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Persistent vertigo, dizziness, imbalance and visual disturbance are common symptoms of patients with concussion and are often associated with objective impairments of the vestibular system.^1,2 
When assessment suggests vestibular dysfunction, vestibular interventions can be considered. While historically, medications have been used to suppress vestibular symptoms, including nausea, current evidence does not support this approach.³  

The most common cause of post-traumatic peripheral vestibular dysfunction is benign paroxysmal positional vertigo (BPPV).^4,5 Patients experience episodes of vertigo, nystagmus and nausea with sudden changes in position, often including rolling over in bed or looking up. Other causes of dizziness can also be caused by post-concussion migraines, autonomic dysregulation, medications and other peripheral vestibular disorder. Patients with dizziness frequently experience concurrent psychological disorders such as anxiety.⁶ A tool such as the Dizziness Handicap Inventory can help to assess the functional impact of dizziness⁷.
A Cochrane review by Hillier and Hollohan (2007) identifies vestibular rehabilitation as an effective intervention for unilateral peripheral vestibular dysfunction¹; this has been supported by Gurley et al.⁶ Weaker evidence also suggests vestibular rehabilitation may be helpful for central vestibular dysfunction.⁸ Vestibular rehabilitation is typically provided by a specialized a healthcare professional with specialized training and involves various movement-based regimens to bring on vestibular symptoms and desensitize the vestibular system, coordinate eye and head movements, and improve functional balance and mobility.

Vision Dysfunction

Patients presenting with vision disorders post-concussion may have impairment of visual acuity, accommodation, versional eye movements, vergence eye movements, visual field integrity and may experience photosensitivity. Practitioners should take a detailed history of vision symptoms and screen for potentially unrecognized visual deficits using simple confrontational field testing.^9,10 Concussion patients with complex visual symptoms including diplopia and/or impaired vision should be referred to a neuro-ophthalmologist.^11-13 Patients with impairments of accommodation, version or vergence movements, and/or photosensitivity may benefit from rehabilitative techniques rendered by qualified optometrists.^11-13 Vision rehabilitation can be beneficial for some patients^14, and should be considered for the treatment of persistent vision disorders.