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Vestibular Rehabilitation Is Associated With Visuovestibular Improvement in Pediatric Concussion

Storey, Eileen P., BA; Wiebe, Douglas J., PhD; D'Alonzo, Bernadette A., MPH; Nixon-Cave, Kim, PT, PhD, PCS; Jackson-Coty, Janet, PT, DPT, PCS; Goodman, Arlene M., MD; Grady, Matthew F., MD, CAQSM; Master, Christina L., MD, CAQSM

Journal of Neurologic Physical Therapy: July 2018 - Volume 42 - Issue 3 - p 134–141
doi: 10.1097/NPT.0000000000000228
Research Articles

Background and Purpose: Vision and vestibular-related deficits are common after concussion and are associated with prolonged recovery times, substantially impacting the quality of life for children. The utility of targeted vestibular rehabilitation for these deficits in children after concussion is unknown. The purpose of this study was to determine whether active vestibular rehabilitation is associated with an improvement in visuovestibular signs and symptoms in children with concussion.

Methods: A retrospective cohort study of children diagnosed with concussion and referred to vestibular rehabilitation between 2012 and 2014 was conducted. Patient-reported symptoms and visuovestibular performance measures were assessed in the medical practice and physical therapy settings.

Results: One hundred nine children were included in the study with a mean age of 11.8 (3.4) years. Among this group, 59 (54%) were male and 48 (44%) had a sports-related concussion. Children presented to a pediatric sports medicine office and physical therapy a median of 24 (interquartile range [IQR], 14-42) and 55 (IQR, 39-94) days after injury, respectively. Concussion symptoms decreased from a median of 9 (IQR, 5-13) symptoms at initial evaluation to a median of 0 (IQR, 0-2) symptoms at final assessment. Performance on all visuovestibular tasks improved significantly over the course of therapy except for near point of convergence. For the 45 children who completed the Balance Error Scoring System at both initial and final therapy visits, there was a significant improvement in mean level of performance (P < 0.0001). Characteristics between those who completed a full versus partial course of physical therapy were similar.

Discussion and Conclusions: Vestibular rehabilitation in children with concussion is associated with improvement in symptoms as well as visuovestibular performance. This active intervention may benefit children with persistent symptoms after concussion. Future prospective studies are needed to determine the efficacy and optimal postinjury timing of vestibular rehabilitation.

Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, available at:

The Children's Hospital of Philadelphia, Division of Orthopaedics, Sports Medicine and Performance Center, Philadelphia, Pennsylvania (E.P.S., K.N-C., J.J-C., M.F.G., C.L.M.); Perelman School of Medicine, University of Pennsylvania, Philadelphia (M.F.G., C.L.M.); Saint Peter's Sports Medicine Institute, Somerset, New Jersey (A.M.G.); and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia (D.J.W., B.D.).

Correspondence: Christina L. Master, MD, CAQSM, The Children's Hospital of Philadelphia, Division of Orthopaedics, Sports Medicine and Performance Center 34th and Civic Center Blvd, Wood Bldg, 2nd Floor, Philadelphia, PA 19104 (

The study was performed at The Children's Hospital of Philadelphia under the approval of CHOP's Institutional Review Board. Part of this work was presented at the Pediatric Research in Sports Medicine Annual Meeting in San Diego, California, in January 2015.

The authors declare no conflict of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

© 2018 Academy of Neurologic Physical Therapy, APTA