Pre- And Post-season Visio-vestibular Function In Healthy Adolescent Athletes

Abstract

PURPOSE: To examine pre- to post-season differences in visio-vestibular examination (VVE) outcomes in healthy adolescent athletes. METHODS AND STUDY DESIGN: This prospective observational study recruited male and female middle and high school athletes. Participants completed a demographic questionnaire prior to the start of their season. Head impact group was determined by factoring previously published head impact frequencies by team, sport, and sport level. The VVE was completed pre- and post-season and includes: smooth pursuits, horizontal/vertical saccades and gaze stability, binocular convergence, left/right monocular accommodation, and complex tandem gait. We used generalized estimating equations adjusting for head impact group to determine changes in VVE outcomes from pre- to post-season. RESULTS: A total of 115 middle and high school subjects (female: 59(51.3%); median age at first assessment = 14.9 years (IQR: 13.6, 16.0)) and 170 subject-seasons were included in our analysis. During pre-season testing, accommodation (10.0%) and complex tandem gait (9.2%) had the largest proportion of abnormal testing, while smooth pursuit (10.6%) and convergence (9.5%) had the largest proportion of abnormal testing at post-season. When assessing the effect of testing session (pre-season vs. post-season) on the relative risk of any abnormal VVE subtest, there were no significant findings (P > 0.05). Additionally, there were no significant effects of testing session when adjusting for head impact group for any VVE subtest (P > 0.05). CONCLUSIONS: Visio-vestibular function as measured by the VVE does not change from pre- to post-season in otherwise healthy pediatric athletes. Our findings suggest that the VVE may be a stable clinical measure of visual and oculomotor function and robust to typical neurodevelopment occurring in this dynamic age group. Additionally, our findings indicate that the VVE may be robust to sport participation and thus allow for flexibility in the timing of baseline test administration. This study provides formative data that may better inform post-injury interpretation of visio-vestibular deficits and provides insight into the clinical meaningfulness of lack of short-term changes in visio-vestibular function in adolescent athletes.