Tag Archives: therapy

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.

The New Normal

Heidi Qua & her sons

Heidi Qua & her sons

Today’s blog is written by Heidi Qua, mother of Jacob and Eric. Her son Jacob suffered a traumatic brain injury, in 2004 when he fell from a third-story window. To read her entire story, click here.

A few days after Suspect Number Two from the Boston marathon bombings had been apprehended, I was speaking to a friend who lives in Virginia. “So, are things returning to normal now that the suspect has been caught?”  I laughed.  Normal? Things will never be normal again. We are entering a chapter of a “new normal.”

New normal is a phrase I used frequently when my then almost three-year-old son was discharged from the rehabilitation hospital, Franciscan Hospital for Children. In September of 2004 Jacob fell from a third floor screened window to the concrete courtyard below. He spent 19 days in NICU, 17 of which he was on a ventilator. Then we were moved to rehab where he, we, stayed for three more months.

When we were discharged, four days before Christmas, people assumed that we would be going back to our “old life.” They didn’t seem to understand that we couldn’t go back to our old life. My husband and I were trying to figure out our new life, our new normal. Rather than working full time, I was now shuttling my youngest child back and forth to therapies, and welcoming other therapists into our home.  I had to explain to my oldest son, Eric, who all these people were, and why his brother needed all this additional attention. We were trying to keep things normal for Eric, but even his life was forever impacted too.

As Jacob grew older, my new normal included monthly visits with different doctors – neurologist, physiatrist, or primary care doctor. The therapies continued, several times a week.  This is not what I call “normal.” As a young woman, when I thought about becoming a mother, I never thought “what pattern should we choose for my son’s AFOs (ankle-foot orthosis)?  Where can I buy shoes big enough to fit his AFOs?”  In fact, before Jacob’s accident, the world of rehab, therapies and AFOs was a world I had never given a second thought.

As much as I lamented my new normal, I realized I only had one option, and that was to accept it.  I actually started to appreciate our new life. Nothing was going to make Jacob “normal” again, and I was beginning to be OK with that. I fell in love with his funny little walk, or the way he throws a ball. Even now, at age 11, all I have to do is hear his walk and I know it is him. I realized quite quickly, back when he was in rehab, that Jacob is a hard worker. He never once complained about all the therapy he went through. To this day he is the hardest working guy I know. This past weekend he hiked over seven miles with a backpack on, carrying his camping gear. He fell down, 10 times to be exact, but got back up each time and kept going.

As we approach the nine-year anniversary of Jacob’s accident, I can honestly say I am content with my family’s new normal. I would be lying if I said I wish the accident never happened – no parent wants their child to suffer any injury, let alone a traumatic brain injury. That said, we have found victories in the small things, in the quietest of places, and we have learned to celebrate each moment with all three of our children, as we take this journey together.

Yoga & Brain Injury: Tips for Beginners

From art and painting to yoga and meditation, there are a number of alternative therapies brain injury survivors find helpful. Yoga has therapeutic benefits and it’s a great form of light exercise for those who may not want to hit the gym for weights or cardio. Many brain injury survivors find yoga is most of all, a great form of relaxation, which can be a wonderful way to start or end the day. Additionally, yoga can help you to increase your flexibility, strength, self-confidence and self-esteem. Thinking about starting yoga? Consider these tips first.

1. Talk to your doctor. Before starting any new kind of exercise regimen, you should always have a conversation with your doctor. Additionally, if you have specific needs, your doctor may be able to recommend a yoga instructor or program to you that could work with your hospital or other brain injury survivors.

2. Get the right gear. If you’ve been cleared by your doctor to start yoga, make sure you get the right gear. Yoga clothes, which don’t need to be by a specific brand – they can even be comfortable sweats, a yoga mat and water bottle are all necessities. Also, get a pair of yoga socks or go barefoot for yoga.

3. Take a beginner class. Start with the basics! Learn the basic moves and master those first, before moving on to anything intermediate. Your local yoga store, such as Lululemon which offers free classes on weekends, may offer classes right in the store!

4. If you’re concerned about anything, speak with your yoga instructor. Let him or her know your concerns and ask for feedback if needed.

5. Be open to it. Many people are fearful of looking “silly” or not knowing what they’re doing. Don’t worry about how you look and focus on the moves, breathing and enjoying this new activity. Remember,  anything new takes practice. The instructor is there to help you, too.

6. Don’t do anything you aren’t comfortable with. Poses range from the most basic to the challenging and extreme. Do what you’re ready for and don’t push yourself. Stay at your own pace.

7. Warm up before every session. Basic stretching for as little as 10 or 15 minutes will help warm up muscles.

8. If practicing yoga at home, make sure you do so in a quiet, clutter-free area where it’s easy for you to focus.

Looking to get into yoga or other alternative therapies, but don’t know where to start? Attend the 32nd Annual Brain Injury Conference on March 28th at the Best Western Royal Plaza Hotel in Marlborough, Mass. where there will be workshops on alternative therapies including yoga and art! Click here to register.