If you speak to someone who has experienced a traumatic head injury, they may say they are experiencing ‘‘spinning spells”, feeling ‘‘lightheaded’’, or being ‘‘unsteady in the dark.” In fact, balance problems are among the most commonly reported symptoms following a concussion. Between 23% to 81% of people report feeling dizzy in the first couple of days after a concussion.

Who is more susceptible to balance problems after a concussion?

A study done on both male and female athletes reported differences in balance symptoms between the two groups following a concussion. They found that females had better balance abilities compared to males after head injury across all age groups, even after accounting for weight and height differences, however, the mechanism for such differences is unclear. 

Additionally, many studies have reported that age may play a variable role in these balance deficits. Younger children up until the age of 18 may have a more challenging time with respect to balance control following a head injury. They can initially display more postural sway, which is a term relating to the horizontal movement around the centre of gravity. This sway is essential due to the many large and small changes in the center of gravity due to functions such as walking and breathing. The balance improvement as children transition to adulthood may be explained by developmental factors such as the maturation of the brain and various sensory systems. 

Dizziness experienced can be categorized into 4 groups:

• Vertigo: The illusion of movement related to the vestibular system.

• Presyncopal lightheadedness: The sensation that you are about to faint. This is usually due to a drop in blood pressure as a result of a change in posture.

• Multisensory dizziness: As the name suggests, it is dizziness involving multiple sensory systems and is usually common in older populations or people with systemic disorders like diabetes.

• Psychophysiological dizziness:  visual vertigo or dizziness accompanied by space phobia or anxiety.

What are the potential causes of dizziness?

Dizziness can be described in relation to the vestibular system that helps maintain balance and the visual system that plays an important role in depth perception, orienting ourselves in relation to the external environment, and moving with respect to oneself. Thus, the interaction of motor, neural, and sensory systems assist in balance, and the disturbance of any could lead to the experience of dizziness or imbalance. Traumatic brain injuries can affect the vestibular system directly, or it may also disrupt the visual and motor systems, leading to challenges in maintaining balance.

Treatment options for persistent dizziness

While most balance impairment and dizziness symptoms subside a few weeks after an injury, these symptoms can persist for a longer period of time for many individuals. Patients experiencing persistent dizziness could benefit from vestibular rehabilitation, which is an exercise-based program that enhances the central nervous system’s compensation of vestibular system dysfunction. A recent study has shown that vestibular rehabilitation was beneficial in improving persistent dizziness, gait, and balance function after a concussion in both children and adults. Children initially may report worse ratings of balance symptoms compared to adults, but they tend to recover faster.

References

Alsalaheen, B. A., Mucha, A., Morris, L. O., Whitney, S. L., Furman, J. M., Camiolo-Reddy, C. E., . . . Sparto, P. J. (2010). Vestibular rehabilitation for dizziness and balance disorders after concussion. Journal of Neurologic Physical Therapy, 34(2), 87-93. doi:10.1097/npt.0b013e3181dde568

Goble, D. J., Rauh, M. J., & Baweja, H. S. (2019). Normative data for the BTrackS balance test concussion-management tool: Results from 10 045 athletes aged 8 to 21 years. Journal of Athletic Training, 54(4), 439-444. doi:10.4085/1062-6050-178-18

Maskell, F., Chiarelli, P., & Isles, R. (2006;). Dizziness after traumatic brain injury: Overview and measurement in the clinical setting. Brain Injury, 20(3), 293-305. doi:10.1080/02699050500488041

Sweeny, M., Inness, E. L., Singer, J., Habib Perez, O., Danells, C., Chandra, T., . . . Mochizuki, G. (2020). The Toronto concussion study: A longitudinal analysis of balance deficits following concussion in community-dwelling adults. Brain Injury, 34(10), 1384-1394. doi:10.1080/02699052.2020.1802665