How can dizziness caused from a traumatic brain injury affect a person? There are many symptoms that occur with a traumatic brain injury (TBI), dizziness/vertigo and balance problems are some of the most common (Kleffelgaard, Langhammer, Hellstrom, Sandhaug, Tamber, & Sobery, 2017). Unfortunately, the connection between dizziness and balance problems with other common post TBI symptoms with typical functioning are misunderstood and less researched (Kleffelgaard, et al. 2017). There are factors one must consider to understand why dizziness occurs in a typical TBI patient such as, pre-disposed factors, and injury related factors. One must also consider common dizziness patterns and diagnosis found in TBI survivors and how it can affect their every day lives.
According to Kleffelgaard, et al. (2017), there is a lack of research on injury related factors, personal factors, and post injury functioning that is associated with dizziness after a TBI. Their study’s aim was to determine what factors connect to dizziness related-disability three months post TBI. In this study, 65 patients with mild-moderate TBI who are experiencing dizziness and reduced balance were selected. Through multiple assessment tools, questionnaires, and self-reports, the study looked at personal factors such as, age, gender, and employment, injury related factors such as, cause and severity of injury, self-reported symptoms of the severity of the dizziness, and any other post-injury symptoms, as well as any psychological distress, such as sleep disturbances, depression, and irritability. The study also looked at physical factors such as participant’s mobility and balance.
The study concluded that dizziness related disability was predicted by pre-injury comorbidities and was associated with more psychological distress, vertigo symptoms, and balance problems (Kleffelgaard, et al. 2017). For personal factors associated with dizziness-related disability, age, gender, and employment had no significant impact on dizziness related disability. However, 43% of the participants had other comorbidities such as, anxiety/depression, migraines/epilepsy, and musculoskeletal conditions which all had negative effects on their dizziness related-disability (Kleffelgaard et al. 2017). Therefore, it can be concluded that having a pre-injury comorbidity can cause increased vulnerability to dizziness. Looking at the results for injury related factors associated with dizziness-related disability, there were no associations. Lastly, post injury factors associated with dizziness-related disability showed self-reported symptoms of vertigo had the strongest connection with dizziness. Next was psychological distress, specifically depression over anxiety. These results were also consistent with a study conducted by Charmelian and Feinstein (2004), who found that psychological functioning in dizzy participants were statistically worse than their non-dizzy control group.
It is well known that dizziness is a consequence of head trauma. Although, some research lacks in the exact cause of dizziness from a TBI, it can be described and diagnosed depending on the patient’s dizzy patterns. In a study conducted by Chandrasekhar (2013), history of participants’ dizzy patterns was recorded, followed by a physical exam, and targeted and non-targeted vestibular based testing was collected. The study’s objective was to determine appropriate testing once a diagnosis for dizzy patterns was found. The study found that one of the most common dizzy diagnosis seen from a TBI is benign paroxysmal positional vertigo (BPPV) (Chandrasekhar, 2013). Participants described BPPV as “getting dizzy from rolling around in bed” and can be seen with other types of vestibular disorders. (Chandrasekhar, 2013). Another common dizzy pattern TBI participants suffered from was migraine associated dizziness (MAD) or migraine associated vertigo (MAV). Participants with MAD/MAV normally have difficulty with visually-stimulating surroundings such as a supermarket, scrolling on a computer, or watching a 3-D movie (Chandrasekhar, 2013). They may also have headaches with episodic periods of vertigo with periods of unsteadiness (Hoffer, Gottshall, Moore, Balough, & Wester, 2004). Meniere’s Disease (MD) occurs when there is increased pressure in the innermost fluid layer in the ear (Chandrasekhar, 2013). Participants with MD felt that their ear was going to explode during their dizziness. Triggers for MD include salt, caffeine, emotional stress, and dehydration (Chandrasekhar, 2013). One last diagnosis seen in the study was superior semicircle canal dehiscence (SSCD) or Minor’s Syndrome.
A survivor of a TBI can experience numerous symptoms that impact their lives every day. It can be said that survivors of a TBI experience ongoing difficulties solely due to dizziness such as, decrease in functioning, less likely to return to work, and psychological distress (Maskell, Chiarelli, & Isles, 2007). Although, according to Maskell et al. (2007), the severity of symptoms one may experience can decrease but, they remain persistent over time. In a study conducted by Maskell et al. (2007), participants were selected at least 18 months post TBI to partake in a series of focus groups and individual interviews alongside their caregiver to answer pre-determined questions about the symptoms they are experiencing. The participants symptoms were talked through three focus group sessions led by a moderator, and four individual sessions with their caregivers partaking in two which, were audiotaped, transcribed, and categorized into common themes. Some of the common themes found amongst the participants were, functional limitations due to dizziness, falls, and the cognitive and emotional impact of dizziness.
Dizziness resulting from a TBI can cause much difficulty for a person in functional tasks. Some participants reported that their dizziness makes some tasks harder to complete and others impossible. Others state that they no longer can take part in some of their favorite activities or they have to modify those activities. Tasks that people did everyday are now difficult such as driving a car, self-care, employment, and leisure activities are something they struggle with (Maskell et al. 2007). Participants with young children noted that it affects their parenting skills and the relationship they have with their children because they are no longer able to do the activities and games they used to. Others noted that their dizziness results in fatigue which makes them unable to partake in certain tasks (Maskell et al. 2007). Something as simple as getting out of bed or getting dressed and ready for the day is compromised for some (Maskell et al. 2007).
In the same study, a common, unexpected theme amongst the participants was a concern for falling. Almost every participant was concerned with falling after the TBI or had experienced a fall after their injury (Maskell et al. 2007). Some concerns of the participants were falling and risking another brain injury, while others didn’t have a fear of falling at all. Triggers for falling included situations in the dark or involved low light, unstable or unsupported surfaces, and curbs (Maskell et al. 2007). Participants also discussed possible consequences for falls. For women, they were afraid of the social embarrassment and men were afraid of possible injury. According to Whitney, Hudak, & Marchetti (2000), they found that 36.8% of participants with vertigo and dizziness reported falling. They also concluded that people with dizziness from a TBI may have a higher risk of falling due to disabling sensations of light headedness and drunkenness.
Another common theme amongst the participants were dizziness effect on their cognition. Depending on their kind of dizziness/vertigo, they would have periods of unawareness (Maskell et al. 2007). Some experienced it immediately after a vertigo attack and others were constantly aware of it. Those with constant symptoms of dizziness felt that it interfered with their ability to concentrate and made it more difficult for them to complete cognitive tasks. Others noted that during a spell of vertigo, the sensations they experienced were so strong that they were not able to attend to anything else at that moment until the spell ended. Lastly, participants reported difficulty with dual tasks such as, balance and completing another task (Maskell et al. 2007). This could be due to their reduction in attention capacity commonly seen after a TBI. Therefore, TBI patients with ongoing dizziness may require an increased amount of attention in order to maintain a sense of orientation in space (Maskell et al. 2007).
This study also concluded that there was no significant emotional impact due to dizziness. There were many reports of frustration, depression, and anger management issues but they did not relate specifically to dizziness, rather they related to the overall impact of the TBI (Maskell, 2007). In another study, dizzy participants were significantly more depressed, anxious, and experienced psychosocial dysfunction compared to the non-dizzy participants but, could not prove that their dizziness promoted this or not (Chamelian et al., 2004). However, in the study conducted by Kleffelgaard, et al., (2017), found that participants experienced a great deal of anxiety and depression. There was also a report of decrease in their quality of life and increase in psychological distress in those with a TBI experiencing dizziness compared to those without dizziness.
In the study conducted by Chamelian et al. (2004), 207 patients with mild to moderate TBI and post-injury dizziness were selected to partake in the study. Demographic data and head injury data were collected from each participant followed by questionnaires and assessment tools. The study focused on psychological distress, psychosocial functioning, and the ability to return to work post injury. The study found that dizzy participants were less likely to return to work six months post injury (Chamelian et al. 2004). Participants losing the ability to return to work due to their dizziness is a major concern and can have serious impacts. Since most TBI victims are commonly young and employed, financial stability is lost, as well as a decrease in their psychosocial and quality of life (Chamelian et al. 2004).
It can be concluded that dizziness and vertigo are some of the most frequently complained effects of a TBI. TBI survivors who experience dizziness have compromised and modified a lot of their everyday life activities, including returning to work, getting dressed, and keeping relations. Looking at pre and post injury factors, it was concluded that pre-injury comorbidities can increase one’s vulnerability to dizziness post TBI (Kleffelgaard, et al. 2017). There are four common dizziness diagnosis post TBI which, can be determined through assessment tools and self- reports (Chandrasekhar, 2013). It is clear that the development of dizziness and vertigo post TBI can negatively affect people in their everyday lives. There is a lack of studies on impact vs. nonimpact TBIs and how it affects a person experiencing dizziness post TBI.
References
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