Dizziness, vertigo, and imbalance after concussion
Shaleen Sulway and Elizabeth Crawford are featured speakers in the Canadian Concussion Centre’s Webinar Series. Learn more about how to manage post-concussion dizziness, vertigo, and balance problems.
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Key concepts from this presentation
Dizziness is a common post-concussion symptom. Although dizziness can have many different underlying causes, it is commonly due to problems in the vestibular system.
Understanding the timing and triggers of your symptoms can help narrow down the possible causes.
Timing: Do your symptoms last seconds, minutes, or hours? Are your symptoms constant?
Triggers: Do your symptoms happen spontaneously? Are your symptoms triggered by head movements, body movements, position changes, seeing movement in your environment?
Vertigo is a specific sensation of dizziness - the illusion that you are moving or that your environment is moving. This is often a spinning or rotational sensation.
The vestibular system involves 1) the balance sensors in the inner ear - peripheral vestibular system, and 2) the areas of the brain that process signals about balance - central vestibular system. Problems in either or both of these can lead to symptoms of dizziness, vertigo, or imbalance.
Benign Paroxysmal Positional Vertigo is the most common cause of vertigo in adults, and the most common cause of vertigo after head injury. BPPV causes recurrent spells of vertigo that last less than a minute at a time. These spells are typically triggered by lying down, turning in bed, getting up from lying down, bending down, or looking up.
Sensory mismatches are a common cause of dizziness and unsteadiness after a concussion. Our brain receives signals about balance from our inner ears, eyes, and body sensation (proprioception). If any of these signals are inaccurate or if the brain is processing this information inaccurately, then you may feel dizzy or off balance. If not addressed, this can lead to prolonged symptoms and Persistent Postural Perceptual Dizziness. Vestibular rehab balance assessments can help determine if you are underusing vestibular inputs, overusing vision, or are sensitive to postural sway. Targeted balance exercises can help your brain appropriately re-weight sensory inputs and improve your balance abilities.
Aerobic exercise is important for brain health, and daily walking allows your brain to compare vision, vestibular and proprioceptive inputs and helps your brain learn to recalibrate. It is important to pace your activity and use symptoms de-escalation strategies like grounding, breath control, and cognitive reframing.
Vestibular rehabilitation physiotherapy involves a comprehensive assessment to determine the cause of your symptoms. Treatment is guided by the assessment and your goals. Vestibular therapy is active and exercise-based.
Watch more videos from the Canadian Concussion Centre Webinar series.
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