Vestibular Rehabilitation for Post-Concussive Vestibular Dysfunction: Pathophysiology, Evidence-Based Practice, and Future Perspectives

Abstract

Mild traumatic brain injury (mTBI) is often referred to as a “silent epidemic” due to its high incidence and frequently overlooked long-term sequelae. A critical factor hindering a patient's return to daily life is post-concussive vestibular dysfunction (PCVD). To optimize rehabilitation outcomes, an early, mechanism-based integrated assessment is essential. Such an approach moves beyond simple symptom relief, focusing instead on identifying specific lesions and underlying pathophysiology to target treatment accurately. PCVD is rarely a single-lesion issue; it emerges from complex interactions between the peripheral vestibular system, the central nervous system, and the cervical spine, often exacerbated by the failure of sensory reweighting. This review provides updated insights into precise diagnosis and evidence-based, individualized vestibular rehabilitation therapy (VRT). Specifically, it addresses the differential diagnosis of cervicogenic dizziness and structural peripheral lesions, while also discussing persistent postural-perceptual dizziness, which is often considered less responsive to standard VRT protocols. The review also explores how advanced technologies, including virtual reality and wearable sensors, are paving the way for digital therapeutics and artificial intelligence-driven precision rehabilitation, potentially reducing reliance on on-site therapy for mTBI patients.