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Identifying Lingering Balance Issues as a Result of a Brain Injury

By on June 21, 2019
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What is a mild-to-moderate traumatic brain injury?

A brain injury, or more specifically a mild-to-moderate traumatic brain injury, refers to damage to the brain caused by a “traumatic” event such as a car accident, a sports injury, or a work-related accident. Mild-to-moderate is often classified as minimal loss of consciousness lasting less than 24 hours and/or minimal amnesia lasting less than 7 days. A concussion is a type of mild-to-moderate brain injury in which the affected individual may not necessarily lose consciousness. 

What are the consequences of a mild-to-moderate brain injury?

Many associate brain injuries with long-term symptoms that may include cognitive (thinking) issues, communication issues, emotional issues, and behavioural issues. What some patients and caregivers may not realize is that mild-to-moderate brain injuries can often lead to long-term physical issues. These may include balance and coordination problems that can result in difficulty walking, trouble climbing stairs, a high risk of falling, and an inability to do simple, everyday functional self-care or household management tasks. Some are unable to return to work or resume the hobbies or activities they engaged in prior to their injury. 

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What are the shortcomings of current standard-of-care physical therapy?

Even after months of standard-of-care rehabilitation therapy, it is estimated that 10%-40% of people who have balance issues following a mild-to-moderate traumatic brain injury do not fully recover. Long-term balance and coordination issues, also known as chronic balance deficit, may continue to persist or last a lifetime. With little advancements in rehabilitation therapy in the past few decades, healthcare providers are left with little hope of helping improve their patients’ persistent balance symptoms. 

What is neuroplasticity and how has it led to new treatment innovations?

Neuroplasticity refers to the ability of the nerves and the network of nerves of the brain (also known as neurons) to change, adapt, and reorganize their connections and behaviour in response to new information, sensory stimulation, development, damage, or dysfunction. 

Researchers from the University of Wisconsin have discovered that stimulating the nerves in the tongue using mild electrical pulses translates into stimulation of the cranial nerves that have direct connections into the brain through the brainstem – the part of the brain that controls posture and balance. When the stimulation is combined with physical activity, changes may occur in the neural (nerve) network. Training helps re-organize the neural pathways and facilitates the recovery of function, which in turn may result in improvements in balance and gait. 

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Neuromodulation-based treatment is now available in Canada

Research in tongue stimulation led to the development of an innovative, non-invasive medical device that has recently become available in Canada, called the Portable Neuromodulation Stimulator, or PoNS. This device, only available by prescription in Canada, delivers mild stimulation to the tongue and is used in conjunction with physical therapy (read more at ponstreatment.ca). 

Clinical trials resulted in nearly 70% of participants experiencing significant improvements in their balance. In a 14-week long-term treatment trial, this benefit persisted for at least 12 weeks following the end of PoNS Treatment™. As a result of improving balance and gait, some of the most impactful and meaningful goals that participants were able to achieve included the ability to perform independent self-care tasks such as dressing, showering, walking up and down the driveway, and going grocery shopping. 

This innovation expands treatment options and provides hope for people with chronic balance deficit due to mild-to-moderate traumatic brain injury.

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Kim Skinner is a licensed physical therapist with a doctorate in Physical Therapy from the University of St. Augustine for Health Sciences. She is the Director of Physical Therapy at Helius Medical Technologies.