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Concussion
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A blow to the head can do more than cause a concussion—it can disrupt the delicate systems that control balance, vision, and spatial awareness. In this episode of the ICU Podcast, we explore vestibular concussion: what it is, why it’s often overlooked, and how it can leave people feeling dizzy, disoriented, and disconnected from their surroundings. Our guests break down how the vestibular system is affected by head injury, why symptoms like vertigo, brain fog, and visual sensitivity can linger, and what recovery can look like with the right care. Whether you’re a patient, caregiver, or clinician, this conversation sheds light on an often misunderstood consequence of concussion and offers hope for healing through targeted support and rehabilitation.
Guests
Jess Winter is a school librarian with a background in teaching journalism and a deep passion for finding, organizing, and sharing information. After experiencing a concussion, Jess developed ongoing vestibular challenges, including vestibular migraine and persistent postural-perceptual dizziness (PPPD), which have shaped both her personal journey and her commitment to supporting others. She holds a Master’s degree in Library Science and is especially interested in pursuing work as a medical librarian, combining her love of research with a desire to help people navigate complex health information. Jess also supports VeDa through the annual Poetry-4-Balance contest and has led poetry writing for social hour.
Dr. Danit Macklin, PT, DPT, specializes in concussion and vestibular rehabilitation, holding certificates from the APTA in both pediatric and adult vestibular rehabilitation and certification as an Impact Trained Physical Therapist. She has served as faculty for the annual APTA Pediatric Vestibular Competency Conference and is a course instructor for Education Resources Inc. (ERI), where she teaches Leading-Edge Approaches for Concussion and Mild TBI Management: Applications for Comprehensive Assessment and Treatment. Dr. Macklin is the owner of Balance & Concussion Therapy Center, a private practice exclusively dedicated to concussion and vestibular rehabilitation. She serves on the BIANJ Concussion Committee, is the founder and chair of the APTANJ Vestibular Special Interest Group, and founded Concussion Awareness Day in New Jersey. She recently joined the International Neurologic Physiotherapy Association and is actively engaged with its vestibular special interest group.
When a Concussion Disrupts Your Sense of Balance
A concussion is often described as a “mild” traumatic brain injury, but for the people living with its effects, the experience can feel anything but mild. When a concussion disrupts the vestibular system—the complex network connecting the inner ear, eyes, brain, and body to help us maintain balance and spatial orientation—the result can be dizziness, motion sensitivity, visual disturbances, nausea, brain fog, and a profound sense that the world no longer feels stable.
In this episode of VeDA’s ICU Podcast, hosts Cynthia Ryan and Kimberly Warner speak with vestibular-trained physical therapist Dr. Danit Macklin and patient advocate Jess Winter about what happens when a concussion affects the vestibular system, how recovery unfolds, and why the right diagnosis and rehabilitation can make all the difference.
A Life Changed in an Instant
Jess’s vestibular journey began after a serious car accident that caused a concussion and changed the course of her health in ways she never expected. What may have initially seemed like an injury she would recover from with time became the start of a much longer and more complicated journey, as lingering dizziness, sensory sensitivity, and disorientation persisted well beyond the acute phase of recovery. That concussion ultimately became the catalyst for ongoing vestibular conditions, including vestibular migraine and persistent postural-perceptual dizziness (PPPD).
Jess describes the disorienting experience of trying to function while her brain and body no longer seemed to agree about where she was in space. Activities many people take for granted—driving, moving through busy environments, keeping up with parenting responsibilities, concentrating at work—became physically and mentally taxing.
Her story reflects something many vestibular patients know well: recovery is not always linear, and symptoms that are invisible to others can still be profoundly disabling.
Today, Jess channels that experience into supporting others, including through co-leading VeDA’s Dizzy Moms Club support group, where she helps connect people navigating similar challenges.
What Is a Vestibular Concussion?
Dr. Macklin explains that a concussion can disrupt multiple systems at once, and the vestibular system is especially vulnerable.
The vestibular system helps the brain interpret movement, orientation, and balance. It works closely with the visual system and proprioception (the body’s awareness of where it is in space). When a blow to the head occurs, these systems can become dysregulated.
That dysfunction may involve:
- The inner ear balance organs
- The nerve leading from the inner ear to the brain
- Visual-vestibular integration
- Eye movement control
- Neck and cervical contributions to dizziness
- Migraine pathways
- Autonomic nervous system regulation
Because a concussion is not simply a structural injury but also a functional one, symptoms can vary dramatically from person to person.
Dr. Macklin emphasizes that dizziness after concussion should never be dismissed as something patients simply need to “wait out,” especially when symptoms persist.
Common Symptoms of Vestibular Concussion
Vestibular concussion symptoms can look very different from the stereotypical image of concussion.
Instead of just headache or temporary confusion, patients may experience:
- Dizziness
- Vertigo
- Motion sensitivity
- Visual instability or “bouncing vision”
- Difficulty focusing
- Brain fog
- Light sensitivity
- Sound sensitivity
- Nausea
- Imbalance
- Fatigue
- Difficulty tolerating screens
- Anxiety related to symptom unpredictability
- Feeling overwhelmed in busy visual environments (stores, crowds, traffic)
One of the challenges is that these symptoms often overlap with migraine, anxiety, visual dysfunction, and cervical injury, making evaluation more nuanced.
Dr. Macklin notes that patients are sometimes told their symptoms are normal or that they simply need rest, when in reality, targeted treatment could significantly improve recovery.
Why Diagnosis may Be Delayed
Vestibular concussion is frequently overlooked.
Patients may first seek care in emergency departments, urgent care clinics, or with primary care providers to rule out life-threatening injuries. Once serious immediate concerns are excluded, lingering vestibular symptoms may not receive further attention.
Some barriers to diagnosis include:
Symptoms are invisible.
A patient may look physically fine while struggling internally with profound dizziness or disequilibrium.
Symptoms fluctuate.
A person may feel relatively functional one day and significantly impaired the next.
Symptoms overlap with other conditions.
Vestibular migraine, PPPD, anxiety, neck dysfunction, and visual processing issues can coexist.
Patients push through symptoms.
Athletes, parents, professionals, and caregivers often try to continue functioning even when they feel unwell.
Not all providers are trained in vestibular concussion.
Specialized evaluation is often needed.
This gap in awareness can leave patients feeling confused, discouraged, or even doubting their own experiences.
The Role of Vestibular Rehabilitation
One of the most hopeful parts of the discussion centers on treatment.
Vestibular rehabilitation therapy (VRT) is a specialized form of physical therapy designed to help the brain adapt, compensate, and recover from vestibular dysfunction.
Dr. Macklin explains that treatment is highly individualized because no two patients present exactly the same way.
A rehabilitation plan may include:
Gaze Stabilization Exercises
These help retrain the vestibulo-ocular reflex (VOR), which maintains stable vision during head movement.
When this system is disrupted, patients may feel the environment jump, blur, or lag as they move.
Balance Retraining
Exercises help restore confidence and function in standing, walking, turning, and navigating uneven surfaces.
Habituation
For motion-sensitive patients, carefully graded exposure to triggering movements can help reduce symptom intensity over time.
Visual-Vestibular Integration
Therapy may address difficulty processing movement and visual input together.
This is particularly important for patients who struggle in busy environments, such as grocery stores, or while scrolling on screens.
Cervical Treatment
Because neck dysfunction can contribute to dizziness after concussion, treatment may also address musculoskeletal contributors.
Activity Progression
Patients are guided back toward normal activity in a structured way, rather than simply being told to avoid movement indefinitely.
Dr. Macklin stresses that recovery often requires finding the right level of challenge—not too little, but not overwhelming the system either.
Recovery Isn’t Always Linear
A powerful message from both guests is that setbacks do not mean failure.
Jess describes how frustrating symptom flares can be, especially when patients believe they should already be “better.”
Dr. Macklin reinforces that healing rarely follows a straight line.
Recovery may include:
- Good days followed by difficult days
- New symptoms emerging as activity increases
- Emotional distress related to uncertainty
- Progress that feels slow but is still meaningful
For patients used to pushing through discomfort, learning to pace activity can be especially difficult.
The goal is not to avoid all symptoms, but to work within an appropriate therapeutic window that supports healing.
How Long Does Recovery Take?
One of the most common questions after a concussion is: How long will this last?
The answer depends on many factors, including:
- Severity and mechanism of injury
- Pre-existing migraine history
- Previous concussions
- Neck involvement
- Anxiety or autonomic dysfunction
- Speed of appropriate intervention
- Presence of overlapping conditions like PPPD
Some patients recover in weeks.
Others may need months.
Those with layered diagnoses may require longer, more multidisciplinary care.
Importantly, prolonged symptoms do not mean recovery is impossible.
The conversation emphasizes that many patients improve significantly with the right diagnosis and targeted treatment.
The Emotional Impact of Vestibular Concussion
Beyond physical symptoms, vestibular concussion can profoundly affect emotional well-being.
- Patients may grieve lost independence.
- They may feel isolated when others do not understand what dizziness actually feels like.
- Parents may worry about caring for children while symptomatic.
- Professionals may struggle to return to work.
- Patients may become anxious about driving, exercise, travel, or simply leaving home.
Jess’s perspective adds an essential reminder: healing is not only physical. Being believed, supported, and connected to others with similar experiences can make a meaningful difference. This is one reason peer support matters so much.
Hope for Recovery
The overarching message of this episode is hopeful.
Vestibular concussion can be complex, disruptive, and frightening—but it is treatable.
The sooner patients receive appropriate evaluation, the better positioned they are for recovery.
Dr. Macklin encourages patients not to accept persistent dizziness as something they simply have to live with after a concussion.
Jess’s story reminds listeners that even when recovery takes unexpected turns, progress is still possible.
If you or someone you love is struggling with dizziness, imbalance, or visual motion sensitivity after a concussion, know that specialized help exists—and that recovery may begin with recognizing that the vestibular system could be part of the story.
Additional Resources
- VeDA’s article on vestibular concussion
- Dr. Danit Macklin explains vestibular concussion (video)
- Dr. Danit Macklin – Tips for Recovery from a Vestibular Concussion (video)
- Vestibular Concussion Recovery – Lessons Learned from a Patient (video)
- Recovering from a vestibular concussion: What to expect – A Patient Perspective (video)
