Balance Problems After Traumatic Brain Injury

Michelle Peterson, PT, DPT, NCS, and Brian D. Greenwald, MD, Model Systems Knowledge Translation Center
Balance Problems After Traumatic Brain Injury

People with traumatic brain injury (TBI) commonly report problems with balance. Between 30% and 65% of people with TBI suffer from dizziness and disequilibrium (lack of balance while sitting or standing) at some point in their recovery. Dizziness includes symptoms such as lightheadedness, vertigo (the sensation that you or your surroundings are moving), and imbalance.

How bad your balance problem is depends on many factors:

  • How serious your brain injury is.
  • Where in your brain you were injured.
  • Other injuries you had along with your brain injury. For example, in a motor vehicle crash, you could suffer a TBI, cervical spine injury, and rib and leg fractures. All of these injuries will affect your ability to maintain your balance.
  • Some medications used to manage the medical issues connected with the traumatic event or accident.

What is balance?

Balance is the ability to keep your body centered over your feet. The ability to maintain your balance is determined by many factors, including your physical strength and coordination, your senses, and your cognitive (thinking) ability.

Most people can control their body movement within certain limits before losing their balance and needing to adjust their posture or take a step to keep from falling. Adjusting your posture or taking a step to maintain your balance before, during, and after movement is a complex process that is often affected after brain injury.

Why is balance important?

When you have poor balance you have a high risk of falling and having another brain injury or broken bone. Maintaining balance while sitting and standing is important for all of our daily activities, including self care and walking. Poor balance can keep you from taking part in many types of activities, such as sports, driving, and work.

Diagnosing balance problems

Many different kinds of health care providers may be involved in diagnosing and treating balance problems, including physiatrists (physical medicine or rehabilitation doctor), neurologists, otolaryngologists (ENT), and neuro-ophthalmologists. The first place to start is by having your physician review your medications, since this is a common cause of balance problems. Physical and occupational therapists may also help identify and treat balance problems.

Two commonly used tests for identifying balance problems are the Berg Balance Scale and the Dynamic Gait Index. Both of these tests can be used to track your progress as your balance improves with therapy and to provide information about potential risk of falls.

What are common causes of balance problems after traumatic brain injury?

Medications: A number of commonly used medications can cause dizziness, lightheadedness and decreased balance. These include some blood pressure medications, antibiotics, tranquilizers, heart medications, and anti-seizure medications. Ask your doctor if any of the medications you are taking may be causing dizziness or balance problems. A change in medications or dosages may improve the problem.

A drop in blood pressure when standing or sitting up suddenly (called postural hypotension) can make you feel lightheaded and dizzy. It may occur when you get up quickly from sitting on the toilet or a chair, or getting out of bed. Having your blood pressure taken while in a lying, sitting and standing position may also help diagnose blood pressure-related balance problems.

Problems with eyesight (vision impairments): Eyesight is one of the key senses you need to keep your balance. Eyesight problems such as double vision, visual instability, partial loss of vision, and problems with depth perception can make your balance worse.

Inner ear problems (vestibular impairments): Your inner ear contains many tiny organs that help you keep your balance (called the vestibular system/labyrinth). Your inner ear has three loop-shaped structures (semicircular canals) that contain fluid and have fine, hair-like sensors that monitor the rotation of your head. It also has other structures (otolith organs) that monitor linear movements of your head. These otolith organs contain crystals that make you sensitive to movement and gravity. If your vestibular system is damaged from your head injury, you may have problems with balance, dizziness, or a sudden sensation that you?re spinning or that your head is spinning. Three types of vestibular impairments are:

  • Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of vertigo. With trauma, the crystals in the inner ear can be moved out of place, making you sensitive to changes in gravity. BPPV is characterized by brief episodes of mild to intense vertigo. Symptoms are triggered by specific changes in head position, such as tipping your head up or down, and by lying down, turning over or sitting up in bed. You may also feel out of balance when standing or walking.
  • Labyrinthine concussion or injury to the nerve to the vestibular system are also causes of vertigo and imbalance after brain injury.
  • Traumatic endolymphatic hydrops occurs when there is a disruption of the fluid balance within the inner ear. When this happens, you may have periods of vertigo, imbalance and ringing in your ears that last for hours to days.

Problems with your ability to sense things (sensory impairments): For example, nerves in your feet send messages to your brain that help you keep your balance. If these nerves are damaged from your brain injury, your brain may not get the messages it needs. The brain may need to rely more on your eyesight and inner ear to keep your balance.

Brainstem injury: A traumatic injury to the brainstem and cerebellum (parts of the brain that control movement) can make it hard for you to walk and maintain your balance.

Leakage of inner ear fluid into the middle ear (called perilymph fistula) sometimes occurs after head injury. It can cause dizziness, nausea, and unsteadiness when walking or standing. It can get worse when you are more active and may get better with rest.

Mental health issues: Sometimes people with brain injuries have anxiety, depression or a fear of falling. These conditions can cause or increase balance problems. Doctors call this psychogenic dizziness.

Treatment options

Balance problems can have many different causes, each one requiring a different treatment. Your doctor, physical and occupational therapists and/or other health care providers will work with you to understand and treat all the different causes.

Ways you can improve your balance:

  • Increasing your strength and flexibility will help your balance. Specific exercises include stretches for your ankle and hip muscles or strengthening activities for your legs, such as mini-squats, toe- raisers, or standing leg lifts. Go to for more information about these exercises, or talk to your doctor or physical therapist.
  • Find your limits in balance by moving your body over your feet as far as you can without lifting your feet. This will help you develop balance strategies to prevent losing your balance. You can also practice movements that allow you to transition from one position to another, such as going from sitting to standing, reaching above your head to get something off a shelf, or picking up something off the ground.
  • Practice standing or walking in different conditions. For example, you can practice standing with your eyes closed to decrease your dependency on vision for balance or stand on a pillow to improve your ability to use vision for balance. Change how far apart your feet are and work on balance by bringing them closer together, in front of one another or even stand on one leg.
  • Practice activities that will improve your balance while walking, such as walking longer distances; walking and keeping up with someone else while carrying on a conversation; walking over different surfaces, such as on grass and sidewalks; and walking in crowded places such as the grocery store.
  • Be cautious when working on your balance, and make sure you work at an appropriate level to avoid falling when no one is around. A physical or occupational therapist can help design a program that is safe for you to practice at home.
  • BPPV is treated by using movements to relocate the crystals in your inner ear back to where they belong. To learn more about the treatment of BPPV, go to

How quickly can your balance improve?

How quickly your balance problems improve depends on the extent of injury and your health status before your injury. A condition such as BPPV can be treated effectively in one or two treatment sessions. Injuries that involve many types of impairments can take weeks, months or years.

Research shows:

  • Most people with TBI are able to walk independently within three months of injury. Although most can return to walking, many continue to have problems with moving quickly and with balance needed to return to high-level activities such as running or sports.
  • With hard work, people with TBI can continue to improve their balance for many years after injury but balance problems are still identified more frequently in people with TBI than in people without TBI.


Katz DI, et al. Recovery of ambulation after traumatic brain injury. Arch Phys Med Rehabil. 2004; 85(6):865-9.

McFayden BJ, et al. Modality-specific, multitask locomotor deficits persist despite good recovery after a traumatic brain injury. Arch Phys Med Rehabil. 2009; 90(9):1596-606.

Maskell F, Chiarelli P, Isles R. Dizziness after traumatic brain injury: overview and measurement in the clinical setting. Brain Inj. 2006;20(3):293-305.

Patla AE, Shumway-Cook A. Dimensions of mobility: defining the complexity and difficulty associated with community mobility. J Aging Phys Activity. 1999: 7: 7-19.

Williams GP, Schache AG. Evaluation of a conceptual framework for retraining high-level mobility following traumatic brain injury: two case reports. J Head Trauma Rehabil. 2010: 25(3): 164-72.


This information is not meant to replace the advice from a medical professional. You should consult your health care provider regarding specific medical concerns or treatment.


Our health information content is based on research evidence whenever available and represents the consensus of expert opinion of the TBI Model System directors.

Posted on BrainLine June 27, 2012.

Balance Problems After Traumatic Brain Injury was developed by Michelle Peterson, PT, DPT, NCS, and Brian D. Greenwald, MD in collaboration with the Model System Knowledge Translation Center. Copyright © University of Washington/MSKTC. 

Please check the MSKTC site for any recent updates on this article.

Comments (34)

Please remember, we are not able to give medical or legal advice. If you have medical concerns, please consult your doctor. All posted comments are the views and opinions of the poster only.

Hi and great day everyone.
In September 2018 I was finishing my studies and drive went home. I had a horrific car accident where I was been told that my car skidded and went to the opposite side of the road, 5 cars including me were involved. Thank God nothing fractured or lost hands or legs. I just been coma for about 3 months
During the time of my awakened, I was using wheelchair for a short period of time. Then I am still going medical appointments, as for physio, language/speech, traumatic etc I already discharged and now I can drive my car back. Basically I'm know many of you can say I'm normal person because my injuries are relating to nerves which people cant see with their naked eye.
The problem of my injuries I noticed until now haven't improve are my :
1) my right hand has strength but cant control (cannot do activities that required fine motor to able it fully funtional. eg, riting with my dominant hand which is right, it become not so neat as it use to be
2)my left side of the lower leg until my waist it feels like numb, but the pain receptors are working fine. The doctor said that waas a good news. I think its because of my blood flow are not circulate properly.
3) my hearing only has a mild loss on the left side, its not a trouble for me but it becomes trouble when we go out ith friends having drinks, the surrounding is too noisy for me hence i could not join the conversation.

So can anyone give me some of your opinion regarding my road to recovery process, what exercise I should do etc. Much obliged for your kindness help. I apologize as my English isn't that good though.
Im 29 and at the end of this year I'll be getting marry. So I want to be a healthy husband who can help my future wife doing household and many more.

Still suffering from two trauma head injuries from Vietnam. Now days referred today as a Traumatic Brain Injury TBI.
To me it took several years to put two and two together. Well actually closer to twenty.
My hunting buddy and long friend made me aware first. By the way I swung my arms when walking, and how rigid I was.
Then applying for employment after returning home from Vietnam.
I found myself forgetting and having trouble with the simple aptitude test answers because they were timed.
Hell, I was a Top Secret crypto communication specialist handling all of America’s top secret information before I was hit in the back of head.
Enough injury to create Amnesia. With no recall of the time of injury till I was on the plane home. Little pieces hear and there. Bad enough the Army medically discharged me in my second year of serving my country.
It didn’t begin becoming a serious problem till ten years later.
Now fifty years later I was unable to ever gain a comfortable paying job. To be able vast any cash wealth. Have a nice home and eight acres I used to be able to make ends meet with.
But the aggressive health problems the TBI created far out numbered any good days. Maybe one a week now. With the rest progress fully taking me down with migraines out of this world. Suicide thoughts cross my mind a many of times.
For the thought of hurting my wife and kids, I continue to endure this daily torture.
I have had four failed spine surgeries with no hope for another one. The pain I was being treated for back injury from a backhoe driving across my leg slinging to the ground. Is nothing compared to the discomfort neuropathy caused from TBI.

Hello Mr. Maness and am sorry to hear about your head injury. I hope that you are getting disability pay from the military that helps with all of your finances. Thank-you for your service to our country and I'm not pleased that the government sent so many into combat.

6 yrs ago I woke with an appalling headache tried to stand up but fell back and after brain surgery in which my heamorrage was clipped. Unable to sit up, stand, or keep up right, my life was over until I insisted on a physiotherapist and being allowed home.
I've been home 12mths and improved dramatically I can stand, sit, and walk with a Zimmer frame and read these pages in the hope of learning any new tips.

I am a Traumatic Brain Injury Survivor. I was walking to the store and was hit by an oncoming vehicle. I was knocked 30 feet. I was flown by helicopter to hospital. I was in icu for three days. When I eventually woke up I could not move my right leg. I use to be a gymnast and cheerleader in college. I’m older now about to turn 48. Before my accident I was still able to do a back handspring. I have trouble walking now. When I was in wheelchair I can remember the day I took my first five steps. It was very difficult. For some reason it was not as disheartening then as it is now. I think I remember the doctor telling me that where my brain was hit was the control center of my lower extremities. If I remember right. I will never be able to walk a hundred percent ever. They said a traumatic brain injury was similar to a stroke victim. I have nerve damage in my right foot. So I do not have all my feeling. I was just wondering if this makes sense and do I remember correctly? Any knowledge or information would be greatly appreciated.

I suffered a TBI in a serious car crash 3 years ago. Still difficult to walk. I don’t go out alone and always use a stick. I’m a registered homeopath and I know that seeing my own homeopath helps very much as does regular yoga. We have to keep practising to walk and balance. We will improve if we keep going.

I’m a TBI survivor too after a near fatal car crash in 2016. Was passenger and car was smashed into at 70 mph. spent 6 months in hospital. Not walked outside in my own since because balance is very difficult. Steps very difficult. Always use stick to walk now. Don’t go out alone. Not driving again yet as still waiting for licence to be given back which I had to “voluntarily” surrender. What helps me most is homeopathy, yoga and being positive. Neural issues are the main issue for me. I’m getting better. You just have to keep on going, trying, practising and be positive.You will improve. It takes time and practise.

yes, that does sound very right. from what i've heard from my mother. i'm 35. when i was 22 my ex pushed me from a 6 story balcony and i landed on the bare ground. was in a coma from that moment until 6 weeks later. but i also cannot hear now, as it knocked my hearing out. and i have no use of my right hand or arm.

Good afternoon all,

Nine years ago I fell off a motorway bridge 54ft drunken and survived, I didn't break my legs or ankles but have other injuries.
Then two years ago I fell head first into a river and landed on my head with my neck taking full impact from my accident.
Now four days ago I lost my balance and Landed on my shoulder breaking my collar bone (man it hurts).

I keep getting really intense headaches and can't lie down properly.

I'm suffering from PTSD and Complex Borderline Personality Disorder and live on my own. I'm paranoid I have a brain problem after my major accident nine years ago, but the doctors keep telling me I'm fine.

Therefore, my question is why do I keep falling over and breaking bones and why do the doctors keep telling me I'm ok?

Hi nice to meet you I’m sorry for your accident how are you doing now ? May God bless you and your family

I sustained a serious concussion (TBI) when I was knocked off my bike and I was Knocked Out for 40 minutes and I woke up in a hospital bed.. Although my head injury has had some small effect (for instance dizzy spells) on my balance and co-ordination (I can walk but not run, i can’t play football and I can’t swim very well) and despite extensive physiotherapy i really think its more to do with being coupled with my permanent partially disabled right leg/knee as a result of the accident. It’s mostly apparent on descending slopes/staircases. I can’t bend at my knees very well.
I have now invested in a pair of good quality “LEKI” walking poles with special hardened metal tips (around 100 Dollars) which help me a lot, especially on descents and going down stairs, to maintain my Balance. There worth it and could save another fall and another concussion. Some days I feel wobbly and the poles are very reassuring.

I had brain aneurysm surgery with clip 20 yrs ago. Recently I have a balance problem and doc said it may be from scar tissue. Anyone heard of this?

It has been 18 years since my initial TBI (Motorcycle Accident.) I suffered a Broken Neck (C-2), 7 Skull Fractures and Severe Eye Injury. I’ve had 2 Head Injuries since then.

The HEAT this Summer is KILLING ME!!!!!!!!

My Speech is getting worse. Everything is.

Nothing helps, No one helps.

I was in car accident in 2017 an suffer from a TBI. My doctors all retired or left. The auto insurance now refused to pay any medical treatment for the last year. I struggle with reading, stuttering, noises, lights. Depends on weather conditions my symptoms are worst. My entire body hurts. My head spins all the time. Sometimes I have to walk with a cane especially after I had a bad fall. I loss my balance a lot. I can’t go grocery shopping without the noise and lights hurting me. I have to use the amigo & get confused.
Some how the auto insurance company doctor think I’m just lying. Then why am I still in pain? Why am I exhausted all the time? Why am I still having all these issues still? It’s like no one is listening to what I am going through. I shake sometimes I have tingling in my hands and legs and thighs. My hands hurt when I use my cane. I was hit with 3 airbags chest area hurts all the time. That one area legs and thighs. My head went back and forth before the airbag deployed. I don’t remember I must of shield my face because my hands were injured in the accident. It seems as if sometimes the lack of the doctors don’t understand after so many falls I have had with no help. No one can give me answers. It’s frustrating.

Try homeopathy and craniotomy sacral treatment. I had a TBI 2 years ago. I’m a registered homeopath and homeopathy has helped me so much since the accident which nearly killed me! I survived and spent nearly 6 months in hospital. Received fantastic care from docs, nurses, OTs etc. Am back working and running a busy homeopathy practice. Try alternative med to help you along.

I suffered TBI 2 years ago. I still have problems finding words at times and especially if I'm tired. I rhyme words. It can be interesting watching people look at each other funny and then I know I said something wrong. I'm wondering if anyone else has had problems associated with a head cold. I am suffering from one for the first time since TBI. I'm so dizzy similar how I felt right after the head injury. Is this normal?

This is great information ... and yet there is more.  another balance issue can be caused by vestibular issue known as SCD - dehiscence of the semi-circular canal ..  which can be debilitating ... and will not get better in 3 months.  surgery MAY be an alternative - or learning to live with it and honing vestibular coping skills is another.

Well 15 years post injury and I still have balance/dizziness problems. Physical & occupational therapy do help but but you have to commit to it. It's really hard cause you are basically doing activity to slowly help your body tolerate vestibular problems. It doesn't help when you can't get the help you need due to insurance issues.

I always remember to sit and make sure to always be hydrated. A seated rolling scooter helps. Canes consistently help, but remember to stop what doing if dizziness starts,

I have 15 months since my horrible fall at local Walmart that cause my almost deadly TBI that lead to emergency brain surgery and now a metal plate holding me together. I have awful balance. I have a rolater scooter and a cane that I use most of the time. I have been in the hospital so many time since then due to falling. My BP and heart rate drop so low. They can't figure out what to do at this point. I just take my time now.

Been to the eye doctor, ear nose and throat doctor, neurologist none of them have answers for me re my balance problem Physio says I damaged the part of my brain that controls my balance and communicates with the rest of my body. 4 years since my TBI   it's a little bit better with physio

I have had balance problems for 13 years now following a brain aneurysm and 2 brain surgeries. My doctor saved my life so no complaints.

Right besides medicine. What is the cure?

I had a severe TBI on 11/7/04 and STILL have balance issues. I am very high ability and am currently training to be only American Ninja Warrior, but balance issues still persist - definitely my biggest challenge in my training. Saying that most people recover from balance issues in 3 months just is not the reality. They may see drastic improvement in 3 months and learn how to hide them from untrained perceptibility... But let's be honest - the brain does not heal, it merely rewires.

I ageee that 3 months is not realistic. It’s been 2 years since my TBI due to car crash. I’m still working in my balance. I don’t get dizzy but I did feel car sick when travelling in the car as a passenger. That seems to have resolved now. The brain does indeed rewire. It needs practice and patience and of course my homeopathy. I do regular yoga dnd have craniosacral treatments as well. Alternative medicine really helps.

This is all good info until the end when it says most people worth TBI recover from balance issues in 3 months. Where does this statistic cone from? It is unrealistic. It does not cover the reality of most TBI survivors. Even those with mild concussions can take up to 6 months. And those with moderately severe TBI, have this problem for years. In 6 years post injury. I still have balance problems, dizziness and nausea. And I now know many others, so in my experience most are still struggle years later.

I have TBI for over 2yrs I don't feel any different this is going to stay with me. My in
balance is crazy, I hate it but, I have to hang in there and your right there is no help.

This is a huge problem for me. Another problem is that when I tell friends and family about how my brain injury affects me its like they think its all psychosomatic just because they can't SEE what's causing it. It is, literally, all in my head!!!!!

Can meds or vitamins help at all?

Will my balance problem ever go away?

I had my severe TBI several years ao, and I still have balance problems. Some help with your balance can be achieved in several ways. Keep hydrated--I have fainted a few times because I was dehydrated. Make sure you eat small amounts of food often. Do not get dizzy because you have not eaten. Use hand rails on stairs. Do not stay outside in hot weather. Stand up from a chair slowly, and try to grab a handrail. Be patient......
Since my brain-injury in 1999 in Italy caused by a cycling club running me down. I have had a balance problem & broken-bones but NO HELP from the Medical profession. The article will help me be more knowledgeable when I try ti find more help