A Positive Vestibular/Ocular Motor Screening (VOMS) Is Associated with Increased Recovery Time after Sports-Related Concussion in Youth and Adolescent Athletes

Anthony J. Anzalone, Damond Blueitt, Tami Case, Tiffany McGuffin, Kalyssa Pollard, J. Craig Garrison, Margaret T. Jones, Robert Pavur, Stephanie Turner, Jonathan M. Oliver*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

132 Scopus citations

Abstract

Background: Vestibular and ocular motor impairments are routinely reported in patients with sports-related concussion (SRC) and may result in delayed return to play (RTP). The Vestibular/Ocular Motor Screening (VOMS) assessment has been shown to be consistent and sensitive in identifying concussion when used as part of a comprehensive examination. To what extent these impairments or symptoms are associated with length of recovery is unknown. Purpose: To examine whether symptom provocation or clinical abnormality in specific domains of the VOMS results in protracted recovery (time from SRC to commencement of RTP protocol). Study Design: Cohort study (prognosis); Level of evidence, 2. Methods: A retrospective chart review was conducted of 167 patients (69 girls, 98 boys; mean ± SD age, 15 ± 2 years [range, 11-19 years]) presenting with SRC in 2014. During the initial visit, VOMS was performed in which symptom provocation or clinical abnormality (eg, unsmooth eye movements) was documented by use of a dichotomous scale (0 = not present, 1 = present). The VOMS used in this clinic consisted of smooth pursuits (SMO-PUR), horizontal and vertical saccades (HOR-SAC and VER-SAC), horizontal and vertical vestibular ocular reflex (HOR-VOR and VER-VOR), near point of convergence (NPC), and accommodation (ACCOM). Domains were also categorized into ocular motor (SMO-PUR, HOR-SAC, VER-SAC, NPC, ACCOM) and vestibular (HOR-VOR, VER-VOR). Cox proportional hazard models were used to explore the relationship between the domains and recovery. Alpha was set at P ≤.05. Results: Symptom provocation and/or clinical abnormality in all domains except NPC (P =.107) and ACCOM (P =.234) delayed recovery (domain, hazard ratio [95% CI]: SMO-PUR, 0.65 [0.47-0.90], P =.009; HOR-SAC, 0.68 [0.50-0.94], P =.018; VER-SAC, 0.55 [0.40-0.75], P <.001; HOR-VOR, 0.68 [0.49-0.94], P =.018; VER-VOR, 0.60 [0.44-0.83], P =.002). The lowest crude hazard ratio was for ocular motor category (0.45 [0.32-0.63], P <.001). Conclusion: These data suggest that symptom provocation/clinical abnormality associated with all domains except NPC and ACCOM can delay recovery after SRC in youth and adolescents. Thus, the VOMS not only may augment current diagnostic tools but also may serve as a predictor of recovery time in patients with SRC. The findings of this study may lead to more effective prognosis of concussion in youth and adolescents.

Original languageEnglish (US)
Pages (from-to)474-479
Number of pages6
JournalAmerican Journal of Sports Medicine
Volume45
Issue number2
DOIs
StatePublished - Feb 1 2017
Externally publishedYes

Keywords

  • concussion
  • ocular motor
  • symptoms
  • vestibular

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Physical Therapy, Sports Therapy and Rehabilitation

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