Risk Factors for Vestibular and Oculomotor Outcomes After Sport-Related Concussion

Abstract

Objective:To investigate the association between risk factors and vestibular–oculomotor outcomes after sport-related concussion (SRC).Study Design:Cross-sectional study of patients seen 5.7 ± 5.4 days (range 0-30 days) after injury.Setting:Specialty clinic.Participants:Eighty-five athletes (50 male athletes and 35 female athletes) aged 14.1 ± 2.8 years (range 9-24 years) seeking clinical care for SRC.Interventions:Participants completed a clinical interview, history questionnaire, symptom inventory, and vestibular/ocularmotor screening (VOMS). Chi-square tests with odds ratios and diagnostic accuracy were used to examine the association between risk factors and VOMS outcomes.Main Outcome Measures:The VOMS.Results:Female sex (χ2 = 4.9, P = 0.03), on-field dizziness (χ2 = 7.1, P = 0.008), fogginess (χ2 = 10.3, P = 0.001), and post-traumatic migraine (PTM) symptoms including headache (χ2 = 16.7, P = 0.001), nausea (χ2 = 10.9, P = 0.001), light sensitivity (χ2 = 14.9, P = 0.001), and noise sensitivity (χ2 = 8.7, P = 0.003) were associated with presence of one or more postconcussion VOMS score above clinical cutoff. On-field dizziness (χ2 = 3.8, P = 0.05), fogginess (χ2 = 7.9, P = 0.005), and PTM-like symptoms including nausea (χ2 = 9.0, P = 0.003) and noise sensitivity (χ2 = 7.2, P = 0.007) were associated with obtaining a postconcussion near-point convergence (NPC) distance cutoff >5 cm. The likelihood ratios were 5.93 and 5.14 for VOMS symptoms and NPC distance, respectively.Conclusions:Female sex, on-field dizziness, fogginess, and PTM symptoms were predictive of experiencing vestibular–oculomotor symptoms/impairment after SRC.

Network Analysis of Sport-Related Concussion Research During the Past Decade (2010–2019)

“…This body of research consisted of risk-factor identification for prolonged recovery or persistent post-SRC symptoms, such as initial symptom burden, preinjury mood disorders, personal or family history of migraine, or vision or vestibular dysfunction preinjury or postinjury. 3,17,18 This work provided important contributions to our clinical understanding of SRC because clinician knowledge about preexisting risk factors can help guide management and intervention strategies. Additional management strategies and safe return-to-play or return-to-school guidelines were also a primary focus of this research cluster, reflecting the emphasis on pediatrics.…”

Network Analysis of Sport-related Concussion Research During the Past Decade (2010–2019)

“…Given that the overarching topic of the current analysis was concussion in sport, it was not surprising that sports medicine journals such as Journal of Athletic Training, American or family history of migraine, vision and/or vestibular dysfunction pre-or post-injury. 3,17,18 This research provides an important contribution to clinical understanding of SRC, as clinician knowledge about pre-existing risk factors can help guide management and intervention strategies. Additional management strategies and safe return-to-play and/or return-to-school guidelines were also a primary focus of this research cluster, reflecting the emphasis on pediatrics.…”

Assessment of Saccades and Gaze Stability in the Diagnosis of Pediatric Concussion

“…12 This tool measures self-reported headache, dizziness, nausea, and fogginess (each rated on a 0-10 scale), assessing severity of symptom provocation with each assessment by comparing pre-assessment and post-assessment symptoms. Previous studies have investigated the validity and reliability of VOMS, [13][14][15][16][17] risk factors for visio-vestibular dysfunction after concussion, 13,[18][19][20] and the association of visio-vestibular dysfunction with prolonged recovery and negative outcomes after concussion. 4,[8][9][10][11]21 Because concussions often manifest with only mild physical examination deficits, concern for ceiling effects has emerged for many concussion tests, including VOMS.…”