Effectiveness of vestibular rehabilitation in children and adolescents post concussion: A systematic review

Objective(s): The primary objectives of this study were: 1) To describe the process of care for vestibular rehabilitation, 2) determine the effectiveness of vestibular rehabilitation in improving vestibular function, postural control and quality of life and 3) reducing symptom severity and return to play duration in children post-concussion. Data Sources: An electronic search was conducted on two databases, MEDLINE and CINAHL, to identify relevant studies published between from January 2009 to April 2023.Study Selection: 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. All study types except case reports were included. Grey literature was excluded. Data Extraction: 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. Four reviewers independently screened articles for inclusion. A fifth reviewer was consulted if mutual consensus was not obtained. Studies were appraised for quality using the Newcastle-Ottawa Quality Assessment Scale (NOS) and the APTA Critical Appraisal Tool for Experimental Studies (CAT-EI). Data Synthesis: Twelve studies with 1,103 patients (average age: 15.7 years) met the inclusion criteria. Nine studies included individualized vestibular rehabilitation programs whereas three studies included general vestibular rehabilitation programs. Following vestibular rehabilitation, patients showed significant improvements in RTP time with early intervention within 30 days. Vestibular Ocular Motor Screening (VOMS) scores , dizziness severity, and balance also demonstrated significant improvements. The Dizziness Handicap Inventory was most utilized in studies, followed by the Activities Specific Balance Confidence Scale. The quality of the studies ranged from 7-9 using the NOS and acceptable to high using the APTA CAT-EI.

Conclusions: Multimodal physical therapy treatment including vestibular rehabilitation improves post concussion symptoms in pediatric patients and early initiation of vestibular rehabilitation might demonstrate better outcomes. Author(s) Disclosures: The authors report no conflict of interest.