Daniel J Corwin1, Douglas J Wiebe2, Mark R Zonfrillo3, Matthew F Grady4, Roni L Robinson5, Arlene M Goodman6, Christina L Master7. 1. Division of Emergency Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA. 2. Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. 3. Division of Emergency Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, PA. 4. Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Sports Medicine and Performance Center, The Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA. 5. Sports Medicine and Performance Center, The Children's Hospital of Philadelphia, Philadelphia, PA. 6. Pediatric Sports Medicine, Saint Peter's Sports Medicine Institute, Somerset, NJ. 7. Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Sports Medicine and Performance Center, The Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA. Electronic address: masterc@email.chop.edu.
Abstract
OBJECTIVE: To characterize the prevalence and recovery of pediatric patients with concussion who manifest clinical vestibular deficits and to describe the correlation of these deficits with neurocognitive function, based on computerized neurocognitive testing, in a sample of pediatric patients with concussion. METHODS: This was a retrospective cohort study of patients ages 5-18 years with concussion referred to a tertiary pediatric hospital-affiliated sports medicine clinic from July 1, 2010 to December 31, 2011. A random sample of all eligible patient visits was obtained, and all related visits for those patients were reviewed. RESULTS: A total of 247 patients were chosen from 3740 eligible visits for detailed review and abstraction; 81% showed a vestibular abnormality on initial clinical examination. Those patients with vestibular signs on the initial examination took a significantly longer time to return to school (median 59 days vs 6 days, P=.001) or to be fully cleared (median 106 days vs 29 days, P=.001). They additionally scored more poorly on initial computerized neurocognitive testing, and it took longer for them to recover from neurocognitive deficits. Those patients with 3 or more previous concussions had a greater prevalence of vestibular deficits, and it took longer for those deficits to resolve. CONCLUSION: Vestibular deficits in children and adolescents with a history of concussion are highly prevalent. These deficits appear to be associated with extended recovery times and poorer performance on neurocognitive testing. Further studies evaluating the effectiveness of vestibular therapy on improving such deficits are warranted.
OBJECTIVE: To characterize the prevalence and recovery of pediatric patients with concussion who manifest clinical vestibular deficits and to describe the correlation of these deficits with neurocognitive function, based on computerized neurocognitive testing, in a sample of pediatric patients with concussion. METHODS: This was a retrospective cohort study of patients ages 5-18 years with concussion referred to a tertiary pediatric hospital-affiliated sports medicine clinic from July 1, 2010 to December 31, 2011. A random sample of all eligible patient visits was obtained, and all related visits for those patients were reviewed. RESULTS: A total of 247 patients were chosen from 3740 eligible visits for detailed review and abstraction; 81% showed a vestibular abnormality on initial clinical examination. Those patients with vestibular signs on the initial examination took a significantly longer time to return to school (median 59 days vs 6 days, P=.001) or to be fully cleared (median 106 days vs 29 days, P=.001). They additionally scored more poorly on initial computerized neurocognitive testing, and it took longer for them to recover from neurocognitive deficits. Those patients with 3 or more previous concussions had a greater prevalence of vestibular deficits, and it took longer for those deficits to resolve. CONCLUSION:Vestibular deficits in children and adolescents with a history of concussion are highly prevalent. These deficits appear to be associated with extended recovery times and poorer performance on neurocognitive testing. Further studies evaluating the effectiveness of vestibular therapy on improving such deficits are warranted.
Authors: Daniel J Corwin; Mark R Zonfrillo; Christina L Master; Kristy B Arbogast; Matthew F Grady; Roni L Robinson; Arlene M Goodman; Douglas J Wiebe Journal: J Pediatr Date: 2014-09-26 Impact factor: 4.406
Authors: Michael McCrea; Kevin Guskiewicz; Christopher Randolph; William B Barr; Thomas A Hammeke; Stephen W Marshall; Matthew R Powell; Kwang Woo Ahn; Yanzhi Wang; James P Kelly Journal: J Int Neuropsychol Soc Date: 2012-10-12 Impact factor: 2.892
Authors: Paul McCrory; Willem H Meeuwisse; Mark Aubry; Bob Cantu; Jirí Dvorák; Ruben J Echemendia; Lars Engebretsen; Karen Johnston; Jeffrey S Kutcher; Martin Raftery; Allen Sills; Brian W Benson; Gavin A Davis; Richard G Ellenbogen; Kevin Guskiewicz; Stanley A Herring; Grant L Iverson; Barry D Jordan; James Kissick; Michael McCrea; Andrew S McIntosh; David Maddocks; Michael Makdissi; Laura Purcell; Margot Putukian; Kathryn Schneider; Charles H Tator; Michael Turner Journal: Br J Sports Med Date: 2013-04 Impact factor: 13.800
Authors: Anne Mucha; Michael W Collins; R J Elbin; Joseph M Furman; Cara Troutman-Enseki; Ryan M DeWolf; Greg Marchetti; Anthony P Kontos Journal: Am J Sports Med Date: 2014-08-08 Impact factor: 6.202
Authors: Carolina P Quintana; Tamara C Valovich McLeod; Anne D Olson; Nicholas R Heebner; Matthew C Hoch Journal: Sports Med Date: 2021-01-05 Impact factor: 11.136
Authors: Kristy B Arbogast; Allison E Curry; Kristina B Metzger; Ronni S Kessler; Jeneita M Bell; Juliet Haarbauer-Krupa; Mark R Zonfrillo; Matthew J Breiding; Christina L Master Journal: Clin Pediatr (Phila) Date: 2017-05-19 Impact factor: 1.168
Authors: Kristy B Arbogast; Allison E Curry; Melissa R Pfeiffer; Mark R Zonfrillo; Juliet Haarbauer-Krupa; Matthew J Breiding; Victor G Coronado; Christina L Master Journal: JAMA Pediatr Date: 2016-07-05 Impact factor: 16.193
Authors: Daniel J Corwin; Kathleen J Propert; Joseph J Zorc; Mark R Zonfrillo; Douglas J Wiebe Journal: Am J Emerg Med Date: 2018-09-05 Impact factor: 2.469
Authors: Jennifer B Christy; Graham D Cochrane; Anwar Almutairi; Claudio Busettini; Mark W Swanson; Katherine K Weise Journal: J Neurol Phys Ther Date: 2019-07 Impact factor: 3.649
Authors: David R Howell; Michael J O'Brien; Michael A Beasley; Rebekah C Mannix; William P Meehan Journal: Acta Paediatr Date: 2016-06-15 Impact factor: 2.299
Authors: Mark W Swanson; Katherine K Weise; Laura E Dreer; James Johnston; Richard D Davis; Drew Ferguson; Matthew Heath Hale; Sara J Gould; Jennifer B Christy; Claudio Busettini; Sarah D Lee; Erin Swanson Journal: Optom Vis Sci Date: 2017-01 Impact factor: 1.973
Authors: Daniel J Corwin; Kristy B Arbogast; Casey Swann; Rebecca Haber; Matthew F Grady; Christina L Master Journal: Am J Emerg Med Date: 2020-06-11 Impact factor: 2.469