Multidomain rehabilitation for persistent concussion symptoms after falls in older adults: A case based review

BACKGROUND: Concussions are increasingly common in older adults, with falls as the leading mechanism of injury. Older adults often experience prolonged recovery, and lingering post-concussive symptoms, perpetuating the cycle of elevated fall risk with significant public health implications. This highlights the need for age-specific concussion care incorporating multidomain assessment and individualized treatment. AIM: This retrospective case series explores the effect of a structured, stepwise evaluation and treatment framework on post-concussive symptoms in older adults. METHODS: Five females over 60 years old with post-concussive symptoms completed the targeted concussion protocol as part of a larger prospective study. The protocol included modules addressing key rehabilitation domains: aerobic exercise to support autonomic regulation, brain-body integration exercises to improve motor control, and progressive visual-vestibular rehabilitation incorporating oculomotor training, postural stability challenges, and dual-tasking. Objective measures included the Post-Concussion Symptom Scale, Brain Injury Vision Symptom Survey (BIVSS), Dizziness Handicap Inventory, King Devick, a binocular vision screening tool, and an enhanced version of the Vestibulo-Oculomotor Screen (VOMS). RESULTS: All patients demonstrated reduced symptom burden and functional improvements. Vestibular-oculomotor and motor control gains included a 53.9% average improvement in BIVSS scores, a mean 10-s reduction in King Devick time, and a 19.05-cm improvement in binocular vision measured via Brock String. Three patients normalized ocular alignment and near point convergence, while all showed improved Super Saccades performance. CONCLUSIONS: Participation in a multimodal protocol shows potential in reducing post-concussive impairments and symptoms in older adults. Larger studies are needed to establish effectiveness and feasibility in this population.