scholarly journals Correlating the King-Devick Test With Vestibular/Ocular Motor Screening in Adolescent Patients With Concussion: A Pilot Study

2018 ◽  
Vol 10 (4) ◽  
pp. 334-339 ◽  
Author(s):  
Shira Russell-Giller ◽  
Diana Toto ◽  
Mike Heitzman ◽  
Mustafa Naematullah ◽  
John Shumko
Keyword(s):  
Visual Motion ◽  
Pearson Correlation ◽  
Case Series ◽  
Naming Task ◽  
Performance Measure ◽  
Motor Deficits ◽  
Testing Time ◽  
Ocular Motor ◽  
Level Of Evidence ◽  
Motion Sensitivity

Background: The King-Devick (K-D) test is a rapid number-naming task that has been well validated as a sensitive sideline performance measure for concussion detection. Patients with concussion take significantly longer to complete the K-D test than healthy controls. Previous research suggests that ocular motor deficits, specifically saccadic abnormalities, may be an underlying factor for the prolonged time. However, these findings have not been studied at length. Hypothesis: K-D testing time of concussed adolescents at the initial clinical concussion visit will positively correlate with vestibular/ocular motor screening (VOMS) total scores. Study Design: Case series. Level of Evidence: Level 3. Methods: A total of 71 patient charts were retrospectively analyzed between October 1, 2016, and January 31, 2017. Included charts consisted of patients between the ages of 10 and 18 years with a diagnosis of concussion and who had completed K-D testing and VOMS assessment at the initial physician visit. Univariate correlation between K-D testing time and the 7 VOMS items was assessed using Pearson correlation coefficients. Results: K-D testing time strongly correlated with all 7 VOMS items ( r(69) = 0.325-0.585, P < 0.01). In a linear regression model that accounted for each VOMS item, the convergence (near point) item and the visual motion sensitivity item significantly predicted K-D testing time (β = 0.387, t(63) = 2.81, P < 0.01 and β = 0.375, t(63) = 2.35, P = 0.02, respectively). Additionally, 37.5% of the 24 patients with worsening symptoms after K-D testing freely reported increased visual problems. Conclusion: Our study suggests that prolonged K-D testing times in adolescents with concussion may be related to subtypes of vestibular/ocular motor impairment that extend beyond saccadic abnormalities. Clinical Relevance: Poor K-D testing performance of adolescents with concussion may indicate a range of vestibular/ocular motor deficits that need to be further identified and addressed to maximize recovery.

scholarly journals Contributions of PCSS, CISS, and VOMS for Identifying Vestibular/Ocular Motor Deficits in Pediatric Concussions

2021 ◽  
pp. 194173812199411
Author(s):  
Rishi D. Patel ◽  
Cynthia R. LaBella
Keyword(s):  
Sports Medicine ◽  
Tertiary Care ◽  
Motor Dysfunction ◽  
Motor Deficits ◽  
Ocular Motor ◽  
Symptom Scale ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Visual Problems ◽  
Clinical Tools

Background: Vestibular/ocular motor dysfunction can occur in pediatric concussions, which can impair reading, learning, and participation in athletics. This study evaluated 3 clinical tools for identifying postconcussion vestibular/ocular motor dysfunction: (1) Post-Concussion Symptom Scale (PCSS), (2) Convergence Insufficiency Symptom Survey (CISS), and (3) Vestibular/Ocular Motor Screening (VOMS). Hypothesis: Evaluating vestibular/ocular motor dysfunction with multiple clinical tools will capture more symptomatic patients than any 1 tool alone. Study Design: Cross-sectional data from a prospective cohort study. Level of Evidence: Level 4. Methods: Patients were between 8 and 17 years old and seen in a tertiary care pediatric sports medicine clinic between August 2014 and February 2018. Data were collected from initial visit and included VOMS, PCSS, and CISS. Descriptive statistics, Pearson’s correlations, and logistic regressions were used to describe relationships between clinical tools. Results: Of the 156 patients (55.1% female; 14.35 ± 2.26 years old) included, this study identified 129 (82.7%) with vestibular/ocular motor dysfunction. Of these 129, 65 (50.4%) reported “visual problems” on PCSS, 93 (72.1%) had abnormal CISS, and 99 (76.7%) had abnormal VOMS. Together, VOMS and CISS identified 64 (49.6%) patients without reported “visual problems” on PCSS. Higher total PCSS scores predicted abnormal CISS (odds ratio [OR], = 1.11; 95% CI, 1.07-1.17) and abnormal VOMS (OR, 1.03; 95% CI, 1.01-1.06). “Visual problems” on PCSS did not predict abnormal CISS or VOMS. Conclusions: Vestibular/ocular motor dysfunction were identified in nearly 83% of study subjects when PCSS, CISS, and VOMS are used together. Clinical Relevance: These results suggest adding CISS and VOMS to the clinical evaluation of concussions can help clinicians identify post-concussion vestibular/ocular motor dysfunction.

scholarly journals Incremental Validity of Components of the Vestibular/Ocular Motor Screening for Concussion

2019 ◽  
Vol 34 (5) ◽  
pp. 769-769
Author(s):  
N Sandel Sherry ◽  
N Ernst ◽  
J Doman ◽  
C Holland ◽  
H Bitzer ◽  
...  
Keyword(s):  
Visual Motion ◽  
Symptomatic Patient ◽  
Incremental Validity ◽  
Ocular Motor ◽  
Final Model ◽  
Motion Sensitivity ◽  
Symptom Provocation ◽  
Ocular Reflex ◽  
Vestibular Ocular Reflex ◽  
Total Score Range

Abstract Purpose The Vestibular/Ocular Motor Screening (VOMS) tool for concussion evaluates symptom provocation (in a fixed order) across the following neuromotor tasks: smooth pursuits (SP), saccades-horizontal (Sac-H), saccades-vertical (Sac-V), near point of convergence (NPC), vestibular-ocular reflex-horizontal (VOR-H), vestibular-ocular reflex-vertical (VOR-V), and visual motion sensitivity (VMS). The current study evaluates the incremental validity of each VOMS component in consecutive order. Methods Retrospective record review of 193 subjects (49% male) aged 10–22 years old diagnosed with concussion (sport and non-sport injuries) and demonstrated an abnormal VOMS (defined by symptom provocation >2 or NPC >5cm) at initial evaluation in a specialty concussion clinic. Hierarchical regression was performed with VOMS total score (range: 0-320) as the dependent variable and each VOMS component as predictors in seven consecutive steps. Results The model was significant (p<.001) at each step; the final model including all seven VOMS components in order (SP, Sac-H, Sac-V, NPC, VOR-H, VOR-V, and VMS) was significant, F(7,185)= 6.87, p<.001 and accounted for 20.6% of the variance in total VOMS score. The only significant predictors in the final model included: SP (p=.01), NPC (p=.04), and VOR-H (p=.04). Conclusion Provocation of symptoms on SP, NPC, and VOR-H are the best predictors of total VOMS score. NPC and VOR-H symptom provocation provide unique value to vestibular screening beyond symptom provocation on SP and after completion of all other VOMS components. This information may be clinically useful when vestibular screening must be expedited (e.g., highly symptomatic patient, sideline assessment).

scholarly journals INFLUENCE OF MAXIMAL ISOMETRIC STRENGTH ON 20-METER SPRINT TIME

2021 ◽  
Vol 27 (1) ◽  
pp. 60-64
Author(s):  
Álvaro Huerta Ojeda ◽  
Daniel Jerez-Mayorga ◽  
Sergio Galdames Maliqueo ◽  
Darío Martínez García ◽  
Ángela Rodríguez-Perea ◽  
...  
Keyword(s):  
Isometric Force ◽  
Pearson Correlation ◽  
Case Series ◽  
Level Of Evidence ◽  
Jump Test ◽  
Wide Range ◽  
Natural Movement ◽  
And Performance ◽  
High Level ◽  
Very High

ABSTRACT Introduction The squat is an exercise that is widely used for the development of strength in sports. However, considering that not all sports gestures are vertical, it is important to investigate the effectiveness of propulsive force stimuli applied in different planes. Objective The main purpose of this study was to determine the influence of maximum isometric force (MIF) exerted on starting blocks over performance in 5, 10 and 20-meter sprints. Methods Seven high-level male sprinters (mean age ± SD = 28 ± 5.77 years) participated in this study. The variables were: a) MIF in squats and on starting blocks (measured using a functional electromechanical dynamometer [FEMD]), b) time in 5, 10 and 20-m sprints and c) jump height (measured by the squat jump test). For data analysis, a Pearson correlation was performed between the different variables. The criteria for interpreting the strength of the r coefficients were as follows: trivial (<0.1), small (0.1−0.3), moderate (0.3−0.5), high (0.5−0.7), very high (0.7−0.9), or practically perfect (>0.9). The level of significance was p < 0.05. Results There was very high correlation between MIF exerted on starting blocks and performance in the first meters of the sprint (5-m: r = -0.84, p = 0.01). However, there was small correlation between MIF in squats and performance in the first meters of the sprint (5-m: r = -0.22, p < 0.62). Conclusion The MIF applied on starting blocks correlates very high with time in the first meters of the sprint in high-level athletes. In addition, the use of the FEMD provides a wide range of possibilities for evaluation and development of strength with a controlled natural movement. Level of evidence IV; Prognostic Studies - Case series.

scholarly journals Effects of exercise on symptoms, vestibular/ocular motor screening and postural stability in a college-aged sample

Concussion ◽  
2020 ◽  
Vol 5 (2) ◽  
pp. CNC73
Author(s):  
Ryan N Moran ◽  
Nicholas G Murray ◽  
Michael R Esco ◽  
Ward Dobbs ◽  
Jamie McAllister-Deitrick
Keyword(s):  
Postural Stability ◽  
Visual Motion ◽  
Maximal Exercise ◽  
Clinical Test ◽  
Ocular Motor ◽  
Symptom Scale ◽  
Post Exercise ◽  
Motion Sensitivity ◽  
Severity Scores ◽  
Exercise Treadmill

Aim: To examine the effects of maximal exercise on symptoms, vestibular/ocular motor screening (VOMS) and postural stability. Methodology: A total of 17 college-aged individuals completed a symptom scale, VOMS and the modified Clinical Test for Sensory Interaction and Balance (m-CTSIB), followed by a graded maximal exercise treadmill test. Assessments were repeated post exercise, 20 and 40 min post-exercise. Results: Significant increases in total symptoms, symptom severity scores and m-CTSIB scores from baseline to immediate post exercise were reported. Following 20-min recovery, improvements were noted on symptoms, visual motion sensitivity on VOMS and m-CTSIB. Conclusion: Symptoms and postural stability are influenced by exercise and following 20 min of rest, returned to baseline, indicating that a period of 20 min following a suspected concussion may be needed to negate exercise effects.

scholarly journals Influence of Pre-Morbid Migraine History on Baseline Vestibular/Ocular Motor Screening and King-Devick Test Performance

2019 ◽  
Vol 34 (5) ◽  
pp. 743-743
Author(s):  
R N Moran ◽  
J Wallace ◽  
T Covassin
Keyword(s):  
Smooth Pursuit ◽  
Test Performance ◽  
Visual Motion ◽  
Average Distance ◽  
Control Group ◽  
Ocular Motor ◽  
Cross Sectional ◽  
Motion Sensitivity ◽  
Youth Athletes ◽  
Migraine Headaches

Abstract Purpose To examine the effects of premorbid migraine history on baseline Vestibular/Ocular Motor Screening (VOMS) and King-Devick (KD) test performance in youth athletes. Methods This study implemented a cross-sectional design and was conducted at a series of youth sport venues in a designated research area. Youth athletes between the ages of 8 and 14 years with a diagnosed history of migraine headaches (n=28) and match controls (n=28) were administered a baseline VOMS and KD test. Between-group comparisons for provocation scores on the VOMS (smooth pursuit, saccades, convergence, vestibular-ocular reflex [VOR], and visual motion sensitivity [VMS]), Near-point of convergence [NPC] average distance (cm), and KD time (seconds) were conducted. Results Individuals diagnosed with migraine headaches reported greater VOMS scores compared to match controls on smooth pursuit (0.43±1.1 vs. 0.00±0.0; p=.02), convergence (0.46±1.2 vs. 0.04±0.1; p=.04), horizontal VOR (0.89±1.4 vs. 0.07±0.2; p<.001), vertical VOR (0.61±1.1 vs. 0.11±0.3; p=.04), and VMS (0.86±1.5 vs. 0.04±0.1; p=.01). Differences were also observed on the KD test with worse times in the diagnosed migraine group (54.33±11.8s) compared to match controls (47.17±8.9s; p=.02). No differences were reported on NPC distance between the migraine (2.22±3.1cm) and control group (0.83±1.2; p=.06). Conclusion Youth athletes with diagnosed migraine history reported higher baseline VOMS scores and worse KD time compared to match controls, further illustrating the influence of premorbid migraine headaches as a risk factor for elevated baseline concussion assessment. Special consideration may be warranted for post-concussion assessment in athletes with diagnosed migraine headaches.

Immediate and 20-Minute Post-Exercise Performance On Vestibular/Ocular Motor Screening (VOMS) and Near Point of Convergence (NPC)

Neurology ◽  
2020 ◽  
Vol 95 (20 Supplement 1) ◽  
pp. S4.1-S4
Author(s):  
Ryan Moran ◽  
Nicholas Murray
Keyword(s):  
Visual Motion ◽  
Maximal Exercise ◽  
Physical Exertion ◽  
Assessment Tools ◽  
Ocular Motor ◽  
Post Exercise ◽  
Motion Sensitivity ◽  
Post Concussion Syndrome ◽  
Minute Post ◽  
Exercise Treadmill

ObjectiveTo examine VOMS and NPC performance immediately and 20-minutes after a bout of maximal exercise.BackgroundThe Vestibular/Ocular Motor Screening (VOMS) and Near Point of Convergence (NPC) have received increased implementation for assessment and management of sport-related concussion. As athletes are often in a state of physical exertion during the immediate or sideline evaluation for concussion, it is imperative to understand the effects of exercise on these two tools.Design/MethodsSeventeen, healthy college-aged individuals (20.7 ± 2.3 years) free of any modifiers for performance, completed a pre-test VOMS and NPC, followed by a graded maximal exercise treadmill test. Participants were re-assessed immediately following exercise and again 20-minutes later. Measures consisted of VOMS symptom provocation change scores per item and NPC distance (cm) averaged across 3 trials. A series of non-parametric Friedman tests and follow-up Wilcoxon signed rank tests were conducted to determine the effects between pre-test, immediate-, and 20-min post-exercise.ResultsPre-to immediate post-exercise differences did not exist on any VOMS item, specifically, smooth pursuits (0.12 vs. 0.29, p = 0.18), saccades (horizontal: 0.18 vs. 0.29, p = 0.70; vertical: 0.24 vs. 0.41, p = 0.70), convergence (2.78 cm vs. 3.99 cm, p = 0.27), vestibular ocular reflex (VOR) (horizontal: 0.59 vs. 0.94, p = 0.31; vertical: 0.41 vs. 0.65, p = 0.27), and visual motion sensitivity (VMS) (0.47 vs. 0.94, p = 0.13). No differences were reported between pre- and immediate post-exercise on NPC distance (2.78 vs. 3.99 cm, p = 0.48). The only change from immediate to 20-min post exercise was an improvement in VMS of the VOMS (0.94 vs. 0.29, p = 0.05). No changes occurred between pre- and 20-min post-exercise.ConclusionsVOMS items and NPC distance remained consistent from pre-to immediate and 20-min post exercise, which may further validate their utility as sideline assessment tools. More research is needed to determine if these results extend across graded exercise testing in acute concussion and post-concussion syndrome return-to-activity management.

Intraoperative Assessment of the Axial Rotational Positioning of a Modern Ankle Arthroplasty Tibial Component Using Preoperative Patient-Specific Instrumentation Guidance

2019 ◽  
Vol 40 (10) ◽  
pp. 1160-1165
Author(s):  
Oliver J. Gagne ◽  
Andrea Veljkovic ◽  
Dave Townshend ◽  
Alastair Younger ◽  
Kevin J. Wing ◽  
...  
Keyword(s):  
Tibial Component ◽  
Rotation Angle ◽  
Pearson Correlation ◽  
Case Series ◽  
Axial Rotation ◽  
Patient Specific ◽  
P Value ◽  
Level Of Evidence ◽  
Patient Specific Instrumentation ◽  
Preoperative Ct

Background: The use of patient-specific instrumentation (PSI) in modern total ankle replacement (TAR) has augmented positioning of the tibial component, eliminating the need for complex jigs. Coronal and sagittal alignment are intuitive with this design and have been studied, but axial rotation has not. The purpose of this study was to assess the relationship between the planned preoperative axial rotation as set by the PSI guide and the rotation determined intraoperatively with non-PSI instrumentation. Methods: This was a prospective cohort study of 22 consecutive cases. The axial rotation angle between the medial gutter and the tibial implant position on the preoperative CT-scan based plan was extracted. At the time of surgery, the medial gutter alignment instrument from the non-PSI instrumentation was inserted and an intraoperative axial photograph obtained to record the angle between the medial gutter and the axial rotation guide pins set by the PSI instrumentation. The 2 measurements were compared and further statistical analysis included Pearson correlation and paired Student t test. Results: The average axial rotation angle between the medial gutter and the implant on the PSI preoperative plan was 5.4 ± 2.9 degrees, whereas the intraoperative photograph from the medial gutter alignment instrument to the pin was 5.9 ±3.8 degrees. This demonstrated a Pearson correlation of R = 0.54 and a P value of .53. The average difference between the two was −0.46 (95% CI: –2.04, 1.10), meaning that components were either slightly externally rotated or that the fork was aimed internally. Based on this group, 50% (11/22) were within 2 degrees of the target and 77% (17/22) were within 4 degrees of the target. Conclusion: Patient-specific guides allowed for reproducible rotational tibial component implantation in modern TAR. Further work is needed to better understand the biomechanical effects of the rotational profile and consequences on survivorship. Level of Evidence: Level IV, case series.

scholarly journals Age-Related Vestibular and Ocular Motor Outcomes Following a Sport-Related Concussion

2021 ◽  
Author(s):  
Christopher P. Tomczyk ◽  
Morgan Anderson ◽  
Kyle M. Petit ◽  
Jennifer L. Savage ◽  
Tracey Covassin
Keyword(s):  
High School ◽  
Visual Motion ◽  
Collegiate Athletes ◽  
Ocular Motor ◽  
Motor Impairments ◽  
Cross Sectional ◽  
Motion Sensitivity ◽  
Change Scores ◽  
Age Related ◽  
Cutoff Scores

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&lt;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&lt;0.001) and change scores in horizontal vestibulo-ocular reflex (VOR; 59.01%, p&lt;0.001), vertical VOR (60.91%, p&lt;0.001), and visual motion sensitivity (60.91%, p&lt;0.001). However, a significantly larger proportion reported smooth pursuit change scores (85.45%, p&lt;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.

scholarly journals Review of Vestibular and Oculomotor Screening and Concussion Rehabilitation

2017 ◽  
Vol 52 (3) ◽  
pp. 256-261 ◽  
Author(s):  
Anthony P. Kontos ◽  
Jamie McAllister Deitrick ◽  
Michael W. Collins ◽  
Anne Mucha
Keyword(s):  
Visual Motion ◽  
Saccadic Eye Movements ◽  
Small Sample ◽  
Screening Tools ◽  
Return To Play ◽  
Ocular Motor ◽  
Motion Sensitivity ◽  
Additional Information ◽  
Clinical Profiles ◽  
Rehabilitation Strategies

Vestibular and oculomotor impairment and symptoms may be associated with worse outcomes after sport-related concussion (SRC), including prolonged recovery. In this review, we evaluate current findings on vestibular and oculomotor impairments as well as treatment approaches after SRC, and we highlight areas in which investigation is needed. Clinical researchers have intimated that recovery from SRC may follow certain clinical profiles that affect the vestibular and oculomotor pathways. Identifying clinical profiles may help to inform better treatment and earlier intervention to reduce recovery time after SRC. As such, screening for and subsequent monitoring of vestibular and oculomotor impairment and symptoms are critical to assessing and informing subsequent referral, treatment, and return to play. However, until recently, no brief-screening vestibular and oculomotor tools were available to evaluate this injury. In response, researchers and clinicians partnered to develop the Vestibular/Ocular-Motor Screening, which assesses pursuits, saccades, vestibular ocular reflex, visual motion sensitivity, and convergence via symptom provocation and measurement of near-point convergence. Other specialized tools, such as the King-Devick test for saccadic eye movements and the Dizziness Handicap Inventory for dizziness, may provide additional information regarding specific impairments and symptoms. Tools such as the Vestibular/Ocular-Motor Screening provide information to guide specialized referrals for additional assessment and targeted rehabilitation. Vestibular rehabilitation and visual-oculomotor therapies involve an active, expose-recover approach to reduce impairment and symptoms. Initial results support the effectiveness of both vestibular and visual-oculomotor therapies, especially those that target specific impairments. However, the evidence supporting rehabilitation strategies for both vestibular and oculomotor impairment and symptoms is limited and involves small sample sizes, combined therapies, nonrandomized treatment groups, and lack of controls. Additional studies on the effectiveness of screening tools and rehabilitation strategies for both vestibular and oculomotor impairment and symptoms after SRC are warranted.

Case Report: Management of a Patient with mTBI and Vestibular Hypofunction with the Binasal Occlusion Technique

2018 ◽  
pp. 87-90
Keyword(s):  
Case Report ◽  
Visual Motion ◽  
Hand Movement ◽  
Motion Sensitivity ◽  
Vestibular Hypofunction ◽  
First Case ◽  
Neurological Exam ◽  
History Of ◽  
Occlusion Technique ◽  
Visual Vertigo

Background: Binasal Occlusion (BNO) is a clinical technique used by many neurorehabilitative optometrists in patients with mild traumatic brain injury (mTBI) and increased visual motion sensitivity (VMS) or visual vertigo. BNO is a technique in which partial occluders are added to the spectacle lenses to suppress the abnormal peripheral visual motion information. This technique helps in reducing VMS symptoms (i.e., nausea, dizziness, balance difficulty, visual confusion). Case Report: A 44-year-old AA female presented for a routine eye exam with a history of mTBI approximately 33 years ago. She was suffering from severe dizziness for the last two years that was adversely impacting her ADLs. The dizziness occurred in all body positions and all environments throughout the day. She was diagnosed with vestibular hypofunction and had undergone vestibular therapy but reported little improvement. Neurological exam revealed dizziness with both OKN drum and hand movement, especially in the left visual field. BNO technique resulted in immediate relief of her dizziness symptoms. Conclusion: To our knowledge, this is the first case that illustrates how the BNO technique in isolation can be beneficial for patients with mTBI and vestibular hypofunction. It demonstrates the success that BNO has in filtering abnormal peripheral visual motion in these patients.

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