Prospective Changes in Vestibular and Ocular Motor Impairment After Concussion.
R J Elbin, Alicia Sufrinko, Morgan N Anderson and 6 others
PMID 29864101WHAT IT FOUND
VOMS symptom scores and near-point convergence distance rose above baseline after concussion, especially days 1-7.
When baseline symptoms were subtracted from post-injury scores, only vertical eye movement reflex and visual motion sensitivity differed from baseline at days 8-14.
Key findings
01Compared with baseline, VOMS total symptom scores and near-point convergence distance were higher at 1-7 and 8-14 days after concussion.
02Using change scores, only vertical VOR and VMS differed significantly from baseline at 8-14 days.
03The total scoring method identified significantly more athletes over clinical cutoffs than the change scoring method at 1-7 days post injury.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The final sample was 63 of 83 referred athletes, and 5 of 83 were excluded for not completing all post-injury visits. The results may not apply to athletes who miss follow-up. Athletes with learning disability, ADHD, headache or migraine treatment, moderate to severe traumatic brain injury, neurological disorder, or psychological disorder were excluded. The findings do not cover those groups. The study did not collect pre-existing vestibular disorders, motion sensitivity, medication use, activity level, or treatment after concussion. These factors could affect VOMS scores. Different researchers administered the visits when scheduling required, and inter- and intra-rater reliability were not recorded. The clinical cutoffs used were based on total scores, not change scores, and have not been validated or replicated with change scores. The first post-injury visit averaged 5.02 days and the second averaged 11.70 days. Symptoms in the first few days may have been missed. Some athletes reported symptom improvement after a VOMS component, and the paper gave no physiological explanation for this.
The easy way to misread this
Do not conclude that change scoring is the better VOMS method. The study showed that total and change scoring identified different numbers of athletes over cutoffs at 1-7 days, and different components at 8-14 days. The authors said new clinical cutoffs using change scores still need to be developed.