Effect of Vestibular Rehabilitation on Gait, Balance, and Coordination in Post Concussion Combat Athletes

This randomized controlled trial aims to evaluate the effectiveness of vestibular rehabilitation in improving gait and balance among post-concussion combat athletes aged 18-25 years. Eligible participants diagnosed with mild traumatic brain injury and persistent post-concussion symptoms will be randomly assigned to either a vestibular rehabilitation group or a control group receiving conventional rehabilitation. Gait performance, balance, post-concussion symptom severity, and concussion severity will be assessed using the Timed Tandem Gait (TTG) Test, Balance Error Scoring System (BESS), Sport Concussion Office Assessment Tool 6 (SCOAT6), and Cantu Concussion Grading Scale. Outcome measures will be evaluated at baseline and after the 8-week intervention to determine the effectiveness of vestibular rehabilitation in enhancing functional recovery following concussion.

Study Overview

• Status: Not yet recruiting
• Conditions: Concussion; Concussion Post Syndrome
• Intervention / Treatment: Other: Vestibular Rehabilitation Program; Other: Conventional Post-Concussion Rehabilitation

Detailed Description

This randomized controlled trial aims to investigate the effect of vestibular rehabilitation on gait and balance in post-concussion combat athletes. Combat sport athletes, including those participating in boxing, mixed martial arts (MMA), taekwondo, judo, and similar disciplines, are at a heightened risk of sustaining concussions due to repetitive head impacts, rapid directional changes, and falls inherent to their sports. Although most athletes recover within a few weeks, a substantial proportion continue to experience persistent vestibular symptoms such as dizziness, postural instability, impaired gait, and balance deficits, which may adversely affect athletic performance, delay return to sport, and increase the risk of recurrent injury.

Despite growing evidence supporting vestibular rehabilitation in the general post-concussion population, there remains a paucity of sport-specific research focusing on combat athletes, whose functional demands and rehabilitation requirements differ considerably from those of non-athletic populations.

This study will recruit combat athletes aged 18-25 years with at least two years of training experience who have been diagnosed with mild traumatic brain injury within the previous six months and continue to exhibit post-concussion symptoms affecting gait and balance. Eligible participants who have been medically cleared by a physician or neurologist will undergo baseline assessments using the Cantu Concussion Grading Scale and the Sport Concussion Office Assessment Tool 6 (SCOAT6), followed by standardized evaluations of gait and balance.

Participants will then be randomly allocated to either the vestibular rehabilitation group or the control group. The intervention group will receive a structured vestibular rehabilitation program designed to improve vestibulo-ocular function, gaze stabilization, postural control, and balance, while the control group will receive conventional rehabilitation. Outcome measures will be reassessed at Week 8 using the same standardized assessment procedures to determine the effectiveness of the intervention.

It is hypothesized that vestibular rehabilitation will result in significant improvements in gait performance, balance, and post-concussion symptom severity among post-concussion combat athletes.

The findings of this study are expected to provide evidence for the development of targeted, sport-specific rehabilitation protocols, facilitate safer and more efficient return-to-play decisions, reduce the risk of recurrent injury, and contribute to the advancement of concussion management strategies in sports physiotherapy and neurorehabilitation.

• Study Type: Interventional
• Enrollment (Estimated): 44
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Zobia Naseem, Phd; Phone Number: 03321963584; Email: zobia.naeem@riphah.edu.pk
• Study Contact Backup: Name: Imran Amjad, Phd; Phone Number: 03324390125; Email: mailto:imran.amjad@riphah.edu.pk

Study Locations

• Pakistan
  • Kpk
    • Peshawar, Kpk, Pakistan, 25000
      • Peshawar Sports Complex
      • Contact: Zobia Naseem, Ms SPT; Phone Number: 03321963584; Email: zobia.naeem@riphah.edu.pk
      • Sub-Investigator: Nigah e Zahra Syed, MS SPT*

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Participants falling in this category would be recruited into the study.
• Age 18-30 years.
• Combat sport athletes (e.g, boxing, MMA, karate) with at least 2 years of training experience.
• Experiencing post-concussion symptoms affecting gait, balance, or coordination
• Willing and able to provide informed consent

Exclusion Criteria:

• Participants fall in this category would be excluded of the study.
• History of moderate to severe TBI or repeated concussions (>3 cantu scale)
• Preexisting vestibular or neurological disorders unrelated to concussion (e.g., Meniere's disease, multiple sclerosis).
• Current musculoskeletal injuries affecting gait or balance.
• Visual or auditory impairments that interfere with assessments.
• Use of medications that influence balance or coordination (e.g., sedatives, muscle relaxants).
• Unwillingness or inability to participate in the full duration of the rehabilitation protocol.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Vestibular Rehabilitation Group; Participants assigned to this group will receive a structured vestibular rehabilitation program for 8 weeks designed to improve post-concussion vestibular dysfunction. The program includes vestibulo-ocular reflex (VOR) exercises, gaze stabilization exercises, habituation exercises, balance retraining, postural control exercises, and gait training delivered under the supervision of a physiotherapist in accordance with the study protocol.	Other: Vestibular Rehabilitation Program; Participants will receive a structured vestibular rehabilitation program consisting of vestibulo-ocular reflex (VOR) exercises, gaze stabilization exercises, habituation exercises, balance retraining, postural control exercises, and gait training. The intervention will be supervised by a physiotherapist and delivered over 8 weeks according to the study protocol.
Active Comparator: Conventional Rehabilitation Group; Participants assigned to this group will receive conventional post-concussion rehabilitation for 8 weeks, consisting of standard clinical management, education regarding symptom management, symptom-limited activity, graded aerobic exercise, strengthening and conditioning exercises, sport-specific training, and a staged return-to-play progression. Targeted vestibular rehabilitation exercises will not be provided.	Other: Conventional Post-Concussion Rehabilitation; Participants will receive conventional post-concussion rehabilitation consisting of education regarding symptom management, symptom-limited activity, graded aerobic exercise, strengthening and conditioning exercises, sport-specific training, and a staged return-to-play progression over 8 weeks. Targeted vestibular rehabilitation exercises will not be included.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Gait Performance Assessed Using the Timed Tandem Gait (TTG) Test	Change in gait performance measured by the Timed Tandem Gait (TTG) Test. The outcome will be reported as the average time (seconds) required to complete the test. Lower completion time indicates better gait performance.	Baseline (Week 0) and Week 8 (post-intervention)
Balance Performance Assessed Using the Balance Error Scoring System (BESS)	Change in balance performance measured using the Balance Error Scoring System (BESS). The outcome will be reported as the total number of balance errors during standardized balance tasks. Lower scores indicate better balance performance.	Baseline (Week 0) and Week 8 (post-intervention)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Post-Concussion Symptom Severity Assessed Using the Sport Concussion Office Assessment Tool 6 (SCOAT6) Symptom Scale	Change in post-concussion symptom severity measured using the symptom scale component of the Sport Concussion Office Assessment Tool 6 (SCOAT6). The symptom scale includes 22 symptoms, each rated from 0 (none) to 6 (severe), resulting in a total score ranging from 0 to 132. Higher scores indicate greater post-concussion symptom severity.	Baseline (Week 0) and Week 8 (post-intervention)
Concussion Severity Classification Assessed Using the Cantu Concussion Grading Scale	Concussion severity will be assessed using the Cantu Concussion Grading Scale, which classifies concussion into Grade 1 (mild), Grade 2 (moderate), and Grade 3 (severe). The scale ranges from Grade 1 to Grade 3, with higher grades indicating greater concussion severity. Participants will be assessed at baseline for study characterization and eligibility.	Baseline (Week 0)

Collaborators and Investigators

• Sponsor: Riphah International University
• Investigators: Study Chair: Zobia Naseem, PhD, Riphah International University

Study record dates

Study Major Dates

• Study Start (Estimated): July 1, 2026
• Primary Completion (Estimated): August 30, 2026
• Study Completion (Estimated): May 30, 2027

Study Registration Dates

• First Submitted: June 17, 2026
• First Submitted That Met QC Criteria: July 16, 2026
• First Posted (Actual): July 21, 2026

Study Record Updates

• Last Update Posted (Actual): July 21, 2026
• Last Update Submitted That Met QC Criteria: July 16, 2026
• Last Verified: July 1, 2026

More Information

Terms related to this study

• Keywords: Balance; Vestibular Rehabilitation; Post-Concussion Syndrome; Combat Athletes; Sports-Related Concussion; SCOAT6
• Additional Relevant MeSH Terms: Brain Injuries, Traumatic; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Wounds and Injuries; Craniocerebral Trauma; Trauma, Nervous System; Head Injuries, Closed; Wounds, Nonpenetrating; Brain Injuries; Brain Concussion; Post-Concussion Syndrome
• Other Study ID Numbers: Nigah e Zahra Syed

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No