After a concussion, many people struggle to describe how they feel.
They’re not always in pain.
They’re not always dizzy.
They’re not always confused.
But they often feel… “off”.
Discombobulated.
Out of sync.
Not quite themselves.
This “discombobulated state” is one of the most common—but least clearly defined—experiences following concussion. And it may actually hold the key to understanding why most people recover quickly, while a smaller proportion go on to develop persistent symptoms.
What Do We Mean by “Discombobulated”?
In the days following a concussion, symptoms like dizziness, headache, visual strain, neck discomfort, fatigue, and mental fog often appear together. Traditionally, these have been treated as separate problems.
But clinically, they rarely occur in isolation.
Instead, what we often see is a temporary state of neural desynchronisation—a mismatch between systems that normally work seamlessly together:
- Brain processing speed slows
- Visual and vestibular signals no longer align smoothly
- Eye movement control becomes less precise
- Neck proprioception is altered
- Postural strategies change
- Fatigue sets in earlier
- Sleep is disrupted
- Anxiety rises
- As clinicians, it is the discombobulated state that may be a major contributor to symptom provocation with the Vestibular Ocular Motor Screening (VOMS).
Individually, these changes may be subtle. Together, they create a powerful sense of instability and unreliability.
That’s the discombobulated state.
For some people this feeling is genuinely frightening, especially if the mind is left to flounder and worry without advice and reassurance from a health professional.
A Brain That’s Temporarily Out of Sync
The brain is not a single processor—it’s a distributed network of interacting systems. After concussion, many of these networks appear to fall temporarily out of phase.
This includes:
- Processing Speed Delays
The brain’s ability to integrate information slows. Tasks that once felt automatic now require effort. This can feel like fogginess, slowness, or mental fatigue.
- Visual–Vestibular–Cervical Mismatches
The visual system, inner ear, and neck proprioceptors normally provide tightly integrated and predictable information about where you are in space. After concussion, these signals can become misaligned, leading to:
- Dizziness
- Motion sensitivity
- Visual discomfort
- Disorientation
- Poor spatial confidence
- Oculomotor Dysfunctions
Eye movements—saccades, smooth pursuit, vergence—can lose precision and timing. This can contribute to:
- Headaches
- Visual fatigue
- More dizziness!
- Reading difficulties
- Concentration problems
- A sense that the world feels “wrong”
- Altered Cervical Muscle Control
Concussion (a rapid head acceleration event) frequently co-occurs with neck injury. Changes in cervical muscle activation, joint position sense, and reflexes can amplify dizziness, headaches, and postural instability.
- Postural and Movement Compensations
When the brain feels unreliable, the body compensates. People become stiff, cautious, guarded. This increases energy expenditure and fatigue.
- The Overlay of Anxiety and Poor Sleep
Uncertainty about symptoms, fear of worsening (every week there are headlines about head impacts and neurodegenerative diseases), disrupted routines, and neurochemical changes all increase vulnerability to anxiety and sleep disturbance—both of which further destabilise brain networks.
A Temporary State, Not a Permanent Injury
For most people, this state is transient.
It can last:
- Hours
- Days
- Sometimes weeks
During this time, the brain appears to be managing what some researchers describe as a temporary neurobiological energy crisis—a period where metabolic demand exceeds supply. It also a period to avoid another head impact!
When this energy mismatch is paired with a neck injury, sensory conflict increases further.
But crucially:
This does not necessarily represent ‘permanent brain injury’.
It is a state, not a trait.
Why This Distinction Matters
Up to 70% of people recover from concussion within a few weeks.
But around 30% develop persistent symptoms.
Here’s where we need to be careful.
If we fail to differentiate between:
- A temporary discombobulated state, and
- Additional traits, vulnerabilities, or co-existing injuries
…we risk treating everyone as though they have a moderate brain injury.
In reality, persistent symptoms are often influenced by:
- Pre-existing migraine or headache disorders
- Anxiety or depression
- Vestibular vulnerabilities
- Cervical injury
- Sleep disorders
- Autonomic dysregulation
- Visual or oculomotor inefficiencies
- Pain sensitisation
- Fear-avoidance behaviours and deconditioning
These factors may prolong the discombobulated state—or prevent it from resolving.
A Call for Better Research
At Your Brain Health we will support researchers that:
- Define this state more precisely
What does “out of sync” actually look like at a systems level? Can we catch it in the act? - Separates state from trait
What is transient vs pre-existing vs secondary? More targeted baseline screens will help provide data for this – from young athletes to elderly fallers. - Identify recovery signatures with digital tracking.
What changes as people improve? And at what rate? - Build better clinical profiling tools
So we can target the right systems at the right time.
The Future: From Labels to Networks
Rather than thinking in terms of single symptoms—dizziness, headache, fatigue—we should be thinking in terms of network stability.
Concussion disrupts timing, coordination, and integration. That’s why we promote early cervico-vestibular, visual and physical rehabilitation to force the brain to adapt to this discombobulated state.
Recovery is not just about rest.
It’s about re-synchronisation.
Associate Professor James McLoughlin
Associate Professor James McLoughlin is Chief Academic Officer at Your Brain Health and Director of Advanced Neuro Rehab.