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

3D Printing, DIY

How to Make a 3D-Printed Vestibular Ball Maze

If you’ve ever used the analogy of a ball maze to explain how the crystals in the semicircular canals need to be moved in a certain pattern to get them back to the vestibule–then this DIY project is for you! We have taken the ball maze toy and adapted it to be both fun and […]

Physical-Therapy-equipment-from-national-museum-of-health-1024x841

Clinician-Focused, Product Recommendations

Essential Equipment for a Vestibular Rehabilitation Clinic

Whether you’re starting a vestibular rehab program on your own or joining a team of vestibular clinicians, you’ll want to make sure that you have equipment that is reliable, affordable, and works for your space. When I brought vestibular rehab to a small, previously ortho focused clinic, I complied a list of items that I […]

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Educational Resources, Technology

Vestibular Rehab Technology for Recording Eye Movements

When the vestibular system is faulty, abnormal eye movements (defined as nystagmus if they have slow and fast components) often result, due to the intertwining of inputs and outputs of the visual and vestibular systems. If observed by a trained researcher or clinician, the eye movements can easily differentiate between simple BPPV and more complicated […]

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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