What You Need to Know About Vestibular Therapy for Your Child
Has your child been experiencing vertigo? Or have they had a sudden onset of dizziness and you aren’t really sure who they should see about it? If you notice that your child is clumsier than their friends or they were slower than expected with reaching their motor milestones, a vestibular issue may be the cause.
Maybe you’ve had someone tell you to take your child to a vestibular physiotherapist so you want to know what is vestibular therapy or how do I find a vestibular therapist near me?
I’ll go over what you need to know about vestibular therapy for your child so you feel confident looking for a vestibular therapist for help and know what to expect when you get there!
I’ll cover the following topics:
What are common symptoms when a child has a vestibular issue?
What diagnoses are treated with vestibular therapy for children?
Do you have any resources that may help a child with a vestibular disorder?
What is vestibular therapy for kids?
Pediatric vestibular physiotherapy is an area of rehabilitation that focuses on the assessment and treatment of conditions that cause dizziness, vertigo, and balance disorders in children. When looking for clinics that provide this service you may also find this area of treatment called vestibular rehabilitation for kids, vestibular rehabilitation therapy (VRT) for kids, or vestibular therapy for kids.
Depending on the type of vestibular disorder being treated, vestibular therapy for children could include:
treatment maneuvers to help resolve the cause of the symptoms of benign paroxysmal positional vertigo or BPPV
manual therapy techniques (in the case of cervicogenic dizziness or post-concussion treatment)
an active exercise-based program focused on addressing balance deficits, movement and positional sensitivity (habituation), and/or retraining to improve function (adaptation/compensation)
What is a vestibular therapist?
A vestibular therapist is a healthcare professional that has completed additional training to learn about the assessment and treatment of central and peripheral (inner ear) vestibular disorders. Vestibular therapists (including vestibular physiotherapists) are highly skilled at diagnosing vestibular conditions by analyzing vestibular therapy assessment results. A vestibular therapist will work with your family to get a plan together for the next best steps in helping your child feel better.
There are no minimum educational requirements for a healthcare professional to call themselves a vestibular therapist or to say they provide vestibular rehabilitation. When booking in with a vestibular therapist, inquire about their training and how long they have been providing vestibular therapy services for. This is especially important if your child has experienced very complex symptoms.
At Wave Physiotherapy, Sharon-anne Graham is a vestibular physiotherapist who has been working with the vestibular population for over 8 years. She has continued to take additional training in vestibular rehabilitation to stay up-to-date on the latest research evidence. Learn more about Sharon-anne.
What exactly is the vestibular system?
Typically when the vestibular system is mentioned most folks are talking about the vestibulocochlear organ (aka the inner ear, peripheral vestibular system, or labyrinth). The vestibulocochlear organ is located in the temporal bone at the side of the skull. It is made up of two parts: the hearing organ (cochlea) and the vestibular organ (semicircular canals and vestibule). Each part of the labyrinth have their own nerve output (aka the cochlear nerve and the vestibular nerve) which send information to the brain.
The vestibular organ contains two types of sensors:
three semi-circular canals (the anterior canal, posterior canal and horizontal canal) which sense rotational movement of the head
two otolithic organs (the utricle and the saccule) within the vestibule which sense linear movement of the head and gravitational forces
The sensors of the vestibular organ pick up when we are speeding up and slowing down (acceleration) but are at rest when we are still and when we are moving at a constant speed.
Information from the peripheral vestibular system is sent to and processed by numerous parts of the brain. These areas/connections are considered the central vestibular system.
A great article with further information about the peripheral nervous system is found here on the Vestibular Disorders Association (VeDA) site.
How can I find a vestibular therapist near me?
If you are trying to find a vestibular therapist for an in-person appointment and you aren’t close to Toronto, ON, a great resource for finding a healthcare practitioner is the Vestibular Disorders Association (VeDA) healthcare provider directory. You’ll also find a number of resources prepared by experts in the field on the VeDA website, so be sure to check them out!
If you are looking for a vestibular physiotherapist and live in Toronto or the surrounding Greater Toronto Area, I would love to work with you and your child at Wave Physiotherapy. You can learn more about me or even book a free consult call to see if working together would be a good fit!
If you live in Ontario and are looking for virtual vestibular physiotherapy care, I also provide online vestibular therapy appointments. I would love to speak with you more about your needs, so don’t hesitate to reach out.
What are common symptoms when a child has a vestibular issue?
Each child with a vestibular condition will have a unique set of symptoms that they experience. Common symptoms the families I see in my balance and dizziness clinic tell me about are:
A sense of spinning, also known as vertigo. This may happen with moving in bed, position changes, or even happen when they are still.
Feeling they are moving relative to their environment at rest or during movement. Children that are old enough to describe this may say they are rocking, swaying or shifting, or even feel like they are on a boat.
Loss of balance with tasks that other children their age do without any issues. This may include putting on socks and shoes, getting dressed, reaching for high or low targets, or washing your hair. Some people even tell me they’ve had multiple falls or trip while they are walking.
Headache, migraine, feeling lightheaded or feeling heavy headed
Eye (ocular) symptoms: eye fatigue, eye strain, light sensitivity, blurry, fuzzy or double vision, seeing things moving or bouncing in their vision, or even seeing the eyes move in an unusual way (nystagmus)
Ear (aural) symptoms: hearing ringing, buzzing or whooshing noises (tinnitus), pressure or fullness in the ears, pain in the ears
Feeling faint or like they could pass out
Feeling nauseated, vomiting, and digestive upset (including experiencing diarrhea and constipation).
Feeling hot or cold, sweating, like their heart is racing, and effects on their breathing (feeling short of breath, shallow breathing or faster breathing rate).
Please note this is not an exhaustive list and your child may have symptoms that are not listed above.
Which child benefits from vestibular therapy?
Information from the inner ear (peripheral vestibular system) is used along with information from our eyes (visual system) and skin, muscle and joint sensors (proprioceptive system) to give an accurate picture of where we are in space so we can maintain our balance. When the vestibular system isn’t working as it should, it can lead to the symptoms listed in the section above and also make it difficult for your child to keep their balance when they are still and moving. This can lead to an increased risk of tripping, stumbling or even falling, and more falls can lead to an increased risk of other injuries.
Any child with symptoms of dizziness, vertigo, motion sensitivity, trouble with keeping their vision clear during movement, trouble with balance, and other symptoms listed in the section above would benefit from a vestibular therapy consultation to see what may be causing their symptoms. Vestibular therapy treatment provides a way to address these symptoms in a conservative and holistic way. In most cases, prescribed medications are not needed to assist with your child’s recovery. Should any concerns be identified while in for vestibular therapy sessions, this information will be relayed to your family doctor and/or referring specialist to ensure further testing and referrals are made.
What diagnoses are treated with vestibular therapy?
Vestibular therapy helps to reduce (and in many cases fully resolve) the symptoms your child is experiencing due to a vestibular condition. When booking a vestibular therapy appointment for your child, it is important to inquire if the treating therapist has experience with the diagnosis you are seeking help for to ensure that their practice will be the best fit for your needs.
Common childhood vestibular diagnoses that are treated with vestibular therapy include:
Benign paroxysmal positional vertigo (BPPV)
Enlarged aqueduct syndrome
Sensorineural hearing loss with vestibular dysfunction (dizziness, balance loss, vertigo)
Vestibular neuritis
Vestibular labyrinthitis
Vestibular migraine
Unilateral vestibular loss (UVL) also known as unilateral vestibular weakness or unilateral vestibular hypofunction
Bilateral vestibular loss (BVL) also known as bilateral vestibular weakness or bilateral vestibular hypofunction
Concussion and post-concussion syndrome
Cochlear implantation with post-surgery vestibular dysfunction (vertigo, balance loss, dizziness)
Visual vertigo (visually-induced dizziness)
Persistent perceptual postural dizziness (PPPD or 3PD)
At Wave Physiotherapy, I work with all of the vestibular diagnoses listed above, however, please know that the list above is not exhaustive. If you have questions about whether vestibular physiotherapy is appropriate for your specific medical diagnosis please reach out for further information.
How much does vestibular therapy cost?
In Ontario, vestibular physiotherapy sessions are not covered by OHIP. If you have extended health benefits, your child’s sessions may be reimbursed by your plan’s physiotherapy coverage.
Vestibular physiotherapy services at Wave Physiotherapy are provided by Sharon-anne Graham. She has completed her Certificate in Vestibular Rehabilitation (2017) and Certificate in Pediatric Vestibular Rehabilitation (2024). Sharon-anne has continued to advance her understanding of vestibular conditions through continuing education activities including journal clubs, conferences, and courses.
At Wave Physiotherapy, paediatric vestibular physiotherapy services cost:
$165 for a 1 hour initial assessment appointment
$125 for a 45 minute treatment appointment
How many vestibular therapy appointments are needed?
The number of appointments that may be needed varies between diagnoses and also between children. A child’s symptom response and co-exisiting medical conditions can influence how they feel while participating in vestibular therapy sessions and when completing a prescribed home program.
What happens during a paediatric vestibular therapy assessment?
A vestibular therapy assessment is made up of several components. Each provides valuable insight into what is causing the symptoms your child experiences. Depending on the complexity of your child’s symptoms and how they feel during the session, the assessment may need to be completed in more than one session.
The assessment session will be individualized for each child and may contain the following:
An in-depth review of your child’s gross motor development and medical history: We’ll talk about your child’s current symptoms, their gross motor development and their past medical history. You will be asked questions to assist with ruling out specific diagnoses and to identify what may be useful to track to determine the results of treatment.
Movement screening of the head and neck: I’ll have your child move their head and neck to assess the effect this has on their symptoms. Your child may be asked to hold or repeat a position to see if symptoms change in any way and they will be monitored closely during this.
Movement screening of the eyes: I’ll have your child run through a visual motor screen. During this they will move their eyes in specific ways so I can see the effect this has on their symptoms. They may be asked to hold a position or repeat a test to see if symptoms change in any way and will be monitored closely during this.
Testing of the vestibular system in room light conditions: This type of testing involves moving the head and neck, as well as the head, neck and body, at slower and faster speeds with the eyes focused on a target to test the function of the vestibular system.
Testing of the vestibular system with infrared goggles: Video frenzel (aka infrared goggles) allow me to get a closeup video of your child’s eye with their vision removed. During this portion of the testing, I will have your child move their eyes on camera, move the head and neck, and move into a few different positions to see what happens on camera. Testing may be symptom provoking so we’ll take everything at their pace and include breaks as they need them.
Balance testing: Depending on the results of testing so far, I may have your child try different types of balance tests. This may include standing on a soft foam pad, closing the eyes, standing with one foot ahead of the other (tandem stance), and standing on one foot (single leg stance).
Gait testing: Walking (gait) tests allow me to test your child’s functional (dynamic) balance and see their comfort with movement. During this type of testing, you child may be asked to try different functional walking tasks, such as walking with the head to one side, looking up or down, looking side to side, turning on the spot, and placing the feet one ahead of the other (tandem gait).
I’ll take the information gathered during the physical vestibular assessment along with your child’s history to identify what vestibular diagnosis is present. We’ll speak about treatment options and the best plan of care for your child, and you’ll have the chance to ask any follow-up questions you may have.
What is done for vestibular therapy treatment?
Vestibular therapy treatment sessions vary based on the type of vestibular disorder being treated and the symptoms that your child is experiencing. It’s common for most children to have an active home program that their working on regularly during their week. Treatment varies based on each child’s individual presentation. Even if your child’s symptoms are similar to those of a friend or family member, what helped that person may not be what your child needs to feel better. Treatment recommendations are based on the results of the assessment session and what your child’s goals with treatment are to ensure an individualized approach to care. I’ll talk about each potential component of treatment below with a description of what to expect.
Treating BPPV with canalith repositioning maneuvers and canalith liberatory maneuvers
If benign positional paroxysmal vertigo (BPPV) is identified during the assessment session with your child there are hands-on maneuvers that will be used to help move the displaced inner ear crystals (otoconia) out of the semicircular canals. Moving these crystals out of the canals resolves the cause of your child’s vertigo.
Common treatment techniques that are used in the clinic to resolve BPPV are the:
Epley maneuver
Semont maneuver
BBQ roll maneuver (this is also known as the Lempert, Barbeque or Barbecue maneuver)
Gufoni maneuver
It is common for your child to experience vertigo during these maneuvers as the source of their symptoms is being treated. Some children may even experience post-treatment symptoms. This can include feeling nauseous, a headache, and/or dizziness, so I recommend your child has a quiet day planned after BPPV treatment in case they need time to recover.
Vestibular therapy exercises
When your child’s symptoms aren’t being caused by BPPV it is common to be shown a vestibular physiotherapy exercise program to work on at home. Here is a list of diagnoses treated with vestibular therapy. In many cases, a child with a vestibular disorder does not fully recover function of the inner ear. The goal with vestibular therapy is to retrain their brain to interpret information from the inner ear and use this along with information from their visual and proprioceptive (sensors in the skin, joints, and muscles) systems to help improve function and get them back to what they love again.
Your vestibular therapist will use your child’s assessment findings and the activities that they are having issues with to design a program that’s individualized to meet your child’s needs. Vestibular rehabilitation exercises typically focus on:
Reducing motion and positional sensitivity with habituation exercises
Improving your child’s ability to keep their eyes fixed on a target (gaze stability) while they are stationary and moving
Addressing any balance and gait (walking) issues that are identified during the exam
Read more about the different types of vestibular therapy exercises (coming soon)
Do you have resources that may help a child with a vestibular disorder?
You can find articles about various topics listed on the Wave Physiotherapy blog. Here are some of the most asked about topics that I cover:
I also recommend checking out the articles on the Vestibular Disorders Association (VeDA) website about vestibular dysfunction in children. VeDA’s articles are well-written and provide a lot of valuable information!
Live in Ontario and want to get in touch about a vestibular therapy assessment for your child? Book a free 10-minute consult call to get started now.
Updated: November 2, 2024