Advanced Vestibular Rehabilitation

“When we first get into space, we feel sick. Your body is really confused. You’re dizzy. Your lunch is floating around in your belly because you’re floating.  What you see doesn’t match what you feel, and you want to throw up.”

Chris Hadfield, Astronaut


Advanced Vestibular Rehab Therapists

Dr Tyler Fletcher, DC

Elizabeth Shannon, PT

If you’re suffering from dizziness, vertigo or imbalance as a result of a head injury, viral infection, inner ear disorder, neurological disorder or sports-related injury and you’re searching for relief, you may benefit from vestibular rehabilitation. Using evidence-based assessment and treatment techniques, our knowledgeable and experienced healthcare providers can help you return to your normal activities sooner. Our team will complete an assessment and develop an individualized treatment plan that is designed around your specific needs and goals for the best possible outcome. We will also maintain ongoing communication with your physician and obtain the necessary medical clearance for your safe return to activity or sport.

In addition to developing and implementing a personalized vestibular rehabilitation treatment plan that meets your needs, we provide continuous evaluation and ongoing education every step of the way. We will work closely with you to progressively improve your cognitive-mental and physical functions and adjust treatment as needed for optimal results.

Vestibular Rehabilitation

You’ve come to the right place. We are experts in the assessment and treatment of vertigo, concussion, BPPV and other dizziness disorders.

Cobblestone’s highly regarded Dizziness Clinic, has been helping thousands of patients recover successfully since 2011. We are proud to be the clinic of choice for many hospitals, specialists (otolaryngologists and neurologists), medical practices, and other physiotherapists throughout the Brant County Area. Our registered physiotherapists and chiropractors have undergo extensive training and continuing education and are experienced in treating especially complex vestibular disorders.

We have physiotherapists and chiropractors – Certified in Vestibular Rehabilitation.
We can help.

We offer Vestibular Rehabilitation Therapy (VRT or VBRT) throughout Brant County and surrounding area!


Your vestibular system and your eyes have a direct connection with each other. Problems with your vestibular system can result in changes to your eye reflexes, producing abnormal eye motion (called Nystagmus). Closely examining these nystagmus patterns of your eyes allows us to perform a more detailed assessment resulting in a more accurate diagnosis.

Vertigo and dizziness symptoms most often area a result of a dysfunction of the vestibular organ, which is a small but important structure in your inner ear. The vestibular organ is critical for balance, coordination, and movement and when it’s impaired, patients can experience spinning (vertigo), dizziness, nausea, imbalance, problems with vision, and light-headedness, anxiety, among other often debilitating symptoms.

Dizziness and vertigo are among the most common symptoms that send people to see doctors. After negative MRI and CT scans, patients are often prescribed medication that is of little help and sent to specialists, only to be told nothing can really be done.

Dizziness Clinic appointments in hospitals currently have wait times of several months. At Cobblestone we’ve successfully treated vestibular disorders since 2011, helping hundreds of patients each year.  We have vestibular physiotherapists and chiropractors certified. While our assessment procedures and treatment protocols are generally similar to those in hospital programs, and are based upon clinical and medical evidence, our wait times are significantly shorter — which means you can get better, faster.

We provide assessment and treatment for the following:

What we do.

Initial visits are one-hour, where we take a comprehensive history and perform a complete clinical assessment. Symptoms of dizziness can be from dozens of various pathologies, so special care is taken to rule out non-vestibular causes first.

The physical assessment involves a series of manual and functional tests to categorize the type of dizziness you’re experiencing. We then use special infrared goggle technology, which has been clinically demonstrated to be one of the most accurate ways to assess vestibular dysfunction. This involves recorded observation of irregular eye movement — which is physiologically linked to impaired vestibular function — and we create a treatment plan based on the results of the assessment.

What does Vestibular Rehabilitation Therapy (VRT) involve?

While treatment depends on our findings, it can involve education, manual therapy or head manoeuvres, a patient-specific exercise program, or a combination of these strategies. Certain types of vestibular disorders can resolve in 2-3 visits, whereas other types require more time and include a home exercise program.

Our assessment and treatment protocols are based upon sound evidence-based research and clinically proven techniques, and are customized for each patient.

What about the Epley manoeuvre?

Approximately half of all patients we assess receive a diagnosis of BPPV (Benign Paroxysmal Positional Vertigo), which is caused by calcium carbonate crystal displacement in the inner ear.  Certain types of BPPV can be successfully corrected using the Epley manoeuvre, which we perform often. However, BPPV exists in several different forms with each requiring different manoeuvres, determined by an accurate clinical assessment. We recommend if you perform your own Epley manoeuvre to do so with caution, as you can change a simple vestibular impairment into a more complicated one.  See our post on the Epley as a home treatment.

What do I need to know about my appointment?

Please arrive 15 minutes ahead of your appointment to complete the necessary intake forms, and bring any relevant medical documents with you — MRI/CT scan reports, specialist reports, caloric and hearing tests, and any other appropriate papers.

Vestibular GogglesOur assessment includes a thorough examination of your vestibulo-ocular reflex, where we look for evidence of irregular eye movement.  If you capture any of this irregular eye movement using your smart-phone at home, please bring the video as it can help with a more accurate assessment.

We ask that you not smoke ONE HOUR prior to your appointment, as this may affect the quality of the assessment.  If you’re currently on medications (including Gravol) to treat your dizziness, please continue taking it as prescribed by your doctor.

The assessment procedures do reproduce your symptoms, so you will likely experience an increase in dizziness and/or nausea following your first visit. Most patients are able to drive, return to work, and function normally following the assessment. However, if your symptoms are already quite acute, or if you don’t feel comfortable having them provoked, you may wish to have someone accompany you to the appointment.

Does insurance cover vestibular services?

At Cobblestone Medicine and Rehab Centre, registered physiotherapists and chiropractors perform our vestibular services. If you have extended health benefits for physiotherapy and/or chiropractic, your vestibular visits will be based on this coverage.

— Unsure if vestibular rehabilitation is right for you? —
Take advantage of our 10 min complimentary phone consult at (519) 442-2237.

vestib organ

Your personalized assessment may include:

  • Dizziness questionnaire
  • Posture analysis
  • Joint range of motion measurement
  • Balance testing in sitting and standing
  • Patterns of movement evaluation
  • Positional movement testing
  • Gait assessment
  • Fall risk assessment
  • Oculomotor function using videonystagmography
  • Medical history as it pertains to the condition
  • Neurological screening including coordination, sensation and proprioception

Treatments may include:

  • Habitual exercises
  • Education
  • Balance retraining (static and dynamic retraining)
  • Stretching
  • Gait retraining
  • Relaxation
  • Gaze stability exercises
  • Adaptation exercises (eye-hand coordination exercises)
  • Paroxysmal Positional Vertigo (PPV)

Can help the following conditions:

  • BPPV
  • Unilateral Vestibular Hypofunctioning
  • Bilateral vestibular hypofunctioning
  • Menieres Disease
  • Fistula/ Superior Canal Dehiscence – post surgery
  • Vestibular Schwannoma
  • Stroke
  • Concussion and head traumas
  • Vestibular Migraines
  • Persistant Postural Perceptual Dizziness (PPPD)