EFFECTIVENESS OF VESTIBULAR REHABILITATION IN CHILDREN AND ADOLESCENTS POST-CONCUSSION: A SYSTEMATIC REVIEW

Purpose/Hypothesis: The specific aims of this study were: 1) to describe the process of care for vestibular rehabilitation, 2) determine the effectiveness that vestibular rehabilitation has on improving vestibular function, postural control and quality of life and 3) reducing symptom severity in children post-concussion.

Number of Subjects: 1,103

Materials/Methods: This study utilized the methodologies and procedures of a systematic review according to the guidelines given by the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement. An electronic search was conducted on two databases, MEDLINE and CINAHL, to identify relevant studies published between from January 2009 to April 2023. Four reviewers independently screened articles for inclusion. A fifth reviewer was consulted if mutual consensus was not obtained. Studies were included if they met the following criteria: 1) the studies include children between the ages of 0-18 years who received vestibular rehabilitation post-concussion, and 2) peer-reviewed articles published in English. Studies were appraised for quality using the Newcastle-Ottawa Quality Assessment Scale (NOS) and the APTA Critical Appraisal Tool for Experimental Studies (CAT-EI).

Results: Twelve studies with 1,103 patients (average age: 15.7) met the inclusion criteria. Nine studies included individualized vestibular rehabilitation programs and the remaining three studies included general vestibular rehabilitation programs. The Dizziness Handicap Inventory was most utilized in studies, followed by the Activities Specific Balance Confidence Scale. Following vestibular rehabilitation, patients showed significant improvements in RTP time with early intervention within 30 days, Vestibular Ocular Motor Screening (VOMS), dizziness severity, and balance. The quality of the studies ranged from 7-9 using the NOS and acceptable to high using the APTA CAT-EI.

Conclusions: The included studies suggest evidence for the benefits vestibular physical therapy can have on patients following a concussion. Multimodal physical therapy treatment including vestibular rehabilitation improves post concussion symptoms in pediatric patients. While utilizing a vestibular rehabilitation program, early intervention is found to be more effective.

Clinical Relevance: There has been a 71% increase seen in concussions in children between the ages of 10-19 years. Vestibular impairments occur in up to 88% of children post-concussion and are associated with prolonged recovery. Vestibular impairments negatively impact activities of daily living and participation in sports and school. There is a lack of consensus in regards to treatment guidelines specific to vestibular rehabilitation in children post-concussion.