Treatment of Accommodative Dysfunction in Children: Results from a Randomized Clinical Trial

Scheiman, Mitchell; Cotter, Susan A.; Kulp, Marjean Taylor; Mitchell, G. Lynn; Cooper, Jeffrey; Gallaway, Michael; Hopkins, Kristine; Bartuccio, Mary; Chung, Ida

doi:10.1097/opx.0b013e31822f4d7c

Cited by 84 publications

(77 citation statements)

References 24 publications

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“…8 Research has shown that convergence insufficiency, in particular, is responsive to targeted vision therapy. 31 Additionally, there is evidence to support the use of vision therapy for accommodative deficits, impaired version movements, and minor ocular misalignments. 8 The value of incorporating vestibular and visual rehabilitation into the management of post-concussive patients with vestibular and ocular motor impairments, as identified by the VOMS, warrants further study.…”

Section: Discussionmentioning

confidence: 99%

A Brief Vestibular/Ocular Motor Screening (VOMS) Assessment to Evaluate Concussions

et al. 2014

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Background Vestibular and ocular motor impairments and symptoms have been documented in patients with sport-related concussions. However, there is no current brief clinical screen to assess and monitor these issues. Purpose To describe and provide initial data for the internal consistency and validity of a brief clinical screening tool for vestibular and ocular motor impairments and symptoms after sport-related concussions. Study Design Cross-sectional study; Level of evidence, 2. Methods Sixty-four patients, aged 13.9 ± 2.5 years and seen approximately 5.5 ± 4.0 days after a sport-related concussion, and 78 controls were administered the Vestibular/Ocular Motor Screening (VOMS) assessment, which included 5 domains: (1) smooth pursuit, (2) horizontal and vertical saccades, (3) near point of convergence (NPC) distance, (4) horizontal vestibular ocular reflex (VOR), and (5) visual motion sensitivity (VMS). Participants were also administered the Post-Concussion Symptom Scale (PCSS). Results Sixty-one percent of patients reported symptom provocation after at least 1 VOMS item. All VOMS items were positively correlated to the PCSS total symptom score. The VOR (odds ratio [OR], 3.89; P <.001) and VMS (OR, 3.37; P <.01) components of the VOMS were most predictive of being in the concussed group. An NPC distance ≥5 cm and any VOMS item symptom score ≥2 resulted in an increase in the probability of correctly identifying concussed patients of 38% and 50%, respectively. Receiver operating characteristic curves supported a model including the VOR, VMS, NPC distance, and ln(age) that resulted in a high predicted probability (area under the curve = 0.89) for identifying concussed patients. Conclusion The VOMS demonstrated internal consistency as well as sensitivity in identifying patients with concussions. The current findings provide preliminary support for the utility of the VOMS as a brief vestibular/ocular motor screen after sport-related concussions. The VOMS may augment current assessment tools and may serve as a single component of a comprehensive approach to the assessment of concussions.

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Section: Discussionmentioning

confidence: 99%

A Brief Vestibular/Ocular Motor Screening (VOMS) Assessment to Evaluate Concussions

et al. 2014

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“…Additionally, for our physical examination, we only obtained near-point convergence as a one-time measure; other clinics have taken the approach of averaging three separate measures. 50 …”

Section: Discussionmentioning

confidence: 99%

Characteristics of Prolonged Concussion Recovery in a Pediatric Subspecialty Referral Population

Corwin

Zonfrillo

Master

et al. 2014

The Journal of Pediatrics

210

205

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Objective To identify pre-existing characteristics associated with prolonged recovery from concussion in a sample of patients referred to a pediatric sports medicine clinic. Study design This was a retrospective, exploratory cohort study of 247 patients age 5-18 years old with concussion referred to a tertiary pediatric hospital-affiliated sports medicine clinic from July 1, 2010, through December 31, 2011. A random sample of all eligible patient visits (3740) was chosen for further review and abstraction. Statistical comparisons between subsets of patients were conducted using exact chi-square tests, logistic regression, quantile regression, and Kaplan Meier survival curves. Results The median time until returning to school part-time was 12 days (interquartile range (IQR) 6-21); until returning to school full-time without accommodations was 35 days (IQR 11-105); until becoming symptom-free was 64 days (IQR 18-119); and until being fully cleared to return to sports was 75 days (IQR 30-153). 73% of all patients were symptomatic for >4 weeks, 73% were prescribed some form of school accommodation, and 61% reported a decline in grades. Characteristics associated with a prolonged recovery included a history of depression or anxiety; an initial complaint of dizziness; abnormal convergence or symptom provocation following oculomotor examination on physical examination; and history of prior concussion. Conclusion Pediatric and adolescent patients with concussion may experience cognitive and emotional morbidity that can last for several months following injury. Clinicians should consider specific pre-existing characteristics and presenting symptoms that may be associated with a more complicated recovery for concussion patients.

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“…12 The ruler is placed at the center the subject’s forehead, and a measurement is taken when the patient reported the letters became double. A failed exam was defined as the letters becoming double at greater than 6 cm from the patient’s forehead.…”

Section: Methodsmentioning

confidence: 99%

Vestibular and oculomotor findings in neurologically-normal, non-concussed children

et al. 2018

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OBJECTIVE To determine the proportion of non-concussed, neurologically normal children with failures on a vestibular and oculomotor examination for concussion performed in an acute setting. DESIGN This was a cross-sectional study of subjects 6–18 years old presenting to a pediatric emergency department with non-neurologic chief complaints. The examination was administered by a pediatric emergency medicine physician, and includes assessments of dysmetria, nystagmus, smooth pursuits, saccades, gaze stability, near-point of convergence, and gait/balance testing. RESULTS Of the 295 subjects enrolled, 24% failed at least one element of testing. 13% had >1 failed element and 5% had >2 failed elements. 29% of females and 19% of males had failed examinations. By age, 15% of subjects 6–8 years old, 32% 9–11 years, 32% 12–14 years, and 26% 15–18 years had failed examinations. Overall, 10% were unable to complete the exam due to developmental age. CONCLUSIONS The provider should be aware that a proportion of non-concussed children may demonstrate failure on a single element of the vestibular and oculomotor exam for. While this testing is of benefit to the acute care provider in diagnosing pediatric concussion, its utility is greatest in the context of an injury history with acute onset of concussion symptoms.

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Treatment of Accommodative Dysfunction in Children: Results from a Randomized Clinical Trial

Cited by 84 publications

References 24 publications

A Brief Vestibular/Ocular Motor Screening (VOMS) Assessment to Evaluate Concussions

A Brief Vestibular/Ocular Motor Screening (VOMS) Assessment to Evaluate Concussions

Characteristics of Prolonged Concussion Recovery in a Pediatric Subspecialty Referral Population

Vestibular and oculomotor findings in neurologically-normal, non-concussed children

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