Effectiveness of Vestibular Rehabilitation Therapy for Treatment of Concussed Adolescents With Persistent Symptoms of Dizziness and Imbalance

in Journal of Sport Rehabilitation
Restricted access

Purchase article

USD  $24.95

Student 1 year online subscription

USD  $76.00

1 year online subscription

USD  $101.00

Student 2 year online subscription

USD  $144.00

2 year online subscription

USD  $192.00

Context: Adolescents who suffer sport concussion typically respond to a prescription of cognitive and physical rest in the acute phases of healing; however, some adolescents do not respond to rest alone. Dizziness, unsteadiness, and imbalance are impairments, which may linger longer than 30 days, leading to a diagnosis of postconcussion syndrome (PCS). Vestibular assessment and therapy may benefit adolescents suffering from these persistent symptoms. Clinical Question: Does vestibular rehabilitation therapy (VRT) rather than continued prescription of rest (cognitive and physical) reduce recovery time and persistent symptoms of dizziness, unsteadiness, and imbalance in adolescents (12–18 y) who suffer PCS following a sports-related concussion? Summary of Key Findings: All 4 studies selected included adolescents suffering from PCS, specifically continued dizziness, unsteadiness, and imbalance. VRT was an effective intervention for this population. Adolescents presenting with this cluster of symptoms may also demonstrate verbal and visual memory loss linked to changes in the vestibular system postconcussion. Improved screening tools can help better understand vestibular system changes, identify adolescents who may benefit from VRT sooner, and decrease long-term impairments. Clinical Bottom Line: Moderate evidence supports that adolescents who suffer from persistent symptoms of dizziness, unsteadiness, and imbalance following sport concussion should be evaluated more specifically and earlier for vestibular dysfunction and can benefit from participation in individualized VRT. Early evaluation and treatment may result in a reduction of time lost from sport as well as a return to their premorbid condition. For these adolescents, VRT may be more beneficial than continued physical and cognitive rest when an adolescent’s symptoms last longer than 30 days. Strength of Recommendation: Grade B evidence exists to support that VRT is more effective than continued cognitive and physical rest in reducing persistent symptoms of dizziness, unsteadiness, and imbalance in adolescents who suffer PCS.

Park is with the Department of Kinesiology, The University of North Carolina at Greensboro, Greensboro, NC, USA. Ksiazek is with Sports and Therapy Department, Great Plains Health, North Platte, NE, USA. Olson is with the Department of Health and Nutritional Sciences, South Dakota State University, Brookings, SD, USA.

Olson (Bernie.olson@sdstate.edu) is corresponding author.
  • 1.

    Institute of Medicine and National Research Council. Sports-Related Concussions in Youth: Improving the Science, Changing the Culture. Washington, DC: The National Academies Press; 2014. doi:10.17226/18377

    • Search Google Scholar
    • Export Citation
  • 2.

    Langlois JA, Marr A, Mitchko J, Johnson RL. Tracking the silent epidemic and educating the public: CDC’s traumatic brain injury-associated activities under the TBI Act of 1996 and the Children’s Health Act of 2000. J Head Trauma Rehabil. 2005;20(3):196204. PubMed doi:10.1097/00001199-200505000-00003

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Karlin AM. Concussion in the pediatric and adolescent population: “different population, different concerns”. PMR. 2011;3(10)(suppl 2):369379. PubMed doi:10.1016/j.pmrj.2011.07.015

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4.

    Boden BP, Tacchetti RL, Cantu RC, Knowles SB, Mueller FO. Catastrophic head injuries in high school and college football players. Am J Sports Med. 2007;35(7):10751081. PubMed doi:10.1177/0363546507299239

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Pfister T, Pfister K, Hagel B, Ghali WA, Ronksley PE. The incidence of concussion in youth sports: a systematic review and meta-analysis. Br J Sports Med. 2016;50(5):292297. PubMed doi:10.1136/bjsports-2015-094978

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    McCrory P, Meeuwisse WH, Aubry M, et al. Consensus statement on concussion in sport: the 4th international conference on concussion in sport held in Zurich, November 2012. Br J Sports Med. 2013;47(5):250258. PubMed doi:10.1136/bjsports-2013-092313

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Shrey DW, Griesbach GS, Giza CC. The pathophysiology of concussions in youth. Phys Med Rehabil Clin N Am. 2011;22(4):577602, vii. PubMed doi:10.1016/j.pmr.2011.08.002

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Choe MC, Babikian T, DiFiori J, Hovda DA, Giza CC. A pediatric perspective on concussion pathophysiology. Curr Opin Pediatr. 2012;24(6):689695. PubMed doi:10.1097/MOP.0b013e32835a1a44

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Babcock L, Byczkowski T, Wade SL, Ho M, Mookerjee S, Bazarian JJ. Predicting postconcussion syndrome after mild traumatic brain injury in children and adolescents who present to the emergency department. JAMA Pediatr. 2013;167(2):156161. PubMed doi:10.1001/jamapediatrics.2013.434

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Babcock L, Kurowski BG. Identifying children and adolescents at risk for persistent postconcussion symptoms. JAMA. 2016;315(10):987988. PubMed doi:10.1001/jama.2016.1276

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Broglio SP, Collins MW, Williams RM, Mucha A, Kontos AP. Current and emerging rehabilitation for concussion: a review of the evidence. Clin Sports Med. 2015;34(2):213231. PubMed doi:10.1016/j.csm.2014.12.005

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Valovich McLeod TC, Hale TD. Vestibular and balance issues following sport-related concussion. Brain Inj. 2015;29(2):175184. PubMed doi:10.3109/02699052.2014.965206

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13.

    Alsalaheen BA, Whitney SL, Mucha A, Morris LO, Furman JM, Sparto PJ. Exercise prescription patterns in patients treated with vestibular rehabilitation after concussion. Physiother Res Int. 2013;18(2):100108. PubMed doi:10.1002/pri.1532

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Schneider KJ, Meeuwisse WH, Nettel-Aguirre A, et al. Cervicovestibular rehabilitation in sport-related concussion: a randomised controlled trial. Br J Sports Med. 2014;48(17):12941298. PubMed doi:10.1136/bjsports-2013-093267

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Alsalaheen BA, Mucha A, Morris LO, et al. Vestibular rehabilitation for dizziness and balance disorders after concussion. J Neurol Phys Ther. 2010;34(2):8793. PubMed doi:10.1097/NPT.0b013e3181dde568

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Alsalaheen BA, Whitney SL, Marchetti GF, et al. Relationship between cognitive assessment and balance measures in adolescents referred for vestibular physical therapy after concussion. Clin J Sport Med. 2016;26(1):4652. PubMed doi:10.1097/JSM.0000000000000185

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Zhou G, Brodsky JR. Objective vestibular testing of children with dizziness and balance complaints following sports-related concussions. Otolaryngol Head Neck Surg. 2015;152(6):11331139. PubMed doi:10.1177/0194599815576720

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Howick J, Chalmers I, Glasziou P, et al. The Oxford 2011 Levels of Evidence. Oxford, UK: Oxford Centre for Evidence-Based Medicine. 2011; http://www.cebm.net/index.aspx?o=5653

    • Search Google Scholar
    • Export Citation
  • 19.

    Gottshall K. Vestibular rehabilitation after mild traumatic brain injury with vestibular pathology. NeuroRehabilitation. 2011;29(2):167171. PubMed doi:10.3233/NRE-2011-0691

    • PubMed
    • Search Google Scholar
    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 1433 1029 81
Full Text Views 159 107 5
PDF Downloads 102 57 3