Vestibular Rehabilitation as an Early Intervention in Athletes Who Are Post-Concussion: A Systematic Review

Background: Sports-related concussions (SRC) are a common injury sustained by many athletes of all different age groups and sports. The current standard treatment is rest followed by aerobic activity. Little has been researched on the effects of vestibular rehabilitation for concussion treatment, especially in physical therapy practice. Objective: The purpose of this systematic review was to research the effects of early intervention of vestibular rehabilitation and an athlete’s time to return to play compared to rest alone. Methods: Two searches were conducted (August 2021 & January 2022). Databases looked at were CINAHL complete, MEDLINE, PubMed, Wiley online database, and one hand search. Search terms included vestibular rehabilitation or vestibular therapy, concussion, or mild traumatic brain injury or mild TBI, athletes, sports, athletics or performance, and early interventions or therapy or treatment. Results: Yielded 11 articles (randomized control trials and retrospective cohort studies). Inclusion criteria were athletes who sustained a SRC, incorporation of vestibular rehabilitation in athletes recovery, and early vestibular intervention tools. Discussion: Incorporating visual interventions and cervical manual therapy into early rehabilitation significantly reduces symptoms and time to return to sport. However, balance interventions do not have a significant effect on reducing time to return to sport when used as a sole intervention. Conclusion: Beginning VRT as early as 10 to 30 days post-concussion has been shown to contribute to a quicker resolution of symptoms and a quicker return to sport. However, more data collection needs to be performed to determine the effectiveness of early intervention in concussion recovery.https://digitalcommons.misericordia.edu/research_posters2022/1018/thumbnail.jp

Vestibular Rehabilitation as an Early Intervention in Athletes Who are Post-concussion: A Systematic Review

# Background Sports-related concussions (SRC) are a common injury sustained by many athletes of all different age groups and sports. The current standard treatment is rest followed by aerobic activity. Minimal research has been done on the effects of vestibular rehabilitation for concussion treatment, especially in physical therapy practice. # Objective The purpose of this study was to examine the effects of early intervention of vestibular rehabilitation (VRT) on an athlete’s time to return to play compared to rest alone. # Study Design Systematic Review # Methods Two searches were conducted (August 2021 and January 2022) using databases: CINAHL complete, MEDLINE, PubMed, and Wiley online database. One hand search was performed to find relevant articles. Search terms included “vestibular rehabilitation” or “vestibular therapy” and “concussion” or “mild traumatic brain injury” or “mTBI” and “athletes” or “sports” or “athletics” or “performance”, and “early interventions” or “therapy” or “treatment”. Inclusion criteria were athletes with a SRC, incorporation of vestibular rehabilitation in athletes’ recovery, and early vestibular intervention tools. Tools used to assess quality and risk of bias were the PEDro scale and the _Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence_. The PRISMA method for determining inclusion and exclusion criteria. # Results Eleven articles were included, six randomized control trials and five retrospective cohort studies. Various balance interventions, visual interventions utilizing vestibulo-ocular reflex (VOR), and cervical manual therapy were used during VRT for athletes’ post-concussion. Incorporating visual interventions and cervical manual therapy into early rehabilitation significantly reduced symptoms and time to return to sport. However, balance interventions did not have a significant effect on reducing time to return to sport when used as a sole intervention. # Conclusion Addressing VRT deficits in the acute stages of a concussion may contribute to a quicker resolution of symptoms and a quicker return to sport. More research needs to be performed to determine the effectiveness of early intervention of VRT in concussion recovery. # Level of Evidence