FAQs

We focus on conditions that affect the peripheral vestibular system and their connections in your brain that are resulting in vertigo, dizziness and imbalance.  These are often classified into peripheral and central disorders. Symptoms can also come from closely related non-vestibular conditions, e.g. neck issues. 

Common conditions we treat include: 

• Benign Paroxysmal Positional Vertigo (BPPV)

• Vestibular Neuritis or Labyrinthitis (Unilateral Vestibular Hypofunction) 

• Vestibular Migraine 

• Concussion or Traumatic Brain Injury

• Age-related imbalance, dizziness and falls

• Imbalance as a result of Meniere’s Disease 

• Persistent Postural Perceptual Dizziness (PPPD)

• Mal de-Debarquement Syndrome

• Bilateral Vestibular Hypofunction

• Cervicogenic Dizziness

• Neck pain

• Imbalance resulting from central disorders

• And more….

• Dizziness 

• Vertigo (a sense of spinning)

• Imbalance and feeling unstable

• Sense of being pulled to one side

• Difficulty walking

• Postural changes

• Lightheadedness, floating, rocking

• Motion Sensitivity

• Nausea and/or Vomiting

• Vision issues (blurred, bouncing)

• Discomfort in busy environments or the grocery store

• Discomfort scrolling on a device

• Sensitivity to light and/or noise

• Sleep Changes

• Brain Fog

• Poor memory and/or concentration

• Confusion or disorientation

• Neck Pain

• Tinnitus (ringing in ears)

• Ear pressure or fullness

• Hearing changes

• Headaches

• Loss of self-confidence and self-esteem

• Anxiety/ panic or other psychological changes

• and more…

Vestibular physiotherapy or rehabilitation is a specialized form of therapy intended to alleviate the primary and secondary problems related to vestibular disorders. The goal of physiotherapy is to reduce or resolve symptoms of dizziness or vertigo, improve balance/ reduce fall risk, improve gaze stability, improve neck mobility without pain or dizziness, and provide strategies to cope with symptoms.  Possible treatments and interventions may include repositioning maneuvers (for BPPV), balance and proprioceptive exercises, gaze stabilization exercises, habituation exercises to reduce sensitivity to motion, manual therapy, mobility and/or strengthening exercises, and falls prevention. 

When the vestibular system has sustained an injury or is affected by a vestibular condition, vestibular rehabilitation can help to improve things by aiding the brain in compensation for the loss through neuroplasticity. For many, compensation occurs naturally over time, but for patients whose symptoms do not reduce and who continue to have difficulty returning to daily activities, vestibular physiotherapy can promote compensation.

A tailored program of home exercises is key to help achieve your goals. Gait aids may be recommended to assist with return to function or fall prevention.

Certain fluctuating conditions such as Meniere’s Disease, Vestibular Migraine may benefit from vestibular rehabilitation if a vestibular loss (unilateral or bilateral) has developed, if imbalance is experienced between episodes, or if education and support to maintain physical activity would be beneficial.

Education in self management strategies, body awareness, breathing exercises, mindfulness and lifestyle modifications may also be an important part of therapy. Your Physiotherapist will take a holistic approach to your condition and unique needs. Your Physiotherapist can also facilitate referrals to other specialists and recommend other types of treatment that may be useful to achieve your goals.

You do not need a referral to see a physiotherapist.  You can get started right away.  Check your extended health benefits plan to see if they require a referral.

Your first appointment will focus on understanding your symptoms and how they impact your life, your medical history, and your personal goals. Then we’ll complete a thorough evaluation including balance, eye movements, neck movements, neurological tests, positional tests, and motion sensitivity tests. Infrared video goggles will be used to observe eye movements during parts of the examination. These allow us to observe any abnormal eye movements which are key to diagnosing and understanding vestibular disorders.  These will be observed and recorded during specific tests such as eye and head movements and positional changes, allowing us to assess the function of your vestibular system.  

We’ll discuss the findings together and work with you to create an individualized treatment plan. If you are experiencing signs and symptoms of BPPV, repositioning maneuvers will typically be completed during the first session. You’ll receive education, resources and strategies to manage your symptoms, and initial exercises if appropriate. Our goal is to make you feel supported, heard and confident in your recovery journey.

You will receive an email from EQuilibria Physiotherapy through our Jane platform with a link to join your virtual appointment.  

Decide what device you will be using e.g. computer with webcam, tablet, laptop or phone.  When you click the link it may ask for permission to access your video and microphone. Please select “Allow”. Ensure you can view your whole body in the camera if you step back a little. 

Things that may be useful to have convenient prior to your call are a bed or sofa, or the floor, along with a pillow, some paper and a pen, and wear comfortable clothing. It may be helpful to have someone nearby if you need assistance to hold your device to allow us to observe your eyes during some of the tests. 

Yes, we use infrared video goggles to observe and record any abnormal eye movements (nystagmus) that may be occurring with your condition. The goggles allow us to see your eyes without your eyes being able to focus. Being able to view any abnormal eye movements is very important in the diagnosis of which canal is involved in BPPV, if you have experienced a unilateral vestibular loss or hypofunction, or if a central condition may be present, as these may not be easily observable without the goggles. A recording is produced that allows us to replay the video and ensure we haven’t missed anything. 

You can learn more about them here: https://vestibularfirst.com

The number of sessions will depend on your diagnosis. Some conditions, like BPPV, may resolve in 1-3 sessions. Others may often require several weeks of therapy with gradual improvements over time. We’ll work with you to develop a personalized treatment plan and give you an idea of what to expect. Our goal is to help you feel better and provide you with the tools you need for success.

EQuilibria Physiotherapy is located in London, Ontario and provides services within the City of London and virtually in the Province of Ontario.

Please contact us to discuss the option of in-home physiotherapy where you live.  A small fee adjustment may be applicable to cover the increased travel costs.

If you would prefer clinic-based physiotherapy, Denise can also be seen at Elevate Physiotherapy in Wortley Village in London, Ontario:  www.elevatephysiotherapy.com

A portion or all of your physiotherapy session may be covered if you have extended health benefits. It is best to check with your provider to determine how much is covered and the benefit limit per year. Physiotherapy at EQuilibria physiotherapy is not covered by OHIP.

We are a self-pay practice and do not bill insurance companies directly. Payment can be made by credit card through our Jane platform at the time of our visit.  You will be provided with a receipt you can submit to your extended health benefits provider.  We recommend checking your benefits for physiotherapy with your provider.

Please let us know as soon as possible if you are not able to make your appointment. We require at least 24 hours notice for cancellations.  Late cancellations and no shows are billed the full amount.