**5.10 Dix-Hallpike maneuver**

The Dix-Hallpike Maneuver evaluate the presence of Benign Paroxysmal Positional Vertigo (BPPV). It is important first to evaluate if no concern related


#### **Figure 9.**

*Dizziness handicap inventory (DHI).*

to cervical spine is present, before the administration. It is also termed the "headhanging positioning maneuver" [35].

During the maneuver, the individual is positioned seated and the head is turned 45o toward the tested side. The individual is moved (lying down) into the supine position with the head extending (**Figure 10**). The patient's head is held in this position and the clinician verify the eyes to detect or not the presence of nystagmus. To complete the maneuver, the patient is returned to the seated position and they eyes are observed to detect presence of reversal nystagmus [35, 36].

## **6. Treatment**

Vestibular Rehabilitation Therapy (VRT) is an exercise-based treatment program created to promote vestibular adaptation and substitution [37].

The objectives are: (1) to enhance gaze stability, (2) to enhance postural stability, (3) to improve vertigo, and (4) to improve activities of daily living. After SRC, different vestibular rehabilitation techniques may be used based on the symptoms and impairments present. Vestibular rehabilitation may help reduce dizziness and improve balance after SRC [38]. Studies combining individualized vestibular therapeutic rehabilitation techniques to an established physical therapy program has been seen to benefit individuals returning to play by decreasing recovery times and strengthening athlete's compensatory strategies to prevent reinjury [37–39]. Current evidence for optimal prescription and efficacy of VRT in patients with concussion is limited. Available evidence, although weak, shows promise in this population [37–40].

### **7. Conclusion**

Poor balance has been associated with increased injury risk among athletes. The literature shows that over 6,000 athletes experienced a sport-related injury and

#### *Concussion and Balance in Sports DOI: http://dx.doi.org/10.5772/intechopen.97024*

over 25% of these injuries result in a loss of more than seven days of participation. Consequently, it is urgent to recognize instruments that prevent injuries and could improve balance.

A combination of tools for assessment, as: physical evaluation combined with other tests/exams/inventories provide a better comprehension for vestibular disorders in sport concussions. It is important to understand that the questionnaires and outcomes may have clinical utility in the evaluation of vestibular pathologies post-SRC but should not be used as a distinguishing point for vestibular diagnosis alone.

Knowledge of a patient's diagnosis is a critical foundation for planning comprehensive treatment programs with the goal to reduce impairment and symptoms and expedite the return to daily activities, sports, or work. Although vestibular rehabilitative therapy is beneficial among most populations post-concussion, further research should be conducted using individualized treatment protocol. Limitations of this review include the lack of available randomized controlled trials or crosssectional studies; therefore, further research is determining the effectiveness of vestibular rehabilitative therapy is warranted. Additionally, normative data based on athletes should be included.
