by Kellie Pokrifka
Issues with balance display as some of the most obvious symptoms of a brain injury. But what causes this imbalance? Many areas of our brains contribute to balance, and these areas can all be affected through the physical trauma involved in TBI.
Three main systems compromise our balance: visual, somatosensory, and vestibular. We tend to be the most familiar with our visual system, which utilizes our eyes to gather information from the outside world. The somatosensory system gathers information from our joints, skin, muscles, and other body parts. Information from our posture is sent to the brain, letting the brain know where our bodies are located in space, which is a sense known as proprioception. The vestibular system involves our inner ear and provides our brains with information on movement, both of ourselves and of the outside world. The brain gathers all of this feedback from these systems and then determines how to better maintain balance.
Unfortunately, processes can malfunction in one or all of these systems after brain injury. When one system is compromised, the other two will overcompensate, which will, in turn, lead to further issues. For example, let’s say that a brain injury negatively impacted your vestibular system. When your brain suddenly is not receiving adequate signals from this system it employs the other two systems to work even harder to make up for the slack so it can still function properly. Because of this, the visual system will overwork itself, leading to visual strain, fatigue, and headache. The musculoskeletal system will overwork itself by tightening the muscles around your head, neck, and back to help give your brain more information on where it is in space. This then leads to muscle soreness and more headaches. If the vestibular system is left untreated, the additional problems will also become chronic and more difficult to treat.
Determining which system(s) are affected can be quite challenging and will dictate the pathway to recovery. According to physical therapist Preeti Verma, it is most common that, following traumatic brain injury, both the visual and vestibular systems will be disrupted. However, each patient is unique and the majority of the rehabilitation strategies for these issues are incredibly individualized.
Ask your practitioner if they feel confident in identifying and treating issues from all three systems. If available, a Sensory Organization Adaptation Test (SOT) can help identify exactly which process is malfunctioning. During an SOT, the patient stands in a large box, harnessed in to protect against any imbalance that might lead to a fall. At different points throughout the test, both the floors and the walls of the box will move at different times. The sensors in the floor will calculate your center of balance during the motions to accurately identify which of your systems are affected. Once the systems are identified, the routes to recovery can then be addressed.
Kellie is a TBI survivor and works as an intermediary between the experts and the patients with brain injuries.