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J Manipulative Physiol Ther. 2019 Jul;42(6):399-406. doi: 10.1016/j.jmpt.2018.12.002. Epub 2019 Jul 27.

Retrospective Review: Effectiveness of Cervical Proprioception Retraining for Dizziness After Mild Traumatic Brain Injury in a Military Population With Abnormal Cervical Proprioception.

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Brooke Army Medical Center, Fort Sam Houston, Texas. Electronic address:
South Texas Veterans Health Care System, Audie L. Murphy VA Hospital, San Antonio, Texas.
Department of Defense Hearing Center of Excellence, JBSA Lackland, San Antonio, Texas.
CCRE Spine, Division of Physiotherapy, SHRS, University of Queensland, Queensland, Australia.



This study aimed to assess the outcomes of 2 treatments for patients with dizziness after mild traumatic brain injury (mTBI) who demonstrate abnormal cervical spine proprioception (CSP).


A retrospective records review was conducted on the medical charts of patients treated for dizziness after mTBI who received either standard care (vestibular rehabilitation therapy [VRT]) or cervical spine proprioceptive retraining (CSPR) from 2009 to 2013. All patients included in the analysis were active-duty military with recurring dizziness after mTBI who had at least 1 abnormal CSP test. Patients were excluded for dizziness with a clear peripheral vestibular or central symptom origin, incomplete data, or no CSP assessment, or if both treatments were administered. Forty-eight total patients were included in the final dataset (22 VRT; 26 CSPR). Traditional VRT was compared with CSPR when abnormal CSP tests were present, regardless of the presence or absence of neck pain. A clinician review of records was used to determine improvement of dizziness based on patient reports of symptoms at discharge evaluation (ie, no symptoms for at least 2 weeks).


Patients who received CSPR were 30 times more likely to report improvement in dizziness symptoms compared with those who received VRT (adjusted odds ratio: 30.12; 95% confidence interval 4.44-204.26, P < .001) when abnormal CSP tests were present. Patients with dizziness over 1 year were significantly less likely to improve.


These results suggest that patients with dizziness after mTBI and who had abnormal CSP assessments responded better to CSPR compared with those who received VRT.


Brain Concussion; Cervicalgia; Dizziness; Kinesthesis; Neck Pain; Postural Balance; Vertigo


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