Chapter 26.Dizziness, Imbalance, and Vestibular Dysfunction

Dizziness and vertigo have numerous origins, with a reported annual prevalence of over 20% in the general population. Blunt force trauma to the body resulting in an impulsive load on the cervical tissues is one such source; and loading resulting in occlusion of the vertebral artery at cervical vertebrae C1 and C2, a sudden acceleration/deceleration resulting in whiplash, and cervical arthritis or degeneration are all known to result in cervicogenic dizziness (Hain 2015). Conversely, impulsive or direct force applied to the head resulting in traumatic brain injury (TBI) (McCrory et al. 2013) may manifest as dizziness, vertigo, and imbalance, resulting from damage or dysfunction of the vestibular system, which leads to disconcerting sensory conflict. Such sensory conflict can lead to vertigo and/or inappropriate motor responses that compromise the ability to maintain postural stability. Complicating matters for both clinicians and researchers is the overlay of cognitive and psychosocial factors. Regardless of the exact contributing factors, persistent symptoms of dizziness, vertigo, and imbalance can create post-TBI challenges that can have a significant impact on recovery (Yang et al. 2007). Therefore, an appreciation of vestibular function is requisite to understanding, evaluating, and treating dizziness and balance disorders following TBI.