Tag Archives: Concussion Management Mississauga


Benign paroxysmal positional vertigo(BPPV)


Vestibular Systems
• Comprises five sensory organs that provide your brain with information about head position and movements including head rotation, linear movements and static positions of the head relative to gravity
• Five sensory organs including 3 semicircular canals and 2 otoliths


BPPV is a mechanical problem in the inner ear. It occurs when some of the  crystals that are normally embaded in gel in the ear become dislodged.  They then can move into one or more of the 3-fluid filled semicircular canals.

Benign paroxysmal positional vertigo(BPPV) is  one  of the most common causes of vertigo. It creates a false sensation of spinning.
• Benign: it is not life threatening
• Paroxysmal: it comes in sudden, brief spells
• Positional: it gets triggered by certain head positions or movements
• Vertigo: a false sensation of rotational movement


a)      Dizziness
b)      Vertigo (sensation of spinning)
c)       Nausea
d)      Sense of imbalance or unsteadiness
e)      Poor gaze stability
f)       Vision disturbance

Visual Coordination screening



• The relationship between the inner ears and the eye muscles are what normally allows us to stay focused on our environment while the head is moving.  The dislodged crystals make the brain think you are moving when  you are not. This mistakenly causes the eyes to move, which makes it look like the room is spinning. This is called Nystagmus.

• The Nystagmus will have different characteristics that allow the practitioner to identify which ear the displaced crystals are in and which canal is involved.
• The most common tests are DIX hall pike and Roll test.
• There are two types of  BBPV.  One type, where the loose crystals can move freely in the fluid of the canal(canalithiasis). The more rare type is one where the crystals are thought to be hung up on the bundle of nerves that sense the fluid movement(cupulolithiasis).

Physiotherapy Treatment
• One maneuver that is used for the most common location and type of BPPV is called the Epley maneuver. However , that will not work for all people . Often people have tried the Epley maneuver themselves or had it performed on them without success.
• In the vast majority cases, BPPV can be corrected mechanically by a Registered Physiotherapist. Once your  provider knows which canal is involved and what type it is , we can take you through the appropriate treatment maneuver.

Check out this video for an example of the  Epley Maneuver.  Please do not attempt this yourself until you have been properly assessed and screened by one of our Registered Physiotherapists to see if this maneuver will be appropriate for your condition!

If you have any further questions, please call PhysioNow today! Our experienced Vestibular Physiotherapists would be happy to help you.

Baseline Testing Concussions

Baseline Testing

Why is baseline testing Concussions important?

There are no  special tests to diagnose and gauge the severity of concussions.  Athletes are recommended to undergo baseline testing before the beginning of the sports season. Baseline test results are helpful  for most healthcare professionals  involved in an athlete’s concussion care. This includes Physiotherapists, Physicians, Concussion Specialists, and Vision Therapists.  Baseline tests let the Physiotherapist compare the before injury  function to the results of post concussion baseline testing. It’s a great tool  to measure the severity of concussions.  It helps therapists to make  treatment goals.  Safe return to sports following concussions can be determined with this tool.


Components of Baseline testing  Concussions


  • Impact Test, This is the gold standard test.  It  looks at different functions of your brain before and after concussion. It is a computer based test. It usually takes about 30 minutes. The test assesses your ability to process information, and remember things.  It also tests how quickly you can follow  instructions/tasks. It’s the most scientifically validated test and recently got approved by the FDA.


  • Visual Coordination screening 
    Visual Coordination screening
     Following concussion, functioning of the visual system  is greatly affected. This involves the eyes and part of the brain that processes visual information.   Correct vision and clarity of  vision is not affected. However, the ability of your eyes to move together is affected. This usually leads to symptoms like dizziness, difficulty focussing,  and headaches. Testing the visual system before the sports season provides valuable information about the function of the visual system.  It allows for treatment of any problems.


  • Balance and Postural stability– With Post-concussive injury, both static and dynamic balance is affected. You can feel dizzy with standing, change in position or with certain movements. Most sports require an intact balance system to improve performance.


Registered Physiotherapists at PhysioNow are trained to conduct baseline testing before the beginning of  the sports season and following concussive injury. Registered Physiotherapists at Mississauga are skilled to assess any deficits in your baseline testing and treat them. Visual coordination exercises  will be done to help you  return to sports faster .

Please call today to get your baseline testing done or to treat your concussion.