Vestibular Balance Deficits Following Head Injury: Recommendations Concerning Evaluation and Rehabilitation in the Military Setting

Abstract : 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.

[1]  G. Friedmann.  The judgement of the visual vertical and horizontal with peripheral and central vestibular lesions. , 1970, Brain : a journal of neurology.

[2]  A. R. Fregly.  Vestibular Ataxia and its Measurement in Man , 1975 .

[3]  K L Schunk,et al.  Disorders of the vestibular system. , 1988, The Veterinary clinics of North America. Small animal practice.

[4]  K K Gillingham.  The spatial disorientation problem in the United States Air Force. , 1992, Journal of vestibular research : equilibrium & orientation.

[5]  Space vestibulo-neuroscience in the new century: why proceed in semi-darkness? , 1993, ORL; journal for oto-rhino-laryngology and its related specialties.

[6]  Angus H. Rupert,et al.  The use of a tactile interface to convey position and motion perceptions , 1994 .

[7]  C. Foster,et al.  Vestibular rehabilitation. , 1994, Bailliere's clinical neurology.

[8]  P Era,et al.  Postural stability and skilled performance--a study on top-level and naive rifle shooters. , 1996, Journal of biomechanics.

[9]  N. Suri,et al.  The tactile Situation Awareness System in rotary wing aircraft : Flight test results , 1999 .

[10]  D. Vibert.  Long-term Evolution of Subjective Visual Vertical after Vestibular Neurectomy and Labyrinthectomy , 2000, Acta oto-laryngologica.

[11]  A. Rupert.  Tactile situation awareness system: proprioceptive prostheses for sensory deficiencies. , 2000, Aviation, space, and environmental medicine.

[12]  Transient vestibular balance dysfunction after primary blast injury. , 2001, Military medicine.

[13]  D. Vibert,et al.  Vestibular function in patients with cochlear implantation. , 2001, Acta oto-laryngologica. Supplementum.

[14]  Conrad Wall,et al.  Balance prosthesis based on micromechanical sensors using vibrotactile feedback of tilt , 2001, IEEE Transactions on Biomedical Engineering.

[15]  Eric Vicaut,et al.  Perception of Verticality After Recent Cerebral Hemispheric Stroke , 2002, Stroke.

[16]  Steven J. Kass,et al.  Vestibular Stimuli May Degrade Situation Awareness Even When Spatial Disorientation is not Experienced , 2002 .

[17]  K. Jáuregui-Renaud,et al.  Subjective Assessment of Visual Verticality in follow-up of Patients with Acute Vestibular Disease , 2003, Ear, nose, & throat journal.

[18]  N. Gray,et al.  Objective vestibular tests as outcome measures in head injury patients , 2003, The Laryngoscope.

[19]  Hans-Otto Karnath,et al.  Understanding and treating "pusher syndrome". , 2003, Physical therapy.

[20]  Braden J. McGrath,et al.  Tactile Situation Awareness System Flight Demonstration , 2004 .

[21]  R. Cholewiak,et al.  Vibrotactile localization on the abdomen: Effects of place and space , 2004, Perception & psychophysics.

[22]  D. Wrisley,et al.  Reliability, internal consistency, and validity of data obtained with the functional gait assessment. , 2004, Physical therapy.

[23]  E Kentala,et al.  Control of sway using vibrotactile feedback of body tilt in patients with moderate and severe postural control deficits. , 2005, Journal of vestibular research : equilibrium & orientation.

[24]  K. Taber,et al.  Blast-related traumatic brain injury: what is known? , 2006, The Journal of neuropsychiatry and clinical neurosciences.

[25]  Conrad Wall,et al.  Determining the effectiveness of a vibrotactile balance prosthesis. , 2006, Journal of vestibular research : equilibrium & orientation.

[26]  Gin McCollum,et al.  Cognitive-vestibular interactions: a review of patient difficulties and possible mechanisms. , 2006, Journal of vestibular research : equilibrium & orientation.

[27]  H. Belanger,et al.  Mechanism-of-Injury Approach to Evaluating Patients With Blast-Related Polytrauma , 2006, The Journal of the American Osteopathic Association.

[28]  P. Bach-y-Rita,et al.  Efficacy of electrotactile vestibular substitution in patients with peripheral and central vestibular loss. , 2007, Journal of vestibular research : equilibrium & orientation.

[29]  J. Megna.  Balance and Vestibular Rehabilitation in the Patient with Acquired Brain Injury , 2007 .

[30]  Michael A. Gresty,et al.  Guidance of visual direction by topographical vibrotactile cues on the torso , 2007, Experimental Brain Research.

[31]  J. Viitasalo,et al.  Relationships between postural balance, rifle stability and shooting accuracy among novice rifle shooters , 2006, Scandinavian journal of medicine & science in sports.

[32]  F. Horak,et al.  Effects of practicing tandem gait with and without vibrotactile biofeedback in subjects with unilateral vestibular loss. , 2008, Journal of vestibular research : equilibrium & orientation.

[33]  David R. Cox,et al.  Official Position of the Military TBI Task Force on the Role of Neuropsychology and Rehabilitation Psychology in the Evaluation, Management, and Research of Military Veterans with Traumatic Brain Injury , 2008, The Clinical neuropsychologist.

[34]  Neeraj,et al.  Digital Commons@Becker Digital Commons@Becker Classification of traumatic brain injury for targeted therapies Classification of traumatic brain injury for targeted therapies Classification of Traumatic Brain Injury for Targeted Therapies , 2008 .

[35]  V. Lamb,et al.  Assessment, Intervention, and Prevention of Falls in Elders With Developmental Disabilities , 2008 .

[36]  J. Holcomb,et al.  Now and then: combat casualty care policies for Operation Iraqi Freedom and Operation Enduring Freedom compared with those of Vietnam. , 2008, The Journal of trauma.

[37]  Matthew R. Scherer,et al.  Traumatic Brain Injury and Vestibular Pathology as a Comorbidity After Blast Exposure , 2009, Physical Therapy.

[38]  Grant L Iverson,et al.  Recommendations for diagnosing a mild traumatic brain injury: a National Academy of Neuropsychology education paper. , 2009, Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists.

[39]  Frederick J. Gallun,et al.  Hearing Impairment and Traumatic Brain Injury among Soldiers: Special Considerations for the Audiologist , 2009 .

[40]  Blunt and blast head trauma: different entities. , 2009, The international tinnitus journal.

[41]  AH Chowdhury,et al.  Assessment of coma and impaired consciousness : A critical review , 2009 .

[42]  Steven J. Kass,et al.  Evaluation of Several Common Antimotion Sickness Medications and Recommendations Concerning Their Potential Usefulness During Special Operations , 2009 .

[43]  I. Curthoys,et al.  A review of the scientific basis and practical application of a new test of utricular function--ocular vestibular-evoked myogenic potentials to bone-conducted vibration. , 2009, Acta otorhinolaryngologica Italica : organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale.

[44]  Jeffrey M. Hausdorff,et al.  Self-report of missteps in older adults: a valid proxy of fall risk? , 2009, Archives of physical medicine and rehabilitation.

[45]  A. Lueckenotte,et al.  A Study Guide for the Evidence-Based Approach to Fall Assessment and Management , 2009 .

[46]  A. Rupert,et al.  Initial Consideration of the Feasibility and Optimal Application of Tactile Sway Cueing to Improve Balance Among Persons Suffering from Disequilibrium , 2010 .

[47]  Karen L Hastings-Atkins.  Vibrotactile Postural Control in Patients that have Sit-to-Stand Balance Deficit and Fall , 2010 .

[48]  C. Balaban,et al.  Blast Exposure: Vestibular Consequences and Associated Characteristics , 2010, Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology.

[49]  Mark Speechley,et al.  Quantifying the magnitude of risk for balance impairment on falls in community-dwelling older adults: a systematic review and meta-analysis. , 2010, Journal of clinical epidemiology.

[50]  Justin R. Davis,et al.  Trunk sway reductions in young and older adults using multi-modal biofeedback. , 2010, Gait & posture.

[51]  Foam surfaces and standing balance testing: The balance perturbing effects, the perturbing mechanisms and considerations for clinical and experimental practice, , 2010 .

[52]  F. O. Black,et al.  Diagnostic accuracy of dynamic posturography testing after short-duration spaceflight. , 2010, Aviation, space, and environmental medicine.

[53]  Mark Speechley,et al.  Balance Impairment as a Risk Factor for Falls in Community-Dwelling Older Adults Who Are High Functioning: A Prospective Study , 2010, Physical Therapy.

[54]  E. D. de Bruin,et al.  Exploratory factor analysis of the Dizziness Handicap Inventory (German version) , 2010, BMC ear, nose, and throat disorders.

[55]  90. The clinical utility of Romberg’s test , 2010, Journal of Clinical Neuroscience.

[56]  R. Taylor,et al.  The vestibular evoked-potential profile of Ménière’s disease , 2011, Clinical Neurophysiology.

[57]  Behavioral and kinematic measures in simple screening tests of vestibular function , 2011 .