Vestibular/Ocular Motor Screening Assessment Outcomes After Sport-Related Concussion in High School and Collegiate Athletes

Abstract

Context: Vestibular and ocular motor assessment is an emerging clinical assessment for sport-related concussion (SRC). The increased use of these assessments by clinicians calls for examination of outcomes in populations that may impact clinical practice. Objective: Compare vestibular and ocular motor impairments in high school and collegiate athletes within 72 hours of SRC. Second, examine the distribution of impairments in these populations based upon pre-established clinical cut-off scores. Design: Cross-sectional study. Setting: High school (HS) and collegiate athletics (COL). Patient or Other Participants: Data were collected from 110 athletes (HS: n=47, age=15.40±1.35 years; COL: n=63, age=19.46±1.28 years) within 72 hours of sustained SRC. Main Outcome Measure(s): Total and change scores were calculated for the Vestibular/Ocular Motor Screening (VOMS) assessment, along with average near point of convergence (NPC) distance. Separate Mann Whitney U tests were used to compare group differences and Chi-square analyses were used to examine athlete distribution above clinical cutoff scores for all VOMS outputs (a priori Alpha level<0.5). Results: No significant differences were found between high school and collegiate athletes for VOMS total scores, change scores, and NPC distance. A significantly larger proportion of the sample reported scores above the cutoff for all total scores (p<0.001) and change scores in horizontal vestibulo-ocular reflex (VOR; 59.01%, p<0.001), vertical VOR (60.91%, p<0.001), and visual motion sensitivity (60.91%, p<0.001). However, a significantly larger proportion reported smooth pursuit change scores (85.45%, p<0.001) and NPC distance (73.64%, p=0.01) below the cutoff scores. Conclusions: During the acute phase of SRC, high school and collegiate athletes present with similar vestibular and ocular motor impairments as measured by the VOMS, but vestibular tasks appear to cause greater symptom provocation in concussed athletes. Lastly, VOMS change scores may offer more clinical utility in assessing specific impairments following SRC compared to total scores.

Vestibular/ocular motor screening (VOMS) score for identification of concussion in cases of non-severe head injury: A systematic review

“…Table 1 provides an overview of studies [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] included in this review. The table lists study design (categorized as per Mathes and Pieper's suggested approach for systematic reviews 19 ) as well as brief highlights of methods and/or findings.…”

“…Most data 15,17 indicate VOMS predictive utility does not vary significantly within the age groups evaluated in the existing evidence base. However, the focus of most evidence on high-school or college athletes leaves open the question of generalizability to different age groups.…”

“…1,2 Whether utilized on the athletic field sidelines, the sports medicine clinic, or the Emergency Department (ED), VOMS has been the subject of multiple investigations assessing its ability to correctly classify the head-injured into concussed vs. non-concussed status. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] Despite the growing VOMS evidence base, and despite the existence of systematic reviews of other sideline SRC evaluation tools (e.g., King-Devick), 18 a 2022 literature search identified no systematic review with or without meta-analysis (MA) addressing VOMS diagnostic performance.…”

Cervical Spine and CranioVertebral region function in Elite Short Track Speed Skating Athletes

“…Even if the history of concussion group has a significant total change score difference, the athlete in the history of concussion group with the most total change score had a TCS value of 5 on 8 tests, which is negligeable. Recovery of symptom provocation on VOMS have been demonstrated to take 8 days (Glendon et al, 2021) and the total change score to be a better indicator that the total score (Tomczyk et al, 2021).…”

Determining the Agreement Between Common Measures Related to Vestibulo-ocular Reflex Function After a Mild Traumatic Brain Injury in Children and Adolescents

“…Performance on these measures may also be influenced by the presence of coexisting injuries such as cervical impairments, 12 , 13 , 14 which can also be associated with dizziness and other visuovestibular symptoms after mTBI. 13 , 14 , 15 Because measures of symptom provocation in response to VOR tasks have more recently started to be used to identify the presence of potential vestibulo-ocular impairments, 16 , 17 , 18 these influences need to be better understood.…”