Vestibular rehabilitation following mild traumatic brain injury

Gurley, James M; Hujsak, Bryan D.; Kelly, Jennifer L.

doi:10.3233/nre-130874

Cited by 65 publications

(44 citation statements)

References 65 publications

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“…Researchers 7 have thought that concussion management should include complete cognitive and physical rest until patients were asymptomatic, followed by a stepwise progression to return to participation. However, more recently, investigators [8][9][10][11][12] have suggested a comprehensive approach, including rest, pharmacologic intervention, vestibular therapy, oculomotor training, and balance training. Moreover, patients with cervical injury respond to immediate therapy, including soft tissue massage, passive stretching, strength training, cryotherapy, and thermotherapy, 4,13 and to pharmacologic interventions, vestibular maneuvers, and cervical manipulations.…”

mentioning

confidence: 99%

“…Moreover, patients with cervical injury respond to immediate therapy, including soft tissue massage, passive stretching, strength training, cryotherapy, and thermotherapy, 4,13 and to pharmacologic interventions, vestibular maneuvers, and cervical manipulations. 4,13 Researchers [8][9][10][11][12][13][14] have recently emphasized a targeted evaluation that focuses on all aspects of concussions, including possible involvement of the vestibular and cervical systems. In addition, acute treatment of identified conditions to ensure a restoration of various systems individually and collectively has been recommended.…”

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confidence: 99%

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Cervical Injury Assessments for Concussion Evaluation: A Review

Cheever

Kawata

Tierney

et al. 2016

Journal of Athletic Training

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confidence: 99%

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confidence: 99%

Cervical Injury Assessments for Concussion Evaluation: A Review

Cheever

Kawata

Tierney

et al. 2016

Journal of Athletic Training

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“…Generally, a period of relative rest is recommended following an acute concussive episode. This rest period is variable in length; it is generally accepted that the patient should continue relative rest until they are no longer experiencing concussion symptoms while at rest [20]. Sound postural control is reliant upon the proper functioning and integration of the visual, vestibular and somatosensory systems.…”

Section: Discussionmentioning

confidence: 99%

“…Spectral domain optical coherence tomography (SD-OCT) was first developed at the Massachusetts Institute of Technology and published in 1991 [13][14][15][16][17][18][19][20][21][22][23][24][25]. OCT emits near-infrared light through the pupil into the back of the eye to create a three dimensional image of the retina with micrometer resolution that visualizes each individual cell layer.…”

Section: International Journal Of Physical Medicine and Rehabilitationmentioning

confidence: 99%

Retinal and Balance Changes Based on Concussion History: A Study of Division 1 Football Players

Bigsby¹

2014

Int J Phys Med Rehabil

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Background: The long term effects of a sports concussion or mild traumatic brain injury (mTBI) is poorly understood. The term chronic traumatic encephalopathy (CTE) is associated with protein deposition observed post mortem; thus the diagnosis of CTE in living subjects is impracticable using protein deposition as a diagnostic criterion. To date, there is no validated, objective method to observe and document pathologic changes post mTBI. The brain, optic-nerve, retina axes is closely linked; it is believed that some aspects of mTBI may be reflected in the retinal nerve fiber layer (RNFL) and that optical coherence tomography (OCT) could be a means to observe and document these changes. In this paper we show an association between a history of concussion and RNFL changes in college athletes. Methods: Each member of the University of Cincinnati football team was surveyed for a history of diagnosed concussion during pre-season camp. All players participating in camp were consented and were subjected to both a retinal exam using the Optovue iVue OCT retinal imaging system and a balance challenge by performing a visual motor task (Dynavision D2) on a BOSU Pro Balance Trainer (BOSU ball) and on a firm surface. Eye-hand coordination, balance and RNFL thickness measurements for the athletes with a history of concussion were compared to those the athletes with no history of concussion. Results: A total of 34 athletes reported having at least one previously diagnosed concussion that occurred up to 10 years prior to data collection; 73 reported no history of diagnosed concussion. Data analysis of the OCT retinal images demonstrated significant thickening of the RNFL in those athletes with a remote history of concussion when compared to athletes with no history of concussion, 106.8 µm vs 103.7 µm (p = 0.009), respectively. With the BOSU ball challenge there was no change in performance with or without a balance challenge 4.57 vs 4.63 hits per minute (p=0.93) for those with history of concussion versus no history. The performance task on the Dynavision D2 is an eye hand coordination task and a balance task, so eye hand coordination was not impacted by the RNFL changes. Discussion: In this paper we report significant sustained chronic RNFL thickness changes occurring in athletes with a remote history of concussion when compared to similar athletes without a reported history of concussion. However, there were no statistically significant sustained changes in eye hand coordination or balance challenge performance tasks. We suggest that RNFL changes may be an indicator of a structural brain injury following a postconcussive event and may be caused by subclinical increases in intracranial pressure or other neurovisual-related pathologies.

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“…8 Patients who undergo VRT should first have their symptoms (frequency and intensity) under control, as this allows for the most effective treatment. 9 Similar to any other rehabilitation technique, patients should perform these exercises under the supervision of a trained clinician. This study focused on the DHI as the main outcome measure used to evaluate the efficacy of VRT, as it is a questionnaire that monitors the status of an individual patient recovering from a concussion.…”

Section: Implications For Practice Education and Future Researchmentioning

confidence: 99%

Vestibular Rehabilitation Therapy Improves Perceived Disability Associated With Dizziness Postconcussion

Nagib¹,

Linens²

2019

Journal of Sport Rehabilitation

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Clinical Scenario: Every year, millions of people suffer a concussion. A significant portion of these people experience symptoms lasting longer than ten days, and are diagnosed with post-concussion syndrome. Dizziness is the second most reported symptom associated with a concussion, and may be a predictor of prolonged recovery. Clinicians are beginning to incorporate vestibular rehabilitation therapy in their post concussion treatment plan, in order to address the dysfunctional inner ear structures that could be causing this dizziness. Focused Clinical Question: Can Vestibular Rehabilitation Therapy (VRT) Help Post-Concussion Syndrome (PCS) Patients Experiencing Prolonged Dizziness By Improving Their Perceived Disability? Summary of Key Findings: Three studies were included - one randomized control trial (RCT), one retrospective chart review, and one exploratory study. The RCT compared cervical spine therapy alone to cervical spine therapy in conjunction with VRT to obtain medical clearance for sport. The chart review explored VRT as a treatment for reducing dizziness and improving balance and gait dysfunction. The exploratory study implemented VRT in conjunction with light aerobic exercise to improve perceived disability associated with dizziness post-concussion. All three studies found statistically significant decreases (improvements) in Dizziness Handicap Index (DHI) scores. Clinical bottom Line: There is preliminary evidence suggesting VRT can improve perceived disability in patients with PCS experiencing prolonged dizziness. There is a decrease (improvement) in DHI scores across all three studies. VRT is a relatively safe treatment option, with no adverse reactions or case reports. Strength of Recommendation: There is level 2 and level 3 evidence supporting the use of VRT to treat patients suffering from dizziness post-concussion.

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Vestibular rehabilitation following mild traumatic brain injury

Cited by 65 publications

References 65 publications

Cervical Injury Assessments for Concussion Evaluation: A Review

Cervical Injury Assessments for Concussion Evaluation: A Review

Retinal and Balance Changes Based on Concussion History: A Study of Division 1 Football Players

Vestibular Rehabilitation Therapy Improves Perceived Disability Associated With Dizziness Postconcussion

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