The purpose of this pilot study is to:

1. Determine the feasibility of adherence to completing the home cervico-vestibular exercise program following concussion.
2. Investigate the acceptability of the cervico-vestibular home exercise program.
3. Investigate the impact of the cervico-vestibular home exercise program on symptom reduction, return to play, and return to learn
4. Analyze the timing at which a home exercise program is typically prescribed.

Participants will be asked to do and keep track of exercises made to help in their concussion recovery over a two-week period. Participants will come back to see their doctor and complete surveys about how easy the exercises were to do and if they liked them.

This will be a prospective clinical trial of the acceptability and feasibility of HEP prescription following a concussion in the pediatric population.

Patients who consent to participate in this study will be given an informational handout by clinical athletic trainers that provides information about the study, the exercises in their exercise program, and a detailed progression to higher HEP levels/intensities based on their symptoms. The handout will also provide the purpose of the program, definitions of unfamiliar terms, a planning section for frequency and success, how to monitor symptoms through program completion, and how to properly access their exercises, log their completion, and track their progression in the Medbridge Go app.

The exercises that will make up the HEP will consist of: aerobic activity; horizontal saccades; vertical saccades; horizontal imaginary targets; vertical imaginary targets; pencil push-ups; Vestibulo-Ocular Reflex (VOR)x1 Horizontal; VORx1 Vertical; Horizontal VOR Cancellation; and Vertical VOR Cancellation.

At the initial visit, participants will also receive an exercise log in which they can mark their progression in the different HEP levels/intensities each day until their follow-up visit, their symptoms before and after completing the exercises, if the exercises worsen their symptoms, and if they were able to complete their daily exercises. Patients will also be administered the Concussion Learning Assessment and School Survey (CLASS) if they are seen in clinic during the school year.

Approximately 1-week after the patients' initial clinic visit, a member of the study team will contact the patient and their family via phone call, email or text messaging and ask questions about the patients' status in the HEP protocol, their adherence to the protocol, and if they have had any difficulties in performing and/or logging the exercises on their paper/virtual exercise log. If the patient remarks on any difficulties in performing and/or logging the exercises, a member of the study team will inform the clinical treatment staff and they will reach out to the patient and/or family to instruct them on completing the program again.

At the follow-up visit, patients and their caregiver(s) will be provided with a survey by a member of the study team. This survey will consist of post-intervention questions that ask about the acceptability of the HEP, with questions such as their ability and access to time to perform the exercises, their ability to progress to higher levels/intensities, if they continued the HEP as their symptoms began to improve, and if they believe the HEP helped in their recovery from concussion. Outcomes such as CLASS, time to symptom resolution, return to play and return to learn will also be collected.

OPTIONAL: Patients will be contacted by a member of the study team via phone call, e-mail or text messaging approximately 1 month after their initial clinic visit. The purpose of contacting the patient at this time point will be to ask if the patient has returned to play or returned to learn, as well as if they continued to perform their home program exercises after their follow-up visit. Patients will be contacted approximately 1-month post-clinic visit only if they are not cleared to return to play and/or learn at their follow-up visit.

Inclusion Criteria:

1. Patients <18 years old
2. Presenting to clinic ≤1 month after injury
3. Diagnosed with a concussion at their clinic visit
4. Have a total symptom score of 3 or more on the PCSI
5. Visual acuity/hearing adequate for testing
6. Parent/patient must be fluent in English
7. Ability to provide assent, Legally Appointed Representative available to provide informed consent

Exclusion Criteria:

1. Patients ≥18 years old
2. Moderate and severe TBI
3. History of seizures
4. History of >3 prior concussions
5. History of chronic headaches/migraines
6. Presenting to clinic >1 month after injury

Individual participant data (IPD) will be shared following publication of the primary study results. Requests for data access can be submitted to Anna Wilhelmy, Bobby Van Pelt or Dr. Angela Shierk starting 6 months after publication, and data will be available for a period of 24 months. De-identified participant data and data dictionaries will be shared. Access will be granted to researchers with appropriate IRB/ethics approval.

IPD will be available starting 6 months after publication, and data will be available for a period of 24 months.

Bobby Van Pelt and Anna Wilhelmy, the study coordinators, and Dr. Angela Shierk, the Co-Investigator, will be able to access and share the IPD, which will be de-identified participant data and data dictionaries. Access will be granted to these researchers, as they have the appropriate IRB/ethics approval.