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Resources

Recent Articles & News

Stay informed about the latest updates and research in vestibular disorders and Traumatic Brain Injury (TBI) with our "Resources" section. We aim to provide valuable updates to professionals and individuals alike, fostering a deeper understanding and facilitating better management of these complex conditions.

Lack of vestibular-specific training and skills leads to poor care for patients with acute TBI

Title: Why are patients with acute traumatic brain injury not routinely assessed or treated for vestibular dysfunction in the UK? A qualitative study

Authors: Rebecca M Smith, Caroline Burgess, Vassilios Tahtis, Jonathan Marsden, Barry M Seemungal

Source: BMJ Open 2023;13:e067967.

In a recent study, Smith and colleagues in 2023, interviewed 28 healthcare professionals (including occupational therapists, physiotherapists, and surgical and trauma doctors) at two major UK trauma wards to identify barriers and facilitators that influenced their management of patients with vestibular dysfunction. The study found uncertainty around who was responsible for managing vestibular dysfunction, and variability in current methods of management.

Vestibular dysfunction is common in patients following acute traumatic brain injury (aTBI) with damaging consequences such as dizziness. Yet, in this study, doctors' perception of dizziness was that it was short lived, and generally gave it less importance than therapists. Notably, there was a perception among doctors that dizziness was a vague symptom without a specific treatment, or even that it was unfixable.

All respondents had some relevant knowledge around vestibular dysfunction, but a widespread lack of practical skills was noted.This implied that patients are not routinely assessed and treated for it. Doctors cited limited training, similar to physiotherapists and occupational therapists who viewed their training around vestibular dysfunction as insufficient. They felt that its management did not fall within the scope of their role. Specifically, occupational therapists in this study expressed a concern that treatment of vestibular dysfunction would cross professional boundaries.

Secondary barriers for effective management of vestibular dysfunction following aTBI included time (especially in emergency settings), feasibility of diagnosis and treatment, motivation and confidence. Trauma therapists cited a lack of relevant role models as an issue, as well as a difficulty with diagnosis and treatment due to the patients' state such as their physical pain and cognition.

Despite the challenges mentioned by healthcare professionals in this study for the effective management of dizziness following aTBI, therapists acknowledged the serious implications of dizziness and prioritised the problem. Therapists showed the most desire to change in order to successfully treat vestibular dysfunction. Doctors also noted that therapists would be best placed for this responsibility. Suggested wider facilitators to improvement included changes to guidelines and better availability of information for practitioners and patients. Several role related facilitators were mentioned, including enhanced theoretical and practical training.

Key findings

Lack of vestibular specific knowledge and practical skills in healthcare professionals.
Need for enhanced practical training for the clinicians.

Vestibular issues are under recognised in acute TBI patients

Title: Vestibular dysfunction in acute traumatic brain injury

Authors: Marcus HJ, Paine H, Sargeant M, Wolstenholme S, Collins K, Marroney N, Arshad Q, Tsang K, Jones B, Smith R, Wilson MH, Rust HM, Seemungal BM. Vestibular dysfunction in acute traumatic brain injury.

Source: J Neurol. 2019 Oct;266(10):2430-2433.

Vestibular dysfunction is an incredibly common and long-lasting impact of Traumatic Brain Injury, with a large proportion of TBI victims facing vestibular problems several years post-injury. Vestibular dysfunction alone contributes heavily towards unemployment post-TBI, increasing it threefold. Hence, proper diagnosis and treatment of vestibular conditions resulting from TBI are important for the long term wellbeing of the patient, as well for a reduction of the socioeconomic impact of TBI.

Unfortunately, it is difficult to study the causes of post-TBI vestibular conditions, potentially because of adaptive brain mechanisms which occur in chronic TBI. These adaptive brain mechanisms may obscure the link between the vestibular symptoms and their signs. Thus, the study proposes that investigation of acute cases, where brain adaptation has not occurred, would be useful to conduct.

In the study, 111 Major Trauma Ward patients were screened for vestibular symptoms, and subsequently underwent neuro-otological assessment. Of the 111 patients, 96 were found to have vestibular dysfunction. 47 of this 96 were then assessed for the study. Multiple signs of vestibular dysfunction were found, the most common being gait ataxia, which 62% of the 47 presented with. Importantly, half of the 62% did not even perceive their problem, suggesting that vestibular symptoms may be a larger issue in TBI patients than currently recognised. Additionally, the study notes that injury of both central and peripheral systems can occur simultaneously, an occurrence that is relatively unique to acute TBI, which can theoretically delay recovery.

Overall, the study finds that vestibular dysfunction is highly common among TBI patients, but that the signs are under recognised. Additionally, it recognises that there is not enough evidence that routine assessment for vestibular problems at the acute stage is worthwhile to patient outcomes. Due to the lack of existing research and the negative impacts of post-TBI vestibular dysfunction, the study calls for more mechanistic, prospective studies into acute TBI.

Key findings
Vestibular dysfunction is common in TBI patients but the vestibular signs are under recognised in acute care.

Traumatic Benign Paroxysmal Positional Vertigo (BPPV) after Head Trauma (t-BPPV)

Title: The Risk of Benign Paroxysmal Positional Vertigo After Head Trauma

Authors: Helene Andersson, MS ; Greg Eigner Jablonski, MD, PhD; Stein Helge Glad Nordahl, MD, PhD; Karl Nordfalk, MD, PhD; Eirik Helseth, MD, PhD; Camilla Martens, MD, PhD ; Kjetil Røysland PhD, Frederik Kragerud Goplen, MD, PhD

Source: Laryngoscope, 132:443–448, 2022

A 2021 study into the onset of BPPV after head trauma aimed to investigate the pervasiveness of BPPV after varying severities of head trauma, and to create a risk-time curve for its onset. The study was conducted on 117 patients at Oslo University Hospital between August 2019 and March 2020. Around one-fifth of patients who had experienced minimal-to-moderate head trauma were found to have BPPV. Higher severity of injury was related to a higher risk of developing BPPV. The time immediately after the trauma showed the highest risk of onset. This risk subsequently decreased and stabilised. Most cases showed symptoms of BPPV within two weeks of the trauma.

The study noted that there is not an internationally accepted standard criteria for traumatic BPPV (t-BPPV) at present. The cut-off time between trauma and development of symptoms used in literature varies anywhere from days to three months.

Significant BPPV was found in cases with minimal head traumas, showing that even relatively minor injuries can result in BPPV. The risk of t-BPPV did not vary with age or gender. Additionally, the study found a different distribution of subtypes of BPPV compared to the reported distribution within cases of i-BPPV (there were more bilateral, lateral and anterior canal cases), highlighting the need to conduct the supine roll test on dizzy head injury patients. Due to the high prevalence of BPPV after head trauma, the study noted that BPPV should first be investigated before denoting symptoms to a concussion.

To conclude, the study proposed that in head trauma cases where development of BPPV occurs within two weeks of the trauma, the trauma is the cause. Consequently, head trauma patients should be educated about the possibility of developing BPPV, and protocols should be developed specifically to diagnose and treat BPPV after minimal to moderate head trauma.

Improving balance in community elders by volunteers within faith-based institutions: a feasibility study

Improving balance in community-dwelling elders using trained volunteers within faith-base institutions: a mixed methods feasibility study

Sheeba Rosewilliam, Colin J. Greaves, Arokkiyasamy Selvanayagam & Andrew A. Soundy

School of Sports, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK; Dizzy care clinic ltd, Wolverhampton, UK

This study explored whether trained volunteers in churches and other faith-based institutions could help improve balance in older adults living in the community. The researchers wanted to see if this approach was practical and effective.

The study involved a mix of different research methods, including surveys, interviews, and balance tests. Volunteers from churches were trained to lead balance exercises with older adults. The researchers then measured the progress of these participants to see if their balance improved over time.

The results showed that this approach was feasible—meaning it worked well in a real-world setting. The older adults who participated found the balance exercises helpful, and many experienced improvements in their ability to stay steady and avoid falls. The study also highlighted the benefits of using trusted community spaces like churches to support the health and well-being of older adults.

Overall, this research suggests that trained volunteers in faith-based institutions can play an important role in helping older adults maintain their balance and reduce the risk of falls, making it a promising approach for community health programs.