Outcome after mild to moderate traumatic brain injury: The role of dizziness

University of Toronto, Toronto, ON, Canada.
Archives of Physical Medicine and Rehabilitation (Impact Factor: 2.57). 10/2004; 85(10):1662-6. DOI: 10.1016/j.apmr.2004.02.012
Source: PubMed


To assess the specific effect of dizziness on psychosocial outcome after mild to moderate traumatic brain injury (TBI).
Six-month cross-sectional study. Setting An outpatient TBI clinic in a tertiary care referral center. Participants A consecutive sample of 207 adults with mild to moderate TBI, 138 (66.7%) of whom had subjective complaint of posttraumatic dizziness.
Not applicable.
Psychosocial indices (Glasgow Outcome Scale [GOS], General Health Questionnaire [GHQ], Rivermead Head Injury Follow-Up Questionnaire [RHFUQ], return to work status) were collected from dizzy and nondizzy patients.
Despite similar demographic, TBI, and global disability (GOS) profiles of both groups, psychosocial functioning (GHQ, RHFUQ, return to work) was significantly worse in dizzy subjects ( P <.01 for all indices). A logistic regression analysis identified dizziness ( P =.006), total GHQ ( P =.001), and psychotropic and analgesic use ( P =.05) as significant independent predictors of reemployment.
Although dizziness was closely linked to psychologic distress at 6 months after head injury, it also emerged as an independent predictor of failure to return to work, suggesting that not all its adverse effects on outcome are psychologically mediated. Clinicians need to be alert to the presence of dizziness as an adverse prognostic indicator after mild to moderate TBI.

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    • "Many people with TBI experience physical, sensory, and various neurological symptoms [3] [11] [31] [35] [43], but most research on TBI and employment focuses on cognitive, emotional, behavioral, and social functioning. Few comparisons to previous research can be made, yet relationships between medical symptoms and employment status have been found, such as Chamelian and Feinstein's [3] investigation of dizziness and Stulemeijer et al.'s [43] study regarding pain. Medical symptoms may interfere with a TBI worker's ability to perform physical job functions, such as lifting, bending, and standing/sitting/walking for extended periods of time. "
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    ABSTRACT: Abstract. Using data from the Job Accommodation Network Information System (JANIS), the utility of self-reported functional limitations was examined in relationship to job maintenance for individuals with traumatic brain injury (TBI) who had returned to work. It was found that memory loss and attention/concentration concerns were the most common functional limitations reported. To further establish which limitations were associated with job maintenance, a binary logistic regression was applied. Results suggested that the presence of medical symptoms and emotional dysregulation were reliably and inversely associated with job maintenance. Implications are provided for further research as well as the practice of rehabilitation counseling.
    Journal of Vocational Rehabilitation 01/2013; 39(1):13-21. DOI:10.3233/JVR-130638
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    • "Similarly, postconcussive dizziness (Chamelian and Feinstein 2004; Marzo et al 2004), sleep disturbance (Rao and Rollings 2002), and fatigue (Parsons and Ver Beek 1982; Perlis et al 1997), are common, and their occurrence may confound the neuropsychiatric assessment of persons with mild TBI. The use of anticholinergic agents for posttraumatic dizziness is common in clinical practice, but must be undertaken with vigilance for treatment-emergent cognitive impairment in light of the role of cholinergic deficits in post-traumatic cognitive impairments (Arciniegas 2003). "
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    ABSTRACT: Traumatic brain injury (TBI) is a common occurrence in the United States, with an estimated incidence exceeding 1 million injuries per year. Cognitive, emotional, behavioral, and physical impairments are common sequelae of TBI and may, in a significant minority of patients, persist well into the late period following injury. The etiology of these symptoms in individuals with mild TBI is controversial, with hypotheses of postconcussive symptom formation variously ascribing greater or lesser weight to neural damage, pre- and/or post-injury psychological or psychiatric factors, somatization, malingering, or some combination of these. Some of these hypotheses reflect biases common to medicolegal or compensation-related contexts, whereas others are derived from recent neuroimaging and electrophysiology studies. Studies of the latter sort suggest that many of the typical postconcussive symptoms are associated with neurobiological dysfunction in one or more areas of the central nervous system. Whether these symptoms constitute a postconcussive syndrome per se is debatable. Instead, it may be more accurate to describe them as commonly co-occurring symptoms rather than as a syndromal sequela of TBI. The present review addresses these issues including the epidemiology and course of recovery from mild TBI and the validity of the postconcussive syndrome. Suggestions regarding the assessment and treatment of individuals with post-concussive symptoms are offered.
    Neuropsychiatric Disease and Treatment 01/2006; 1(4):311-27. · 1.74 Impact Factor
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    ABSTRACT: Investigations demonstrated a correlation between oto-neurological illnesses mani-fested subjectively by instability and dizziness and anxiety and other psychiatric disorders. The concept of chronic vertigo offered a systematic approach to patients with a last-ing dizziness not caused by an evident patophysiological vestibular damage. According to newer neurobiological investigations, there are three subtypes of chronic dizziness: oto-genic, psychogenic and interactive. Nowadays there is a greater diagnostic accuracy and insight into the basic pathophys-iological processes of the vestibular migraene, post-concussional syndrom and dysautono-mias that can cause chronic dizziness. Selective serotonin reuptake inhibitors, rehabilitation therapy for restoring the bal-ance, and cognitive-behavioural therapy can be effective in treatment, but this effective-ness is limited.
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