WHAT ARE INFRARED VIDEO GOGGLES?

Infrared video goggles, sometimes referred to as “video frenzel goggles”, have been used in research and clinical practices since the 1970’s to make examination of a dizzy vestibular patient more effective by allowing a clinician to see eye movements that are often suppressed in room light. The patient wearing the goggles only sees darkness. This is also clinically known as visual fixation removed since the patient cannot see any object upon which they could fix their gaze. At the same time, the infrared cameras inside the goggles (one in front of each eye) allow the clinician to view the patient’s eyes via a computer or laptop screen.

Helena Esmonde PT, DPT, NCS performing a Right Dix-Hallpike maneuver while watching the video from the infrared goggles

How infrared light works: An infrared camera (also known as night vision) is a device that forms an image using infrared radiation, just as a traditional camera forms an image using visible light. Instead of the normal range of the visible light camera, infrared cameras utilize wavelengths at 940 nanometers in length. This invisible-to-the-eye light is what allows the infrared camera to sense and then have the connected screen display the patient’s eyes while they are in the dark inside the goggles.

How goggles improve diagnosis and treatment: When visualized via an infrared camera with visual fixation removed, specific eye movements can allow for a more efficient and accurate diagnosis and so lead to the best treatment for vestibular treatments, rather than a “best guess.” Effective treatments can get your patients better faster, and happy patients lead to repeat clientele and excellent word of mouth reports. You, your patients, and your company – everyone benefits!

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Vestibular Technologies Comparison

	Insight Infrared Video Goggles	Other Infrared Goggles	Frenzel Goggles
Equipment and Training Requirements	No specialized hardware or training needed Goggles plug directly into standard laptops or desktops with USB port	Requires purchase of specialized laptop or computer Additional costs for training on equipment	Battery or AC adapter power supply Light bulbs which require replacement Not able to record eye movements
Portability	Small, light, and portable - can move between treatment rooms, hospital rooms or ER, doctor’s office exam rooms, or in and out of patients’ homes as needed	Most not easily portable - stationary single room setup for an outpatient clinic; not designed for use in hospital rooms, ER, or patient’s homes	Small and portable with battery use; room must be dark for use, limiting utility in certain settings e.g. ER unless in private room
Software	No additional software if using Windows 10 Requires free camera viewer application if using MacOS, Windows 7, 8, 8.1 or Linux	Specialized software purchased with the system Software may require annual maintenance agreement and updates	No software or laptop required for use Viewer aligns with patient so not able to see eyes if patient in nose down positions
Camera Features	Dual cameras come standard and allows for viewing of one or both eyes per viewer preference	Single and dual camera systems are available; dual cameras are newer and more expensive	Thickened lenses utilized instead of camera for viewing, so visual fixation not fully removed
Best Usage	Real-time eye movement viewing and recording Research on vestibular disorders Assessment and treatment planning for conditions such as BPPV, peripheral nerve hypofunction, and central vestibular dysfunctions Educational use including academic settings and professional courses	Complex data analyses and detailed data of eye movements most useful for research settings Advanced vestibular testing such as calorics, saccade and reaction time, and smooth pursuit testing Can allow for charting to link with an EMR system	No need to increase size of viewing image on a screen to see eyes more clearly for diagnosis and/or to educate patients, family members, and students For those who cannot afford >$700 For those with no option for treatment room laptop use

Educational Resources

Clinician-Focused

5 Strategies to Increase Referrals for Your Vestibular Practice

Once you’ve put the time, resources, and finances towards becoming an advanced vestibular clinician, it’s time to get your referrals flowing. Here are 5 strategies you can use to increase awareness, improve education, build relationships with referral sources, and grow your vestibular practice! 1.) Host education events and invite physicians and their patients Show that […]

Clinician-Focused, Product Recommendations

5 Steps to Becoming a Skilled Vestibular Clinician

Are you looking to provide best practice care for patients with vertigo, dizziness, or imbalance? Vestibular assessment and/or care is currently being provided by clinicians in the following licensed professions: Physicians Audiologists Physical and Occupational Therapists Physical and Occupational Therapist Assistants Chiropractors/Functional Neurologists Physician Assistants, Nurse Practitioners, and RNs How you go about becoming a […]

3D Printing, DIY

How to Make A Fluid-Filled Vestibular Apparatus

We LOVE supporting vestibular education and as part of this, we are excited to share the model we have made to help researchers, clinicians, educators, students, and other inner-ear aficionados understand the fluid dynamics of the semicircular canals better. This project should take you about 6-10 hours to print (depending on the 3D printer and […]

Patient-Focused

Top 5 Signs that You’ve Found the Right Healthcare Provider to Help You with Your Vertigo

You are suffering with vertigo, dizziness, an “off-feeling,” imbalance, or all of the above. You may or may not know why you feel this way, but you definitely want to feel better! In addition, these sensations put you at increased risk for falls even if you are otherwise healthy and active. But how do you […]

3D Printing, DIY

How to 3D Print a solid Vestibular Apparatus Model

Here at Vestibular First, we are excited to share our knowledge and passion for the anatomy that makes up the vestibular system! Combining this knowledge with technology is at the heart of our company. There are only a limited amount of high-quality 3D models of the inner ear available, and none that are specific to […]

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Visualizing Eye Movements

The primary use of infrared video goggles is to see a close-up image of the patient’s eye. While using infrared video goggles, you may see brisker and/or a greater variety in types of eye movements than you are used to seeing if your prior vestibular exams have been done in room light.

Refer to your vestibular education resources from prior education/courses and use mentorship, including online resources such as social media groups of experienced vestibular therapists if in-person mentorship is less available to you, to continually get feedback and refine your skill at interpreting various eye movements.

Research-Based Evidence

The articles listed below demonstrate how infrared video goggles and related technologies have been used in the diagnosis and treatment of vestibular disorders.

Baba S, Fukumoto A, Aoyagi M, Koizumi Y, Ikezono T, Yagi T. (2004). A Comparative Study on the Observation of Spontaneous Nystagmus with Frenzel Glasses and an Infrared CCD Camera. Journal of Nippon Medical School. 71 (1): 25-29. Full text: https://www.jstage.jst.go.jp/article/jnms/71/1/71_1_25/_pdf/-char/en
Gananca M, Caovilla H, Gananca F. (2010). Electronystagmography versus videonystagmography. Brazilian Journal of Otorhinolaryngology (Impr.). 76 (3): 399-403. Full text: http://www.scielo.br/pdf/bjorl/v76n3/en_v76n3a21.pdf or http://www.scielo.br/scielo.php?pid=s1808-86942010000300021&script=sci_arttext&tlng=en
Hain T. “Frenzel goggles.” Dizziness and Balance. Chicago Hearing and Balance, 3 August 2016. Web. Accessed 12 April 2018.
Huh YE, Kim JS. (2013). Bedside evaluation of dizzy patients. Journal of Clinical Neurology. 9 (4): 203-213. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3840130/
Kattah JC, Talkad AV, Wang DZ, Hsieh YH, Newman-Toker DE. (2009). HINTS to diagnose stroke in the acute vestibular syndrome: three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging. Stroke. 40(11): 3504-3510.
Klaus J, Strupp M, Siegbert K, Schuler O, Glasauer S, Brandt T. (2002). Suppression of eye movements improves balance. Brain. 125 (9): 2005-2011.
Newman-Toker DE, Curthoys IS, Halmagyi GM. Diagnosing stroke in acute vertigo: the HINTS family of eye movement tests and the future of the “Eye ECG.” Seminars in Neurology. 35 (5): 506-521.
“Nystagmus.” American Optometric Association. American Optometric Association, 2018. Web. Accessed 12 April 2018.
Ruckenstein MJ, Shepard N. (2000). Balance function testing: a rational approach. Practical Issues in the Management of the Dizzy and Balance Disorder Patient. 33 (3): 507-517.
Shepherd N. (2009). Signs and symptoms of central vestibular disorders. American Speech-Language-Hearing Association. https://www.asha.org/Articles/Signs-and-Symptoms-of-Central-Vestibular-Disorders/ Accessed 12 April 2018.
Stern RM, Hu S, Anderson RB, Leibowitz HW, Koch KL. (1990). The effects of fixation and restricted visual field on vection-induced motion sickness. Aviation Space and Environmental Medicine. 61 (8): 712-715.
Webb NA, Griffin MJ. (2002). Optokinetic stimuli: motion sickness, visual acuity, and eye movements. Aviation Space and Environmental Medicine. 73 (4): 351-358.

Vestibular Course Providers

Organization	Course Topics	Format	Level	PT	PTA	OT	OTA	MD/DO	AuD	DC	PA/NP
360 Neuro Health	Rehabilitation; Concussion	In-Person Courses	Basic; Intermediate; Advanced	x		x			x
American Academy of Audiology	Healthcare	Conference	Basic; Intermediate						x
American Academy of Otolaryngology	Healthcare	Conference	Intermediate; Advanced					x
APTA - Academy of Neurologic Physical Therapy	Rehabilitation; Concussion	In-Person Courses	Basic; Intermediate; Advanced	x		x
APTA - Combined Sections Meeting	Rehabilitation; Concussion; Pediatric	In-Person Courses	Intermediate; Advanced	x
APTA - University of Pittsburgh	Rehabilitation	In-Person Courses	Intermediate; Advanced	x		x		x	x		x
Association of Migraine Disorders	Healthcare	Conference	Intermediate; Advanced					x			x
Audiology Online	Healthcare	Online Courses	Basic; Intermediate; Advanced						x
Carrick Institute	Chiropractic Care	In-Person Courses	Basic; Intermediate; Advanced	x	x					x
Combined Otolaryngolgy Spring Meetings	Healthcare	In-Person Courses	Intermediate					x
Dizziness and Balance Rehabilitation Clinic in Canada	Rehabilitation; Concussion	In-Person Courses	Basic; Intermediate; Advanced	x		x		x		x
Duke Competency Based Renewal Course	Rehabilitation	In-Person Courses	Advanced	x
Education Resources, Inc.	Rehabilitation; Concussion; Cervicogenic Dizziness; Pediatric	In-Person Courses; Online Courses	Basic; Intermediate; Advanced	x	x	x	x		x
Elite Rehabilitation Solutions	Rehabilitation; Concussion	In-Person Courses; Online Courses	Basic; Intermediate	x
Emory University Competency Based Course	Rehabilitation	In-Person Courses	Intermediate; Advanced	x		x		x
Functional Neurology Seminars	Chiropractic Care	Online Courses	Intermediate; Advanced							x
Great Lakes Seminars	Rehabilitation	In-Person Courses	Basic	x
Healthclick	Rehabilitation; Concussion	In-Person Courses; Online Courses	Basic; Intermediate; Advanced	x	x	x	x
Integrative Clinical Concepts	Rehabilitation; Concussion	In-Person Courses	Intermediate; Advanced	x	x
International Association of Functional Neurology and Rehabilitation	Chiropractic Care	Conference	Basic; Intermediate; Advanced							x
International Symposium on Clinical Neuroscience	Chiropractic Care	Conference	Intermediate; Advanced							x
International Vestibular Conference	Healthcare; Rehabilitation	Conference	Intermediate; Advanced	x
Johns Hopkins Medicine	Healthcare	In-Person Courses	Advanced					x
Medbridge	Rehabilitation	Online Courses	Basic; Intermediate	x	x	x	x
Motivations, Inc.	Rehabilitation; Pediatric	In-Person Courses	Basic; Intermediate	x	x	x
Myopain Seminars	Chiropractic Care	In-Person Courses	Basic							x
OTcourses.com	Rehabilitation	Online Courses	Basic; Intermediate; Advanced			x	x
PESI Rehab/Vyne Education	Rehabilitation	In-Person Courses	Basic; Intermediate	x	x	x	x	x	x
Posture and Balance Concepts	Rehabilitation	In-Person Courses	Basic; Intermediate	x	x	x	x
Shirley Ryan Ability Lab Academy	Rehabilitation	In-Person Courses	Basic; Intermediate	x	x	x	x
Skill Works	Rehabilitation; Cervicogenic Dizziness	In-Person Courses	Basic; Intermediate	x
Specialty Therapy	Rehabilitation; Pediatric	In-Person Courses	Basic; Intermediate; Advanced	x	x	x	x
St. Joseph's/Candlar Center for Oto-Neurology	Healthcare	In-Person Courses	Intermediate					x	x
Summit Professional Education	Rehabilitation	Online Courses	Basic	x	x	x	x
Therapy Network Seminars	Rehabilitation	In-Person Courses	Basic; Intermediate	x	x	x	x
University of Manchester	Healthcare	Online Courses	Intermediate; Advanced						x
Vestibular Schwannoma Conference	Healthcare	Conference	Intermediate; Advanced					x
Vestibular Seminars	Rehabilitation	In-Person Courses	Basic; Intermediate	x	x	x	x		x