What Causes Balance Problems After Head Trauma?

Man balancing on log
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Dizziness and balance problems are common complaints from individuals who have sustained head trauma and traumatic brain injury. It’s currently estimated that at least 30 percent of brain injury survivors suffer from these problems. Common symptoms include:

  • feeling light-headed or woozy
  • a sense that the surrounding environment is warped, or undulating
  • difficulty maintaining an upright posture
  • stumbling, falling down
  • inability to coordinate body, limb, and hand movements
  • nausea and vomiting

There are a number of factors that influence one’s risk of developing balance problems after sustaining head trauma. These include what part of the brain was injured, the severity of that brain injury, and damage to other organs and structures of the body.

Traumatic accidents that affect the head can affect numerous other body systems. There may be injuries to the spinal cord, major bones of the skeleton, and organs such as the eyes and ears. All of these systems contribute to maintaining balance.

Finally, medications that are used to treat the symptoms of head trauma can also lead to dizziness and balance problems.

All of these possible causes have to be considered when trying to determine the origin of balance problems after head trauma.

Inputs and Outputs

Staying balanced and coordinated is a continuous process. The eyes, ears, skin, muscles, and pressure sensors continuously send messages to the brain, specifically the brainstem and cerebellum, about the body’s position in space.

The brainstem and the cerebellum are located in the base of the brain at the back of the head. The brainstem integrates the information it receives from the numerous sense organs, muscles, and pressure sensors, and together with the cerebellum decides how the body needs to respond.

The brain may direct some muscles to tighten and other muscles to relax.

It may also send a near instant message through something called the “vestibular-ocular reflex” between the inner ear and the eyes. This enables the eyes keep up with any sudden body position changes, so you can see where you’re going.

Damage to the Brain

Injury to either the brainstem or the cerebellum is extremely serious. It interferes with several critical balance and equilibrium processes. Damage may block the ability to receive feedback from the body, analyze that information, or send the right corrective response.

Associated Injuries: Bones, Ears, and Eyes

Head trauma often happens in the context of other physical injuries. If the ribs, spine, pelvis, or long bones in the legs are broken, there is a structural issue contributing to overall imbalance.

Damage to the ears is significant because the inner ear contains several fluid-filled canals that are part of the vestibular system. This system sends instant messages to the brainstem about the head’s position in space. If small crystals located inside this section of the ear become dislodged, it can lead to a condition called benign paroxysmal positional vertigo (BPPV).

Injuries to the visual system also contribute to imbalance after head trauma. These injuries may include damage to the eye itself, or damage to nerves that communicate visual signals to the brain. Partial loss of vision, lost or altered depth perception, double vision, difficulty focusing the eyes, and not responding quickly enough to the environmental cues may all develop.

Medications

A variety of medications are used to treat the symptoms of head trauma. These include:

  • antibiotics
  • blood pressure medications
  • anti-seizure drugs
  • pain medications
  • sleeping pills

In the presence of dizziness and vertigo, a careful review of medications should be completed to determine if any are the cause of symptoms.

Once the cause of balance problems is determined, treatment can be initiated.

Sources:

Inness EL, Howe J, Niechwiej-Szwedo E, et al. Measuring Balance and Mobility after Traumatic Brain Injury: Validation of the Community Balance and Mobility Scale (CB&M). Physiotherapy Canada. 2011; 63(2), 199-208 10p. 

Characterizing effects of mild traumatic brain injury and posttraumatic stress disorder on balance impairments in blast-exposed servicemembers and Veterans using computerized posturography. Journal of Rehabilitation Research & Development. 2015; 52(5), 591-604 13p.

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