A review of the current practice in diagnosis and management of visual complaints associated with concussion and postconcussion syndrome

Heinmiller, Laura; Gunton, Kammi B.

doi:10.1097/icu.0000000000000296

Cited by 11 publications

(7 citation statements)

References 57 publications

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“…However, there are a few compelling measurements that acutely reflect neuronal impairment from concussion/subconcussion, and thereby potentially hold the promise of gauging chronic neuronal damage. Easily administered visual and oculomotor function tests have recently shown such promise in sensitively detecting the effects of concussion [24,54,55]. One such test probes the ocular near point of convergence (NPC).…”

Section: Introductionmentioning

confidence: 99%

A History of Concussion Does Not Lead to an Increase in Ocular Near Point of Convergence

et al. 2018

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Ocular near point of convergence (NPC) has been shown to be sensitive to the effects of concussion and subconcussive impacts. To determine if NPC is also sensitive to a previous history of concussion, male contact-sport athletes either with (n=26) or without (n=16) a history of at least one previous concussion had their NPC assessed. The results showed that participants with a history of concussion displayed NPC values (9.4±1.6 cm) indistinguishable from those with no history of concussion (8.4±2.1 cm, t-test, p=0.09). This was the case regardless of whether 1, 2, or 3 or more concussions had occurred and despite the fact participants with concussion (mean time since last concussion: 1136 days) suffered from an increased number and severity of symptoms as assessed with the SCAT 3 (3.6±2.2 vs. 2.13±1.89 symptoms, 6.1±4.1 vs. 3.19±2.99 severity, t-test, p<0.05). Taken together, these results imply that NPC may not be a suitable tool to assess the potential long-term effects of one or more concussions over a longer time frame.: Future research using larger sample sizes is warranted to evaluate the potential dose-response relationship between number of prior concussions and NPC.

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Section: Introductionmentioning

confidence: 99%

A History of Concussion Does Not Lead to an Increase in Ocular Near Point of Convergence

et al. 2018

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“…The GST captures maximum head movement speeds in all three planes (horizontal yaw, vertical pitch, and roll plane) in degrees per second that an individual can perform while maintaining stable vision on a consistent sized computer-based target or optotype. 27,28 Optotype size was set to 0.2 logMAR above the established SVA value for the GST. The participant was instructed to slowly increase head velocity until the optotype appeared on the screen, with follow on-screen visual indicators to maintain consistent head displacement to the right and left, and to reach a trigger head velocity.…”

Section: Methodsmentioning

confidence: 99%

“…1,3,4 Visual and vestibular symptoms post-injury include blurry vision, diplopia, dizziness, and/or imbalance are reported in 50%-80% of athletes and are currently assessed as part of the comprehensive post-concussive evaluation. [5][6][7] Common acute post-injury assessments to include the Sport Concussion Assessment Tool, version 5, and King-Devick test provide information in regard to balance impairment and saccadic eye functioning, though do not capture function of the gaze stabilization system. [8][9][10][11] Assessment of vestibular ocular system dysfunction to include gaze stability is gaining recognition through both high-and low-technology assessments to include devices such as Eye Sync/SyncThink™ and the Vestibular Ocular Screening Tool (VOMs) which was designed for the non-vestibular practitioner to screen for vestibulo-ocular dysfunction following concussion.…”

Section: Introductionmentioning

confidence: 99%

Gaze stabilization function does not predict injury incidence among collegiate athletes

et al. 2021

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Maintenance of visual acuity during head movement is essential for optimal performance in sport. While it seems reasonable to suspect that reduced gaze stabilization might impair physical performance on the playing field and contribute to increased incidence of injury, the relationship between gaze stabilization function and athletic injury has not been examined. The purpose of this study was to examine the influence of gaze stabilization on the incidence of injury in collegiate athletes. A total of 147 collegiate athletes were assessed using the Neurocom Invision gaze stabilization test (GST) prior to season of play in the horizontal plane. Injury reports for each athlete were recorded during the fall season, and then, comparisons between GST performance for those injured versus not were performed. Fifty‐eight percent of the athletes were injured during the season. There was no difference in average GST scores or asymmetry between athletes who sustained injury during season and those who did not. Lower horizontal gaze stabilization function does not appear to be associated with an increase in injury incidence in collegiate athletes. Baseline gaze stabilization testing is not recommended for identification of athletes at risk but could be utilized to establish baseline function.

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

Section: Concussionmentioning

confidence: 99%

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

Section: Concussionmentioning

confidence: 99%

Considerations for Testing and Treating Children with Central Vestibular Impairments

Christy

2018

Semin Hear

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

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A review of the current practice in diagnosis and management of visual complaints associated with concussion and postconcussion syndrome

Cited by 11 publications

References 57 publications

A History of Concussion Does Not Lead to an Increase in Ocular Near Point of Convergence

A History of Concussion Does Not Lead to an Increase in Ocular Near Point of Convergence

Gaze stabilization function does not predict injury incidence among collegiate athletes

Considerations for Testing and Treating Children with Central Vestibular Impairments

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