TOOL 10.1: Post-concussion Vision, Vestibular, and Oculomotor Disturbances Algorithm

pediatric concussion care icon

TOOL 10.1: Post-concussion Vision, Vestibular, and Oculomotor Disturbances Algorithm

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)

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