Vestibular Treatment in Adolescents Following Sport Related Concussion
Condition: Vestibular Disorder
MeSH terms: Vestibular Diseases
Study type: Interventional

Summary: 
      Each year, nearly 2 million children and adolescents have a sport-related concussion (SRC) in
      the U.S., but 57% of them do not receive appropriate clinical care following their injury.
      These injuries involve a wide range of symptoms including headache, dizziness, and sleep
      problems; and cognitive, emotional, visual, and vestibular impairment. The investigators have
      developed a clinical treatment model for SRC that addresses the heterogeneity of this injury
      using different clinical subtypes or profiles that inform precision interventions. To date,
      the investigators have identified cognitive, anxiety/mood, post-traumatic migraine, cervical,
      oculomotor, and vestibular clinical profiles. Patients with vestibular clinical profiles-
      involving dizziness, environmental sensitivity, and imbalance- are common (60-65% of
      concussions), and have worse outcomes and longer recovery following SRC. Consequently, the
      investigators have developed and applied precision vestibular treatments that can be matched
      to specific impairments and symptoms to actively treat patients with vestibular clinic
      profiles.
    

Detailed description: 
      To determine using a RCT design the effectiveness of standard of care behavioral management
      (i.e., sleep, walking, nutrition, stress management) to standard of care behavioral
      management (i.e., sleep, walking, nutrition, stress management) (STANDARD OF CARE) plus
      vestibular exercises (i.e., balance, eye-head movements, and dynamic walking exercises)
      (VESTIBULAR) for reducing recovery time, symptoms, and vestibular (balance, eye-head
      movements) and cognitive (e.g., memory, processing speed) impairment in adolescent patients
      with vestibular clinical profiles following sport--related concussion (SRC).
    

Intervention name(s): Vestibular Exercise Intervention; Standard of Care
Intervention type(s): Behavioral; Behavioral
Intervention description(s): The vestibular exercise intervention group will complete behavioral management activities, and prescribed in--office/at home vestibular exercises from four groups: 1) gaze stability training (integrated eye and head movements on fixed target), 2) visual motion training (integrated eye and head movements on moving target), 3) standing balance (standing with eyes closed in different stances), and 4) dynamic gait (walking with head turns and eye movements). Participants will be prescribed to one of four levels of these exercise groups based on presentation of symptoms/impairment as indicated on VOMS. Progression through the levels will be based on symptom tolerance and successful completion of all exercises at the current level.; The standard of care consists of standardized in office/at home behavioral management including sleep, hydration, nutrition, and stress management interventions.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Care Provider, Outcomes Assessor)
Primary purpose: Treatment
Keywords: adolescent; concussion