What is an example treatment plan for a person with a mild traumatic brain injury (mTBI) concussion referred for balance rehabilitation and vestibular rehabilitation?

From the Guidelines

A comprehensive treatment plan for a person with a mild traumatic brain injury (mTBI) concussion referred for balance and vestibular rehabilitation should include a progressive, multi-faceted approach, incorporating vestibular adaptation exercises, balance training, and addressing cervical spine issues, as recommended by the most recent guidelines 1. The treatment plan would begin with a thorough assessment of the patient's vestibular function, balance abilities, and gait patterns to identify specific deficits.

• The rehabilitation program would then include:
  • Vestibular adaptation exercises such as gaze stabilization and habituation exercises, starting at 3-5 repetitions, 3 times daily, and gradually increasing as tolerated.
  • Balance training incorporating static standing exercises on various surfaces, progressing from eyes open to eyes closed, and eventually adding cognitive tasks while maintaining balance.
  • Dynamic balance activities, including controlled weight shifting, tandem walking, and obstacle courses, starting at 10-15 minutes per session.
• For patients with benign paroxysmal positional vertigo (BPPV), specific repositioning maneuvers like the Epley or Semont maneuvers would be performed, as supported by clinical practice guidelines 1.
• The program would also address cervical spine issues with gentle range of motion exercises and proprioceptive training.
• Sessions would typically occur 2-3 times weekly for 4-8 weeks, with daily home exercises, promoting neuroplasticity and allowing the brain to compensate for vestibular deficits by utilizing visual and somatosensory inputs more effectively, while gradually desensitizing the patient to movements that trigger symptoms, as outlined in recent systematic reviews and meta-analyses 1.

From the FDA Drug Label

Meclizine hydrochloride tablets are indicated for the treatment of vertigo associated with diseases affecting the vestibular system in adults. Meclizine hydrochloride tablets are indicated for the treatment of vertigo associated with diseases affecting the vestibular system in adults (1).

An example treatment plan for a person with a mild traumatic brain injury (mTBI) concussion referred for balance rehabilitation and vestibular rehabilitation may include:

• Vestibular rehabilitation therapy to improve balance and reduce vertigo symptoms
• Medications such as meclizine to treat vertigo associated with vestibular system diseases 2, 2
• Balance exercises to improve overall balance and stability
• Vestibular compensation exercises to help the brain compensate for vestibular system damage The treatment plan should be individualized and supervised by a healthcare professional.

From the Research

Treatment Plan Overview

• The treatment plan for a person with a mild traumatic brain injury (mTBI) concussion referred for balance rehabilitation and vestibular rehabilitation typically involves a customized approach, taking into account the individual's specific symptoms and needs 3, 4.
• Vestibular rehabilitation is an effective modality for managing dizziness, vertigo, and imbalance following concussion, and can be used in conjunction with other therapies to address co-morbidities such as cognitive and behavioral issues, visual-perceptual dysfunction, metabolic dysfunction, and autonomic dysfunction 3, 5.

Assessment and Goal Setting

• A comprehensive assessment is necessary to identify the individual's specific vestibular dysfunction and other co-morbidities, and to establish realistic goals for treatment 4, 6.
• The assessment may include the use of outcome measures such as the Dizziness Handicap Inventory (DHI) to track progress and evaluate the effectiveness of treatment 5, 6, 7.

Treatment Interventions

• Vestibular rehabilitation exercises, such as gaze stabilization, balance training, and canalith repositioning, may be used to improve vestibular function and reduce symptoms of dizziness and vertigo 3, 4, 7.
• Other interventions, such as cognitive and behavioral therapy, visual-perceptual training, and metabolic and autonomic dysfunction management, may be used to address co-morbidities and promote overall recovery 3, 5.
• Early intervention with vestibular rehabilitation has been shown to be effective in reducing symptoms of vertigo and unsteadiness in patients with acute and sub-acute head trauma 7.

Progress Monitoring and Adjustment

• Regular progress monitoring is necessary to adjust the treatment plan as needed and to ensure that the individual is meeting their goals 5, 6.
• The treatment plan may need to be adjusted to address any co-morbidities or other factors that may be impacting the individual's recovery, such as cognitive and behavioral issues or visual-perceptual dysfunction 3, 5.