Treatments

Transcranial Magnetic Stimulation (TMS)

-Repetitive Transcranial Magnetic Stimulation (rTMS) is a therapeutic medical procedure that was approved by Health Canada in 2002. Since 1985, research has been conducted with TMS to understand and treat a number of neurological conditions (i.e. migraine, refractory tinnitus) and psychiatric conditions (i.e. depression and auditory hallucinations in individuals with schizophrenia). Most recently, researchers have been focusing on the use of repetitive TMS pulses (rTMS) as a treatment option for major depressive disorder and concomitant depression (eg post stroke depression), Functional Neurologic disorders, Upper extremity rehabilitation post-stroke, and mild traumatic brain injury and traumatic brain injury related headaches and depression. Additional evidence is emerging in the treatment of auditory hallucinations in schizophrenia, cognitive disorders, obsessive-compulsive disorder and posttraumatic stress disorder.

Nerve blocks target certain nerves or groups of nerves causing the discomfort, where Trigger Point Injections are used to treat painful areas of muscle or knots of muscle that form when muscles do not relax. Commonly we offer trigger point injections to patients with Cervicogenic headache, or whiplash associated disorders. Common nerve blocks include: Occipital Nerve blocks for Headache management and Occipital neuralgia, and superficial nerve blocks for pain management.

They can interrupt your relationships and hobbies and cause you to miss work. There are many different treatment options, including medications and Botox injections, Botox or onabotulinum toxin A, has been approved by the U.S. Food and Drug Administration as a treatment for chronic migraines. The treatment involves a series of several small injections targeting muscles in your face, head and neck once every three months. The amount injected, as well as injection locations, is adjusted based on your reported pain. How long should I try Botox before making a decision? A trial of 3 cycles (or 9 months) is reasonable. The effect over the first treatments seems to be cumulative. 10% of people will notice an improvement only at the third treatment, especially if the situation was very severe to start with. Could Botox work if I have medication overuse headache? Studies show that Botox works for people with or without medication overuse. Of course, if there is a severe overuse, or if there is opioid use, it might be best to plan a withdrawal as a part of your treatment plan. People taking opioids were not included in the Botox studies. Could Botox work if other preventives did not work for me? Yes. Botox has a different mechanism of action than oral preventives. Studies have demonstrated a benefit in patients who had tried other preventives. In real life, Botox is covered only after previous trials, and improvements are observed. Is the effectiveness of Botox sustained over time? Yes. For most people who respond to Botox, the benefit are sustained over time. Remember that migraine is a fluctuating disease and that even if Botox is effective for you, you may have better phases and more difficult ones.

The anatomy of your wrist, health problems and possibly repetitive hand motions can contribute to carpal tunnel syndrome. Injecting corticosteroids near the carpal tunnel is a common treatment. Steroids reduce swelling in the connective tissue, which relieves the pressure on the median nerve. The benefits of corticosteroid injections have been tested in several studies. In these studies, the corticosteroid injections were compared with either non-surgical treatments or injections that didn't contain any medication (placebo injections).

Physiotherapy is indicated and can be effective in concussion management when dizziness, neck pain, headache and impaired balance have cervical spine and/or vestibular involvement. Treatment is based on the physiotherapy differential diagnosis made through patient history and clinical assessment of presenting signs and symptoms. Physiotherapy management includes education and support, treatment of signs and symptoms responsive to physiotherapy such as impairments of the cervical spine and/or vestibular system and sub-symptom threshold aerobic exercise.

Conditions Treated People with balance issues, a history of falls and certain types of dizziness, may benefit from a comprehensive physical therapy evaluation to determine the cause of balance problems and dizziness. BPPV: Benign Proximal Positional Vertigo Unilateral Vestibular Hypofunction / Vestibular Neuritis Bilateral Vestibular Hypofunction Cervicogenic Dizziness Motion Sensitivity Abnormality of Walking and Balance concussion Individualized Treatment Physical therapists evaluate a person’s strength, range of motion, gait and balance as well as perform specific tests of the vestibular system. Vestibular rehabilitation Balance retraining Gait training ROM, flexibility, strength and endurance exercises Patient education Fall risk reduction Vestibular rehabilitation has been shown to be effective in the management of dizziness and gait and balance dysfunction following concussion in both children and adults. Techniques may include adaptation, substitution, habituation, standing and dynamic balance retraining, and canalith repositioning maneouvers. A retrospective chart review of home programs prescribed by vestibular therapists to patients following concussion showed that the most frequent home program exercises prescribed were eye/head co-ordination, followed by standing static balance exercises and ambulation exercises

Nerves in your neck provide sensation and strength in your arms, while nerves in your low back provide sensation and strength in your legs. The symptoms associated with radiculopathy are typically unilateral (affecting one side of the body). The pain can worsen with certain movements of the neck or low back, with prolonged sitting or walking, and sometimes with coughing or sneezing. The diagnosis of radiculopathy is based on your medical history and a physical examination, including evaluation of nerve function (testing reflexes, strength, and sensation).An EMG (electromyogram) is a needle test that can be done to assess the health of muscles and nerves and can show evidence of a nerve problem such as radiculopathy. Typically, neck pain, low back pain, and radiculopathy can be treated successfully without surgery. Physical therapy is an effective treatment for cervical radiculopathy, and in many cases, it completely resolves symptoms. Your physical therapist will develop an individual treatment plan based on the findings of your initial evaluation. This may include specific excercises, mechanical traction therapy and pain management stratergies.