Vestibular Dysfunction Post ABI

Vestibular dysfunction is commonly overlooked in both the adult and pediatric population post ABI. Symptoms may include vertigo, balance problems, visual complaints (double vision, blurriness) and nausea. Mann and Black (1996) noted that the most common persisting vestibular symptom after TBI is positional vertigo (symptoms caused by head movement). Head trauma is the third most common cause of vertigo in children at 14% (Gioacchini et al. 2014), and therefore should not be overlooked. Unfortunately, the majority of research on vestibular dysfunction following brain injury is for sports-related mild-TBIs. Two studies were conducted looking at treatment for balance deficits in children following a severe ABI (Katz-Leurer et al. 2008; Katz-Leurer et al. 2009). 

Individual Studies

Table: Treatment of Balance Deficits Post ABI in Children

Discussion

Home based exercise programs are effective at improving motor function in children that have sustained an ABI (Katz-Leurer et al. 2008; Katz-Leurer et al. 2009). Both of the home based exercise programs were considered a short term intensive programs and were implemented in the chronic phase of brain injury rehabilitation. Balance and walking performance improved within the group of children that received exercise therapy for the practiced exercises, but there was no generalized effects for unpracticed motor skills (i.e., grasping action) (Katz-Leurer et al. 2008). In theory it would be beneficial for training programs to create positive transfer of practice tasks to everyday activities (Katz-Leurer et al. 2008). Within this population, there was variation in the number of training days each child received and spectrum of etiology of ABI (Katz-Leurer et al. 2008).

When compared to a group of children who continued with daily activities, children in exercise therapy still improved in their functional balance performance, but not in walking performance or muscle strength (Katz-Leurer et al. 2009). These improvements were maintained at six week follow-up within the exercise group; however there was a lack of comparison to the control group at this time period (Katz-Leurer et al. 2009). Results should be taken with caution as there appears to be a high dropout rate for both studies (Katz-Leurer et al. 2008; Katz-Leurer et al. 2009). There also was a variation in children studied, as half of the participants had cerebral palsy and a subgroup analysis was not conducted to determine the effects of the exercise specifically on children with TBI (Katz-Leurer et al. 2009).

Conclusions

There is Level 1b evidence suggesting that home based exercise programs improve balance compared to regular daily activities in children who have sustained an ABI.

 

Home based exercise programs improve functional balance in children with an ABI.