We all know, or should know, that balance issues are a primary concern with concussions and post-concussion syndrome. Along with memory problems, balance disturbance is high on the predictor list for duration of symptoms ergo severity.
As an athletic trainer one of our primary tests, and “go-to” is the Rhomberg Test, or sobriety test as most may know it as. What is tested there is the gross balance and fine motor movements controlled by the brain and vestibular system of our ears. During a concussive episode the synapses (or messages being sent) between the neurons in the brain get disrupted, each individual will experience different durations. Using the knowledge that balance is commonly and most immediately affected by a concussion the Rhomberg provides great feedback.
During the Rhomberg the athlete is challenged with single leg balance, tandem walking, spatial awareness and other concentration efforts that would otherwise be very simple. These menial tasks become very difficult when you are concussed. Now imagine those small but difficult tasks and dizziness plaguing you on a daily basis days, weeks or even months after you have sustained a concussion.
Alsalaheen, Mucha, et al. provided a research study in which they looked back in charts of patients that had a concussion and experienced long-term balance/dizziness issues. This group of patients were sent to a rehabilitation center for vestibular training, usually (mean time) 61 days after initial concussion evaluation.
What they found was that with vestibular rehabilitation (as few as two visits) patients self-reported a decrease in dizziness and increased their scores on the balance tests used at the facility. What is more, is that the adolescent group (< 16 y/o) improved more significantly and quicker as compared to their “adult” counterparts.
The rehabilitation techniques are not that difficult, and for the majority of them, were done as a home exercise program. Leading me to believe that identifying the balance issue early and combating it with this type of rehab will allow for quicker return to school and play.
Some of the techniques that were most often used were as simple as;
- Holding a gaze at a fixed point and moving head, in sitting and standing
- Standing balance with eyes open/closed
- Gait challenges like head rotations while walking, or maneuvering around obstacles
- Getting in and out of a chair while having a fixed gaze
As the authors suggested more research in this area is needed but simple, yet complex tasks like those above could help bring a quicker end to some of the most frustrating symptoms of a concussion.
B. Alsalaheen, A. Mucha, et al., Vestibular rehabilitation for dizziness and balance disorders after concussion. Journal of Neurologic Physical Therapy, 2010, June; 34(2):87-93.