Cervicovestibular Rehabilitation in Adults with Mild Traumatic Brain Injury: A Randomized Clinical Trial

The objective of this study was to compare the effects of a cervicovestibular rehabilitation program combined with symptom-limited aerobic exercise (SLAE) program to a SLAE program alone in adults with persistent symptoms after mild traumatic brain injury (mTBI) on severity of symptoms and other indicators of clinical recovery. In this single-blind, parallel-group randomized controlled trial, 60 adults with persistent symptoms after mTBI were randomly assigned to: (1) a 6-week SLAE program or (2) a 6-week cervicovestibular rehabilitation program combined with a SLAE program. All participants took part in four evaluation sessions (baseline, week 6, 12, and 26) performed by a blinded evaluator. The primary outcome was the Post-Concussion Symptoms Scale (PCSS). The secondary outcomes were Numerical Pain Rating Scale (NPRS), Neck Disability Index (NDI), Headache Disability Inventory (HDI), Dizziness Handicap Inventory (DHI), time to return to function, and physical cervical and vestibular measures. Non-parametric analysis for longitudinal data was used to evaluate the effect of interventions on outcomes. For PCSS, NPRS, NDI, HDI, DHI, and return to function, there were no group-by-time interactions at any time points follow-up (p > 0.05); clinically significant time effects were, however, observed (p < 0.05). There were group-by-time interactions at weeks 6 and 12 for vestibulo-ocular reflex (p < 0.003) and the craniovertebral mobility (p < 0.001) measures in favor of the cervicovestibular rehabilitation group. The study indicates that a cervicovestibular rehabilitation program combined with SLAE was not superior to a SLAE program alone in term of symptoms and functional level improvement but resulted in improved physical cervical and vestibular function.