A Diagnostic Framework for the Management of Post-Concussion Visually Induced Dizziness: Recognising Postural and Visuoperceptual Subtypes Using an Optokinetic Balance Assessment

Background/Objectives: Dizziness is highly prevalent in patients with concussion, with a significant proportion of these patients experiencing visually induced dizziness (VID) in complex visual environments. As current diagnoses rely primarily on subjective questionnaires, establishing objective diagnostic frameworks remains a challenge. This study aimed to quantify responses to optokinetic stimulation to explore potential clinical subtypes based on objective postural and subjective symptom measures. Methods: Concussed patients and healthy controls underwent optokinetic stimulation, with patients stratified into High and Low VVAS groups by the median Visual Vertigo Analogue Scale (VVAS) score. Induced postural metrics and symptoms were statistically compared and modelled to establish a framework for subtype classification of VID. Results: Patients with High VVAS exhibited significantly greater postural instability and higher symptom scores during optokinetic stimulation than healthy controls. While mean induced postural performance and dizziness in patients with Low VVAS were comparable to healthy controls, this patient cohort demonstrated increased heterogeneity in individual responses. Regression modelling successfully distinguished patients with High VVAS from healthy controls, achieving strong diagnostic accuracy for the postural (AUC = 0.815) and symptom-based (AUC = 0.958) models. Using this diagnostic framework, distinct postural and visuoperceptual subtypes were identified within the visual–vestibular mismatch cohort. Conclusions: This study provides a robust framework for post-concussive VID by combining objective postural metrics with subjective induced symptom scales. This classification identifies distinct clinical subtypes and characterises specific manifestations to facilitate tailored rehabilitation programmes. Future research should investigate whether these findings can guide targeted and individualised programmes to optimise rehabilitation.