Changes in Vestibular/Ocular-Motor Screen Scores in Adolescents Treated With Vestibular Therapy After Concussion

Abstract

Purpose: To examine interrelationships among Vestibular/Ocular-Motor Screen (VOMS) items and to characterize the recovery of VOMS performance in a sample of adolescents treated with vestibular physical therapy (VPT) after concussion. Methods: Seventy-seven patients with concussion and 77 participants without concussion completed the study. Adolescents with concussion received an individualized VPT intervention consisting of targeted exercises for gaze stability, postural stability, ocular-motor control, habituation, and aerobic activities. The exercises were performed during a weekly clinic visit and via a home exercise program. Results: Except for near-point convergence distance, all VOMS items were significantly interrelated. Over the course of VPT, significant improvements in VOMS performance were observed, and discharge scores were similar to scores observed in adolescents without concussion. Conclusions: The VOMS measured moderately related functions and captured changes over the course of VPT. Clinicians should consider the contextual risk of “false positive” in their interpretation of VOMS.

Vestibulo-ocular dysfunction in mTBI: Utility of the VOMS for evaluation and management – A review

“…VOMs can capture improvements over the course of vestibular physical therapy (VPT) when administered at initiation and termination of treatment. It should be noted that participants may still experience positive VOMS scores at the conclusion of therapy, however, these scores are often comparable to scores observed in a sample of adolescents without concussion (Alsalaheen et al, 2020).…”

The effect of a home exercise program on visio-vestibular function in concussed pediatric patients

“…Previous studies assessing both in-office and athome vestibular rehabilitation programs in pediatric patients have demonstrated improvements in visio-vestibular function (18, 19, 22). Alsalaheen et al (19) found that in-office vestibular therapy supplemented with home exercises significantly improved all elements of the Vestibular/Oculomotor Screening (VOMS) assessment. Our results more closely align with a previous study assessing an at-home program only, which found that a 4-week (25,26).…”

“…Visual and vestibular impairments are estimated to occur in up to 88% of adolescent concussion patients (15)(16)(17) and have been associated with prolonged recovery (17). In-office therapy targeting vision and vestibular function has demonstrated improved clinical outcomes, including overall symptom reduction (18), improved vestibulo/ocular-motor performance (19), and earlier medical clearance (20) in adults and adolescents. Additionally, early initiation (≤30 days) of vestibular physical therapy has been associated with earlier return-to-play and symptom resolution in pediatric and young adult patients (aged 5-23 years) (21).…”

Does Exercise Increase Vestibular and Ocular Motor Symptom Detection After Sport-Related Concussion?

“…This scoring method is consistent with the scoring method in the original VOMS investigation, 3 as well as subsequent investigations examining various aspects related to VOMS. 11,26 In addition to a symptom score, the NPC distance was measured from the point at which the participant reported diplopia on a target moving slowly toward their face. A tongue depressor with a 14-point font "X" at the tip was used as the target.…”