Concussion symptoms that may indicate a disruption of the Vestibular System include:
loss of balance
dizziness or spinning
The symptoms can occur right away or they can develop several weeks after the concussion.
Additional information about symptoms:
Dizziness when moving around, such as quick head movements, or changing positions such as bending over or looking up to reach above your head.
Dizziness in visually stimulating environments such as malls and stores, walking over shiny or patterned floors or watching action films or TV with a lot of visual action.
Gaze or Vision issues:
The patient's "visual world appears to bounce or jump around, such as when reading or trying to identify objects in the environment, especially when the patient is moving about."
Loss of balance that affects everyday life and may cause the patient to limit physical activity.
Thank you to VeDA for this information.
Concussions can result in damage to the inner ear and brain and lead to chronic vestibular disorders which impact balance, learning, social interactions and the ability to perform everyday tasks. Video by the Vestibular Disorders Association (VeDA).
Different ways to access to Vestibular Therapy:
Ask your medical provider for a referral to
An Otolaryngologist who specializes in balance disorders
A Physical Therapist who specializes in Vestibular Rehabilitation Therapy.
An ENT (ear, nose, throat) doctor
Review this guide on how to choose a vestibular specialist.
This guide to vestibular disorder specialists explains the different types of healthcare professionals in this field.
The "Find A Vestibular Specialist" search tool is courtesy of the Vestibular Disorders Association (VeDA.)
What is Vestibular Rehabilitation Therapy?
Your rehab will be customized to your needs and may include:
Exercises for motion sensitivity
Exercises specific to your sports or work. Source
Epley Maneuver for dizziness or vertigo
One type of rehabilitation therapy called the canalith repositioning procedure (also called the “Epley maneuver”), specifically addresses dizziness or vertigo (a spinning sensation) caused by dislodged gravity-sensing crystals in the ear. The crystals can end up in the wrong place from a blow to the head. Vestibular rehabilitation therapy addresses vertigo and dizziness caused by other injuries to the systems for equilibrium and balance that can occur after a concussion." Elizabeth Sandel, M.D.
It may be necessary to investigate vision issues further
"Those with ongoing eye-tracking problems that interfere with reading and computer-related tasks benefit from vision examinations, usually performed by optometrists or ophthalmologists who have completed residency programs in vision therapy and rehabilitation." Nicole Miranda, PT, DPT, Concussion & Vestibular Involvement
See our page on Vision Therapy
Clinical trials of PoNS device for balance deficits
Helius Medical Technologies is running a clinical trial studying the PoNS device to see if it improves chronic balance deficit due to mild-to-moderate TBI. They have recently closed the recruitment for the trial. The laboratory of the University of Wisconsin developed the PoNS device which is a new device that makes use of neurological stimulation of the tongue to enhance neuroplasticity of the brain, and they have identified that the PoNS unit is particularly helpful with balance issues from PCS. The PoNS unit is not available for sale, although we have not contacted the laboratory to see if an individual might work with them to use the PoNS unit. We recommend the remarkable story of the PoNS device in the book by Norman Doidge, The Brain's Way of Healing Itself.
An Explanation of Concussion and Vestibular System Disruption
Excerpt from Nicole Miranda, PT, DPT, Concussion & Vestibular Involvement:
"Trauma to the brain can result in abnormal vestibular system functioning, and the brain can receive abnormal signals regarding the position and movement of the head in space. When vestibular information is inaccurate, the brain most often relies on visual input to stabilize the head on the body. This means that the visual system becomes the most reliable system to quickly assess one’s position in space and to remain balanced. Relying upon vision alone as the primary source of balance often leads to fatigue and difficulty performing routine daily activities. Reliance on the visual system for balance can result in eyestrain and tension headaches. If the vestibular system is delivering inaccurate information to the brain about the head’s position in space, the brain must rely on visual input and joint sensors (proprioception) to feel the body in space. Failure to effectively compensate for the use of visual references and being aware of the surface on which one is sitting or standing results in dizziness and a sense of instability. Dizziness encourages a person to refrain from moving the head and leads to neck stiffness and headaches. Presence of a whiplash associated with the concussion further complicates the diagnosis and suddenly symptoms limit the ability to participate in life activities."
"The best treatment for symptoms of concussion involves an assessment of vestibular function by a physical therapist. A comprehensive vestibular evaluation should include an examination of balance activities that involve the vestibular, vision and proprioceptive systems, which reveals how the brain interprets the movement of the body and head relative to space and the visual surround. A cervical examination determines if neck sprain or dizziness from the neck is contributing to symptoms and perpetuating headaches. Based on examination findings, customized exercises and recommendations for participating in or modifying school, work, and home activities expedites recovery.
If necessary, medical assessment by a primary care physician or neurologist can help determine if migraine headaches are present and whether medication could improve recovery. Finally, those with ongoing eye-tracking problems that interfere with reading and computer-related tasks benefit from vision examinations, usually performed by optometrists or ophthalmologists who have completed residency programs in vision therapy and rehabilitation."