Balance
Balance is frequently found to be abnormal after TBI, as it involves effective integration of the sensory, motor-programming, and musculoskeletal system (73). Cochlear and vestibular function may be impaired.
True vertigo may be present. The clinical exam could be normal, despite children being symptomatic (73). Blocking visual input during quiet standing is a simple and sensitive test for postural instability (74). Gait analysis and vestibular testing may be necessary to evaluate subtle changes leading to imbalance (73). When postural instability is assessed quantitatively, longterm impairment of static and dynamic control of posture is often found after TBI (74,75). It may be related to latency of response and asymmetric stance (76). Treatment options include oral medications, visual therapy, vestibular balance rehabilitation therapy (VBRT), and surgery (77). Oral medications, including meclizine and scopolamine, should be used sparingly, as they could slow the natural compensatory process (77). Specific training with VBRT exercises that promote habituation and/or adaptation and/or substitution can be used (77).
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