“Dizziness after a Head Injury.... Now What?"

What is a concussion (mTBI)?

A concussion is a mild Traumatic Brain Injury (mTBI). It can be caused by a hit to the head or the body. The movement of the brain can create chemical changes in the brain or sometimes stretching or injury to brain cells.

Each concussion is similar to a snowflake, unique as it can present with a variety of symptoms, clinical presentations, and recovery pathways. There are 5 different types of concussions that can occur, and you can experience more than one type at a time.

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Facts about concussion subtypes: 

• Multiple concussion subtypes MAY occur at the same time, for example: you have mainly vestibular symptoms (dizziness, vertigo, imbalance) and headaches as well 

• Your concussion subtype MAY change throughout your injury, for example: you may have headache subtype initially and then later in your recovery you may have more symptoms of the ocular-motor subtype 

What other issues can you have following a concussion?

Vertigo and Concussion 

The vestibular subtype of concussion is often a disruption of the central vestibular system. The central vestibular system includes the brain (cerebrum) and the brainstem. These areas are involved in movement and orientation of the body to space and time. 

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Sometimes, in concussion we can get peripheral vestibular dysfunction. Peripheral vestibular dysfunction occurs when the inner ear and the pathways (nerves) to the brainstem are affected, which can also cause vertigo. An example of a peripheral dysfunction is Benign Paroxysmal Positional Vertigo (BPPV). In BPPV, the crystals (otoconia) are displaced in the semicircular canals and trigger positional vertigo.

Vertigo and/or dizziness may also be seen in the vestibular, oculomotor or headache subtypes of concussion. The important part is identifying the root cause or causes of the vertigo and/or dizziness to determine the best treatment(s) for it.

Vertigo, dizziness and/or imbalance are often triggered by movements such as walking, bending, rolling, twisting, etc. These movements require your head, body and vestibular system (inner ear) to work together. If these systems are not working together well it can create dysfunction which causes symptoms. This explains why symptoms can come from so many different subtypes! 

Vestibular Therapy and Concussion: 

A vestibular physiotherapist will do a thorough virtual telehealth assessment to help you identify your concussion subtype(s). After identifying your subtype(s), your therapist will be able provide you with strategies and exercises to help! A vestibular therapist can help you determine the underlying causes of your post-concussion signs and symptoms.

A vestibular physiotherapist can help choose, teach, and appropriately progress vestibular exercises and education to help with your post-concussion symptoms. These may include: 

• Balance & walking exercises 

• Oculomotor exercises 

• Decrease dizziness &/or motion sensitivity 

• Strategies to help for return to work &/or sport 

• Exercises & strategies to help with headaches &/or neck pain

• Strategies to help with sleep, fatigue, planning & pacing 

The human brain is amazing and is able to change with appropriate exercise and strategies due to neuroplasticity! Neuroplasticity is the ability of nerve connections in the brain to change, grow and reorganize to help the brain heal after a concussion. 

It is never too late to get help. If it's 1 week, 1 month or years please reach out to get a better understanding and control of your symptoms following concussion! 

Resources:

• Bloom, J., Brody, D., Chesnutt, J., Clugston, J., Collins, M., Gioia, G., Kontos, A., Lal, A., Sills, A., & Gharjar, J. (2020). Concussion Guidelines Step 2: Evidence for Subtype Classification. Neurosurgery, 86, 1–13.

• Craton, N., Ali, H., & Lenoski, S. (2017). COACH CV: The Seven Clinical Phenotypes of Concussion. Brain Sciences, 7(12), 119. https://doi.org/10.3390/brainsci7090119

• Pugh, M. J., Kennedy, E., Prager, E. M., Humpherys, J., Dams-O’Connor, K., Hack, D., McCafferty, M. K., Wolfe, J., Yaffe, K., McCrea, M., Ferguson, A. R., Lancashire, L., Ghajar, J., & Lumba-Brown, A. (2021). Phenotyping the Spectrum of Traumatic Brain Injury: A Review and Pathway to Standardization. Journal of Neurotrauma. Published. https://doi.org/10.1089/neu.2021.0059

• Santo, A. L., Race, M. L., & Teel, E. F. (2020). Near Point of Convergence Deficits and Treatment Following Concussion: A Systematic Review. Journal of Sport Rehabilitation, 29(8), 1179–1193. https://doi.org/10.1123/jsr.2019-0428