Rehabilitation Medicine/Physiatry

Physiatrists are physicians who specialize in physical medicine and rehabilitation and focus on the non-surgical management of symptoms due to neurological and musculoskeletal disease and disorders. For patients with concussion, physiatrists often work with physical and occupational therapists and, together, can provide short- and long-term treatment to help patients improve balance, vision, headaches, and cognition (thinking), among other symptoms.

Problems with balance are a common symptom of post-concussion syndrome — patients typically report dizziness, clumsiness, and vertigo — and may be indicative of trouble with the vestibular system. The vestibular system is made up of the inner ear and its chambers, which connect to the brain and help regulate balance. When this system is affected by a traumatic brain injury, an individual will have difficulty with posture, balance, reflexes, and coordination. These effects are more than just annoying, especially in athletes, since anyone experiencing significant delays in reaction time or balance is vulnerable to problems with walking and activities of daily living and to a second head injury. On the playing field, someone who has not fully recovered from a first concussion is at increased risk for a second one — which can occur after a much smaller impact than the first one.

The vestibular system also keeps the eyes focused when the head is moving, so vestibular issues after a concussion may manifest themselves as vision issues. This makes it even more important that concussion and TBI patients be seen at a multidisciplinary clinical practice, where specialists in physiatry, occupational therapy, and neuro-ophthalmology can work together to assess the symptoms and create the most effective individual rehabilitation plan. This plan may include vestibular therapy to address any problems with balance.