Vestibular Deficits following Youth Concussion

Abstract

Objective To characterize the prevalence and recovery of pediatric patients with concussion who manifest clinical vestibular deficits, and to describe the correlation of these deficits with neurocognitive function, based on computerized neurocognitive testing, in a sample of pediatric patients with concussion. Methods This was a retrospective cohort study of patients age 5–18 years old with concussion referred to a tertiary pediatric hospital-affiliated sports medicine clinic from 7/1/2010–12/31/2011. A random sample of all eligible patient visits was obtained, and all related visits for those patients were reviewed. Results 247 patients were chosen from 3740 eligible visits for detailed review and abstraction. 81% showed a vestibular abnormality on initial clinical exam. Those patients with vestibular signs on initial exam took a significantly longer time to return to school (median 59 days vs. 6 days, p=0.001) or to be fully cleared (median 106 days vs. 29 days, p=0.001). They additionally scored more poorly on initial computerized neurocognitive testing, and took longer for neurocognitive deficits to recover. Those patients with three or more prior concussions had a higher prevalence of vestibular deficits and took longer for those deficits to resolve. Conclusion Vestibular deficits in children and adolescents with a history of concussion are highly prevalent. These deficits appear to be associated with extended recovery times and poorer performance on neurocognitive testing. Further studies evaluating the effectiveness of vestibular therapy on improving such deficits are warranted.

RISUS study: Rugby Injury Surveillance in Ulster Schools

“…These figures are higher than most previous reports in youth rugby 15. Young athletes are more vulnerable to concussion and may be affected by more complicated recovery times and higher risk of adverse outcomes 11 12. In addition to the potential of acute catastrophic traumatic brain injury, there have been increasing concerns of potential long-term adverse effects of sports-related concussion particularly when multiple concussive blows are sustained over a lifetime 17–19.…”

“…Concussion can have devastating outcomes if not identified or managed accordingly. This is particularly pertinent in adolescent and young athletes, as developing brains undergo a more complex and protracted recovery postconcussion in comparison to an adult 11 12…”

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

“…3,4 Recently, studies evaluating the validity and prognostic value of vestibular and oculomotor examination have been completed. 5,6 These studies, however, focus on patients presenting to specialty sports medicine clinics, likely representing a specific cohort of injured patients, though have demonstrated that a portion of this specific population exhibits abnormalities on this testing. Over the past several years, guidelines and position statements have begun recommending the use of a routine a vestibular and oculomotor assessment for the concussed pediatric patient, 7 with the most recent International Consensus Statement on Concussion recommending vestibular and oculomotor testing by all providers evaluating concussion in the acute setting.…”

Repetitive transcranial magnetic stimulation (rTMS) as a treatment for chronic dizziness following mild traumatic brain injury

“…Dizziness is a common problem following mTBI 10. Post-traumatic dizziness as a symptom of acute mTBI has been noted to abate earlier than other symptoms such as fatigue and headache 20.…”

“…Up to 81% of these patients will have dizziness on initial examination,10 which has been shown to prolong recovery when compared with other initial symptoms 11. The aetiology of persistent post-traumatic dizziness may be peripheral or central in origin, affecting inner ear or central nervous system integration and output, respectively.…”