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

Bilingual lexical skills of school-age children with Chinese and Korean heritage languages in the United States

2014 ◽  
Vol 38 (4) ◽  
pp. 350-358 ◽  
Author(s):  
Gisela Jia ◽  
Jennifer Chen ◽  
HyeYoung Kim ◽  
Phoenix-Shan Chan ◽  
Changmo Jeung
Keyword(s):  
High School ◽  
The United States ◽  
Cross Sectional Study ◽  
School Age Children ◽  
Primary Study ◽  
School Age ◽  
Cross Sectional ◽  
Age Related ◽  
Lexical Skills ◽  
At Home

This cross-sectional study investigated the bilingual lexical skills of 175 US school-age children (5 to18 years old) with Cantonese, Mandarin, or Korean as their heritage language (HL), and English as their dominant language. Primary study goals were to identify potential patterns of development in bilingual lexical skills over the elementary to high school time span and to examine the relation of environmental factors to lexical skills. HL and English productive lexical skills were assessed with a Picture Naming and a Verbal Fluency task. English receptive lexical skills were assessed with Peabody Picture Vocabulary Test. A survey obtained information about participants’ language use in six environmental contexts. There were age-related significant increases in both HL and English skills. However, English proficiency already had a significant lead over HL proficiency at the youngest age. English receptive lexical skills reached monolingual expectations from age 8, whereas for HL, high school age participants on average only reached the level of early elementary school monolinguals. Although more English use at home at younger ages was associated with stronger English skills, the relation did not exist for older participants. Instead, among older participants, more English use at home was associated with weaker HL skills. Children’s attendance at HL programs and visits to home countries bore little relation to HL proficiency.

scholarly journals Injury Rehabilitation Overadherence: Preliminary Scale Validation and Relationships With Athletic Identity and Self-Presentation Concerns

2013 ◽  
Vol 48 (3) ◽  
pp. 372-381 ◽  
Author(s):  
Leslie Podlog ◽  
Zan Gao ◽  
Laura Kenow ◽  
Jens Kleinert ◽  
Megan Granquist ◽  
...  
Keyword(s):  
High School ◽  
National Collegiate Athletic Association ◽  
Athletic Identity ◽  
Return To Sport ◽  
Collegiate Athletes ◽  
Functional Rehabilitation ◽  
Cross Sectional ◽  
Injury Rehabilitation ◽  
Self Presentation ◽  
Bivariate Correlation

Context: Evidence suggests that nonadherence to rehabilitation protocols may be associated with worse clinical and functional rehabilitation outcomes. Recently, it has been recognized that nonadherence may not only reflect a lack of rehabilitation engagement but that some athletes may “overadhere” to their injury-rehabilitation regimen or risk a premature return to sport. Presently, no measure of overadherence exists, and correlates of overadherence and risking a premature return to sport remain uncertain. Objective: To provide initial validation of a novel injury-rehabilitation overadherence measure (study 1) and to examine correlates of overadherence and risking a premature return to sport (study 2). Design: Cross-sectional study. Setting: High school athletes (study 1) and collegiate athletes (study 2). Patients or Other Participants: In study 1, 118 currently injured US adolescent athletes competing in a range of high school sports participated. In study 2, 105 currently injured collegiate athletes (National Collegiate Athletic Association Divisions I–III) volunteered. Main Outcome Measure(s): The Rehabilitation Overadherence Questionnaire was a novel instrument developed to assess injured athletes' tendency toward overadherence behaviors and beliefs. We used an adapted version of the Injury Psychological Readiness to Return to Sport Scale to assess the tendency to risk a premature return to sport. Results: In study 1, the construct validity of the overadherence measure was supported using principal axis factoring. Moreover, bivariate correlation and regression analyses indicated that self-presentation concerns and athletic identity were positive predictors of adolescent rehabilitation overadherence and a premature return to sport. Study 2 provided support for the 2-factor structure of the overadherence measure found in study 1 via confirmatory factor analysis. Further support for the relationship among self-presentation concerns, athletic identity, and rehabilitation overadherence was also noted. Conclusions: The Rehabilitation Overadherence Questionnaire is a valid and reliable measure of overadherence.

scholarly journals King-Devick Sensitivity and Specificity to Concussion in Collegiate Athletes

2021 ◽  
Author(s):  
Rachel K. Le ◽  
Justus D. Ortega ◽  
Sara P. D. Chrisman ◽  
Anthony P. Kontos ◽  
Thomas A. Buckley ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Sensitivity And Specificity ◽  
Area Under The Curve ◽  
Collegiate Athletes ◽  
Return To Play ◽  
Cutoff Score ◽  
Confounding Factors ◽  
Post Injury ◽  
Cross Sectional ◽  
Cutoff Scores

Context: The King-Devick (K-D) is used to identify oculomotor impairment following concussion. However, the diagnostic accuracy of the K-D over time has not been evaluated. Objective: (a) Examine the sensitivity and specificity of the K-D test at 0–6 hours of injury, 24–48 hours, asymptomatic, return-to-play, and 6-months following concussion and (b) compare outcomes for differentiating athletes with a concussion from non-concussed across confounding factors (sex, age, contact level, school year, learning disorder, ADHD, concussion history, migraine history, administration mode). Design: Retrospective, cross-sectional design. Setting: Multisite institutions within the Concussion Assessment, Research, and Education (CARE) Consortium. Patients or Other Participants: 1239 total collegiate athletes without a concussion (age=20.31±1.18, male=52.2%) were compared to 320 athletes with a concussion (age=19.80±1.41, male=51.3%). Main Outcome Measure(s): We calculated K-D time difference (sec) by subtracting baseline from the most recent time. Receiver operator characteristics (ROC) and area under the curve (AUC) analyses were used to determine the diagnostic accuracy across timepoints. We identified cutoff scores and corresponding specificity at 80% and 70% sensitivity levels. We repeated ROC with AUC outcomes by confounding factors. Results: King-Devick predicted positive results at 0-6 hours (AUC=0.724, p&lt;0.001), 24-48 hours (AUC=0.701, p&lt;0.001), return-to-play (AUC=0.640, P&lt;0.001), and 6-months (AUC=0.615, P&lt;0.001), but not at asymptomatic (AUC=0.513, P=0.497). The 0–6 and 24–48-hour timepoints yielded an 80% sensitivity cutoff score of −2.6 and −3.2 seconds (faster) respectively, but 46% and 41% specificity. The K-D test had significantly better AUC when administered on an iPad (AUC=0.800, 95%CI:0.747,0.854) compared to the spiral card system (AUC=0.646, 95%CI:0.600,0.692; p&lt;0.001). Conclusions: The K-D test has the greatest diagnostic accuracy at 0–6 and 24–48 hours of concussion, but declines across subsequent post-injury timepoints. AUCs did not significantly differentiate between groups for confounding factors. Our negative cutoff scores indicate that practice effects contribute to improved performance, requiring athletes to outperform their baseline.

Comparing High School Sport Specialization Trends Between Division I and Club Collegiate Athletes

2021 ◽  
pp. 194173812110602
Author(s):  
Kevin M. Biese ◽  
Madeline Winans ◽  
Mayrena I. Hernandez ◽  
Daniel A. Schaefer ◽  
Eric G. Post ◽  
...  
Keyword(s):  
High School ◽  
Sport Participation ◽  
Female Athletes ◽  
Collegiate Athletes ◽  
Nonparametric Tests ◽  
Influential Factors ◽  
Division I ◽  
School Sport ◽  
Age Related ◽  
High School Sport

Background: Adolescent athletes report that sports specialization improves their ability to receive a collegiate athletics scholarship, though this is not well-understood. The purpose of this study was to examine self-reported trends in high school specialization and influences for sport participation between Division I (D-I) and college-aged club (club) athletes. Hypothesis: There would be no difference in high school sport specialization or sport participation influences between D-I and club athletes. Study Design: Retrospective cross-sectional study. Level of Evidence: Level 3. Methods: A survey included specialization classification (low, moderate, and high) for 9th to 12th grade, age that the athlete started organized sport and his or her collegiate sport, and several influential factors for participation in one’s primary high school sport (1 = no influence to 5 = extremely influential). Chi-square analyses were used to compare specialization classifications between groups. Nonparametric tests were used to determine significant differences in age-related variables and influential factors between D-I and club athletes. All analysis were also conducted with boys and girls separately. Results: Participants included 266 D-I (girls, 155; 58%) and 180 club (girls, 122; 68%) athletes. Club athletes were more likely to be classified as low specialization at every grade in high school, and this difference was more pronounced between D-I and club female athletes than male athletes. The number of years an athlete was classified as highly specialized in high school was not different between D-I and club athletes. Club athletes were more influenced by playing with friends than D-I athletes and D-I athletes were more influenced by pursuing a collegiate scholarship than club athletes. Conclusion: High levels of specialization in high school sport may not be necessary for playing at the collegiate level, though some level of specialization in high school might be necessary. Clinical Relevance: Clinicians should advocate for healthy long-term athlete development, which does not support high specialization in high school sports.

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.

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 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 Association Between Previous Concussion History and Symptom Endorsement During Preseason Baseline Testing in High School and Collegiate Athletes

2009 ◽  
Vol 1 (1) ◽  
pp. 61-65 ◽  
Author(s):  
Johna K. Register-Mihalik ◽  
Jason P. Mihalik ◽  
Kevin M. Guskiewicz
Keyword(s):  
High School ◽  
College Athletes ◽  
Collegiate Athletes ◽  
Cross Sectional Study ◽  
Acute Stage ◽  
Self Report ◽  
Symptom Checklist ◽  
Cross Sectional ◽  
Baseline Testing ◽  
Concussion History

Background: A graded symptom checklist is a commonly used concussion evaluation measure. Little is known about pre-season baseline symptomatology of high school and college athletes with and without a previous concussion history. Hypothesis: The primary hypothesis investigated was that those individuals with a concussion history would report more symptoms at baseline testing. The effects of sex and age on symptoms were also examined. Study Design: Cross-sectional study. Methods: Subjects included 8930 high school and collegiate athletes (height, 177.79 ± 9.97 cm; mass, 75.20 ± 19.21 kg; age, 16.60 ± 1.64 years). Subjects completed a self-report graded symptom checklist and concussion history questionnaire during a preseason clinical testing session. Symptoms reported (yes or no) on the 18-item graded symptom checklist served as the dependent variables. Results: A significant association was observed between symptoms on the graded symptom checklist and previous concussion history ( P ≤ .001). No differences were observed between high school and college athletes regarding symptom endorsement (t8928 = 0.620; P = .535). A statistical but not clinically meaningful difference was observed between the means for males and females symptom endorsement (t8928 = −3.03; P = .002): men endorsed 1.88 ± 2.81 symptoms, and women endorsed 2.09 ± 2.90 symptoms. Headache, sleeping more than usual, difficulty concentrating, drowsiness, difficulty remembering, fatigue, difficulty sleeping, and irritability were reported by more than 10% of athletes. Conclusion: High school and college athletes with a history of multiple concussions may be at risk for experiencing concussion-linked symptoms well beyond the acute stage of injury. Clinicians should be mindful of previous concussion history in athletes with increased presence of base-rate symptoms as they may be predisposed to future injury.

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