Vision and Vestibular System Dysfunction Predicts Prolonged Concussion Recovery in Children

Master, Christina L.; Master, Stephen R.; Wiebe, Douglas J.; Storey, Eileen; Lockyer, Julia; Podolak, Olivia E.; Grady, Matthew F.

doi:10.1097/jsm.0000000000000507

Cited by 136 publications

(129 citation statements)

References 39 publications

Supporting

Mentioning

122

Contrasting

Order By: Relevance

“…Of course, 4 months likely represents a biased population seen in a concussion specialty clinic, so it may not represent the natural history of concussion. Although previous work has identified several prognostic factors for concussion recovery, 22,30,37,44 our results did not indicate that premorbid conditions, injury characteristics, or functional factors relate to symptom resolution time. This may be due to the fact that we focused only on sport-related injuries that were evaluated in a specialty care sports medicine clinic.…”

Section: Discussioncontrasting

confidence: 99%

“…In patients evaluated within 14 days after injury, Master and colleagues found that balance deficits during tandem gait testing were associated with prolonged recovery. 30 Thus, balance deficits may be more readily predictive of prolonged recovery when tested sooner after injury (2 weeks in that study). Furthermore, our results suggest that almost all patients report symptom resolution within approximately 4 months after injury, which is valuable for clinicians to recognize as they provide counseling for patients regarding the expected duration of recovery.…”

Section: Discussionmentioning

confidence: 79%

“…The Health and Behavior Inventory (HBI) is included as a common data element for sport concussion 6 and pediatric TBI, 12 and it has been developed specifically for the pediatric population by assessing the frequency of different symptoms associated with an mTBI. 2,14 In addition to symptom frequency and noninjury factors, postural stability assessments 44 and tests of vestibular-oculomotor abilities 9,10,15,30 may also provide predictive value to determine the length of time that will be required for symptom resolution.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Clinical predictors of symptom resolution for children and adolescents with sport-related concussion

Howell¹,

Potter²,

Kirkwood

et al. 2019

Journal of Neurosurgery: Pediatrics

View full text Add to dashboard Cite

OBJECTIVEThe goal of this study was to determine which variables assessed during an initial clinical evaluation for concussion are independently associated with time until symptom resolution among pediatric patients.METHODSData collected from a prospective clinical registry of pediatric patients with concussion were analyzed. The primary outcome variable was time from injury until symptom resolution. Predictor variables assessed within 10 days after injury included preinjury factors, Health and Behavior Inventory scores, headache severity, and balance, vestibular, and oculomotor test performances. The researchers used univariate Cox proportional models to identify potential predictors of symptom resolution time and constructed a multivariate Cox proportional hazards model in which total duration of concussion symptoms remained the outcome variable.RESULTSThe sample consisted of 351 patients (33% female, mean age 14.6 ± 2.2 years, evaluated 5.6 ± 2.6 days after concussion). Univariate Cox proportional hazards models indicated that several variables were associated with a longer duration of symptoms, including headache severity (hazard ratio [HR] 0.90 [95% CI 0.85–0.96]), headache frequency (HR 0.83 [95% CI 0.71–0.96]), confusion (HR 0.79 [95% CI 0.69–0.92]), forgetfulness (HR 0.79 [95% CI 0.68–0.92]), attention difficulties (HR 0.83 [95% CI 0.72–0.96]), trouble remembering (HR 0.84 [95% CI 0.72–0.98]), getting tired often (HR 0.86 [95% CI 0.76–0.97]), getting tired easily (HR 0.86 [95% CI 0.76–0.98]), dizziness (HR 0.86 [95% CI 0.75–0.99]), and abnormal performance on the Romberg test (HR 0.59 [95% CI 0.40–0.85]). A multivariate Cox proportional hazards model indicated that an abnormal performance on the Romberg test was independently associated with a longer duration of symptoms (HR 0.65 [95% CI 0.44–0.98]; p = 0.038).CONCLUSIONSFor children and adolescents evaluated within 10 days after receiving a concussion, abnormal performance on the Romberg test was independently associated with a longer duration of symptoms during recovery. In line with findings of other recent studies investigating predictors of symptom resolution, postural stability tests may provide useful prognostic information for sports medicine clinicians.

show abstract

Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 79%

mentioning

confidence: 99%

See 1 more Smart Citation

Clinical predictors of symptom resolution for children and adolescents with sport-related concussion

Howell¹,

Potter²,

Kirkwood

et al. 2019

Journal of Neurosurgery: Pediatrics

View full text Add to dashboard Cite

show abstract

“…Although most symptoms related to concussions resolve within 7 to 10 days, symptoms could last longer than a month significantly impacting academic performance. 59 Although concussion reportedly impacts the vestibular system [60][61][62][63][64] and vestibular rehabilitation is often prescribed for athletes with chronic concussion syndrome, 58,65 the studies that report vestibular system deficits in children with concussion do not directly measure the vestibular system using gold standard objective tests. Concussion diagnosis is, instead, based on symptom scales such as the vestibular oculomotor measurement scale.…”

Section: Concussionmentioning

confidence: 99%

“…Concussion diagnosis is, instead, based on symptom scales such as the vestibular oculomotor measurement scale. [60][61][62][63][64] Alshehri et al 66 showed no VOR deficit to the video head impulse test (vHIT) in 56 participants post-concussion, aged 10 to 20 years and determined that the vHIT test significantly increased symptoms of headache, dizziness, and nausea. Many of the intervention studies that reported the effectiveness of vestibular rehabilitation for patients with concussion are retrospective and not controlled.…”

Section: Concussionmentioning

confidence: 99%

Considerations for Testing and Treating Children with Central Vestibular Impairments

Christy

2018

Semin Hear

View full text Add to dashboard Cite

This perspective explores common pediatric diagnoses that could present with central vestibular pathway dysfunction, leading to delays in motor development and postural control, and gaze instability. Specifically, the following diagnoses are considered: cerebral palsy, myelomeningocele, vestibular migraine, attention-deficit hyperactivity disorder, developmental coordination disorder, concussion, childhood cancer, congenital muscular torticollis, adolescent idiopathic scoliosis, and autism. Suggestions for clinical screening, vestibular function testing, and vestibular rehabilitation for children with these diagnoses are based on evidence for the efficacy of testing and interventions for children with peripheral vestibular hypofunction. More research is needed to explore peripheral and central vestibular function in children with these diagnoses. Testing and intervention methods may need to be modified to accommodate for the specific behavior and motor challenges that some children might present. Researchers should develop technology so that gaze stabilization exercises can be delivered in a fun, functional, and effective way.

show abstract

Association of Posttraumatic Headache With Symptom Burden After Concussion in Children

et al. 2023

View full text Add to dashboard Cite

ImportanceHeadache is the most common symptom after pediatric concussion.ObjectivesTo examine whether posttraumatic headache phenotype is associated with symptom burden and quality of life 3 months after concussion.Design, Setting, and ParticipantsThis was a secondary analysis of the Advancing Concussion Assessment in Pediatrics (A-CAP) prospective cohort study, conducted September 2016 to July 2019 at 5 Pediatric Emergency Research Canada (PERC) network emergency departments. Children aged 8.0-16.99 years presenting with acute (&lt;48 hours) concussion or orthopedic injury (OI) were included. Data were analyzed from April to December 2022.ExposurePosttraumatic headache was classified as migraine or nonmigraine headache, or no headache, using modified International Classification of Headache Disorders, 3rd edition, diagnostic criteria based on self-reported symptoms collected within 10 days of injury.Main Outcomes and MeasuresSelf-reported postconcussion symptoms and quality-of-life were measured at 3 months after concussion using the validated Health and Behavior Inventory (HBI) and Pediatric Quality of Life Inventory–Version 4.0 (PedsQL-4.0). An initial multiple imputation approach was used to minimize potential biases due to missing data. Multivariable linear regression evaluated the association between headache phenotype and outcomes compared with the Predicting and Preventing Postconcussive Problems in Pediatrics (5P) clinical risk score and other covariates and confounders. Reliable change analyses examined clinical significance of findings.ResultsOf 967 enrolled children, 928 (median [IQR] age, 12.2 [10.5 to 14.3] years; 383 [41.3%] female) were included in analyses. HBI total score (adjusted) was significantly higher for children with migraine than children without headache (estimated mean difference [EMD], 3.36; 95% CI, 1.13 to 5.60) and children with OI (EMD, 3.10; 95% CI, 0.75 to 6.62), but not children with nonmigraine headache (EMD, 1.93; 95% CI, −0.33 to 4.19). Children with migraine were more likely to report reliable increases in total symptoms (odds ratio [OR], 2.13; 95% CI, 1.02 to 4.45) and somatic symptoms (OR, 2.70; 95% CI, 1.29 to 5.68) than those without headache. PedsQL-4.0 subscale scores were significantly lower for children with migraine than those without headache only for physical functioning (EMD, −4.67; 95% CI, −7.86 to −1.48).Conclusions and RelevanceIn this cohort study of children with concussion or OI, those with posttraumatic migraine symptoms after concussion had higher symptom burden and lower quality of life 3 months after injury than those with nonmigraine headache. Children without posttraumatic headache reported the lowest symptom burden and highest quality of life, comparable with children with OI. Further research is warranted to determine effective treatment strategies that consider headache phenotype.

show abstract

Vision and Vestibular System Dysfunction Predicts Prolonged Concussion Recovery in Children

Cited by 136 publications

References 39 publications

Clinical predictors of symptom resolution for children and adolescents with sport-related concussion

Clinical predictors of symptom resolution for children and adolescents with sport-related concussion

Considerations for Testing and Treating Children with Central Vestibular Impairments

Association of Posttraumatic Headache With Symptom Burden After Concussion in Children

Contact Info

Product

Resources

About