Visio-Vestibular Deficits in Healthy Child and Adolescent Athletes

Abstract

Objective: To determine the relationship between patient characteristics and performance on the visio-vestibular examination (VVE) in a cohort of healthy youth athletes and explore the potential association between the VVE and other standardized concussion batteries. Design: Cross-sectional. Setting: Suburban middle and high school. Patients: One hundred ninety subjects age 11 to 18 enrolled before their respective scholastic sport season between August 2017 and March 2020. Assessment of Independent Variables: Patient age, sex, concussion history, comorbidities, hours of weekly exercise, Sport Concussion Assessment Tool, 5th edition (SCAT-5), King-Devick (K-D), Postconcussion Symptom Inventory (PCSI). Main Outcome Measures: Visio-vestibular examination abnormalities (smooth pursuit, horizontal and vertical saccades, horizontal and vertical gaze stability, convergence, right and left monocular accommodation, complex tandem gait). Results: Overall, 29.5% of subjects had at least one of 9 VVE elements abnormal, 7.9% at least 2, and 3.2% at least 3. None of 72 comparisons of the VVE elements, when stratified by age, sex, concussion history, history of headaches, attention deficit hyperactivity disorder, learning issues, psychiatric problems, motion sickness, or weekly hours of exercise, reached significance using the Benjamini-Hochberg procedure at a false discovery rate of 5%. There were no significant associations between VVE elements and the SCAT-5, K-D, or PCSI. Conclusions: The VVE is robust across multiple patient characteristics. Although healthy subjects may have one abnormal element, multiple abnormal elements are a less common feature, making multiple abnormal elements more indicative of concussion, highlighting the use of this assessment in the setting of injury. The VVE tests unique domains when compared with the PCSI, SCAT-5, and K-D.

Athletes With Attention-Deficit/Hyperactivity Disorder: Position Statement of the American Medical Society for Sports Medicine

“…Conditions affecting the vestibular-visual system simulate ADHD symptoms and can be assessed with vestibular, visual, and audiologic testing and referral to suitable specialists (ie, audiologist, ophthalmologist, or otorhinolaryngologist). 38,39…”

“…36,37 Conditions affecting the vestibular-visual system simulate ADHD symptoms and can be assessed with vestibular, visual, and audiologic testing and referral to suitable specialists (ie, audiologist, ophthalmologist, or otorhinolaryngologist). 38,39 It has also been reported that psychosocial factors, such as social media, can lead to impaired attention, memory, information processing, and problem-solving (Table 6). 40,41 Effects of stress or considerable fluctuations in the athlete's environment, including school absence, disorientation, and changes in mental health, can mimic ADHD.…”

A Randomized Trial of Incentivization to Maximize Retention for Real-Time Symptom and Activity Monitoring Using Ecological Momentary Assessment in Pediatric Concussion

“…Finally, we used Fisher exact test to compare the proportion of participants for whom recovery based on symptom score could be elucidated. We defined recovery in the EMA group as total PCSI symptom score ≤ 5 at any point during the 21-day follow-up, based on normative data in both national and local samples 22,23 . Given a lack of consistency in follow-up clinical documentation of standardized symptom scales, we defined recovery at follow-up clinical visits as complete symptom resolution.…”

“…We defined recovery in the EMA group as total PCSI symptom score ≤ 5 at any point during the 21-day follow-up, based on normative data in both national and local samples. 22,23 Given a lack of consistency in follow-up clinical documentation of standardized symptom scales, we defined recovery at follow-up clinical visits as complete symptom resolution. We conducted analyses using Stata version 14.2 (College Station, Tex).…”

The Variability of Recovery From Pediatric Concussion Using Multimodal Clinical Definitions

“…Finally, we compared the total PCSI/cPCSI symptom score to predetermined thresholds normalized for age and sex based on data for uninjured youth (PCSI <9 for women, PCSI <6 for men, and cPCSI <10 for both sexes). 10 These participants were categorized as recovered as defined by symptoms below standardized threshold (8).…”