Unstable Balance: Elizabeth Part Five
Unstable balance is one of the biggest issues that put Elizabeth at risk for another fall that could cause additional brain injury. Her chances of another blow to the head was substantial.
Elizabeth is a poster child as to how dangerous a second blow to the head can be for someone with a history of TBI and unstable balance. There are many reasons for this, but it largely comes down to the cumulative effect of each neurological insult, and even a mild TBI can be the proverbial straw that broke the camel’s back . There is little controversy in the medical world that the second injury can come with the risk of further brain injury. A fairly conservative text on Neuropsychiatry, in a chapter written by two well-known insurance company doctors, even acknowledges such risk:
Having one previous head injury increases the risk three-fold for having another head injury, and two previous head injuries increase the risk eight fold. Having a previous head injury may prolong recovery and disability from a second injury. The hypothesis is that head injuries deplete the cognitive reserve capacity that is necessary to sustain vigilance for hazards and to bounce back from injury.
From Neuropsychiatry: A Comprehensive Textbook Schiffer, Rao, Fogel, 2003, page 1157, from a chapter by Thomas Hammeke, Ph.D. and Thomas Gennarelli, M.D. http://www.amazon.com/Neuropsychiatry-Comprehensive-Textbook-Randolph-Schiffer/dp/0781726557/ref=sr_1_1?ie=UTF8&s=books&qid=1299527668&sr=1-1
Of all of the risk factors that create a greater hazard for the second injury and the risk of further brain injury, unstable balance problems, which come secondary to head injury, are perhaps the worst. Elizabeth’s case fits squarely within that category. When asked what her biggest issues were, she talks about her unstable balance:
The balance issues (unstable balance) with the dizziness, and I was able to handle a lot of that really well. It took my neurologist and my family doctor and my husband, and I have to be careful. I know I have to be careful, like using the shower, walking in the wintertime where there’s ice, walking up and down stairs. I know I can’t reach straight up over my head, but I can reach at an angle, and so working with all of that, you know, helped my dizziness and was helping me be able to do normal things. And the second accident after that the dizziness hit more if I’d sit up in bed. You know, you wake up, you sit up and, I mean, if the phone’s ringing or anything you can jump up and run, you know, to answer the phone. I can’t do it.
She got unstable balance therapy after her first injury, consisting of:
What they had me do is with the physical therapist and you know how you lift weights and squatting and standing up straight, and so the things they were helping me learn all over again that really helped me and I was good at it, and so I knew what would make me dizzy and what I should not even try to do, and that’s what helped.
The dizziness and unstable balance problems persist to this day.
The biggest problem I have is the dizziness because I’ve, doing everything I can do, and the dizziness can be good. It can make it up to six months without a problem or anything and all of a sudden it snaps and it’s kind of like, I, and it’s not fear, and I know I’m not going to get what word it should be or – I don’t think it’s anxiety but it’s doing something that you normally do every day and it hasn’t happened in how long and all of a sudden I, that’s when I snap and I lose it. I don’t understand it so I get frustrated. I yell. I cry. I’m scared but like you said it’s like an eighth grader. I can’t, I can’t connect.
One wonders if she has had a full work up for unstable balance, dizziness and vertigo. She is unfamiliar with any of these terms: benign positional vertigo, BPV, BPPV or even “vestibular” as in vestibular disorder. Click here for a glossary of dizziness and balance terms. She clearly has not had all of the tests a neurootologist would give her. What did they do to test her unstable balance?
Normally stand up, sit down. They, they do the testing my flexibility. You know that they’ve done and being able to stand, how long can you stand up, stand straight, reaching up over my head. I, I can reach at an angle but if I put my hands straight up over my head the dizziness can start. If I hold my, if I hold my arms up that high and I wait the dizziness can start.
Her husband agrees that dizziness and unstable balance are amongst her ongoing problems:
Yes, her biggest issue is her dizziness. I mean, if I would stand up, she would probably, I mean if she would do it as fast as I do, she would probably fall down.
Whether her unstable balance problems are the reason she had her second fall is not clear, but they certainly could contribute to it. Even an intermittent dizziness or unstable balance problem can cause a fall, and falls are one of the biggest causes of TBI. Dizziness can also be a major source of anxiety in someone with a brain injury. Emotional stressors and pain can also bring on dizziness. Elizabeth thinks that dizziness is part of a physiological response to her symptom complex:
I don’t (think anxiety) creates it. I think its part of it. I think the, the nervousness and the, the fear of the not understanding. When it hurts so bad I think the dizziness comes because of that.
It is critical that anyone with a head injury get the maximal dizziness and balance therapy, as the consequences of a TBI in the next fall, can be as dire as they were for Elizabeth. Preventing another fall is paramount in her approach and cutting back on most of her pre-injury activities:
Volleyball you can hit your head again and my neurologist and my other doctors have said it’s been hit twice. That’s enough for it. It can’t, it can’t go again. I’ve already gone downhill. If I hit it again they don’t know what it’s going to do or what I’m going to come out like and so that’s, that’s the one thing I have to deal with every day and I know that so I can’t, I can’t do volleyball. I can’t water ski. If I do fish I can’t do a lot of things alone. Somebody’s got to be with me and watch me like a hawk so I don’t slip, so I don’t fall.