We provide In-Home and Virtual Vestibular Physiotherapy services.

Benign Paroxysmal Positional Vertigo (BPPV) is the most common cause of vertigo, often felt as a spinning sensation triggered by certain head movements. It happens when tiny calcium carbonate crystals inside the inner ear drift out of place, and it's treated with a specific repositioning maneuver based on an accurate diagnosis. Learn more about BPPV treatment →

Vestibular neuritis is inflammation of the balance nerve (vestibular nerve, CN 8), often triggered by a virus, causing sudden, severe vertigo that usually settles within days to weeks. Some people are left with lingering imbalance that needs targeted rehabilitation to fully resolve. Learn more about vestibular neuritis treatment →

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