Vestibular Rehabilitation for Post-Concussive Vestibular Dysfunction: Pathophysiology, Evidence-Based Practice, and Future Perspectives.

Mild traumatic brain injury (mTBI) is often referred to as a major public health concern due to its high incidence and frequently overlooked long-term sequelae. A critical factor hindering functional recovery and return to daily activities is post-concussive vestibular dysfunction. To optimize rehabilitation outcomes, an early, mechanism-based integrated assessment is essential. Such an approach moves beyond simple symptom relief, focusing instead on identifying specific dysfunctions and underlying pathophysiology to target treatment accurately. Post-concussive vestibular dysfunction is rarely a single-lesion issue; it emerges from complex interactions between the peripheral vestibular system, the central nervous system, and the cervical spine, often exacerbated by impaired sensory reweighting. This review provides updated insights into precise diagnosis and evidence-based, individualized vestibular rehabilitation therapy (VRT). Specifically, it addresses the differential diagnosis of cervicogenic dizziness and structural peripheral lesions, while also discussing persistent postural-perceptual dizziness, which often requires multimodal therapeutic approaches beyond standard VRT alone. The review also explores how advanced technologies, including virtual reality and wearable sensors, are paving the way for digital therapeutics and artificial intelligence-driven precision rehabilitation, potentially expanding access to remote and individualized care for patients with mTBI.