Vestibular Rehab and Concussion

While most concussed individuals will return to pre-injury levels of functioning within two weeks without any intervention, 17% of athletes experience a prolonged recovery lasting longer than three weeks (Collins et al, 2006).  2.5% will remain symptomatic 45 days post-injury (McCrea et al, 2013). 

Vestibular and oculomotor impairment and symptoms occur in approximately 60% of athletes following a sports related concussion (Mucha et al, 2014).  These impairments are associated with poor outcomes and delayed return to function (Lau et al, 2011).  A patient with an impairment to the vestibular system may experience impaired balance, dizziness, vertigo, blurred or unstable vision, discomfort in busy environments and nausea.  Symptoms from an oculomotor dysfunction include blurred vision, double vision, difficulty reading, eyestrain, headaches and problems with visual scanning.   

In order to get the best clinical outcomes for patients with concussion, a good assessment is important in order to identify a clinical subtype of concussion.  Once this has been ascertained, targeted treatments and rehabilitation strategies can be applied.  These subtypes include benign paroxysmal positional vertigo (BPPV), vestibulo-ocular reflex (VOR) impairment, visual motion sensitivity and cervicogenic dizziness.      

This is the most common disorder of the vestibular system.  It can occur post-traumatically after sports related concussion.  As a result of the impact from the concussion, otoconia or calcium carbonate crystals become dislodged from the otolith organs of the inner ear and relocate to one of the semicircular canals of the inner ear.  Once diagnosed, this may be successfully treated with a canalith repositioning manoeuvre.  For more detail on BPPV, please see my earlier blog posts.

The VOR is a fast-acting reflex that maintains eye position during head movement.  It does this by generating eye movements precisely in proportion to the head movement.  For example, if you were focus on one of the words in this blog and move your head side to side or up and down, your VOR allows you to maintain that focus.  If your VOR is impaired, you may experience blurring of vision, dizziness, or a sense that the word is bouncing on the page.  Vestibular rehabilitation for a VOR impairment involves exercises that require the patient to focus on a target while moving their head.  

This refers to a sense of disorientation, dizziness or unsteadiness that arises when the brain is not effectively processing information from the patient’s vestibular system and over-relying on their vision.  Patient’s with visual motion sensitivity will find that their symptoms are particularly aggravated when they are in busy environments like the supermarket.  Vestibular rehabilitation here will involve gradually exposing the patient to what they are having difficulty with.   

This is dizziness arising from dysfunction in the joints and/or muscles in the neck.  Symptoms can also include imbalance and impaired eye movement.  Treatment here involves a mixture of manual therapy and exercises to address the dysfunction in the neck along with vestibular rehabilitation. 

In all cases, restoring a person’s balance and postural control is also an important part of vestibular rehabilitation following a sports related concussion.  Exercises will be based on balance tests done within the clinic and will be designed with the sport or activity the patient is returning to in mind. 

While suffering from vestibular and oculomotor impairments can prolong a patient’s recovery, studies have shown that these patients may respond well to vestibular rehabilitation (Broglio et al, 2015).   

If you are suffering from persistent symptoms of a concussion or are struggling to return to function, you can contact me on 01-8253997 or book a vestibular rehabilitation appointment on our website booking page.  

• Collins MW, Lovell MR, Iverson GL, Ide T, Maroon JC.  Examining concusion rates and return to play in high school football players wearing newer helmet technology: a three year prospective study. Neurosurgery. 2006; 58(2):275-86 

• McCrea M, Guskiewicz KM, Randolph C, Barr WB, Hammeke TA, Marshall SW, et al. Incidence, clinical course, and predictors of prolonged recovery time following sport-related concussion in high school and college athletes. J Int Neuropsychol Soc. 2013;19(1):22-33 
• Mucha A, Collins MW, Elbin RJ, Furman JM, Troutman-Enseki C, DeWolf RM, et al. A Brief Vestibular/Ocular Motor Screening (VOMS) Assessment to Evaluate Concussions: Preliminary Findings. The American journal of sports medicine. 2014 
• Lau BC, Kontos AP, Collins MW, Mucha A, Lovell MR. Which on-field signs/symptoms predict protracted recovery from sport-related concussion among high school football players? Am J Sport Med. 2011; 39(11):2311–8. 
• Broglio SP, Collins MW, Williams RM, Mucha A, Kontos A. Current and emerging rehabilitation for concussion: A review of the evidence. Clin Sports Med. 2015;34(2):213-231