Vestibular and oculomotor findings in neurologically-normal, non-concussed children.
Daniel J Corwin, Mark R Zonfrillo, Douglas J Wiebe and 3 others
PMID 29584455WHAT IT FOUND
24% of non-concussed children failed at least one balance and eye movement test item.
The most common failures were symptoms during quick eye movement testing, often after 10 repetitions. A single failed item alone should not be treated as evidence of concussion.
Key findings
0124% (n = 71) of the 295 children failed at least one of nine balance and eye movement exam elements.
02Of the 71 children with a failed exam, 48% (n = 34) had an abnormality on only one element. In the study sample, 13% (n = 37) had more than one failed element, and 5% (n = 15) failed more than two elements.
03None of the children with failed exams reported daily symptoms on the secondary questionnaire.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The study used a convenience sample from one pediatric emergency department, so it may not represent children seen in other settings or by other clinicians. Only one trained emergency physician performed all exams, and the exam was a modified version of the VOMS with added finger-to-nose, eye movement, and gait testing rather than visual motion sensitivity. Children who could not complete an element because of age or attention were excluded from that element's failure estimate, and 10% (n = 28) were unable to complete at least one element, all under 10 years old. Reliability was checked in only 29 subjects, and a standard agreement statistic could not be calculated because abnormalities were uncommon on each individual test. The study enrolled only non-concussed children with non-neurologic complaints, so it describes baseline exam findings in that group rather than performance in children with concussion.
Declared interests
The authors reported no financial relationships, no payment for producing the manuscript, and no conflicts of interest relevant to the article.
The easy way to misread this
Do not treat a single failed exam item, especially symptoms during quick eye movement testing, as proof of concussion or a new balance or eye movement problem. In non-concussed children, 24% failed at least one item, 48% of those failures were on only one item, and none reported daily symptoms on the follow-up questionnaire.