Treating Head Injury Related Balance Problems

Therapists can Design a Specialized Blanced Treatment Plan

A significant number of head trauma survivors suffer from dizziness and balance problems. Treating this problem requires an initial comprehensive medical assessment to determine what is leading to the problem. After the cause is determined, the treatment team can initiate the right interventions and therapies. There are several common causes of balance problems after head injury

  • Direct damage to the brain, ears and eyes
  • Body injuries and overall physical weakness
  • Medications used to treat the head injury

Damage to the Brain, Ears, and Eyes

The word Ataxia means reduction or loss of control over physical movements. Direct damage to the brain may result in Frontal or Cerebellar Ataxia, depending on if the front or the base of the brain was injured.

Treatment involves numerous therapeutic disciplines, and often includes physical therapy that is focused on strengthening one’s ability to perform coordinated and complex movements. Medications to reduce tremors or spasticity may also be beneficial.

If the ears are damaged from head trauma, resulting balance problems are called Vestibular Ataxia.

For patients who have damage to the vestibular system of the inner ear, a specially designed vestibular rehabilitation program is put together for their unique symptoms. Since the inner ear and the eyes work together to maintain balance, the rehab exercises used for ear damage complement those used for damage to the visual system.

For example, habituation and gaze stabilization exercises involve moving the head in a certain direction while keeping the eyes focused on a point in space. These exercises become more complex to include associated body movements, or by actively moving the focus point.

Exercise programs that focus on developing strength and balance are also helpful.

For example, there is a strong body of research that shows Tai Chi is helps individuals with balance problems improve their core strength and reduce the risk falls.

Any exercise program should be overseen by a trained therapist to ensure maximum benefit for that individual’s type of injury.

Treating Fractures and Muscle Weakness

Secondary injuries such as broken bones and damaged tendons can be addressed at the same time as the brain is relearning how to position itself in space.

Physical therapy programs often begin by reinforcing control over the trunk of the body. This includes strengthening the muscles of the back, abdomen, pelvis, and legs. Flexibility and muscle tone are often lost during hospitalization, so during a lengthy recovery, stretching all of the muscles of the body, and keeping the pelvis, hips and legs loose, is important.

As mobility improves, taking walks that are a bit longer every day builds endurance and contributes to strength. After head trauma, the brain has to regain the ability to carry out several tasks at once.

In the beginning, it may only be possible to walk while holding onto a railing with one’s entire focus on the activity.

Once this is mastered, the next challenge will be learning how to walk while carrying on a conversation, or doing some other activity such as bouncing a ball.

Medications that Lead To dizziness

If the balance problem is caused by medications, then the treatment team can explore using alternative drugs.

Sometimes it is not possible to completely eliminate the side effects of medications that are required for medical conditions. For example, it may not be possible to just stop taking blood pressure or anti-seizure meds. Instead, other strategies are necessary to adjust to their side effects.

If a patient knows that s/he is more unsteady after a medication, timing can be adjusted to taking it primarily at night, or avoiding activities after taking the prescribed dose.


Lei-Rivera, L., Sutera, J., Galatioto, J. A., Hujsak, B. D., & Gurley, J. M. (2013). Special tools for the assessment of balance and dizziness in individuals with mild traumatic brain injury. Neurorehabilitation, 32(3), 463-472 10p. doi:10.3233/NRE-130869

Matchett, K., & Institute of Medicine, (. (U.S.). (2013). Cognitive Rehabilitation Therapy for Traumatic Brain Injury : Model Study Protocols and Frameworks to Advance the State of the Science: Workshop Summary. Washington, District of Columbia: National Academies Press.

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