Assistant Professor SUNY Downstate Health Sciences University Brooklyn, New York, United States
Case Diagnosis: Vestibular dysfunction in Concussion
Case Description: Pt a 35/ M reported to the clinc with medical diagnosis of vestibular dysfunction and h/o traumatic head injury with LOC. On arrival patient reported significant ADL limitation with presentation with a helmet on head, ear plugs to block the sound and dark sunglasses to limit the exposure to light. Anxiety and fear of having another concussion was reported. Patient was limited to his house due to inability walk or run, difficulty in reading, doing slow or fast head turns, getting in and out of bed and standing and balance activities. Patient reports of dizziness: 0/10 in sitting and 5/10 with head turns, tends to sit in dark room to reduce dizziness and headaches.
Discussions: Secondary to a concussion profile patient presented with somatosensory, vestibular and ocular system dysfunction. Balance dysfunction noted: Romberg's EO = 60 secs, Romberg's EC = 60 secs, apprehensive, Compliant Surface: Romberg's EO = 30 secs , apprehensive, Romberg's EC= 10- 20 secs. Dizziness in visually busy environments and with fast head movements. Above findings indicate poor integration of vestibular system and higher reliance on visual system. Sensory conflict between ocular and vestibular system led to dizziness with visually busy environments. Vestibular rehabilitation enhanced ability to perform his balance and reweigh the systems appropriately. Patient returned to prior level of functioning with vestibular rehabilitation.
Conclusions: Use of vestibular Rehabilitation in people post concussion plays a key role in recovery of function and improvement of postural control. Secondary to vestibular profile like dizziness and vertigo with activities of daily living patient's often become highly reliant on their visual system. A need to retrain the vestibular system is clinically important as it allows patient's to reduce their visual dependence and correctly utilize all the three systems ( somatosensory, vestibular and ocular) in postural control post concussion.
