Concussion by Anthony P. Kontos Michael W. Collins & Michael W. Collins

Author:Anthony P. Kontos,Michael W. Collins & Michael W. Collins
Language: eng
Format: epub
Publisher: American Psychological Association

Vestibular Therapies

In our experience, most vestibular dysfunction and symptoms in patients with vestibular clinical profiles following concussion result from disruption in the central vestibular pathways and structures. In brief, centrally mediated vestibular function is adversely affected following concussion, resulting in disequilibrium, imbalance, dizziness, vertigo, and other symptoms and dysfunction (Furman, Raz, & Whitney, 2010). Peripheral vestibular dysfunction appears to be less common following concussion, although prevalence rates are not established in the literature. (For a thorough review of additional vestibular dysfunction following concussion and associated therapies, including those targeting peripheral vestibular issues, see Broglio, Collins, Williams, Mucha, & Kontos, 2015, and Kontos & Ortega, 2011.) These vestibular symptoms and dysfunction are categorized as either vestibulospinal (involving the balance and gait) or vestibulo-ocular (involving integration of visual and vestibular input with the movement of the head and body). The underlying categorization and concomitant symptoms and dysfunction will drive which therapies will be most effective for each patient.

A growing body of evidence suggests that vestibular therapies can help to alleviate vestibular-related symptoms and impairment following a concussion. In fact, in a study of 114 patients both dizziness and imbalance were decreased following vestibular rehabilitation (Alsalaheen et al., 2010). These same researchers reported that these positive effects were obtained after only a single session of vestibular rehabilitation in both adult and adolescent patients. In addition, patients in the same study who completed vestibular rehabilitation exercises also reported being more confident in their ability to maintain balance following injury. However, this study was retrospective in nature and did not include a control group for comparison.

K. J. Schneider and colleagues (2014) extended this initial work by conducting an RCT of the effectiveness of vestibular rehabilitation with 31 adolescent and young adult patients with a concussion. They reported that the patients randomized to the vestibular rehabilitation intervention were nearly 4 times more likely to be recovered by 8 weeks than the control group. However, this study did not differentiate the treatment effects of the vestibular compared with cervicogenic interventions that were combined into one treatment group. Therefore, it is impossible to determine whether the effects reported were attributable to one or both of these interventions. Regardless, this research provides tentative empirical support for the use of vestibular therapies in general. However, just as targeted treatments for concussion should match specific clinical profiles, so too should vestibular therapies match specific vestibular impairments and symptoms. Therefore, we review specific subtypes of vestibulospinal and vestibulo-ocular therapies in the sections that follow.

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