Academic Difficulty and Vision Symptoms in Children with Concussion

Abstract

Purpose Academic difficulty is reported in children with prolonged post-concussive symptoms. Despite growing evidence that vestibular-ocular and vision-specific dysfunction are common in children following concussion, vision is rarely mentioned in return-to-learn protocols. The purpose of this project was to evaluate a cohort of children with prolonged post-concussive symptoms to determine if vision symptoms are associated with those reporting academic difficulty. Methods Data was obtained from the Children’s of Alabama Concussion Clinic REDCap dataset from the period January 2007 to October 2013. From this dataset of 1,033 concussion events, a cohort of 276 children aged 5–18 years with three or more concussion-related symptoms present for 10 days or more was identified. A cross-sectional cohort study was undertaken to evaluate the association of concussion symptoms, SCAT2 scores, demographic and concussion severity markers to reported educational difficulty among children with prolonged post-concussive symptoms. Univariate and multivariate logistic regression techniques were used to model the association of reported educational difficulty to self-reported vision abnormalities. Results Mean age was 13.8 years. Median time since the concussive event was 21 days, with 33% (95/276) reporting their concussion more than thirty days prior to data collection. Academic difficulty was reported by 29% (79/270) and vision abnormalities in 46% (128/274). After model reduction, vision symptoms (OR 2.17, 95% CI 1.02, 4.62), hearing disturbance (OR 2.39, 95% CI 1.06, 5.36) and concentration difficulty (OR 21.62, 95% CI 9.50, 44.47) remained associated with academic difficulty. For those with symptoms 30 days or more after concussion, only vision (OR 3.15, 95% CI 1.06, 9.38) and concentration difficulty (OR 15.33, 95% CI 4.99, 47.05) remained statistically significant. Conclusions Vision problems were commonly reported in children with concussions and were independently associated with those reporting academic difficulty. Comprehensive vision assessment should be considered in children reporting academic difficulty and in the development of return-to-learn protocols.

Indirect traumatic optic neuropathy after head trauma in adolescent male mice is associated with behavioral visual impairment, neurodegeneration, and elevated endoplasmic reticulum stress markers at acute and subacute times

“…[2] Visual sequelae of TBI can also cause significant issues with recovery, [3] and can impact functional outcomes in children after even mild injuries. [4] Among the pathophysiologic mechanisms of TBI-associated visual deficits is traumatic optic neuropathy (TON). TON is particularly associated with facial or frontal head impact, and can lead to severe visual impairment.…”

Optimizing Return to Learn Following a Sport-Related Concussion: A Quality Improvement Project

“…While there is some evidence to suggest that short-term academic dysfunction occurs following sport-related concussion, 4-7 these seem to resolve and not impact long-term academic outcomes, as reported through end of year grade point average. 8 Specifically, Wasserman et al 5 noted higher academic dysfunction scores in the initial week following concussion compared to peers with extremity injuries and Swanson et al 7 reported academic difficulty among students with vision symptoms, hearing difficulty, and concentration issues. 7,9 Furthermore, surveys of student-athletes found that 27-90% 5 of students and parents reported difficulty completing homework or classwork during the recovery time following concussion.…”

“…8 Specifically, Wasserman et al 5 noted higher academic dysfunction scores in the initial week following concussion compared to peers with extremity injuries and Swanson et al 7 reported academic difficulty among students with vision symptoms, hearing difficulty, and concentration issues. 7,9 Furthermore, surveys of student-athletes found that 27-90% 5 of students and parents reported difficulty completing homework or classwork during the recovery time following concussion. 5 When recovery is prolonged, there is a greater impact on perceived health status, with adolescent athletes reporting deficits in healthrelated quality of life related to school and cognitive functioning.…”

Considerations for Testing and Treating Children with Central Vestibular Impairments

“…The incidence of concussion, especially in children, is rapidly increasing. 58,59 Concussion results in many symptoms, the most common of which are attributed to the peripheral and/or central vestibular systems (e.g., balance problems, dizziness, visual problems). Although most symptoms related to concussions resolve within 7 to 10 days, symptoms could last longer than a month significantly impacting academic performance.…”

“…Although most symptoms related to concussions resolve within 7 to 10 days, symptoms could last longer than a month significantly impacting academic performance. 59 Although concussion reportedly impacts the vestibular system [60][61][62][63][64] and vestibular rehabilitation is often prescribed for athletes with chronic concussion syndrome, 58,65 the studies that report vestibular system deficits in children with concussion do not directly measure the vestibular system using gold standard objective tests. Concussion diagnosis is, instead, based on symptom scales such as the vestibular oculomotor measurement scale.…”