The Role of Vestibular
Rehabilitation in Concussion
Management
Ann Leinenwever, PT, NCS
Regional Manager
Physical Therapist at the Brooks Balance Center
Vestibular System
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Peripheral System/Labyrinth
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Central Nervous System Processing
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5 sensory organs that detect linear and angular
acceleration
Cranial Nerve VIII (Vestibulocochlear)
Vestibular Nuclei in the Midbrain
Primary Function

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Gaze Stabilization
Postural Stability
Vestibular System

Injury to the peripheral apparatus
(labyrinthine concussion) or to the central
nervous system can lead to symptoms of:
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Imbalance
Dizziness
Vertigo
Difficulty Focusing
Balance System
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Vestibular system works in conjunction with
the visual and somatosensory system in order
to maintain one’s balance in any given
environment or activity
Vestibular System is crucial in high demand
activities, i.e. sports or when visual or
somatosensory input is either absent, impaired
or conflicting
Vestibular Rehabilitation

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Examination by a trained physical therapist
will determine one’s functional limitations
and impairments
Once identified, a plan of care will be
established to focus on deficits in order to
improve gaze stabilization, balance and
reduce dizziness
Goal is to return patient to prior activity level
or sport without symptoms
Tests and Measures
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Positional Testing
Vestibulo-ocular Reflex (VOR) Testing
Balance Testing
Computerized Dynamic Posturography
Subjective Questionnaires
Sample Exercises
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VOR: Focus on a non-moving target, move head
through a small range right and left, while
maintaining gaze on target. Repeat for 1 minute and
then repeat moving head up and down
Balance: Single Limb Support, altering challenge by
performing eyes closed, with head motions, while on
compliant/foam surfaces, or a combination of all
Customized based on need’s of patient and goal of
their sport or activity
Questions?
Ann Leinenwever, PT, NCS
Brooks Balance Center
10475 Centurion Parkway N. Ste 304
Jacksonville, FL 32256
904-854-2050
904-854-2058-fax
Ann.Leinenwever@brooksrehab.org