Cutting-edge technology for diagnosis and treatment of Vertigo

1. Cutting-edge technology for diagnosis and treatment of Vertigo, Dizziness, and Balance Disorders

2. Rotary Chair Features • Integrated with NeuroEquilibrium VNG • Fully automatic and computer controlled chair • PLC and Servo control • Safety features Emergency stop switch, over speed cut-of, high torque cut-of etc Safety features Emergency stop switch, over speed cut-of, high • Automatic calculation of Gain & Gain symmetry in SHA test • Automatic calculation of Time Constant in Velocity Step Test Automatic calculation of Time Constant in Velocity Step Test Tests Included • Sinusoidal Harmonic Accelaration (SHA) Test • Velocity Step Test • Spontaneous Nystagmus Video Head Impulse Test (VHIT) The VHIT tests function of all 6 semi-circular canals at high frequency. Features • Quick test : 10 minutes to independently test the 6 semi-circular canals • The motion sensor accurately measures head movement allowing for simultaneous comparison of head and eye movement • High frame rate camera (200fps) allows precise tracking of eye movements during head impulse • Lightweight goggle design to reduce slippage (Maximum weight 250 grams) • Built-in lasers that provide stimulus for calibration

3. Advanced Video Nystagmography (VNG) NeuroEquilibrium VNG is the most advanced technology to evaluate the vestibular and oculomotor systems in a non-invasive, accurate and afordable way. This cutting-edge equipment eliminates contamination by myogenic and electrical noise seen in ENG. NeuroEquilibrium Video Nystagmography evaluates peripheral and central vestibular functions through the following protocols: • Spontaneous nystagmus - with & without optic fixation • Gaze evoked nystagmus • Saccades – Random Target Movement • Smooth tracking - with varying frequencies • Optokinetic test • Head shaking test • Caloric test • Positional testing, Dix–Hallpike, Supine Head Roll and Deep Head Hanging • Valsalva and Hyperventilation induced nystagmus • Skew deviation Intelligent Software • Advanced eye tracking algorithm. • Automatic calculation of slow phase velocity, canal paresis and fixation index in caloric test • Advanced algorithm to generate random saccades and remove anticipated saccades • Generates smooth pursuit at varying frequencies • Automatically generates graphs of all parameters with easy visual comparison with normative data • Automatic calculation of slow phase velocity, canal paresis and fixation NeuroEquilibrium VNG has the industry’s leading binocular goggle design • Binocular eye recording • No adjustment required for focus or mirror setting • Lightweight with direct USB connection to a laptop or desktop computer • Easy fit magnetic cover allowing for both occluded and unoccluded measurements. • Built in fixation light • Enhanced image quality because of a high frame rate camera • Hot mirror to view the eye in primary ocular axis, as torsion can get distorted if not viewed in the primary ocular axis. The hot mirror allows eye imaging to be aligned within ±10o of the primary ocular axis to minimize par

4. Caloric Irrigator The Caloric test is the gold standard in vestibular testing for over 100 years. NeuroEquilibrium Caloric Irrigators are used in combination with the VNG machine to conduct caloric tests on patients with dizziness or balance disorders. Water Caloric Irrigator Provides water at specified flow of 500ml/min and fixed temperatures of 30o & 44o C. Air Caloric Irrigator Provides air at specified flow of 8 liters per minute and fixed temperatures of 24o & 50o C. The Air Caloric Irrigator is especially useful in cases of ear perforation and comes with an illuminated and magnified otoscope. Subjective Visual Vertical (SVV) For detection of abnormal subjective tilt Subjective Visual Vertical (SVV) is an investigation to evaluate the otolith system, which is responsible for perception of verticality. Static and dynamic SVV are important to: • Assess otolithic disorders • Assess chronic dizziness • Decide side of peripheral vestibular insult during the acute stage. • Diagnose compensated vestibular disorders. • Assess efect of rehabilitation Product Specifications • Tubular vision goggle with IMU • Measurment of head angle during testing to ensure correct head position Tests Conducted • Static SVV, head vertical • Static SVV, head inclined at 30 degrees • Dynamically moving background, head vertical

5. Dynamic Visual Acuity (DVA) For screening of Vestibular impairment Dynamic Visual Acuity is used for: • Evaluation of the Vestibulo-Ocular Reflex (VOR) • Early detection of Vestibulotoxicity • Detection of Bilateral Peripheral Vestibulopathy • Rehabilitation tool • Assessing outcome of rehabilitation How it works: DVA assesses the function of VOR in maintaining the image, on the fovea of the retina during head movement. Defective VOR results in slippage of the image resulting in blurring of vision. Craniocorpography (CCG) Fast and simple investigation NeuroEquilibrium Craniocorpography (CCG) evaluates the vestibulospinal reflex, which is responsible for maintenance of balance during gait testing. The protocols evaluated by CCG include: evaluates the vestibulospinal reflex, which is responsible for maintenance of balance during gait testing. • Romberg Test • Tandem Walking • Unterberger’s / Fukuda Test

6. Computerized Stabilometry (Posturography) To evaluate postural control Stabilometry is an objective and functional evaluation of the postural control system in its steady-state behaviour. It is also a very good evaluation tool to measure the outcome of vestibular rehabilitation. It consists of the following tests: • Modified Clinical Test of Sensory Interaction of Balance (mCTSIB) • Limits of Stability (LOS) • Rhythmic Weight Shift (RWS) • Modified Clinical Test of Sensory Interaction of Balance (mCTSIB) Computerized Dynamic Posturography (CDP) Computerized Dynamic Posturography is an objective and functional evaluation of the postural control system. It determines deficits in balance strategies and helps customize rehabilitation according to the patient’s requirements. It comprises of the following standard tests for assessment and treatment of patients with balance disorders :– Tests Included Sensory Organization Test (SOT) : It comprises of the following standard tests for assessment and treatment It objectively identifies abnormalities in the patient’s use of the three sensory systems that contribute to postural control - somatosensory, visual and vestibular. Motor Control Test (MCT) : Measures motor responses to unexpected perturbation. Quantification of motor strategies used to prevent falls. Adaptation Test (ADT) : Measures ability to regain balance on disruption of somatosensory input. Useful to teach stabilization strategies to prevent falls. Features Platform with 4 load cells, forward-backward toe-up, and toe-down movement. Automatic storage of data on the cloud. Customized reports with charts for easy viewing and understanding. Integrated with virtual reality. Includes 3 rehabilitation modules.

7. Virtual Reality Based Vestibular Rehabilitation State-of-the-art Rehab Protocols Vestibular Rehabilitation Therapy (VRT) is essential for treatment of various vestibular disorders. NeuroEquilibrium has pioneered Virtual Reality-based VRT exercise protocols designed to help in: • Gaze stabilization • Sensory reorganization • Desensitization and development of alternative compensatory pathways Our cutting-edge Vestibular Rehabilitation Therapy is helpful in the following symptoms: • Dizziness • Blurred vision during head movement • Imbalance while walking • Frequent falls • Sensation of spinning The VR-based VRT advantage • Ability to simulate real life dynamic situations • Interactive and engaging. • Gamification of exercises improves compliance and helps in quantifying the improvement based on scores • Head movements can be tracked in VR • Immersion therapy for certain phobic and psychogenic disorders. • Patient improvement is accelerated The NeuroEquilibrium VRT suite includes exercises for - • Acrophobia (fear of heights) • Motion sickness • Visual vertigo/Agoraphobia • VOR & VOR supression exercises • Gaze stabilization • Head & eye coordination • Sea sickness NeuroEquilibrium App The NeuroEquilibrium app (iOS/Android) helps patients with their daily home-based exercise. It has: • Home exercise videos • Progressively changing exercises • Medicine & exercise reminder • Vertigo and Migraine diary

8. GAIT Lab Human gait depends on a complex interplay of diferent systems, including the CNS, vestibular, and musculoskeletal systems. The unique NeuroEquilibrium Gait Lab harnesses the power of computer vision to analyse gait patterns. It helps in devising strategies for rehabilitation and provides an objective tool to follow up on the outcome of rehabilitation. The Gait lab accurately tracks the following parameters: • Step Length • Gait Cycle Duration • Stance (% of Gait Cycle) • Step Duration • Gait Speed • Stride Length • Double Support (% of Gait Cycle) • Swing (% of Gait Cycle) • Cadence • Arm Swing (per cycle) The deficit causing the impairment in gait can be quantified and the rehab outcome can be measured. This helps the clinician & therapist plan rehabilitation strategies. Useful in • Vestibular Disorders • Cerebellar Ataxia • Stroke • Gait Disorder Analysis • Sensory Ataxia • Parkinson’s Disease • Unsteadiness • Fall Risk Assessment Features • 3D reconstruction of patient's gait (sagittal plane) is generated without using markers • Two wide angle cameras with FOV of minimum 80 degrees, 60 fps • Patient's video is recorded in both frontal and sagittal plane with help of a front camera and a side mounted camera • Final video is created by concatenating input frame from both side camera and front camera

9. Vestibular Evoked Myogenic Potential (VEMP) This test is used to test otolith and vestibular nerve function. It is a short latency EMG potential evoked response to high level acoustic stimuli: Useful in • Vestibular Neuritis • Superior Semi-circular Canal Dehiscence (SSCD) • Meniere’s Disease • Demyelinating Disorders Specifica�ons • Number of channels : 2 • Stimulus : Clicks, Air conduction earphones • Sound Intensity - 90 dB nHL • Stimulus frequency - 5.1 Hz • Automated VEMP ratio calculation • Automatic calculation of Interaural diference of P1 Latency, Interaural diference of N1 Latency, Interaural diference of P1- N1 Inter amplitude, Side Ratio L/R, Asymmetrical Ratio (%) • VEMP box with 4 sets of electrodes, VEMP Software

10. BPPV Maneuver Guidance System Canalith repositioning maneuvers (CRM) are highly efective in the treatment of BPPV. For each involved canal, the appropriate repositioning maneuvers should be performed. For posterior canal BPPV, maneuvers like Epley or Semont are recommended; for horizontal canal BPPV, 360⁰ Roll, Zuma or Gufoni Maneuver are recommended; for anterior canal, BPPV Modified Yacovino maneuver is used. The BPPV Maneuver Guidance System provides information to the clinician about the angle and plane of the head at each step of the repositioning maneuver. The guidance system gives visual feedback about the head angulation and allows the clinician to proceed to the next step only after achieving the desired head position. Each step of the BPPV maneuvers is displayed on a screen, using a 3D model of the human body. Head Orientation is measured with a head band with custom-made sensors (the “tracker”). The system is configured with a waiting period of 30 seconds between each step of the maneuver. This waiting period ensures that the debris reach the desired position in the canal before proceeding to the next step. • BPPV Maneuver Guidance system provides a step-by-step visual guidance for the care giver to carry out the maneuvers for BPPV. The device calculates the angle at each step. Maneuvers- Features- • An animated model of human body which shows the desired head and body movement for each step. ? Posterior canal a) Epley Maneuver b) Semont Maneuver c) Semont Plus Maneuver ? Lateral Canal a) 360 Degree Roll Maneuver b) Gufoni Maneuver c) Zuma Maneuver ? Anterior Canal a) Modified Yacovino Maneuver • The device visually indicates the head movement and indicates that each step was done correctly with less than +/- 4 degree variation. • The inner ear labyrinth is shown on the screen which moves with the actual head movement. • Adjustable timer for each step.

11. Vestibular Assessment Platform Comprehensive and robust The NeuroEquilibrium Vestibular Assessment Platform is the most comprehensive vertigo and balance assessment platform. The platform integrates various diagnostic tests on one platform and helps doctors diagnose and treat vertigo & balance disorders through comprehensive evaluation, customized reporting, one-click patient data retrieval, rehabilitation, and patient monitoring modules. Product Specifica�ons Cloud integra�on for anywhere access • Comprehensive history module • All reports on one platform • Automatically generates graphs of all parameters with easy visual comparison with normative data • Patient scheduling with SMS reminders, etc. • Data from the tests is automatically and seamlessly saved on the cloud and can be accessed over the internet anywhere in the world. • Allows for easy restoration of data in case the local system crashes.

12. NeuroEquilibrium Vestibular Lab Installations 40+ institutions and counting 40+ institutions and counting Corporate Ofce : 255 SriGopal Nagar Gopalpura Bypass Road Jaipur 302015 info@neuroequilibrium.in www.neuroequilibrium.in India