Vestibular Therapy for Concussion

Vestibular rehabilitation is exercise-based therapy that retrains the balance system after a concussion. It is the first-line treatment for post-concussion dizziness, motion sensitivity and unsteadiness, and it is delivered by physical therapists or audiologists with specific vestibular training rather than by general balance exercises at home.

Dizziness after a concussion is rarely a problem with the ears alone. The vestibular system, the eyes and the neck all feed the brain information about where the head is in space, and a concussion can leave those three inputs disagreeing with each other. The result is the specific, awful sensation people describe as the supermarket aisle tilting, or the room continuing to move after they stop turning.

A vestibular assessment is hands-on and takes time. Expect eye-movement testing, positional maneuvers, gaze-stabilization and habituation tasks, balance testing on different surfaces, and a graded exercise plan you repeat at home between visits. The home program is the part that actually does the work; the appointments exist to calibrate it.

The evidence here is real but worth reading with its sample size attached. The most-cited trial is a 2014 randomized controlled study in the British Journal of Sports Medicine in which 73% of participants receiving cervicovestibular physiotherapy were medically cleared within 8 weeks, against 7% of controls — a striking result from a total of 29 participants. Larger systematic reviews point the same direction without the same drama.