Equilíbrio corporal no traumatismo cranioencefálico: da avaliação à reabilitação

Abstract

Introduction: Traumatic Brain Injury (TBI) is a silent epidemic that affects millions of people around the world, causing physical and functional sequelae, causing physical and functional sequelae, including the difficulty in maintaining body balance. Purpose: evaluate vestibular, oculomotor and postural functions in subjects with TBI sequelae and the effectiveness of vestibular rehabilitation in the recovery of these functions. Methods: subjects with TBI sequelae underwent anamnesis, cognitive, visual and hearing screening and the procedures: audiological assessment, Dizziness Handicap Inventory (DHI), tests of motor coordination and static and dynamic balance, Dix-Hallpike and Head Roll Test, Foam Laser Dynamic Posturography (Sensory Organization Test - SOT), Computerized Vectoelectronistgmography (VENG), Cervical Vestibular Evoked Myogenic Potential (cVEMP) and ocular (oVEMP). Subsequently, they underwent vestibular rehabilitation through repositioning maneuvers for Benign Paroxysmal Positional Vertigo (VPPB), followed by the adapted Cawthorne-Cooksey protocol. To compare the results before and after the intervention, Wilcoxon and McNemar's paired tests were used, Spearman's Test was used for correlations and for comparison of independent samples the Mann-Whitney U test, using the computer application STATISTICA 9.1, with a significance level of 5%. Results: traumatic BPPV was observed in five (31.25%) subjects. SOT alterations involved all systems, but mainly the vestibular and visual preference. In VENG, they presented altered saccades, pendular and optokinetic tracking, in addition to asymmetries in the rotational and caloric tests. There were changes in cVEMP and oVEMP, including latency, amplitude, asymmetry index, as well as lack of response uni or bilaterally. The analysis indicated a severe handicap in the DHI. The subjects showed improvement in all SOT positions, and in all systems, but significantly in the vestibular after the intervention. There was a significant decrease in oculomotor alterations and a significant increase in symmetry in the rotational and caloric tests. There was a significant improvement in the asymmetry index in the cVEMP, as well as in the latencies and amplitudes of the oVEMP, with a decrease in altered cases after rehabilitation. In the DHI, there was a significant decrease in the score of all aspects, changing the general handicap from severe to mild. Conclusion: The subjects presented vestibular, vestibulo-visual, postural and visual symptoms. The SOT and the oculomotor and vestibular tests showed important changes in the vestibulo-ocular and postural system, with a significant improvement in scores and a reduction in altered cases after the intervention. VEMPs showed alterations in the vestibulo cervical and vestibulo-ocular pathways regardless of the severity of the TBI, with significant improvement in latency and amplitude values in the cVEMP and the asymmetry index in the oVEMP, a decrease in altered cases and the handicap caused by dizziness after intervention.