Persistent dizziness, BPPV, and balance disorders have a measurable cause. We identify the Primary Constraint in your vestibular system, restore Adaptive Capacity, and then progress demand. Serving Pittsford, Rochester, and the surrounding region.
New patient appointments typically available within 1–2 weeks. No referral required.
We identify which vestibular, oculomotor, or cerebellar system is the Primary Constraint.
Capacity Markers recorded at intake and discharge in our Clinical Outcome Registry.
Most vestibular events resolve within days to weeks. When they don't, the reason is almost always a constraint that standard care hasn't identified — or a combination of systems that requires sequenced rehabilitation.
The vestibular system does not operate in isolation. It integrates with the oculomotor system (gaze stabilization), the cerebellar system (timing and coordination), and the autonomic nervous system (energy and arousal regulation). When one system fails, the others compensate — until they can't. Persistent dizziness, chronic imbalance, and motion sensitivity are almost always the result of a Primary Constraint that has not been identified and addressed in the correct sequence.
BPPV is the most common vestibular disorder and responds quickly to repositioning when correctly identified. But post-concussion vestibular dysfunction, vestibular neuritis, and chronic dizziness involve multi-system impairment that requires Constraint-Based sequencing — restoring vestibular capacity before adding gaze stabilization demands, and confirming gaze stabilization before adding dynamic balance load.
Detects head movement and position, providing the brain with spatial orientation signals. Deficits cause vertigo, dizziness, and motion sensitivity — especially with rapid head movements or position changes.
Stabilizes gaze during head movement via the vestibulo-ocular reflex (VOR). Deficits cause visual blurring with movement, difficulty reading, and visual vertigo in busy environments.
Coordinates the timing and precision of vestibular and motor responses. Deficits cause gait unsteadiness, coordination problems, and difficulty adapting to changing surfaces or environments.
Regulates arousal, energy, and cardiovascular response to positional change. Autonomic dysfunction amplifies vestibular symptoms and limits tolerance for vestibular rehabilitation exercises.
Dizziness, imbalance, and motion sensitivity are endpoints of an underlying system failure. Treating the symptom alone rarely resolves recovery. Identifying the Primary Constraint and restoring Adaptive Capacity in the correct sequence does.
Constraint-Based evaluation and sequenced Care Track delivery
Your initial evaluation (60–90 minutes) examines the vestibular, oculomotor, cerebellar, and autonomic systems to identify which is the Primary Constraint limiting recovery at this phase. Capacity Markers are established and recorded in our Clinical Outcome Registry.
You leave your first visit with a clear explanation of why dizziness or imbalance has persisted and what the Care Track will address first.
Treatment targets the Primary Constraint first. If the peripheral vestibular system is limiting (as in BPPV or vestibular neuritis), we restore vestibular function before adding gaze stabilization demands. If the oculomotor system is the constraint, we restore VOR gain and smooth pursuit before adding dynamic balance load.
This is sequenced rehabilitation based on physiologic readiness — not a generic habituation protocol.
Demand increases only when Adaptive Capacity has been restored and confirmed. We reassess at each phase to confirm the Primary Constraint has shifted before progressing the program. Physiology determines readiness — not elapsed time or visit count.
Discharge is defined by Durability: the ability to sustain full functional demand — driving, busy environments, exercise, work — without regression, confirmed by objective Capacity Markers.
Serving Pittsford, Rochester, Brighton, Penfield, Victor, and Fairport
BPPV (Benign Paroxysmal Positional Vertigo)
Canalith repositioning and canal confirmation
Vestibular Neuritis & Labyrinthitis
Peripheral vestibular hypofunction
Post-Concussion Vestibular Dysfunction
Dizziness after head injury
Chronic Dizziness & Persistent Postural Perceptual Dizziness (PPPD)
Functional vestibular disorder
Visual Vertigo & Motion Sensitivity
Busy environments, screens, and crowds
Balance Disorders
Unsteadiness and fall risk
Cervicogenic Dizziness
Dizziness from cervical spine dysfunction
Vestibular Migraine
Migraine-associated vertigo and dizziness
The initial evaluation is a structured neurologic assessment designed to identify the Primary Constraint: the vestibular, oculomotor, or cerebellar system most limiting recovery at this phase. Objective Capacity Markers are recorded in our Clinical Outcome Registry. You leave with a clear constraint explanation, a sequenced Care Track, defined progression criteria, and measurable benchmarks.
BPPV typically resolves in 1–3 visits. Vestibular neuritis, post-concussion vestibular dysfunction, and chronic dizziness typically require 3–5 visits for single-constraint presentations. Duration is determined by physiologic readiness, not a fixed schedule or insurance authorization.
Discharge is defined by Durability — the ability to sustain full functional demand (driving, busy environments, exercise, screen use) without regression — confirmed by objective Capacity Markers, not symptom scores alone.
Serving Pittsford, Rochester, and the surrounding region. Complete the intake form to begin your Constraint-Based vestibular evaluation.
Common questions about vestibular rehabilitation in Pittsford and Rochester
Pittsford Performance Care is located at 3800 Monroe Ave Suite 22, Pittsford, NY 14534 — serving patients throughout the greater Rochester area including Brighton, Penfield, Victor, Fairport, and Webster. We specialize in Constraint-Based vestibular rehabilitation: identifying the Primary Constraint in the vestibular, oculomotor, or cerebellar system, and designing a structured Care Track to restore measurable Adaptive Capacity.
We evaluate and treat BPPV, vestibular neuritis, post-concussion dizziness, chronic dizziness, balance disorders, motion sensitivity, visual vertigo, cervicogenic dizziness, and vestibular migraine. Our approach identifies the Primary Constraint — the specific vestibular, oculomotor, or cerebellar failure driving your symptoms — rather than treating dizziness as a single symptom.
General balance therapy typically addresses stability through exercise without identifying which system is the Primary Constraint. Our Constraint-Based approach evaluates the vestibular, oculomotor, and cerebellar systems separately to identify the specific failure driving your dizziness or imbalance. Care is then sequenced by Readiness Gating — vestibular capacity is restored before gaze stabilization demands are added, and gaze stabilization is confirmed before dynamic balance load is increased.
Neurologic Care is private-pay. This allows treatment to be sequenced according to physiologic response rather than authorization limits. A clear fee structure is provided at scheduling. Documentation for out-of-network submission is available upon request.
Duration is determined by restoration of measurable Adaptive Capacity, not a fixed visit count. BPPV with a single canal involvement typically resolves in 1–3 visits. Vestibular neuritis, post-concussion vestibular dysfunction, and chronic dizziness involve longer Care Tracks — typically 3–5 visits for single-constraint presentations — with Readiness Gating at each phase to confirm vestibular recovery before load is increased.