Objective Persistent vestibular dysfunction may occur after concussion. The purpose of this study was to identify the etiology of persistent vestibular symptoms after concussion using an algorithm to identify vestibular, oculomotor, and cervical impairments in patients who were referred for physical therapy (PT).

Design Retrospective chart review.

Setting University physical therapy center.

Participants Adolescents aged 12–19 (n=103, 16.8±2y, 59% female, 58% sport-related, 193±177 days since injury); young adults aged 20–40 (n=159, 28.0±7y, 63% female, 19% sport-related, 187±131 days since injury); and older adults aged 41–65 (n=190, 52.7±7y, 69% female, 2% sport-related, 203±156 days since injury).

Interventions (or Assessment of Risk Factors) The following tests were performed and a clinical algorithm was used to direct clinical management: symptoms, cervical assessment (palpation, proprioception, and range of motion), head thrust, ocular motility (smooth pursuits, repetitive saccades, directional nystagmus), vestibulo-ocular reflex, dynamic visual acuity, dynamic gait, and Romberg.

Outcome Measures Algorithm-derived etiology of vestibular symptoms.

Main Results Out of 494 patients assessed, 383 (77.6%) reported dizziness (83% vertigo, 16% lightheadedness, 1% unspecified). PT-identified etiology differed between age groups (p<.001): (a) adolescents had 49% cervicogenic only, 21% vestibular/ocular only, 28% both, and 2% none; (b) young adults had 20% cervicogenic only, 39% vestibular/ocular only, 36% both, and 4% none; and (c) older adults had14% cervicogenic only, 57% vestibular/ocular only, 23% both, and 6% none.

Conclusions Younger patients more often have a cervical cause for persistent vestibular symptoms after concussion than older patients, who more often have a vestibular/oculomotor etiology. This information is useful for clinicians caring for patients with persistent vestibular symptoms after concussion.