Vestibular Rehabilitation for Concussions in Atlanta, GA

70% of those who suffer a concussion, a mild form of traumatic brain injury, also experience dizziness at some point thereafter.  However this ‘dizziness’ is more accurately described as an “illusion of movement” or vertigo, the  sensation of spinning or being off balance and a common complaint accompanying concussion.  Vertigo is a disorder of the vestibular system, a complex sensory structure of the inner ear that senses head movement and gravity and regulates balance and spatial orientation.

A concussion damages (and in some cases destroys) nerve cells called ‘neurons’ which are essential for communication between the brain and vestibular system.  The damage to the vestibular system from a concussion isn’t structural and therefore won’t show up on any routine brain scan such as CT or MRI, and there is no diagnostic test for concussions.  Consequently the affected neurons, sending incorrect messages to the brain regarding balance and spatial orientation, are the origin of the dizziness, imbalance, and vision issues - which is also known as “post-concussion syndrome”. 

Sometimes this errant communication is brief, ending with the healing of the initial bruising and inflammation from the concussion.  However when symptoms persist beyond the 2 to 3 week time period, you may be diagnosed as having post-concussion syndrome to which vestibular rehabilitation is an effective intervention to help resolve the symptoms.  

When diagnosed with post-concussion syndrome, medication can help control some dizziness and nausea, but it will not cure the problem the vestibular system has suffered with the concussion.  Fortunately research has shown vestibular rehabilitation physical therapy to be highly effective in reducing dizziness, improving balance, and accelerating recovery time in treating patients who’ve suffered a concussion. 

Our therapists specialize in vestibular system rehabilitation physical therapy for concussions and can help anyone coping with balance issues, dizziness, headaches, difficulty concentrating and/or visual disturbances.  We offer a custom tailored approach to concussion recovery in treating both physical and cognitive symptoms.

What Is the Vestibular System?

The vestibular system of organs forming a single structure that connects the inner ear to the brain and manages our sense of balance, eye movement and gravity.  It’s always operating and turned ‘on’ monitoring all movement of the head and body including rotation, up/down, and forward/backward motion.  The vestibular system is also involved in: 

• stabilizing our visual gaze, which is the eye's ability to focus on a stable point when the head is moving in space and; 
• maintaining posture which is the ability to remain upright and stable when moving  

As messages to the brain are always being sent, even when you’re not moving the vestibular system is “sensing” the effects of gravity pushing you down - despite the fact that you’re still.  Thus under normal circumstances the vestibular system can be a ‘transparent experience” as we’re often unaware it’s there, operating and functioning properly.  However, in contrast to this, people coping with vestibular system dysfunction are not having a transparent experience and are aware of a problem & notice something is wrong (disorientation).  When coping with vestibular system dysfunction, even simple tasks like standing up, walking, or driving a car - can be difficult and in some situations dangerous.

How a Concussion Affects the Vestibular System 

The brain is composed of soft material and is usually well protected by membrane and the skull, but it is not invincible.  Sudden jolts and hard impact will jostle and rattle the brain causing it to crash into its protective cover the skull. When this happens neurons are stressed, stretched and sometimes break.  The most common vestibular system dysfunction after a concussion is a disease called benign paroxysmal positional vertigo (BPPV). Even injuries not directly impacting the head, such as the neck in the case of whiplash, can cause BPPV. Click here for a comprehensive discussion on how we treat BPPV.  

A concussion can directly interfere with the vestibular system damaging or entirely destroying the neural connections to and from the brain. This disrupts the brain's ability to communicate with the vestibular system and understand the position of the head in context to the rest of the body, gravity and the surroundings. 

Neurovascular coupling is the fragile and sensitive communication patterns between neurons (nerve cells) within the blood vessels in which they travel.  Disrupting neurovascular coupling, the cells or the highway in which they travel (blood vessels), can cause some brain and vestibular regions to be hyperactive (doing too much or consuming too many of the brain’s resources) or hypoactive (underperforming in function).  Either way, dysfunctional neurovascular coupling can cause one side of the brain to send different or stronger signals than the other.  When one ear is sending the brain one message, and the other ear isn’t quite on the same page and sending a different message, dizziness or disorientation can arise. Dysfunctional neurovascular coupling exasperates the brain to the point of producing  headaches,  brain fog, vision issues, sleep issues, neck pain, and more.

When the vestibular system’s  information is inaccurate, the brain more heavily relies on visual input for head on the body stabilization and the visual system assumes the leading role to make quick assessments of spatial orientation and balance.   However, relying primarily on vision alone as the primary source of balance leads to fatigue, eyestrain and tension headaches.  

Symptoms of Vestibular System Injury after a Concussion

Every concussion is unique and symptoms appear immediately upon the injury while other symptoms emerge days, weeks or even months later. Occasionally the injury itself makes it difficult for people to recognize or accept that they are having problems.  Depending on how the concussion occurred and part of the brain impacted, the effect of the concussion on the vestibular system will be different.  In general, those coping with a concussion overwhelming describe “dizziness”, which usually functions as a larger umbrella term for one or more of the following:

• Vertigo: sensing spinning or rotational movement, a falling sensation or being spatially disoriented as if you're not sure where you are.
• Presyncope: feeling lightheaded (dizzy) or nauseated, weak, and about to faint.

• Unsteadiness: imbalance, sensing a loss of your personal equilibrium, your balance feels ‘off’ when standing or walking. 
• Blurred vision: eye strain, difficulty focusing eyes.
• Nausea or vomiting: movement or the perception of movement causing feelings of nausea or actual vomiting.  

How Does Vestibular Rehabilitation for Concussion Work?

Vestibular rehabilitation physical therapy is an effective evidence-based physical therapy aimed to treat balance and or spatial orientation problems by retraining the brain how to process sensory information involving movement.

A thorough vestibular evaluation is key for smooth and swift recovery from a concussion.  We’ll start by gathering a detailed patient medical history and have a comprehensive discussion of the current symptoms being experienced.   We’ll listen to your concerns, learn about your daily challenges and try to form a clear picture on what it’s going to take to enable you to return to and resume your full lifestyle prior to the concussion. 

We’ll get started by asking you to center your vision on a focal point while moving your head horizontally side to side, then vertically up and down.  You’ll also be asked to move your head diagonally as we observe for any irregular eye movement and symptom triggers. This helps us to individually diagnose each inner ear and tailor a rehabilitation program accordingly.  Patients often have one ear transmitting a stronger signal to the brain than the other, which will be a persistent problem if not corrected.

Testing for blurred vision, pupil response and other functional vision matters is important early in treatment because vestibular dysfunction and ocular (eye)  issues frequently co-exist.   Ease of eye focusing, eye tracking, peripheral vision, and your response to screens (visual stimuli) are examples of where and how functional vision is often impacted by a concussion.  Even when unnoticed by patients,  vision changes due to concussion could be the origin of symptoms such as eye strain, headaches,  fatigue, and more. 

A primary early goal in vestibular rehabilitation for concussion is to ensure your vision is clear, stable and at the level prior to the injury.   In that effort we apply an exercise regimen effective in gaining visual improvements centered on what’s called gaze stabilization.  The vestibular system plays a key role in vision and enables your eyes to stay focused on something even when your head is moving.  This is known as the vestibulo-ocular reflex, and is vulnerable to damage with a concussion resulting in vertigo and vision problems.  After some gaze stabilization exercises to strengthen eye focus during head movements, we’ll turn our attention to exercises involving more balance and movement initiatives.  These may include:

• full body exercises like the ‘infinity walk’ which calls for walking in a Figure 8 pattern around obstacles while keeping your eyes on a focal point 
• while standing on a wobbly surface, catching a ball tossed to you
• learning breathing techniques to keep your body thoroughly oxygenated which helps recovery.   
• cognitive exercises, such as solving a logic puzzle, memorizing pictures, and finding patterns. These exercises improve any cognitive deficits such as brain fog, trouble focusing, difficulty making decisions, and more.

It’s common for exercises to initially bring a little discomfort in triggering your symptoms, however this is a positive sign as it means you’re doing exercises properly and on track to getting better.  The reality is the vestibular system can only be retrained to understand balance signals if the movements that make you dizzy are revisited and practiced.  Over time most patient’s symptoms decrease until they are manageable if not completely resolved. 

Our goal in vestibular rehabilitation physical therapy is to reduce if not eliminate symptoms of vertigo or dizziness, strengthen gaze stability, improve balance and mobility, and lower the risk of falls and accidents.  Beyond the physical benefits, vestibular rehabilitation can also improve emotional and mental health, increasing your confidence in maintaining balance, and  decreasing any stress and anxiety.   At FYZICAL Therapy & Balance Centers - Alpharetta, our team of experienced therapists is dedicated to helping our patients diagnose and alleviate the causes of concussion to achieve optimal health and wellness.