Concussion Rehabilitation

Physiotherapist Megyn Robertson

Megyn Robertson

Physiotherapist Megyn Robertson will be overseeing clinical interventions and research into cases of concussion that become chronic, have significant balance disturbances or require neck treatments.

Physiotherapy  management of the patient with vestibular dysfunction from head trauma

Symptomatology in head trauma:  There are 4 basic categories of impairment and typical symptoms associated with traumatic brain injury (TBI): namely sleep, cognitive, emotional and somatic. The role of the physiotherapist is predominantly somatic with respect to dizziness, imbalances, headaches, nausea, sensitivity to light and sound and neck pain.


(Morris & Gottshall, ch 26 Physical therapy of the patient with with vestibular dysfunction from head trauma, p504-529)

My rehabilitation protocol is a Problem Oriented intervention incorporating musculoskeletal intervention as well as vestibular rehabilitation techniques.

  • Cervical treatment
  • Gaze stabilisation
  • Oculomotor training
  • Exertion programme
  • Motion sensitivity training
  • Balance training


The patient is treated for any signs of cervicogenic dizziness or headache a result of the trauma to the musculoskeletal system. For e.g.  O/C1/C2 dysfunction, TMJ and muscular tightness, strengthening of DNF and global head/neck structures.


Exercises focus on improving gaze stabilisation and eye-head co-ordination within the patient’s tolerance.  Oculomotor training is used to treat saccadic or smooth pursuit deficits in his/her enviroments.


Exertion intolerance is common in mTBI. Patients who present symptomatically with exertion are given an individualised, controlled sub-symptom threshold programme (usually measured by heart rate).


Rehabilitation includes exercises that are more large amplitude, fast movements are used to treat motion sensitivity, with gradual introduction of head motion with trunk motion or whole-body motion retraining.

We are still in the experiential phase but some of the programmes utilized on HUMAC for motion sensitivity and balance training  include:

  1. Clinical test of Sensory Organisation and Balance (CTSIB)

To test how a patient’s vision, vestibular and somatosensory systems interact, and if a deficit exists compared to a normal population. Similar to the Romberg test. We are then able to adjust the settings to perform the test as a protocol

  • Eyes open, firm surface
  • Eyes closed, firm surface
  • Eyes open, foam surface ( I use an airex balance pad on top of the balance board to do this)
  • Eyes closed, foam surface (use airex pad as above)
  1. Mobility

To test how a patient’s ability to hold their Centre of Pressure (COP) on a moving target that circles around a neutral balance point. Results report on the percentage of time the patient holds their COP inside the moving target.

  1. Limits of Stability

The goal is for the patient to move the round cursor (their COP) to the highlighted target. After the patient remains in the target for the hold time, the system turns the target gray and moves to the next target. The patient moves between the centre target and each surrounding target in a random order.