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
  • Source
    • "Generally, symptoms lasting more than three months are considered PCS (Bigler, 2008).Mild TBI can arise as a result of explosive blasts or blunt forces on the battlefield. Blastrelated injuries account for more than 80 percent of all battlefield injuries in Iraq and Afghanistan (Hoffer et al., 2010). They can result from improvised explosive devices (IEDs), rocket-propelled grenades (RPGs), and landmines. "

    Full-text · Technical Report · Apr 2014
  • 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.
    Full-text · Article · May 2013 · Neurorehabilitation
    • "m , & Davies , 2010 ) , spasticity ( Zafonte , Elovic , & Lombard , 2004 ) , impaired balance ( Lendraitiene & Krisciunas , 2010 ) , hemiparesis or hemiplegia ( Denes , 2009 ) , tremor and ataxia ( Andrew , Fowler , Harrison , & Kendall , 1982 ; Iwadate et al . , 1989 ; Mandelcorn , Cullen , & Bayley , 2004 ; Obeso & Narbona , 1983 ) , dizziness ( Hoffer et al . , 2010 ; Maskell , Chiarelli , & Isles , 2006 , 2007 ; Peterson , 2010 ) , post - traumatic epilepsy ( Perron , Brady , & Huff , 2001 ; Schwartz et al . , 2008 ) , oro - pharyngeal dyspha - gia and swallowing disorders ( Terre & Mearin , 2007 ) , oro - facial hypersensitivity ( Gilmore , Aram , Powell , & Greenwood , 2003 ) , and urinary and f"
    [Show abstract] [Hide abstract]
    ABSTRACT: Brain injury can directly and indirectly affect important aspects related to sexuality and sexual function. In this critical review of the literature, traumatic brain injury (TBI) and sexuality are examined. A general review of the concept of sexuality and the neurological correlates of sexual function are proposed as a framework to understand the cognitive, behavioral and physical effects of TBI on sexuality and sexual function. Studies are then classified according to the participants enrolled and findings are presented from the professional's, the survivor's, the patient/partner's, and the non-injured spouse's perspectives. Results are discussed taking into account methodological limitations and knowledge gaps. Next, implications for sexual rehabilitation for individuals with TBI are discussed. Finally, suggestions for future research and their pertinence for improving rehabilitation outcomes are considered.
    No preview · Article · Feb 2013 · Neurorehabilitation
Show more