Revision 7T · Full Tutorial Edition · Updated 1 September 2026
PWR-096 · SUPERVISED full tutorial
Maintain a heading judgement during clinician-controlled motion with a strict recovery rule
Orientation under motion means preserving a useful estimate of direction while visual, vestibular and body cues change. A qualified clinician or instructor controls the motion source, seating, dose, escape and progression. The learner learns to fix a reference heading, make one direction judgement, report symptoms and stop early. There is no driving, water, rotating-chair experiment or provocative home exposure.
What you will produceUnder qualified supervision, the learner completes a short controlled-motion orientation block and records heading error, task accuracy, symptoms and recovery for the exact configuration.
Method8 numbered Power-specific steps
Practice authorityFull method with qualified supervision where stated
Full step-by-step individual tutorial · TLU-PWR-096
Under qualified supervision, the learner completes a short controlled-motion orientation block and records heading error, task accuracy, symptoms and recovery for the exact configuration.
Record baseline nausea, dizziness, headache, disorientation and anxiety and identify the recovery place.
3 · The method
Follow these steps in order
Anchor a reference heading
While stationary, identify forward and two side headings using fixed visual or tactile markers.
Why: A known reference is needed to score orientation after motion.
Check: The learner labels all reference directions correctly at baseline.
Record recent motion exposure
Before each block, list travel, exercise, screen motion, simulator use and symptom-provoking activity during the provider-set look-back period.
Why: Prior motion can sensitise later sickness and make a matched dose respond differently.
Check: The session sheet states either no relevant prior exposure or names its type, timing and symptoms.
Rehearse stop and response
Practise the stop signal and one forced heading response while the apparatus is stationary.
Why: A rapid stop must work before motion begins.
Check: The provider confirms both controls without ambiguity.
Run a stationary control trial
With no visual or physical motion, present the same heading cue, collect one answer and record response time and symptoms.
Why: A control trial separates misunderstanding or response difficulty from motion-related orientation error.
Check: The learner answers the stationary cue correctly and remains at baseline symptoms before motion is authorised.
Apply the smallest prescribed motion
The provider initiates only the declared low dose while the learner remains supported and looks at the prescribed scene.
Why: A fixed starting dose prevents uncontrolled provocation.
Check: Motion parameters and support match the written plan.
Commit the orientation answer
At the cue, point or select the estimated heading once and rate confidence without searching or standing.
Why: One committed response yields a heading error without adding fall risk.
Check: Heading, confidence and response time are captured.
Stop and recover
End at the time limit or first stop sign. Remain supported and record symptoms each minute until the provider-defined recovery band.
Why: Symptoms can build after motion and recovery is part of safety and dose.
Check: Peak symptoms and recovery time are complete.
Review one-variable progression
Compare heading error and symptoms with baseline; the provider holds, reduces or changes one feature only.
Why: Accuracy improvement with worsening sickness is not clean progress.
Check: The next decision accounts for both function and burden.
4 · Worked example
See the whole method used once
Scenario
A clinician uses a supported, non-driving visual-motion simulator with a stationary chair and three heading markers.
Walkthrough
Ari identifies forward, left and right markers while stationary and rehearses the stop switch.
The clinician sets a 15-second low-speed visual rotation with Ari seated and supported.
At the cue Ari selects forward-left once, confidence 60%, without standing.
Nausea rises from 0 to 2/10 and returns to 0 in four minutes, all recorded.
Because heading error improved but recovery lengthened from the prior block, the clinician holds the dose.
Result
Ari’s record links orientation accuracy with symptom cost in one controlled configuration. It gives no permission for driving, water or independent motion exposure.
5 · Right and wrong
Compare correct or safer execution with the common wrong version
Right and wrong comparison
Moment
Right / safer
Wrong / riskier
Why it matters
Setting
Use a provider-controlled, supported, consequence-free setup.
Test during driving, boating or amusement rides.
Operational environments turn an error into immediate danger.
Response
Give one heading answer while seated.
Stand or turn repeatedly to find the direction.
Searching adds cues and fall risk.
Progress
Review accuracy and symptom recovery together.
Increase dose because nausea was tolerated.
Tolerance is not safe orientation performance.
Change
Alter one provider-selected variable.
Change speed, duration, scene and posture together.
Multiple changes obscure sensitisation or benefit.
6 · Common mistakes
Spot the error and apply the correction
Common mistakes and corrections
Mistake
Fix
The reference heading is not calibrated.
Test all markers while stationary before each block.
Only peak symptoms are logged.
Record time to return to the agreed band.
Confidence replaces angle error.
Capture the selected heading and compare it with the true heading.
Prior motion exposure is ignored.
Record travel, exercise, simulator or vestibular exposure earlier that day.
7 · Practice
Turn the steps into a usable skill
First session
Provider screen and stationary baseline.
Stop-control and heading rehearsal.
One smallest-dose block.
Supported recovery and full symptom log.
Provider hold/reduce/continue decision.
Repeat plan
The qualified provider determines intervals, repetitions and progression. Repeats match motion, visual scene, posture and timing; prior exposure is logged. No home or operational practice is supplied.
Progress when
Heading error improves without longer recovery or new symptoms.
The stop response is immediate and reliable.
The provider observes stable supported posture and correct task execution.
Do not progress when
Nausea, dizziness, headache or disorientation accumulates.
A prior motion exposure may sensitise the session.
The next environment has real transport, water, height or fall consequences.
8 · Check the result
Measure what changed
Heading error during one controlled-motion configuration, paired with symptom recovery.
How: Record true and selected heading, absolute angular/category error, response time, confidence, baseline/peak symptoms, recovery minutes, support and motion parameters.
Good result: Provider-defined heading improvement occurs across matched blocks without increased peak symptoms, prolonged recovery or loss of support.
This does not prove: It does not show safe driving, boating, flight, occupational readiness, vestibular immunity or transfer to other motion.
Self-check
What is the fixed reference heading?
Can the stop control end motion immediately?
Are heading error and symptom recovery both recorded?
Who controls the next dose?
9 · Stop, adapt or get help
Keep the safety boundary practical
Stop and get help
Stop immediately for severe or rapidly rising nausea, vomiting, faintness, severe headache, double vision, new weakness, chest symptoms, panic or inability to orient.
Remain supported and obtain clinical review if symptoms do not return to the agreed band.
Do not attempt transport or hazardous activity while dizzy, nauseated or disoriented.
Accessibility and adaptations
Use large visual headings, tactile direction markers or spoken response options.
Use supported seating and an accessible stop switch.
Reduce sensory clutter and allow longer recovery; accessibility changes are recorded as configuration.
10 · Evidence and limits
Why these instructions are here
official guidance
The official vestibular rehabilitation guideline supports clinician-configured care for diagnosed peripheral vestibular hypofunction and does not justify generic provocative practice.
A randomised study found prior provocative physical motion sensitised later visually induced motion sickness, supporting conservative exposure and recovery tracking.
Progress is saved only in this browser on this device.
Step-by-step learner mode
Each activity includes its success check, a nearby accessible alternative and an “I’m stuck” correction path. Alternatives preserve the target where possible; when they change the task, Titan labels them as related rather than equivalent.
01
Anchor a reference heading
While stationary, identify forward and two side headings using fixed visual or tactile markers.
Why this step exists
A known reference is needed to score orientation after motion.
Success check
The learner labels all reference directions correctly at baseline.
I’m stuck on this step
Reset: Re-read this authored instruction — “While stationary, identify forward and two side headings using fixed visual or tactile markers.” — and its success check, then attempt only this step.
Possible snag: The reference heading is not calibrated.
Correction: Test all markers while stationary before each block.
Stop / get help: Stop immediately for severe or rapidly rising nausea, vomiting, faintness, severe headache, double vision, new weakness, chest symptoms, panic or inability to orient.
02
Record recent motion exposure
Before each block, list travel, exercise, screen motion, simulator use and symptom-provoking activity during the provider-set look-back period.
Why this step exists
Prior motion can sensitise later sickness and make a matched dose respond differently.
Success check
The session sheet states either no relevant prior exposure or names its type, timing and symptoms.
I’m stuck on this step
Reset: Re-read this authored instruction — “Before each block, list travel, exercise, screen motion, simulator use and symptom-provoking activity during the provider-set look-back period.” — and its success check, then attempt only this step.
Possible snag: Prior motion exposure is ignored.
Correction: Record travel, exercise, simulator or vestibular exposure earlier that day.
Stop / get help: Stop immediately for severe or rapidly rising nausea, vomiting, faintness, severe headache, double vision, new weakness, chest symptoms, panic or inability to orient.
03
Rehearse stop and response
Practise the stop signal and one forced heading response while the apparatus is stationary.
Why this step exists
A rapid stop must work before motion begins.
Success check
The provider confirms both controls without ambiguity.
I’m stuck on this step
Reset: Re-read this authored instruction — “Practise the stop signal and one forced heading response while the apparatus is stationary.” — and its success check, then attempt only this step.
Possible snag: The result from “Practise the stop signal and one forced heading response while the apparatus is stationary.” does not yet meet this declared check: The provider confirms both controls without ambiguity.
Correction: Return to the start of “Rehearse stop and response”, reduce complexity or pace, and repeat only the part needed to satisfy: “The provider confirms both controls without ambiguity.”
Stop / get help: Stop immediately for severe or rapidly rising nausea, vomiting, faintness, severe headache, double vision, new weakness, chest symptoms, panic or inability to orient.
04
Run a stationary control trial
With no visual or physical motion, present the same heading cue, collect one answer and record response time and symptoms.
Why this step exists
A control trial separates misunderstanding or response difficulty from motion-related orientation error.
Success check
The learner answers the stationary cue correctly and remains at baseline symptoms before motion is authorised.
I’m stuck on this step
Reset: Re-read this authored instruction — “With no visual or physical motion, present the same heading cue, collect one answer and record response time and symptoms.” — and its success check, then attempt only this step.
Possible snag: The result from “With no visual or physical motion, present the same heading cue, collect one answer and record response time and symptoms.” does not yet meet this declared check: The learner answers the stationary cue correctly and remains at baseline symptoms before motion is authorised.
Correction: Return to the start of “Run a stationary control trial”, reduce complexity or pace, and repeat only the part needed to satisfy: “The learner answers the stationary cue correctly and remains at baseline symptoms before motion is authorised.”
Stop / get help: Stop immediately for severe or rapidly rising nausea, vomiting, faintness, severe headache, double vision, new weakness, chest symptoms, panic or inability to orient.
05
Apply the smallest prescribed motion
The provider initiates only the declared low dose while the learner remains supported and looks at the prescribed scene.
Why this step exists
A fixed starting dose prevents uncontrolled provocation.
Success check
Motion parameters and support match the written plan.
I’m stuck on this step
Reset: Re-read this authored instruction — “The provider initiates only the declared low dose while the learner remains supported and looks at the prescribed scene.” — and its success check, then attempt only this step.
Possible snag: The result from “The provider initiates only the declared low dose while the learner remains supported and looks at the prescribed scene.” does not yet meet this declared check: Motion parameters and support match the written plan.
Correction: Return to the start of “Apply the smallest prescribed motion”, reduce complexity or pace, and repeat only the part needed to satisfy: “Motion parameters and support match the written plan.”
Stop / get help: Stop immediately for severe or rapidly rising nausea, vomiting, faintness, severe headache, double vision, new weakness, chest symptoms, panic or inability to orient.
06
Commit the orientation answer
At the cue, point or select the estimated heading once and rate confidence without searching or standing.
Why this step exists
One committed response yields a heading error without adding fall risk.
Success check
Heading, confidence and response time are captured.
I’m stuck on this step
Reset: Re-read this authored instruction — “At the cue, point or select the estimated heading once and rate confidence without searching or standing.” — and its success check, then attempt only this step.
Possible snag: The result from “At the cue, point or select the estimated heading once and rate confidence without searching or standing.” does not yet meet this declared check: Heading, confidence and response time are captured.
Correction: Return to the start of “Commit the orientation answer”, reduce complexity or pace, and repeat only the part needed to satisfy: “Heading, confidence and response time are captured.”
Stop / get help: Stop immediately for severe or rapidly rising nausea, vomiting, faintness, severe headache, double vision, new weakness, chest symptoms, panic or inability to orient.
07
Stop and recover
End at the time limit or first stop sign. Remain supported and record symptoms each minute until the provider-defined recovery band.
Why this step exists
Symptoms can build after motion and recovery is part of safety and dose.
Success check
Peak symptoms and recovery time are complete.
I’m stuck on this step
Reset: Re-read this authored instruction — “End at the time limit or first stop sign. Remain supported and record symptoms each minute until the provider-defined recovery band.” — and its success check, then attempt only this step.
Possible snag: Only peak symptoms are logged.
Correction: Record time to return to the agreed band.
Stop / get help: Stop immediately for severe or rapidly rising nausea, vomiting, faintness, severe headache, double vision, new weakness, chest symptoms, panic or inability to orient.
08
Review one-variable progression
Compare heading error and symptoms with baseline; the provider holds, reduces or changes one feature only.
Why this step exists
Accuracy improvement with worsening sickness is not clean progress.
Success check
The next decision accounts for both function and burden.
I’m stuck on this step
Reset: Re-read this authored instruction — “Compare heading error and symptoms with baseline; the provider holds, reduces or changes one feature only.” — and its success check, then attempt only this step.
Possible snag: Confidence replaces angle error.
Correction: Capture the selected heading and compare it with the true heading.
Stop / get help: Stop immediately for severe or rapidly rising nausea, vomiting, faintness, severe headache, double vision, new weakness, chest symptoms, panic or inability to orient.
Correct versus incorrect execution
These accessible process diagrams are built from the tutorial’s own right/wrong teaching. They are not anatomical illustrations and do not add technique beyond the canonical tutorial.
Setting — Operational environments turn an error into immediate danger.
Correct / safer
Use a provider-controlled, supported, consequence-free setup.
Wrong / riskier
Test during driving, boating or amusement rides.
Response — Searching adds cues and fall risk.
Correct / safer
Give one heading answer while seated.
Wrong / riskier
Stand or turn repeatedly to find the direction.
Progress — Tolerance is not safe orientation performance.
Correct / safer
Review accuracy and symptom recovery together.
Wrong / riskier
Increase dose because nausea was tolerated.
Change — Multiple changes obscure sensitisation or benefit.
Correct / safer
Alter one provider-selected variable.
Wrong / riskier
Change speed, duration, scene and posture together.
Method-structure checklist
10 of 10 structural checks present
✓ Ordered, Power-specific instructions — present
✓ Every activity has a success check — present
✓ Materials or supplied records are declared — present
✓ Measurement or assessment rule is present — present
✓ Tutorial-specific troubleshooting is present — present
✓ Stopping or escalation boundary is present — present
✓ Every activity has an adjacent alternative — present
✓ Correct-versus-incorrect comparison is present — present
✓ Evidence context is bound to the Power record — present
✓ Planning metadata is present — present
The method-readiness band and presence checklist assess tutorial presentation and are separate from evidence quality for the underlying Power. They are automated editorial aids, not human approval.
Manual editorial sign-off: Pending. This tutorial must not display a human-approved state until an identified editor signs the exact content hash.