Otoneurological Evaluation and Rehabilitative Considerations after Head Trauma (original) (raw)
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Otolith function in patients with head trauma
European Archives of Oto-Rhino-Laryngology, 2011
This study evaluates the otolith function of patients with head trauma, postulating that otolith dysfunction is a cause of nonspecific dizziness after head trauma. We prospectively enrolled 28 patients referred within 3 months after head trauma between March 2007 and December 2009. Pure tone audiometry, caloric testing and otolith function tests, including cervical vestibular evoked myogenic potential (cVEMP) and subjective visual vertical (SVV) tests, were performed on all patients. The relationship between otolith function and otologic symptoms was analyzed. Of the 28 patients with head trauma, 18 complained of dizziness and 12 experienced hearing loss, including 6 patients who complained of both. On defining otolith dysfunction as an abnormal cVEMP or abnormal SVV, a significant difference in otolith dysfunction existed between the groups with and without dizziness [72 (13/18) vs. 20% (2/10)]. In contrast, no significant difference in otolith dysfunction was detected between the abnormal and normal hearing groups. A significant number of the patients who complained of nonspecific dizziness after trauma had abnormal otolith function. After trauma, when patients complain of dizziness, vestibular function tests, including otolith function tests, should be considered.
Vestibular disorders following different types of head and neck trauma
Functional Neurology, 2016
This review focuses on the published literature on vestibular disorders following different types of head and neck trauma. Current knowledge of the different causes and underlying mechanisms of vestibular disorders, as well as the sites of organic damage, is presented. Non-organic mechanisms are also surveyed. The frequency of occurrence of vestibular symptoms, and of other accompanying subjective complaints, associated with different types of trauma is presented and related to the specific causes. Hypotheses about the pathogenesis of traumatic vestibular disorders are presented, and the knowledge derived from animal experiments is also discussed. We believe this to be a very important topic, since vestibular complaints in traumatic patients often remain undiagnosed or underestimated in clinical practice. This review article aims to suggest directions for additional research and to provide guidance to both the scientific and clinical practice communities.
Risk Factors for Vestibular and Oculomotor Outcomes After Sport-Related Concussion
Clinical Journal of Sport Medicine, 2019
Objective-To investigate the association between risk factors and vestibular-oculomotor outcomes following sport-related concussion (SRC). Study Design-Cross-sectional study of patients seen 5.7 +/− 5.4 days (range, 0-30 days) postinjury. Setting-Specialty clinic Participants-Eighty-five athletes (50 males, 35 females) aged 14.1 +/− 2.8 years (range, 9-24 years) seeking clinical care for SRC. Interventions-Participants completed a clinical interview, history questionnaire, symptom inventory, and vestibular/ocular-motor screening (VOMS). Chi-square with odds ratios (OR) and diagnostic accuracy were used to examine the association between risk factors and VOMS outcomes. Main Outcome Measures-Vestibular and ocular-motor screening (VOMS) Results-Female sex [χ 2 = 4.9, p = .03], on-field dizziness [χ 2 = 7.1, p = .008], fogginess [χ 2 = 10.3, p = .001], and post-traumatic migraine (PTM) symptoms including headache [χ 2 = 16.7, p = .001], nausea [χ 2 = 10.9, p = .001], light sensitivity [χ 2 = 14.9, p = .001] and noise sensitivity [χ 2 = 8.7, p = .003] were associated with presence of one or more post-concussion VOMS score
Vestibular and balance issues following sport-related concussion
Brain Injury, 2015
Primary objective: To review relevant literature regarding the effect of concussion on vestibular function, impairments, assessments and management strategies. Reasoning: Dizziness and balance impairments are common following sport-related concussion. Recommendations regarding the management of sport-related concussion suggest including tests of balance within the multifactorial assessment paradigm for concussive injuries. Analysis: The literature was searched for guidelines and original studies related to vestibular impairments following concussion, oculomotor and balance assessments and treatment or rehabilitation of vestibular impairments. The databases searched included Medline, CINAHL, Sport Discus and the Cochrane Database of Systematic Reviews through October 2013. Main outcomes and results: Dizziness following concussion occurs in $67-77% of cases and has been implicated as a risk factor for a prolonged recovery. Balance impairments also occur after concussion and last 3-10 days post-injury. Assessments of balance can be done using both clinical and instrumented measures with success. Vestibular rehabilitation has been shown to improve outcomes in patients with vestibular impairments, with one study demonstrating success in decreasing symptoms and increasing function following concussion. Conclusions: Best practices suggest that the assessment of vestibular function through cranial nerve, oculomotor and balance assessments are an important aspect of concussion management. Future studies should evaluate the effectiveness of vestibular rehabilitation for improving patient outcomes.
Review of Vestibular and Oculomotor Screening and Concussion Rehabilitation
Journal of athletic training, 2017
Vestibular and oculomotor impairment and symptoms may be associated with worse outcomes after sport-related concussion (SRC), including prolonged recovery. In this review, we evaluate current findings on vestibular and oculomotor impairments as well as treatment approaches after SRC, and we highlight areas in which investigation is needed. Clinical researchers have intimated that recovery from SRC may follow certain clinical profiles that affect the vestibular and oculomotor pathways. Identifying clinical profiles may help to inform better treatment and earlier intervention to reduce recovery time after SRC. As such, screening for and subsequent monitoring of vestibular and oculomotor impairment and symptoms are critical to assessing and informing subsequent referral, treatment, and return to play. However, until recently, no brief-screening vestibular and oculomotor tools were available to evaluate this injury. In response, researchers and clinicians partnered to develop the Vestib...
Vestibular and Oculomotor Assessment in Sideline Concussion Evaluation
Clinical Scenario: When evaluating for concussion in sport, symptom manifestation may align within a clinical trajectory of a neurological subsystem. Identification of such conditions is vital to orient treatment in accordance with the patient's clinical trajectory. Current literature has acknowledged the paucity of evidence regarding effect of intervention but has found that rehabilitation of vestibulo-oculomotor dysfunctions show potential to facilitate recovery. As this subject continues to be investigated, detecting these dysfunctions needs to be achieved through the use of valid and accurate diagnostic testing. Clinical Question: With patients suspected of sustaining a concussion, can the Post-Concussion Symptom Score or other tests better detect vestibular or oculomotor dysfunction? Summary of Evidence: Three articles of level 2b evidence were identified in the literature. Mucha et al. (2014) used Vestibular/Ocular Motor Screening (VOMS) in a panel of concussed vs control subjects in a concussion clinic, finding VOMS results possess high sensitivity for detecting concussions with moderate correlation to total symptom scores of the Post-Concussion Symptom Scale (PCSS). Seidman et al. (2015) and Leong et al. (2014) found significantly worse (increased) scores on the King-Devick test compared to baseline in individuals diagnosed with concussion, but the methodological shortcomings challenge the validity of their results. Clinical Bottom Line: KD and VOMS may provide usefulness in supplementing sideline evaluation tools to improve detection of concussion. SUMMARY of Search, 'Best' Evidence' appraised, and Key Findings: • Search of the literature to identify articles evaluating the utility of vestibular or oculomotor tests to identify dysfunctions in concussed patients. Level 2 evidence and above was utilized.
Patterns of vestibular dysfunction in chronic traumatic brain injury
Frontiers in Neurology, 2022
Conclusions: Dizziness and/or imbalance in chronic TBI was associated with impaired postural stability for tasks requiring high levels of use of vestibular and Frontiers in Neurology frontiersin.org Taylor et al.. /fneur.. visual input for balance. Vestibular hypofunction identified through vHIT, VEMP and caloric testing was recorded but was less common, except when the injury involved a fractured skull-base. There was no specific pattern of end-organ or nerve involvement which characterized this group of patients.
International Journal of Audiology, 2020
Objective:To establish the frequency of occurrence of peripheral vestibular dysfunction in adults who have sustained non-blast-related traumatic brain injury (TBI) as measured through the standard audiological vestibular test battery. Design: A systematic search of English language literature using MEDLINE, EMBASE, PsycINFO, CINAHL, hand-searching of reference lists and SCOPUS author search was conducted from January 1, 1990 to May 14, 2019. Study samples: Twenty-three out of 417 originally identified articles were retained. TBI and peripheral vestibular findings were extracted and synthesised. Results: Quality appraisal using the Oxford Centre for Evidence-Based Medicine (OCEBM) revealed Level 2b as the highest level of evidence. None of the primary studies explored vestibular deficits in acute settings, with data collected from tertiary institutions and in 20 of 23 studies retrospectively. Although retrospective studies provided important data, they fail to control for numerous threats to internal validity. BPPV was the most frequently identified peripheral vestibular deficit following TBI, diagnosed in 39.7% of 239 participants across six of 23 studies. Conclusions: Further prospective longitudinal research into comparative recovery trajectories in patients across TBI severity levels would provide additional information to guide clinical diagnosis, prognosis and management of this patient population.
Vestibular pathology has been documented following barotrauma and/or head acceleration associated with exposure to explosions. The usual symptoms include dizziness and headache, with dizziness and associated imbalance contributing disproportionately to disability. Several agencies have noted the need for better vestibular evaluation and rehabilitation following exposure to improvised explosive devices (IEDs). The authors asked subject matter experts to assist in formulating recommendations for initial assessment and rehabilitation of balance problems following IED exposure, focusing on strategies that are either available or in development. This report summarizes feedback obtained from approximately 50 vestibular researchers, scientific advisors, clinicians, and biomedical engineers working for government agencies, universities, clinics/hospitals, and businesses. Tests appropriate for early (post-injury) functional assessment in the military setting are considered, along with the optimal application of novel tactile balance feedback technologies being developed to augment vestibular rehabilitation.
2014
Background: It is well established that vestibular injury can occur with traumatic brain injury (TBI). Symptoms that could be related to vestibular dysfunction rather than a brain injury include vertigo, dizziness, and imbalance. Reports indicate that the incidence of dizziness or imbalance secondary to vestibular dysfunction may occur in up to 83% of adults following mild TBI but there are few studies examining this in children. It is difficult, but clinically very relevant, to differentiate symptoms due to vestibular injury as the treatment is very different. Objective: 1) To examine the symptom of dizziness in children with TBI and 2) Investigate the prevalence of vestibular dysfunction in children following a TBI using a novel diagnostic technique. Methods: Prospective cohort study. Population: Children aged 11-18 years with a) mild TBI presenting to the Emergency Department (ED) (acute/subacute); and b) mild to severe TBI symptomatic ≥1 month post-injury (chronic). Outcome mea...