What Happens During a Vestibular Physiotherapy Evaluation?

One of the most common questions that I get from potential patients who call the clinic is “What can I expect to happen during my assessment for dizziness or vertigo?”, closely followed by “Will I be more dizzy after my assessment?”. In this article, I’ll try to demystify what goes on in my office during a vertigo or dizziness assessment.

The Subjective Assessment

We’ll start by sitting down and having a discussion about what exactly brought you into my office. I’ll ask you some detailed questions about your symptoms (vertigo vs. dizziness), the time course of your problem, what brought it on, how long it’s been going on for and more.I’ll also ask some questions about your overall health as well as your daily habits. I’ll ask lots of questions, some of which might feel a little repetitive.

All of the questions that I ask during the first step of the assessment will help me decide how I will structure my physical exam, and which parts of the physical exam should be prioritized. Every case of vertigo or dizziness is different, and different tests can tease out exactly what the problem might be. The more information that I have before starting the physical exam, the more I can tailor that exam to be specific to your needs.

The Neurological Assessment – Ruling out Red Flags

The first part of the assessment for EVERY case of vertigo or dizziness that I assess is a detailed neurological scan. The goal of the neuro exam is to make sure that a physiotherapist’s office is the right place for you, and to rule out any other major serious issues that could be causing your symptoms. Doing the neuro scan, which might seem redundant if you;ve already seen a doctor, is an important part of the assessment, making sure that we aren’t missing a potentially serious issue.

The Physical Exam

Depending on what your symptoms are, the physical exam will vary a little patient to patient. 

We will normally check 3 things: positional testing, balance testing, and vestibular function testing.

Step 1: Positional Testing

Positional testing involves having the patient sit on the bed and quickly change positions with the head placed in a specific way. During positional testing, we will observe the patient’s eyes for characteristic eye movements called “nystagmus”, the characteristics of which can help us determine our clinical diagnosis. 

At Physiothérapie Avantex, we use infra-red goggles during our vestibular assessments. Infra-red goggles allow us to record the eyes during positional and other tests, and greatly help with diagnostic accuracy. You can learn more about infra-red goggles by checking out vestibularfirst.com , our supplier for infra-red goggles.

Step 2: Vestibular Function Testing

After positional testing, we will often do vestibular function testing, again to help us determine what exactly the issue is. Vestibular function testing can include gently shaking the head and observing for nystagmus, asking the patient to read an eye chart while their head is in motion, or having the patient sit on a slowly rotating chair while observing the eyes for nystagmus.

Step 3: Balance and Gait Testing

The last step of the physical assessment is often balance and gait testing. This involves asking the patient to stand with the feet in various different positions, or on different surfaces and observing how well and for how long they can keep their balance. 

It can also involve tests like walking on a straight line, walking backwards or forwards, or walking with eyes closed.  The goal of balance and gait testing to gain an idea of what the client’s functional deficits are, and how their vestibular problem may put them at risk of falls.

Step 4: Creating A Clinical Diagnosis, Educating the Patient and Prescribing Exercises

Once the evaluation has been completed, the physiotherapist will take a moment to synthesize all the findings and come to a clinical diagnosis. Basically, I will look at all the tests that we did and try to come to a conclusion regarding what is causing your symptoms and what we need to do to improve them.

If you are found to have benign paroxysmal positional vertigo (BPPV or ear crystals), the treatment will consist of particle repositioning maneuvers such as the Epley. If you have been diagnosed with a problem like vestibular migraine, unilateral or bilateral hypofunction, vestibular neuritis or one of the many other myriade vestibular problems that exist, you will be taught an exercise program and educated on self-management techniques specific to your diagnosis and clinical findings.

Conclusion

Disclaimer: a vestibular assessment is not always pleasant. Yes, we need to move you around and push your limits a little to find out exactly what provoked your dizziness. This is the first step on the path to getting better. 

Please rest assured that the therapists at Physiothérapie Avantex will always communicate with you and will NEVER force you to do any test or exercise that you don’t want to do. We recognise that vertigo and dizziness are very unpleasant symptoms, and we do all we can to minimize any discomfort or anxiety that the assessment might cause.

If you have any other questions about what we do during an assessment, or whether vestibular physiotherapy is right for you, please reach out to us by phone or email. We would be happy to answer any questions and put your mind at ease!