Dizziness and Vertigo Clinic

Expert Treatment and Diagnosis for Vertigo, Dizziness, and Concussion

Are you experiencing dizziness or vertigo? Do you find yourself feeling off balance? These symptoms could be the result of a vestibular disorder. Our physiotherapists have been specially trained to assess and treat vertigo as well as a variety of other dizziness and balance disorders.

Did you know?
  • 1 in 3 over the age of 40 will experience dizziness or vertigo
  • Dizziness and vertigo can be difficult to diagnose – the average dizzy patient sees 4-5 health professionals before receiving a diagnosis
  • Physiotherapists are the health professionals trained to treat most types of dizziness and vertigo
  • That some types of vertigo can be completely resolved after 1-2 sessions of vestibular rehabilitation? Other types of dizziness require a longer treatment course but have a very high success rate with rehabilitation
Vestibular conditions we treat:
  • BPPV (Benign Paroxysmal Positional Vertigo)
  • Vestibular Neuritis (Neuronitis)
  • Labyrinthitis
  • Vestibular Hypofunction or Loss
  • Meniere’s Disease
  • PPPD (Persistent Postural-Perceptual Dizziness)
  • Vestibular Migraine
  • Mal de Debarquement
  • Cervicogenic Dizziness (dizziness related to your neck)
  • Falls Risk and Balance or Gait Disorders
  • Concussion – Acute and Chronic
  • Other vestibular disorders
The vestibular system:

Vertigo and dizziness are often due to a dysfunction of the vestibular system. The vestibular system consists of an apparatus located deep in your inner ear consisting of otolith organs, semicircular canals, and nerves that send information from these structures to your brain. The vestibular apparatus plays an important role in balance, coordination, and movement. When your vestibular apparatus is impaired, vertigo, dizziness, nausea, imbalance, vision problems, lightheadedness, and other debilitating symptoms can occur.

Our assessment process:

We use a comprehensive assessment approach that will look at all components of your vestibular system including:

  • Screening for serious/urgent medical conditions
  • Testing of balance
  • Positional testing including the Dix-Hallpike Maneuver and Roll Testing
  • Oculomotor testing – looks at how your inner ear may be affecting your eyes and vision
  • Infrared Nystamography – uses a high-resolution camera to further examine the connection between the eyes and inner ear for a more precise diagnosis

This testing helps your physiotherapist find the exact cause of your dizziness and so that we can provide you with an accurate diagnosis and treatment plan.

[pictures: someone in goggles doing an Epley’s Maneuver, someone working on a balance exercise, someone having eye gaze tested]

What is Vestibular Rehabilitation?

Once an accurate diagnosis has been made, your therapist will work with you to develop a treatment plan to address your particular condition.

Your rehabilitation program may include:

  • Repositioning maneuvers for BPPV, including Epley’s Maneuver and others
  • Exercises to strengthen your vestibulocochlear reflexes (connection between your inner ear and eyes)
  • Balance and stability exercises
  • Exercises to improve your neck mobility, strength, and fine motor control
  • Education on how to prevent falls, manage symptoms, and prevent recurrences

Don’t wait to be diagnosed and start treatment – contact us today to book an assessment.

Book My Treatment for Dizziness

FAQs

What happens in a Vestibular Assessment?

Your initial vestibular assessment will consist of your physiotherapist performing a comprehensive history, physical assessment, and an initial treatment.

During the history, your physiotherapist will ask you a number of questions about the onset of symptoms, your current symptom state, your medical history, and your functional limitations.

Symptoms of dizziness can be due to a number of various pathologies, so our physiotherapists take special care to rule out non-vestibular causes. Our first priority is to screen vascular and neurological structures, as well as other conditions, that may require immediate medical attention.

After the manual and functional tests, our physiotherapists will then use state of the art infrared goggle technology. This technology has been found to be one of the most accurate ways to diagnose vestibular impairments. The goggles allow our physiotherapists to observe and record irregular eye movements that may not be evident in room light testing.  Your vestibular system and your eyes have a direct connection. Problems with your vestibular system can result in changes to your eye reflexes, producing abnormal eye movements called nystagmus. Using our infrared goggle technology, our physiotherapists are better able to examine these eye movements, and, in turn, diagnose your vestibular impairment.

After the physical assessment, our physiotherapists will take the time to educate you on their clinical findings and a diagnosis. Depending on your diagnosis, your initial treatment may include manual therapy techniques, repositioning maneuvers, exercises, or a combination of these. Our physiotherapists will also discuss a treatment plan that will be customized specifically for you. Our treatment plans are based on up to date, evidence-based research and clinically proven techniques.

WHAT IS BPPV?

Benign Paroxysmal Positional Vertigo or BPPV is a mechanical problem in the inner ear, and is the most common cause of vertigo or that false sensation of spinning you may be experiencing. BPPV occurs when calcium carbonate crystals become dislodged from utricle and migrate into one of the 3 semicircular canals, where they are not supposed to be. These crystals interfere with the normal fluid movement that the semicircular canals use to sense head motion, causing the inner ear to send false signals to the brain. These false signals do not match with what the other ear is sensing, what our eyes are seeing, and what our muscles and joints are doing. This mismatched information is perceived by the brain as a spinning sensation or vertigo.

IS THERE A CURE FOR BPPV?

One of the most common questions our physiotherapists are asked is, “is there a cure for BPPV?” In the vast majority of cases, BPPV can be corrected mechanically. Our physiotherapists have been trained to identify what semicircular canal(s) the crystals are in, by observing your nystagmus or abnormal eye movements. Based on these findings, our physiotherapists will take you through the appropriate treatment maneuver to reposition the crystals back into the chamber where they are supposed to be.  Studies have found rates of resolution using these repositioning maneuvers well into 90% within 1-3 treatment sessions. However, it is not uncommon to still experience some sensitivity to motion and unsteadiness even after successful repositioning has occurred. It is important to follow up with our physiotherapists so that they can evaluate your residual symptoms and provide you a with a treatment plan to address these things.

IS VESTIBULAR REHABILITATION COVERED BY HEALTH BENEFIT PLANS?

At Coeur Physiotherapy, our physiotherapists perform all of our vestibular services. If you have extended health benefits for physiotherapy, your vestibular treatments will be covered under this benefit.

References:

Parnes LS, et al. Diagnosis and management of benign paroxysmal positional vertigo (BPPV). CMAJ. 2003 169(7):681-693.

VEDA Website: https://vestibular.org/