Vestibular/Ocular Motor Screening Items Research Articles

Hormonal Contraceptive Influence on Baseline Vestibular/Ocular Symptomatology and Provocation for Concussion.

Hormonal contraceptives (HCs) and the menstrual cycle have been suggested to affect symptom severity and postconcussion recovery. Additionally, hormones have been a suggested rationale for sex differences between female and male athletes on concussion assessment. Researchers have yet to explore the effects of HC use on baseline symptomatology, including symptom reporting and provocation. To examine the influence of HC use on a baseline symptom reporting and vestibular/ocular provocation battery. Cross-sectional study; Level of evidence, 3. A total of 61 college-aged individuals (21 HC-using women, 21 non-HC-using women, 19 men) were administered a baseline symptom battery consisting of the Post-Concussion Symptom Scale (PCSS), Headache Impact Test-6 (HIT-6), Pediatric Vestibular Symptom Questionnaire (PVSQ), and Vestibular/Ocular Motor Screening (VOMS). The main outcome measures consisted of PCSS symptom reporting (total symptoms, symptom severity score, and symptom factors), HIT-6 and PVSQ total scores, and VOMS item (ie, saccades, convergence, or vestibular/ocular reflex) symptom provocation scores. Significant differences were reported on HIT-6, with the highest headache reporting in the HC group (P = .026). On the PVSQ, the HC group also reported greater dizziness and unsteadiness symptoms than the non-HC group (P = .023). Similar findings existed on the PCSS, with the HC group reporting greater total symptoms (P < .001), symptom severity (P < .001), and vestibular-somatic (P = .024), cognitive-sensory (P = .004), sleep-arousal (P = .001), and affective (P < .001) factors compared with the non-HC group. Smooth pursuit (ie, following finger smoothly with eyes) was the only VOMS items with differences between groups (P = .003), with the HC group having greater provocation compared with non-HC users (P = .020). HC use was associated with overall symptomatology and worse self-reported symptoms on vestibular-related inventories and concussion symptom scales and factors when compared with non-HC users and male controls. Additionally, HC users reported higher VOMS provocation scores on the smooth pursuit item than non-HC users and male controls.

Comparison of Vestibular/Ocular Motor Screening (VOMS) and Computerized Eye-tracking to Identify Exposure to Repetitive Head Impacts.

Military service members (SMs) are exposed to repetitive head impacts (RHIs) in combat and training that are purported to adversely affect brain health, including cognition, behavior, and function. Researchers have reported that RHI from blast-related exposure may affect both vestibular and ocular function, which in turn may be related to symptomology. As such, an examination of the effects of RHI on exposed military SMs should incorporate these domains. To date, researchers have not compared groups of exposed special operations forces (SOF) operators on combined clinical vestibular/ocular and eye-tracker-based outcomes. Therefore, the primary purpose of this study was to compare participant-reported symptoms and performance on the Vestibular/Ocular Motor Screening (VOMS) tool with performance on the computerized RightEye tracking system between SOF operators exposed to blast-related RHI and healthy controls without blast-related exposure. In addition, the study aimed to compare subgroups of snipers and breachers exposed to RHI to controls on the preceding metrics, as well as identify a subset of individual (demographic) factors, participant-reported symptoms, and performance metrics on VOMS and RightEye that best identify SOF operators exposed to RHI from unexposed controls. The study involved a cross-sectional design including 25 Canadian SOF SMs comprised of breachers (n = 9), snipers (n = 9), and healthy, unexposed controls (n = 7). The former 2 groups were combined into an RHI group (n = 18) and compared to controls (n = 7). Participants provided demographics and completed a self-reported concussion-related symptom report via the Military Acute Concussion Evaluation 2, the VOMS, and RightEye computerized eye-tracking assessments. Independent samples t-tests and ANOVAs were used to compare the groups on the outcomes, with receiver operating characteristic curve and area under the curve (AUC) analyses to identify predictors of blast exposure. This study was approved by the Defence Research Development Canada Human Research Ethics Committee and the Canadian Forces Surgeon General/Special Forces Command. The results from t-tests supported group differences for age (P = .012), participant-reported symptoms (P = .006), and all VOMS items (P range = <.001-.02), with the RHI group being higher than healthy controls on all variables. ANOVA results supported group differences among snipers, breachers, and controls for age (P = .01), RightEye saccades (P = .04), participant-reported total symptom severity (P = .03), and VOMS total scores (P = .003). The results of the receiver operating characteristic curve analyses supported age (AUC = 0.81), Military Acute Concussion Evaluation 2 participant-reported total symptom severity (AUC = 0.87), and VOMS total scores (AUC = 0.92) as significant predictors of prior blast exposure. Participant-reported concussion symptoms, VOMS scores, and age were useful in identifying SOF operators exposed to RHI from controls. RightEye metrics were not useful in differentiating RHI groups from controls. Differences between snipers and breachers warrant further research. Overall, the findings suggest that VOMS may be a useful tool for screening for the effects of exposure to RHI in SOF operators. Future investigations should be conducted on a larger sample of military SMs, consider additional factors (e.g., RHI exposure levels, medical history, and sex), and include additional assessment domains (e.g., balance, cognitive, and psychological).

A-48 Comparative Analysis of Adolescents With a Sport-Related Concussion Versus Non-Sport-Related Concussion During Initial Visit

Abstract [Outstanding Trainee Award Winner] Purpose To investigate differences in pre-injury risk factors and clinical outcomes in adolescents with a Sport-Related Concussion (SRC) versus non-Sport-Related Concussion (non-SRC). Methods Participants (n=136, aged 10-18) presented to a specialty concussion clinic 2-30 (M=9.25) days post-injury. They completed a clinical interview with a trained clinician and were administered the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT), Post-Concussion Symptom Scale (PCSS), Concussion Clinical Profile Screening (CP Screen), Vestibular/Ocular-Motor Screening (VOMS), Screen for Child Related Anxiety Disorders - Child Version (SCARED-C), and the Generalized Anxiety Disorder Assessment (GAD-7). Data analyses utilized independent sample t-tests, chi-square tests, and descriptive statistics to compare clinical outcomes of both groups during initial visit. Alpha was set to p&amp;lt;.05 for all analyses. Results Adolescents with non-SRC took longer to seek specialty concussion care, were majority female, and were older than the SRC group. Non-SRC participants also reported a higher rate of migraine, depression, and anxiety history (i.e., SCARED-C Panic Disorder, SCARED-C Generalized Anxiety Disorder, and SCARED-C Anxiety Disorder). Additionally, non-SRC participants reported more symptoms on the PCSS Total score, and on most VOMS items, including Smooth Pursuits, Horizontal and Vertical Saccades, Horizontal and Vertical Vestibular-Ocular Reflex, Visual Motion Sensitivity, as well as VOMS Total. Non-SRC group also reported higher post-injury anxiety scores (i.e., GAD-7). All findings were below the p-value of .05. Conclusions The study findings suggest that mechanism of injury and individual risk factors play a significant role in determining the clinical presentation of a concussion in an SRC and non-SRC adolescent population.

Optimizing VOMS for identifying acute concussion in collegiate athletes: Findings from the NCAA-DoD CARE consortium

The Vestibular/Ocular-Motor Screening (VOMS), an important component in acute (<72 h) sport-related concussion (SRC) assessment, is increasingly used alongside the Sport Concussion Assessment Tool (SCAT) and as part of the Military Acute Concussion Evaluation 2 (MACE2). VOMS demonstrates clinically useful diagnostic accuracy for acute SRC and improves the overall utility when added to the SCAT3. However, potential overlap among VOMS’s vestibular and oculomotor items suggests the possibility of a more efficient version. VOMS and SCAT3 scores were analyzed for 3,958 preseason (47.8% female) and 496 acute-SRC (37.5% female) NCAA-DoD Concussion Assessment, Research, and Education (CARE) consortium collegiate athlete evaluations. Analyses revealed very large effect sizes (d = 2.39–2.45) and high correlations (rho = 0.95–0.99) among all VOMS items except near point of convergence distance (d = 0.79, rho ≤ 0.341). Receiver operating characteristic (ROC) curve analyses showed clinically useful discriminative utility for VOMS Total (AUC = 0.85) and the VOMS Total change score, where pretest symptoms were incorporated (AUC = 0.81). A modified VOMS (mVOMS) consisting of four items (smooth pursuits, horizontal saccades, horizontal vestibulo-ocular reflex, visual motion sensitivity) yielded identical AUCs to VOMS Total. Integer cutoff analyses suggest a score of ≥4 for VOMS Total and ≥4 for mVOMS Total optimizes concussion identification. Incorporating VOMS or mVOMS into SCAT3 (AUC = 0.79) significantly improved the combined tool’s acute utility for acute concussion identification by a maximum of 4% (SCAT3+VOMS AUC = 0.84, SCAT3+mVOMS AUC = 0.83). Future versions of SCAT or MACE may want to consider incorporating a more parsimonious VOMS for the purpose of identifying acute concussion.

The acute, systemic effects of aerobic exercise in recently concussed adolescent student-athletes: preliminary findings.

Examine the acute effects (pre-, during, post-intervention) of two different intensities of aerobic exercise or rest on autonomic, oculomotor, and vestibular function and symptom burden in patients with a recent sport-related concussion (SRC) and compare their responses to sex-matched, age-stratified, non-concussed (HEALTHY) student-athletes. Student-athletes between the ages of 13 and 18 that presented to the sports medicine clinic within Day 3-7 post-SRC and from local schools were recruited for a randomized controlled trial (RCT). The participants were administered the Vestibular/Ocular Motor Screening (VOMS), King-Devick (K-D), and Post-Concussion Symptom Scale (PCSS) before and after the intervention. Heart rate variability (HRV) and mean arterial pressure (MAP) were collected before, during, and after the intervention. The intervention was either a single, 20-min session of treadmill walking at 40% (40HR) or 60% of age-predicted max heart rate (60HR), or seated, rest (NOEX). 30 participants completed the intervention with the SRC group treated 4.5 ± 1.3days post-injury. Pre-exercise HRV and MAP were significantly different (p's < 0.001) during treatment but returned to pre-exercise values within 5min of recovery in both the SRC and HEALTHY groups. Both the SRC and HEALTHY groups exhibited similar reductions pre- to post-intervention for symptom severity and count (p's < 0.05), three VOMS items (p's < 0.05) but not K-D time. To date, this is the first adolescent RCT to report the acute, systemic effects of aerobic exercise on recently concussed adolescent athletes. The interventions appeared safe in SRC participants, were well-tolerated, and provided brief therapeutic benefit. Clinicaltrials.gov Identifier NCT03575455.

Minimum detectable change and false positive rates of the vestibular/ocular motor screening (VOMS) tool: an NCAA-DoD care consortium analysis

ABSTRACT Objective To derive minimum detectable change (MDC) across individual Vestibular-Ocular Motor Screening (VOMS) items and VOMS overall score in 17–25 years old collegiate athletes and to examine false positive rates. Method Participants (n = 378) completed VOMS pre-season for two consecutive years. MDC was identified for individual VOMS symptom items and NPC distance (cm). Both total and change methods of VOMS scoring were included in analysis. Results Regarding total scoring, MDC for ocular VOMS symptom items was 1 and MDC for vestibular VOMS symptoms items was 2. MDC for NPC was 4 cm and for VOMS overall score was 10. Regarding change scoring, MDC for each VOMS symptom item was 1, and for VOMS overall score was 8. False positives ranged from 5.3% to 15.9%. Conclusions This study presents MDCs for each VOMS item and overall VOMS score, using total and change scoring. These values can be considered true change outside measurement error with 95% confidence in a 17–25 year old collegiate athlete population.

Immediate and 20-Minute Post-Exercise Performance On Vestibular/Ocular Motor Screening (VOMS) and Near Point of Convergence (NPC)

To examine VOMS and NPC performance immediately and 20-minutes after a bout of maximal exercise. The Vestibular/Ocular Motor Screening (VOMS) and Near Point of Convergence (NPC) have received increased implementation for assessment and management of sport-related concussion. As athletes are often in a state of physical exertion during the immediate or sideline evaluation for concussion, it is imperative to understand the effects of exercise on these two tools. Seventeen, healthy college-aged individuals (20.7 ± 2.3 years) free of any modifiers for performance, completed a pre-test VOMS and NPC, followed by a graded maximal exercise treadmill test. Participants were re-assessed immediately following exercise and again 20-minutes later. Measures consisted of VOMS symptom provocation change scores per item and NPC distance (cm) averaged across 3 trials. A series of non-parametric Friedman tests and follow-up Wilcoxon signed rank tests were conducted to determine the effects between pre-test, immediate-, and 20-min post-exercise. Pre-to immediate post-exercise differences did not exist on any VOMS item, specifically, smooth pursuits (0.12 vs. 0.29, p = 0.18), saccades (horizontal: 0.18 vs. 0.29, p = 0.70; vertical: 0.24 vs. 0.41, p = 0.70), convergence (2.78 cm vs. 3.99 cm, p = 0.27), vestibular ocular reflex (VOR) (horizontal: 0.59 vs. 0.94, p = 0.31; vertical: 0.41 vs. 0.65, p = 0.27), and visual motion sensitivity (VMS) (0.47 vs. 0.94, p = 0.13). No differences were reported between pre- and immediate post-exercise on NPC distance (2.78 vs. 3.99 cm, p = 0.48). The only change from immediate to 20-min post exercise was an improvement in VMS of the VOMS (0.94 vs. 0.29, p = 0.05). No changes occurred between pre- and 20-min post-exercise. VOMS items and NPC distance remained consistent from pre-to immediate and 20-min post exercise, which may further validate their utility as sideline assessment tools. More research is needed to determine if these results extend across graded exercise testing in acute concussion and post-concussion syndrome return-to-activity management.

Concussion Clinical Profiles Screening (CP Screen) Tool: Preliminary Evidence to Inform a Multidisciplinary Approach.

Current concussion symptom inventories emphasize total number or symptoms and severity and overlap with other conditions, such as mental health disorders, which may limit their specificity and clinical utility. To develop and test the reliability and validity of a new Concussion Clinical Profiles Screening tool (CP Screen) in both healthy controls and concussed. CP Screen is a 29-item self-report, clinical profile-based symptom inventory that measures the following 5 concussion clinical profiles: 1) anxiety/mood, 2) cognitive/fatigue, 3) migraine, 4) ocular, and 5) vestibular; and the following 2 modifying factors: 1) sleep and 2) neck. Post-Concussion Symptom Scale (PCSS), vestibular/ocular motor screening (VOMS) tool, and Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) were conducted. CP Screen was administered in community a concussion surveillance program and 2 sports medicine concussion clinics. Responses include 248 athletes, 121 concussed, and 127 controls, enrolled between 2018 and 2019. Internal consistency of the CP Screen in the control (Cronbach's alpha=.87) and concussed (Cronbach's alpha=.93) samples was high. Moderate to high correlations among the CP Screen factors and PCSS factors and VOMS items, supporting concurrent validity. ROC curve analysis for identifying concussed from controls was significant (P<.001) for all CP Screen factor and modifier scores with excellent AUCs for migraine (.93), ocular (.88), vestibular (.85), and cognitive (.81) factors, demonstrating predictive validity. The CP Screen demonstrated strong reliability, concurrent validity with commonly used concussion assessment (ie, PCSS, VOMS, and ImPACT), and predictive validity for identifying concussion. The CP Screen extends current symptom inventories by evaluating more specific symptoms that may reflect clinical profiles and inform better clinical care.

Association of sleep symptoms with mood and vestibular subtypes following sport-related concussion

Sport-related concussion (SRC) is a heterogenous injury with diverse symptoms and impairments that can be aggregated into clinical subtypes (cognitive, headache/migraine, vestibular, ocular-motor, anxiety/mood). Sleep disruption has been defined as potential exacerbating conditions that may accompany the five clinical subtypes. The authors sought to better characterize the role of impaired sleep in each clinical subtype and to identify other risk factors for sleep impairment after SRC. 281 patients (15.3 ± 2.1 years) aged 10–22 years within 21 days of SRC completed the Post-Concussion Symptom Scale (PCSS), the Vestibular/Ocular Motor Screening (VOMS), and a clinical assessment to identify clinical subtype. Subjects were then divided into HIGH (≥7; n = 82) and LOW (≤3; n = 132) sleep symptom groups for comparison. HIGH participants had greater proportions of females (p < 0.001), history of psychiatric disorder (p < 0.001); total PCSS (p < 0.001); and impairment on all VOMS items (p < 0.001). HIGH participants were associated with mood/anxiety (p < 0.001), vestibular (p = 0.003) and ocular (p = 0.03) subtypes. Results of a logistic regression (LR) model with adjusted odds ratios (OR) to predict HIGH sleep symptoms supported anxiety/mood profile (OR = 2.98), vestibular profile (OR = 2.81), psychiatric history (OR = 4.99), and history of motion sickness (OR = 2.13) as significant predictors. Prescribing behavioral and sleep interventions may improve outcomes in cases where these factors co-occur.

Reliability and Factors Associated with False Positives on the Vestibular/Ocular Motor Screening (VOMS) Tool in US Military Personnel

Abstract Purpose The US Military recently added the Vestibular/Ocular Motor Screening (VOMS) to the Military Acute Concussion Evaluation-2 (MACE-2). However, there are no published data on the VOMS in US military personnel. The purpose of this study was to examine the reliability of the VOMS and factors associated with false positives in healthy US Army Special Operations (USASOC) personnel. Methods 206 healthy USASOC military personnel aged 18–40 completed VOMS between March 2018 – January 2019. Analyses included internal consistency, false-positive rates, intraclass correlation coefficients (ICC), chi-square analyses with odds ratios (OR), and independent samples t-tests. VOMS clinical cut-off scores (2+ on any symptom, &gt;5cm for NPC) were used to determine false positives. Results Reliability for the VOMS symptom items (Cronbach alpha=.98, ICC=.90) and NPC distance (Cronbach’s alpha=.98, ICC=.93) were high. False positive rates ranged from 10.2% (smooth pursuits) to 16.9% (NPC distance). Concussion history was associated with a 2.5 fold increase for one or more VOMS items above cut-offs (p=.01). Participants with at least one VOMS item above cut-offs were deployed nearly 6 months longer on average than those without (p=.04). Conclusion The findings indicate that VOMS is reliable in US military personnel with few false positives. False positives were associated with concussion history and longer deployment history, which should be considered by military medical providers when administering and interpreting VOMS in this population. Moving forward, researchers should examine the stability of VOMS and its ability to identify mTBI in this population.

Correlating the King-Devick Test With Vestibular/Ocular Motor Screening in Adolescent Patients With Concussion: A Pilot Study.

Background:The King-Devick (K-D) test is a rapid number-naming task that has been well validated as a sensitive sideline performance measure for concussion detection. Patients with concussion take significantly longer to complete the K-D test than healthy controls. Previous research suggests that ocular motor deficits, specifically saccadic abnormalities, may be an underlying factor for the prolonged time. However, these findings have not been studied at length.Hypothesis:K-D testing time of concussed adolescents at the initial clinical concussion visit will positively correlate with vestibular/ocular motor screening (VOMS) total scores.Study Design:Case series.Level of Evidence:Level 3.Methods:A total of 71 patient charts were retrospectively analyzed between October 1, 2016, and January 31, 2017. Included charts consisted of patients between the ages of 10 and 18 years with a diagnosis of concussion and who had completed K-D testing and VOMS assessment at the initial physician visit. Univariate correlation between K-D testing time and the 7 VOMS items was assessed using Pearson correlation coefficients.Results:K-D testing time strongly correlated with all 7 VOMS items (r(69) = 0.325-0.585, P < 0.01). In a linear regression model that accounted for each VOMS item, the convergence (near point) item and the visual motion sensitivity item significantly predicted K-D testing time (β = 0.387, t(63) = 2.81, P < 0.01 and β = 0.375, t(63) = 2.35, P = 0.02, respectively). Additionally, 37.5% of the 24 patients with worsening symptoms after K-D testing freely reported increased visual problems.Conclusion:Our study suggests that prolonged K-D testing times in adolescents with concussion may be related to subtypes of vestibular/ocular motor impairment that extend beyond saccadic abnormalities.Clinical Relevance:Poor K-D testing performance of adolescents with concussion may indicate a range of vestibular/ocular motor deficits that need to be further identified and addressed to maximize recovery.

Reliability and Normative Reference Values for the Vestibular/Ocular Motor Screening (VOMS) Tool in Youth Athletes

Background: The Vestibular/Ocular Motor Screening (VOMS) measure is a newly developed vestibular and ocular motor symptom provocation screening tool for sport-related concussions. Baseline data, psychometric properties, and reliability of the VOMS are needed to further understand the applications of this tool, especially in the youth population, where research is scarce. Purpose: To establish normative data and document the internal consistency and false-positive rate of the VOMS in a sample of nonconcussed youth athletes. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 423 youth athletes (male = 278, female = 145) between the ages of 8 and 14 years completed baseline VOMS screening before the start of their respective sport seasons. Internal consistency was measured with Cronbach α and inter-item correlations. Results: Approximately 60% of youth athletes reported no symptom provocation on baseline VOMS assessment, with 9% to 13% scoring over the cutoff levels (score of ≥2 for any individual VOMS symptom, near point convergence distance of ≥5 cm). The VOMS displayed a high internal consistency (Cronbach α = .97) at baseline among youth athletes. Conclusion: The current findings provide preliminary support for the implementation of VOMS baseline assessment into clinical practice, due to a high internal consistency, strong relationships between VOMS items, and a low false-positive rate at baseline in youth athletes.

Utility of the Vestibular/Ocular Motor Screening (VOMS) Tool During High School Sport Participation

The Vestibular/Ocular Motor Screening (VOMS) Tool has previously demonstrated the ability to identify differences between healthy and concussed participants in clinical populations, with an 89% positive prediction value. However, there is little information on incidence of clinically significant change in healthy athletes. PURPOSE: To identify rates of change scores on the VOMS in a sideline testing environment with healthy adolescent athletes, within an 89% PPV, allowing for an 11% false positive rate. METHODS: Seventy-eight healthy athletes (15.77 ± 1.39 years) were administered the VOMS three times during their sport season; prior to their sport season (T1) and at a later date, before practice (T2) and within 5 minutes of removal from sport practice (T3). Descriptive statistics and multivariate base rate analyses were performed using Microsoft Excel. RESULTS: Multivariate base rate analyses reveals that a change of 2+ symptom provocation on any 1, 2, or 3 VOMS items achieved a false positive rate of 21%, 14%, and 10% respectively. Using a change of 3+ symptom provocation on any 1, 2, or 3 VOMS items achieved a false positive rate of 13%, 9%, and 6% respectively. Using a change of 4+ symptom provocation on any 1, 2, or 3 VOMS items achieved a false positive rate of 9%, 6%, and 3% respectively. The false positive rate using NPC distance ≥5 cm ranged from 21% to 32% across the three times. In the context of sport participation (T3), a more valid clinical metric during sport participation would be using a change of 2+ symptom provocation on 3 VOMS items, 3+ on 2 VOMS items, or 4+ on 1 VOMS item. CONCLUSIONS: To our knowledge, this is the first study to examine the utility of multivariate base rates in interpreting VOMS change scores in the context of a structured high school sport practice. Our findings suggest interpretation of clinical change on the VOMS using a change of 2+ on 3 VOMS items, 3+ on 2 VOMS items, or 4+ symptom on 1 VOMS item would obtain a false positive rate of ≤11%, whereas a NPC distance of ≥5 centimeters greatly increases the rate of false positive.

Baseline Normative Data Of The Vestibular/ocular Motor Screening (voms) Assessment For High School Athletes

Dizziness occurs in 50% of athletes following sport-related concussion (SRC) and is indicative of vestibular and oculomotor dysfunction. The Vestibular/Ocular-Motor Screening (VOMS) assessment is a brief, screening tool designed to detect vestibular and ocular motor impairment and symptoms following SRC. Currently there are no normative data for this measure in high school (HS) athletes, and the base rate of scores above clinical cutoffs is unknown. PURPOSE: To establish normative baseline (i.e., pre-season) data for the VOMS in high school athletes. METHODS: A total of 468 HS athletes (15.84 + 1.23 years; 140 females - 29.9%) completed baseline VOMS testing. The VOMS is comprised of a series of vestibular (e.g., vestibular oculomotor reflex) and ocular motor components (e.g., saccadic eye movement). Symptom provocation ratings for headache, dizziness, nausea, and fogginess are recorded on a 10-point Likert scale each VOMS component. Descriptive statistics were used to document normative performance for the total sample. The percentage of baseline scores above published clinical cut-offs were tabulated for each VOMS component. Scores outside of 95% confidence intervals (CI) were documented and new cutoff scores were determined using multivariate base rates. RESULTS: Approximately 83% (388/468) of the total sample exhibited VOMS scores within the expected, normal range, whereas 17% (80/468) of the sample were above clinical cutoffs on any one VOMS item. In addition, 12% (54/486) were above clinical cut-offs on two VOMS items, 6% (27/486) were above clinical cut-offs on three VOMS items. However, the clinical cut-off of four VOMS items yielded an acceptable false-positive rate of less than 5% in this population. CONCLUSION: Approximately 83% athletes reported VOMS symptoms scores below clinical cutoffs. These findings suggest that researchers and sports medicine professionals should consider using clinical cutoff scores ≥ 2 on at least 4 VOMS items.

A Brief Vestibular/Ocular Motor Screening (VOMS) Assessment to Evaluate Concussions

Background: Vestibular and ocular motor impairments and symptoms have been documented in patients with sport-related concussions. However, there is no current brief clinical screen to assess and monitor these issues. Purpose: To describe and provide initial data for the internal consistency and validity of a brief clinical screening tool for vestibular and ocular motor impairments and symptoms after sport-related concussions. Study Design: Cross-sectional study; Level of evidence, 2. Methods: Sixty-four patients, aged 13.9 ± 2.5 years and seen approximately 5.5 ± 4.0 days after a sport-related concussion, and 78 controls were administered the Vestibular/Ocular Motor Screening (VOMS) assessment, which included 5 domains: (1) smooth pursuit, (2) horizontal and vertical saccades, (3) near point of convergence (NPC) distance, (4) horizontal vestibular ocular reflex (VOR), and (5) visual motion sensitivity (VMS). Participants were also administered the Post-Concussion Symptom Scale (PCSS). Results: Sixty-one percent of patients reported symptom provocation after at least 1 VOMS item. All VOMS items were positively correlated to the PCSS total symptom score. The VOR (odds ratio [OR], 3.89; P < .001) and VMS (OR, 3.37; P < .01) components of the VOMS were most predictive of being in the concussed group. An NPC distance ≥5 cm and any VOMS item symptom score ≥2 resulted in an increase in the probability of correctly identifying concussed patients of 38% and 50%, respectively. Receiver operating characteristic curves supported a model including the VOR, VMS, NPC distance, and ln(age) that resulted in a high predicted probability (area under the curve = 0.89) for identifying concussed patients. Conclusion: The VOMS demonstrated internal consistency as well as sensitivity in identifying patients with concussions. The current findings provide preliminary support for the utility of the VOMS as a brief vestibular/ocular motor screen after sport-related concussions. The VOMS may augment current assessment tools and may serve as a single component of a comprehensive approach to the assessment of concussions.