Vestibular Rehabilitation for Dizziness and Balance Disorders after Concussion

Many individuals who acquire a concussion are seen for vestibular rehabilitation. The studies describing the prescribed exercises and the outcomes of vestibular rehabilitation are sparse.\ud Additionally, the outcome measures that have been used lack normative reference values for healthy adolescents and have not been examined for correlation with established neurocognitive measures. Therefore, the purpose of this dissertation is to provide normative data for the measures used in vestibular rehabilitation, to describe the exercises and the outcomes of a vestibular physical therapy program and to examine the relationship between self-reported symptoms, neurocognitive and balance performance in individuals referred to vestibular physical therapy.\ud A cross – sectional design was used to establish normative reference values; Ninety- one participants completed the Activities – specific Balance Confidence scale, Dynamic Gait Index, Functional Gait Assessment, Timed “UP & GO”, Five Times Sit to Stand test, tests of gait speed and the Balance Error Scoring System. Percentile scores were computed for all measures. \ud A retrospective chart review of 114 consecutive subjects referred for vestibular physical therapy after concussion was performed. At the time of initial evaluation and discharge, recordings were made of outcome measures of self-report and balance performance. A repeated-measures mixed ANOVA tested whether there was an effect of time and age on the outcome measures. Frequency counts of the most common exercise types were recorded. A correlation analysis was performed to examine the relationship between balance measures and Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) at the initiation of vestibular physical therapy and to examine the relationship between change in ImPACT and change in balance measures.\ud Normative reference values for balance were provided. An improvement was observed in all measures at the time of discharge from vestibular rehabilitation. Eye-Head Coordination exercises were the most commonly prescribed exercise type. Significant relationships between the ImPACT neurocognitive scores and balance measures at the start of vestibular rehabilitation were supported.\ud In conclusion, Individuals who received vestibular physical therapy after concussion had favorable outcomes, but it is not possible to determine if the outcomes were solely due to the therapy. The interventions provided by physical therapists were consistent across patients.\u