Vestibular and oculomotor findings in neurologically-normal, non-concussed children

Abstract

OBJECTIVE To determine the proportion of non-concussed, neurologically normal children with failures on a vestibular and oculomotor examination for concussion performed in an acute setting. DESIGN This was a cross-sectional study of subjects 6–18 years old presenting to a pediatric emergency department with non-neurologic chief complaints. The examination was administered by a pediatric emergency medicine physician, and includes assessments of dysmetria, nystagmus, smooth pursuits, saccades, gaze stability, near-point of convergence, and gait/balance testing. RESULTS Of the 295 subjects enrolled, 24% failed at least one element of testing. 13% had >1 failed element and 5% had >2 failed elements. 29% of females and 19% of males had failed examinations. By age, 15% of subjects 6–8 years old, 32% 9–11 years, 32% 12–14 years, and 26% 15–18 years had failed examinations. Overall, 10% were unable to complete the exam due to developmental age. CONCLUSIONS The provider should be aware that a proportion of non-concussed children may demonstrate failure on a single element of the vestibular and oculomotor exam for. While this testing is of benefit to the acute care provider in diagnosing pediatric concussion, its utility is greatest in the context of an injury history with acute onset of concussion symptoms.

Longitudinal Vestibular and Oculomotor Impairments Among Amateur Athletes 1 Year Following Sport-Related Concussion: A Prospective Follow-Up

“…12,14,27,32,35 The rates of receded NPC (>5 cm) in the control group at the 6-month (30%) and 1-year (32%) study assessments fall within the range (11%-33%) of receded NPC (>5 cm) proportions observed across studies evaluating healthy, nonconcussed athletes. 31,33,35,36,38,43 These results collectively suggest that the VOMS may not be an appropriate tool to identify persistent vestibular or oculomotor impairments following sport-related concussion, given the lack of between-group differences observed in our study and the relatively high rate of positive findings among noninjured controls. As such, use of the VOMS may be better suited to acute screening for more detailed examination, appropriate injury management, and treatment pathway guidance than detecting persistent impairment.…”

Baseline profiles of auditory, vestibular, and visual functions in youth tackle football players

“…The recent focus on neurosensory measures, which provide objective signs to complement symptom evaluations, was motivated in part by the hope that there would be lower failure rates in healthy athletes. Yet, failure rates are still relatively high among some vision tests [12].…”

“…Still, these tests have their limitations, including individual variations and potential learning effects, complicating their interpretation -especially in the absence of a baseline. For example, Corwin et al [12] administered vestibular and visual tests used in concussion evaluation to children presenting to the emergency department with non-neurologic complaints; about one quarter of the children failed one or more components of these tests.…”

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

“…In the original study, data was collected exclusively among healthy athletes 9-40 years old, by sports medicine providers, limiting exam generalizability (Mucha et al, 2014). Some studies on VOMS with subject demographics more reflective of the general population suggest that non-athletes may be more symptom-provoked due to less developed oculomotor and balance systems (Corwin et al, 2018), therefore specific score cutoffs from the original study may not be applicable to the general non-athlete population.…”

“…Additionally, a proportion of non-concussed children may demonstrate failures on a single exam element, specifically on the tests of horizontal and vertical saccades (Corwin et al, 2018), and/or on NPC as developmental CI is prevalent in 2-33% of the general population and can occur in other neurological conditions (Cacho-Martinez et al, 2010;Scheiman et al, 2003). Thus, one or two failed VOMS elements, in the absence of other symptoms, may not be sufficient for a concussion diagnosis (Corwin et al, 2018).…”