A Positive Vestibular/Ocular Motor Screening (VOMS) Is Associated With Increased Recovery Time After Sports-Related Concussion in Youth and Adolescent Athletes
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...
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| Veröffentlicht in: | The American journal of sports medicine 2017-02, Vol.45 (2), p.474-479 |
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| creator | Anzalone, Anthony J. Blueitt, Damond Case, Tami McGuffin, Tiffany Pollard, Kalyssa Garrison, J. Craig Jones, Margaret T. Pavur, Robert Turner, Stephanie Oliver, Jonathan M. |
| description | 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. |
| doi_str_mv | 10.1177/0363546516668624 |
| format | Article |
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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.</description><identifier>ISSN: 0363-5465</identifier><identifier>EISSN: 1552-3365</identifier><identifier>DOI: 10.1177/0363546516668624</identifier><identifier>PMID: 27789472</identifier><language>eng</language><publisher>Los Angeles, CA: SAGE Publications</publisher><subject>Adolescent ; Athletes ; Athletic Injuries - diagnosis ; Athletic Injuries - etiology ; Brain Concussion - diagnosis ; Brain Concussion - etiology ; Child ; Concussion ; Cross-Sectional Studies ; Eye movements ; Female ; Humans ; Male ; Medical diagnosis ; Medical screening ; Neurologic Examination - methods ; Ocular Motility Disorders - diagnosis ; Ocular Motility Disorders - etiology ; Physical examinations ; Prognosis ; Recovery (Medical) ; Retrospective Studies ; Sports injuries ; Sports medicine ; Teenagers ; Vestibular Diseases - diagnosis ; Vestibular Diseases - etiology ; Young Adult</subject><ispartof>The American journal of sports medicine, 2017-02, Vol.45 (2), p.474-479</ispartof><rights>2016 The Author(s)</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c365t-8c8feff427b6f52524cb98b57b08994585194c779891cd9469a0267732dce3f3</citedby><cites>FETCH-LOGICAL-c365t-8c8feff427b6f52524cb98b57b08994585194c779891cd9469a0267732dce3f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/0363546516668624$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/0363546516668624$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,776,780,21798,27901,27902,43597,43598</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27789472$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Anzalone, Anthony J.</creatorcontrib><creatorcontrib>Blueitt, Damond</creatorcontrib><creatorcontrib>Case, Tami</creatorcontrib><creatorcontrib>McGuffin, Tiffany</creatorcontrib><creatorcontrib>Pollard, Kalyssa</creatorcontrib><creatorcontrib>Garrison, J. Craig</creatorcontrib><creatorcontrib>Jones, Margaret T.</creatorcontrib><creatorcontrib>Pavur, Robert</creatorcontrib><creatorcontrib>Turner, Stephanie</creatorcontrib><creatorcontrib>Oliver, Jonathan M.</creatorcontrib><title>A Positive Vestibular/Ocular Motor Screening (VOMS) Is Associated With Increased Recovery Time After Sports-Related Concussion in Youth and Adolescent Athletes</title><title>The American journal of sports medicine</title><addtitle>Am J Sports Med</addtitle><description>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.</description><subject>Adolescent</subject><subject>Athletes</subject><subject>Athletic Injuries - diagnosis</subject><subject>Athletic Injuries - etiology</subject><subject>Brain Concussion - diagnosis</subject><subject>Brain Concussion - etiology</subject><subject>Child</subject><subject>Concussion</subject><subject>Cross-Sectional Studies</subject><subject>Eye movements</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Medical diagnosis</subject><subject>Medical screening</subject><subject>Neurologic Examination - methods</subject><subject>Ocular Motility Disorders - diagnosis</subject><subject>Ocular Motility Disorders - etiology</subject><subject>Physical examinations</subject><subject>Prognosis</subject><subject>Recovery (Medical)</subject><subject>Retrospective Studies</subject><subject>Sports injuries</subject><subject>Sports medicine</subject><subject>Teenagers</subject><subject>Vestibular Diseases - diagnosis</subject><subject>Vestibular Diseases - etiology</subject><subject>Young Adult</subject><issn>0363-5465</issn><issn>1552-3365</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kU1r3DAQhkVpabZp7z0VQS_pwY0k6_Noln4sJGxJlpSejC2PEwWvtJHkQH5N_2q13bSUQE_DMM_7zkgvQm8p-UipUqeklrXgUlAppZaMP0MLKgSr6lqK52ixH1f7-RF6ldItIYQqqV-iI6aUNlyxBfrZ4G8huezuAV9Byq6fpy6eru2-4POQQ8SXNgJ456_xydX6_PIDXiXcpBSs6zIM-LvLN3jlC9Sl0l6ADfcQH_DGbQE3Y4bisAsxp-oCpt-KZfB2TskFj53HP8JcDDo_4GYIEyQLPuMm30yQIb1GL8ZuSvDmsR6jzedPm-XX6mz9ZbVszipbnporbfUI48iZ6uUomGDc9kb3QvVEG8OFFtRwq5TRhtrBcGk6wqRSNRss1GN9jE4OtrsY7ubyD-3WlUOmqfMQ5tRSXQtpGGO8oO-foLdhjr4cVyjJjeaKy0KRA2VjSCnC2O6i23bxoaWk3WfXPs2uSN49Gs_9Foa_gj9hFaA6AKm7hn-2_s_wF5ECoPc</recordid><startdate>201702</startdate><enddate>201702</enddate><creator>Anzalone, Anthony J.</creator><creator>Blueitt, Damond</creator><creator>Case, Tami</creator><creator>McGuffin, Tiffany</creator><creator>Pollard, Kalyssa</creator><creator>Garrison, J. Craig</creator><creator>Jones, Margaret T.</creator><creator>Pavur, Robert</creator><creator>Turner, Stephanie</creator><creator>Oliver, Jonathan M.</creator><general>SAGE Publications</general><general>Sage Publications Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TS</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>U9A</scope><scope>7X8</scope></search><sort><creationdate>201702</creationdate><title>A Positive Vestibular/Ocular Motor Screening (VOMS) Is Associated With Increased Recovery Time After Sports-Related Concussion in Youth and Adolescent Athletes</title><author>Anzalone, Anthony J. ; Blueitt, Damond ; Case, Tami ; McGuffin, Tiffany ; Pollard, Kalyssa ; Garrison, J. Craig ; Jones, Margaret T. ; Pavur, Robert ; Turner, Stephanie ; Oliver, Jonathan M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c365t-8c8feff427b6f52524cb98b57b08994585194c779891cd9469a0267732dce3f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adolescent</topic><topic>Athletes</topic><topic>Athletic Injuries - diagnosis</topic><topic>Athletic Injuries - etiology</topic><topic>Brain Concussion - diagnosis</topic><topic>Brain Concussion - etiology</topic><topic>Child</topic><topic>Concussion</topic><topic>Cross-Sectional Studies</topic><topic>Eye movements</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Medical diagnosis</topic><topic>Medical screening</topic><topic>Neurologic Examination - methods</topic><topic>Ocular Motility Disorders - diagnosis</topic><topic>Ocular Motility Disorders - etiology</topic><topic>Physical examinations</topic><topic>Prognosis</topic><topic>Recovery (Medical)</topic><topic>Retrospective Studies</topic><topic>Sports injuries</topic><topic>Sports medicine</topic><topic>Teenagers</topic><topic>Vestibular Diseases - diagnosis</topic><topic>Vestibular Diseases - etiology</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Anzalone, Anthony J.</creatorcontrib><creatorcontrib>Blueitt, Damond</creatorcontrib><creatorcontrib>Case, Tami</creatorcontrib><creatorcontrib>McGuffin, Tiffany</creatorcontrib><creatorcontrib>Pollard, Kalyssa</creatorcontrib><creatorcontrib>Garrison, J. Craig</creatorcontrib><creatorcontrib>Jones, Margaret T.</creatorcontrib><creatorcontrib>Pavur, Robert</creatorcontrib><creatorcontrib>Turner, Stephanie</creatorcontrib><creatorcontrib>Oliver, Jonathan M.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Physical Education Index</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of sports medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Anzalone, Anthony J.</au><au>Blueitt, Damond</au><au>Case, Tami</au><au>McGuffin, Tiffany</au><au>Pollard, Kalyssa</au><au>Garrison, J. Craig</au><au>Jones, Margaret T.</au><au>Pavur, Robert</au><au>Turner, Stephanie</au><au>Oliver, Jonathan M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A Positive Vestibular/Ocular Motor Screening (VOMS) Is Associated With Increased Recovery Time After Sports-Related Concussion in Youth and Adolescent Athletes</atitle><jtitle>The American journal of sports medicine</jtitle><addtitle>Am J Sports Med</addtitle><date>2017-02</date><risdate>2017</risdate><volume>45</volume><issue>2</issue><spage>474</spage><epage>479</epage><pages>474-479</pages><issn>0363-5465</issn><eissn>1552-3365</eissn><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.</abstract><cop>Los Angeles, CA</cop><pub>SAGE Publications</pub><pmid>27789472</pmid><doi>10.1177/0363546516668624</doi><tpages>6</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0363-5465 |
| ispartof | The American journal of sports medicine, 2017-02, Vol.45 (2), p.474-479 |
| issn | 0363-5465 1552-3365 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1835692224 |
| source | SAGE Complete A-Z List; MEDLINE; Alma/SFX Local Collection |
| subjects | Adolescent Athletes Athletic Injuries - diagnosis Athletic Injuries - etiology Brain Concussion - diagnosis Brain Concussion - etiology Child Concussion Cross-Sectional Studies Eye movements Female Humans Male Medical diagnosis Medical screening Neurologic Examination - methods Ocular Motility Disorders - diagnosis Ocular Motility Disorders - etiology Physical examinations Prognosis Recovery (Medical) Retrospective Studies Sports injuries Sports medicine Teenagers Vestibular Diseases - diagnosis Vestibular Diseases - etiology Young Adult |
| title | A Positive Vestibular/Ocular Motor Screening (VOMS) Is Associated With Increased Recovery Time After Sports-Related Concussion in Youth and Adolescent Athletes |
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