Effectiveness of Vestibular Rehabilitation Therapy for Treatment of Concussed Adolescents With Persistent Symptoms of Dizziness and Imbalance. 2018

Kyoungyoun Park, and Thomas Ksiazek, and Bernadette Olson

BACKGROUND Adolescents who suffer sport concussion typically respond to a prescription of cognitive and physical rest in the acute phases of healing; however, some adolescents do not respond to rest alone. Dizziness, unsteadiness, and imbalance are impairments, which may linger longer than 30 days, leading to a diagnosis of postconcussion syndrome (PCS). Vestibular assessment and therapy may benefit adolescents suffering from these persistent symptoms. OBJECTIVE Does vestibular rehabilitation therapy (VRT) rather than continued prescription of rest (cognitive and physical) reduce recovery time and persistent symptoms of dizziness, unsteadiness, and imbalance in adolescents (12-18 y) who suffer PCS following a sports-related concussion? Summary of Key Findings: All 4 studies selected included adolescents suffering from PCS, specifically continued dizziness, unsteadiness, and imbalance. VRT was an effective intervention for this population. Adolescents presenting with this cluster of symptoms may also demonstrate verbal and visual memory loss linked to changes in the vestibular system postconcussion. Improved screening tools can help better understand vestibular system changes, identify adolescents who may benefit from VRT sooner, and decrease long-term impairments. Clinical Bottom Line: Moderate evidence supports that adolescents who suffer from persistent symptoms of dizziness, unsteadiness, and imbalance following sport concussion should be evaluated more specifically and earlier for vestibular dysfunction and can benefit from participation in individualized VRT. Early evaluation and treatment may result in a reduction of time lost from sport as well as a return to their premorbid condition. For these adolescents, VRT may be more beneficial than continued physical and cognitive rest when an adolescent's symptoms last longer than 30 days. Strength of Recommendation: Grade B evidence exists to support that VRT is more effective than continued cognitive and physical rest in reducing persistent symptoms of dizziness, unsteadiness, and imbalance in adolescents who suffer PCS.

UI MeSH Term Description Entries
D001924 Brain Concussion A nonspecific term used to describe transient alterations or loss of consciousness following closed head injuries. The duration of UNCONSCIOUSNESS generally lasts a few seconds, but may persist for several hours. Concussions may be classified as mild, intermediate, and severe. Prolonged periods of unconsciousness (often defined as greater than 6 hours in duration) may be referred to as post-traumatic coma (COMA, POST-HEAD INJURY). (From Rowland, Merritt's Textbook of Neurology, 9th ed, p418) Cerebral Concussion,Commotio Cerebri,Concussion, Intermediate,Concussion, Mild,Concussion, Severe,Mild Traumatic Brain Injury,Brain Concussions,Cerebral Concussions,Concussion, Brain,Concussion, Cerebral,Intermediate Concussion,Intermediate Concussions,Mild Concussion,Mild Concussions,Severe Concussion,Severe Concussions
D004244 Dizziness An imprecise term which may refer to a sense of spatial disorientation, motion of the environment, or lightheadedness. Lightheadedness,Orthostasis,Dizzyness,Light-Headedness,Light Headedness
D004856 Postural Balance A POSTURE in which an ideal body mass distribution is achieved. Postural balance provides the body carriage stability and conditions for normal functions in stationary position or in movement, such as sitting, standing, or walking. Postural Control,Posture Balance,Posture Control,Posture Equilibrium,Balance, Postural,Musculoskeletal Equilibrium,Postural Equilibrium,Balance, Posture,Control, Postural,Control, Posture,Equilibrium, Musculoskeletal,Equilibrium, Postural,Equilibrium, Posture,Postural Controls,Posture Balances,Posture Controls,Posture Equilibriums
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000066530 Neurological Rehabilitation Physician-supervised programs designed to rehabilitate people with diseases, trauma, or disorders of the NERVOUS SYSTEM. Neurologic Rehabilitation,Neurorehabilitation,Rehabilitation, Neurologic,Rehabilitation, Neurological
D000293 Adolescent A person 13 to 18 years of age. Adolescence,Youth,Adolescents,Adolescents, Female,Adolescents, Male,Teenagers,Teens,Adolescent, Female,Adolescent, Male,Female Adolescent,Female Adolescents,Male Adolescent,Male Adolescents,Teen,Teenager,Youths
D001265 Athletic Injuries Injuries incurred during participation in competitive or non-competitive sports. Sports Injuries,Injuries, Athletic,Injuries, Sports,Athletic Injury,Injury, Athletic,Injury, Sports,Sports Injury
D038223 Post-Concussion Syndrome The organic and psychogenic disturbances observed after closed head injuries (HEAD INJURIES, CLOSED). Post-concussion syndrome includes subjective physical complaints (i.e. headache, dizziness), cognitive, emotional, and behavioral changes. These disturbances can be chronic, permanent, or late emerging. Post-Concussive Syndrome,Post-Concussion Symptoms,Post-Concussive Symptoms,Post-Concussive Syndrome, Chronic,Chronic Post-Concussive Syndrome,Chronic Post-Concussive Syndromes,Post Concussion Symptoms,Post Concussion Syndrome,Post Concussive Symptoms,Post Concussive Syndrome,Post Concussive Syndrome, Chronic,Post-Concussion Symptom,Post-Concussive Symptom,Post-Concussive Syndromes,Post-Concussive Syndromes, Chronic

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