When Concussions Disrupt Balance: Navigating Vestibular Challenges After Head Injury
A concussion is more than just a bump on the head. It can trigger a cascade of neurological effects, especially when the vestibular system is involved. Concussions with vestibular dysfunction uniquely disrupt balance, spatial orientation, and coordination, significantly impacting an individual's ability to function.
The vestibular system—responsible for maintaining balance and coordinating movement—relies on a finely tuned interplay between the inner ear, brainstem, and cerebellum. When a concussion alters this balance network, it can result in symptoms that are both difficult to detect and profoundly disabling.
Bringing Balance to the Forefront with Objective Testing
Sway Balance provides a critical solution in evaluating these impairments. By turning a mobile device into a precision balance assessment tool, Sway enables athletic trainers and clinicians to objectively measure postural stability in real time.
Its 100-point scoring system quickly identifies abnormalities, eliminating guesswork and supporting timely intervention. The scoring system also makes it easy for patients to understand and visualize their progress.
Whether used immediately post-injury or during follow-up assessments, Sway's validated protocols—including mBESS and mCTSIB—make balance testing both accessible and clinically reliable. Notably, research confirms that Sway's measurements correlate closely with force plate data, particularly under challenging balance conditions (source).
Recognizing Vestibular Dysfunction in Concussed Patients
Not all concussions affect the vestibular system, but when they do, symptoms extend beyond the usual headache and fatigue. Individuals with vestibular concussions often report:
Dizziness or vertigo
Imbalance or unsteadiness
Motion sensitivity
Blurred or unstable vision (oscillopsia)
Nausea related to head or visual motion
These symptoms arise because the brain struggles to integrate sensory inputs from the inner ear, eyes, and body. Damage or disruption to vestibular pathways—whether structural or functional—can cause mismatched signals that confuse the brain and impair equilibrium.
Objective Concussion Assessments
Anytime, Anywhere
Sway’s FDA-cleared mobile app provides fast, reliable testing for athletic trainers and healthcare professionals.
At the core of vestibular function is the vestibulo-ocular reflex (VOR), which stabilizes gaze during head movement. Concussion can impair the VOR, making it difficult for patients to maintain visual focus during activities like reading or walking. Additionally, the cerebellum's role in motor control becomes compromised, leading to delayed reaction times and poor postural adjustments.
Functional MRI studies have shown decreased activation in regions such as the insular cortex and cerebellum post-concussion, particularly when vestibular symptoms are present. The insular cortex is critical for vestibular integration, and dysfunction here can lead to dizziness and spatial disorientation. This study outlines the role of the insula in vestibular processing and its implication in concussion-related symptoms. Similarly, the cerebellum is essential for balance and coordination, and concussion-related changes in cerebellar activation have been observed in individuals with vestibular symptoms. This research discusses altered cerebellar activity in the context of vestibular dysfunction.
(source). This further supports the need for objective diagnostics and targeted vestibular rehabilitation.
Vestibular Symptoms Often Go Unrecognized
Vestibular symptoms after a concussion are frequently misdiagnosed or underreported, especially in youth sports. Dizziness may be dismissed as dehydration or anxiety. Without specific assessments, vestibular dysfunction may remain hidden, prolonging recovery and increasing the risk of further injury. Patients also have a very difficult time verbalizing these types of symptoms.
Tools like the VOMS (Vestibular/Ocular Motor Screening) and Sway's balance assessments bridge this diagnostic gap. By pairing symptom provocation testing with postural stability scores, clinicians gain a fuller picture of injury severity and track improvement with greater accuracy.
Who Is Most at Risk?
Athletes in contact sports such as football, hockey, and soccer are particularly vulnerable to vestibular dysfunction after concussion due to frequent rotational forces and impacts. However, these injuries are not limited to sports. Motor vehicle accidents, falls, and blast exposures (in military settings) can all produce vestibular symptoms.
Interestingly, research shows that female athletes report vestibular symptoms more frequently than males, and younger individuals may take longer to recover (source). These findings underscore the need for personalized care and regular reassessment.
Rehabilitation: Resetting the Brain Balance Connection
Treatment for vestibular dysfunction after a concussion should involve a multidisciplinary approach. Vestibular rehabilitation therapy (VRT), often led by physical therapists trained in concussion management, can significantly reduce symptoms and improve functional outcomes.
VRT exercises typically include:
Gaze stabilization drills
Balance training on variable surfaces
Habituation to motion sensitivity
Coordination tasks to restore motor timing
Gradual progression is key. Overexertion can worsen symptoms, so programs must be individualized and monitored closely—another reason why tools like Sway are invaluable for real-time feedback and data tracking.
Why Objective Balance Testing Matters?
Traditional balance assessments are often subjective and reliant on observer interpretation. Sway eliminates this variability, providing consistent, quantitative results across settings. Its ease of use means assessments can be done anywhere—on the sidelines, in clinics, or during home health visits.
Moreover, balance impairments tend to persist longer than other concussion symptoms. As such, they are a vital marker of neurological recovery and a predictor of readiness for return to activity. Sway’s integrated reporting features allow clinicians to document improvement and share findings with the care team, ensuring aligned decisions and safer outcomes.
Vestibular dysfunction after a concussion challenges both patients and providers. Their subtle yet pervasive symptoms demand careful evaluation, tailored rehabilitation, and clear communication. Through evidence-based tools like Sway, clinicians can detect impairments early, intervene effectively, and monitor recovery with precision.
As awareness grows around the diverse presentations of concussion, integrating objective balance testing into routine care is not just a best practice—it’s essential.
If you're managing athletes with concussion symptoms, explore how Sway can strengthen your protocol. Accurate, mobile, and evidence-backed, Sway helps you bring balance back—objectively and efficiently.
Reviewed by Kim Wyand, PT, DPT
Director of Customer Experience, Sway Medical
Dr. Kim Wyand is a licensed physical therapist and concussion education specialist with more than a decade of experience in outpatient orthopedic and neurological rehabilitation. On top of leading the customer experience team, Kim works closely with Sway's research team, ensuring the platform remains grounded in research and consistently aligned with evidence-based best practices. She leads the development of tools and resources that support over 13,000 clinicians and athletic programs in delivering high-quality concussion care.
