Vestibular/Ocular Motor Screening Research Articles

Acute Eye-Tracking Changes Correlated With Vestibular Symptom Provocation Following Mild Traumatic Brain Injury.

To quantify norms and changes in eye-tracking proficiency, and determine vestibular symptom correlations in varsity college athletes following acute mild traumatic brain injury (mTBI). We hypothesized that mTBI impacts central coordination between the vestibular and oculomotor systems with resultant changes in eye-tracking proficiency that are correlated with vestibular symptom provocation. Retrospective cohort study. Sports medicine care at a single institution. One hundred and nineteen college athletes diagnosed with mTBI by a physician between 2013 and 2019. N/A. Standard deviation of tangential error, standard deviation of radian error, mean phase error, and horizontal gain from virtual reality-based, circular eye-tracking goggles used at baseline and within 72 hours post-mTBI. Headache, dizziness, nausea, and fogginess provocation after the Vestibular Ocular Motor Screening (VOMS) smooth pursuits subtest compared with pretest baseline, assessed within 72 hours post-mTBI. One hundred and nineteen college athletes (N = 56 women and 63 men) aged 18 to 24 years sustained a total of 177 mTBI. Forty-four percent of athletes displayed abnormal eye-tracking on at least 1 eye-tracking measure following acute mTBI compared with their baseline. From the VOMS, horizontal gain showed medium-sized to large-sized positive correlations with headache (r = 0.34) and dizziness (r = 0.54), respectively. Mean phase error showed a medium-sized negative correlation with nausea (r = -0.32) on the VOMS. Eye-tracking proficiency was impaired and correlated with vestibular symptom provocation following acute mTBI in college athletes. Future research should examine eye-tracking proficiency testing in other acute care settings to support mTBI diagnosis.

IVOMS: Instrumented Vestibular / Ocular Motor Screen in healthy controls and mild traumatic brain injury

OBJECTIVE: Vestibular/ocular deficits occur with mild traumatic brain injury (mTBI). The vestibular/ocular motor screening (VOMS) tool is used to assess individuals post-mTBI, which primarily relies upon subjective self-reported symptoms. Instrumenting the VOMS (iVOMS) with technology may allow for more objective assessment post-mTBI, which reflects actual task performance. This study aimed to validate the iVOMS analytically and clinically in mTBI and controls.METHODS: Seventy-nine people with sub-acute mTBI (<12 weeks post-injury) and forty-four healthy control participants performed the VOMS whilst wearing a mobile eye-tracking on a one-off visit. People with mTBI were included if they were within 12 weeks of a physician diagnosis. Participants were excluded if they had any musculoskeletal, neurological or sensory deficits which could explain dysfunction. A series of custom-made eye tracking algorithms were used to assess recorded eye-movements.RESULTS: The iVOMS was analytically valid compared to the reference (ICC2,1 0.85-0.99) in mTBI and controls. The iVOMS outcomes were clinically valid as there were significant differences between groups for convergence, vertical saccades, smooth pursuit, vestibular ocular reflex and visual motion sensitivity outcomes. However, there was no significant relationship between iVOMS outcomes and self-reported symptoms.CONCLUSION: The iVOMS is analytically and clinically valid in mTBI and controls, but further work is required to examine the sensitivity of iVOMS outcomes across the mTBI spectrum. Findings also highlighted that symptom and physiological issue resolution post-mTBI may not coincide and relationships need further examination.

The role of the physiotherapist in concussion.

Concussion is complex. A basic mental health, Vestibular Ocular Motor Screening (VOMS) and four key components relating to concussion management (autonomic, cervicogenic, vestibular oculomotor, and psychological approaches to management) should be included in the undergraduate and postgraduate curriculum. This will aid clinical physiotherapists to support their patients. A call to advance more intradisciplinary physiotherapy teamwork should be encouraged as valuable knowledge sharing is potentially lost within the framework of 'specialisation'. If needed, the skills of a greater interdisciplinary team are imperative to facilitate patient management and recovery from this multi-faceted injury.

Perceived Stress, Mindfulness, and Clinical Concussion Outcomes in Adults with a Concussion History

ABSTRACT Introduction Higher perceived stress negatively impacts concussion recovery, but there are limited data examining connections between perceived stress and concussion. Additionally, higher mindfulness is associated with lower perceived stress, but there is limited research on how mindfulness impacts concussion outcomes. Therefore, this study aimed to estimate the associations among perceived stress, mindfulness, and clinical concussion outcomes. Methods This was a cross-sectional, observational study in 80 young adults with a concussion history. Participants completed a single study visit measuring the following: 1) demographics, concussion history, and current mindfulness practice; 2) perceived stress (Perceived Stress Scale); 3) mindfulness (Five Facet Mindfulness Questionnaire); and 4) clinical concussion outcomes/symptoms (Rivermead Post-Concussion Symptoms Questionnaire), balance performance (Balance Error Scoring System (BESS) and center of mass), autonomic nervous system function (heart rate variability), vestibular/ocular function (vestibular ocular motor screening), and exertion tolerance (step test). Separate multivariable linear regression models were used to determine the associations among 1) perceived stress and clinical concussion outcomes and 2) mindfulness and clinical concussion outcomes. Next, a perceived stress and mindfulness interaction term was included to test the potential moderation effect of mindfulness on clinical concussion outcomes. Results Higher perceived stress was significantly associated with higher concussion symptom severity (P &lt; 0.001) and higher number of concussion symptoms reported as worse than before injury (P &lt; 0.001). Higher mindfulness was associated with lower concussion symptom severity (P &lt; 0.001), and fewer concussion symptoms reported as worse than before injury (P = 0.002). There were no clinically significant models where the interaction effect was also significant, but the BESS parameter estimate did show statistical significance in the interaction model. Conclusions Our results provide a novel understanding of the association among perceived stress, mindfulness, and clinical concussion outcomes. These data are necessary to inform mechanistic concussion rehabilitation interventions.

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).

Collegiate Adapted Athlete Baseline Performance on the Vestibular/Ocular Motor Screening.

Concussion assessment in adapted and para-sport athletes has continued to evolve with growing considerations in para-sports, but little is known about vestibular/ocular performance assessment in this sample. To examine baseline performance on the Vestibular/Ocular Motor Screening (VOMS) in collegiate adapted athletes. A secondary objective was to investigate the role of sex, history of concussion, and functional classification on baseline measures. Cross-sectional study. University adapted athletics facility. 54 collegiate adapted athletes (age=21.19±2.6 years) from multiple institution's adapted athletics programs across the United States. Adapted athletes completed a baseline VOMS assessment while at the host university for in-season competition and tournaments. Independent variables were sex, history of concussion and functional classification (1.0-4.5 at 0.5 intervals). VOMS performance consisted of pre-test symptoms (headache, dizziness, nausea, and fogginess) and post-item (e.g., smooth pursuits, saccades) symptom provocation/change from pre-test scores. 50.9% reported 0 symptom provocation on the VOMS, with 72% having no pre-test symptoms. No sex differences were noted on the VOMS (p>0.05); However, adapted athletes with a history of concussion reported greater VOMS provocation on horizontal saccades (p=0.008) than those with no history. Higher functional classifications (2.0-4.5) reported greater provocation on horizontal saccades (p=0.010), horizontal and vertical saccades (p=0.043 and 0.048) vestibular ocular reflex (VOR), and VOR cancellation (p=0.036) than 1.0-1.5 athletes. Our findings provide context for baseline VOMS performance in collegiate adapted athletes and identifying modifiers at baseline. Special consideration is warranted on vestibular and oculomotor assessment in adapted and para-sport athletes with a history of concussion and higher functional classifications.

Reconsidering Vestibular/Ocular Motor Screening Cutoff Scores forConcussion.

Vestibular/Ocular Motor Screening (VOMS) is often part of a comprehensive evaluation to identify acute mild traumatic brain injury. Most of the reports describe the use of the VOMS in adolescents/young adults and not in older adults or military service members. The purpose of this study was to describe VOMS findings in healthy civilians and active duty military service members up to the age of 50 years. Seventy-seven healthy civilians between 18 and 50 years of age (22 males, age 31.8 [9.0] years) participated across three sites in addition to 40 healthy active duty service members (25 males, age 27.5 [4.9] years) from one site. Demographics, Neurobehavioral Symptom Inventory scores, mean near point convergence (NPC) distance, and Total Symptom Change (TSS) scores from the VOMS were evaluated. For civilians, the group mean NPC distance was 4.98 (3.8) cm. For military service members, the group mean NPC distance was 6.17 (4.57) cm. For civilians, the mean TSS was 1.2 (2.3) with 53.2% reporting 0 TSS, 27.3% reporting one TSS, and 19.5% reporting two or more TSS. For military service members, the mean TSS was 0.20 (0.72) with 92.5% reporting 0 TSS, 0% reporting one TSS, and 7.5% reporting two or more TSS. Age did not correlate with the mean NPC distance and TSS in healthy civilians and active duty military service members. Reconsideration of the Military Acute Concussion Evaluation, Version 2 cutoff value for abnormal mean NPC distance may be warranted to improve diagnostic accuracy in both civilian and military adult populations. Similarly, re-evaluating criteria for interpreting the TSS results of the VOMS, specifically in civilians, may be warranted.

Temporal Changes in Fixational Eye Movements After Concussion in Adolescents and Adults: Preliminary Findings.

Concussions often involve ocular impairment and symptoms such as convergence insufficiency, accommodative insufficiency, blurred vision, diplopia, eye strain, and pain. Current clinical assessments of ocular function and symptoms rely on subjective symptom reporting and/or involve lengthy administration time. More objective, brief assessments of ocular function following concussion are warranted. The purpose of this study was to evaluate changes in fixational eye movements (FEMs) and their association with clinical outcomes including recovery time, symptoms, cognitive and vestibular/ocular motor impairment. Thirty-three athletes (13-27 years of age; 54.5% female) within 21 days of a diagnosed concussion participated in the study. A tracking scanning laser ophthalmoscope (TSLO) evaluated FEMs metrics during fixation on a center and corner target. Participants completed symptom (Post-Concussion Symptom Scale [PCSS]), cognitive (Immediate Post-concussion Assessment and Cognitive Testing [ImPACT], and Vestibular/Ocular Motor Screening (VOMS) evaluations. All measures were administered at the initial visit and following medical clearance, which was defined as clinical recovery. Changes in FEMs were calculated using paired-samples t tests. Linear regression (LR) models were used to evaluate the association of FEMs with clinical recovery. Pearson product-moment correlations were used to evaluate the associations among FEMs and clinical outcomes. On the center task, changes across time were supported for average microsaccade amplitude (p = 0.005; Cohen's d = 0.53), peak velocity of microsaccades (p = 0.01; d = 0.48), peak acceleration of microsaccades (p = 0.02; d = 0.48), duration of microsaccade (p < 0.001; d = 0.72), and drift vertical (p = 0.017; d = -0.154). The LR model for clinical recovery was significant (R2 = 0.37; p = 0.023) and retained average instantaneous drift amplitude (β = 0.547) and peak acceleration of microsaccade (β = 0.414). On the corner task, changes across time were supported for drift proportion (p = 0.03; d = 0.43). The LR model to predict clinical recovery was significant (R2 = 0.85; p = 0.004) and retained average amplitude of microsaccades (β = 2.66), peak velocity of microsaccades (β = -15.11), peak acceleration of microsaccades (β = 12.56), drift horizontal (β = 7.95), drift vertical (β = 1.29), drift amplitude (β = -8.34), drift proportion (β = 0.584), instantaneous drift direction (β = -0.26), and instantaneous drift amplitude (β = 0.819). FEMs metrics were also associated with reports of nausea and performance within the domain of visual memory. The FEMs metric were also associated with PCSS, ImPACT, and VOMS clinical concussion outcomes, with the highest magnitude correlations between average saccade amplitude and VOMS symptoms of nausea and average instantaneous drift speed and ImPACT visual memory, respectively. FEMs metrics changed across time following concussion, were useful in predicting clinical recovery, and were correlated with clinical outcomes. FEMs measurements may provide objective data to augment clinical assessments and inform prognosis following this injury.

Optimizing baseline and post-concussion assessments through identification, confirmation, and equivalence of latent factor structures: findings from the NCAA-DoD CARE Consortium

Objective: Concussion evaluations use a multidimensional assessment to evaluate unique patient function dimensions (e.g., subjective symptoms differ from balance assessments), but the overarching latent factor structure has not been empirically substantiated. Our objective was to determine the cumulative latent factor structure of pre-injury baseline and acute (<48-h) post-concussion assessment battery outcomes, and determine measurement equivalence among common factors in collegiate student-athletes. Methods: Collegiate student-athletes at baseline (n = 21,865) and post-concussion (n = 1,537) across 25-institutions completed standardized assessments. Individual items were used from the baseline and post-concussion assessments and consisted of: Sport Concussion Assessment Tool, Brief Symptom Inventory-18, Standardized Assessment of Concussion, Balance Error Scoring System, Immediate Post-Concussion Assessment and Cognitive Test, and vestibular-ocular motor screening. Exploratory factor analysis was used on half the baseline data, and confirmatory factor analysis on the remaining baseline data and post-concussion data separately. Measurement equivalence was assessed between sex, sport contact classification, concussion history, and time. Results: A 10-factor exploratory model was established and comprised of: depression, somatic, vestibulo-ocular, headache, postural stability, neurocognition, emotional, fatigue, cognitive, consciousness clouding. The 10-factor model was confirmed at baseline and post-concussion with strong measurement equivalence between timepoints. Strong to strict measurement equivalence was observed for sex, sport contact classification, and concussion history at both timepoints separately. Conclusion: Our findings established a robust 10-factor latent factor model equivalent across timepoints and common factors among healthy and concussed collegiate athletes. Clinicians can use these findings to target specific factors while reducing redundant elements to provide efficient, comprehensive post-concussion assessments.

A - 136 Association of Pre-Injury Anxiety and Oculomotor Symptoms Following Concussion among Adolescents.

To investigate the utility of demographic risk factors and post-concussion oculomotor symptoms to identify adolescents with anxiety panic disorder symptoms. Participants included 124 patients (63 male) aged 10 to 18 (M = 14.4, SD = 2.3) within 2-30days of injury (M = 9.3, SD = 6.3) who presented to a concussion specialty clinic between 2017-2018. All participants completed the Screening for Child Anxiety Related Disorders (SCARED-C) to evaluate pre-injury anxiety as well as the Vestibular/Ocular Motor Screening (VOMS) as part of standard clinical care. A backward logistic regression (LR) was employed to determine the utility of symptom provocation on oculomotor components of the VOMS (i.e., smooth pursuits, horizontal saccades, vertical saccades, and near point of convergence) and demographic risk factors (i.e., history of anxiety or depression and gender) to identify adolescents with panic disorder symptoms on the SCARED-C. The LR model was statistically significant (χ2 (6) = 26.8, p < 0.001) and explained 32.0% of the variance. The model correctly classified 84.7% of cases with high specificity = 0.97 but low sensitivity = 0.27. Variables retained in the model included provocation of dizziness during vertical saccades (OR = 1.85, p = 0.016), self-reported history of depression (OR = 7.34, p = 0.032), and sex (i.e., female; OR = 5.45, p = 0.009). The results indicate that symptom provocation on oculomotor components of the VOMS (i.e., dizziness during vertical saccades), sex, and self-reported history of depression diagnosis are modest predictors of panic disorder symptoms in adolescents. Clinicians should consider these symptoms when interpreting symptoms post-injury.

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.

A-03 Preliminary Evidence for Motor Vehicle Accidents and Associated Concussion Response Severity in Older Adults

Abstract Purpose To determine if mechanism of injury is associated with differences in initial response to concussion in older adults. Methods Fifty older adults (54% female) aged 50-84 (59.14±6.54) were recruited from a sports medicine concussion clinic at initial appointment. Inclusion criteria included age (50+) and injury date within the last year. Exclusion criteria included prior diagnosis of a neurological disorder and/or brain malformation, psychiatric diagnosis other than anxiety/depression, prior history of moderate or severe brain injury, and/or ongoing litigation. Mechanism of injury in the sample included 22 falls/accidents (44%), 20 MVAs (40%), 2 sport/recreation (4%), 1 assault (2%), and 5 other (10%). Participants were assigned to two independent groups, MVA and Non-MVA. Outcome measures included Vestibular/Ocular-Motor Screening (VOMS), Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT), and Concussion Clinical Profile Screening (CP Screen). Response severity was operationalized by VOMS Total and CP Screen Total. Two-tailed independent t-tests (alpha&amp;lt;.05) examined differences between groups at initial visit. Results There were no significant differences between groups in terms of demographics or other common risk factors. There were no differences between groups for response severity. The MVA group reported more severe vestibular complaints t(41) =2.07, p=.044, more severe cognitive complaints, t(44)=3.68, p&amp;lt;.001, and demonstrated worse scores on domains of visual memory, t(43)=-2.16, p=.037, reaction time, t(43)=3.07, p=.004, and visual motor speed, t(43)=-2.85, p=.007. Conclusions MVA-related concussions may result in more focal disruption of vestibular and cognitive performance in older adults. Future research is warranted to confirm the findings of this study, to explore potential explanations for these findings, and to further explore how concussion presents in older adults.

A-02 Preliminary Analyses of Brain Injury Perceptions in Adolescents and Associated Concussion Severity

Abstract Purpose To determine the relationship between an adolescent athlete’s understanding of concussion and their initial injury severity. Methods Twenty-eight (75% male) concussed participants ages 11-17 (14.11+/-1.73) completed demographic items and the Brain Injury Perceptions Survey (BIP), an adaptation of the Illness Perceptions Questionnaire (IPQ), immediately following initial clinic evaluation. The sum of five items reflecting injury understanding were composited to form an illness coherence composite score. Clinical outcome measures included Vestibular/Ocular-Motor Screening (VOMS), Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT), Post Concussive Symptom Scale (PCSS), and Concussion Clinical Profile Screening (CP Screen). Linear regressions were computed to determine if illness coherence explained variance in clinical outcomes. Results Illness coherence and clinical outcomes were inversely correlated and was predictive of initial response severity as measured by CP Screen Total (R2=.47, F(1,26)=22.62, p&amp;lt;.001), PCSS Total (R2=.33, F(1,25)=12.08, p=.002), and VOMS Symptom Total (R2=.39, F(1,25)=15.69, p&amp;lt;.001). Illness coherence was not predictive of performance in any cognitive domains. Gender and history of previous concussion did not result in total illness coherence composite score group differences. Conclusions Lesser understanding of injury in adolescent athletes is predictive of a more severe initial response to concussion. Clinicians need to facilitate their patients' understanding of concussion when treating adolescents in clinic. More research is needed to better explain the relationship between initial response severity and injury understanding. Future research can also focus on injury severity and general perceptions of injury.

Beyond acute concussion assessment to office management: a systematic review informing the development of a Sport Concussion Office Assessment Tool (SCOAT6) for adults and children

ObjectivesTo systematically review the scientific literature regarding the assessment of sport-related concussion (SRC) in the subacute phase (3–30 days) and provide recommendations for developing a Sport Concussion Office Assessment Tool...

The 8 January 2020 theatre ballistic missile attack on US soldiers stationed at Al Asad Air Base, Iraq: case series using a concussion subtypes framework to approach a real-world, chaotic blast-related TBI mass casualty event

ObjectivesThis study aims to describe which concussion subtype(s) result specifically from the explosions of theatre ballistic missiles (TBMs) blast waves, an extremely rare occurrence in modern warfare. We provide feedback...

Association of Multidomain Assessment Outcomes with Referral for Vestibular Therapy following Concussion.

Multiple aspects of a multidomain assessment have been validated for identifying concussion, however, researchers have yet to determine which components are related to referral for vestibular therapy. To identify which variables from a multidomain assessment were associated with receiving a referral for vestibular therapy following a concussion. Retrospective chart review, level of evidence 3. Participants (n=331; age: 16.9±7.2; 39.3% female) were diagnosed with a concussion per international consensus criteria by a clinical neuropsychologist after presenting to a concussion specialty clinic. Medical chart data was extracted from the first clinical visit regarding pre-injury medical history, computerized neurocognition, Post-Concussion Symptom Scale (PCSS), Concussion Clinical Profiles Screen (CP-Screen) and Vestibular Ocular Motor Screening (VOMS) within 16.2±46.7 days of injury. Five backwards logistic regression models were built to associate the outcomes from each of the five included assessments with referral for vestibular therapy. A final logistic regression model was built using variables retained in the previous five models as potential predictors of referral for vestibular therapy. The five models built from individual components of the multidomain assessment predicted referral for vestibular therapy (R2= 0.01-0.28) with 1 to 6 statistically significant variables. The final multivariate model (R2= 0.40) retained 9 significant variables, represented by each of the five multidomain assessments except neurocognition. Variables with the strongest association to vestibular therapy referral were motor vehicle accident mechanism of injury (odds ratio [OR]=15.45), migraine history (OR=3.25), increased headache when concentrating (OR=1.81) and horizontal vestibular ocular reflex (OR=1.63). The present study demonstrates the utility of a multidomain assessment, and identifies outcomes associated with a referral for vestibular therapy following a concussion.

The Value of the Vestibular/Ocular Motor Screening (VOMS) in Evaluating Adolescent Patients with Concussions

To determine the VOMS can differentiate between typical and protracted recoveries in adolescent patients.

Virtual Reality Application for Vestibular/Ocular Motor Screening: Current Clinical Protocol Versus a Novel Prototype.

Virtual reality (VR) has been explored to improve baseline and postinjury assessments in sport-related concussion (SRC). Some experience symptoms related to VR, unrelated to concussion. This may deter use of vestibular/ocular motor screening (VOMS) using VR. Baseline VR VOMS symptomatology differentiates baseline from overall symptomatology. There will be no difference between current clinical manual VOMS (MAN), a clinical prototype (PRO), and VR for symptom provocation change score (SPCS) and near point of convergence (NPC) average score in a healthy population and sex differences among the 3 modes of administration. Cohort study. Level 3. A total of 688 National Collegiate Athletic Association Division I student-athletes completed VOMS using 3 methods (MAN, N = 111; female athletes, N = 47; male athletes, N = 64; average age, 21 years; PRO, N = 365; female athletes, N = 154; male athletes, N = 211; average age, 21 years; VR, N = 212; female athletes, N = 78; male athletes, N = 134; average age = 20 years) over a 3-year period (2019-2021) during annual baseline testing. Exclusion criteria were as follows: self-reported motion sickness in the past 6 months, existing or previous neurological insult, attention deficit hyperactivity disorder, learning disabilities, or noncorrected vision impairment. Administration of MAN followed the current clinical protocols, PRO used a novel prototype, and VR used an HTC Vive Pro Eye head mounted display. Symptom provocation was compared using Mann-Whitney U tests across each VOMS subtest with total SPCS and NPC average by each method. MAN had significantly (P < 0.01) more baseline SPCS (MAN = 0.466 ± 1.165, PRO = 0.163 ± 0.644, VR = 0.161 ± 0.933) and significantly (P < 0.01) and more SPCS (MAN = 0.396 ± 1.081, PRO = 0.128 ± 0.427, VR = 0.48 ± 0.845) when compared with PRO and VR. NPC average measurements for VR (average, 2.99 ± 0.684 cm) were significantly greater than MAN (average, 2.91 ± 3.35 cm; P < 0.01; Cohen's d = 0.03) and PRO (average, 2.21 ± 1.81 cm; P < 0.01; Cohen's d = 0.57). For sex differences, female athletes reported greater SPCS with PRO (female athletes, 0.29 ± 0.87; male athletes, 0.06 ± 0.29; P < 0.01) but not in VR or MAN. Using a VR system to administer the VOMS may not elicit additional symptoms, resulting in fewer false positives and is somewhat stable between sexes. VOMS may allow for standardization among administrators and reduce possible false positives.

Neck Symptoms and Associated Clinical Outcomes in Patients Following Concussion.

To examine the frequency and association of neck pain symptoms in patients with a concussion. Three-hundred and thirty-one consecutively enrolled patients aged 9 to 68 years with a diagnosed concussion 1 to 384 days post-injury were enrolled at a concussion clinic from a single integrated healthcare system in Western Pennsylvania between 2019 and 2021. Retrospective cohort analysis of prospectively collected concussion screening tool intake survey responses and clinical outcomes data. The primary outcome was self-reported neck pain or difficulty with neck movement on the Concussion Clinical Profiles Screening (CP Screen) tool, recovery time, and incidence of treatment referral. Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) composite scores, Vestibular/Ocular Motor Screening (VOMS) item scores, type and severity of neck symptoms, mechanism of injury, time from injury to clinic presentation, medical history, and concussion symptom profile were secondary outcomes. Of the 306 consecutively enrolled eligible patients in the registry, 145 (47%) reported neck pain, 68 (22.2%) reported difficulty moving their neck, and 146 (47.7%) reported either symptom. A total of 47 (15.4%) participants reported more severe neck symptoms, and this group took longer to recover (40 ± 27 days) than those not reporting neck symptoms (30 ± 28 days; U = 8316, P < .001). Stepwise logistic regression predicting more severe neck symptoms was significant (Nagelkerke R2 = 0.174, χ 2 = 9.315, P = .316) with older age ( P = .019) and mechanism of injury including motor vehicle collisions (MVCs) ( P = .047) and falls ( P = .044) as risk factors. MVCs and falls were associated with over 4 times and 2 times greater risk, respectively, for reporting more severe neck symptoms. Neck pain and stiffness symptoms are common in patients with a concussion following high-energy mechanisms of injury including MVCs or falls from height. These symptoms are associated with prolonged recovery. Providers should evaluate neck symptoms and consider targeted treatment strategies to limit their effects in patients with a concussion.

Vestibular/ocular motor screening (VOMS) score for identification of concussion in cases of non-severe head injury: A systematic review

Background and importance Each year, 1.4 million patients attend a UK ED with a head injury. Mild traumatic brain injury affects up to 300/100 000 admitted patients/year and a greater number of non-admitted patients. Identifying those patients with a head injury that have concussion, and of those, which will have a prolonged recovery, is critical for discharge planning. The Vestibular/Ocular Motor Screening test (VOMS) has been reported as a useful “sideline tool” to evaluate for sports-related concussion (SRC). VOMS has been assessed for utility primarily for predicting in head-injured, which cases will have concussion, and secondarily in predicting in concussed patients, which will have prolonged recovery. Originally described in 2014, VOMS has not been subject to systematic review or meta-analysis, with regard to its predictive performance for concussion. Objective To assess the state of VOMS evidence for dichotomously classifying concussion status in patients with non-severe head injury Design Systematic review. Setting and participants Studies comprising the review enrolled ambulatory head-injured adults and children, usually from sports-related settings, in Europe or the USA. Exposure VOMS. Outcome measures Presence of concussion, presence of prolonged recovery in concussed patients Main results The review identified 17 studies, characterized by a wide variety of specific approaches to administering and scoring VOMS. While VOMS showed promise as a screening tool for concussion, marked study heterogeneity precluded generation of a pooled effect estimate for VOMS performance. Conclusion VOMS is potentially useful as a concussion screening tool. Available evidence from the SRC arena suggests sensitivity ranging from 58–96%, with specificity 46−92%. Directions for future VOMS research should include evaluation of standardized administration and scoring, potentially of a simpler VOMS (with fewer components), in a general head-injured population. Further analysis of precisely defined VOMS application may be useful to determine the proper place of VOMS screening for the head-injured.