Dizziness & Balance Clinic in Toronto

Dizziness and Balance Clinic in CF Shops at Don Mills

Physiomobility has physiotherapists Certified in Vestibular Rehabilitation (VRT) who assess and treat common conditions such as BPPV, Vertigo, Concussion and other disorders causing recurrent dizziness.

Once the acute phase of dizziness has passed, or in cases like Meniere’s disease, patients may develop a fear of movement which may result in decreased stimulation of their vestibular system, therefore subjecting them to experience recurrent dizziness. Like any other system or organ in your body, if you do not use it, you will lose it. It is very important to keep up with normal activities and to resist the temptation of avoiding movements to prevent provoking or worsening dizziness.

With a tailored home exercise program and education, we encourage our patients to engage in activities that involve head movement and stimulate the balance system. Vestibular rehabilitation exercises will help to minimize dizziness, fear of falling and may help to reduce the frequency and intensity of vertigo attacks.

Physiomobility Dizziness & Balance Centre offers a true Vestibular Rehabilitation Therapy in addition to treating BPPV

Our clinic is more than just a center to treat BPPV & vertigo, we are a rehabilitation center and our focus is on rehabilitating vestibular weakness, treating recurrent and chronic dizziness and improve balance and prevent falls. Our vestibular physiotherapy team has extensive training in treating complex dizziness and balance disorders and we have a dedicated clinic space and equipment for assessment and treatment of dizziness disorders. In advanced stages of rehabilitation, we simulate real-life experiences through VR videos and games to help our patients overcome the fear of getting dizzy in their real life and go back to living their normal life.

Read through this page to learn how we treat a spectrum of dizziness caused by vestibular (inner ear) dysfunction from BPPV to more complex chronic dizziness and how our patients benefit from Vestibular Rehabilitation Therapy:

What are the Symptoms of Inner Ear Vestibular Pathology?

• Dizziness or vertigo which is a false sense of spinning
• Imbalance, unsteadiness or feeling of floating
• Nausea, vomiting & blurred vision or other visual-motor disturbance
• Nystagmus (Involuntary movement of eyes with head or eye movement)
• Headaches
• Balance disturbance and falls

The vestibular system interacts with so many other parts of the nervous system, therefore when the patient is experiencing dizziness or imbalance, many secondary symptoms of memory problems, muscular stiffness, muscle weakness, fatigue, and anxiety may be experienced. Many patients reports sleeping problems as well.

What are some of the Causes of Inner Ear Vertigo and Imbalance?

• Infections either viral or bacterial
• Trauma
• Meniere’s Disease
• Neuroma
• Ototoxicity
• Vascular ischemia/ stroke
• BPPV (Benign positional vertigo
• Mal de debarquement syndrome (mdds)
• Migraine associated vertigo
• Seizures

Why should I choose Physiomobility Dizziness & Balance clinic?

Physiomobility has a dedicated clinic to treat dizziness and balance issues. Physiomobility’s dizziness and balance programs are based on research. In a nutshell; we assess the cause of the dizziness and provide resolution for the acute dizziness and rehabilitate the more chronic or complex cases to help to return back to normal life. We assess fall risk and address the causes of the balance impairment in elderly and have developed cost-effective programs to assist our patients to access treatments they need in a safe environment and with the help of experts in the field. We employ assessment and treatment techniques and methods to alleviate dizziness associated with the inner ear and design exercise programs to improve function and balance. We use the latest technology such as infrared goggles to record involuntary eye movement for a thorough examination. Our physical therapists work closely with audiologists, ENT physicians, vision therapists, and other physicians to ensure our patients befit from an appropriate individualized program for each person based on testing and evaluations.

How does a physiotherapist assess dizziness?

A thorough assessment will be conducted by our Vestibular Physiotherapist to identify problems that are affecting a person’s function. The evaluation is focused on four main areas:-

• A comprehensive relevant medical history
• An evaluation of the impact of dizziness on a person’s life through standard assessment tools
• An assessment of Neuromuscular (nerves & muscles) system
• An assessment of Visual Motor (observing involuntary eye movements by infrared video goggles and visual observation)
• Balance Assessment – measured by standardized tests
• Vertigo Assessment
• Developmental of equilibrium and protective reflexes

What dizziness disorders do you treat at Physiomobility?

We commonly treat the following conditions:

• BPPV or vertigo (spinning sensation)
• Recurrent Dizziness
• Imbalance or disequilibrium
• Migraine causing dizziness
• Decreased strength and endurance
• Cervicogenic Dizziness (dizziness originating from neck)
• Falls

 

There are conditions that cause acute or ongoing dizziness and vertigo symptoms and would require medical treatment by a GP, ENT or Neurologist. During the acute stage and once the acute stage subsides, patients are commonly left with ongoing dizziness and imbalance. We assist in maintaining the necessary stimulation of the vestibular system during the period that medical treatment is provided, we teach patients techniques to prevent falls and injuries and once our patients are ready for rehabilitation, we assist them to gain maximum functionality of their balance and vestibular system. We commonly treat dizziness and imbalance left after these conditions:

• Acoustic Neuroma
• Neuritis
• Labyrinthitis
• Meniere’s Syndrome
• BPPV (Commonly known as Vertigo)
• Neurological Disorders (stroked, brain injury, multiple sclerosis, Parkinson’s)
• Physical Deconditioning
• Concussion
• After ear surgeries

Viral and bacterial infections, Meniere’s disease, head injuries, concussions, and recurrent vertigo attacks can leave patient with decreased activity of their vestibular system and cause unilateral (one-sided) or bilateral (both sides) vestibular hypofunction (vestibular system weakness). Most of the patients who require vestibular rehabilitation show symptoms of hypofunction (decreased function) and are excellent candidates for VRT (Vestibular Rehabilitation Therapy).

How do I prepare for my dizziness or BPPV assessment?

Please bring any relevant medical reports such as MRI/CT scan, specialist reports, caloric and hearing tests, and any other appropriate documents. Also, bring a list of your medication as some medication can cause dizziness. A complete vestibular, or dizziness, the assessment will take 45-60 minutes. The assessment includes a series of eye-head movements and some positioning maneuvers. You may feel dizzy or nauseated for some time after the appointment. It is recommended that you arrange for someone to drive you home following your appointment.

Please do not smoke ONE HOUR prior to your appointment since this may affect the quality of the assessment. If you have been taking over the counter medication such as Gravol or have been prescribed medication for dizziness, continue taking them unless you can manage a few hours without medication.  There is no evidence that taking medication such as Serc or Gravol significantly changes the findings of the assessment.

We ask that you do not take any nonessential medications for a period of 48 hours before your appointment time and that you avoid the following:

• • Sleeping pills
  • Tranquilizers
  • Narcotics
  • Alcoholic beverages

Do not discontinue medications for blood pressure control, cardiac or circulatory problems, diabetes or other medications for similar medical disorders.

Also,

• Do not eat or drink anything for a period of three hours before the time of the test
• Do not wear eye make-up on the day of the test.

Be sure to inform your therapist if you have had any neck pain, severe neck arthritis, heart condition or any recent surgery.

After the exam and once a diagnosis has been determined, there may be multiple treatment options available. If it is determined that you will benefit from vestibular physiotherapy, a treatment plan will be discussed with you. You may be referred for more testing or a specialist. Vestibular physiotherapy has been proven effective for most inner ear related dizziness and balance disorders.

What happens on the day of your vestibular assessment? Read more detail…

On the day of your assessment, we take a comprehensive relevant medical history and then perform a clinical exam.  Dizziness is a symptom and could have many different causes. Our scope of practice is to manage dizziness caused by inner ear disorders. During your assessment, we rule out other possible causes for your dizziness and may refer you back to your GP or a specialist for more tests.

During our assessment, a great deal of information is obtained by observing your eye movements. Vestibular disorders cause the eye movement to change since the vestibular system and eye reflexes have a direct connection. This eye movement is called “Nystagmus”.  Depending on the pattern, direction, intensity, and duration of Nystamus, a trained vestibular physiotherapist can identify the existing problem and then choose proper treatment maneuver or technique.

In acute vertigo, Nystagmus is very strong and most of the times, this eye movement can be observed with naked eyes. In more chronic condition, Nystagmus or other pathological eye movements may not be easily visible. For a comprehensive assessment, we use Infrared goggle technology to observe & record eye movement and provide more accurate reading and therefore a better diagnosis.

Physiomobility is one of only a very few clinics in Toronto that provides research-based assessment and treatment for vestibular disorders by trained vestibular physiotherapists, using Infrared goggle technology.

Based on the findings of the assessment, specific goals for the patient are developed, a treatment plan is devised and the rehabilitation program and the journey to recovery begins.

What is Vestibular Rehabilitation Therapy (VRT)?

Vestibular Rehabilitation is an exercise approach using movement. In summary, the goal of a VRT program is to:

• Decrease or eliminate dizziness & vertigo
• Improve balance
• Improve the visual control which impacts balance and dizziness
• Increase tolerance of movement or decrease motion sensitivity
• Reduce the risk of falling
• Improve reflexes and sensory organization
• Improve safety
• Decrease anxiety related to dizziness

Depending on the findings of the assessment, the treatment plan may include manual therapy, repositioning maneuvers such as Epley Maneuver, rehabilitation exercises and education combined with a home exercise program.

In the majority of patients, a Vestibular Rehabilitation Therapy (VRT) is necessary. For BPPV or vertigo patients this may be just a few sessions and a few short weeks of treatment. Most of the exercises will be performed at home and there is more focus on education and self-management. However, for more chronic dizziness disorders or patients with vestibular hypofunction or more complex conditions, the treatment program is more frequent and longer. Vestibular Rehabilitation is a specific individualized exercise-based program to promote the brain’s compensation for inner ear deficits such as reduced inner ear function on one or both sides (referred to as Vestibular Hypofunction) and other conditions listed above. The success rate of vestibular rehabilitation is very high (on average 85%) to a point that even individuals with long-term unresolved inner ear disorders and balance concerns who have undergone a period of medical management with little or no success may benefit from it. Vestibular rehabilitation is highly effective in acute episodes of dizziness such as BPPV, it is drug-free and cost-effective and significantly improves patient’s quality of life. Not every dizzy symptom is related to inner ear problems. Patients struggling with imbalance will benefit from the balance retraining component of the program. Many orthopedic and neurological conditions and even vision changes can affect balance.

Dizziness and balance disorders can be debilitating and frustrating. Having problems with dizziness and balance can limit driving, working, sports, walking, or simply getting out of bed. A large portion of the population suffers from dizziness at some time in life. If you are experiencing any of these problems, we are here to help.

The Dizziness and Balance Program is designed to address balance, dizziness, and gait (walking pattern) to improve our patients walking and daily function and to prevent falls. The program provides vestibular physiotherapy and rehabilitation to decrease dizziness, increase confidence and lower anxiety. It also utilizes traditional exercise therapies to strengthen lower extremities and core muscles and improve mobility and posture.

Do I benefit from vestibular rehabilitation and balance retraining?

Any person suffering from vertigo, dizziness, unsteadiness, and imbalance who has not recovered completely within 3-4 weeks after the onset of the symptoms will benefit from Vestibular Rehabilitation Therapy (VRT).

After an acute onset of BPPV or vertigo, people may slow down due to fear of movement. This will cause less stimulation for the vestibular system and may result in vestibular weakness. Although in the majority of BPPV patients symptoms resolve almost completely, it is advisable to participate in a few VRT sessions as part of vertigo treatment to introduce movements to prevent vestibular weakness.

How often do I need Vestibular Rehabilitation Therapy (VRT)?

Typically, a VRT program is less frequent and a longer period of treatment. There is a huge reliance on home exercise program and patients are usually on an outpatient basis once every 1-2 weeks. Patients are encouraged to do their home exercise program a few times during the day and participate in walking and light strengthening exercise programs. The vestibular exercise programs are upgraded as appropriate and are designed with the patient’s function and life and job demands in mind addressing the specific problems and goals of the individual patient.

How effective is Vestibular Rehabilitation Therapy (VRT)?

The Vestibular Rehabilitation Therapy program is very effective. Below report represents the diagnosis outcome of Atlanta Ear Clinic:

Benign Positional Vertigo 95% (N=10,000 patients)

Vestibular neuritis 75% (N=1,500 patients)

Disequilibrium of Aging 85% (N=500, includes fall reduction)

Labyrinthine concussion 90% (dizziness) 75% (imbalance)

(N=400 patients)

Acoustic neuroma 90% (N=100 patients)

Ototoxicity 60% (N=45 patients)

What does a typical Vestibular Rehabilitation Therapy (VRT) program look like?

A typical Vestibular Rehabilitation Therapy (VRT) program includes re-positioning maneuvers for BPPV to eliminate vertigo symptoms and progressive exercise programs tailored to each patient’s symptoms as well as education.

The exercises are very specific and although they are simple movements but are very effective when they are prescribed with the appropriate frequency, speed, distance, and level of complexity. A physiotherapist trained in Vestibular Rehabilitation is one of the most qualified medical practitioners in a vestibular care team.

Canalith Re-positioning Maneuvers for BPPV:

Have you heard of Epley maneuver? It is one of the most applied Canalith Re-positioning maneuvers for vertigo. A re-positioning maneuver involves moving patient’s head in a sequence of positions for certain period of time to move the calcium particles or otoconia in the inner ear canals and re-position them into the proper place in the inner ear where they belong. These maneuvers are designed based on the anatomy of semi-circular canals in the inner ear and use the gravity and some movement to move the particles. This procedure is very effective (up to 95%) in eliminating vertigo and usually, only 1-4 visits are required.

Do I need Epley Maneuver?

Approximately half of all patients whom we treat at our clinic are diagnosed with BPPV (Benign Paroxysmal Positional Vertigo) or vertigo. As the name suggests, this is a mechanical disorder which is caused by the displacement of calcium carbonate crystals in the vestibular canals in the inner ear. This crystal displacement can occur in different canals and therefore different manoeuvers may be used to re-position the crystals. Epley or modified Epley are frequently performed successfully by our therapists. An accurate assessment determines the necessity and form of a re-positioning maneuver.  Different re-positioning maneuvers such as Epley, Semont, Gufoni are only a few of the re-positioning techniques and each is indicated for a specifically involved canal and a certain form of BPPV. Not every dizziness disorder requires re-positioning or Epley.

Vestibular habituation or adaptation exercises:

Patients who have experienced an acute onset of BPPV or other conditions causing dizziness and continue to be sensitive to movement require habituation or adaptation exercises which are specific movements in specific patterns, frequency, and range to stimulate the brain until the brain habituates the response. In simple terms, we challenge the brain and progressively improve the connection between the brain and the inner ear with specific exercises that are tailored to each patient to habituate to the movement or learn how to process the conflicting information it receives from the inner ear.

This is necessary to stimulate the remaining sensory and movement systems to not only increase their activity but to compensate for the loss of vestibular function if the loss is irreversible.

Visual motor exercises:

The nerves from the inner ear (vestibular nerve) have a connection to visual and balance centers in the brain. When the vestibular system is conflicted, this can affect the person’s ability to maintain their gaze and focus. Majority of patients with dizziness experience this dysfunction. A series of visual and head movement exercises are given to patients to stabilize their gaze and improve head-eye movement co-ordination.

Balance retraining exercises:

Balance exercises are designed to improve muscle responses to postural changes, improve sensory-motor integration and coordinate and improve the brain’s information processing for the stimulation received from eyes, ears and joints and muscles. In addition, body weight strengthening, core, and postural muscle strengthening are included.

Physiomobility’s Dizziness & Balance Exercise Program