Wearable Technology: An Objective Tool for Monitoring Concussion Recovery and Guiding Return-to-Activity

As clinicians, we're constantly seeking objective measures to guide our decision-making and provide the best possible care for our patients. This is especially true in the realm of concussion recovery, where subjective symptom reporting can be unreliable and variable. We've all had those patients who say they feel fine, but our clinical intuition tells us something is still amiss. This is where wearable technology is emerging as a powerful ally, offering us a window into our patients' physiological state and daily activities that we've never had before. Recent research is shedding light on how we can leverage consumer-grade wearables—the same devices our patients might already be using to track their steps or sleep—to monitor concussion recovery and guide return-to-activity protocols. A 2025 pilot study published in the *Journal of Head Trauma Rehabilitation* provides some compelling insights. Researchers followed a cohort of adolescent athletes who had sustained a sport-related concussion (SRC) and compared them to a group with musculoskeletal (MSK) injuries. Both groups were given a Fitbit Sense to wear for up to six weeks post-injury. The results were fascinating. The SRC group showed significantly more light sleep and more time awake during the night in the first four weeks after their injury compared to their MSK peers. They also had lower daily step counts. This suggests that even when our patients report feeling better, their bodies may still be in a state of physiological disruption. What's particularly interesting is that these wearable-derived metrics correlated with symptom burden. In the SRC group, more time awake at night and a lower resting heart rate were associated with higher cognitive symptom scores. This gives us a tangible, objective measure that can complement our clinical assessments and help us identify patients who might need more support or a slower return-to-activity progression. The study also found that emotional symptoms were modestly associated with step counts, which makes sense. When we're not feeling our best emotionally, we tend to be less active. Another exciting area of research is the use of wearable sensors to provide real-time biofeedback during vestibular rehabilitation. A 2026 study protocol for a randomized controlled trial outlines a plan to use inertial sensors—specifically, instrumented socks and a lumbar-mounted sensor—to provide biofeedback on head and trunk movement and postural sway during VRT exercises. The idea is to help patients with persistent vestibular and ocular-motor (V/O) symptoms after mTBI improve their exercise performance and, ultimately, their outcomes. This is a game-changer because it allows us to move beyond simply prescribing exercises and hoping for the best. We can now provide our patients with real-time, data-driven feedback to help them perform the exercises correctly and get the most benefit from their rehabilitation program. The study also aims to collect data on daily mobility for seven days in an unsupervised setting. This will give us a much more realistic picture of how our patients are functioning in their everyday lives, not just in the controlled environment of the clinic. By establishing normative data for daily living mobility, we can better assess our patients' readiness to return to their daily activities, including work, school, and sports. So, how can we start to incorporate these findings into our clinical practice? First, we can encourage our patients with concussions to use wearable devices to track their sleep and activity levels. This can provide us with valuable data to monitor their recovery and identify any red flags. For example, if a patient's sleep patterns are consistently disrupted or their activity levels are significantly lower than their baseline, it might be a sign that they need a more gradual return-to-activity plan. We can also use this data to have more informed conversations with our patients about their recovery and to help them understand the importance of rest and a gradual return to activity. Second, we can start to explore the use of biofeedback in our vestibular rehabilitation programs. While the technology used in the study protocol may not be widely available yet, there are other biofeedback tools that we can use to help our patients improve their exercise performance. For example, we can use a simple metronome to help patients control the speed of their head movements during gaze stability exercises. We can also use a mirror to provide visual feedback on their posture and alignment. Of course, it's important to remember that wearable technology is just one piece of the puzzle. It's not a replacement for our clinical judgment or a comprehensive clinical assessment. But it is a powerful tool that can provide us with objective data to supplement our clinical findings and help us make more informed decisions about our patients' care. As the technology continues to evolve and more research is conducted, we can expect to see even more innovative ways to use wearable devices to improve concussion recovery and help our patients get back to doing the things they love, safely and effectively.