Rishi D Patel1, Cynthia R LaBella1,2. 1. Feinberg School of Medicine, Northwestern University, Chicago, Illinois. 2. Division of Orthopaedic Surgery and Sports Medicine, Lurie Children's Hospital, Chicago, Illinois.
Abstract
BACKGROUND: Vestibular/ocular motor dysfunction can occur in pediatric concussions, which can impair reading, learning, and participation in athletics. This study evaluated 3 clinical tools for identifying postconcussion vestibular/ocular motor dysfunction: (1) Post-Concussion Symptom Scale (PCSS), (2) Convergence Insufficiency Symptom Survey (CISS), and (3) Vestibular/Ocular Motor Screening (VOMS). HYPOTHESIS: Evaluating vestibular/ocular motor dysfunction with multiple clinical tools will capture more symptomatic patients than any 1 tool alone. STUDY DESIGN: Cross-sectional data from a prospective cohort study. LEVEL OF EVIDENCE: Level 4. METHODS: Patients were between 8 and 17 years old and seen in a tertiary care pediatric sports medicine clinic between August 2014 and February 2018. Data were collected from initial visit and included VOMS, PCSS, and CISS. Descriptive statistics, Pearson's correlations, and logistic regressions were used to describe relationships between clinical tools. RESULTS: Of the 156 patients (55.1% female; 14.35 ± 2.26 years old) included, this study identified 129 (82.7%) with vestibular/ocular motor dysfunction. Of these 129, 65 (50.4%) reported "visual problems" on PCSS, 93 (72.1%) had abnormal CISS, and 99 (76.7%) had abnormal VOMS. Together, VOMS and CISS identified 64 (49.6%) patients without reported "visual problems" on PCSS. Higher total PCSS scores predicted abnormal CISS (odds ratio [OR], = 1.11; 95% CI, 1.07-1.17) and abnormal VOMS (OR, 1.03; 95% CI, 1.01-1.06). "Visual problems" on PCSS did not predict abnormal CISS or VOMS. CONCLUSION: Vestibular/ocular motor dysfunction were identified in nearly 83% of study subjects when PCSS, CISS, and VOMS are used together. CLINICAL RELEVANCE: These results suggest adding CISS and VOMS to the clinical evaluation of concussions can help clinicians identify post-concussion vestibular/ocular motor dysfunction.
BACKGROUND: Vestibular/ocular motor dysfunction can occur in pediatric concussions, which can impair reading, learning, and participation in athletics. This study evaluated 3 clinical tools for identifying postconcussion vestibular/ocular motor dysfunction: (1) Post-Concussion Symptom Scale (PCSS), (2) Convergence Insufficiency Symptom Survey (CISS), and (3) Vestibular/Ocular Motor Screening (VOMS). HYPOTHESIS: Evaluating vestibular/ocular motor dysfunction with multiple clinical tools will capture more symptomatic patients than any 1 tool alone. STUDY DESIGN: Cross-sectional data from a prospective cohort study. LEVEL OF EVIDENCE: Level 4. METHODS: Patients were between 8 and 17 years old and seen in a tertiary care pediatric sports medicine clinic between August 2014 and February 2018. Data were collected from initial visit and included VOMS, PCSS, and CISS. Descriptive statistics, Pearson's correlations, and logistic regressions were used to describe relationships between clinical tools. RESULTS: Of the 156 patients (55.1% female; 14.35 ± 2.26 years old) included, this study identified 129 (82.7%) with vestibular/ocular motor dysfunction. Of these 129, 65 (50.4%) reported "visual problems" on PCSS, 93 (72.1%) had abnormal CISS, and 99 (76.7%) had abnormal VOMS. Together, VOMS and CISS identified 64 (49.6%) patients without reported "visual problems" on PCSS. Higher total PCSS scores predicted abnormal CISS (odds ratio [OR], = 1.11; 95% CI, 1.07-1.17) and abnormal VOMS (OR, 1.03; 95% CI, 1.01-1.06). "Visual problems" on PCSS did not predict abnormal CISS or VOMS. CONCLUSION: Vestibular/ocular motor dysfunction were identified in nearly 83% of study subjects when PCSS, CISS, and VOMS are used together. CLINICAL RELEVANCE: These results suggest adding CISS and VOMS to the clinical evaluation of concussions can help clinicians identify post-concussion vestibular/ocular motor dysfunction.
Entities:
Keywords:
Convergence Insufficiency Symptom Survey (CISS); Post-Concussion Symptom Scale (PCSS); Vestibular/Ocular Motor Screening (VOMS); concussion; vestibular/ocular motor dysfunction
Authors: M W Rouse; E Borsting; L Hyman; M Hussein; S A Cotter; M Flynn; M Scheiman; M Gallaway; P N De Land Journal: Optom Vis Sci Date: 1999-09 Impact factor: 1.973
Authors: Mitchell Scheiman; G Lynn Mitchell; Susan Cotter; Jeffrey Cooper; Marjean Kulp; Michael Rouse; Eric Borsting; Richard London; Janice Wensveen Journal: Arch Ophthalmol Date: 2005-01
Authors: Christina L Master; Stephen R Master; Douglas J Wiebe; Eileen P Storey; Julia E Lockyer; Olivia E Podolak; Matthew F Grady Journal: Clin J Sport Med Date: 2018-03 Impact factor: 3.638
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