Fully understanding your condition and treatment options empowers you to participate in your rehabilitation, and leads to better outcomes. This process begins before you even meet with us. We strongly encourage you to browse this website, as well as our YouTube, Instagram, TikTok, and Facebook pages. So many patients find a lot of clarity once they better understand the potential causes of their symptoms.

Prior to your initial visit, Dr. Perman will review your paperwork in-depth to make his time with you as valuable as possible. When your initial visit begins, you will be asked targeted questions to better understand your condition. You will then learn about the potential condition(s) you are living with, as well as details about the assessment you are about to begin. You will also have the opportunity to ask any questions that you may have.

During your assessment, you will be guided through various tests while you are observed on camera. If he is unable to see something clearly, Dr. Perman may ask you to record yourself performing a task, and send it to him to analyze after your visit. We will typically assess your balance, eye movements, and coordination. We may also observe your posture, range of motion, and more. The assessment helps Dr. Perman evaluate your vestibular, oculomotor, and proprioceptive systems. It also allows him to test different regions of your brain to determine which areas are the best target for your rehabilitation.

At this point, you will be given an initial impression. You will learn whether or not we think we can help you, and give you a brief overview of your findings. You will then discuss your treatment options with Virtual Brain Rehab, as well as other types of treatment available with other types of practitioners. You will be guided on all of these options from most-conservative to most-invasive, and receive help finding other practitioners and services in your area that you may benefit from, if necessary. Finally, any additional questions will be answered, and you will discuss how you would like to proceed. We want you to be as informed as possible, so you can make the right decision for yourself, even if that doesn’t involve us going forward.

The vestibular system helps your brain understand where your head is in 3D space, and contributes to your overall balance, posture, and spatial awareness. It consists of a system of fluid-filled tubes (called semicircular canals) located in your inner ear. When you move your head, the fluid in the semicircular canals washes up against sensors, which tells your brain what direction your head has moved. If there is an issue with the vestibular system itself (called a peripheral vestibular dysfunction), or with the brain’s connection to the vestibular system (called a central vestibular dysfunction), symptoms may occur.

Vestibular dysfunction commonly leads to symptoms of dizziness/vertigo, imbalance, tight muscles, and pain. It may also lead to anxiety. The type of symptom you experience helps to determine whether there is an issue with the vestibular system itself (peripheral), or with the brain’s connection to the vestibular system (central). We help rehabilitate the vestibular system by teaching you targeted head movement exercises.

Certain vestibular conditions, such as Benign Paroxysmal Positional Vertigo (BPPV) can often be treated within 1-2 sessions. Other vestibular conditions may take a significant amount of time to rehabilitate. In some instances, nutritional interventions may be recommended. Sometimes additional testing with another specialist is required to help diagnose vestibular issues. Dr. Perman will help guide you to the proper specialist, if necessary.

Specificity is key when retraining the vestibular system. Sometimes generalized vestibular therapies are beneficial, but often a tailored approach is necessary to stabilize your vestibular system appropriately. Dr. Perman does his best to design an exercise routine that gives you the best chance of improvement.

There’s more to seeing clearly than just making sure your lens prescription is up to date with your optometrist. The way that your eyes move is also extremely important when it comes to having proper vision. When the eyes do not move accurately, or in sync with each other, you may experience blurred/double vision, abnormal depth perception, eye strain/fatigue, tight muscles, head pain, eye pain, and more. Eye motion abnormalities can arise when an eye muscle is weak, when there is trauma to the eye, or due to brain dysfunction. Sometimes these issues are acquired at birth. Other times they may come on later in life.

There are 5 primary types of eye movements that your brain depends on to keep your picture of the world clear; gaze stability, saccades, pursuits, vergence, and the optokinetic response.

Gaze stability is actually the absence of movement. It is your eye’s ability to look at a target and hold in place steadily so that they can focus clearly on that target. Gaze stability is important when we are looking to a target while holding our head still or moving our head around. This is one of the first types of “eye movements” (or lack-thereof) that we learn as a baby.

Saccades are quick eye movements where your eyes jump to a target, or look quickly between more than one target. Saccades are important for accurately finding objects in your field of view.

Pursuits are smooth eye movements where your eyes track a target as it moves. Pursuits are crucial for keeping objects in focus as they move throughout your environment.

Vergence is your ability to track targets in towards your body and out into the distance. Vergence is critical for keeping objects in focus as they move towards your or away from you. Convergence is when you track targets in towards your body and “cross your eyes”. Divergence is when you track targets away from your body and “uncross” your eyes. Vergence can both be accomplished with quick movements (saccades), or smooth movements (pursuits).

The optokinetic response is a reflex used to keep your entire environment in focus, rather than only a specific object. We use the optokinetic response when our environment is changing rapidly around us (e.g. watching a train go by, looking out the side window as a passenger in the car, spinning around, etc.). It involves a short pursuit (smooth movement) opposite the direction that the world is moving followed by a saccade (quick movement) towards the direction that the world is moving.

With Virtual Brain Rehab, Dr. Perman will help identify any eye motion abnormalities, as well as the cause of those abnormalities. You will learn eye-motion therapies specific to your dysfunction and help you find the proper eye specialist for additional testing and treatment, if necessary.

Your brain relies on your muscles, joints, and skin to understand where your body parts are in 3D space. Proprioceptors are sensors in your muscles, joints, and skin that tell your brain about the position of every muscle and joint. When these sensors function abnormally due to trauma, misuse, or genetics, you may experience pain, tight muscles, dizziness, or incoordination.

There are lots of ways to rehabilitate proprioceptive dysfunction. Many of them can be done on your own, such as stretches, physical exercise, foam rolling, and coordination exercises involving the arms, legs, body, or neck. Other interventions may require the help of a musculoskeletal specialist. Some beneficial treatments may include chiropractic care, physical therapy, acupuncture, massage therapy, myofascial release, fitness training, electrical stimulation, cold laser therapy, cupping, and much, much more.

Our program aims to help improve your proprioception by advising you on relevant physical exercises, stretches, and coordination exercises to practice on your own. You will also receive help finding the correct type of manual practitioner if you require any hands-on work. Dr. Perman has met with dozens of musculoskeletal specialists of varying backgrounds and expertise to fully understand the benefits and risks of each service. He is confident in his abilities to help you find the right types of specialists for your needs.

Nutritional and hormonal issues can lead to fatigue, weight-gain, brain fog, mood abnormalities, and more. These issues also make it harder for us to build stability in your brain. Dr. Perman tries his hardest to improve your nutrition and hormone balance as non-invasively as possible.

To begin, you will typically receive nutritional advice, as most people can have a healthy internal environment simply by eating the right types and amounts of food. In certain cases, supplements may be recommended to assist your body. We will only recommend reputable products from reputable companies. While you can order supplements through Virtual Brain Rehab, we have no direct affiliations with any supplement manufacturers.

Nutritional plans will usually begin with an elimination-style diet. You will avoid foods that may be contributing to your condition for a certain time. You will then add those foods back into your diet one at a time to gauge your sensitivity to each type of food. If necessary, you may also be sent out for various tests, such as blood chemistry analysis or food sensitivity/allergy panels.

Assessing and modifying hormone balance typically requires laboratory testing. You may take an at-home urinalysis and saliva sample, or be sent out for a blood test to gather as much information as possible. The goal of this testing is to provide us with your hormone levels, but also various co-factors involved in building up or breaking down your hormones. This added information helps identify WHY a certain hormone level might be abnormal.

This approach allows him to prescribe you supplements that give your body the building blocks it needs to operate normally on its own, rather than more-invasive approaches like hormone replacement. The goal of the hormone treatment is to “reset” your hormone cycle. Re-testing will be recommended periodically to track your improvement. The goal is to take you off of any recommended supplements over the course of 6-24 months.

Of course, if Dr. Perman is concerned about any of your hormonal or nutritional testing, or if you aren’t seeing positive results, he will gladly help guide you to the proper endocrinologist, functional medicine practitioner, or registered dietitian.