Balance Problems after Traumatic Brain Injury (2022)

People with traumatic brain injury (TBI) often have problems with balance. About half of people with TBI have dizziness and loss of balance at some point in their recovery. When you are dizzy, you may have vertigo (the feeling that you or your surroundings are moving) and feel unsteady. You may also feel faint or lightheaded.

Many factors determine how bad your balance problem is, including:

  • How severe your brain injury is.
  • What part of the brain was injured.
  • If you have other injuries along with your TBI. For example, in a car crash, you could have a TBI, neck injury, and broken ribs and legs. All of these injuries will affect your ability to keep your balance.
  • Some medications can have an effect on your balance.

What is balance?

Balance is the ability to keep your body centered over your base of support. When standing, your base of support is your feet. When sitting, your base of support is your butt, thighs, and feet. Many factors affect your ability to keep your balance. These factors include your physical strength and coordination, your senses, and your ability to think.

Most people can control the movement of their body for a time before they lose their balance and need to change their posture or take a step to keep from falling. Changing your posture or taking a step to keep your balance before, during, or after movement is a complex process; TBI may affect this process.

Why is balance important?

Falls are one of the main causes of TBI. Falls affect children (younger than 17) and older adults (older than 65) the most. Improving balance can help prevent TBIs.

If you have poor balance after a TBI, you have a high risk of falling. Falls can cause another TBI or a broken bone. Keeping your balance while sitting and standing is important for doing daily activities. These activities include walking and self-care tasks like bathing, using the toilet, and dressing. Poor balance can keep you from being able to play sports, drive, or work.

Diagnosing balance problems

Several of your body’s systems are involved in keeping your balance. Many health care providers diagnose and treat balance problems. These may include doctors who focus on physical medicine or rehabilitation (physiatrists) or doctors who focus on the nervous system and brain (neurologists). Other providers may include doctors who focus on the ears, nose, and throat (otolaryngologists) and physical therapists (PTs). Your doctor may start by looking at the medicines you take. Medicines are a common cause of balance problems.

PTs and occupational therapists (OTs) use balance tests to identify specific problems and assess your risk for a fall. These tests also measure and track your progress with balance.

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What are common causes of balance problems after TBI?

Medications. Many medicines can make you feel dizzy, lightheaded, and off-balance. These include antibiotics, tranquilizers, and blood pressure, heart, and seizure medicines. Ask your doctor if any of the medicines you take may be causing dizziness or balance problems. A change in medicine or dosage may fix the problem.

Postural hypotension. If your blood pressure drops when you stand or sit up quickly, you may feel lightheaded and dizzy. This can happen when you stand up quickly from sitting on the toilet or a chair or when you get out of bed. Taking your blood pressure while lying, sitting, and standing may help diagnose balance problems caused by your blood pressure.

Vision problems. Eyesight is one of the key senses you need to keep your balance. Problems such as double vision, visual instability, partial loss of vision, and problems with depth perception can make your balance worse.

Inner ear problems. Your inner ear has tiny organs that help you keep your balance. This is called the vestibular system. Your inner ear has three loop-shaped structures called semicircular canals. These canals contain fluid and have fine, hair-like sensors that monitor the rotation of your head. Your ear also has other structures called otolith organs that monitor the linear movements of your head. The otolith organs contain crystals that make you sensitive to movement and gravity. If your TBI damages your vestibular system, you may have balance problems, dizziness, or a sudden feeling that you’re spinning or that your head is spinning.

Problems with your ability to feel things. Nerves in your feet send messages to your brain that help you keep your balance. If your TBI damages these nerves, your brain may not get the messages it needs. In this case, your brain may need to rely more on your eyesight and inner ear to keep your balance.

Brain stem injury. A traumatic injury to the brain stem and cerebellum (the parts of the brain that control movement) can make it hard for you to walk and keep your balance.

Mental health issues. Some people with TBIs have anxiety, depression, or a fear of falling. These issues can cause or increase balance problems. Practitioners call this psychogenic dizziness.

(Video) PoNS Device/Balance Issues/Traumatic Brain Injury

Treatment options

Balance problems have many different causes. Each cause requires a different treatment. Your doctor, PT and OT, and other health care providers will work with you to find out and treat the different causes. Treatment needs to be tailored to your needs. It should also challenge you without compromising your safety.

How can you improve your balance?

  • Be cautious when working on your balance. Make sure you work at the right level to avoid falling when no one is around. A PT or OT can help design a program that is safe for you to practice at home.
  • Increase your strength and flexibility. You can do stretches for your ankle and hip muscles. Other exercises will help strengthen your legs. These include mini squats, toe raises, or standing leg lifts. Go to www.nia.nih.gov/Go4Life for more information about these exercises. You can also talk to your doctor or PT about what you can do.
  • Find your limits in balance. You can do this by moving your body over your feet as far as you can without lifting your feet. This will help you develop strategies to keep from losing your balance. You can also practice movements that allow you to move from one position to another. These movements include going from sitting to standing, reaching above your head to get something off a shelf, or picking up something on the ground.
  • Practice standing or walking in different conditions. Practice standing with your eyes closed. This will decrease your dependence on using your vision for balance. Stand on a pillow; this will improve your ability to use your vision for balance. Change how far apart your feet are; bring them closer together or in front of one another. You can also stand on one leg.
  • Practice activities that will improve your balance while walking. These include walking longer distances; walking and keeping up with someone else while talking; walking over different surfaces, such as on grass and sidewalks; and walking in crowded places such as the grocery store.
  • Try a balance program that is based on evidence and designed for groups. Examples include A Matter of Balance, or the Otago Exercise Program. These programs may be available in your community.

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How quickly can your balance improve?

The extent of your injury and your health status before your injury determine how quickly your balance problems will get better. Some balance problems can be treated effectively in one or two treatment sessions; others can take weeks, months, or years.

Research shows that:

(Video) Rightsided Balance Problems After Traumatic Brain Injury

  • Most people with a TBI can walk on their own within 3 months of their injury. While most people walk again, many have problems moving quickly. They do not have the balance they need to return to activities such as running or sports.

With hard work, people with TBI can continue to improve their balance for many years after injury. But balance problems are more common in people with TBI than in people without TBI.

References

Katz, D. I., White, D. I., Alexander, M. P., & Klein, R. B. (2004). Recovery of ambulation after traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 85(6), 865–859.

McFayden, B. J., Cantin, J.-F., Swaine, B., Duchesneau, G., Doyon, J., Dumas, D., & Fait, P. (2009). Modalityspecific, multitask locomotor deficits persist despite good recovery after a traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 90(9), 1596–1606.

Maskell, F., Chiarelli, P., & Isles, R. (2006). Dizziness after traumatic brain injury: overview and measurement in the clinical setting. Brain Injury, 20(3), 293–305.

Patla, A. E., & Shumway-Cook, A. (1999). Dimensions of mobility: Defining the complexity and difficulty associated with community mobility. Journal of Aging and Physical Activity, 7(1), 7–19.

Williams, G. P., & Schache, A. G. (2010). Evaluation of a conceptual framework for retraining high-level mobility following traumatic brain injury: Two case reports. Journal of Head Trauma Rehabilitation, 25(3), 164–172.

Authorship

Balance Problems after TBI was developed by Michelle Peterson, PT, DPT, NCS, and Brian D. Greenwald, MD, in collaboration with the Model Systems Knowledge Translation Center.

Factsheet Update

Balance Problems after TBI was reviewed and updated by Michelle Peterson, PT, DPT, NCS, and Brian D. Greenwald, MD, in collaboration with the Model Systems Knowledge Translation Center.

(Video) Getting Back Balance After Traumatic Brain Injury

Source: The content in this factsheet is based on research and/or professional consensus. This content has been reviewed and approved by experts from the Traumatic Brain Injury Model Systems (TBIMS), funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR), as well as experts from the Polytrauma Rehabilitation Centers (PRCs), with funding from the U.S. Department of Veterans Affairs.

Disclaimer: This information is not meant to replace the advice of a medical professional. You should consult your health care provider regarding specific medical concerns or treatment. This publication was produced by the TBI Model Systems in collaboration with the University of Washington Model Systems Knowledge Translation Center with funding from the National Institute on Disability and Rehabilitation Research in the U.S. Department of Education, grant no. H133A060070. It was updated under the American Institutes for Research Model Systems Knowledge Translation Center, with funding from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR; grant number 90DP0082). NIDILRR is a Center within the Administration for Community Living (ACL), U.S. Department of Health and Human Services (HHS). The contents of this factsheet do not necessarily represent the policy of NIDILRR, ACL, or HHS, and you should not assume endorsement by the federal government.

Copyright © 2021 Model Systems Knowledge Translation Center (MSKTC). May be reproduced and distributed freely with appropriate attribution. Prior permission must be obtained for inclusion in fee-based materials.

FAQs

How do you regain your balance after brain injury? ›

Struggling with balance problems after brain injury? Try these 12 exercises to help
  1. Build and maintain strength, especially core strength. ...
  2. Build and maintain flexibility. ...
  3. Walking. ...
  4. Gym ball. ...
  5. Balance boards. ...
  6. Weight adjustment. ...
  7. Standing on one leg. ...
  8. Practise walking on different surfaces.
23 Nov 2016

What part of the brain causes lack of balance? ›

The cerebellum controls a number of functions including movement, speech, balance, and posture.

Why does TBI cause balance problems? ›

Balance problems are common after a traumatic brain injury (TBI). Symptoms of dizziness, unsteadiness, or imbalance have been most frequently attributed to sensory organization problems involving the use of visual, proprioceptive, and/or vestibular information for postural control.

What are the four most common obstacles experienced by a person who has had a TBI? ›

Physical barriers to a TBI can include chronic headaches, bladder and bowel difficulties, sensory impairments, muscle weakness, and even temporary or long-term paralysis.

Can balance be restored? ›

Fortunately, balance can be maintained by exercising to strengthen your hips, knees and ankles. These exercises are recommended and used by home health providers and physical therapists. They can help you or a loved one to regain and maintain balance.

What part of the brain controls balance and dizziness? ›

The brain stem and cerebellum are important junctions in the control of balance as they co -ordinate information from the vestibular system, the cerebral cortex, muscles and joints in order to make adjustments to body movements and balance control.

How do you fix lack of balance? ›

Treatment
  1. Balance retraining exercises (vestibular rehabilitation). Therapists trained in balance problems design a customized program of balance retraining and exercises. ...
  2. Positioning procedures. ...
  3. Diet and lifestyle changes. ...
  4. Medications. ...
  5. Surgery.
18 Jun 2020

Can a neurologist help with balance problems? ›

Our neurologists and neurosurgeons diagnose and treat balance dysfunction that is the result of neurologic disorders or neurologic impairment. While the vast majority of balance problems are caused by problems with the inner ear, there may be neurological causes for balance disorders which require neurological care.

Is there medication to improve balance? ›

Fampridine, also known as Fampyra (and in America as Ampyra), is a drug that can help with walking. It helps about one in three people who take it.

How long does it take to walk again after TBI? ›

Most people with TBI are able to walk independently within three months of injury. Although most can return to walking, many continue to have problems with moving quickly and with balance needed to return to high-level activities such as running or sports.

Does frontal lobe damage affect balance? ›

Generally, this loss of voluntary motor control in the body is caused by damage to the motor cortex on the opposite side of the brain. For example, damage to the left side of the frontal lobe may affect movements on the right side of the body. This may affect balance and walking ability.

Can TBI symptoms last for years? ›

One thing we know for sure: people with moderate or severe TBI have multiple physical problems that can last for years. In fact, at least one-fifth of those with more severe injuries have reported difficulties with their physical health—in some cases decades later.

What is the most traumatic brain injury? ›

Falls. Falls from bed or a ladder, down stairs, in the bath, and other falls are the most common cause of traumatic brain injury overall, particularly in older adults and young children. Vehicle-related collisions.

What is the most severe complication of traumatic brain injury? ›

A more severe brain injury can increase the risk of dementia, a group of conditions that cause impaired memory and judgment. Repeated TBIs may also increase the risk of Alzheimer's disease, a type of dementia that causes a progressive loss of memory and confusion.

What are some common disabilities as a result of TBI? ›

In most patients with moderate-to-severe TBI, cognitive difficulties are the most prominent impairments. However, functional difficulties can occur and are more much more common in patients with very severe TBI.
...
  • depressive temperament.
  • irritability.
  • impatience.
  • socialisation problems.

Do balance problems ever go away? ›

Generally, balance disorders last for a couple of days and the patient recovers slowly over 1 to 3 weeks. However, some patients may experience symptoms that can last for several months.

How do I bring my balance back into my life? ›

Balancing Your Life
  1. Build healthy self-esteem. Self-esteem is more than just seeing your good qualities. ...
  2. Receive as well as give. ...
  3. Create positive parenting and family relationships. ...
  4. Make friends who count. ...
  5. Figure out your priorities. ...
  6. Get involved. ...
  7. Learn to manage stress effectively. ...
  8. Cope with changes that affect you.

How do I gain balance again? ›

Easy ways to improve your balance
  1. Walking, biking, and climbing stairs strengthen muscles in your lower body. ...
  2. Stretching loosens tight muscles, which can affect posture and balance.
  3. Yoga strengthens and stretches tight muscles while challenging your static and dynamic balance skills.

What three things control balance? ›

The three components of balance comprise of the visual system (SEE), proprioceptive system (FEEL), and the vestibular system (HEAR – located in the inner ear). The brain integrates and processes all the information from these 3 systems to help us maintain our balance or sense of equilibrium.

What side of brain affects balance? ›

The Cerebellum

This area of the brain is responsible for fine motor movement, balance, and the brain's ability to determine limb position.

What nerve in the brain controls balance? ›

Cranial nerve 8: The vestibulocochlear nerve facilitates balance and hearing.

How long does it take to improve balance? ›

Your balance will not improve overnight, but may improve over just a few weeks. I encourage my patients to take balance training seriously for at least 3 to 4 weeks before expecting significant results.

What is a balance test? ›

This test measures your ability to maintain balance while standing. During this test: You will stand barefoot on a platform, wearing a safety harness. There will be a landscape screen around you. The platform will move around to test your ability to remain standing on a moving surface.

What therapy is used for balance? ›

Balance therapy is also known as vestibular rehabilitation therapy. It uses exercises to help you improve symptoms of balance disorders and reduce your risk of falling.

What surgery is done for balance problems? ›

Labyrinthectomy. A labyrinthectomy is a destructive procedure used for Ménière's disease. The balance end organs are removed so that the brain no longer receives signals from the parts of the inner ear that sense gravity and motion changes. The hearing organ (cochlea) is also sacrificed with this procedure.

What kind of doctor takes care of balance? ›

Audiologists specialize in testing and treatment of many problems associated with hearing and balance disorders that cannot be medically or surgically treated such as hearing aid evaluations and treatment of some balance disorders.

How long does it take to relearn to walk? ›

By 6 months, more than 80% are able to walk independently without physical assistance from another person (Balasubramanian et al., 2014).

Is learning to walk again hard? ›

"Learning to walk again is hard--the hardest thing I've ever had to do," says Howard Rutman, a film maker who was virtually paralyzed in a motorcycle accident last December. Rutman remembers little about the accident -- except excruciating pain.

Can you return to normal after a TBI? ›

The most rapid recovery occurs in the first week after mild TBI. Most patients will be back to normal in a week to a month. Everyone recovers differently. People under the age of 40 get better faster.

What are three symptoms of frontal lobe damage? ›

Some potential symptoms of frontal lobe damage can include:
  • loss of movement, either partial (paresis) or complete (paralysis), on the opposite side of the body.
  • difficulty performing tasks that require a sequence of movements.
  • trouble with speech or language (aphasia)
  • poor planning or organization.

Does frontal lobe damage show on MRI? ›

It's a question we get asked often by our clients who've suffered brain injuries. And the answer is if it's moderate or severe, most of the time it will show up on an MRI. If it's a mild brain injury, often it will not show up on an MRI.

What medication helps frontal lobe? ›

Medications such as Ritalin (also known as methylphenidate) increase frontal lobe activity in individuals who have difficulty with self-regulation and self-control.

Will a TBI show on MRI years later? ›

Long after the injury, MRI as well as CT may demonstrate brain atrophy, which results when dead or injured brain tissue is reabsorbed following TBI. Because injured brain tissue may not completely recover following TBI, changes due to TBI may be detectable many years after an injury.

How long do TBI survivors live? ›

Long-term negative effects of TBI are significant. Even after surviving a moderate or severe TBI and receiving inpatient rehabilitation services, a person's life expectancy is 9 years shorter.

Can a head injury affect you 20 years later? ›

New research led by the Perelman School of Medicine at the University of Pennsylvania shows that a single head injury could lead to dementia later in life. This risk further increases as the number of head injuries sustained by an individual increases.

Do traumatic brain injuries get worse with age? ›

Medically reviewed by Elizabeth Denslow, OTR/L. Can a TBI get worse over time? The short answer is: yes, it can. Every brain injury is different and even though many secondary effects of a brain injury improve with time, others may linger and interfere with rehabilitation.

How long does a traumatic brain injury last? ›

In fact, depending on the severity of the injury, recovery time for a TBI may vary from a few weeks to six or more months. Each person reacts differently to injury and illness. Thus, recovery time will vary between individuals. However, the length of recovery time for TBI depends on how long a patient is unconscious.

What is the most common long lasting effect of brain injury? ›

Traumatic Injury Long-term Effects

“Trauma to the left side of your brain can cause problems with logic, speech difficulties, trouble understanding others or talking, versus right side injury, which can cause problems processing visual information, neglect, or apraxia - the ability to perform regular or familiar tasks.

Does MRI show traumatic brain injury? ›

Newer, specialized MRIs can measure brain function for detecting changes in brain function and structure because of TBI or evaluate the structure of the brain at an even finer level. MRI might show brain atrophy long after the injury, which results when injured or dead brain tissue is reabsorbed after TBI.

What is the best treatment for severe traumatic brain injury? ›

Emergency surgery may be needed to minimize additional damage to brain tissues. Surgery may be used to address the following problems: Removing clotted blood (hematomas). Bleeding outside or within the brain can result in a collection of clotted blood (hematoma) that puts pressure on the brain and damages brain tissue.

How does the brain repair itself after a traumatic injury? ›

The brain “heals” itself following a TBI by rerouting neural connections and dispersing a damaged neuron's job throughout a new network.

What are three cognitive deficits that can occur with a TBI? ›

Cognitive impairments due to traumatic brain injury (TBI) are substantial sources of morbidity for affected individuals, their family members, and society. Disturbances of attention, memory, and executive functioning are the most common neurocognitive consequences of TBI at all levels of severity.

What are the five cognitive problems of TBI? ›

After a TBI it is common for people to have problems with attention, con- centration, speech and language, learning and memory, reasoning, planning and problem-solving. A person with TBI may be unable to focus, pay attention, or attend to more than one thing at a time.

How long does it take to walk after a brain injury? ›

Most people with TBI are able to walk independently within three months of injury. Although most can return to walking, many continue to have problems with moving quickly and with balance needed to return to high-level activities such as running or sports.

How do you train your brain to walk? ›

Practicing rehab exercises that target the legs will help retrain the brain to use the legs with increasing coordination. As movements become more coordinated, individuals can also focus on strengthening the legs through exercise. Some examples of leg exercises for gait rehabilitation include: Seated marching.

How long does it take for your brain to heal from brain damage? ›

A plethora of complications from traumatic brain injuries, ranging from minor cognitive delays to debilitating and life threatening symptoms such as seizures and coma, can follow the victim for years after the injury. You need to know that brain injury recovery time can take anywhere from a few weeks to ten years.

Can brain damage reverse itself? ›

And the answer is yes. The brain is incredibly resilient and possesses the ability to repair itself through the process of neuroplasticity. This phenomenon is the reason why many brain injury survivors can make astounding recoveries.

How long do traumatic brain injury symptoms last? ›

“Recovery is usually within a 30- to 90-day window, with most people recovering from a concussion within days to weeks.” Possible short-term effects include: Headaches. Light sensitivity.

Can you regain ability to walk? ›

Treatments that will help you walk again

In order to regain mobility, you will need to retrain the spinal cord, muscles, and the brain to work together again through specific and repetitive movements. The more you practice these movements, the better developed will become the neural pathways that facilitate navigation.

What part of your brain controls walking? ›

The Cerebellum

This area of the brain is responsible for fine motor movement, balance, and the brain's ability to determine limb position.

What part of the brain affects the ability to walk? ›

Cerebellum. The cerebellum sits at the back of the brain and controls your sense of balance. This allows you to stand up, walk in a straight line, and know if you are standing up or sitting down.

Can a damaged brain get better? ›

Brain injury can take time and effort to recover. Some people may not fully return to their cognitive function before their injury. Over time and with treatment, doctors can work with a person and their loved ones to identify realistic expectations for their recovery.

Do traumatic brain injuries get worse over time? ›

These changes may affect a person's ability to function in their everyday life. Despite initial hospitalization and inpatient rehabilitation services, about 50% of people with TBI will experience further decline in their daily lives or die within 5 years of their injury.

Does brain damage show on MRI? ›

Newer, specialized MRIs can measure brain function for detecting changes in brain function and structure because of TBI or evaluate the structure of the brain at an even finer level. MRI might show brain atrophy long after the injury, which results when injured or dead brain tissue is reabsorbed after TBI.

How do you know if you have permanent brain damage? ›

Cognitive symptoms of brain damage include:
  1. Difficulty processing information.
  2. Difficulty in expressing thoughts.
  3. Difficulty understanding others.
  4. Shortened attention span.
  5. Inability to understand abstract concepts.
  6. Impaired decision-making ability.
  7. Memory loss.
11 Sept 2022

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