The overlap between dysautonomia and vestibular dysfunction in moderate-severe sub-acute traumatic brain injury
Lead Research Organisation:
IMPERIAL COLLEGE LONDON
Abstract
Background
Traumatic brain injury (TBI) impacts around 68 million individuals globally and stands as the primary cause of death and lasting impairment among those below 40 years old. Half of patients with moderate-severe TBI have persisting symptoms 6 months post-injury, with negative reports of long-term health and overall quality of life. These individuals often encounter disruptions in body regulation, indicating issues with the autonomic nervous system (ANS), a network of nerves that maintain heart rate and breathing rhythm. ANS dysfunction can lead to dizziness and balance problems in about half of TBI patients, significantly increasing the risk of falls. Moreover, research indicates that certain individuals who have experienced TBI are predisposed to falls because they encounter challenges in identifying symptoms of dizziness or imbalance, thereby increasing their susceptibility to falling. This increased fall risk is associated with a higher chance of long-term disability and premature death, underscoring the critical need for awareness among these patients regarding their body changes. In research, we know that problems with balance and the body's automatic functions separately affect people with TBIs. However, we predict that when both systems are dysfunctional the risk of falls will increase in multiplicative manner.
Aim: To understand the mechanistic overlap between the vestibular and ANS in affecting postural control and to ultimately develop targeted and personalized treatment to reduce falls in TBI survivors.
Objectives: (i) neuroimaging to identify regions affected by TBI that may impact ANS and vestibular function (ii) behavioral testing of objective ANS and vestibular function independently and simultaneously in 80 patients; (iii) collect autonomic and vestibular subjective symptom scores, including linked quality of life questionnaires and assessment.
Objective 1: Conduct detailed brain MRI scans to assess changes in brain structure related to traumatic brain injury (TBI). Our main goal is to see if there's an association between these structural changes in the brain and issues with the body's automatic functions and balance.
Objective 2: Using the same group, we will assess the change in blood pressure with lying in supine to standing and then again with vestibular system activation. We expect a rise in blood pressure with healthy participants and a drop in the TBI cohort. We hope to detect any abnormalities that might cause sensations of dizziness or unsteadiness.
Objective 3: Collect quality of life information. Our aim is to grasp how disturbances in their body's self-regulation influence their overall well-being. We're interested in whether they experience increased falls and find it challenging to resume participating in their community or social activities after their injury.
All evaluations will be conducted 3-4 months post injury.
Impact:
TBI survivors suffer from chronic imbalance that worsens both quality of life and longevity, primarily via falls. ANS and vestibular dysfunction are independently linked to falls, however vestibular-ANS overlap and associated brain mechanisms has never been assessed previously. This project will reveal this overlap and enable interventions to treat these under-investigated clinical manifestations of TBI.
Traumatic brain injury (TBI) impacts around 68 million individuals globally and stands as the primary cause of death and lasting impairment among those below 40 years old. Half of patients with moderate-severe TBI have persisting symptoms 6 months post-injury, with negative reports of long-term health and overall quality of life. These individuals often encounter disruptions in body regulation, indicating issues with the autonomic nervous system (ANS), a network of nerves that maintain heart rate and breathing rhythm. ANS dysfunction can lead to dizziness and balance problems in about half of TBI patients, significantly increasing the risk of falls. Moreover, research indicates that certain individuals who have experienced TBI are predisposed to falls because they encounter challenges in identifying symptoms of dizziness or imbalance, thereby increasing their susceptibility to falling. This increased fall risk is associated with a higher chance of long-term disability and premature death, underscoring the critical need for awareness among these patients regarding their body changes. In research, we know that problems with balance and the body's automatic functions separately affect people with TBIs. However, we predict that when both systems are dysfunctional the risk of falls will increase in multiplicative manner.
Aim: To understand the mechanistic overlap between the vestibular and ANS in affecting postural control and to ultimately develop targeted and personalized treatment to reduce falls in TBI survivors.
Objectives: (i) neuroimaging to identify regions affected by TBI that may impact ANS and vestibular function (ii) behavioral testing of objective ANS and vestibular function independently and simultaneously in 80 patients; (iii) collect autonomic and vestibular subjective symptom scores, including linked quality of life questionnaires and assessment.
Objective 1: Conduct detailed brain MRI scans to assess changes in brain structure related to traumatic brain injury (TBI). Our main goal is to see if there's an association between these structural changes in the brain and issues with the body's automatic functions and balance.
Objective 2: Using the same group, we will assess the change in blood pressure with lying in supine to standing and then again with vestibular system activation. We expect a rise in blood pressure with healthy participants and a drop in the TBI cohort. We hope to detect any abnormalities that might cause sensations of dizziness or unsteadiness.
Objective 3: Collect quality of life information. Our aim is to grasp how disturbances in their body's self-regulation influence their overall well-being. We're interested in whether they experience increased falls and find it challenging to resume participating in their community or social activities after their injury.
All evaluations will be conducted 3-4 months post injury.
Impact:
TBI survivors suffer from chronic imbalance that worsens both quality of life and longevity, primarily via falls. ANS and vestibular dysfunction are independently linked to falls, however vestibular-ANS overlap and associated brain mechanisms has never been assessed previously. This project will reveal this overlap and enable interventions to treat these under-investigated clinical manifestations of TBI.
Organisations
People |
ORCID iD |
| Kathryn Lewis (Principal Investigator / Fellow) |