Medical follow-up and referral to healthcare professionals/interdisciplinary concussion team
(1-4 weeks following acute injury)
- Focused vision and vestibular history, physical examination, determine need for imaging
- Post-injury education and guidance on symptom management
- Refer to healthcare professionals/interdisciplinary concussion team if symptoms last longer than 4 weeks (or sooner as needed/using clinical judgment), or if the child has modifiers that may delay recovery
- Consider particle re-positioning for BPPV (e.g. Epley)
Post Concussion Vision Management
Consider early referral (< 4 weeks) if child/adolescent has modifiers that may delay recovery/ high risk of prolonged post-concussion symptoms
Healthcare professionals/ interdisciplinary concussion team
- Medical assessment by physician with expertise in concussion
- Adjunctive testing (graded aerobic exercise testing, formal vestibular testing, automated visual field testing)
- Interdisciplinary management of vision and vestibular disorders
BPPV, vestibular hypofunction, balance
Central vestibulopathy SSCD
Vision or oculomotor disorder
Cervicogenic dizziness
Physiotherapist*
Otolaryngologist/ Neuro-Otologist, NeuroOphthalmologist, Physiotherapist*
NeuroOphthalmologist, NeuroOptometrist, Physiotherapist*
Physiotherapist*, Chiropractor*
Acronyms: paroxysmal positional vertigo (BPPV); superior semicircular canal dehiscence syndrome (SSCD) *denotes health care professional with competency-based training in vestibular or visual system rehabilitation