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
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!

Educational Resources

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

OrganizationCourse TopicsFormatLevelPTPTAOTOTAMD/DOAuDDCPA/NP
360 Neuro HealthRehabilitation; ConcussionIn-Person CoursesBasic; Intermediate; Advancedxxx
American Academy of Audiology HealthcareConferenceBasic; Intermediatex
American Academy of OtolaryngologyHealthcareConferenceIntermediate; Advancedx
APTA - Academy of Neurologic Physical TherapyRehabilitation; ConcussionIn-Person CoursesBasic; Intermediate; Advancedxx
APTA - Combined Sections MeetingRehabilitation; Concussion; PediatricIn-Person CoursesIntermediate; Advancedx
APTA - University of PittsburghRehabilitationIn-Person CoursesIntermediate; Advancedxxxxx
Association of Migraine DisordersHealthcareConferenceIntermediate; Advancedxx
Audiology OnlineHealthcareOnline CoursesBasic; Intermediate; Advancedx
Carrick InstituteChiropractic CareIn-Person CoursesBasic; Intermediate; Advancedxxx
Combined Otolaryngolgy Spring MeetingsHealthcareIn-Person CoursesIntermediatex
Dizziness and Balance Rehabilitation Clinic in CanadaRehabilitation; ConcussionIn-Person CoursesBasic; Intermediate; Advancedxx x x
Duke Competency Based Renewal CourseRehabilitationIn-Person CoursesAdvancedx
Education Resources, Inc.Rehabilitation; Concussion; Cervicogenic Dizziness; PediatricIn-Person Courses; Online CoursesBasic; Intermediate; Advancedxxxxx
Elite Rehabilitation SolutionsRehabilitation; Concussion In-Person Courses; Online CoursesBasic; Intermediatex
Emory University Competency Based CourseRehabilitationIn-Person CoursesIntermediate; Advancedxxx
Functional Neurology SeminarsChiropractic CareOnline CoursesIntermediate; Advancedx
Great Lakes SeminarsRehabilitationIn-Person CoursesBasicx
HealthclickRehabilitation; ConcussionIn-Person Courses; Online CoursesBasic; Intermediate; Advancedxxxx
Integrative Clinical ConceptsRehabilitation; ConcussionIn-Person CoursesIntermediate; Advancedxx
International Association of Functional Neurology and RehabilitationChiropractic CareConferenceBasic; Intermediate; Advancedx
International Symposium on Clinical NeuroscienceChiropractic CareConferenceIntermediate; Advancedx
International Vestibular ConferenceHealthcare; RehabilitationConferenceIntermediate; Advancedx
Johns Hopkins MedicineHealthcareIn-Person CoursesAdvancedx
MedbridgeRehabilitationOnline CoursesBasic; Intermediatexxxx
Motivations, Inc.Rehabilitation; PediatricIn-Person CoursesBasic; Intermediatexxx
Myopain SeminarsChiropractic CareIn-Person CoursesBasicx
OTcourses.comRehabilitationOnline CoursesBasic; Intermediate; Advancedxx
PESI Rehab/Vyne EducationRehabilitationIn-Person CoursesBasic; Intermediatexxxxxx
Posture and Balance ConceptsRehabilitationIn-Person CoursesBasic; Intermediatexxxx
Shirley Ryan Ability Lab AcademyRehabilitationIn-Person CoursesBasic; Intermediatexxxx
Skill WorksRehabilitation; Cervicogenic DizzinessIn-Person CoursesBasic; Intermediatex
Specialty TherapyRehabilitation; PediatricIn-Person CoursesBasic; Intermediate; Advancedxxxx
St. Joseph's/Candlar Center for Oto-Neurology HealthcareIn-Person CoursesIntermediatexx
Summit Professional EducationRehabilitationOnline CoursesBasicxxxx
Therapy Network SeminarsRehabilitationIn-Person CoursesBasic; Intermediatexxxx
University of ManchesterHealthcareOnline CoursesIntermediate; Advancedx
Vestibular Schwannoma ConferenceHealthcareConferenceIntermediate; Advancedx
Vestibular SeminarsRehabilitationIn-Person CoursesBasic; Intermediatexxxxx

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