Concussion and Traumatic Brain Injury (TBI): Modern Rehabilitation Approaches

Concussion and Traumatic Brain Injury: Modern Rehabilitation Approaches

“Concussion is not just a bump on the head—it’s a disruption of life.”

— International Concussion Society

Concussions and Traumatic Brain Injuries (TBI) are far more common than most people think. In fact, an estimated 69 million people worldwide experience TBI each year (The Lancet Neurology). Yet, recovery is often approached with outdated advice like “just rest and wait.”

In reality, rehabilitation for concussion and TBI requires a targeted, symptom-specific plan. That’s where interventions like vestibular rehabilitation, gait and balance training, visual retraining, and BPPV treatment come in.

But how do we know what a patient needs? It starts with accurate assessment and a multidisciplinary approach—because not every concussion looks the same.

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A concussion is a form of mild traumatic brain injury, but “mild” doesn’t mean insignificant. It can affect multiple systems:

Vestibular system (balance and spatial awareness)

Oculomotor system (eye movement and visual tracking)

Cognitive function (concentration, memory, mental fatigue)

Emotional regulation (anxiety, irritability, mood swings)

Autonomic function (heart rate, blood pressure control, dizziness with exertion)

This wide range of symptoms is why rehabilitation must be cluster-specific. No two concussion patients present the same way.

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To guide treatment, clinicians use specific assessments. Two of the most valuable are:

VOMS: Vestibular/Ocular Motor Screening

The VOMS is a simple but powerful tool to identify deficits in:

Smooth pursuit (tracking a moving target)

Saccades (quick eye movements between two points)

Convergence (ability to focus on near objects)

Vestibular-ocular reflex (keeping vision stable during head movement)

Visual motion sensitivity

If a patient reports symptom provocation during these tasks, targeted visual retraining and vestibular rehabilitation become priorities.

PROMs help quantify the patient’s experience. Common tools include:

Dizziness Handicap Inventory (DHI)

Post-Concussion Symptom Scale (PCSS)

Neck Disability Index (NDI) if cervical symptoms are present

Activities-specific Balance Confidence (ABC) Scale

These measurements track progress and guide clinical decisions.

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When concussion affects the vestibular system, patients may feel dizzy, off-balance, or “disconnected” from their body in space. This is where vestibular rehabilitation becomes central to recovery.

Interventions include:

Gaze stabilization exercises (improving the vestibular-ocular reflex)

Habituation exercises (gradually reducing motion sensitivity)

Balance retraining with variable surfaces and head movements

Some patients develop Benign Paroxysmal Positional Vertigo (BPPV) after head injury. For them, specific BPPV treatment—like the Epley manoeuver—can resolve vertigo in just a few sessions.

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After a concussion or traumatic brain injury, even simple walking may feel unstable. That’s because balance is controlled by a three-part system:

Vestibular input

Vision

Somatosensory feedback (from muscles and joints)

Gait and balance training targets this system holistically. Exercises might include:

Walking with head turns or eyes closed

Tandem walking (heel-to-toe)

Dynamic balance tasks on unstable surfaces

These interventions don’t just restore physical ability—they rebuild confidence.

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Concussion frequently impacts oculomotor function. Patients may report:

Blurred vision

Double vision

Difficulty focusing

Headaches with reading

Visual retraining addresses these issues through:

Eye tracking exercises

Convergence training

Visual motion desensitization

In some cases, collaboration with a neuro-optometrist is recommended for prism therapy or specialized lenses.

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Concussion and traumatic brain injury require a multidisciplinary approach. Depending on the cluster of symptoms, different specialists may be involved:

Symptom Cluster Treatment Focus Professional Involvement

Vestibular Dysfunction Vestibular Rehabilitation, BPPV Treatment Physiotherapist, Audiologist

Visual Impairment Visual Retraining, Prism Therapy Neuro-Optometrist

Cognitive Symptoms Cognitive Therapy Neuropsychologist

Cervical Pain & Dizziness Manual Therapy, Posture Training Physiotherapist

Emotional Symptoms Mood Support, Sleep Hygiene Psychologist, Physician

This team-based approach ensures no aspect of recovery is overlooked.

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The days of “rest until you feel better” are gone. Modern evidence supports active rehabilitation, customized to each person’s symptom profile.

That includes:

Vestibular rehabilitation for dizziness

Gait and balance training for mobility

Visual retraining for oculomotor deficits

BPPV treatment when positional vertigo is present

These interventions, combined with careful monitoring using tools like VOMS and PROMs, form the backbone of successful recovery.

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Recovering from concussion or traumatic brain injury is complex—but it doesn’t have to be confusing. With the right assessments and a multidisciplinary approach, clinicians can tailor rehabilitation to exactly what the patient needs.

If you or someone you know is struggling after a head injury, seek out professionals trained in these advanced rehabilitation techniques. Recovery isn’t about waiting—it’s about working the right plan.