The Adelaide Guide to Neurological and Vestibular Physiotherapy
The Adelaide Guide to Neurological and Vestibular Physiotherapy: Regaining Movement, Balance and Independence
From NeuroPhysiotherapy Services, a specialist neurological practice in Adelaide since 2001.
If you or someone in your family has had a stroke, been diagnosed with Parkinson's disease or MS, had a brain injury, or is dealing with dizziness that will not settle, you have probably been told to see a physiotherapist. What is rarely explained is that neurological physiotherapy is a distinct field, that not every physiotherapist practises it, and that the difference matters a great deal to the outcome.
This guide explains what it is, how it works, what to expect, and how to pay for it.
What neurological physiotherapy is
Physiotherapy for conditions affecting the brain, spinal cord and nervous system, rather than for a muscle or joint injury.
The distinction matters because the problem is different. A torn hamstring is a damaged tissue that needs to heal and then be strengthened. A stroke is not damaged muscle. The muscle is generally fine. What has changed is the brain's ability to send the signal that makes it work.
So the treatment is different too. You are not primarily rehabilitating tissue. You are retraining a nervous system.
How neuroplasticity based rehabilitation works
Neuroplasticity is the brain's capacity to reorganise itself, forming new connections and recruiting areas to take on functions previously handled elsewhere. It is the mechanism behind almost all recovery after neurological injury.
It is not unlimited, and it is not automatic. It responds to specific conditions, and those conditions are what a neurological physiotherapist is designing for.
Specificity. The brain learns the task you practise. If the goal is walking safely to the letterbox, the rehabilitation has to look like walking, not like a general leg exercise. This is why programmes are built around functional goals rather than around muscle groups.
Repetition, at volume. Meaningful change requires far more repetitions than most people expect, which is why home programmes matter as much as clinic sessions. What happens in the other six days determines the result more than the hour with the physiotherapist.
Difficulty. The task has to be hard enough to challenge the system. A task that is too easy produces little change. Too hard and it cannot be attempted. Sitting in that window, and moving it as you improve, is a large part of the skill.
Salience. The brain prioritises what matters to the person doing it. Rehabilitation built around something you actually want to do again works better than rehabilitation built around an abstract exercise.
Timing, without a deadline. Recovery is fastest in the early months, which is why early rehabilitation matters. But the old idea that recovery stops at six or twelve months is outdated. Improvement is possible years later with the right training. If you have been told your window has closed, that is worth a second opinion.
Who neurological physiotherapy helps
Stroke and transient ischaemic attack. Parkinson's disease. Multiple sclerosis. Acquired and traumatic brain injury. Spinal cord injury. Peripheral neuropathies. Facial nerve injury including Bell's palsy. Persistent symptoms after concussion. Vestibular disorders including BPPV, vestibular neuritis and Meniere's disease. Balance disorders and falls. Functional neurological disorder. And other progressive neurological conditions where the goal is maintaining function for as long as possible.
What treatment actually involves
Assessment first. A thorough assessment of movement, strength, balance, coordination, sensation, gait and function, plus what you specifically want to be able to do. That last part shapes everything else.
Goals set with you. Not "improve mobility". Something concrete, like getting up the back step unaided, or walking to the shop without stopping. Concrete goals can be measured, and measurement tells you whether the programme is working.
Task specific training. Practising the actual movement you want to recover, broken into achievable parts and progressively made harder.
Strength and conditioning where relevant. Neurological conditions cause secondary deconditioning, and that deconditioning is often as limiting as the primary condition. It is also very treatable.
Balance and falls work. Falls are one of the biggest risks in this population and balance responds well to training.
Equipment and home advice. The right walking aid, the right setup at home, and the right technique for the transfers you do twenty times a day.
A home programme. The part that does most of the work.
Vestibular physiotherapy, and why dizziness is different
Dizziness is one of the most common reasons people are referred to us and one of the most commonly mistreated, because several very different problems produce a similar complaint.
BPPV, benign paroxysmal positional vertigo. Crystals in the inner ear move into a canal where they do not belong, and the result is short, intense spinning triggered by head position, typically rolling over in bed or looking up.
BPPV is important because it is often correctable in one or two sessions using a corrective manoeuvre, which is a specific sequence of head and body positions that moves the crystals back. People routinely live with this for months or years, taking medication that does not address the cause, when the actual treatment is quick.
Our physiotherapists teach BPPV corrective manoeuvres to other physiotherapists as an accredited course.
Vestibular neuritis and labyrinthitis. Inflammation of the vestibular nerve or inner ear, usually causing sudden severe vertigo lasting days. Recovery involves the brain compensating for the reduced signal, and vestibular rehabilitation exercises drive that compensation. Resting and avoiding movement, which is the instinct, actually slows it.
Meniere's disease. Episodes of vertigo with hearing changes, tinnitus and fullness in the ear. Medical management sits with an ENT specialist, and physiotherapy addresses the balance deficits between episodes.
Persistent postural perceptual dizziness. Ongoing dizziness and unsteadiness that continues after an initial trigger has resolved, often worse in visually busy places like supermarkets. It is a real and treatable condition and it is frequently dismissed.
Cervicogenic dizziness. Dizziness arising from the neck, often after whiplash.
Post concussion vestibular dysfunction. Dizziness and visual disturbance persisting after a head injury.
The reason to see someone with vestibular training rather than a general physiotherapist is that these are distinguished by specific assessment, and the treatment for one is not the treatment for another. Doing habituation exercises for what is actually BPPV wastes months.
Concussion, and which service you need
Two different phases, and it is worth knowing which one you are in.
The acute phase, meaning the first days and weeks after a knock, is about same day assessment, relative rest and a graded return to sport plan. Our sister practice PhysioXtra handles that side, and works with sporting clubs across South Australia on return to play protocols.
The persistent phase is ours. If symptoms have continued beyond about four weeks, particularly dizziness, visual disturbance, difficulty with busy environments or balance problems, that is specialist vestibular and oculomotor territory. Edwina's specialism is concussion rehabilitation and our team includes accredited vestibular physiotherapists.
If you are unsure which you need, call and ask. We will tell you honestly, including when the answer is the other practice.
How to pay for it
NDIS. Physiotherapy is fundable under an NDIS plan where it relates to your disability related goals, usually under Capacity Building, Improved Daily Living. We are a registered NDIS provider, which means we can work with self managed, plan managed and agency managed participants.
Medicare. Through a Chronic Disease Management plan arranged by your GP, you may be eligible for up to five allied health sessions per calendar year at a rebate. Your GP determines eligibility.
Private health. Physiotherapy is generally claimable on extras cover, subject to your policy and annual limit.
DVA. Available for eligible veterans with a referral.
You do not need a referral to see a physiotherapist in Australia unless you are claiming through Medicare or DVA.
Care that comes to you
Getting to a clinic is genuinely difficult for a lot of people with neurological conditions, and that difficulty is a real barrier to the rehabilitation that would help.
We see people at our Eastwood clinic, in their own homes across Adelaide, and by telehealth. Home visits are often better than clinic sessions for practising the specific transfers, steps and spaces you actually use, because we can address the real back step rather than a step in a gym.
What to ask before choosing a practice
Does the physiotherapist have specific neurological training, and what is it. A Masters in Neurological Physiotherapy is a different thing to an interest in neuro.
For dizziness, are they an accredited vestibular physiotherapist. This is a specific accreditation, not a description.
What will be measured, and when will it be reassessed.
Will they see me at home if getting to the clinic becomes hard.
Will they communicate with my GP, specialist and support coordinator.
Where to start
Call us on 08 8331 2700. We are at 121 Glen Osmond Road, Eastwood.
Edwina Reid founded the practice in 2001 and has 40 years in neurological physiotherapy and a Masters in Physiotherapy specialising in Neurological Physiotherapy. Our team includes accredited vestibular physiotherapists and members of the APA National Neurological Group, and we run accredited courses training other physiotherapists in facial nerve injury, BPPV corrective manoeuvres and patient education.