Vestibular Rehabilitation and Concussion

4 days ago
6 min read

Concussion, medically termed mild traumatic brain injury (mTBI), is a multisystem neurologic disruption, not an isolated injury to a single brain region. This explains why symptoms vary widely across individuals and often persist beyond the expected recovery window of 7-10 days. Among the most common and impactful contributors to prolonged recovery is vestibular dysfunction, which affects balance, eye movement control, spatial orientation, and sensory integration.

The vestibular system is a sensory organ that helps your brain understand and process movement, balance, and where your head is in space. The peripheral vestibular system (in the inner ear) senses head movement and position, while the central vestibular system (in the brain) processes that information and works with your eyes and muscles to keep you balanced and steady. Concussion symptoms are commonly grouped into four overlapping symptom categories. Vestibular dysfunction after concussion often sits at the center of all four symptom categories (listed below) making it a critical target for evaluation and rehabilitation.

Somatic (Physical) Symptoms: Vestibular dysfunction directly causes dizziness, imbalance, headaches, visual disturbances, and motion sensitivity.
Cognitive Symptoms: Because the brain uses vestibular input to process sensory information, dysfunction can contribute to “brain fog,” difficulty concentrating, and slowed thinking.
Emotional Symptoms: Persistent dizziness and instability can increase anxiety, irritability, and mood swings, linking vestibular issues to emotional challenges.
Sleep Disturbance: Disruption in vestibular signals can interfere with rest and circadian regulation, worsening sleep quality and prolonging recovery.

What Is Vestibular Rehabilitation Therapy (VRT)?

Vestibular Rehabilitation Therapy (VRT) is an individualized intervention designed to recalibrate vestibular and sensory systems. Through graded, repetitive challenges, VRT creates neuroplasticity, the brain’s ability to adapt and reorganize after injury. VRT may include:

Cervicovestibular Rehabilitation: This combines neck mobility and proprioceptive training with vestibular exercises to address dizziness, balance issues, and headache when concussion also involves the cervical spine. Cervicovestibular exercises focus on the central vestibular system by teaching the brain to combine balance signals from the neck, inner ear, and eyes. Cervicovestibular rehabilitation also affects the peripheral vestibular system, since the inner ear senses rotation and position during neck movements. Overall, it improves balance, posture, and head movement control. A randomized controlled trial in sport-related concussion found that adding cervicovestibular physiotherapy to standard rehabilitation significantly increased the likelihood of medical clearance within 8 weeks compared with standard care alone.
Integration of Visual, Vestibular, and Proprioceptive Inputs: This challenges the brain’s ability to appropriately use and integrate inputs from visual, vestibular, and proprioceptive systems for postural control. Integration of these three systems mainly involves the central vestibular system because it trains the brain to choose which sensory signals (eyes, inner ear, or body) to rely on in different situations. The brain learns to adjust balance when one sense is less reliable. The peripheral vestibular system is also activated, as the inner ear continues to send signals during movement. Exercises such as eyes-closed balance, unstable surfaces, and head movement tasks have been shown to improve dynamic balance and reduce reliance on less accurate sensory sources.
Dual-Task Training: This involves performing cognitive tasks while moving or balancing. The central vestibular system is the part of the brain that combines signals from your inner ears, eyes, and body to help you move safely and stay oriented. By challenging it with movement plus performing a cognitive task, you strengthen the brain’s ability to coordinate balance and cognitive functions together. These exercises can also indirectly support the peripheral vestibular system (the inner ear) by encouraging it to send clear signals to the brain during motion. Together, this helps improve overall balance, focus, and coordination in real-life activities. Research shows that dual-task deficits often persist even after single-task performance improves, making this a valuable component of advanced concussion rehab.
Postural Control and Gait Retraining: This focuses on improving dynamic stability and walking mechanics, especially in complex sensory environments. Postural control and gait retraining mainly target the central vestibular system because they train the brain to use balance information from the inner ears, eyes, and body together while walking or moving. The central vestibular system helps your brain plan and adjust movements in real time, especially in tricky environments. These exercises also indirectly involve the peripheral vestibular system by keeping its signals accurate during movement. Overall, this helps patients walk, balance, and react better in everyday situations.
GyroStim: This FDA approved treatment delivers precise, multi-axis rotational vestibular stimulation combined with visual and cognitive tasks to drive rapid vestibular recalibration and multisensory integration. Clinical summaries indicate that combining GyroStim with standard care may accelerate recovery, improve balance, and reduce dizziness and cognitive symptoms by promoting neuroplasticity and compensatory mechanisms in both central and peripheral vestibular systems. The multi-axis rotation combined with head movements stimulate the brain to integrate balance, vision, and spatial awareness. This helps the brain rewire itself to handle movement better after a concussion. This improves overall balance, dizziness tolerance, resiliency, and coordination.
Motion Guidance: These therapies provide real-time visual feedback during balance, gait, and vestibulo-ocular exercises to improve motor control and sensory integration. This enhances sensorimotor learning and functional performance, supporting central nervous system adaptation to vestibular deficits. Motion Guidance exercises target the central vestibular system because they train the brain to use visual feedback to control posture and movement. The interactive tasks teach the brain to quickly adjust balance and walking in real time. This also indirectly trains the peripheral vestibular system by keeping inner ear signals accurate while moving. Over time, the brain becomes better at coordinating information from the eyes, inner ears, and body.
Balance Therapy: This involves progressively challenging static and dynamic postural tasks to improve functional stability. Structured balance training as part of vestibular rehabilitation can reduce dizziness, increase balance confidence, and enhance daily functioning compared with rest alone. Balance therapy targets the central vestibular system by helping the brain coordinate signals from the eyes, inner ears, and body to stay upright. The brain learns to adapt to changes in surfaces or movement. The peripheral vestibular system is also activated, sending accurate information about head motion and orientation.
Oculomotor Therapy: This involves using specific eye movements to improve visual-vestibular interaction and reduce symptoms like visual motion sensitivity. Oculomotor therapy mainly targets the central vestibular system because the brain must coordinate eye movements with balance and spatial awareness. Exercises like tracking, saccades, and convergence train the brain to process visual and vestibular information together. Strengthening this connection reduces dizziness and visual motion problems. This improves reading, walking, and general coordination in daily life. Strengthening oculomotor function supports overall vestibular recovery by enhancing central adaptation and vestibulo-ocular reflex performance.

Why Vestibular Rehabilitation Works

After concussion, the brain may struggle to accurately process vestibular, visual, and proprioceptive input. VRT uses targeted exercises to promote central adaptation and compensation, integration between the visual, vestibular, and proprioceptive systems, and restoration of vestibulo-ocular reflex function (this is the ability of your eyes to stay steady on a target while your head is moving).

A 2024 review demonstrated that vestibular rehabilitation significantly reduced perceived dizziness, improved vestibular and ocular motor function, and lowered overall concussion symptom severity. While improvements in objective balance measures and return-to-sport outcomes were more variable, symptom reduction was consistent across studies.

Recent narrative and mini-systematic reviews continue to report positive effects of VRT on both self-reported symptoms (dizziness, motion sensitivity) and functional performance, supporting its role as a core intervention for concussion-related vestibular dysfunction.

Emerging research within the past year shows that children and adolescents benefit significantly from vestibular rehabilitation, with improvements in dizziness severity, balance and visual-motor integration. Earlier initiation of VRT in younger populations has even been associated with shorter recovery and return-to-activity timelines.

Key Takeaways

Vestibular dysfunction is a major driver of prolonged concussion symptoms, particularly dizziness, imbalance, and cognitive fatigue.
Vestibular rehabilitation is an evidence-based, safe, and effective intervention, supported by recent high-quality reviews.
Early identification and targeted therapy matter, especially for patients with prominent vestibular or visual-motor complaints.
Rehabilitation must be individualized - there is no one-size-fits-all protocol.

Conclusion

Concussion affects multiple interconnected brain systems — somatic, cognitive, emotional, and sleep-related. Vestibular dysfunction frequently sits at the center of persistent symptoms, influencing both physical and cognitive recovery. Current peer-reviewed evidence strongly supports vestibular rehabilitation therapy as a key component of multidisciplinary concussion care, particularly for individuals with lingering dizziness, balance impairment, and visual-motion sensitivity.

As research continues to refine optimal dosing and timing, vestibular rehabilitation remains one of the most effective, targeted tools available to support meaningful recovery after concussion. If you are struggling with vestibular dysfunction after a concussion and would like a personalized treatment plan, please contact us to learn more or schedule a consultation.

Vestibular Rehabilitation and Concussion

What Is Vestibular Rehabilitation Therapy (VRT)?

Why Vestibular Rehabilitation Works

Key Takeaways

Conclusion

References

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