• Carrie W Hoppes, Karen H Lambert, Brooke N Klatt, Orlando D Harvard, and Susan L Whitney.
• U.S. Army Medical Center of Excellence, Army-Baylor University Doctoral Program in Physical Therapy, Fort Sam Houston, TX 78234, USA.
• Mil Med. 2023 Jan 4; 188 (1-2): e198e204e198-e204.

IntroductionFollowing suspected sonic attacks on U.S. Embassies, a subset of individuals presented with a unique cluster of symptoms believed to have resulted from exposure to directed energy. Directed energy has been described as exposure to a unique sound/pressure phenomenon such as infrasonic or ultrasonic acoustic or electromagnetic energy. The Joint Force does not have an established protocol to guide vestibular physical therapy for individuals exposed to directed energy. Therefore, we have provided evidence-based guidance for the treatment of oculomotor- and vestibular-related impairments from similar populations.Materials And MethodsPublished evidence was used to inform suggestions for clinical best practice. We offer resources for the management of non-oculomotor- and non-vestibular-related impairments, before discussing physical therapy interventions for dizziness and imbalance.ResultsThe physical therapist should design a treatment program that addresses the individual's health condition(s), body structure and function impairments, activity limitations, and participation restrictions after suspected directed energy exposure. This treatment program may include static standing, compliant surface standing, weight shifting, modified center of gravity, gait, and gaze stabilization or vestibular-ocular reflex training. Habituation may also be prescribed. Interventions were selected that require little to no specialized equipment, as such equipment may not be available in all settings (i.e., operational environments).ConclusionsEvidence-based guidance for prescribing a comprehensive vestibular physical therapy regimen for individuals exposed to directed energy may aid in their rehabilitation and return to duty. This standardized approach can help physical therapists to treat complaints that do not match any previously known medical conditions but resemble brain injury or vestibular pathology.Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2021. This work is written by (a) US Government employee(s) and is in the public domain in the US.

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