Residual Deficits in Vestibular Function Exist Following Return to Sports Participation from Concussion

ObjectiveDetermine if collegiate athletes exhibit residual deficits in vestibular function at the time of unrestricted return to participation (RTP) following a sports-related concussion (SRC).BackgroundIt has been well documented that afferent vestibular pathways are disrupted after SRC. This includes both the vestibular-ocular and vestibulospinal reflexes which mediate dynamic vision and postural stability. However, few studies have determined if vestibular function is recovered in athletes at the time of RTP from SRC.Design/MethodsTwenty-six NCAA Division-I athletes (1.77 ± 0.14 m, 92.81 ± 31.30 kg, 10 females, 16 males) performed the Concussion Balance Test (COBALT), the Dynamic Visual Acuity Test (DVAT), and Gaze Stability Test (GST). Thirteen athletes were tested within 14 days of RTP following SRC. Thirteen athletes with no history of SRC were matched to the RTP group based on age, sex, and sport to serve as healthy controls (HC). Paired t-tests with corresponding effect sizes compared COBALT, DVAT, and GST scores between groups (SRC, HC). For all tests, the alpha level was set a priori at 0.10.ResultsTwenty-six NCAA Division-I athletes (1.77 ± 0.14 m, 92.81 ± 31.30 kg, 10 females, 16 males) performed the Concussion Balance Test (COBALT), the Dynamic Visual Acuity Test (DVAT), and Gaze Stability Test (GST). Thirteen athletes were tested within 14 days of RTP following SRC. Thirteen athletes with no history of SRC were matched to the RTP group based on age, sex, and sport to serve as healthy controls (HC). Paired t-tests with corresponding effect sizes compared COBALT, DVAT, and GST scores between groups (SRC, HC). For all tests, the alpha level was set a priori at 0.10.ConclusionsOur preliminary findings suggest that collegiate athletes who return to participation from SRC may experience residual deficits in postural control and visual acuity with dynamic head movements that challenge the vestibular system. Therefore, objective measures of vestibular function may be beneficial to ensure postural control and visual acuity are restored at RTP following SRC.

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Return to Sport After Hip Arthroscopy for Femoroacetabular Impingement Syndrome in NCAA Division I Athletes: Experience at a Single Institution

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120918383 ◽

2020 ◽

Vol 8 (5) ◽

pp. 232596712091838

Author(s):

Alexander E. Weber ◽

Haley Nakata ◽

Eric N. Mayer ◽

Ioanna K. Bolia ◽

Marc J. Philippon ◽

...

Keyword(s):

Ncaa Division I ◽

Hip Arthroscopy ◽

Return To Sport ◽

Collegiate Athletes ◽

Endurance Athletes ◽

Division I ◽

Labral Repair ◽

Sport Type ◽

History Of ◽

Division I Athletes

Background: The rate of return to sport after surgical treatment of femoroacetabular impingement (FAI) syndrome (FAIS) has been studied in high-level athletes. However, few studies examining this rate have focused exclusively on National Collegiate Athletic Association (NCAA) Division I athletes. Purpose: To evaluate the return-to-sport rate after hip arthroscopy for FAIS and to examine the influence of sport type on the clinical presentation of FAIS in collegiate athletes. Study Design: Case series; Level of evidence, 4. Methods: Included in this study were NCAA Division I student-athletes who underwent hip arthroscopy for FAIS at our institution between 2010 and 2017. Exclusion criteria were history of previous hip pathology, pediatric hip disease, radiographic evidence of osteoarthritis (Tönnis grade >0), prior lower extremity procedure, history of chronic pain, osteoporosis, or history of systemic inflammatory disease. Athletes were categorized into 6 subgroups based on the type of sport (cutting, contact, endurance, impingement, asymmetric/overhead, and flexibility) by using a previously reported classification system. Patient characteristics and preoperative, intraoperative, and return-to-sport variables were compared among sport types. Results: A total of 49 hip arthroscopies for FAIS were performed in 39 collegiate athletes (10 females, 29 males; mean age, 19.5 ± 1.3 years). A total of 1 (2.6%) cutting athlete, 15 (38.5%) contact athletes, 8 (20.5%) impingement athletes, 6 (15.4%) asymmetric/overhead athletes, and 9 (23.1%) endurance athletes were included in the study. There were no differences among sports groups with respect to the FAI type. Endurance athletes had lower rates of femoral osteochondroplasty (45.5%) and labral debridement (0.0%) ( P < .0001). Contact sport athletes had higher rates of labral debridement (50.0%; P < .0001). Patients were evaluated for return to sport at an average of 1.96 ± 0.94 years. Overall, the return-to-sport rate was 89.7%. There were no differences in return-to-sport rates based on the sport type except for endurance athletes, who returned at a lower rate (66.6%; P < .001). No differences in return-to-sport rate ( P = .411), duration after return ( P = .265), or highest attempted level of sport resumed ( P = .625) were found between patients who underwent labral repair versus debridement. Conclusion: Collegiate-level athletes who underwent hip arthroscopy for FAIS returned to sport at high and predictable rates, with endurance athletes possibly returning to sport at lower rates than all other sport types. Surgical procedures may be influenced by sport type, but the rate of return to sport between athletes who underwent labral debridement versus labral repair was similar.

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Faculty Opinions recommendation of A new dynamic visual acuity test to assess peripheral vestibular function.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.5430957.5389055 ◽

2010 ◽

Author(s):

Detlef Kömpf ◽

Christoph Helmchen ◽

Björn Machner

Keyword(s):

Visual Acuity ◽

Vestibular Function ◽

Dynamic Visual Acuity ◽

Visual Acuity Test ◽

Acuity Test

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Sport-specific differences in dynamic visual acuity and gaze stabilization in division-I collegiate athletes

Journal of Vestibular Research ◽

10.3233/ves-200710 ◽

2020 ◽

Vol 30 (4) ◽

pp. 249-257

Author(s):

C. Quintana ◽

N.R. Heebner ◽

A.D. Olson ◽

J.P. Abt ◽

M.C. Hoch

Keyword(s):

Visual Acuity ◽

A Priori ◽

Collegiate Athletes ◽

Division I ◽

Normative Values ◽

Dynamic Visual Acuity ◽

Gaze Stabilization ◽

Concussion Management ◽

Vestibular Ocular Reflex ◽

Concussion History

BACKGROUND: The vestibular-ocular reflex (VOR) integrates the vestibular and ocular systems to maintain gaze during head motion. This reflex is often negatively affected following sport-related concussion. Objective measures of gaze stability, a function mediated by the VOR, such as the computerized dynamic visual acuity test (DVAT) and gaze stabilization test (GST), may have utility in concussion management. However, normative data specific to sport, sex, or concussion history have not been established in collegiate athletes. OBJECTIVE: The objective of this study was to establish normative values for the DVAT and GST in collegiate athletes and explore the effect of sport, sex, and concussion history on VOR assessments. METHODS: The DVAT and GST were completed by 124 collegiate athletes (72 male, 52 female, mean±SD, age: 19.71±1.74 years, height: 173.99±13.97 cm, weight: 80.06±26.52 kg) recruited from Division-I athletic teams (football, soccer and cheerleading). The DVAT and GST were performed in the rightward and leftward directions during a single session in a standardized environment. Normative values for DVAT and GST measures were expressed as percentiles. Non-parametric statistics were used to compare differences between groups based on sex, sport, and concussion history. Alpha was set a-priori at 0.05. RESULTS: Overall, the median LogMAR unit for 124 athletes completing the DVAT was 0 (IQR = 0.17) for both leftward and rightward. The median velocities achieved on the GST were 145 °/sec and 150 °/sec (IQR = 45 and 40) for the leftward and rightward directions respectively. Significant differences were observed between sports (p = 0.001–0.17) for the GST with cheerleading demonstrating higher velocities than the other sports. However, no significant differences were identified based on sex (p≥0.09) or history of concussion (p≥0.15). CONCLUSIONS: Normative estimates for the DVAT and GST may assist in the clinical interpretation of outcomes when used in post-concussion evaluation for collegiate athletes. Although sex and previous concussion history had no effect on the DVAT or GST, performance on these measures may be influenced by type of sport. Sport-related differences in the GST may reflect VOR adaptations based on individual sport-specific demands.

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Y-Balance test asymmetry is greater in collegiate athletes with a history of concussion

Neurology ◽

10.1212/01.wnl.0000550655.96792.92 ◽

2018 ◽

Vol 91 (23 Supplement 1) ◽

pp. S26.1-S26

Author(s):

Hoch Matthew ◽

Curry Nicole ◽

Hartley-Gabriel Emily ◽

Heebner Nicholas ◽

Hoch Johanna

Keyword(s):

Lower Extremity ◽

Injury Risk ◽

Collegiate Athletes ◽

Lower Extremity Injury ◽

Absolute Difference ◽

Group Differences ◽

Extremity Injury ◽

Balance Test ◽

Increased Risk ◽

History Of

Athletes with a history of concussion (HC) are at an increased risk of sustaining lower extremity injuries. It is unclear if these individuals exhibit dynamic postural control deficits associated with lower extremity injury risk. The purpose of this study was to determine if collegiate athletes with a HC demonstrate differences in Y-Balance Test (YBT) performance compared to athletes with no history of concussion (NHC). A total of 116 varsity and club athletes from a Division-I university participated. Forty participants reported a HC (female/male: 31/9, age: 20.0 ± 1.4 years, height: 169.3 ± 13.1 cm, mass: 68.4 ± 14.0 kg) while 76 reported NHC (female/male: 60/16, age: 20.0 ± 1.7 years, height: 168.5 ± 12.9 cm, mass: 68.7 ± 14.6 kg). Individuals with a current concussion or lower extremity injury, or a history of lower extremity surgery were excluded. Participants completed the YBT anterior reach direction barefoot on both limbs. The YBT was completed by maximally reaching anteriorly, maintaining balance, and returning to the starting position without errors. Participants completed 4 practice trials and 3 test trials. Reach distances were averaged and normalized to leg length. Between-limb asymmetry was calculated as the absolute difference between the left and right limbs. Separate independent t-tests examined group differences in normalized reach distances and asymmetry. The proportion of participants in each group with >4 cm of asymmetry was compared using a χ2 test. Alpha was set at 0.05 for all analyses. No group differences were identified in normalized reach distances for the left (HC: 61.4% ± 9.2%, NHC: 60.8% ± 6.2%, p = 0.88, ES = 0.08) or right (HC: 61.4% ± 6.2%, NHC: 60.2% ± 6.8%, p = 0.51, ES = 0.17) limbs. However, a greater proportion of HC participants demonstrated >4 cm asymmetry (HC: 40.0%, NHC: 19.7%; p = 0.02) and these participants exhibited greater asymmetry (HC: 3.87 ± 3.69 cm, NHC: 2.40 ± 2.13 cm, p = 0.03; ES = 0.53). Athletes with a HC exhibited greater asymmetry compared to athletes with NHC. Anterior reach asymmetries of >4 cm are associated with greater lower extremity injury risk. The YBT may provide a clinical technique to further explore the relationship between concussion and lower extremity injury.

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Preliminary Scale of Reference Values for Evaluating Reactive Strength Index-Modified in Male and Female NCAA Division I Athletes

Sports ◽

10.3390/sports6040133 ◽

2018 ◽

Vol 6 (4) ◽

pp. 133 ◽

Cited By ~ 3

Author(s):

Christopher Sole ◽

Timothy Suchomel ◽

Michael Stone

Keyword(s):

Reference Values ◽

Ncaa Division I ◽

National Collegiate Athletic Association ◽

Collegiate Athletes ◽

Division I ◽

Strength Index ◽

Male And Female ◽

Significant Difference ◽

Males And Females ◽

Division I Athletes

The purpose of this analysis was to construct a preliminary scale of reference values for reactive strength index-modified (RSImod). Countermovement jump data from 151 National Collegiate Athletic Association (NCAA) Division I collegiate athletes (male n = 76; female n = 75) were analyzed. Using percentiles, scales for both male and female samples were constructed. For further analysis, athletes were separated into four performance groups based on RSImod and comparisons of jump height (JH), and time to takeoff (TTT) were performed. RSImod values ranged from 0.208 to 0.704 and 0.135 to 0.553 in males and females, respectively. Males had greater RSImod (p < 0.001, d = 1.15) and JH (p < 0.001, d = 1.41) as compared to females. No statistically significant difference was observed for TTT between males and females (p = 0.909, d = 0.02). Only JH was found to be statistically different between all performance groups. For TTT no statistical differences were observed when comparing the top two and middle two groups for males and top two, bottom two, and middle two groups for females. Similarities in TTT between sexes and across performance groups suggests JH is a primary factor contributing to differences in RSImod. The results of this analysis provide practitioners with additional insight as well as a scale of reference values for evaluating RSImod scores in collegiate athletes.

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A New Dynamic Visual Acuity Test to Assess Peripheral Vestibular Function

Archives of Otolaryngology - Head and Neck Surgery ◽

10.1001/archoto.2010.99 ◽

2010 ◽

Vol 136 (7) ◽

pp. 686 ◽

Cited By ~ 38

Author(s):

Domenic Vital ◽

Stefan C. A. Hegemann ◽

Dominik Straumann ◽

Oliver Bergamin ◽

Christopher J. Bockisch ◽

...

Keyword(s):

Visual Acuity ◽

Vestibular Function ◽

Dynamic Visual Acuity ◽

Visual Acuity Test ◽

Acuity Test

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Applications of dynamic visual acuity test in clinical ophthalmology

International Journal of Ophthalmology ◽

10.18240/ijo.2021.11.18 ◽

2021 ◽

Vol 14 (11) ◽

pp. 1771-1778

Author(s):

Ting-Yi Wu ◽

◽

Xue-Min Li ◽

Keyword(s):

Visual Acuity ◽

Contrast Sensitivity ◽

Visual Function ◽

Vestibular Function ◽

Ocular Diseases ◽

Static Perimetry ◽

Dynamic Visual Acuity ◽

Ocular Disorders ◽

Visual Acuity Test ◽

Acuity Test

Dynamic visual acuity test (DVAT) plays a key role in the assessment of vestibular function, the visual function of athletes, as well as various ocular diseases. As the visual pathways conducting dynamic and static signals are different, DVATs may have potential advantages over the traditional visual acuity tests commonly used, such as static visual acuity, contrast sensitivity, and static perimetry. Here, we provide a review of commonly applied DVATs and their several uses in clinical ophthalmology. These data indicate that the DVAT has its unique clinical significance in the evaluation of several ocular disorders.

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Concussion History and Time Since Concussion Do not Influence Static and Dynamic Balance in Collegiate Athletes

Journal of Sport Rehabilitation ◽

10.1123/jsr.2016-0119 ◽

2017 ◽

Vol 26 (6) ◽

pp. 518-523 ◽

Cited By ~ 4

Author(s):

Eric D. Merritt ◽

Cathleen N. Brown ◽

Robin M. Queen ◽

Kathy J. Simpson ◽

Julianne D. Schmidt

Keyword(s):

Outcome Measures ◽

Scoring System ◽

Dynamic Balance ◽

Collegiate Athletes ◽

Balance Performance ◽

Balance Test ◽

History Of ◽

Balance Deficits ◽

Balance Error Scoring System ◽

Balance Error

Context:Dynamic balance deficits exist following a concussion, sometimes years after injury. However, clinicians lack practical tools for assessing dynamic balance.Objectives:To determine if there are significant differences in static and dynamic balance performance between individuals with and without a history of concussion.Design:Cross sectional.Setting:Clinical research laboratory.Patients or Other Participants:45 collegiate student-athletes with a history of concussion (23 males, 22 females; age = 20.0 ± 1.4 y; height = 175.8 ± 11.6 cm; mass = 76.4 ± 19.2 kg) and 45 matched controls with no history of concussion (23 males, 22 females; age = 20.0 ± 1.3 y; height = 178.8 ± 13.2 cm; mass = 75.7 ± 18.2 kg).Interventions:Participants completed a static (Balance Error Scoring System) and dynamic (Y Balance Test-Lower Quarter) balance assessment.Main Outcome Measures:A composite score was calculated from the mean normalized Y Balance Test-Lower Quarter reach distances. Firm, foam, and overall errors were counted during the Balance Error Scoring System by a single reliable rater. One-way ANOVAs were used to compare balance performance between groups. Pearson’s correlations were performed to determine the relationship between the time since the most recent concussion and balance performance. A Bonferonni adjusted a priori α < 0.025 was used for all analyses.Results:Static and dynamic balance performance did not significantly differ between groups. No significant correlation was found between the time since the most recent concussion and balance performance.Conclusions:Collegiate athletes with a history of concussion do not present with static or dynamic balance deficits when measured using clinical assessments. More research is needed to determine whether the Y Balance Test-Lower Quarter is sensitive to acute balance deficits following concussion.

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Examining Effects of Physical Exertion on the Dynamic Visual Acuity Test in Collegiate Athletes

Journal of the American Academy of Audiology ◽

10.3766/jaaa.15110 ◽

2017 ◽

Vol 28 (01) ◽

pp. 036-045

Author(s):

Jessie N. Patterson ◽

Anna M. Murphy ◽

Julie A. Honaker

Keyword(s):

Postural Control ◽

Repeated Measures ◽

Intraclass Correlation ◽

Collegiate Athletes ◽

Physical Exertion ◽

Time Points ◽

Balance System ◽

Gaze Stability ◽

Visual Acuity Test ◽

Acuity Test

AbstractAcute symptoms of dizziness and/or imbalance commonly experienced in athletes postconcussion are speculated to arise from dysfunction at multiple levels (i.e., inner ear or central vestibular system) to appropriately integrate afferent sensory information. Disruption along any pathway of the balance system can result in symptoms of dizziness, decreased postural control function (vestibulospinal reflex), and reduced vestibulo-ocular reflex function. This may also lead to decreased gaze stability with movements of the head and may account for symptoms of blurred vision or diplopia reported in almost half of athletes sustaining a concussion. Current concussion position statements include measures of postural control to examine changes to the balance system postconcussion. The Balance Error Scoring System (BESS) is a commonly used low-cost postural control measure for concussion assessment. Although this is a widely used measure for documenting balance function on both immediate (sideline) and recovery monitoring, the BESS has been shown to be affected by physical exertion. Therefore, the BESS may not be the most efficient means of examining functional changes to the balance system immediately after head injury. Dynamic Visual Acuity Test (DVAT) has been found to effectively evaluate and monitor changes to the gaze stability system postinjury. Thus, DVAT may be an additional measure in the concussion assessment battery, as well as an alternative for more immediate sideline assessment to help make objective return-to-play decisions.The aim of the study was to determine the effects of physical exertion on a clinical vestibular assessment, the DVAT, in collegiate athletes, as a first step in defining the role of this measure in the concussion assessment battery.Cross-sectional, repeated-measures design.Twenty-eight healthy collegiate athletes (20 males, 8 females; age = 20.25 ± 1.46 yr, range = 18–25 yr) volunteered to participate in the study.Participants were randomly assigned to complete a 20-min protocol of physical exertion or rest. DVAT was completed pre-exertion or rest (pre-DVAT), immediately following the 20-min protocol (post-DVAT I), and again 10 min after the completion of the 20-min protocol (post-DVAT II). Ratings of perceived exertion (RPE) and heart rate (HR) were monitored throughout testing. Repeated-measures analysis of the variance were used to examine the effects of exertion on DVAT. Additionally, intraclass correlation coefficients were used to examine test reliability.No significant main effect was observed for right and left DVAT logarithm of the minimal angle of resolution loss between groups or across time points (p > 0.05). A significant main effect was observed for RPE and HR for groups and time points (p < 0.001), indicating adequate physical exertion and rest. Fair to good reliability (intraclass correlation coefficient values between 0.4 and 0.74) was observed for both rightward and leftward movements of the head across the three time points.Findings from this study suggest that DVAT is not affected by physical exertion and may provide a more immediate assessment of the balance system that may be of use for the sideline concussion assessment. Future studies will be performed to examine additional factors (e.g., background noise, complex visual backgrounds) that may affect DVAT performance in the sideline environment.

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