A Case-Oriented Approach Exploring the Relationship Between Visual and Vestibular Disturbances and Problems of Higher-Level Mobility in Persons With Traumatic Brain Injury

Abstract

Dizziness and impaired balance are common complaints after traumatic brain injury as a result of injuries to many systems. Ambient visual and vestibular system impairments are strong contributors to imbalance and dizziness, often leading to problems with spatial orientation and gaze stability during movement. The purpose of this review is to provide an overview of visual-vestibular impairments common to traumatic brain injury and summarize the contribution impairments in these systems will have on higher-level mobility. Standard visual and vestibular tests and measures are described and summarized, followed by several case presentations discussing the examination and evaluation processes and interventions chosen for visual-vestibular difficulties and their relationship to higher-level mobility.

Postural Perturbations Induced by a Moving Virtual Environment Are Reduced in Persons With Brain Injury When Gripping a Mobile Object

“…[1][2][3][4][5][6] Impairment of postural stability is particularly evident in visually crowded environments (ie, places with a large number of moving objects). 7,8 These posture-related deficits increase the risk of falling and the associated secondary trauma. 9,10 Considering that TBI survivors constitute one of the largest groups of people with disability worldwide, 11 investigations of potentially destabilizing conditions and strategies for reducing postural instability are important in the context of rehabilitation.…”

Vestibular Rehabilitation for Dizziness and Imbalance Following Concussion: A Critically Appraised Topic

“…Anywhere from 23-81% of patients report dizziness in the days following injury. [1][2][3] An initial presentation of dizziness can be a predictor of prolonged recovery from concussion, both in athletic and general populations. [4][5][6] The vestibular system's regulation of balance, spatial orientation, and gaze stability plays a key role in athletic tasks and many activities of daily living.…”

Vision Evaluation Tools for Adults With Acquired Brain Injury: A Scoping Review

“…Although several reviews have been conducted on interventions for clients with ABI with VD, few have examined assessments of this population in the rehabilitation setting. Of the 10 reviews conducted on evaluation tools for clients with stroke and TBI (Akhand et al, 2019a;Akhand et al, 2019b;Aksionoff & Falk, 1992;Hanna et al, 2017b;Hepworth et al, 2015;Hunt et al, 2016;Peterson, 2010;Pillai & Gittinger, 2017;Ventura et al, 2014;Ventura et al, 2015), none encompassed all conditions of adult ABI, most focused on one area of VD (e.g., unilateral spatial neglect [USN]). Eight reviews (Hanna et al, 2017a;Peterson, 2010) came from the fields of ophthalmology and neurology.…”

“…Of the 10 reviews conducted on evaluation tools for clients with stroke and TBI (Akhand et al, 2019a;Akhand et al, 2019b;Aksionoff & Falk, 1992;Hanna et al, 2017b;Hepworth et al, 2015;Hunt et al, 2016;Peterson, 2010;Pillai & Gittinger, 2017;Ventura et al, 2014;Ventura et al, 2015), none encompassed all conditions of adult ABI, most focused on one area of VD (e.g., unilateral spatial neglect [USN]). Eight reviews (Hanna et al, 2017a;Peterson, 2010) came from the fields of ophthalmology and neurology. Hepworth et al (2015) and Pillai and Gittinger (2017) concluded that a combination of evaluation tools may be required for a thorough evaluation of VD in stroke and TBI.…”