Abstract
Mild traumatic brain injury (mTBI) and concussion substantially burden patients, care providers, and society. The Centers for Disease Control and Prevention (CDC) (Centers for Disease Control and Prevention & National Center for Injury Prevention and Control, 2010) stated that concussion and brain injury symptoms could persist for days, weeks, or longer, and that recovery can be slower for old individuals, young children, teens, and those with a prior traumatic brain injury (TBI) history. Evidence shows that individuals with mTBI can have delayed recovery with limited community integration and substantial long-term disability. Also, considerable evidence from multiple sources underscore the association between mTBI and the increased rate of suicide, suicide attempt, and suicide ideation. Yet, according to the New York Academy of Science, there is limited concordance between neurobiological explanations for concussion and neuropsychological functions. Current medical research is equivocal on the prognosis rate of recovery and duration of mTBI, particularly after many months. While some experts suggest that those not showing signs of improvement are a distinct group of patients that have “intentional” TBI symptoms (e.g., for litigation and disability entitlement purposes), many individuals genuinely suffer from sensory dysfunctions months post-TBI. Using an evidence-based approach, we review the relevant literature on the chronic somatosensory dysfunctions emanating from mTBI/concussion, including vestibular dysfunction, and start by presenting a clinical case. It is believed that vestibular dysfunctions (e.g., ataxia, benign paroxysmal positional vertigo (BPPV), and persistent postural-perceptual dizziness (PPPD), just to name a few), whether due to a central or peripheral lesion and with impact on return to work or to sport that affects roughly half of acute TBI patients, tend to be cryptogenic in nature in chronic TBI cases. In forensic detailed evaluations, it is often challenging to separate the cognitive impact of mTBI from the vestibular issues alone. Furthermore, assessment of vestibular dysfunction (e.g., dizziness, vertigo, nystagmus, imbalance, and persistent nausea), diagnostic criteria, neurocognitive consequences, psychiatric comorbidities with psychological impacts, and treatment approaches (e.g., pharmacotherapy and rehabilitation), with emphasis on implications for neuropsychological assessment practice, and future research guideline are discussed. Also reviewed is the nosology of vestibular dysfunction and mTBI.