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

Abstract

BackgroundA visio-vestibular home exercise program (VV-HEP) can provide an equitable and cost-effective method for therapy targeted towards visio-vestibular deficits that are common following concussion. The effects of a VV-HEP on improving concussion symptoms and visio-vestibular function are unclear.PurposeDetermine the effect of VV-HEP on symptoms and visio-vestibular function in concussed pediatric patients.MethodsThis study included 527 patients [294 female (55.8%); age = 14.4 ± 2.1 years] reporting to a specialty care concussion center within 28 days of injury and for a first follow-up within 60 days of injury. Patients completed the Post-Concussion Symptom Inventory (PCSI) and Visio-Vestibular Examination (VVE). Patients were prescribed the VV-HEP at initial visit, with exercises including saccades, gaze stability, convergence, and balance, and instructed to complete these 1–2 times/day. At follow-up, patients self-reported their VV-HEP progress as (1) has not done, (2) in progress, or (3) completed. Primary outcomes included VV-HEP progress at follow-up, PCSI endorsement and severity, VVE subtests (normal/abnormal), and total VVE score (abnormal = 2 + abnormal subtests). Kruskal-Wallis tests and chi-square were used to determine if concussion symptoms or the proportion of abnormal VVE outcomes, respectively, were associated with VV-HEP status. Post-hoc pairwise comparisons with Bonferonni corrections were used to determine concussion symptom (α = 0.017 a priori) and VVE (α = 0.005 a priori) differences in VV-HEP status.ResultsAt follow-up, patients who had completed the VV-HEP reported lower symptom endorsement (median = 1, IQR = 0–3) and lower symptom severity (median = 1, IQR = 0–4) relative to patients who had not started the VV-HEP (endorsement median = 7, IQR = 1–13, p < 0.0001; severity median = 15.5, IQR = 2–32.5, p < 0.0001) and those in progress (endorsement median = 8, IQR = 3–14, p < 0.0001; severity median = 15, IQR = 4–30, p < 0.0001). A lower proportion of patients who completed the VV-HEP reported with abnormal vestibular-ocular reflex (22.2%), tandem gait (0%), and total VVE score (22.2%) relative to those who had not started or those in progress (p < 0.005).ConclusionOur findings indicate that patients who completed the VV-HEP had lower symptom burden and improved visio-vestibular function relative to those who did not start or were in progress. This suggests that a VV-HEP can effectively reduce visio-vestibular dysfunction following concussion and may serve as a means to minimize inequities in access to care.

Dose-Response Effect of Mental Health Diagnoses on Concussion Recovery in Children and Adolescents

“…In addition to addressing pre-existing mental health disorders, identification of these VVE deficits present targets for active intervention, including active rehabilitative approaches, such as a home visio-vestibular exercise program or formal visio-vestibular physical therapy, for such deficits. 29,32 Active management of pediatric patients with concussion with visio-vestibular dysfunction, early initiation of a visio-vestibular home exercise program, or referral for visual or vestibular rehabilitation may reduce some of the concussion symptom burden experienced that may add to the emotional symptom burden in these patients who already have substantial pre-and postinjury mental health burden. We also examined time to return to symptom-limited exercise after concussion in our cohort because of the important role that early exercise has been demonstrated to play in ameliorating concussion, influencing concussion symptom resolution and time to recovery.…”

Contemporary diagnosis and management of mild TBI (concussions): What you need to know

“…A home exercise program, targeting horizontal and vertical saccades and angular ocular reflex can be initiated in the acute management phase for concussion and has been shown to be effective in lowering symptom burden and improving visio-vestibular function in pediatric concussion. 38 If further intervention is required, formal vestibular therapy may be of benefit and individualized vestibular therapy care plans under the supervision of a specialized physical therapist in vestibulopathies are recommended. Rehabilitation focuses on eye coordination and balance function through targeted exercises, progressing in difficulty to gradually increase motion tolerance and decrease symptoms while returning the patient to their preinjury levels of function.…”

“…Vestibular therapy involves targeted exercises and tasks aimed at re-training the system that manages motion sensitivity for patients. A home exercise program, targeting horizontal and vertical saccades and angular ocular reflex can be initiated in the acute management phase for concussion and has been shown to be effective in lowering symptom burden and improving visio-vestibular function in pediatric concussion 38 . If further intervention is required, formal vestibular therapy may be of benefit and individualized vestibular therapy care plans under the supervision of a specialized physical therapist in vestibulopathies are recommended.…”