Neurological Physiotherapy: Rehabilitation for Neurological Conditions

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

Neurological physical therapy can improve walking, balance, and daily activities following certain disorders of the nervous system. 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 specific 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 activities¹. 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 recovery⁴.

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 ability⁷.
• The Type and Amount of Care Matter: A Cochrane Review of 267 Studies on Rehabilitation Following a Stroke⁸. 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 response⁸.
• 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 ear⁹. 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 benzodiazepines¹⁰.
• Post-concussion care focuses on the observed difficulties: An evaluation guides the gradual return to activities¹¹. 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 persist¹².

This guide outlines treatment approaches for various neurological conditions. It focuses in particular on our vestibular rehabilitation and concussion management services, two areas of practice offered at Physioactif. For complex conditions such as stroke, Parkinson’s disease, or multiple sclerosis, we refer patients to the appropriate programs.

What is neurological physiotherapy?

Neurological physical therapy treats difficulties with movement, balance, and coordination resulting from damage to the nervous system¹³. The central nervous system consists of the brain and the spinal cord. The spinal cord is the bundle of nerves in the spine that transmits messages between the brain and the body. The peripheral nervous system includes, among other things, the nerves outside these two organs. See the anatomical definitions in OpenStax.

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 strength¹⁴. The physical therapist uses this information to clarify 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 someone stretches the muscle more quickly¹⁵. 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^{nerve signals⁷, ¹⁶}. Their connections and extensions can change following an injury. Some changes facilitate a particular function, while others may impair it⁷. 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 improved walking¹⁷. 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.

What neurological conditions are treated in physiotherapy?

Physical therapy treats the effects of strokes¹⁸, Parkinson’s disease, multiple sclerosis, vestibular disorders, concussions, and spinal cord injuries. These conditions can limit walking, balance, or other activities. Treatment varies depending on their cause and effects.

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.

Progressive or inflammatory diseases:

• 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.
• Care may involve several professionals and different care settings, depending on the diagnosis and the patient’s needs. The Neurology Department at the University of Montreal Hospital Center (CHUM) describes these areas.

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 offered at Physioactif):

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

Concussions (service available at 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 techniques⁸. 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.

Balance Training: The exercises vary the points of support, visual cues, head movements, or the environment. The physical therapist adjusts the difficulty level and safety measures.

Increased practice with the most affected limb: After a stroke, constraint-induced therapy temporarily limits the use of the less affected arm to encourage more practice with the other one¹⁹. Trials primarily involve people 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 the individual’s abilities¹⁹.

Functional Electrical Stimulation (FES): Electrical impulses are sent to the muscles while the user performs a task. Some devices are manually triggered; others use brain or muscle activity as a signal to adjust the current²⁰. This description distinguishes between control systems²⁰.

Strength Training and Cardiovascular Exercise: Strength training works the muscles against resistance. Cardiovascular exercise, such as walking or cycling, increases the workload on the heart and breathing. A review of 22 trials in multiple sclerosis found that both types of exercise reduced fatigue²¹. The results for walking are less consistent; strength training, in particular, shows a small benefit on short-distance tests. The program takes symptoms and safety into account²².

Technological Approaches: Virtual reality uses interactive images to practice tasks. Some programs also use robots or electronic devices²³. A 2025 Cochrane review compiled 190 trials on virtual reality following a stroke²⁴. Compared to other treatments, it found small 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 used²⁰.

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 challenging²⁵. 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.

Progress in walking is measured over the course of follow-up. After a stroke, repeating tasks can improve movement and the distance covered¹⁷. The need for care may continue beyond the first few months. The NHS explains that recovery can take months or years.

What is vestibular rehabilitation?

Vestibular rehabilitation refers to the exercises and maneuvers used to treat certain balance disorders¹. 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.²⁶ A review of research on vertigo in multiple sclerosis describes its possible causes²⁷. 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.

Vestibular dysfunction may be associated with an increased risk of falls, depending on the type of disorder and other factors.²⁸ A controlled cross-sectional study, which compares groups at a single point in time, measured the risk of falls based on diagnosis²⁹. Disorders originating in the brain and loss of balance in both ears were associated with more repeated falls. Individuals with so-called functional dizziness did not experience more repeated falls than the control group. This does not mean they never fall. A functional disorder alters the way balance is controlled; it can coexist with another disease. The Bárány Society consensus explains this distinction.

Conditions Treated by Vestibular Rehabilitation:

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 ear³⁰. These crystals may float or remain attached to the cupula, a flexible structure that detects movement within the canal³¹. Lying down, getting out of bed, or looking up can then trigger a brief episode where everything seems to spin¹⁰.

For a confirmed VPPB, a procedure is selected based on the affected canal⁹. 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 term⁹. 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 it¹⁰. 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.

Vestibular Neuritis and Labyrinthitis:

A sudden disorder affecting the inner ear or the vestibular nerve can cause persistent dizziness, nausea, and difficulty walking³². 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 response³³. In a series of 25 patients, most of the abnormalities did not exactly follow the distribution of the vestibular nerve³⁴. 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 dizziness³⁵. In another study, 2.4% of the 24,266 eligible participants were hospitalized for a stroke during that visit³⁶. 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 activities¹. The physical therapist selects movements based on the observed difficulties. He or she monitors symptoms and adjusts the program.

Ménière'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 symptoms³⁷. 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.

Post-Traumatic Vestibular Disorders :

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

Components of Vestibular Rehabilitation :

Eye Stabilization Exercises:

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 target¹. Eye movements alone are not a substitute for these exercises. The program addresses symptoms and activity limitations¹.

Habituation Exercises :

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 hypofunction¹. If symptoms increase significantly or remain severe, the physical therapist adjusts the amount of exercise and reassesses the situation.

Balance and Walking Exercises :

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.

Education and Adaptive Strategies :

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 quickly¹². The plan includes a gradual resumption of physical activity and interventions tailored to the specific difficulties observed¹².

Relative rest during the first 24 to 48 hours allows for light, tolerable activities. It does not mean remaining motionless or isolated in the dark. A 2023 review found that recovery is faster with early light activity and prescribed cardiovascular exercise⁴. It does not support strict rest until all symptoms have resolved⁴. INESSS guidelines then recommend a gradual return to normal activities, provided there is no significant or lasting worsening of symptoms.

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

Post-Concussion Assessment :

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.

Components of Physiotherapy Treatment :

Cervical Treatment :

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 therapy to an exercise program did not further reduce overall symptoms. However, the addition did improve certain measures of the reflex that stabilizes eye movement and neck mobility³⁸. Both groups showed improvement.

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.³⁹ 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.

Vestibular Rehabilitation :

After a concussion, balance and visual stability exercises may be incorporated into neck care when warranted by the evaluation¹². The progression of these exercises takes into account dizziness, walking, and the activities the patient needs to resume.

Eye Movement Exercises:

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 gradual exercise test helps determine the 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 stretching¹¹. The median recovery time was 13 days versus 17 days. “Median” means that half recovered sooner and 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 return-to-play date⁴⁰.

Return-to-Work/Study Protocol :

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.

Before proceeding to Stage 4 of returning to sports, a full resumption of intellectual activities without any accommodations must be complete, and symptoms must have resolved both at rest and during exertion. The Quebec concussion management protocol recommends authorization from a qualified healthcare professional, particularly before engaging in activities that carry a risk of contact, collision, or fall. The sports association’s requirements also apply.

Typical Recovery Duration :

• For many people, symptoms improve within the first two weeks and disappear in less than a month. This is not a deadline for recovery². INESSS describes this typical course of the illness.
• Among adolescents as well, the duration varies depending on the severity of the initial symptoms and certain medical history³.
• A review of 13 studies involving a total of 5,307 children and adolescents estimates that about 35% still had symptoms after at least four weeks⁴¹. Rates varied by age, sex, and place of care. Initial severity remains an important factor³.

Persistent symptoms may require evaluation and targeted care. A study describes six young people who participated in an exercise program. Four resumed their previous activities, and two resumed modified activities. This small case series, which lacked a control group, does not allow us to attribute these improvements solely to the program⁴². The trials and reviews presented above support certain interventions¹¹. 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 is causing 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 needs²⁵.

What symptoms require urgent care?

Call 9-1-1 if any signs of a stroke appear suddenly. Signs include a drooping face, weakness in one arm or one side of the body, difficulty speaking or understanding speech, loss of sensation, vision problems, or a new, significant loss of balance. A sudden, extremely painful headache that won’t go away also requires calling 9-1-1, even if there’s no injury. The NHS notes that this warning sign is particularly associated with a brain hemorrhage. Just one symptom is enough; don’t wait until all of them are present or until the pain sets in. Do not drive. It remains an emergency even if the symptoms disappear. Review the symptoms and guidelines from the Public Health Agency of Canada.

After a blow to the head, go to the emergency room immediately or call 9-1-1 if any of the following signs appear. INESSS distinguishes these from the usual symptoms of a concussion.

• 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.

Reasons to Consult a Private Clinic (Physioactif Services) :

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-Concussion :

• 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.

Conditions Requiring Specialized Programs :

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

The Neuro is the Montreal Neurological Institute and Hospital, affiliated with the McGill University Health Center (MUHC). The CHUM and the Neuro offer programs dedicated to movement disorders, including Parkinson’s disease. Available resources vary by program. Explore the Neuro’s programs.

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

Spinal Cord Injuries:

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.

How to Refer to the Right Resources:

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

• Gingras-Lindsay Rehabilitation Institute of Montreal (IRGLM) : programs for stroke, spinal cord injuries, and traumatic brain injuries.
• CHUM, Department of Neurology : areas including multiple sclerosis and movement disorders, such as Parkinson's disease.
• Jewish Rehabilitation Hospital in Laval : post-stroke rehabilitation program, either inpatient or outpatient.
• Villa Medica Rehabilitation Hospital : Rehabilitation following a stroke and for other eligible neurological conditions.
• Constance-Lethbridge Rehabilitation Center : outpatient services for adults with physical disabilities, including certain neurological programs.

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 you¹³. 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 over the long term. For BPPV, a specific maneuver may provide rapid relief, but a follow-up evaluation within a month is needed to confirm the response. After a concussion, symptoms often improve within the first two weeks and usually resolve within less than a month; some may persist longer. After a stroke, follow-up care may continue for months or longer, with goals reassessed⁴³. 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 care⁴⁴.

Are the services covered by insurance?

In the public healthcare system, physical therapy is covered according to the facility’s access policies. In the private sector, reimbursement depends on your insurance plan. Some insurers still require a doctor’s prescription⁴⁵. Check the amount covered 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.

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

For stroke, the IRGLM, the Jewish Rehabilitation Hospital, and Villa Medica offer programs. For Parkinson’s disease, consult the services at the CHUM or the Neuro, at the MUHC. For multiple sclerosis, the CHUM and the neurology clinic at the Jewish General Hospital are listed in the MS Canada directory. Your care team can refer you; eligibility criteria vary.

Is vestibular rehabilitation effective for all types of vertigo?

Vestibular rehabilitation is not the same treatment for all types of dizziness. Maneuvers are effective for certain confirmed cases of BPPV, while exercises improve symptoms and functional ability in cases of^confirmed peripheral vestibular hypofunction¹⁰^{, ¹}. Dizziness originating in the brain or vestibular migraine requires its own evaluation; the previous recommendations do not automatically apply in these cases.

How long after a concussion can I return to sports?

Returning to sports should be done in stages, with each stage lasting at least 24 hours; there is no single date that works for everyone. A suspected concussion precludes a return to play on the same day². The former statement from the American College of Sports Medicine also supports this ban⁴⁶. The Amsterdam Consensus outlines the gradual return to play². Before engaging in activities that carry a risk of impact or falls, follow the criteria described above: full cognitive recovery, resolution of symptoms, clearance from a qualified professional, and your organization’s requirements.

References

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