After a concussion, individuals may experience vestibular dysfunction, a disturbance in the balance system of the body. This can often lead to dizziness, nausea, or imbalance, just to name a few. Fortunately, these symptoms are usually not permanent and can be treated through vestibular therapy for concussions.
This article will discuss the causes of vestibular dysfunction, symptoms, and the most effective vestibular exercises for concussion.
What Is Vestibular Dysfunction?
A concussion is a mild traumatic brain injury that can cause different effects depending on the areas of the brain and neural pathways affected. For instance, damage to the brainstem, temporal lobe, cerebellum, can cause vestibular dysfunction, which can interfere with the peripheral and central vestibular systems.
The vestibular system is a sensory system that helps you create a sense of balance and orientation, which are both necessary for coordinating movement. The vestibular system relies on the vestibular organ found in the inner ear. Within the vestibular system, the cochlea and auditory system work together to constitute the labyrinth of the inner ear. The inner ear is further categorized into two main parts: the semicircular canals and the otolith organs.
The semicircular canals are three, fluid-filled tubes lined with tiny hairs that monitor head motion. The fluid in particular sloshes around and helps move the hairs when the head moves, allowing the brain to detect motion. Each canal detects a specific direction of movement, one focuses on up-and-down movement while the other focuses on tilting left or right. The third canal focuses on rotational movement.
While the otolith organs have similar functions to the canals, they respond more to gravitational force. The calcium carbonate crystals inside these organs detect when the body is in motion, such as moving up in an elevator.
When a concussion disrupts any part of the vestibular system, the neural connections to and from the brain may also become damaged or destroyed. This makes it difficult for the brain to communicate with the vestibular system and recognize the position of the head in relation to the rest of your body and surroundings.
Damage or disruption to the vestibular system can then lead to the most common form of acute peripheral vestibular dysfunction known as vestibular neuronitis, which may include vertigo, imbalance, and more.
Symptoms of Vestibular Dysfunction Post-Concussion
Studies estimate roughly 30% of survivors experience persistent symptoms that can last months or years after the injury. Symptoms may linger after the initial impact and can include a variety of different vestibular function issues including:
- Dizziness
- Imbalance
- Eye strain or blurred vision
- Disorientation
- Nausea or vomiting
- Vertigo (sudden spinning sensation)
- Nystagmus (rapid and uncontrollable eye movement)
- Spatial impairment (awareness of your body in relation to space)
- Motion sickness or sensitivity
- Unsteady gait (abnormal walking)
- Postural instability
Symptoms for peripheral and central vestibular dysfunction can sometimes overlap. Therefore obtaining a proper diagnosis is essential to differentiate between the two. Though symptoms may vary for every survivor, most can benefit from vestibular therapy for concussions.
How Vestibular Therapy for Concussions Works
Vestibular therapy targets the various functions of the vestibular system. It is one of the most effective, evidence-based methods for treating vestibular issues such as imbalance and spatial disorientation after a concussion. Vestibular therapy helps retrain the brain to orient itself according to your position in space.
There are several goals in vestibular therapy such as improving balance, restoring clear and stable vision for head movement, and learning breathing techniques. Proper breathing is crucial, especially after sustaining a mild traumatic brain injury to keep the brain and body oxygenated.
Controlled breathing can also help reduce symptoms such as dizziness and nausea. While improper breathing may not be a vestibular issue, studies show breathing techniques are effective tools for vestibular rehabilitation after concussion.
Survivors may have vision problems without other vestibular issues or vice versa, while others may have both. Therefore, a vestibular therapy session will usually include much more complex vestibular physical therapy exercises than simply standing on a balance board. You must engage your peripheral, central, and visual system and practice moving your head around to maximize vestibular therapy and improve function.
Before diving into vestibular therapy, however, a medical team will need to assess and make an evaluation. This will help doctors narrow down your diagnosis for you to obtain proper treatment. Nearly all survivors can benefit from vestibular therapy, but the outcome will depend on how dedicated you are to the rehabilitation process. The more practice, the more neuroplasticity will be activated.
Neuroplasticity is the brain’s ability to rewire itself by strengthening existing neural pathways and creating new ones as needed. With neural pathways restored, the brain will be able to communicate better with the rest of the body and vestibular system, making it once again aware of space and its surrounding environment.
Evaluation for Inner Ear Concussion Treatment
A doctor or physical therapist will first perform a series of exams. Tests such as vision and balance help determine your issues stemming from the inner ear. Additionally, symptoms of vestibular dysfunction often vary, as such there is no one symptom that is used to identify this disorder. Medical history, physical, and cognitive exams are all necessary in order to provide an adequate diagnosis.
During an evaluation, your doctor may ask you to:
- Focus your vision on a single point
- Move your head side-to-side and up-and-down
- Move your head diagonally while they look for irregular eye movements
Doctors will also search for any ocular or vision problems that can cause more issues. For example, survivors with visual impairment may have clear vision when standing or sitting still. However, movement may cause their vision to blur.
Vision not only involves a 20/20 eyesight but other factors such as eye tracking, ease of focus, and peripheral vision. They all play a role in the vestibular system and can become affected after a concussion.
However, vision changes may not be present at first and can be masked behind symptoms such as eye straining, fatigue, and headaches. Therefore a full evaluation and assessment is imperative to ensure all symptoms are accounted for. With a proper diagnosis, vestibular therapy can begin.
Vestibular Exercises for Concussion
To address your specific needs, your therapist will likely create a customized vestibular therapy plan. There are three types of rehabilitation methods commonly used in vestibular therapy including: gaze stabilization, habituation exercises, and balance and exertional training.
Gaze Stabilization
The vestibulo-ocular reflex allows you to stay focused on an object even when your head is moving. After a concussion, this reflex can become damaged, causing disorientation and vertigo. Eye exercises can help improve gaze stabilization and restore the vestibulo-ocular reflex after a concussion.
Eye exercises can include a variety of exercises such as:
- Sitting upright in a chair
- Drawing an X in the center of a piece of paper
- Holding a paper in your hand at arm’s length and keeping it at eye level
- Focusing your gaze on the X and turning your head side to side
- Moving as fast as you can without the X becoming blurry
The level of difficulty can be increased depending on your comfort level. For instance, while the goal is to perform the exercise above for 1 minute, you should start with a shorter goal of a couple seconds and increment the time as you improve.
Habituation Exercises for Concussion
The second popular method used in vestibular therapy is habituation exercises. These exercises are particularly helpful for individuals who experience extreme dizziness when they move around. Habituation exercises help reduce dizziness by gradually increasing exposure to the movements that trigger them, such as bending over to pick something up off the ground.
A sample habituation exercise may include:
- Moving from a sitting position to laying flat on your back
- Standing up and sitting back down
- Sitting up and bending forward until your head is between your knees
The goal is to build up enough tolerance until those movements are no longer triggering or causing motion sickness. Your therapist will help ensure the exercise is both challenging and manageable to prevent you from overexertion.
Balance and Exertional Training
Another common method used in vestibular therapy for concussions is balance and exertional training. This type of training focuses on improving endurance, balance, and building up strength. Balance and exertional training is also particularly useful for athletes who sustained a concussion because it helps build up stamina, improve steadiness, and cardio.
Although balance and exertional training is usually done at a slow pace, based on your ability level, it’s important to treat other symptoms (such as dizziness) beforehand to prevent exhaustion or other complications. If you notice any vestibular symptoms flaring up while exercising, stop immediately or take a break. Your therapist can provide you with more guidance and ensure which vestibular physical therapy exercises for concussion are suitable and safe for you.
Epley Maneuver
Additionally, a concussion may cause the crystals in the otolith organs to dislodge, resulting in severe vertigo. Fortunately, the crystals can be pushed back into their proper place with the Epley Maneuver. This method involves moving the head into four positions and remaining in each position for at least 30 seconds. It’s a quick process that usually takes 5 minutes to complete and has a high success rate.
However, the Epley Maneuver must be performed by a specialist; do not try it on your own. If you are interested in the technique or want to learn more information, search through this list of certified vestibular specialists to find the right one for you.
Participating in Vestibular Therapy After Concussion
Vestibular therapy is one of the most effective treatments for balance disorders after a concussion. However, not all dizziness is caused by inner ear issues. Some, for example, can be caused by cervical problems, such as whiplash. If that’s the case, vestibular therapy will not have any positive effects.
Survivors may experience a variety of vestibular symptoms after a concussion such as nausea, imbalance, and blurred vision. Consult with your doctor to obtain a proper assessment to identify all the vestibular symptoms. With a diagnosis, treatment can begin which may include a variety of vestibular exercises for concussion.
We hope this article has encouraged you to participate in vestibular therapy after concussion.
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