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.

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.

Premorbid migraine history as a risk factor for vestibular and oculomotor baseline concussion assessment in pediatric athletes

2019 ◽  
Vol 23 (4) ◽  
pp. 465-470 ◽  
Author(s):  
Ryan N. Moran ◽  
Tracey Covassin ◽  
Jessica Wallace
Keyword(s):  
Risk Factor ◽  
Smooth Pursuit ◽  
Migraine Headache ◽  
Visual Motion ◽  
Assessment Tools ◽  
Motion Sensitivity ◽  
Ocular Reflex ◽  
Migraine Headaches ◽  
Vestibular Ocular Reflex ◽  
History Of

OBJECTIVEMigraine history has recently been identified as a risk factor for concussion and recovery. The authors performed a cross-sectional study examining baseline outcome measures on newly developed and implemented concussion assessment tools in pediatrics. The purpose of this study was to examine the effects of premorbid, diagnosed migraine headaches as a risk factor on vestibular and oculomotor baseline assessment in pediatric athletes.METHODSPediatric athletes between the ages of 8 and 14 years with a diagnosed history of migraine headache (n = 28) and matched controls without a history of diagnosed migraine headache (n = 28) were administered a baseline concussion assessment battery, consisting of the Vestibular/Ocular Motor Screening (VOMS), near point of convergence (NPC), and the King-Devick (K-D) tests. Between-groups comparisons were performed for vestibular symptoms and provocation scores on the VOMS (smooth pursuit, saccades, convergence, vestibular/ocular reflex, visual motion sensitivity), NPC (average distance), and K-D (time).RESULTSIndividuals diagnosed with migraine headaches reported greater VOMS smooth pursuit scores (p = 0.02), convergence scores (p = 0.04), vestibular ocular reflex scores (p value range 0.002–0.04), and visual motion sensitivity scores (p = 0.009). Differences were also observed on K-D oculomotor performance with worse times in those diagnosed with migraine headache (p = 0.02). No differences were reported on NPC distance (p = 0.06) or headache symptom reporting (p = 0.07) prior to the VOMS assessment.CONCLUSIONSPediatric athletes diagnosed with migraine headaches reported higher baseline symptom provocation scores on the VOMS. Athletes with migraine headaches also performed worse on the K-D test, further illustrating the influence of premorbid migraine headaches as a risk factor for elevated concussion assessment outcomes at baseline. Special consideration may be warranted for post-concussion assessment in athletes with migraine headaches.

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 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.

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 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.

Sports Concussions (TBI), Imbalance, and Dizziness

2015 ◽  
Vol 25 (1) ◽  
pp. 36-41 ◽  
Author(s):  
Steven M. Doettl
Keyword(s):  
Assessment Tools ◽  
Vestibular Evoked Myogenic Potentials ◽  
Post Injury ◽  
Management Tools ◽  
Concussion Management ◽  
Post Concussion Syndrome ◽  
Behavioral Marker ◽  
Valid Assessment ◽  
Injury Assessment

It has been widely accepted that the assessment of balance after concussion plays a large role in determining deficit. Qualitative balance assessments have been an established piece of the post-injury assessment as a clinical behavioral marker of concussion for many years. Recently more specific guidelines outlining the role of balance evaluation in concussion identification and management have been developed as part of concussion management tools. As part of the ongoing development of concussions protocols, quantitative assessment of balance function following concussion has also been identified to have an important role. Frequently imbalance and dizziness reported following concussion is assumed to be associated with post-concussion syndrome (PCS). While imbalance and dizziness are common complaints in PCS, they can also be a sign of additional underlying pathology. In cases of specific dizziness symptoms or limited balance recovery beyond the initial post-concussive period, a quantitative vestibular assessment may also be needed. Electronystagmography and videonystagmography (ENG/VNG), rotary chair testing (RCT), and vestibular evoked myogenic potentials (VEMPs) have all been identified as valid assessment tools for vestibular dysfunction following traumatic brain injury (TBI). The assessment of balance and dizziness following sports-related concussions is an integral piece of the puzzle for removal from play, assessment of severity, and management.

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.

Obesity does not Impair Ambulatory Cardiovascular and Autonomic Responses Post-exercise

2021 ◽  
Author(s):  
Gabriel Kolesny Tricot ◽  
Fabiula Isoton Isoton Novelli ◽  
Lucieli Teresa Cambri
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Diastolic Blood Pressure ◽  
Maximal Exercise ◽  
Young Men ◽  
Autonomic Modulation ◽  
Incremental Test ◽  
Post Exercise ◽  
Cardiac Autonomic Modulation ◽  
Main Effect

AbstractThis study aimed to assess whether obesity and/or maximal exercise can change 24 h cardiac autonomic modulation and blood pressure in young men. Thirty-nine men (n: 20; 21.9±1.8 kg·m−2, and n: 19; 32.9±2.4 kg·m−2) were randomly assigned to perform a control (non-exercise) and an experimental day exercise (after maximal incremental test). Cardiac autonomic modulation was evaluated through frequency domain heart rate variability (HRV). Obesity did not impair the ambulatory HRV (p>0.05), however higher diastolic blood pressure during asleep time (p=0.02; group main effect) was observed. The 24 h and awake heart rate was higher on the experimental day (p<0.05; day main effect), regardless of obesity. Hypotension on the experimental day, compared to control day, was observed (p<0.05). Obesity indicators were significantly correlated with heart rate during asleep time (Rho=0.34 to 0.36) and with ambulatory blood pressure(r/Rho=0.32 to 0.53). Furthermore, the HRV threshold workload was significantly correlated with ambulatory heart rate (r/Rho=− 0.38 to−0.52). Finally, ambulatory HRV in obese young men was preserved; however, diastolic blood pressure was increased during asleep time. Maximal exercise caused heart rate increase and 24h hypotension, with decreased cardiac autonomic modulation in the first hour, regardless of obesity.

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