The Vestibular System and Concussions

Today we want to talk about what the vestibular system is, how it is impacted after a concussion and what we can do to help your child recover.

The Vestibular System:

The vestibular system is the system our bodies use to help us balance and know where our body is in space so we can move and react to the environment properly. It is a very complex system, so we will only briefly touch on the topic.  The vestibular system helps us both with balance and coordinating movements. It also helps us move our eyes and head in a coordinated and efficient way.

The vestibular system uses 3 main pieces to help us balance. These include:

1. Our Visual System (eyes)
2. Our Inner Ear: has small crystals inside the cochlea in our inner ear which move when our head moves. This move small hairs (cilia) and sends a signal to our brain that our head is moving.
3. Proprioceptive receptors in our arms and legs: these send signals back to our brain to let our brain know where our body is in space, what kind of surface we are standing on, and helps us move without falling down.

Concussions Impact on the Vestibular System:

A concussion damages the cells in the brain called neurons. Depending on where and how the hit occurred it can cause damage to the neurons involved in the vestibular system. This can cause neurons to be activated when they should not be or can cause them not to be activated as typically  expected. When this occurs it can cause the patient to feel dizzy and off balance, common symptoms after a concussion.

Tests that help us determine vestibular system involvement:

The Vestibular Ocular Motor Screen (VOMS) is an excellent tool providers utilize when examining someone with a concussion. This test involves the patient moving their head and eyes in 6 different ways and rating their symptoms after each trial.  These eye and head movements stress the vestibular system, and through the provider observing the patient’s eyes and monitoring his/her symptoms, valuable information on how the systems are working is gained. It is common for the tests to produce significant symptoms within a few days after the injury.  If 1-2 weeks after the injury the test continues to produce worsening symptoms or abnormal findings, there is likely a vestibular issue complicating the concussion recovery and appropriate treatments need to be started.

Treatment options

Most people fully recover from a concussion within about 3-4 weeks; if the vestibular system is significantly involved, the duration can be longer. If your provider determines that there is a vestibular component to your injury, they will likely refer you to a vestibular therapist. Most commonly, these are physical therapists who have undergone additional education and training in the vestibular system. Here in the Austin area, we have several great vestibular therapists who we work with on a daily basis. These therapists will give the patient many challenging exercises to retrain the damaged pathways in the brain. They often encourage patients to push themselves until symptoms  begin to worsen and then recommend stopping the exercise to let the symptoms decrease. This can help the recovery process. This approach is not the case for every patient, so we recommend talking with you provider about the best way to recover in your individual case.