Advancing Rehabilitation: Physiological, Psychological and Neuroimaging Measures of Factors that Predispose, Promote, and Perpetuate Post- Traumatic Dizziness
Abstract
Vestibular symptoms (vertigo, unsteadiness, dizziness, or gait imbalance) are among the most common and pernicious symptoms of mild traumatic brain injury (mTBI). When present, they delay or reduce the likelihood of affected individuals returning to military duty, athletic activities, or work. State-of-the-art therapeutic interventions are symptom-focused because there are no clear models of pathophysiological mechanisms that may be causing post-mTBI vestibular symptoms. As a result, at least 20 percent of patients remains chronically ill, often disabled, even with expert care. The leading mechanistic hypotheses include failure to compensate for peripheral vestibular injury (possibly otolith damage) and diffuse axonal injury. Psychosocial factors may play a role as well, but there are no specific processes that link these to post-mTBI vestibular morbidity. Various lines of research on chronic vestibular symptoms in patients without TBI have consolidated around a novel model of illness. Experts have begun to move away from a focus on the putative long-term structural effects of acute peripheral or central deficits to a model of illness that describes the onset of chronic symptoms as a dynamic interaction of clinically observable physiological and psychological processes that produce functional changes in locomotor control (stiffening of posture and gait) and reweighting of multi-modal space-motion information processing to favor visual stimuli (visual dependence). Evidence from researchers worldwide has identified psychological risk factors that interact with acute injuries (vestibular, headache, autonomic, or cardiac disorders and psychological distress) to promote a transition from acute to chronic symptoms maintained by persistent postural stiffening and visual dependence. The recently defined vestibular disorder of persistent postural-perceptual dizziness (PPPD) embodies these new concepts.
Document Details
- Document Type
- Technical Report
- Publication Date
- Oct 01, 2019
- Accession Number
- AD1097641
Entities
People
- Jeffrey P Staab