Neurological Physiotherapy: Rehabilitation for Neurological Conditions

Can neurological physical therapy help with recovery from a neurological condition?

Neurological physical therapy can improve gait, balance, and activities of daily living following certain disorders of the nervous system. The Babinski reflex is one of the neurological tests used. The benefits have been documented, in particular, following a stroke and for certain balance disorders. The extent of these benefits varies depending on the diagnosis, the patient’s challenges, and the treatment goals.

Dizziness, balance problems, and symptoms following a concussion can limit your activities. Rehabilitation involves care and exercises that help you regain or adapt to these activities.

In cases of peripheral vestibular hypofunction, one of the balance organs in the inner ear is not functioning as well as it should. When this loss is confirmed by testing, vestibular rehabilitation reduces symptoms and improves eye stability, balance, and daily activities ¹. The 2022 guidelines classify this evidence as strong. These conclusions do not apply to all cases of dizziness. After a concussion, the severity of initial symptoms and certain medical histories influence ^{recovery2, 3}. A systematic review—which methodically searches for and compares studies—supports an early return to light activity and prescribed exercises. Prolonged strict rest does not improve recovery ⁴.

The research provides four useful points of reference:

• The nervous system can change: Neuroplasticity refers to its ability to alter its organization and connections. The brain retains this ability throughout life and after an injury—that is, damage to its ^{tissues⁵, ⁶}. Some changes may aid recovery, while others are detrimental. Reorganization does not guarantee the return of a lost ability ⁷.
• The Type and Amount of Care Matter: A Cochrane Review of 267 Studies on Rehabilitation Following a Stroke ⁸. Cochrane is a network that compares treatments. Rehabilitation can improve daily activities, movement, and walking compared to no rehabilitation. Additional care may also help. Training in specific activities may improve certain abilities more than other approaches. Confidence in many of the results remains limited; the optimal amount of care has not been established. The program therefore takes into account the individual’s abilities, goals, and response ⁸.
• Maneuvers can treat confirmed BPPV: Benign paroxysmal positional vertigo causes brief episodes in which everything seems to spin after certain head movements. The term “benign” does not mean that there is no risk of falling. A repositioning maneuver guides the displaced particles in the inner ear ⁹. The 2017 guidelines recommend maneuvers tailored to the affected canal rather than the common use of medications that suppress the balance system. These medications include certain antihistamines and benzodiazepines ¹⁰.
• Post-concussion care focuses on the observed difficulties: An evaluation guides the gradual return to activities ¹¹. A 2023 review supports a program combining neck and balance exercises when dizziness, neck pain, or headaches last more than ten days. Active exercises may also help some adolescents whose symptoms persist ¹².

Ce guide présente les approches pour différentes conditions neurologiques. Il détaille particulièrement nos Services de rééducation vestibulaire et de gestion des commotions cérébrales, deux domaines de pratique offerts chez Physioactif. Pour des conditions complexes comme l’AVC, Parkinson ou la Multiple Sclerosis, nous orientons vers les programmes appropriés.

What is neurological physiotherapy?

La physiothérapie neurologique traite les difficultés de mouvement, d’équilibre et de coordination liées à une atteinte du système nerveux¹³. Le système nerveux central comprend le cerveau et la moelle épinière. La moelle est le cordon nerveux dans la colonne qui transmet des messages entre le cerveau et le corps. Le système périphérique comprend notamment les nerfs à l’extérieur de ces deux organes. Consultez les définitions anatomiques d’OpenStax¹⁴.

The assessment links your abilities to the activities you find challenging. A review combining quantitative data and descriptions of practice focuses primarily on measurements of activities, posture, walking, balance, and strength ¹⁵. The physical therapist uses this information to refine your goals and track your progress.

The main objectives include:

• Improve mobility, such as walking or moving from bed to a chair.
• Work on your balance during activities where it becomes difficult.
• Take into account spasticity, a form of muscle resistance that increases when a muscle is stretched more quickly ¹⁶. Muscle tone refers to the baseline muscle tension. Spasticity can interfere with certain movements.
• Increase independence in daily activities.
• To help you participate in society and resume the roles that are important to you.

Neurological physical therapy is provided to people of all ages: a child with cerebral palsy, an adult who has had a stroke, or an older adult living with Parkinson’s disease. Cerebral palsy is a group of long-term movement disorders caused by damage to the developing brain. The diagnosis and the patient’s needs determine the setting of care and the level of supervision.

Neuroplasticity involves, in particular, changes among neurons—the cells that transmit signals10. Their connections and extensions can change following an injury. Some changes facilitate a particular activity, while others may impair it. In practice, repeating a task such as grasping an object or walking can be part of rehabilitation. A review of stroke patients reports small gains in arm and leg function, as well as improvements in walking. It does not allow us to determine precisely how the amount of practice affects the outcome. This does not prove that the amount is unimportant. ^{7, 17718}

What neurological conditions are treated in physiotherapy?

Physical therapy treats the effects of ¹⁹, Parkinson’s disease, multiple sclerosis, vestibular disorders, concussions, and spinal cord injuries. These conditions can limit a person’s ability to walk, maintain balance, or perform other activities. Treatment varies depending on the cause and effects of each condition.

Here are the main categories of neurological conditions encountered:

Cerebrovascular conditions :

• Ischemic stroke: a blood vessel is blocked. Hemorrhagic stroke: a blood vessel ruptures. These conditions can weaken or paralyze one side of the body.
• Cerebral aneurysm: a portion of the wall of a brain artery dilates. A complication can result in difficulty moving.
• The setting and intensity of care depend on the patient's medical stability, challenges, goals, and available support.

Maladies évolutives ou inflammatoires :

• Parkinson's disease: can cause tremors, stiffness, and balance problems.
• Multiple sclerosis (MS): The body's immune system attacks certain parts of the central nervous system. Movement and sensation may be affected.
• Amyotrophic lateral sclerosis (ALS): affects the nerve cells that control the muscles.
• Ataxia: coordination disorders that can have various causes.
• Le suivi peut réunir plusieurs professionnels et milieux de soins selon le diagnostic et les besoins. Le service de neurologie du Centre hospitalier de l’Université de Montreal (CHUM) décrit ces domaines²⁰.

Traumatic injuries :

• Moderate or severe head injuries: brain injuries requiring medical treatment.
• Spinal cord injuries: injuries to the spinal cord. The injury may be complete or may leave some sensation or movement below the injury site.
• These injuries may require rehabilitation in a program that provides the necessary care and supervision.

Vestibular Disorders (service offert chez Physioactif) :

• Benign Paroxysmal Positional Vertigo (BPPV)
• Labyrinthitis and vestibular neuritis
• Meniere's Disease
• Balance disorders of vestibular origin
• Post-Traumatic Vestibular Disorders

Commotions cérébrales (service offert chez Physioactif) :

• Concussion during sports.
• Mild head injury, also known as a concussion.
• Symptoms that persist after a concussion.
• Balance or neck problems following the injury.

Other Conditions :

• Peripheral neuropathies: nerve damage that can affect sensation or strength.
• Guillain-Barré syndrome: a neurological disorder for which medical treatment may be followed by rehabilitation.
• Cerebral Palsy in Children and Adults.
• Muscular dystrophies: conditions that can limit strength, endurance, and daily activities.

After a stroke or another complex condition, the treatment team selects the appropriate services based on your medical condition, your limited activities, your goals, and available resources.

The following sections describe treatment options, followed by situations in which a medical consultation or a rehabilitation program is necessary.

What are the treatment approaches in neurological physiotherapy?

Neurological physical therapy uses exercises for walking, balance, strength, and activities of daily living, as well as certain manual techniques ⁸. Devices, including electrical stimulation, are also used in some programs. Their use does not replace an assessment of your needs.

Gait rehabilitation: The program may include walking on the floor, on various surfaces, or on a treadmill with a device that supports part of the body weight. Distance, speed, and breaks are adjusted according to the patient’s abilities.

Entraînement de l’équilibre : Les exercices font varier les appuis, la vision, les mouvements de tête ou l’environnement. Le physiothérapeute ajuste la difficulté et les mesures de sécurité.

Increased practice with the most affected limb: After a stroke, constraint-induced movement therapy temporarily limits the use of the less affected arm to encourage more practice with the other one. Trials primarily involve individuals who retain active movement, with little pain or spasticity. The 2015 review found a small benefit in arm function. It did not clearly demonstrate an improvement in independence in activities of daily living. The duration and tasks are tailored to individual’s. ²¹²¹

Functional Electrical Stimulation (FES): Electrical impulses are sent to the muscles while the person is performing a task. Some devices are manually triggered; others use brain or muscle activity as a signal to adjust the current ²². This description distinguishes between ²² systems18.

Strength Training and Cardiovascular Exercise: Strength training involves working the muscles against resistance. Cardiovascular exercise, such as walking or cycling, increases the workload on the heart and breathing. A review of 22 trials on multiple sclerosis found that both types of exercise reduced fatigue ²³. The results for walking are less consistent; strength training, in particular, shows a small benefit on short-distance tests. The program takes symptoms and ²⁴ into account19.

Technological approaches: Virtual reality uses interactive images to practice tasks. Some programs also use robots or devices A 2025 Cochrane review compiled 190 trials on virtual reality following a stroke. Compared to other treatments, it found modest improvements in arm function, balance, and activities of daily living. When virtual reality is added to standard care, it also increases the amount of practice time; therefore, the observed benefit cannot be attributed solely to the technology. The effects on walking remain uncertain, and data on social participation or quality of life are insufficient. The review on electrical stimulation describes the control systems used. ²⁵²⁶²²

Vestibular Rehabilitation and Concussions: The treatment plan may include exercises for eye stability, balance, and neck strength, as well as a gradual return to physical activity. The following sections explain when these interventions are beneficial.

Manual techniques may include joint movements guided by the physical therapist. They are incorporated into the exercise program based on the observed limitations, but are not a mandatory step.

How is gait and balance rehabilitation performed?

Gait and balance rehabilitation involves practicing movement, weight-shifting, and tasks that gradually become more challenging ²⁷, such as the intermediate-level cross-step exercise. The physical therapist first assesses your abilities and the assistive devices you typically use to select safe exercises.

Training Progression:

According to the assessment, training can affect one or more of the following:

• Support and transfers: shifting weight from one foot to the other, standing up or sitting down with the necessary assistance.
• Vision and movements: Vary your gaze or head movements when the exercise is appropriate for the condition.
• Surface: Practice on firm ground, then move on to a more challenging surface if it is safe to do so.
• Tasks: changing direction, reacting to a shift in weight, or walking while performing another task. These exercises require appropriate supervision.

Gait rehabilitation (post-stroke or spinal cord injury):

After a stroke or spinal cord injury, training may focus on walking distance, speed, or an activity such as walking through a doorway. The surfaces, endurance, home exercises, and frequency of sessions are adjusted based on your progress. Assistance from others or assistive devices may still be necessary.

Assistive devices:

A cane, a walker, or a brace can make certain tasks easier. A brace is a device that supports or guides a part of the body. The choice depends on your gait, your environment, and safety. The assistive device is reevaluated with you; it does not necessarily have to be discontinued.

Les progrès de marche se mesurent au fil du suivi. Après un AVC, répéter des tâches peut améliorer les mouvements et la distance parcourue¹⁸. Les besoins de soins peuvent se poursuivre au-delà des premiers mois. Le NHS explique que la récupération peut prendre des mois ou des années²⁸.

What is vestibular rehabilitation?

Vestibular rehabilitation refers to the exercises and maneuvers used to treat certain balance disorders ¹. For a confirmed case of BPPV, a maneuver reposition the displaced particles. For a confirmed case of peripheral hypofunction, the exercises focus on visual stability, balance, and adaptation to movement. These two treatments address different problems.

Not all cases of dizziness originate in the inner ear. Multiple sclerosis can also cause dizziness and lightheadedness. Among people living with this disease, more debilitating lightheadedness was associated with a lower quality of life. ²⁹ A review of research on dizziness in multiple sclerosis describes its possible causes ³⁰. Vertigo is common in this condition. It can originate in the brain itself or in the balance pathways located closer to the ear.

The vestibular system helps maintain visual stability and balance during head movements. Vestibular dysfunction can contribute to dizziness, unstable vision, or balance problems, but these symptoms can also have other possible causes.

Une dysfonction vestibulaire peut être associée à un risque accru de chute selon le type de trouble et d'autres facteurs.³¹ Une étude transversale contrôlée, qui compare des groupes à un moment donné, a mesuré le risque de chute selon le diagnostic³². Les atteintes venant du cerveau et la perte d'équilibre des deux oreilles allaient de pair avec plus de chutes répétées. Les personnes avec des étourdissements dits fonctionnels n’avaient pas davantage de chutes répétées que le groupe témoin. Cela ne signifie pas qu’elles ne chutent jamais. Un trouble fonctionnel modifie la façon dont l’équilibre est contrôlé; il peut coexister avec une autre maladie. Le consensus de la Société Bárány explique cette distinction³³.

Conditions traitées par rééducation vestibulaire :

Benign Paroxysmal Positional Vertigo (BPPV) :

BPPV is the most common cause of vertigo. It occurs when small crystals, called otoconia, move within a canal in the inner ear ³⁴. These crystals may float or remain attached to the cupula, a flexible structure that detects movement within the canal ³⁵. Lying down, getting out of bed, or looking up can then trigger a brief episode where everything seems to be ¹⁰.

For a confirmed VPPB, a procedure is selected based on the affected canal ⁹. In trials involving the posterior canal, the Epley maneuver resolves vertigo more often than a sham maneuver or observation without a maneuver: approximately 56% versus 21% in the short term ⁹. A sham maneuver serves as a comparison. The Dix-Hallpike test detects vertigo and characteristic eye movements by having the person lie down with their head turned. This test also yields a negative result more often after the Epley maneuver. The 2017 guidelines recommend performing the maneuver or referring the patient to a professional who performs it ¹⁰. It calls for a reevaluation within one month. Symptoms may return; if they persist, the diagnosis should be reevaluated.

Our guide on dizziness and lightheadedness details the possible causes and treatment options.

Névrite vestibulaire et labyrinthite :

A sudden disorder affecting the inner ear or the vestibular nerve can cause persistent dizziness, nausea, and difficulty walking ³⁶. Hearing loss helps guide the diagnosis. Vestibular neuritis affects the balance system; labyrinthitis can also affect hearing. The cause of neuritis remains unclear: hypotheses include a viral infection, a circulatory problem, or an immune system reaction ³⁷. In a series of 25 patients, most of the abnormalities did not exactly follow the distribution of the vestibular nerve ³⁸. These observations do not allow all cases to be attributed to a virus.

A stroke can also cause sudden dizziness. One review estimates that it accounts for about 3 to 5 percent of emergency department visits for dizziness ³⁹. In another study, 2.4% of the 24,266 eligible individuals were hospitalized for a stroke during that visit ⁴⁰. These percentages should not be used to rule out a stroke in a patient. Sudden, severe dizziness accompanied by new difficulty walking requires urgent medical evaluation, even in the absence of obvious weakness.

When peripheral vestibular hypofunction is confirmed, exercises can improve eye movement, balance, and daily activities ¹. The physical therapist selects movements based on the observed difficulties. He or she monitors symptoms and adjusts the program.

Meniere's Disease :

Ménière's disease is characterized by episodes of vertigo combined with auditory symptoms. For the confirmed form, the 2020 guidelines describe spontaneous episodes lasting from 20 minutes to 12 hours, measurable hearing loss, and variable auditory symptoms ⁴¹. These signs include tinnitus, sounds with no external source, or a sensation of a blocked ear. Between attacks, an evaluation assesses for persistent balance disorders and determines whether exercises are indicated.

Vestibular Disorders post-traumatiques :

After a head injury, patients may report dizziness, unsteadiness, visual symptoms, or difficulty concentrating. The physical therapist assesses balance, neck function, and exercise tolerance to select appropriate exercises. ¹²

Composantes de la rééducation vestibulaire :

Exercices de stabilisation du regard :

The vestibulo-ocular reflex automatically causes the eyes to move in the opposite direction of the head. It helps maintain a stable image. If this reflex is not working as well as it should, exercises involve moving the head while keeping the eyes focused on a target ¹. Eye movements alone are not a substitute for these exercises. The program addresses symptoms and activity limitations ¹.

Exercices d'habituation :

Habituation exercises involve gradually repeating movements or visual situations that trigger symptoms. Their goal is to reduce this reaction through practice. The guide includes them in programs designed for confirmed hypofunction ¹. If symptoms increase significantly or remain severe, the physical therapist adjusts the amount of exercise and reassesses the situation.

Exercices d'équilibre et de marche :

The exercises may combine walking, weight-shifting, and head movements. For persistent unilateral vestibular loss, the guide specifically recommends at least 20 minutes of balance exercises per day for four to six weeks. This guideline is based on limited evidence and should be adapted; it is not a universal recommendation.

Éducation et stratégies adaptatives :

The physical therapist explains the diagnosis, the signs to watch for, and ways to adapt activities. For example, he or she may discuss lighting for getting around and the assistance needed during an exercise. This advice accompanies the program and the follow-up evaluations.

To learn more about our approach to vestibular rehabilitation, including detailed assessment and specific protocols, consult our comprehensive guide dedicated to this service.

How does physiotherapy help after a concussion?

After a concussion, physical therapy can help patients resume their activities through progressive exercises and treatments that target the neck or balance. A 2023 review found that some adolescents and adults with persistent dizziness, neck pain, or headaches were able to return to sports more quickly ¹². The plan includes a gradual resumption of physical activity and interventions tailored to the specific difficulties observed ¹².

Le repos relatif des premières 24 à 48 heures laisse une place aux activités légères tolérées. Il ne signifie pas rester immobile ou isolé dans le noir. Une revue de 2023 trouve une récupération plus rapide avec une activité légère précoce et de l’exercice cardiovasculaire prescrit⁴. Elle ne soutient pas le repos strict jusqu’à disparition de tous les symptômes⁴. Les conseils de l’INESSS⁴² recommandent ensuite une reprise graduelle sans aggravation importante ou durable.

There are still several common misconceptions about concussions: we address them in our article on the myths and facts about concussions.

Évaluation post-commotion :

The physiotherapist assesses several systems that may contribute to symptoms:

Balance: dizziness, unsteadiness, sensitivity to moving images.
Neck: pain, headaches, stiffness.
Eye movements: difficulty tracking an object, blurred vision, eye strain.
Response to exertion: symptoms during exercise and changes in heart rate.
Concentration and thinking: difficulty concentrating or a feeling of “brain fog.”

This assessment is used to guide the gradual resumption of activities and to determine the appropriate interventions based on symptoms.

Composantes du traitement physiothérapique :

Traitement cervical :

Neck treatment may include exercises and movements guided by a physical therapist. In a trial involving 60 adults with persistent symptoms, adding six weeks of neck and balance care to an exercise program did not further reduce overall symptoms. However, the addition did improve certain measures of the gaze-stabilizing reflex and mobility Both groups showed improvement. ⁴³

Dizziness and neck pain may occur together. After ruling out other relevant causes, the evaluation may include an examination of the neck without concluding that it is the cause of the dizziness. ⁴⁴ It is important to note that no single test can confirm a cervical origin for dizziness. The diagnosis is made by process of elimination, once causes related to the inner ear, medical conditions, and blood vessels have been ruled out.

Rééducation vestibulaire :

After a concussion, balance and visual stability exercises may be incorporated into neck care when warranted by the evaluation ¹². The progression of these exercises takes into account dizziness, walking, and the activities the patient needs to resume.

Exercices des mouvements des yeux :

Blurred vision or persistent eye strain requires an evaluation. Exercises may target a specific problem with eye movements. Depending on the results, you may need to see an eye care professional. The effectiveness of the program will be reassessed with you.

Gradual return to exercise :

A graded exercise test helps determine an appropriate exercise intensity. In one study, 103 adolescents aged 13 to 18 were randomly assigned to either approximately 20 minutes of daily adapted cardiovascular exercise or stretching ¹¹. The median recovery time was 13 days versus 17 days. Median means that half recovered sooner and the other half later. The exercise intensity remained below the level that triggered their symptoms. This result applies to adolescents evaluated within ten days of a sports-related concussion; it does not predict your ⁴⁵ date32.

Protocole de retour au travail/études :

Returning to work or school gradually increases activities such as reading, using a screen, or concentrating. Measures may include:

• Resume some activities, taking breaks along the way.
• Use temporary accommodations, such as extra time on exams or a reduced workload.
• Choose a quiet environment and adjust the lighting as needed. INESSS advises against isolating yourself in the dark or routinely wearing sunglasses indoors.

Progression criteria :

Progression depends on the increase in symptoms, their duration, and the criteria for that stage. According to INESSS, a slight increase—of no more than two points out of ten and lasting less than one hour—may be tolerated during activities in the early stages.

• Monitor for symptoms during and after the activity.
• If the worsening exceeds the expected limits, stop the activity and wait until it returns to the usual level before trying again at a lower intensity.
• Allow at least 24 hours for each stage of returning to physical and sports activities.

Avant l’étape 4 de retour au sport, la reprise complète des activités intellectuelles sans mesure d’adaptation doit être terminée, et les symptômes doivent avoir disparu au repos et à l’effort. Le protocole québécois de gestion des commotions⁴⁶ recommande une autorisation d’un professionnel de la santé qualifié, particulièrement avant les activités présentant un risque de Contact, de collision ou de chute. Les exigences de l’association sportive s’appliquent aussi.

Typical recovery time :

• Chez beaucoup de personnes, les symptômes s’améliorent dans les deux premières semaines et disparaissent en moins d’un mois. Ce repère n’est pas une date limite de récupération². L’INESSS décrit cette évolution habituelle⁴².
• Among adolescents as well, the duration varies depending on the severity of the initial symptoms and certain medical history ³.
• A review of 13 studies involving a total of 5,307 children and adolescents estimates that approximately 35% still had symptoms after at least four weeks ⁴⁷. Rates varied by age, sex, and place of care. Initial severity remains an important factor ³.

Persistent symptoms may require evaluation and targeted care. One study describes six young people who participated in an exercise program. Four resumed their previous activities, and two resumed modified activities. This small series, which lacked a control group, does not allow us to attribute this progress solely to the program ⁴⁸. The trials and reviews presented above support certain ¹¹. Seek medical advice if your condition worsens, shows little improvement after two weeks, continues to limit your activities after one month, or causes you concern.

Preventing Repeated Concussions :

A suspected concussion requires the athlete to stop playing and prohibits a return to play on the same day. A phased return to play assesses tolerance before further exposure to risk. If symptoms recur during stages 4 through 6, the protocol calls for returning to stage 3 and undergoing reevaluation. Competition may resume only after a full training session has been completed and well tolerated, in accordance with the protocol and upon receiving the required authorization.

For more details on our concussion management protocols, including comprehensive assessment and return-to-play criteria, consult our dedicated guide.

When to consult a physiotherapist for a neurological disorder?

A physical therapist can help you if a neurological disorder causes persistent difficulties with walking, balance, or returning to your usual activities. A sudden onset of neurological symptoms or a warning sign following an injury requires urgent medical attention first. After a stroke, the medical team will organize your rehabilitation based on your condition and ²⁷

What symptoms require urgent care?

Composez le 9-1-1 si un signe d’AVC apparaît soudainement. Les signes comprennent un visage affaissé, une faiblesse d’un bras ou d’un côté, une difficulté à parler ou à comprendre, une perte de sensibilité, un trouble de vision ou un nouveau trouble important d’équilibre. Un mal de tête soudain, extrêmement douloureux et qui ne passe pas demande aussi le 9-1-1, même sans blessure. Le NHS précise cette alerte liée notamment à un saignement cérébral⁴⁹. Un seul signe suffit; n’attendez pas qu’ils soient tous présents ou que la douleur apparaisse. Ne conduisez pas. L’urgence demeure même si les signes disparaissent. Consultez les signes et les consignes de l’Agence de la santé publique du Canada⁵⁰.

Après un choc à la tête, consultez immédiatement à l’urgence ou appelez le 9-1-1 si un des signes suivants apparaît. L’INESSS les distingue des symptômes habituels d’une commotion⁴².

• A severe headache or one that is getting worse.
• Repeated vomiting.
• Double vision or loss of vision.
• Seizures: uncontrolled body movements.
• Difficulty walking or speaking.
• Weakness or loss of sensation in an arm or leg.
• Unusual drowsiness, confusion, loss of consciousness, or difficulty recognizing people or places.
• Restlessness, aggression, excessive crying, or unusual behavior.

Indications pour consultation en clinique privée (Services Physioactif) :

Vestibular Disorders :

• Spinning dizziness triggered by changes in position (possibly BPPV)
• Constant dizziness or instability for several weeks
• Sensation of swaying or floating
• Difficulty walking in the dark or with eyes closed
• Sensitivity to visual motion (shopping, driving, crowds)

These symptoms are described in detail on our page about dizziness and lightheadedness.

Post-commotion cérébrale :

• Symptoms following a head injury that persist or limit activities, after ruling out any urgent medical conditions
• Difficulty returning to work, studies, or sports
• Persistent headaches, dizziness, or blurred vision
• Difficulty tolerating physical exertion or activities that require concentration
• Need for a structured return-to-activity protocol

Physical therapy can help manage certain vestibular disorders or symptoms following a concussion. A rapid worsening of symptoms, a warning sign, or an uncertain diagnosis requires a medical evaluation; do not delay seeking care by waiting to schedule a clinic appointment.

Indications nécessitant programmes spécialisés :

Stroke (CVA) :

After a stroke, a coordinated team will determine your care based on your condition, abilities, and goals. Services may include:

• Physical therapy for mobility; occupational therapy for daily activities; speech-language therapy for communication or swallowing; neuropsychology for memory and thinking difficulties.
• Professionals with experience in stroke recovery.
• Tools such as robotics and virtual reality, when the program uses them.

After hospitalization, care may continue at a rehabilitation center, on an outpatient basis, in the community, or at a private clinic. The choice depends on the patient’s needs and available resources.

Parkinson's Disease :

Depending on the symptoms and treatment goals, the management of Parkinson's disease may involve several departments:

• Regular neurological assessment and monitoring
• Depending on the symptoms and goals, exercises and strategies can be tailored to walking, balance, and daily activities.
• Occupational therapy for daily activities
• Speech-Language Therapy for Difficulties with Swallowing or Speaking
• Psychological Support and Support Groups

Le Neuro est l’Institut et hôpital neurologiques de Montreal, rattaché au Centre universitaire de santé McGill (CUSM). Le CHUM et le Neuro offrent des programmes consacrés aux troubles du mouvement, dont Parkinson. Les Resources accessibles varient selon le programme. Consultez les programmes du Neuro⁵¹.

Multiple Sclerosis :

In multiple sclerosis, care is tailored to symptoms, their progression, and treatment goals; it may include:

• Neurologist specializing in MS
• Exercise programs adapted for fatigue
• Management of episodes of new symptoms or worsening symptoms—known as flare-ups—and the progression of the disease
• Team understanding the complexity of the condition

Lésions médullaires :

After a spinal cord injury, treatment takes into account the level of the injury, your remaining movement and sensation, any complications, and your environment. It may include:

• A tailored rehabilitation program, such as the one offered at the Gingras-Lindsay Rehabilitation Institute in Montreal.
• Learning how to move around in a wheelchair, transfer from bed to chair, and perform activities independently.
• Adaptive devices, including certain orthoses; electrical devices are also available in some programs.
• Long-term follow-up to monitor and prevent certain complications.

Comment orienter vers les bonnes Resources :

In the Montreal area, several centers offer specialized neurological programs:

• Institut de réadaptation Gingras-Lindsay-de-Montreal (IRGLM)⁵² : programmes pour AVC, lésions de la moelle et traumatismes crâniens.
• CHUM, service de neurologie²⁰ : domaines comprenant la Multiple Sclerosis et les troubles du mouvement, dont Parkinson.
• Hôpital juif de réadaptation à Laval (Jewish Rehabilitation Hospital)⁵³ : programme de réadaptation après AVC, à l’hôpital ou en consultation externe.
• Hôpital de réadaptation Villa Medica⁵⁴ : réadaptation après AVC et pour d’Other Conditions neurologiques admissibles.
• Centre de réadaptation Constance-Lethbridge⁵⁵ : Services en consultation externe pour adultes ayant une déficience motrice, dont certains programmes neurologiques.

Your family doctor, neurologist, or care team can refer you to these resources. Each facility has its own admission criteria. After the intensive phase, a combination of program-based care and private physical therapy can support your exercises and activities.

The choice of setting takes into account the diagnosis, safety, capabilities, goals, and available support. Professionals can work together to tailor the care plan.

What to expect during your first neurological physiotherapy consultation?

The first neurological physical therapy consultation includes questions about your health, movement tests, and developing a plan with you ¹³. The physical therapist selects the tests based on your symptoms, your abilities, and safety considerations.

Before your appointment: Write down your symptoms, the activities that trigger them, the medications you’re taking, and the activities you’d like to resume. Bring any imaging results you already have, such as an MRI (magnetic resonance imaging) or a CT scan (computed tomography). Wear comfortable clothing and closed-toe shoes.

Initial Questionnaire: Medical history, symptoms, affected activities, previous treatments, environment, and support can be addressed as appropriate.

Physical tests selected based on the assessment:

Balance: The physical therapist observes how you maintain a position or shift your weight.

Walking: The physical therapist observes the patient's gait, changes in direction, and any assistive devices used.

Muscle strength: Tests may include pushing against the physical therapist’s hand, standing up from a chair, or gripping a device with the hand.

Joint Range of Motion: The examination measures the range of motion and checks for stiffness or spasticity.

Coordination: Some tests require you to touch your nose with a finger, bring a heel toward the opposite knee, or perform rapid alternating movements.

Note: The physical therapist may observe the patient's ability to follow instructions or perform another task while moving.

Vestibular tests (if applicable): Depending on the symptoms, positional tests and eye movement tests can help determine whether balance or the inner ear appears to be involved.

Goals: Discussion of specific goals that are relevant to the individual and reassessed throughout the follow-up process:

• Walking: Increase the duration or distance measured.
• Work: Choose the tasks and accommodations to try.
• Leisure Activities: Specify the activity you are interested in and the steps needed to resume it.

Treatment Plan: The frequency, approaches, home exercises, and reassessment criteria are discussed based on the diagnosis, goals, safety, and available resources.

Start of treatment: An intervention may be tried if it is consistent with the diagnosis, the goal, and the results of the assessment.

Questions to ask: What seems to be the most likely cause? How long is the expected recovery time? How often should I do the exercises? Which activities should I adjust? What criteria will allow me to resume my activities? Should I contact my doctor?

Your participation helps us adjust the plan, but the outcome also depends on the situation, how it evolves, and many factors that are beyond your control.

What are your frequently asked questions about neurological physiotherapy?

Frequently asked questions about neurological physical therapy include the duration of treatment, the roles of healthcare professionals, insurance, resources in Montreal, dizziness, and returning to sports.

How long does neurological rehabilitation last?

Neurological rehabilitation may last a few weeks for some conditions or continue long-term. For BPPV, a specific maneuver may provide rapid relief, but a follow-up evaluation within a month is needed to assess the response. After a concussion, symptoms often improve within the first two weeks and usually resolve within less than a month; some persist longer. After a stroke, follow-up care may continue for months or longer, with goals ⁵⁶ For a progressive condition, care adapts to changing needs.

What is the difference between occupational therapy and neurological physiotherapy?

Physical therapy focuses primarily on movement, mobility, and balance. Occupational therapy focuses primarily on activities such as bathing, dressing, cooking, or returning to work, with environmental adaptations as needed. Both professions may address the same activities and coordinate their ⁵⁷.

Are the services covered by insurance?

In the public health care system, physical therapy services are covered according to the facility’s access policies. In the private sector, reimbursement depends on your insurance policy. Some insurers still require a prescription Check the coverage amount and the required documents before your appointment. Depending on your situation, the CNESST, which covers workplace accidents, or the SAAQ, for traffic accidents, may also cover treatment under certain conditions. ⁵⁸

Where to seek consultation for stroke, Parkinson's, or multiple sclerosis in Montreal?

Pour un AVC, l’IRGLM, l’Hôpital juif de réadaptation et Villa Medica offrent des programmes. Pour Parkinson, consultez les Services du CHUM ou du Neuro, au CUSM. Pour la Multiple Sclerosis, le CHUM et la clinique de neurologie de l’Hôpital général juif figurent dans le répertoire de SP Canada⁵⁹. L’équipe traitante peut vous orienter; les critères d’accès varient.

Is vestibular rehabilitation effective for all types of vertigo?

Vestibular rehabilitation is not the same treatment for all types of vertigo. Maneuvers are effective for certain confirmed cases of BPPV, while exercises improve symptoms and functional ability in cases of peripheral vestibular hypofunction Vertigo originating in the brain or vestibular migraine requires its own evaluation; the previous recommendations do not automatically apply in these cases. ^{10, 1}

How long after a concussion can I return to sports?

The return to sports occurs in stages, each lasting at least 24 hours; there is no single date that works for everyone. A suspected concussion precludes a return to play on the ² The American College of Sports Medicine’s previous statement also supports this restriction ⁶⁰. The Amsterdam Consensus outlines the gradual return ². Before proceeding to stages involving a risk of impact or falls, follow the criteria described above: full cognitive recovery, resolution of symptoms, authorization from a qualified professional, and your organization’s requirements.

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