Exercise Prescription Patterns in Patients Treated with Vestibular Rehabilitation After Concussion
Exercise Prescription Patterns in Patients Treated with Vestibular Rehabilitation After Concussion Free Phone Consultation Dizziness and balance dysfunction are among the most persistent and debilitating symptoms following a mild traumatic brain injury (mTBI) or sports-related concussion. Clinical studies show that 23% to 81% of post-concussion patients report dizziness during the acute phase, and 16% to 18% continue to experience persistent dizziness three months after injury. While Vestibular Rehabilitation Therapy (VRT) is known to significantly reduce dizziness and improve postural control, understanding how expert clinicians sequence and progress exercise prescriptions provides valuable guidance for optimal recovery. A key retrospective study evaluated these exercise prescription patterns to reveal how physical therapists successfully treat vestibular deficits post-concussion. Study Overview & Patient Demographics The study analyzed a cohort of 104 post-concussion patients (mean age of 24) who received a customized vestibular rehabilitation home exercise program. Initiation of Therapy: Interventions began between 7 and 181 days post-concussion, with a median start time of 33 days. Frequency & Duration: Patients completed a range of 2 to 13 physical therapy visits (mean of 4 visits) with physical therapists who had at least 3 years of specialized experience in vestibular therapy. Exercise Customization: Standardized home exercise software (Visual Health Information, WA, USA) was adapted and progressed by treating therapists to match each patient’s functional deficits. The 5 Core Categories of Vestibular Rehabilitation Expert clinicians categorized prescribed exercises into five distinct domains based on patient needs: Eye-Head Coordination: Focuses on restoring gaze stability, vestibulo-ocular reflex (VOR) function, smooth pursuits, saccades, and convergence. Sitting Balance: Maintains upright trunk alignment and stability while seated, including weight-shifting tasks. Standing Static Balance: Challenges balance in stationary positions (e.g., single-leg stance, tandem positioning, or standing on foam pads). Standing Dynamic Balance: Involves weight transfer and balance movement while standing in place (e.g., marching, stepping side-to-side, or turning). Ambulation: Integrates dynamic balance with walking (e.g., forward/backward walking, gait with head turns, obstacle navigation, and running). Prevalence of Functional Impairments The study highlighted three primary areas where concussion patients experienced the most severe functional deficits: Eye-Head Coordination Impairments (95% of patients): Nearly all participants suffered from gaze instability or vestibulo-ocular reflex (VOR) disruption, causing severe symptom spikes during head or visual motion. Standing Static Balance Impairments (88% of patients): Most patients demonstrated postural instability even weeks after injury, increasing their fall risk and spatial disorientation. Ambulation Impairments (76% of patients): Dynamic walking deficits were widespread, resulting in slower gait speed, shortened stride length, and wider step width. Clinical Reasoning: Prioritizing Eye-Head Tracking First A critical finding of this research was the decision-making sequence used by specialized physical therapists. Therapists did not address ambulation impairments on the initial visit. Instead, initial care prioritized eye-head coordination and static balance. Addressing vestibulo-ocular dysfunction and gaze instability early in therapy reduces visual-motion sensitivity and stabilizes sensory input. Once eye-head coordination improves, patients can safely progress to dynamic walking, complex movement, and return-to-play protocols without overwhelming the nervous system. Overall, the study demonstrates that expert physical therapists prescribe exercise patterns post-concussion that closely parallel protocols used for unilateral vestibular hypofunction, underscoring the vital role of specialized vestibular care in concussion management. See full study. Get Expert Vestibular Rehabilitation in New York City If you or your athlete are dealing with lingering dizziness, off-balance sensations, or motion sensitivity after a head injury, specialized care can accelerate your recovery. Contact Concussion Management of New York at (212) 717-8331 or visit our Manhattan clinic at 109 W. 38th Street, 4th Floor, New York, NY 10018 to schedule a comprehensive evaluation.