Brian Werner, Physical Therapist

Physical Therapist, 25+ yrs exp. Founder - Werner Vestibular Solutions. Clinician. Independent Consultant, Author at Substack

[Brian Werner, Physical Therapist @BW27811]

Understanding Vestibular Migraine: Managing the Cumulative Threshold https://t.co/47DxmSjNHo

[Brian Werner, Physical Therapist @BW27811]

https://t.co/Y3kyhoJifk

[Brian Werner, Physical Therapist @BW27811]

@zebrahoofbeat Appreciate the kudos!

[Brian Werner, Physical Therapist @BW27811]

Crucial to understand is that there are healthy balance systems and maladaptive ones - this is an infographic on the shift.

[Brian Werner, Physical Therapist @BW27811]

When I work with my patients in Vestibular Therapy, I always use a 7-Head Position approach to attempt to capture the various aspects of the vestibular system. I do this statically and dynamically and use a simple 5 count rule to encourage #timeundertension:

Static: 5-10-15-20-25 count holds
Dynamic: 5-10-15-20-25 turns/nods/rolls
- Speed/Velocity: I use either Beats/Minute (BPM) or a more advanced concept called Peak Head Velocity (PHV), which is BPM over a specific distance (typically 10-20 degrees or a 20-40 degree arc).

What are others doing in the VRT world?

Please feel free to use my image with your patients.

[Brian Werner, Physical Therapist @BW27811]

The Inner Ear's Canary in the Coal Mine: Why 'Presbystasis' is a Critical Missed Diagnosis https://t.co/fGfVlYL9Ol

[Brian Werner, Physical Therapist @BW27811]

@zebrahoofbeat I think MAD is the Canary in the Coalmine for vascular disease. Review my article on Presbystatis and Presbyvestibulopathy.

https://t.co/pkqmVjQNRL

[Brian Werner, Physical Therapist @BW27811]

I feel like PPPD is overdiagnosed, but good to know. It's like the patients in the past with natural anxiety with a UVL or BVW are getting lumped into PPPD and blurring the lines between, say, a true PPPD (FND) versus a patient that is just anxious because they are now lumped into PPPD.

[Brian Werner, Physical Therapist @BW27811]

@zebrahoofbeat Appreciate - I work with some interesting Zebras - one being Mal De Debarquement Syndrome (MdDS) and PPPD (Persistent Postural Perceptual Dizziness).

[Brian Werner, Physical Therapist @BW27811]

What is the Problem? The #dizziness trigger shatters the brain's truth. What happens now? Then the neck stiffens, there is #brainfog, #hypervigilance, and #anxiety about movement.

The Solution?

Neuroplastic #adaptation.

[Brian Werner, Physical Therapist @BW27811]

Crucial to understand in vestibular therapy and management is that patients have a #SensoryMismtch. What happens - I hear - patient avoids this, gets to the store early to avoid that, and it just gets worse. Then they blame their inner ear - it isn't - it is how you are adapting.

#ZeroOutMethod,#SensoryIntegration

[Brian Werner, Physical Therapist @BW27811]

I hear this time and time again from my active patients with dizziness. I am exercising hard, pushing I CrossFit, working out, but my dizziness is not going away.

Why?

It is the Activity Paradox!

#WSIM, #ZeroOutMethod, #WernerInstutute, #PPPD

[Brian Werner, Physical Therapist @BW27811]

The brain of a patient with #VestibularMigraines is often overwhelmed by visual input. One is caused by a #SensoryMismatch.

[Brian Werner, Physical Therapist @BW27811]

See this Instagram post by @dizzypt1022 https://t.co/W0kkR5RI2r

[Brian Werner, Physical Therapist @BW27811]

See this Instagram photo by @dizzypt1022 https://t.co/UAECaPfGyn

[Brian Werner, Physical Therapist @BW27811]

June is MdDS Awareness Month - I want to introduce you to a Two-Part Clinical Series: Unmasking the Afferent-Efferent Battleground in Mal de Debarquement Syndrome https://t.co/iasJvQ4aTe

[Brian Werner, Physical Therapist @BW27811]

Differential Diagnosis of the Complex Vestibular Patient: Application of the SO STONED Mnemonic https://t.co/xbt4tD0eh2

[Brian Werner, Physical Therapist @BW27811]

What is MdDS?

It is a software adaptation where the brain adapts to a moving vessel, train, plane, and even spontaneously leads to a phenomenon called the land legs paradox. June is MdDS Awareness Month, and I wanted to introduce a concept I am working on called the Zero Out Method.