- Physical Therapy Management of Adults with Mild Traumatic Brain Injury. [Journal Article]
- SSSemin Speech Lang 2019; 40(1):36-47
- Rehabilitation for individuals after mild traumatic brain injury (mTBI) or concussion requires emphasis on both cognitive and physical rest, with a gradual return to activity including sports. As the…
Rehabilitation for individuals after mild traumatic brain injury (mTBI) or concussion requires emphasis on both cognitive and physical rest, with a gradual return to activity including sports. As the client becomes more active, the rehabilitation professional should pay close attention to symptoms associated with mTBI, such as headache, dizziness, nausea, and difficulty concentrating. The systematic approach to return to play provided by the Berlin Consensus Statement on Concussion in Sport can apply to adults with mTBI. This protocol calls for gradually increasing the intensity of physical activity while attending to postconcussion symptoms. During the incident that led to an mTBI, the injured individual may incur injuries to the vestibular and balance system that are best addressed by professionals with specific training in vestibular rehabilitation, most commonly physical therapists. Benign paroxysmal positional vertigo is a condition in which otoconia particles in the inner ear dislodge into the semicircular canals, resulting in severe vertigo and imbalance. This condition frequently resolves in a few sessions with a vestibular physical therapist. In conditions such as gaze instability, motion sensitivity, impaired postural control, and cervicogenic dizziness, improvement is more gradual and requires longer follow-up with a physical therapist and a home exercise program. In all of the above-stated conditions, it is essential to consider that a patient with protracted symptoms of mTBI or postconcussion syndrome will recover more slowly than others and should be monitored for symptoms throughout the intervention.
- Hearing loss in the trenches - a hidden morbidity of World War I. [Review]
- JLJ Laryngol Otol 2018; 132(11):952-955
- CONCLUSIONS: Today, one can recognise that a scant evidence base and misconceptions influenced the mismanagement of hearing loss by otolaryngologists in World War I. However, noise-induced hearing loss is still very much a feature of armed conflict.
- Vestibular Rehabilitation Therapy Improves Perceived Disability Associated With Dizziness Postconcussion. [Journal Article]
- JSJ Sport Rehabil 2019 Feb 14; :1-5
- Clinical Scenario: Every year, millions of people suffer a concussion. A significant portion of these people experience symptoms lasting longer than 10 days and are diagnosed with postconcussion synd…
Clinical Scenario: Every year, millions of people suffer a concussion. A significant portion of these people experience symptoms lasting longer than 10 days and are diagnosed with postconcussion syndrome. Dizziness is the second most reported symptom associated with a concussion and may be a predictor of prolonged recovery. Clinicians are beginning to incorporate vestibular rehabilitation therapy (VRT) in their postconcussion treatment plan, in order to address the dysfunctional inner ear structures that could be causing this dizziness. Focused Clinical Question: Can VRT help postconcussion syndrome patients experiencing prolonged dizziness by improving their perceived disability? Summary of Key Findings: Three studies were included: 1 randomized control trial, 1 retrospective chart review, and 1 exploratory study. The randomized control trial compared cervical spine therapy alone to cervical spine therapy in conjunction with VRT to obtain medical clearance for sport. The chart review explored VRT as a treatment for reducing dizziness and improving balance and gait dysfunction. The exploratory study implemented VRT in conjunction with light aerobic exercise to improve perceived disability associated with dizziness postconcussion. All 3 studies found statistically significant decreases (improvements) in Dizziness Handicap Index scores. Clinical Bottom Line: There is preliminary evidence suggesting that VRT can improve perceived disability in patients with postconcussion syndrome experiencing prolonged dizziness. There is a decrease (improvement) in Dizziness Handicap Index scores across all 3 studies. VRT is a relatively safe treatment option, with no adverse reactions or case reports. Strength of Recommendation: There is level 2 and level 3 evidence supporting the use of VRT to treat patients suffering from dizziness postconcussion.
- [Analysis of 118 cases of benign paroxysmal positional vertigo after trauma]. [Journal Article]
- LCLin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2017 May 20; 31(10):774-775
- Objective: The aim of this study is to retrospective analysis the clinic features of 118 cases of benign paroxysmal positional vertigo after trauma. Method:Analyzes clinic features of injury in 118 c…
Objective: The aim of this study is to retrospective analysis the clinic features of 118 cases of benign paroxysmal positional vertigo after trauma. Method:Analyzes clinic features of injury in 118 cases of benign paroxysmal positional vertigo after trauma, and classified and localized the craniocerebral trauma. The 118 cases were tested with different positioning tests in the sequence of Dix hallpike test and rolling test. Then, proper otolith manual reduction was given. Result:In 118 cases of BPPV after trauma including 35 cases of skull fracture, 6 cases of concussion, 17 cases of scalp hematoma, 28 cases of scalp laceration, 14 cases of mild brain contusion and 18 cases of head combined injury. The distributions of head injury were 57 at front temporal, 24 at top, 22 at occipital and 15 at maxillofacial region. The latency of BPPV after head injury varies from 1day to 1month. The incidence of 3-7 day after head injury was the highest, followed by 7-14 days, 0-3 days, and the lowest incidence rate of 14 day to 1 month. Canal type 118 BPPV patients after head injury accounting for up to 57.6% of the horizontal semicircular canal accounted for 33.1%, mixed 9.3%. Conclusion: The patients with front temporal trauma and skull fracture were prone to have BPPV. The peak incidence of BPPV was 3-14 days after head injury. The most common type of BPPV was PC BPPV, and the HC BPPV was the second type. A good curative effect can be manipulative reduction after trauma BPPV..
- Peripheral Vestibular Disorders in Children and Adolescents with Concussion. [Journal Article]
- OHOtolaryngol Head Neck Surg 2018; 159(2):365-370
- Objective To review peripheral vestibular disorders in pediatric patients with dizziness following concussion. Study Design Case series with chart review. Setting Pediatric vestibular clinic and pedi…
Objective To review peripheral vestibular disorders in pediatric patients with dizziness following concussion. Study Design Case series with chart review. Setting Pediatric vestibular clinic and pediatric multidisciplinary concussion clinic at a tertiary level pediatric hospital. Subjects and Methods We retrospectively reviewed 109 patients seen for dizziness following a concussion between September 2012 and July 2015. Patients were ≤20 years of age at the time of concussion. Incidences of specific peripheral vestibular disorders were assessed along with timing of diagnosis relative to the date of injury, diagnostic test findings, and treatment interventions associated with those diagnoses. Results Twenty-eight patients (25.7%) were diagnosed with peripheral vestibular disorders. None of these disorders were diagnosed prior to evaluation in our pediatric vestibular clinic or our multidisciplinary concussion clinic, which occurred a mean of 133 days (95% confidence interval, 89.2-177.3) after injury. Benign paroxysmal positioning vertigo was diagnosed in 19 patients, all of whom underwent successful canalith repositioning maneuvers. Other diagnoses included temporal bone fracture (n = 3), labyrinthine concussion (n = 2), perilymphatic fistula (n = 2), and superior semicircular canal dehiscence (n = 2). Both patients with perilymphatic fistula and 1 patient with superior semicircular canal dehiscence underwent successful surgical management, while 1 patient with superior semicircular canal dehiscence was managed nonsurgically. Conclusion Peripheral vestibular disorders may occur in pediatric patients with dizziness following concussion, but these disorders may not be recognized until symptoms have persisted for several weeks. An algorithm is proposed to guide the diagnosis and management of peripheral vestibular disorders in pediatric patients with concussion.
- Correlating the King-Devick Test With Vestibular/Ocular Motor Screening in Adolescent Patients With Concussion: A Pilot Study. [Journal Article]
- SHSports Health 2018 Jul/Aug; 10(4):334-339
- CONCLUSIONS: Our study suggests that prolonged K-D testing times in adolescents with concussion may be related to subtypes of vestibular/ocular motor impairment that extend beyond saccadic abnormalities.Poor K-D testing performance of adolescents with concussion may indicate a range of vestibular/ocular motor deficits that need to be further identified and addressed to maximize recovery.
- Reevaluating Order Effects in the Binaural Bithermal Caloric Test. [Journal Article]
- AJAm J Audiol 2018 Mar 08; 27(1):104-109
- CONCLUSIONS: This experiment demonstrated that while there is great inter-individual and intra-individual variability in caloric test results, the order of irrigations had no significant effect in the test. Future studies may explore the effects of nonphysiological factors on test results.
- How to diagnose cervicogenic dizziness. [Review]
- APArch Physiother 2017; 7:12
- Cervicogenic dizziness (CGD) is a clinical syndrome characterized by the presence of dizziness and associated neck pain. There are no definitive clinical or laboratory tests for CGD and therefore CGD…
Cervicogenic dizziness (CGD) is a clinical syndrome characterized by the presence of dizziness and associated neck pain. There are no definitive clinical or laboratory tests for CGD and therefore CGD is a diagnosis of exclusion. It can be difficult for healthcare professionals to differentiate CGD from other vestibular, medical and vascular disorders that cause dizziness, requiring a high level of skill and a thorough understanding of the proper tests and measures to accurately rule in or rule out competing diagnoses. Consequently, the purpose of this paper is to provide a systematic diagnostic approach to enable healthcare providers to accurately diagnose CGD. This narrative will outline a stepwise process for evaluating patients who may have CGD and provide steps to exclude diagnoses that can present with symptoms similar to those seen in CGD, including central and peripheral vestibular disorders, vestibular migraine, labyrinthine concussion, cervical arterial dysfunction, and whiplash associated disorder.
- Vestibular consequences of mild traumatic brain injury and blast exposure: a review. [Review]
- BIBrain Inj 2017; 31(9):1188-1194
- The purpose of this article is to review relevant literature on the effect of mild traumatic brain injury (mTBI) and blast injury on the vestibular system. Dizziness and imbalance are common sequelae…
The purpose of this article is to review relevant literature on the effect of mild traumatic brain injury (mTBI) and blast injury on the vestibular system. Dizziness and imbalance are common sequelae associated with mTBI, and in some individuals, these symptoms may last for six months or longer. In war-related injuries, mTBI is often associated with blast exposure. The causes of dizziness or imbalance following mTBI and blast injuries have been linked to white matter abnormalities, diffuse axonal injury in the brain, and central and peripheral vestibular system damage. There is some evidence that the otolith organs may be more vulnerable to damage from blast exposure or mTBI than the horizontal semicircular canals. In addition, benign paroxysmal positional vertigo (BPPV) is a common vestibular disorder following head injury that is treated effectively with canalith repositioning therapy. Treatment for (non-BPPV) mTBI-related vestibular dysfunction has focused on the use of vestibular rehabilitation (VR) augmented with additional rehabilitation methods and medication. New treatment approaches may be necessary for effective otolith organ pathway recovery in addition to traditional VR for horizontal semicircular canal (vestibulo-ocular reflex) recovery.
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- Traumatic brain injury and vestibulo-ocular function: current challenges and future prospects. [Review]
- EBEye Brain 2016; 8:153-164
- Normal function of the vestibulo-ocular reflex (VOR) coordinates eye movement with head movement, in order to provide clear vision during motion and maintain balance. VOR is generated within the semi…
Normal function of the vestibulo-ocular reflex (VOR) coordinates eye movement with head movement, in order to provide clear vision during motion and maintain balance. VOR is generated within the semicircular canals of the inner ear to elicit compensatory eye movements, which maintain stability of images on the fovea during brief, rapid head motion, otherwise known as gaze stability. Normal VOR function is necessary in carrying out activities of daily living (eg, walking and riding in a car) and is of particular importance in higher demand activities (eg, sports-related activities). Disruption or damage in the VOR can result in symptoms such as movement-related dizziness, blurry vision, difficulty maintaining balance with head movements, and even nausea. Dizziness is one of the most common symptoms following traumatic brain injury (TBI) and is considered a risk factor for a prolonged recovery. Assessment of the vestibular system is of particular importance following TBI, in conjunction with oculomotor control, due to the intrinsic neural circuitry that exists between the ocular and vestibular systems. The purpose of this article is to review the physiology of the VOR and the visual-vestibular symptoms associated with TBI and to discuss assessment and treatment guidelines for TBI. Current challenges and future prospects will also be addressed.