High-level vestibular impairment in a veteran with mild traumatic brain injury

Background: Imbalance, dizziness and impaired dual tasking are common symptoms reported by veterans with mild traumatic brain injury (mTBI). According to a Congressional Research Service report in 2014, approximately 220 000 veterans have sustained TBI in Iraq and Afghanistan wars, with 82.4% diagnosed with mTBI. Symptoms of subtle balance impairment, resulting in decreased ability to dual-task are frequently overlooked during the initial evaluation. Therefore, clinicians need to detect these symptoms and establish a treatment plan to address the underlying causes. Currently, few studies have addressed imbalance as a result of subtle balance impairment in patients with mTBI, and none has examined veterans with mTBI. Aims: The aim of this study was to develop a systematic approach to the assessment and treatment of imbalance in a veteran with mTBI. The imbalance was a result of impairment in the constitutional components, i. e. somatosensory, vestibular and visual inputs to the brain. Methods: The patient was a 56-year-old veteran with mTBI and post-traumatic stress disorder, secondary to improvised explosive device blast exposure during the Iraq war in 2005. He was evaluated with clinical vestibular assessments, Dizziness Handicap Inventory, Activities-specific Balance Confidence Scale, functional gait and balance analyses, and posturography to determine sensory organisational deficits. The patient's past medical history did not show any comorbidity resulting in imbalance. The patient received one therapy session per week for 8 weeks to address his balance and sensory deficits. Data from outcome measures were analysed and compared with those collected at baseline. Results: The results indicated that the patient improved significantly on measures of balance and sensory integration deficits after the treatment protocol. Conclusions: Data from the sensory organisation test provided a reliable basis for the identification and treatment of balance deficits in a veteran with mTBI. An intervention, emphasising visual, vestibular and somatosensory integration, may result in significant improvement of the patient's functional balance.