In my personal experience, evaluating patients with the assistance of infrared video goggles has been instrumental to building my experience as a clinician, building the reputation of a comprehensive vestibular program, and providing the absolute highest quality of patient centered care. The use of the infrared technology has gained me the trust and loyalty of referring physicians, as well as patients and their families and friends. Having the knowledge of how to perform a comprehensive bedside evaluation in combination with the right technology immediately sets a program and a clinician apart from other establishments that market vestibular rehabilitation in the surrounding area.
Over the last 4 years, a few specific patient cases stand out to me where having goggles has made all the difference. This includes the early identification of two Acoustic Schwannomas that were originally missed on imaging, identifying additional diagnoses/dysfunctions that were mislabeled as BPPV, and treating numerous cases of atypical BPPV that were successfully treated because of the additional information the infrared goggles were able to provide.
Infrared Video Goggles, in my opinion, are one of the few “must-have” pieces of equipment that requires a significant investment for a comprehensive vestibular program. All additional equipment for treatment/testing, aside from computerized posturography, can be homemade or purchased for reasonable prices.
The following information is provided to help describe how specifically evaluating with Infrared Video-Oculography Goggles (IVOG) can provide a more thorough evaluation and add value to your practice. It is my hope that this information will be useful to you while you consider adding IVOG technology as an investment for raising your vestibular program to the next level.
What can we miss without IVOGs?
I should first mention that I am a physical therapist treating in an outpatient physical therapy clinic. It is a wonderful thing that we live in a time where patients have more direct access to physical therapy! However, this also means that sometimes physical therapists can be the first clinician who evaluates a patient suffering from dizziness, imbalance, and/or vestibular dysfunction. So what additional information can IVOGs give us to make us more secure in the fact that we are appropriately treating a patient? Or do they actually need a referral out to a specialist?
When I started my new job in July of this year, I knew I would have to be organized and provide a very detailed, research supported, pitch for immediately asking my new employer to invest a good amount of money in IVOGs. So I've compiled a list of peripheral and central issues that are better assessed using IVOGs:
In addition to highlighting the purpose of the additional tests that can be performed with IVOGs, I also used a picture comparing my evaluation forms which demonstrated the difference in a vestibular evaluation with goggles, and without goggles.
Another visual tool I used to demonstrate the importance of IVOGs and removing fixation was a montage of IVOG videos showing the difference in spontaneous nystagmus with and without fixation, as well as demonstrations of head shaking, mastoid vibration, and hyperventilation testing with fixation removed.
Finally, after about a month and a half of treating patients, I compiled a list of active patients who I felt potentially would have benefited from additional testing using IVOGs to assess their symptoms.
General Pros and Cons: How do we justify the initial investment?
Okay, yes... Infrared goggles are great... Now which set do I invest in?
This brings me to my current task at hand... finding the right IVOG system to meet the needs of my clinic and patient population. As I started to do my research, I was pleasantly surprised to see that there are a good amount of options out on the market! I feel that every clinician, their needs, and their clinic's needs are different. Meaning, what I may be looking for in an ideal set may not be what YOU are looking for. In the next few blogs, my hope is to share with you the information I've been collecting on different systems. I'd also like to provide comprehensive written reviews and video demonstrations (when possible) of each system to highlight unique features and discuss different aspects such as usability with patients, and what the software is like.
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