Vestibular Rehabilitation Therapy Improves Perceived Disability Associated With Dizziness Postconcussion

Abstract

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.

Classification of Comprehensive Neuro-Ophthalmologic Measures of Postacute Concussion

“…13 Axonal injury in these networks is thought to underlie postconcussive imbalance, dizziness, and vision blurriness, especially when tracking objects in motion. 10,14 Some eye movements (eg, predictive smooth pursuits) rely on intact working memory and attention to generate accurate prediction of future events, which is important for tracking moving objects. 13,15 Thus, postconcussion impairments in cognitive processing may exacerbate eye movement performance.…”

Review of the Management of Pediatric Post-Concussion Syndrome—a Multi-Disciplinary, Individualized Approach

“…VRT combined with cervical spine physiotherapy was found to significantly decrease RTP time at 8 weeks compared to usual care [29]. Preliminary evidence shows that VRT may decrease perceived disability in patients with dizziness from PCS [37]. Another study found faster improvements in dizziness, balance problems, symptoms, and disability with VRT for individuals with mild-to-moderate TBI in comparison to a control group, although the effects were not significant between the groups 2 months after the intervention was stopped [38].…”

Otoneurological Evaluation and Rehabilitative Considerations after Head Trauma

“…A review by Nagib & Linens has brought evidence that vestibular rehabilitation (VRT), associated with light aerobic exercise or cervical spine therapy reduced Dizziness Handicap Index scores, improving quality of life and balance [46], whereas a study by Murray, Meldrum and Lennon also suggests that VRT might be useful in mild brain trauma, although more studies are necessary to fully establishment of the practice [47]. This evidence was also supported by the study of Park, Ksiazek and Olson, on VRT in adolescents who suffered sports-related concussion [25].…”