Prospective Changes in Vestibular and Ocular Motor Impairment After Concussion

Elbin, R.J.; Sufrinko, Alicia; Anderson, Morgan; Mohler, Samantha; Schatz, Philip; Covassin, Tracey; Mucha, Anne; Collins, Michael W.; Kontos, Anthony P.

doi:10.1097/npt.0000000000000230

Cited by 62 publications

(86 citation statements)

References 37 publications

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“…Meta-analyses were not performed, because studies were heterogeneous in sample (participant age and general characteristics) and methodology. In accordance with previous literature, 7,14,16,17 NPC measurements >5 cm were considered abnormal for the purpose of this review. Many of the studies had primary and secondary outcomes.…”

Section: Evidence Acquisitionmentioning

confidence: 96%

“…All of the studies were prospective and included the following designs: case-control, 9,32 cohort, 34,37 controlled observational, 35 cross sectional, 7,36,38 and repeated measures. 17,31,33 While Capó-Aponte et al 31 used a repeated-measures -Acute concussed group performed worse than healthy control group (P = .02) -Prolonged recovery group performed worse than healthy control group (P = .04) -No significant differences between the acute concussed group and prolonged recovery group (P = .11)…”

Section: Evidence Synthesismentioning

confidence: 99%

“…15 While NPC is typically used as part of the criteria for diagnosis of CI, receded NPC and CI are not synonymous. There is some variability in the criteria used for CI, such as measurement parameters of abnormal NPC (eg, >5 cm 7,14,16,17 vs 17.5 cm 18 ). Rates of CI in the healthy population are about 5%.…”

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confidence: 99%

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Near Point of Convergence Deficits and Treatment Following Concussion: A Systematic Review

Santo¹,

Race²,

Teel³

2020

Journal of Sport Rehabilitation

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Context: Convergence dysfunction following concussion is common. Near point of convergence (NPC) is a quick and easy assessment that may detect oculomotor dysfunction such as convergence insufficiency (CI), but NPC measurements are rarely reported. Convergence dysfunction is treatable in otherwise healthy patients; the effectiveness of oculomotor therapy following concussion is unclear. Objectives: The purpose of this article was to systematically review the literature and answer the following clinical questions: (1) Is performance on NPC negatively affected in patients diagnosed with a concussion compared with pre-injury levels or healthy controls? (2) In patients diagnosed with concussion, what is the effect of oculomotor/vision therapy on NPC break measurements? Evidence Acquisition: The search was conducted in CINAHL, SPORTDiscus, MEDLINE, and PubMed using terms related to concussion, mild traumatic brain injury, convergence, vision, and rehabilitation. Literature considered for review included original research publications that collected measures of NPC break in concussion patients, with a pretest–posttest comparison or comparison with a healthy control group. A literature review was completed; 242 relevant articles were reviewed, with 18 articles meeting criteria for inclusion in the review. Evidence Synthesis: Articles were categorized according to the clinical question they addressed. The patient or participant sample (number, sex, age, and health status), study design, instrumentation, or intervention used, and main results were extracted from each article. Conclusions: The authors' main findings suggest that there is a moderate level of evidence that patients have impaired NPC up to several months postconcussion, and a low level of evidence that impairments can be successfully treated with oculomotor therapy. These findings should be cautiously evaluated; the studies are limited by weak/moderate quality, small sample sizes, varied methodology, and nonrandomized treatment groups. Future research should explore factors affecting convergence postconcussion and include randomized, controlled studies to determine if performing vision therapy improves visual measures and promotes recovery.

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Section: Evidence Acquisitionmentioning

confidence: 96%

Section: Evidence Synthesismentioning

confidence: 99%

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Near Point of Convergence Deficits and Treatment Following Concussion: A Systematic Review

Santo¹,

Race²,

Teel³

2020

Journal of Sport Rehabilitation

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“…4 To date, most investigators [5][6][7][8] who used the VOMS applied posttest-only research designs in patient cohorts with SRC. However, other authors have used the VOMS as a baseline (ie, preinjury) measure to identify false-positives, 9 document normative values, 10 and examine prospective changes 11 in vestibular and ocular-motor performance. Although these studies advanced the knowledge base and underscored the importance of the vestibular and ocular-motor assessment after SRC, several clinical questions warrant continued study.…”

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confidence: 99%

Motion Sickness Susceptibility and Baseline Vestibular and Ocular-Motor Performance in Adolescent Athletes

Elbin

Kontos

Sufrinko

et al. 2019

Journal of Athletic Training

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Context High school athletes with a history of motion sickness susceptibility exhibit higher baseline vestibular and ocular-motor scores than those without a history of motion sickness susceptibility. Objective To examine the effects of motion sickness susceptibility on baseline vestibular and ocular-motor functioning, neurocognitive performance, and symptom scores. Design Cross-sectional study. Setting Preseason concussion testing. Patients or Other Participants A convenience sample of high school athletes (N = 308, age = 15.13 ± 1.21 years) involved in a variety of sports. Main Outcome Measure(s) Vestibular/Ocular Motor Screening, computerized neurocognitive assessment, symptom scale, and Motion Sickness Susceptibility Questionnaire-Short Form (MSSQ-S). Results Participants were categorized into 3 groups based on a median split of the scores (eg, NONE, LOW, and HIGH). The LOW (n = 95) and HIGH (n = 92) groups (ie, MSSQ-S score > 0) were 2.64 times more likely (χ21,257 = 7.94, P = .01, 95% confidence interval = 1.32, 5.26) to have baseline Vestibular/Ocular Motor Screening scores larger than the clinical cutoffs for the NONE group (n = 70). No between-groups main effects were present for the NONE (n = 52), LOW (n = 89), and HIGH (n = 90) MSSQ-S groups for verbal (F2,230 = .09, P = .91, η2 = .001) and visual (F2,230 = .15, P = .86, η2 = .001) memory, processing speed (F2,230 = .78, P = .46, η2 = .007), or reaction time (F2,230 = 2.21, P = .11, η2 = .002). The HIGH group exhibited higher total baseline symptom scores than the LOW (U = 3325.50, z = −1.99, P = .05, r = .15) and NONE (U = 1647.50, z = −2.83, P = .005, r = .24) groups. Conclusions Motion sickness should be considered a preexisting risk factor that might influence specific domains of the baseline concussion assessment and postinjury management.

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“…This approach of linking symptom reports to a specific impairment in body structure/function or activity limitation is the foundation of what we do as physical therapists because it leads to the development of hypotheses to explain the cause of the problem, and the selection of targeted interventions most likely to result in optimal outcomes. The articles in this issue by Elbin et al 9 and McQueary et al 10 report on recent advances in clinical tests related to oculomotor function, vestibular function, and postural control that we believe will be useful in identifying the impairments related to concussion. Refining and validating and useful clinical tests will move the field forward, especially if the application of these tests and measures is expanded beyond athletes to the larger population of individuals of all ages who incur a concussion.…”

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confidence: 99%

Returning Individuals to Activities and Participation...It's What We Do!

McCulloch¹,

Gill-Body²

2018

Journal of Neurologic Physical Therapy

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Body, PT, DPT, MS, NCS, FAPTA Concussion. These days we hear this word regularly in the news in reference to sports and military-related injuries. In the past decade, there has been a dramatic increase in our understanding of the effects of injuries to the head, especially for those injuries that may, at first, seem inconsequential. Individuals injured while playing sports have been a major focus of recent public health efforts to ensure that concussive injuries are identified immediately when they happen, sufficient rest and recovery is allowed, and repeat concussions are prevented. Animal research, which has allowed us to better understand the neurometabolic cascade that occurs postconcussion, has also raised concerns about possible injury extension with rapid return to activity. 1 This preclinical evidence resulted in the development of a "best practice" approach to rest athletes until they became asymptomatic, followed by a graded resumption of activity.

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Prospective Changes in Vestibular and Ocular Motor Impairment After Concussion

Abstract: Both total and change scoring methods on the VOMS are useful for identifying impairments following concussion.Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, http://links.lww.com/JNPT/A230).

Cited by 62 publications

References 37 publications

Near Point of Convergence Deficits and Treatment Following Concussion: A Systematic Review

Near Point of Convergence Deficits and Treatment Following Concussion: A Systematic Review

Motion Sickness Susceptibility and Baseline Vestibular and Ocular-Motor Performance in Adolescent Athletes

Returning Individuals to Activities and Participation...It's What We Do!

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