Minimum detectable change and false positive rates of the vestibular/ocular motor screening (VOMS) tool: an NCAA-DoD care consortium analysis

Eagle, Shawn R.; Ferris, Lyndsey M.; Mucha, Anne; Sinnott, Aaron M.; Marchetti, Gregory F.; Trbovich, Alicia; Port, Nicholas; Clugston, James R.; Ortega, Justus D.; Collins, Michael W.; Broglio, Steven P.; McAllister, Thomas W.; McCrea, Michael; Pasquina, Paul F.; Kontos, Anthony P.

doi:10.1080/02699052.2021.1973561

Cited by 4 publications

(12 citation statements)

References 19 publications

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“…Consistent targets among subjects decrease the chance for false positives within the testing battery allowing the subject to use their eyes for foveal fixation. Similar to previous research, 10 the NPC measurement reported a high amount of false negatives (Eagle et al 10 : 15.9%; current study MAN = 20.7%, PRO = 7.9%, VR = 0%). During the standard administration, it is clear the false positives are very high and that these decrease drastically when using some type of convergence stick or measurement tool.…”

Section: Discussionsupporting

confidence: 90%

“…Previous research has reported on baseline values using the VOMS in various populations 10,20,21,27,29,43 ; however, to the authors’ best knowledge, no current research has evaluated how VOMS symptoms are reported in VR. The data in the current study when using the MAN are comparable with other study means, 10,20,21 with a moderate increase in overall mean symptoms when compared with other NCAA Division I athletes. 10 For example, Eagle et al 10 reported an overall mean of 0.24 ± 0.64 symptoms during smooth pursuits and the current study observed 0.455 ± 1.17 symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…The VOMS tests were administered by 5 trained administrators who were evaluated by the principal investigator as being the most consistent and reliable, as determined by subjective analysis. The subtests were administered as follows according to literature standards 10,26,28,29,32 :…”

Section: Methodsmentioning

confidence: 99%

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Virtual Reality Application for Vestibular/Ocular Motor Screening: Current Clinical Protocol Versus a Novel Prototype

Pavilionis

Adhanom

Moran

et al. 2023

Sports Health: A Multidisciplinary Approach

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Background: Virtual reality (VR) has been explored to improve baseline and postinjury assessments in sport-related concussion (SRC). Some experience symptoms related to VR, unrelated to concussion. This may deter use of vestibular/ocular motor screening (VOMS) using VR. Baseline VR VOMS symptomatology differentiates baseline from overall symptomatology. Hypothesis: There will be no difference between current clinical manual VOMS (MAN), a clinical prototype (PRO), and VR for symptom provocation change score (SPCS) and near point of convergence (NPC) average score in a healthy population and sex differences among the 3 modes of administration. Study Design: Cohort study. Level of Evidence: Level 3. Methods: A total of 688 National Collegiate Athletic Association Division I student-athletes completed VOMS using 3 methods (MAN, N = 111; female athletes, N = 47; male athletes, N = 64; average age, 21 years; PRO, N = 365; female athletes, N = 154; male athletes, N = 211; average age, 21 years; VR, N = 212; female athletes, N = 78; male athletes, N = 134; average age = 20 years) over a 3-year period (2019-2021) during annual baseline testing. Exclusion criteria were as follows: self-reported motion sickness in the past 6 months, existing or previous neurological insult, attention deficit hyperactivity disorder, learning disabilities, or noncorrected vision impairment. Administration of MAN followed the current clinical protocols, PRO used a novel prototype, and VR used an HTC Vive Pro Eye head mounted display. Symptom provocation was compared using Mann-Whitney U tests across each VOMS subtest with total SPCS and NPC average by each method. Results: MAN had significantly ( P < 0.01) more baseline SPCS (MAN = 0.466 ± 1.165, PRO = 0.163 ± 0.644, VR = 0.161 ± 0.933) and significantly ( P < 0.01) and more SPCS (MAN = 0.396 ± 1.081, PRO = 0.128 ± 0.427, VR = 0.48 ± 0.845) when compared with PRO and VR. NPC average measurements for VR (average, 2.99 ± 0.684 cm) were significantly greater than MAN (average, 2.91 ± 3.35 cm; P < 0.01; Cohen’s d = 0.03) and PRO (average, 2.21 ± 1.81 cm; P < 0.01; Cohen’s d = 0.57). For sex differences, female athletes reported greater SPCS with PRO (female athletes, 0.29 ± 0.87; male athletes, 0.06 ± 0.29; P < 0.01) but not in VR or MAN. Conclusion: Using a VR system to administer the VOMS may not elicit additional symptoms, resulting in fewer false positives and is somewhat stable between sexes. Clinical Relevance: VOMS may allow for standardization among administrators and reduce possible false positives.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

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Virtual Reality Application for Vestibular/Ocular Motor Screening: Current Clinical Protocol Versus a Novel Prototype

Pavilionis

Adhanom

Moran

et al. 2023

Sports Health: A Multidisciplinary Approach

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“…However, the VOMS provides little information about the underlying vestibular or ocular impairment. 39,53 Further assessments of function are needed to determine how these tasks elicit symptoms; the vestibular and ocular motor systems work in conjunction with each other and at times provide overlapping information that may conflict to elicit symptoms. 27,54 Further, the large percentage of dizziness that is not explained by the VOMS – the VOMS alone explained only 24% of the variance in DHI – suggests that functional activities common to daily living may be important to self-reported dizziness handicap.…”

Section: Discussionmentioning

confidence: 99%

A Multimodal Assessment of the Heterogeneous Nature of Post-mTBI Dizziness

Pelo

Gaudette

Millsap

et al. 2022

Preprint

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Dizziness after mild traumatic brain injury (mTBI) is commonly attributed to impairment within the vestibular system. However, oculomotor, mobility, and autonomic dysfunction can also contribute to patient-reported dizziness. The purpose of this preliminary study was to examine whether a multimodal battery of assessments could help explain patient-reported dizziness after mTBI. Twenty-three participants with concussion-related symptoms completed the Dizziness Handicap Inventory (DHI) to evaluate burden imposed by dizziness on daily activities and a battery of tests designed to incorporate domains that have been shown to contribute to dizziness (e.g., vestibular, oculomotor, balance and mobility, and autonomic dysfunction). Specific outcomes included quantitative variables obtained from: Vestibular Ocular Motor Screening (VOMS); standing for 30 seconds with feet together, eyes closed, with hands on their hips on both firm and foam surfaces; walking for one minute at a comfortable pace; and a Head-up Tilt (HUT) Test. Univariate associations between DHI and individual measures were assessed, and a backwards-stepwise regression model determined the multi-variable association. There were no strong associations and only a few moderate associations between individual functional measure and DHI total score. A total of eight variables had univariate correlation coefficients larger than 0.20 in magnitude. The final model from the backwards-stepwise procedure explained 69% of the variance in DHI and retained only three variables: peak turning speed from the one-minute walk; mean blood pressure (MBP) during the HUT; and the total VOMS score. Isolated assessments of individual domains of function have weak-to-moderate associations with post-mTBI dizziness. Conversely, a multivariable model that contained measures of mobility, autonomic function, and symptomatic complaints to vestibular and ocular provocation explained 69% of the variance in dizziness. These results suggest that dizziness is physiologically heterogeneous in nature and support the use of multi-domain assessments in patients with dizziness after mTBI.

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“…17,18 The false-positive rate for the NPC test in healthy collegiate student-athletes has been previously recorded as high as 16%. 19,20 Reading skill level, learning disorders, and a primary home language other than English are factors that affect performance on the K-D and may falsely flag an individual as abnormal. 21 Clinicians should be aware of individuals testing outside the normal range at baseline, particularly during any postinjury test interpretation because they fall outside the expected outcomes.…”

Section: Discussionmentioning

confidence: 99%

Premorbid Primary Headache and Vestibular and Oculomotor Baseline Assessments in Collegiate Athletes

Burns

Langford

Tierney

et al. 2021

Clinical Journal of Sport Medicine

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Objective:The purpose of this study was to determine the effects of premorbid headache status on vestibular and oculomotor baseline tests in collegiate club athletes.Design:Retrospective case–control study.Setting:Sport Concussion Laboratory.Patients (or Participants):Collegiate club athletes with a self-reported premorbid headache history (n = 32, 19.50 ± 1.98 years, and 31% women) and age–sex–sport–matched controls (n = 32, 19.56 ± 1.47 years, and 31% women) without a self-reported headache history were included.Interventions:Participants were grouped based on a self-reported headache history at baseline. Controls were randomly matched to self-reported headache participants by age, sex, and sport.Main Outcome Measures:Vestibular/ocular motor screen (VOMS) baseline symptoms, symptom provocation, near point of convergence (NPC) distance, and King–Devick (K-D) test time were compared between groups.Results:Athletes with a self-reported headache history at baseline are 3.82 times more likely to have abnormal NPC scores (P = 0.032) and 4.76 times more likely to have abnormal K-D test times (P = 0.014) than those without a headache history. There was no difference in VOMS baseline symptoms or symptom provocation between groups (P > 0.05).Conclusions:Club collegiate athletes with a headache history were more likely to screen as abnormal during a vestibular/ocular motor function assessment than athletes without a history of headaches. Healthcare professionals should screen for pre-existing headache during baseline concussion assessments before test interpretation.Clinical Relevance:A premorbid headache history at preseason baseline assessment may influence vestibular and oculomotor function, and care should be taken when interpreting these individuals' tests.

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Minimum detectable change and false positive rates of the vestibular/ocular motor screening (VOMS) tool: an NCAA-DoD care consortium analysis

Cited by 4 publications

References 19 publications

Virtual Reality Application for Vestibular/Ocular Motor Screening: Current Clinical Protocol Versus a Novel Prototype

Virtual Reality Application for Vestibular/Ocular Motor Screening: Current Clinical Protocol Versus a Novel Prototype

A Multimodal Assessment of the Heterogeneous Nature of Post-mTBI Dizziness

Premorbid Primary Headache and Vestibular and Oculomotor Baseline Assessments in Collegiate Athletes

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