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Vestibular & Concussion Rehab

Physical Therapy for Dizziness & Concussions

Vestibular & concussion rehabilitation is a special program designed to treat and minimize dizziness, motion sensitivity, vertigo, and balance disorders.  Most of us take for granted our ability to get out of bed or turn our head while walking without getting dizzy or losing our balance, but when we have vestibular dysfunction, our quality of life and ability to perform normal daily tasks becomes very difficult. Equilibrium, balance and moving around smoothly within a changing environment are due to our vestibular system, our vision and proprioception or ability to feel the ground under our feet.

Vestibular & concussion rehab works to restore our equilibrium through a series of position changes and exercises that aid the brain in learning to adapt to the aggravating stimuli, make changes to use other sensory pathways or learn to get used to the change in vestibular input to the brain.

At GPT, a physical therapist certified in Vestibular & Concussion Rehabilitation will perform an evaluation of your vestibular system based on your history and complaints, as well as administer a series of tests to assess balance, postural control, tolerance to movement and reflexes.  Then they will determine your cause of dizziness and develop a treatment plan to address your symptoms and get you feeling better.

How Physical Therapy Can Help with Vestibular Issues

There are several types of dizziness and vertigo that can be treated with vestibular rehab. Benign Paroxysmal Positional Vertigo (BPPV) is the most common type of vertigo and occurs in the inner ear when crystals become dislodged from the otolith organs and travel into one of the three semicircular canals, causing an immediate sense of vertigo.  The therapist will determine which canals these crystals are in, then take the patient through a series of position changes called canalith-repositioning maneuvers to restore the crystals to their proper resting place. Treatment for BPPV is typically very quick and can often be treated in the first visit or two.

Vestibular rehab is also used to treat dizziness and motion sensitivity caused by vestibular neuritis, peripheral vestibular loss, Meniere’s disease, labyrinthitis, cervicogenic dizziness, and migraine-related dizziness.  In these cases, the therapist will craft an individualized exercise program consisting of adaptation, habituation and substitution exercises.  Adaptation exercises work to strengthen the vestibulo-ocular reflex (VOR) and help to jump-start the connection between our ears, eyes, and brain.  Substitution exercises are aimed at training the body to use input from our visual field and other joints in our body to give us information about our body and environment so that, as our head moves, our eyes can focus on a target.  Habituation exercises are to expose the patient to an aggravating stimulus multiple times to fatigue the vestibular system and reduce the severity of the vestibular dysfunction with each repeated exposure to the stimulus.  Treatment for vestibular dysfunction, not BPPV, can take anywhere from a couple of weeks to a few months in some cases.  Vestibular rehabilitation can fully eliminate symptoms for some disorders and can help to minimize and manage symptoms for other disorders.

Common symptoms patients might complain of are: dizziness, vertigo, lightheadedness, blurry vision, disequilibrium, headache, light and sound sensitivity, tinnitus, hearing loss, anxiety, nystagmus, fear of falling, feeling of being pulled to one side, unsteadiness, and depression.

What Is a Concussion?

A concussion is a type of brain injury that can occur when there is a bump, blow, or sudden movement of the head, causing the brain to move in the skull. This creates changes to the brain, either chemical or mechanical, which result in temporary changes to brain function. (CDC). You can sustain a concussion in a variety of ways, most commonly from falls, motor vehicle accidents, bumping your head, and sports. When you have a suspected concussion, you may experience a variety of symptoms. The following is not an exhaustive list, but here are some examples of what you may be experiencing:

  • Headaches
  • Neck pain
  • Balance deficits
  • Difficulty with head or eye movement
  • Blurry vision
  • Dizziness and/or vertigo
  • Nausea or vomiting
  • Difficulty concentrating, multi-tasking, or memory deficits
  • Behavioral changes
  • Fatigue
  • Sensitivity to light and sound
  • Sleep disturbances (Mayo Clinic)
  • Inability to exercise or increase your heart rate

Physical Therapy After a Concussion

Most people recover fully from a concussion in days or weeks, but sometimes it takes longer. Physical therapy can help with both acute and persisting symptoms, and often will shorten the recovery period. Our physical therapists that are specifically trained in concussion rehab, will do a full assessment of your symptoms and function. Treatment will be tailored to the deficits you are experiencing.

For symptoms related to difficulty with head and eye movement, blurry vision, and balance deficits; often treatment will involve re-training of eye and head control, balance training, and vestibular therapy as indicated.

With symptoms of headache and neck pain, often a combination of specific guided exercise, neck proprioception training, and manual therapy is beneficial.

When you are having difficulty with activities that increase your heart rate, you may be experiencing something called dysautonomia. This means that the autonomic nervous system (the system that regulates our internal organs and “fight, flight or freeze” response) is not functioning properly. With testing, we can come up with an individualized exercise plan to help regulate and re-train your heart rate response and return to exercise safely.

Lastly, education is one of the most important things involved in concussion rehab, so you can gradually and safely return to daily activities, work, school, and exercise. This is multi-faceted, as the brain controls all of your functions!