What to expect
This dysautonomia service was developed following Gerard Farrell’s PhD research into autonomic mechanisms, particularly heart rate variability, in response to neck manual therapy.
While the initial focus was on supporting people with Postural Orthostatic Tachycardia Syndrome (POTS), a primary form of dysautonomia, it quickly became clear that dysautonomia rarely occurs in isolation. It frequently overlaps with a range of conditions that can lead to secondary dysautonomia, including (but not limited to):
- Orthostatic Hypotension (OH)
- Ehlers-Danlos Syndromes (EDS)
- Hypermobility Spectrum Disorders
- Chronic fatigue presentations
- Post viral dysautonomia (i.e. following COVID or glandular fever)
Because these conditions are complex and interconnected, the service is designed to be comprehensive, patient-centred, and closely aligned with your individual goals.
Conditions related to dysautonomia
Many dysautonomia-related conditions are long term, and while the physiotherapist does not claim to have all the answers or to be able to help every person in the same way, every effort is made to provide the best possible care within a physiotherapist’s professional scope.
Often, progress comes from a series of small, meaningful insights; one useful piece of information here, another strategy from a different health professional there.
When these small gains add up, they may make a genuine difference to your function, confidence, and ability to live life as fully as possible.
Medical input
Many conditions treated within this service (primary and secondary dysautonomia) are very complex and have a strong link with conditions that require medical input.
Physiotherapists are primary-care practitioners (meaning anyone can come in and see us directly). However, it is strongly preferred that patients have at least some medical input, such as from a general practitioner, to ensure that symptoms are not related to an alternative underlying cause.
If a concern is identified as being outside the physiotherapist’s scope or requiring further medical assessment, appropriate guidance and referral will be provided.
How the sessions work
Session logistics
Booking an appointment
To book an appointment, call reception and advise that you would like to book an appointment with the Dysautonomia Service.
Tel +64 3 479 7460
Initial sessions
Initial sessions are one hour long.
Much of this session is spent on detailed history taking, as this provides the foundation for safe and effective management.
Follow-up sessions
Follow-up sessions are 30 minutes long.
Follow-up frequency varies. Some people prefer to take the initial guidance and work independently; others like to schedule follow-ups. Both approaches are completely fine and up to you.
Costs
Visit our Fees page for costs of initial, follow-up consultations, and reports
Location and hours
Visit our Location and hours page
Telehealth
Zoom sessions are available. This is especially helpful for people living outside of Dunedin.
Please let reception know upon booking the appointment, and a Zoom link will be emailed to you.
Session specifics
Your goals guide the session
Each session is built around what you want to focus on. Your priorities, whether understanding symptoms, exploring management strategies, or planning next steps, come from you.
Have a think about what you want to get out of the session before you come.
Comprehensive history taking
Most appointments begin with a detailed history. This helps determine which testing is safe and appropriate and informs a tailored management plan. You will have the opportunity to describe:
- Your story: how your symptoms started and how they have changed over time
- Your main symptoms and their impact on daily life
- Triggers, factors or situations that worsen your symptoms
- Triggers, factors or situations that help your symptoms
- Relevant past medical history, injuries, events, illnesses, and family history
Objective testing available
Physiotherapists do not perform medical investigations such as skin biopsies, small fibre neuropathy testing, sweat testing etc. These require specialist services.
What can be offered includes:
- Active stand test, NASA lean test, or tilt table testing*
- Hypermobility assessment
- Exercise capacity testing
- General musculoskeletal evaluation
* Physiotherapists cannot formally diagnose many of these conditions (such as POTS, Orthostatic Hypotension, Ehlers-Danlos Syndromes), but they can provide a clinical impression to support your GP or specialist’s decision making.
Tilt table testing
While tilt table testing has traditionally formed part of the diagnostic assessment for POTS, current diagnostic guidelines do not require it for diagnosis and support the use of an active stand test instead. However, tilt table testing is still widely regarded as the gold standard assessment and can be offered when clinically appropriate. The suitability of different testing options can be discussed during consultation.
We do not perform tilt table testing at the first session unless your GP or another medical specialist has directly requested it and deemed it safe to perform.
A clear understanding of your history (especially your medical history) is needed to ensure the test is safe and appropriate.
After completing the test, the physiotherapist can send a summary of your results to your GP outlining the findings.
Management approach
Physiotherapy management remains within a non-pharmacological scope of practice, and medication recommendations are not provided.
The physiotherapist's role is to help patients understand the broader clinical picture (or “big picture”) and identify strategies most likely to support symptom management and functional improvement. These may include:
- Daily lifestyle and autonomic support strategies for symptom management
- Autonomic modulation and regulation strategies
- Guidance on activity frequency, pacing, and recovery
- Symptom led pacing and activity strategies, tailored to your individual condition, symptom profile, preferences, and safety limits
- Graduated orthostatic and joint protective exercise strategies
- Recognition and interpretation of symptom patterns
- Individualised adaptations when standard protocols do not fit your situation
- Guidance on appropriate referrals and whom might be worth adding to your management team (e.g. dietitians, psychologists, GPs for specialist referral, exercise physiologists)
There are many structured programmes available, and these work very well for many people. Others benefit more from a personalised, adaptive approach. This is where the Dysautonomia service can help.
Communication and timeframe to get an appointment
Please note that Gerard works in the clinic on two half days per week. Due to this, there may be some wait time before you are able to get an appointment with him.