Blast Exposure: Vestibular Consequences and Associated Characteristics

Spatial Orientation Center, Department of Otolaryngology, Naval Medical Center San Diego, CA 92134-2200, USA.
Otology & neurotology: official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology (Impact Factor: 1.79). 12/2009; 31(2):232-6. DOI: 10.1097/MAO.0b013e3181c993c3
Source: PubMed


To characterize vestibular and related symptoms seen after blast exposure.
Prospective single-subject design.
Tertiary care facility and military field hospital.
Active-duty US Military personnel exposed to blast(s) in Iraq and/or Afghanistan.
Vestibular function tests, auditory tests, and a structured history and physical examination.
Blast exposure induced vestibular disorders, and related symptoms are significantly different than those seen in blunt head trauma. The vestibular characteristics and objective tests of vestibular function significantly worsen in blast-exposed patients as a function of time between injury and presentation.
Blast exposure produces a unique set of vestibular disorders and associated symptoms that progress over time. Understanding the characteristics of these symptoms as they vary over time may be critical in designing treatment strategies that modify long-term outcome.

Download full-text


Available from: C.D. Balaban, Jan 01, 2014
70 Reads
  • Source
    • "Early assessment of the vestibular system may help to differentiate between dizziness that arises from the metabolic insufficiency and symptoms related to vestibular dysfunction. Other contributors to early persistent dizziness may include post-traumatic migraine (Hoffer, 2010; Donaldson, 2010), cervical spine dysfunction (Wrisley, 2000), visual-perceptual dysfunction (Kapoor, 2002), and autonomic dysfunction (Leddy, 2007). As dizziness following concussion has been shown to be a marker of poorer prognosis and prolonged recovery as noted above (Lau, 2011), careful early assessment and treatment of these areas should be considered. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Vertigo, dizziness, and imbalance are a symptom complex that is commonly found following concussion. Early metabolic changes following concussion may lead to worsening of the injury and symptoms in individuals not properly managed from the outset. When symptoms do not recover spontaneously, skilled vestibular rehabilitation can be an effective modality in an attempt to normalize the individual's vestibular responses. The purpose of this review is to appraise the current and accepted methods available to the skilled clinician in quantifying and treating vestibular dysfunction following concussion. Incidence and prognostic indicators will be reviewed along with common barriers to recovery. Vestibular Rehabilitation following concussion utilizes similar tools and techniques employed when treating those solely with peripheral pathology. The clinician must not only have a solid understanding of when and why certain exercises are required, but also be willing to accept that less exercise may be indicated in this population. As injury to the system following mild traumatic brain injury can include both peripheral and central structures, the duration of therapy and the time to recovery may be prolonged. Co-morbidities including cognitive and behavioral issues, visual-perceptual dysfunction, metabolic dysfunction, and autonomic dysfunction may hamper the effectiveness of the traditional Vestibular Rehabilitation approach. As successful treatment does not occur in a vacuum, working closely with other disciplines well versed in treating these co-morbid issues will help the individual to obtain optimal recovery. Vestibular Rehabilitation is an effective modality for managing dizziness, vertigo, and imbalance following concussion. Careful consideration of the acuity of the injury, along with effective management of co-morbid conditions will optimize the result.
    Neurorehabilitation 05/2013; 32(3):519-28. DOI:10.3233/NRE-130874 · 1.12 Impact Factor
    • "The majority of individuals suffering from blunt and blast trauma will have abnormalities in both the sensoryorganization test and motor control posturography tests. In this test, as much as 70% of those with symptomatic balance complaints from mTBI will show abnormalities if untreated even if they present 18 months after their injury [5] [6]. Currently, the Department of Defense utilizes virtual reality based therapy programs to rehabilitate wounded warriors [8]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Advanced technology such as virtual reality or immersive environments increases the complexities and challenges therapists can impose on their patients. In this study, four patients with mild traumatic brain injury utilized a Computer Assisted Rehabilitation Environment (CAREN) in place of traditional vestibular physical therapy. Patients visited the CAREN twice weekly for 6 weeks. Therapy sessions included a variety of applications that tasked the cognitive and physical capabilities of individual patients. After the 6 weeks, all patients showed improvement on balance, gait and visual measures. Virtual reality based therapy is an engaging and effective tool to treat patients with deficiencies related to a prior brain injury.
    Conference proceedings: ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Conference 08/2012; 2012:6141-4. DOI:10.1109/EMBC.2012.6347395
  • Source
    • "There is currently no objective diagnosis for mbTBI, a minimal understanding of its underlying pathologies, and consequently a lack of specific, evidence based treatments. Symptoms of blast-induced TBI (bTBI) include increased anxiety as well as memory impairment that may not be detectable for weeks or months after the exposure (Ryan and Warden, 2003; Okie, 2005; Nelson et al., 2009; Terrio et al., 2009; Cernak and Noble-Haeusslein, 2010; Hoffer et al., 2010). The delayed onset of neurobehavioral impairments suggests a lasting secondary injury process involving distinct brain regions (Moser and Moser, 1998). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Mild traumatic brain injury (mTBI) represents a significant challenge for the civilian and military health care systems due to its high prevalence and overall complexity. Our earlier works showed evidence of neuroinflammation, a late onset of neurobehavioral changes, and lasting memory impairment in a rat model of mild blast-induced TBI (mbTBI). The aim of our present study was to determine whether acute treatment with the non-steroidal anti-inflammatory drug minocycline (Minocin(®)) can mitigate the neurobehavioral abnormalities associated with mbTBI, Furthermore, we aimed to assess the effects of the treatment on select inflammatory, vascular, neuronal, and glial markers in sera and in brain regions associated with anxiety and memory (amygdala, prefrontal cortex, ventral, and dorsal hippocampus) following the termination (51 days post-injury) of the experiment. Four hours after a single exposure to mild blast overpressure or sham conditions, we treated animals with a daily dose of minocycline (50 mg/kg) or physiological saline (vehicle) for four consecutive days. At 8 and 45 days post-injury, we tested animals for locomotion, anxiety, and spatial memory. Injured animals exhibited significantly impaired memory and increased anxiety especially at the later testing time point. Conversely, injured and minocycline treated rats' performance was practically identical to control (sham) animals in the open field, elevated plus maze, and Barnes maze. Protein analyses of sera and brain regions showed significantly elevated levels of all of the measured biomarkers (except VEGF) in injured and untreated rats. Importantly, minocycline treatment normalized serum and tissue levels of the majority of the selected inflammatory, vascular, neuronal, and glial markers. In summary, acute minocycline treatment appears to prevent the development of neurobehavioral abnormalities likely through mitigating the molecular pathologies of the injury in an experimental model of mbTBI.
    Frontiers in Neurology 07/2012; 3:111. DOI:10.3389/fneur.2012.00111
Show more