All ETDs from UAB

Advisory Committee Chair

Jennifer B Christy

Advisory Committee Members

Claudio Busettini

Tamara Oechslin

Talene Yacoubian

Document Type

Dissertation

Date of Award

2021

Degree Name by School

Doctor of Philosophy (PhD) School of Health Professions

Abstract

Dizziness and imbalance are commonly reported by people with concussion and people with multiple sclerosis (MS). Dysfunction of the vestibular system is likely a major cause of dizziness and imbalance in both diseases, but it is not well understood whether this dysfunction typically occurs in peripheral vestibular organs and pathways or higher-level central vestibular integration pathways. As these systems are assessed and targeted with rehabilitation differently, understanding how both are affected in these diseases will improve management of dizziness and imbalance. In addition, balance has been demonstrated to correlate with self-reported fatigue in people with MS, presumably through shared dysfunction of sensory integration pathways. However, the relationships between other vestibular functions and fatigue in people with MS have not been explored. Better understanding of this potential relationship could lead to rehabilitation to simultaneously improve balance and fatigue in people with MS. This dissertation aims to describe peripheral and central vestibular functions in people with concussion and people with MS when compared to controls, as well as to explore the hypothesized relationship between central vestibular integration and fatigue in people with MS. Results are presented through three study chapters. Peripheral vestibular deficits were not commonly identified in people with concussion or MS, but measures requiring central integration of vestibular information were frequently worse when compared to controls. These results suggest that peripheral organ and brainstem nuclei are typically intact in both diseases but iv that cortical pathways processing the input from these structures is impaired. Both balance dysfunction and other central vestibular integration measures correlated with self-reported fatigue and objective physical fatigue in people with MS, suggesting that fatigue may be associated with impairment in central sensory integration pathways in people with MS. These results help identify clinical measures of central vestibular integration that should be included in a dizziness and imbalance workup of people with concussion or MS and suggest that fatigue should be included as a secondary outcome measure of future studies of vestibular rehabilitation in people with MS, and potentially with concussion as well.

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