We provide In-Home and Virtual Vestibular Physiotherapy services.

Benign Paroxysmal Positional Vertigo (BPPV) is the most common cause of vertigo, often reported as a spinning sensation.  It occurs when tiny calcium carbonate crystals (otoconia) that are normally embedded in the utricle of the vestibular system, are dislodged and travel into one or more of the 3 fluid semicircular canals where they are not supposed to be. Vertigo will then be triggered by movement and changes in position.  BPPV can be effectively treated with the appropriate repositioning maneuvers performed by a qualified healthcare professional. 

The most common presentation of BPPV is treated with the Epley Manoeuvre, but this technique is not the appropriate treatment for all variants of BPPV.  Before testing for BPPV,  a neurological exam, neck assessment and other safety tests should be performed to determine if the procedure is appropriate for the condition, or if it needs to be modified due to other concerns. 

At EQuilibria Physiotherapy we use infrared video goggles to observe abnormal eye movements called nystagmus which occur with BPPV to assist in the diagnosis of the canal that is involved. This will allow the most appropriate treatment to be performed. 

Reference:
Woodhouse, S & Doriangricchia, J.P. (2022). Benign Paroxysmal Positional Vertigo. Vestibular.org  https://vestibular.org/article/diagnosis-treatment/types-of-vestibular-disorders/benign-paroxysmal-positional-vertigo-bppv/

Vestibular neuritis is a vestibular condition that is commonly caused by inflammation of the vestibular branch of the 8th cranial nerve, which carries information from the receptors in the vestibular system to the brain, allowing the eyes and head to move in a synchronous way and contributing to balance.  This is also known as Acute Unilateral Vestibulopathy (AUVP). It is one of the most common causes of vertigo, often with a viral cause. 

The acute symptoms are quite debilitating, including vertigo lasting at least 24 hours with nystagmus, nausea and vomiting, worsened with movement. Medical treatment may be indicated in the acute phase. Vestibular neuritis does not have associated hearing loss, but labyrinthitis does if the hearing portion of the nerve is also affected. Acute symptoms typically resolve after a few days or weeks although some people do not compensate completely and continue to suffer from symptoms and imbalance. Vestibular therapy is critical to encourage central compensation through neuroplasticity to improve balance, gait, gaze stability and reduce motion sensitivity. 

Reference:
Rizk, H, &Shah, S. Labyrinthitis and Vestibular Neuritis. Vestibular.org https://vestibular.org/article/diagnosis-treatment/types-of-vestibular-disorders/labyrinthitis-and-vestibular-neuritis/

Migraine is a leading cause of disability worldwide. Migraine is more than a headache and can often include symptoms of vertigo and dizziness. Vestibular migraine is the most common neurological cause of vertigo among adults and there are specific diagnostic criteria. The best approach to vestibular migraine treatment is a holistic, multidisciplinary plan that encompasses non-pharmacologic nutraceuticals, medications, lifestyle changes, and addressing concurrent medical conditions and vestibular physiotherapy.

Vestibular physiotherapy may assist between episodes to improve balance and reduce symptoms of motion sensitivity, ensuring the program is appropriate not to trigger a migraine. Addressing pain and tension in the neck and upper body may also be beneficial, as well ensuring common concurrent conditions including BPPV, PPPD and Meniere’s Disease are also addressed.

Reference: 
Beh, S.C. & Beh, Z (2024). Vestibular Migraine.  Vestibular.org. https://vestibular.org/article/diagnosis-treatment/types-of-vestibular-disorders/vestibular-migraine/

A concussion is a type of mild traumatic brain injury. It may be caused by a blow to the head, face, neck or body that results in a jarring of the brain inside the skull.  Loss of consciousness does not need to have occurred. A concussion can result from a variety of activities including contact in sport, falling or being in a motor vehicle collision.  

Signs and symptoms of a concussion may include:  headache, neck pain, dizziness, imbalance, blurred vision, nausea or vomiting, fatigue, sensitivity to light or noise, general confusion or fogginess, difficulty concentrating and difficulty remembering.  Mood changes may also occur including irritability, emotional lability, sadness, or anxiety.  Sleep issues may also occur. 

A concussion can lead to abnormal vestibular system functioning, and the brain can receive abnormal signals regarding the position and movement of the head in space. When vestibular information is inaccurate, the brain most often relies on visual input to stabilize the head on the body. Relying upon vision alone as the primary source of balance often leads to fatigue and difficulty performing routine daily activities.

After a medical evaluation, most concussions will heal gradually with an initial period of mental and physical rest, followed by gradual return to mental and physical activity. Physiotherapists can provide guidance in symptom management, improving function and safe return to activities, as well as rehabilitation of balance and spatial orientation, visual skills and comfort, exercise prescription and cervical spine treatments based on assessment findings. 

References:
Miranda, N & Dorangricchia, J.P. (2022). Traumatic Brain Injury.  Vestibular.org. https://vestibular.org/article/diagnosis-treatment/types-of-vestibular-disorders/tbi/
Robertson, M.K. & McLoughlin, J. (2024). The role of the Physiotherapist in Concussion. South African Journal of Physiotherapy 80 (1). https://pmc.ncbi.nlm.nih.gov/articles/PMC11079349/#CIT0010

Meniere’s disease is a chronic inner ear disorder that presents with recurrent episodes of vertigo, ringing in the ear (tinnitus) and hearing loss as a result of endolymphatic hydrops (abnormally large amounts of endolymph fluid in the inner ear). It is more likely to occur in adults 40- 60 years of age. The exact cause is not known and there is no cure. Medical treatments are available to help manage the condition, with conservative treatment often including diuretic medication to reduce inner-ear fluid pressure. Dietary changes are also key, including a reduced sodium diet. 

Vestibular therapy can be useful to address imbalance that can occur between episodes with the goal of retraining the body and brain to process balance information. Education can also be useful to provide management and coping strategies. 

Reference:
Haybach, R.P.J, Goebel, J, & Gomez J. (2024). Meniere’s Disease. Vestibular.org.
https://vestibular.org/article/diagnosis-treatment/types-of-vestibular-disorders/menieres-disease/

Dizziness and balance problems affect up to 40% of the adult population at some point in their life.  A recent surveillance report noted falls were the cause of 88.6% of injury-related hospitalizations in adults over 65 years of age(Government of Canada, 2023) .  

When dizziness is combined with older age and increased risk of falling, it is a serious concern. Loss of balance is often a part of normal aging, along with other health issues and age related changes in other sensory systems such as hearing and vision, making seniors at greater risk for falls. 

But, falls can be prevented. Talk to your physician to ensure all medical issues that may contribute to symptoms are addressed.  Consult with a physiotherapist who can help provide specific exercises for strength and balance as well as gait aid recommendations for safety.  Balance in older adults can be maintained and improved. It requires good general physical condition and lifestyle habits including good nutrition and regular exercise. 

References:
Government of Canada (2023). Falls among older adults in Canada. Canada.ca. https://health-infobase.canada.ca/falls-in-older-adults/
Shupert, C & Horak, F. (2016). Fall Prevention. Vestibular.org.  https://vestibular.org/article/coping-support/living-with-a-vestibular-disorder/age-related-dizziness-and-imbalance/fall-prevention/

Persistent Postural-Perceptual Dizziness is considered a chronic functional vestibular disorder and includes persistent sensations of rocking or swaying unsteadiness and/or dizziness without vertigo lasting 3 months or more. Symptoms are typically experienced on most days, often intensifying as the day progresses, though severity can fluctuate. They occur more frequently than not, being present for at least 15 days in a 30-day period, with many patients experiencing daily symptoms. PPPD typically starts shortly after an event that causes acute vertigo, unsteadiness, dizziness, or disruption of balance such as BPPV, vestibular neuritis, Meniere’s disease, vestibular migraine, concussion, panic attacks with dizziness, dysautonomia, or other medical conditions. 

A multidisciplinary approach is likely to be most successful, including medications (including SSRIs or SNRIs), psychotherapy and vestibular physiotherapy. Vestibular physiotherapy can assist with brain compensation and improve balance and postural stability.  Individualized exercises may help to reduce sensitivity to motions that trigger dizziness. Working to reduce reliance on visual sensory information and increase awareness of vestibular and proprioceptive information may be necessary.  Work on specialized exercises to reduce visual motion sensitivity may also be appropriate based on individual tolerances.

Reference:
Staab, J.P. & Hollins, B. (2024). Persistent Postural Perceptual Dizziness.  Vestibular.org.
https://vestibular.org/article/diagnosis-treatment/types-of-vestibular-disorders/persistent-postural-perceptual-dizziness/
Staab JP, Eckhardt-Henn A, Horii A, et al. (2017) Diagnostic criteria for persistent postural-perceptual dizziness (PPPD): Consensus document of the committee for the Classification of Vestibular Disorders of the Bárány Society. Journal of Vestibular Research, 27(4):191-208. doi:10.3233/VES-170622