Info & Booking: 0447 201 763
An Initial Vestibular Assessment is up to 90 mins and consists of:
Learn in detail about each step of the initial assessment process.
A vestibular review up to 60 mins long and consists of:
Learn in detail about vestibular reviews.
Sydney Mobile Vertigo Clinic has invested in advanced, purpose designed infrared goggles produced by Vesticam to improve vestibular assessments and patient outcomes. The use of infrared goggles in vestibular management is considered the "Gold Standard" by vestibular professionals.
Learn more about why infrared goggles are so important by reading the "Initial Vestibular Assessment" section and the "Advanced Vestibular Equipment" section below.
Neil has experience providing general physiotherapy services since 2016 is proficient in managing a wide range of common and complex musculoskeletal and neurological conditions.
Neil is also familiar with how to navigate a wide range of funding instruments including NDIS, Workcover & CTP, Medicare, and private healthcare funds.
Please contact us to discuss a general physiotherapy inquiry.
After booking, there are a few steps you can take to ensure the consultation goes smoothly:
The consultation begins with a detailed discussion about the quality of your symptoms of dizziness, imbalance, or vertigo. This information is very important and will enable Neil to form hypotheses about the cause of your symptoms.
Questions Neil will ask you about your symptoms include:
It is extremely important the vestibular objective examination is conducted by a qualified, skilled, and experienced clinician with the correct equipment. The objective examination is so important because one of the primary aims of the assessment is to investigate if your symptoms are originating from the brain - which may require an urgent medical consultation.
Neil will conduct a series of tests, many of which appear to be eye exams, to assess your brain and its function. This is because "the eyes are the window to the brain," meaning various eye behaviors can give information about the condition of the brain. Additionally, the vestibular organ has a reflex that controls eye movement during head movements, so other tests of eye behaviors investigate this reflex performance.
However, observing eye movements accurately is very challenging as crucially important eye movements may only be a few millimeters and occur in fractions of a second. To complicate matters further, some abnormal eye behaviors are reduced and can become unobservable simply by the patient focusing their vision. Therefore, it is possible for a clinician to fail to identify signs of abnormal brain function and fail to refer the patient for appropriate medical consultation.
This is the reason infrared goggles are so important for accurate testing and are considered the "Gold Standard" in vestibular assessment. Infrared goggles block your vision and your ability to focus which ensures any abnormal eye movements are detected. Your eyes are observed in the dark by infrared cameras and are enlarged on a computer screen for the clinician to observe in real time. Recording provides the ability to review results enabling Neil to interpret them more accurately.
After the brain is assessed for abnormalities and the vestibular reflexes to the eyes are examined, positional testing of the head may be indicated. It remains optimal to perform positional testing with infrared goggles due to the improvements in diagnostic accuracy and thus treatment efficacy.
The purpose of positional testing is to place the vestibular organ in different orientations to test for a common condition called Benign Paroxysmal Positional Vertigo (BPPV). This condition occurs when there is loose debris present in the semicircular canals of the vestibular organ. The loose debris moves with different head positions causing the eyes to flicker (called "nystagmus") which gives you vertigo - a visual illusion of the world spinning or moving.
Infrared goggles enable Neil to determine which of the 6 semicircular canals the debris is located inside based upon the directions of the eye flickers produced by different positions. He can then treat BPPV with debris repositioning manoeuvres to clear the canals. Epley manoeuvres are used for the canals that are most often affected - but an Epley is not always the correct BPPV treatment manoeuvres. For example, an Epley will not treat a horizontal canal and will only provoke symptoms.
Occasionally, reporting to your GP that BPPV is not responsible for the symptoms you are experiencing is an invaluable part of informing the next steps of the medical diagnostic process.
Finally, functional balance is assessed while standing, walking, and navigating your environment. Neil will choose balance tests that are appropriate for your current symptoms and abilities.
There are 3 sensory systems that comprise our sense of balance:
The aim of balance assessments is to evaluate your overall sense of balance and to investigate each one of the individual sensory systems in order to determine if one area is under performing. This is accomplished by modifying variables of balance such as your base of support, the ground texture, the ability to see, adding head movements, turning and changing directions, stepping over obstacles, or adding a second mental or physical task while balancing.
Identifying the specific areas of balance that need improvement allows Neil to prescribe an individualized and targeted Vestibular Rehabilitation Therapy ( VRT) program customized for each patient.
Neil will combine the information gathered during the subjective and objective assessments to form a diagnostic impression. He will take the time to explain his impression to you in detail so you understand his clinical reasoning and the evidence he found during his consultation that supports that diagnosis.
To explain the diagnosis, Neil uses anatomical models to provide education about:
After explaining his diagnostic impression, Neil will explain the scientific, evidence based management recommendations and options for your condition. He also will provide educational handouts from reputable institutions and sources so you have reference material about managing your condition you can trust.
In instances of complex presentations where a vestibular diagnosis is unclear, Neil may recommend returning to your GP for further medical consultation or to discuss a referral to a specialist such as an ENT (ear, nose, throat) or a neurologist. Neil will be happy to write a letter to your GP explaining his impression and why a specialist referral may be indicated.
Appropriate vestibular treatment varies widely depending on the vestibular diagnosis.
For example, BPPV is treated with repositioning manoeuvres. In exceptional cases a single treatment may be effective but on average it takes about 3 treatment sessions to treat BPPV.
Many other vestibular conditions require several months of Vestibular Rehabilitation Therapy (VRT) exercises that are individualized to each patient and progressed in order to improve their function and independence.
Some conditions involving permanent deficits require effective substitution exercises and strategies to improve function.
After providing an initial assessment and treatment, it is strongly recommended to rebook a review so Neil may provide the highest standard of care with appropriate follow up reassessment, treatment, and management advice.
The amount of time until a vestibular review is clinically indicated is dependent upon the condition being treated and varies from a couple days to several weeks.
With your consent, Neil is happy to send a report to your GP explaining his assessments findings, his diagnostic impression, his management plan, and any suggested next steps to consider.
A vestibular review is usually much more straight forward than an initial assessment as a diagnosis has typically been established which allows the session to focus on treatment.
The aim of a vestibular review is to:
The use of infrared goggles in vestibular assessment is considered the "Gold Standard" by vestibular professionals.
The reason infrared goggles are so important for vestibular assessment is because some abnormal eye behaviors are reduced and can become unobservable simply by the patient focusing their vision. Infrared goggles block your vision so you are unable to focus which ensures any abnormal eye movements are observable to the clinician through the infrared cameras.
This improves the clinicians accuracy when examining the brain for signs of serious dysfunction that may require urgent medical consultation. It also improves accuracy when diagnosing vestibular disorders which means more effective treatment.
Vesticam is an Australian company founded by Suzanne Douglas, a leading vestibular clinician in Australia. Over the course of her extensive vestibular career, Suzanne recognized the need for portable video goggles to improve clinician and patient outcomes. She researched and developed her Vesticam googles for over 2 years and the first models launched in 2018. She continues to refine, upgrade, and support her products to ensure she offers the best equipment for vestibular healthcare.
Please visit the Vetsticam website to learn more about Suzanne's mission to improve vestibular healthcare with her extensive knowledge and products.
Illawarra Vertigo Clinic has ceased offering services in the Illawarra but has relaunched to serve the Greater Sydney Area as the Sydney Mobile Vertigo Clinic.
Appointments in Sydney available Feb 1st, 2025!