Vestibular and Oculomotor Assessments May Increase Accuracy of Subacute Concussion Assessment

Abstract

In this study, we collected and analyzed preliminary data for the internal consistency of a new condensed model to assess vestibular and oculomotor impairments following a concussion. We also examined this model's ability to discriminate concussed athletes from healthy controls. Each participant was tested in a concussion assessment protocol that consisted of the Neurocom's Sensory Organization Test (SOT), Balance Error Scoring System exam, and a series of 8 vestibular and oculomotor assessments. Of these 10 assessments, only the SOT, near point convergence, and the signs and symptoms (S/S) scores collected following optokinetic stimulation, the horizontal eye saccades test, and the gaze stabilization test were significantly correlated with health status, and were used in further analyses. Multivariate logistic regression for binary outcomes was employed and these beta weights were used to calculate the area under the receiver operating characteristic curve ( area under the curve). The best model supported by our findings suggest that an exam consisting of the 4 SOT sensory ratios, near point convergence, and the optokinetic stimulation signs and symptoms score are sensitive in discriminating concussed athletes from healthy controls (accuracy=98.6%, AUC=0.983). However, an even more parsimonious model consisting of only the optokinetic stimulation and gaze stabilization test S/S scores and near point convergence was found to be a sensitive model for discriminating concussed athletes from healthy controls (accuracy=94.4%, AUC=0.951) without the need for expensive equipment. Although more investigation is needed, these findings will be helpful to health professionals potentially providing them with a sensitive and specific battery of simple vestibular and oculomotor assessments for concussion management.

What domains of clinical function should be assessed after sport-related concussion? A systematic review

“…Therefore, to the extent possible, a standardised vestibular and ocular motor screening examination should be included in existing screening and testing batteries 68. A symptom-based, detailed and interdisciplinary examination by sports medicine clinicians experienced in concussion management should be initiated in athletes with recovery exceeding the typical recovery duration of 14 days.…”

Persistent impairment based symptoms post mild traumatic brain injury: Does a standard symptom scale detect them?

“…Evolving evidence suggests that clinical instruments relating to neck pain and disability (24,25), fatigue (26), sleep quality (27) and psychological distress (28) may also be relevant in patients post-mTBI. (Figure1) Such instruments may give insight regarding persisting sensorimotor, musculoskeletal, endocrine, neurodegenerative, or affective deficits in these patients (15,(29)(30)(31)(32). The aim of this study was therefore to further investigate whether symptoms potentially indicative of impairment persist in patients beyond the expected recovery period post-mTBI, and whether a standard self-report symptom tool (ie.…”

“…Studies have demonstrated persistent multi-system impairments, particularly sensorimotor and physiological disturbances, following mTBI, beyond expected recovery times (8)(9)(10)(11)(12)(13)(14)(15)(16)(17) and following self-reported symptom abatement (8,11,13,14). One recent review (18) identified persistent impairments in 36 individual sensorimotor and/or physiological variables (postural control, oculomotor function, and sleep) in individuals subacutely post mTBI, with additional meta-analysis evidence of impaired heart-beat regulation.…”

Considerations for Testing and Treating Children with Central Vestibular Impairments

“…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.…”