You have completed treatment after a car accident or head injury. You have been told that you can return to normal activities, but something still does not feel right.
You may feel dizzy, unsteady, mentally foggy, sensitive to movement, or unable to keep up with conversations. According to vestibular training specialist Sheila Thelen, the missing piece may involve the body’s balance control system.
During this episode of Mind Matters: Navigating Head Injuries and Concussions, legal nurse consultant Kiley Como spoke with Sheila about vestibular dysfunction, its connection to brain injuries, and how specialized training may help some survivors regain important abilities.
What Is the Vestibular System?
Sheila is a master figure skating coach who has worked with athletes ranging from developing skaters to Olympic-level competitors. Her work studying how spinning affects the brain eventually led her into vestibular training.
The vestibular system is located inside the inner ear. It includes three semicircular canals on each side of the head and helps the brain understand movement and position.
Although it is commonly associated with balance, Sheila explained that the system also affects spatial awareness, cognitive processing, and sleep.
When the head experiences a sudden impact or violent movement, such as during a car accident, sports injury, or fall, the vestibular system may be disrupted.
A person may then experience symptoms such as:
- Dizziness or vertigo
- Poor balance
- Mental fog
- Slower processing
- Sensitivity to light, sound, or movement
- Difficulty sleeping
- Trouble navigating crowded or visually busy environments
These symptoms can interfere with nearly every part of daily life, including working, driving, exercising, and participating in conversations.
The Connection Between Concussions and Balance
After a concussion, many people instinctively try to keep their heads completely still because movement makes their symptoms worse.
However, Sheila explained that carefully controlled movement may be an important part of rehabilitation.
Her vestibular training uses slow, gentle spinning rather than rapid or aggressive movement. Sessions may begin with only a few minutes of carefully supervised activity and gradually progress based on the individual’s tolerance.
The goal is not to make someone dizzy or sick. It is to slowly challenge the vestibular system while helping the brain and body respond more effectively to movement.
Sheila stressed that the process should be calm, controlled, and adapted to the person’s symptoms.
When Recovery Does Not Follow a Clear Plan
One of the greatest frustrations for concussion survivors is the lack of a clear recovery plan.
People may be told to rest, limit screen time, avoid bright lights, sleep more, or slowly resume activity. However, they may receive little guidance about how to put those recommendations together.
Vestibular symptoms may also go unrecognized.
A person may finish physical therapy or be cleared by a physician but continue to feel clumsy, disconnected, exhausted, or mentally slow. These symptoms may affect the entire family, particularly when the survivor cannot return to work, drive safely, or tolerate normal household activity.
Sleep problems can make recovery even more difficult. Sheila said that many of the concussion patients she works with report being unable to sleep normally.
Because restorative sleep plays an important role in brain recovery, ongoing sleep disruption can contribute to a larger cycle of fatigue, cognitive problems, and emotional distress.
Regaining More Than Balance
Sheila shared the story of a client who experienced a brain bleed after a snowboarding accident.
During the months following the initial injury, he repeatedly struck his head on walls, doors, furniture, and other objects because his balance and spatial awareness were impaired.
When he began vestibular training, he could not tolerate light, sound, or motion. He could not drive and had difficulty sleeping. He also struggled to follow fast-moving conversations.
After continuing with the program, he began noticing abilities returning gradually.
He could tolerate more light and noise. His sleep improved. He performed better at work and eventually realized that he could once again participate in quick group conversations.
For him, one of the most meaningful signs of improvement was recognizing that his sense of humor had returned.
These changes were not limited to standing or walking more steadily. They affected his confidence, personality, relationships, and ability to participate in everyday life.
Why Everyday Environments Can Feel Overwhelming
People with vestibular dysfunction may struggle in environments that other people barely notice.
Patterned carpets, grocery store aisles, busy restaurants, crowded hallways, flashing lights, and constant movement can place a significant demand on the brain.
The person may feel as though the floor is moving or the room is shifting. They may become nauseated, confused, fatigued, or unable to focus.
This does not mean the person is imagining the symptoms.
Their brain may be struggling to organize the information it receives from the eyes, inner ears, body, and feet.
Sheila described vestibular training as a way of strengthening the connection between the brain and the body so that movement and sensory information can be processed more effectively.
What Should You Do If You Still Feel Off?
Anyone experiencing persistent dizziness, balance problems, confusion, or other neurological symptoms after an accident should seek medical attention.
Explain the symptoms clearly to a trusted medical professional. Do not simply say that you feel bad or different. Describe exactly what happens when you move your head, walk through a crowded space, drive, look at screens, or attempt to follow a conversation.
Ask whether vestibular dysfunction could be contributing to your symptoms and whether an evaluation by a qualified vestibular rehabilitation professional may be appropriate.
Specialized treatment should be based on the individual’s injury, abilities, and medical needs. Activities involving balance, spinning, or head movement should not be attempted without appropriate guidance when someone is experiencing significant post-concussion symptoms.
A Frequently Overlooked Part of Brain Injury Recovery
A concussion can affect much more than memory or headaches.
It can disrupt how the brain understands movement, controls balance, processes visual information, and connects with the rest of the body.
Vestibular dysfunction may help explain why some people continue to feel unsteady, mentally foggy, or disconnected even after their other injuries appear to have healed.
Recognizing those symptoms is an important first step.
For more information about Sheila Thelen and her work, visit spinyourbrain.com.
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