Concussion Impairments and Rehabilitation: A Guide for Recovery

Concussion is often misunderstood as a temporary knock to the head that clears up with rest. In reality, for many people it triggers a series of complex neurological and physiological changes that can affect vision, balance, movement, thinking, mood, and even the way the body responds to exercise. Without targeted intervention, these problems can linger, affecting quality of life and delaying a full return to work, study, or sport.

This guide explores the most common concussion-related impairments, the science behind why they occur, and the rehabilitation strategies proven to support recovery. It is designed to help clinicians, therapists, and patients better understand the road to recovery.

 

1. Oculomotor Impairments

Why it happens
A concussion can interfere with the brain regions responsible for controlling precise eye movements, including the frontal eye fields, brainstem nuclei, basal ganglia, and cerebellum. Damage or disruption here can impair saccades (quick shifts in gaze), smooth pursuits (tracking a moving object), convergence (inward movement of both eyes), and visual fixation. Even minor deficits can make everyday activities such as reading, scrolling on a phone, or walking in a busy environment more challenging.

How rehabilitation helps
Vision therapy retrains the eyes to move smoothly and accurately. Programmes often include saccade and smooth pursuit exercises, convergence drills (such as Brock string or pencil push-ups), gaze stabilisation while moving the head, and structured visual tracking tasks using tools like the HeadX Kross. Progress is always guided by symptom response, with gradual increases in speed and complexity.

 

2. Vestibular Impairments

Why it happens
Concussion can affect the vestibular system, which includes both the inner ear (peripheral vestibular system) and central brain pathways. This disruption impacts the vestibulo-ocular reflex (VOR), which helps stabilise vision during head movement, as well as balance and spatial awareness. Symptoms may include dizziness, vertigo, nausea, imbalance, and disorientation, especially when moving the head or when surrounded by moving visual stimuli.

How rehabilitation helps
Vestibular rehabilitation encourages the brain to adapt and recalibrate. Techniques include VOR training, graded exposure to movement triggers, visual-vestibular integration exercises, and combining head movement with balance training. Treatment is often personalised by a specialist vestibular physiotherapist.

 

3. Balance and Postural Control Issues

Why it happens
The brain integrates information from the eyes, inner ear, and body’s proprioceptive sensors to maintain balance. After concussion, this integration can be disrupted, particularly when cerebellar pathways are affected. The result can be increased postural sway, delayed motor responses, and reduced stability—even in otherwise fit individuals.

How rehabilitation helps
Balance training progresses from simple static stances to dynamic challenges. Examples include single-leg stands, tandem walking, proprioceptive training on foam or unstable surfaces, dual-task drills that add cognitive load, and using visual targets such as the HeadX Kross wall charts. Therapy is progressed to match the patient’s functional or sport-specific needs.

4. Cervical Spine Dysfunction

Why it happens
The rapid acceleration-deceleration forces that cause concussion often strain the neck’s muscles, joints, and sensory receptors. This can lead to headaches, dizziness, and blurred vision that overlap with other concussion symptoms, making diagnosis and management more complex.

How rehabilitation helps
Neck-specific rehabilitation includes gentle mobilisation to restore range of motion, proprioceptive retraining for accurate head positioning, strengthening of deep neck flexors and postural muscles, and manual therapy. Integrating head and eye movement drills can also improve coordination between the neck and vestibular system.

 

5. Cognitive Impairments

Why it happens
The “neurometabolic cascade” following concussion involves chemical and structural changes in the brain, such as ionic imbalances, reduced glucose metabolism, and stretching of nerve fibres. This can affect memory, attention, reaction time, and executive function.

How rehabilitation helps
Cognitive rehab begins with low-intensity mental activities and gradually increases complexity. Tools such as reaction-time games, memory exercises, and dual-task training (combining physical and mental challenges) help restore performance. Computerised testing, such as NeuroFlex or ImPACT, can track progress and guide adjustments.

6. Exertional Intolerance

Why it happens
Some people develop an abnormal cardiovascular and autonomic response to exercise after concussion, causing dizziness, headache, or fatigue when active. This may be linked to brainstem and hypothalamic dysfunction, which can affect heart rate, blood pressure, and blood flow to the brain.

How rehabilitation helps
Sub-threshold aerobic exercise, guided by heart-rate monitoring, helps restore the body’s ability to regulate blood flow. Programmes often start with light cycling or treadmill walking and progress gradually, with protocols such as the Buffalo Concussion Treadmill Test used to establish safe limits.

7. Psychological and Sleep Disturbances

Why it happens
Concussion can disrupt the brain’s limbic system, alter neurotransmitter balance, and disturb circadian rhythms. This, combined with anxiety, fear of reinjury, and social isolation, can prolong recovery and amplify symptoms.

How rehabilitation helps
Effective management includes patient education, reassurance, cognitive behavioural therapy (CBT), sleep hygiene strategies, mindfulness, and relaxation techniques. If symptoms persist, referral to a psychologist or neuropsychiatrist may be appropriate.

In conclusion

Recovering from concussion requires a multifaceted, tailored approach. Each patient presents a unique mix of impairments, and the best outcomes are achieved when rehabilitation directly targets these areas.

By addressing the root causes rather than just managing symptoms, clinicians can help patients return to work, school, or sport with confidence and reduced risk of recurrence.