(I failed to read the blog right before creating my post and
Mia beat me to it. I guess great minds think alike!)
While studying the ear, we focused primarily on the sensory
conduction of sound waves; however, another aspect of the inner ear and its
associated regions of the brain includes the vestibular system. The vestibular system provides sensory input
about equilibrium, spatial awareness, rotation and linear movement, but it must
also work in conjunction with visual and touch receptors to allow us to achieve
balance.
Redirecting our focus specifically to the vestibular system,
we understand that it contributes to our body’s ability to maintain
balance. It is comprised of 5 main
structures: 3 semicircular canals (anterior, lateral and posterior) and 2
otolith organs (the utricle and saccule) that are sensitive to angular and
linear accelerations, respectively. Each of the semicircular canals is filled
with endolymphatic fluid that exerts pressure against sensory receptors within
the canal that corresponds to the direction in which the head rotates. The nerve impulses that are subsequently generated
synapse in the brainstem, cerebellum and cerebral cortex. To maintain balance and symmetry, it is
imperative that the vestibular structures on either side of the head fire nerve
impulses in sync with each other.
When disease or trauma causes damage to our vestibular
system, several disorders can result. In
particular, athletes, like soccer players who repeatedly head the soccer ball, are
prone to sustaining injuries that damage their vestibular systems. For one collegiate soccer player, one too
many of these headers caused concussions, which then led to severe headaches,
spotted vision, dizziness, and fogginess on a regular basis. These symptoms became so intense that
day-to-day tasks such as driving became difficult to complete. Eventually, her doctor found the source of
her problems to be her vestibular system, and she began vestibular
rehabilitation therapy, which involved exercises for her eyes, body and
head. The goal of therapy was to
“retrain her brain” to identify and integrate impulses from the vestibular
system and synchronize them with sensory information from vision and touch
receptors. Now a college graduate and at the beginning of her career, it took
several months of therapy for this retired soccer player to learn to drive only
short distances on side streets, and she is just now starting to work her way
up to highway speeds.
References:
1. Understanding vestibular disorders; the human balance
system. Vestibular Disorders Association. [Internet] Available from: http://vestibular.org/understanding-vestibular-disorder/human-balance-system.
2. Emmanuel A. 2013. Former Loyola athlete had to ‘retrain
her brain’ after multiple concussions. DNAinfo Chicago. [Internet] Available
from: http://www.dnainfo.com/chicago/20131030/andersonville/former-loyola-athlete-had-retrain-her-brain-after-multiple-concussions.
Danielle, perfectly timed post! :) I didn't think about head injuries affecting the vestibular system before this and didn't realize that PTs and OTs can help with vestibular rehabilitation therapy. I did a quick google search and it looks like repetition is also the key here (as it was with my post), as well as "general" fitness. To overcome problems with certain movements, therapy can involve repeating those movements until dizziness or other symptoms go away. Did the soccer player regain all of her abilities or was there permanent damage?
ReplyDeleteReference:
http://vestibular.org/understanding-vestibular-disorders/treatment/vestibular-home-therapy
The article was only just published at the end of October and ended by saying that she has come leaps and bounds in regaining most of her abilities with everyday tasks, but is still struggling with driving because there are so many stimuli, especially visual, that it's almost sensory overload for her. It seems as though she becomes overwhelmed and has panic attacks in these types of situations. She's working up to faster speeds and greater distances, and particularly accomplishing them on her own without someone in the passenger seat in case something goes wrong. However, it has been a long process seeing as how it has been over 2 years since she graduated from college.
DeleteThis past summer, I worked in a Sports Performance Complex where I was able to shadow a variety of doctors. One of the doctors I shadowed treated concussion patients. Her main role for concussion patients was prescribing medications, but she also ensured that her patients were staying on track with their vestibular therapy (there was a concussion center in the complex where the patients went for vestibular therapy). From talking to her, I learned that when the vestibular system is compromised from a concussion, it makes the severity of the concussion much worse. However, once the vestibular system is able to recover, quality of life for the patient is much better.
ReplyDeleteVestibular therapy involves exercises that the patient can do both in the office and at home on their own. Some of these exercises involve rotating the head while keeping eyes steady, working on balance by walking in a straight line but allowing eyes to scan peripherally, and strengthening the eye-ear reflex. Essentially, like Danielle, mentioned, all these exercises help to restore the vestibular system back to its pre-concussion state. However, the one issue I saw in the clinic with concussion patients was noncompliance. The doctor I shadowed made sure to stress the importance of doing these exercises at home on their own, and not only when they had appointments. I also learned that for some of the patients, the vestibular therapy can be exhausting and cause more severe headaches than they already had, which contributed to the noncompliance rate.
Home program vestibular rehabilitation exercises. Colorado ENT and Allergy. http://www.coloradoent.com/home-program-vestibular-rehabilitation-exercises