CAN NEAR POINT CONVERGENCE IN PEDIATRIC CONCUSSION PATIENTS PREDICT STUDENTS’ SUCCESSFUL RETURN TO LEARNING?

Abstract

Purpose:The purpose of this study was to identify whether abnormal near point convergence (NPC) could be used as a clinical predictor of a 10-18 year old student’s ability to successfully return to learning (RTL).Methods and Study Design:This was a retrospective chart review of 122 students who initially visited a sports medicine clinic between 11/22/17 to 02/27/19 due to a concussion. A total of 268 visits were analyzed. RTL is graded in color zones, with red = no school, orange = half time or less, yellow = half time or more, green = full time with accommodations, and blue = full clearance. No patients were reported in the red zone in our cohort due to its severity. Patients with learning disabilities or oculomotor deficits were excluded.Results:Of the patients who met the inclusion criteria, we found a statistically significant difference in average NPC between the blue and orange zones (p<0.001) using a pooled proportions test. Average NPC was 7.03cm for blue, 8.84cm for green, 12.67cm for yellow, and 14.40cm for orange representing a positive linear correlation with an R2 of 0.975. Whereas 81% of patients in the blue zone had a normal NPC (<9cm), this was true for only 31% of patients in the orange zone. There was a 43% increase in average NPC from yellow to green zone. Yellow was the most frequent color zone with 56.7% of all visits in this zone.Conclusions:NPC appears to have a strong correlation with academic tolerance and can be predictive of RTL zones.Significance:Currently, little research has been done on clinical predictors of RTL. This data supports the use of oculomotor testing, such as NPC, which can easily be completed at office visits, as predictive tools that may indicate which patients presenting with concussion need increased academic accommodations.Graph 1.