Concussion & Vestibular Rehabilitation
Initial Consult (55 mins) $120
Follow up (40 mins) $80
A Concussion is a mild traumatic brain injury that typically occurs through a rapid head acceleration/deceleration. Concussions generally resolve on their own and often do not require any other extra care than is provided by your family physician. However, for some people, they may need help with balance issues, ongoing dizziness and visual concerns.
If you are not improving after a few weeks of following a return to learn/activity 'step' program, you will likely benefit from further assessment and management from a physiotherapist that is trained on concussion and vestibular/occulomotor management.
Physiotherapy management will start with a thorough assessment of your vestibular, occulomotor, cognitive, balance and musculoskeletal systems. Treatment may include soft tissue/hands-on work for your neck, habituation excercises for motion/visual sensitivity or exercises to improve your balance. The initial assessment takes approximately 60 minutes, it is normal to feel slight aggravation of your symptoms following the assessment. We suggest having a driver to take you home if possible.
For patients with long standing post concussion syndrome, a thorough assessment by one of our staff will help determine the ongoing issues (vestibular, ocular, cervicogenic, psychological, cognitive, physiological) and direct care. Some of the findings may warrant you working with other health care professionals for the best care and treatment outcomes (councillors, psychologists, occupational therapists, neuropsychologists, medical specialists), we can provide a report for your GP and also have connections to many good clinicians in the community that we work closely with.
The vestibular system includes the inner ear and brain that process the sensory information involved with controlling balance and eye movements. If you have a disease, disorder or injury that affects these areas, vestibular disorders can occur. Vestibular disorders can be a result of, or be worsened by genetic or environmental conditions, or occur for unknown reasons.
The most commonly diagnosed vestibular disorders include benign paroxysmal positional vertigo (BPPV), labyrinthitis and vestibular neuritis, Ménière’s disease, secondary endolymphatic hydrops, and perilymph fistula. Vestibular disorders also include superior canal dehiscence, acoustic neuroma, ototoxicity, enlarged vestibular aqueduct syndrome, and mal de débarquement. Other problems related to vestibular dysfunction include vestibular migraine and complications from autoimmune disorders and allergies.
Vestibular rehabilitation (VR), or vestibular rehabilitation therapy (VRT) is a specialized form of therapy intended to alleviate both the primary and secondary problems caused by vestibular disorders. It is an exercise-based program primarily designed to reduce vertigo and dizziness, gaze instability, and/or imbalance and falls. For most people with a vestibular disorder the deficit is permanent because the amount of restoration of vestibular function is very small. However, after vestibular system damage, people can feel better and function can return through compensation. This occurs because the brain learns to use other senses (vision and somatosensory, i.e. body sense) to substitute for the deficient vestibular system. The health of particular parts of the nervous system (brainstem and cerebellum, visual, and somatosensory sensations) is important in determining the extent of recovery that can be gained through compensation.
Vestibular Rehabilitation is provided by Roly and Farron who are both Certified Vestibular Therapists through Emory University in Atlanta, members of the Vestibular Disorders Association and sit on the Board of Directors for the BC Balance and Dizziness Society. While many physiotherapists attend introductory weekend courses and offer ‘vestibular services’, only those that are Certified through Emory University have thorough training and are required to pass an intensive examination process. Both Roly and Farron utilize infrared goggles for assessment purposes to gain a more detailed exmaination of your eye movements. This is important in the assessment process to help determine peripheral vs central causes of dizziness and vertigo. Unfortunately, we’ve seen many patients treated for incorrect vestibular conditions. Feel free to ask your local therapists where they received their training and if they are certified.
What to expect: The initial assessment is about 55 minutes. It is normal to feel a little unwell and nauseous after the assessment, we therefore suggest having a driver if at all possible, or allowing time after the assessment before you drive home. Some conditions can be treated right there and then, but the majority of vestibular disorders require exercises and time, in order for your systems to adapt. Exercises are normally given in a follow up appointment (when your symptoms have settled from the assessment) where we dedicate time to teaching you the correct techniques. Most patients will not need to attend that frequently and are given exercises to do at home and monitored every 2-4 weeks. Depending on how quickly you progress, the number of visits could vary from 4-10.