What is it with balance and vestibular issues post-brain injury?

elderly african american lady with canePortions of this blog were written with information from the Brain Injury Association of America’s document on vestibular and balance issues, with input from David Krych, MS, CCC-SLP and Ann Pereira-Ogan.

Following a brain injury of any kind, one might experience issues with balance–keeping yourself upright and walking in a straight line without tipping or drifting. Did you know that almost 40 percent of individuals with a diagnosis of traumatic brain injury (TBI) complain about balance issues? You might expect dizziness following a brain injury. These issues are referred to as “vestibular disorders.” Another vestibular disorder is vertigo, or a feeling of spinning. These disorders are commonly misdiagnosed and diagnosis following a brain injury can be challenging.

Brain injury can cause inner ear damage that can develop into vestibular dysfunction, but these issues might not show immediately following a brain injury. In fact, the symptoms of vestibular disorders can appear in days, weeks and months following an injury, which is why they are so difficult to diagnose. A neurologist or ear, nose and throat doctor can evaluate an individual for several symptoms including:

  • Visual symptoms such as trouble focusing, blurred or double vision, reacting to busy environments, sensitivity to light, discomfort when focusing on far away objects, decreased night vision and depth perception.
  • Auditory symptoms such as hearing distortion or loss, tinnitus (ringing in the ears), sensitivity to loud noises and environments and imbalance or dizziness caused by loud noises.
  • Cognitive or psychological symptoms such as difficulty concentrating, short-term memory loss, confusion, disorientation, difficulty following directions, anxiety, panic or depression.
  • Other symptoms like nausea, motion sickness, ear pain or headache, sensation of fullness/fluid in the ears, slurred speech, vertigo or spinning or the inability to complete activities at work and home.

If you go to a neurologist or ear, nose and throat specialist, you want to make sure the specialist evaluates you on the following things:

  1. Your patient history
  2. Vestibulo-Occular function
  3. Benign Paroxysmal Positional Vertigo (BPPV)
  4. Motion Sensitivity
  5. Balance
  6. Visual System
  7. Motor/sensory systems
  8. Vascular
  9. Headache
  10. Cognitive
  11. Mood Stability
  12. Current activities in home, work or school
  13. Pain issues

Your specialist will make sure you are at a lower risk of falling, as that is the leading cause of TBI. Then he or she might consider adapting your lifestyle, substituting activities in your lifestyle, and having you habituate yourself to some new things. Everyone suffers differently from vestibular issues, but there are many common adaptations that specialists recommend such as relaxation techniques like yoga or tai chi, gaze stabilization exercises, periods of rest, environmental changes and schedule adaptations. Vestibular Rehabilitation Therapy (VRT) is an exercise-based program designed to promote central nervous system compensation for inner ear issues. It can help with BPPV and reduced inner ear function. The goal of VRT is to retrain the brain to recognize and process signals from the vestibular organs in conjunction with vision and input from the muscles and joints. Sometimes symptoms of vestibular disorders get worse before they get better with the different therapies and adaptations, but it’s a process in which your body is reconnecting and retraining the parts of the brain that aren’t getting adequate signals from the vestibular systems as it did before.

You need a doctor’s evaluation if you feel any of the above symptoms or have continuing issues. We like to tell you to call our office if you are living in Massachusetts and need a list of providers in your geographic area. Our number is 800-242-0030 and you can speak with an information and resource specialist about this and many other issues. Never try to self-diagnose. Always seek the service of a medical practitioner.

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