peri-insular vestibular cortex (PIVC). Her curiosity derailed my plan to post “Part 5” of my EOM educational series —because the conversation focused on […]

Click here to get the ‘Neural Asymmetry & The Recovery Paradox’ handout We’ve explored the VOR—how semicircular canals drive compensatory eye movements through elegant push-pull dynamics. But here’s what the anatomy lesson doesn’t tell you: When peripheral vestibular function is lost, how much of VOR recovery actually comes from the periphery healing? In patients with […]

Click here to get the ‘Semicircular Canal Influence – The VOR Connection’ handout In Parts 1 and 2, we built the foundation: conjugate gaze and how individual muscle actions combine into synergistic patterns. Now the payoff: why the vestibular system cares about all of this. The VOR isn’t random. It exploits the exact same muscle […]

Click here to get the ‘From Primary Cranial Nerve Actions to Functional Synergistic Patterns’ handout We learn the extraocular muscles one at a time. Clean. Organized. Easy to memorize. But here’s the reality: our patients don’t functionally move one muscle at a time. When your patient looks up, each eye fires both its Superior Rectus […]

Click here to access the handout – a deeper dive into the primary extraocular muscle actions and how conjugate gaze creates the compass foundation for clinical assessment I recently made a bold claim: You cannot holistically assess vestibular dysfunction without understanding ocular motility. Today, we start building that foundation. Part 1 of our 5-part series […]

The APTA’s recent Vestibular Rehabilitation Practice Guideline states clearly: “Vision training is not VRT.” And I completely agree. But here’s the challenge: that statement has led some clinicians to question why our education—including Certificate of Competency in Vestibular Rehabilitation (CCVR) 3.0 Course—embraces such an in-depth understanding of ocular motility beyond nystagmus assessment. Here’s my answer: […]

We must understand eye movements to help us identify the cause(s) of someone’s dizziness or balance problems. Nystagmus is the cardinal sign for peripheral and central vestibular dysfunction. We know there is much more to cover about nystagmus – from more complex cases to the different types of nystagmus associated with BPPV. We are constantly […]