Vestibular Rehabilitation

Here at Active Physio Works we have extensively trained physiotherapists that provide effective, evidence-based vestibular treatment, complimented by the latest infrared goggle technology.  Our team provides thorough testing, and works collaboratively with referring physicians, to assist in the differential diagnosis process of dizziness.

Who needs vestibular rehabilitation?
Vestibular rehabilitation is appropriate for many symptoms, including:

  • Dizziness/ vertigo/ false senses of motion
  • Unsteady/ balance changes/ frequent falling
  • Nausea/ vomiting
  • Sensitivity to visual stimulation (while driving, watching screens, in busy environments)
  • Blurry/ jumpy vision
  • Residual symptoms following an inner ear infection, trauma, tumour, degeneration or vascular compromise.

Dizziness is a common symptom among the adult population that can be quite debilitating. Most diagnoses for dizziness can be effectively treated by vestibular rehabilitation. Specifically, vestibular rehabilitation is appropriate for:

  • Benign Paroxysmal Positional Vertigo
  • Unilateral Vestibular Hypofunction
  • Vestibular Neuritis, Labyrinthitis, Acoustic Neuroma, Trauma
  • Bilateral Vestibular Hypofunction
  • Ototoxicity, Endolymphatic Hydrops, Age related degeneration
  • Central Vestibular Dysfunctions
  • Post Head Trauma/ Concussion
  • Migraine Related Dizziness
  • Cervicogenic Dizziness

What is vestibular rehabilitation?
Vestibular conditions arise when the workings of our inner ear and visual system send mixed messages to the brain. These mixed messages result in symptoms of dizziness, visual changes or deficits in balance. Left unmanaged these signals can continue to worsen resulting in significant impacts on function, quality of life and potentially increasing ones fall risk. Therefore, early intervention is recommended. Vestibular rehabilitation aims to correct the signals, teach compensatory mechanisms for the mixed signals, or decrease sensitivity to the signals. Vestibular rehab is well supported in research and is effective in reducing or eliminating symptoms in many types of dizziness conditions.

We are aware that dizziness can be a sign of potentially serious pathology requiring further medical evaluation, and we put the safety of our patients first by providing thorough assessments.

Our assessment includes: 

  • Detailed subjective history
  • Cranial nerve exams
  • Static and dynamic balance evaluation
  • Motion sensitivity and visual sensitivity testing
  • Vestibular-ocular reflex tests
  • Cerebellar testing
  • Cervical spine and vascular screening

Based on assessment findings we can determine if you are appropriate for vestibular rehabilitation and then create an individually tailored treatment plan. Treatments will look different based on what was concluded in the assessment. Possible treatments include repositioning maneuvers for BPPV, various visual exercises, motion sensitivity training, balance exercises and possible strengthening.

Infrared Blackout Goggles
These goggles help improve assessment accuracy by capturing quick eye movements known as nystagmus. Nystagmus has a strong diagnostic value, and is a key indicator for numerous ear-related and brain-related vestibular conditions. However, nystagmus can sometimes be subtle or not even present in room lighting.  The goggles black out the visual field and help the physiotherapist better visualize types of nystagmus. This accuracy is imperative in determining specific treatment techniques. 

Goals of vestibular rehabilitation
In the case of BPPV, we expect a ‘fix’ with quick resolution of symptoms. In the case of the other vestibular conditions our goal is to reduce or eliminate symptoms by teaching the body to adapt, substitute or habituate to the vestibular abnormalities. Challenges with balance or cervicogenic dizziness respond well to musculoskeletal interventions, such as strengthening.

Ultimately, we aim to optimize patients’ functional abilities to allow them to return to work, and the activities they love, in a capacity suitable to their abilities.

Benign Peripheral Proximal Vertigo - BPPV
BPPV is common in the adult population, with an onset of dizziness that often comes with no warnings and is sudden. BPPV is caused when otoconia crystals in one ear, that typically rest in the utricle of the inner ear, become detached and free floating in the semi-circular canals.  The movement of these loose crystals in one ear sends differing signals to the brain than the unaffected ear, thus causing a mixed signal. It is this mixed signal that gets perceived as dizziness. Dizziness from BPPV is often brought on with body movements, especially with movements like rolling over in bed.

Treatment for BPPV involves maneuvers that allow gravity to act on the crystal and bring it back to the utricle. There are 12 different types of BPPV, that can be diagnosed by the presenting nystagmus. The various types of BPPV have unique and specific treatment techniques and maneuvers that are required.

Active Physio Works has both the training and technology to ensure the treatment selected is the most accurate for your needs.



What to Expect

We understand that you may have a few questions before visiting our clinics for your initial appointment.

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We understand each person is different so we offer a variety of techniques that are best suited to your individual needs.