Vestibular Rehab for Concussions

Health & wellness article written by Dr. Kaitlyn Hamel, Physical Therapist at Seacoast Spine & Sports Injuries Clinic.

A concussion is a type of traumatic brain injury (TBI) caused by a bump, blow to the head, or whiplash injury that causes that brain to move quickly back and forth. Concussions can cause four different types of symptoms: 1) physical (migraine, dizziness, nausea, sensitivity), 2) cognitive (concentration, memory, attention), 3) neuro-psychiatric (irritability, sadness, nervousness), 4) sleep disturbance. There are no diagnostic tests for concussions and therefore they are diagnosed based on a group of symptoms that can become immediately present or arise over weeks to months following the initial injury. Acute symptoms can be present for 1-2 weeks following the concussion. Post-concussion syndrome is defined as prolonged symptoms lasting greater than a month after the initial head injury.

A generalized rule of recovery following concussion is no exercise or vigorous activity within 24 to 48 hours of initial injury. Dependent on the severity of the injury and symptoms the individual may need to decrease hours at school and/or work. It is important to abide by these guidelines even if no symptoms are present. Research shows that some individuals can be symptom free for up to 3 days post-concussion while brain studies continue to show decreased nerve transmission and risk for injury for up to 30 days.

The multi-disciplinary approach includes a multitude of professionals that play roles from the initial decision to withdraw an athlete from play to returning the athlete safely to the game. It all starts with a decision from the coach and athletic trainer. The athlete should then be referred to a sports medicine physician and neurologist to be examined and diagnosed. A vestibular therapist will then educate, examine, evaluate, and develop a treatment plan in order to decrease symptoms and return to function. In order to return to play the sports medicine physician and neurologist must clear the athlete. This may occur shortly or long following the abolishment of initial symptoms post-concussion.

The American Physical Therapy Association (APTA) “recognizes that physical therapists are part of the multidisciplinary team of licensed health care providers that provides concussion management, which includes education, examination and evaluation to establish a diagnosis.”

When a concussion involves the disturbance to the vestibular system the individual may have symptoms of dizziness, ringing in the ears, lightheadedness, visual problems (double, blurred, difficulty focusing), and imbalance (increased in dark settings). In 85% of the concussive population these symptoms will resolve without requiring therapeutic services. If symptoms last longer than 7-14 days then referral to a vestibular specialist is highly recommended.

What does vestibular rehabilitation focus on? Every concussion is different and presents with its own unique signs and symptoms. Thus, vestibular rehabilitation will be personalized to the individual’s needs. Some of the focus points are reaction times, vision, eye/head coordination, balance and coordination, dual task performance, and safe return to activity.

The body’s balance is maintained by coordination between three systems: 1) vestibular, 2) visual, and 3) somatosensory. In order for an athlete to return to sport these three systems must be working effectively together. Questions that will be asked to determine if they are ready to return to activity are: does the athlete have skewed or blurred vision while their body is in motion? Does the athlete have continued headaches? Do visual tasks increase or produce symptoms? Have balance/vestibular tests been re-assessed and results found to be within normal limits?

NOTE: Red flags that would require immediate medical attention to rule out serious brain trauma are repeated vomiting, seizure activity, loss of consciousness, unequal pupil size, confusion and/or slurred speech.

For more information on other vestibular disorders, the Vestibular Disorders Association’s website is a useful tool (www.vestibluar.org).

Reach out to Dr. Hamel at drhamel@seacoastsportsinjuries.com if you have any questions pertaining to this article.