Dataset Information

Vestibular, Oculomotor, and Balance Functions in Children With and Without Concussion.

ABSTRACT:

Objective

The main objective of this study was to assess whether objective vestibular, oculomotor, and balance functions were impaired in children with a current diagnosis of concussion with vestibular and/or ocular symptoms.

Setting

Data were collected in a vestibular/ocular clinical laboratory. Patient participants were recruited from a concussion clinic in a children's hospital.

Participants

Thirty-three children aged 8 to 17 years with a current diagnosis of concussion and vestibular and/or ocular symptoms and 30 children without concussion.

Design

Cross-sectional single-visit study.

Main outcome measures

Eye-tracking rotary chair oculomotor and vestibular measures, vestibular evoked potentials, and static posturography.

Results

There were no statistically significant differences on any clinical measure between children with concussion and children without concussion. Younger children without concussion performed significantly worse on several rotary chair and balance measures compared with older children without concussion.

Conclusions

No vestibular, oculomotor, or balance measures were significantly different between children with concussion and children without concussion, suggesting these measures may not be useful in the evaluation of a child with concussion and vestibular and/or oculomotor symptoms. Future research should investigate age effects and other vestibular and oculomotor tests to identify objective findings that better relate to vestibular and/or ocular symptoms in children with concussion.

SUBMITTER: Cochrane GD

PROVIDER: S-EPMC8249322 | biostudies-literature | 2021 Jul-Aug 01

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Vestibular, Oculomotor, and Balance Functions in Children With and Without Concussion.

Cochrane Graham D GD Christy Jennifer B JB Almutairi Anwar A Busettini Claudio C van Heyningen Hendrik K Kits HKK Weise Katherine K KK Swanson Mark W MW Gould Sara J SJ

The Journal of head trauma rehabilitation 20210701 4

<h4>Objective</h4>The main objective of this study was to assess whether objective vestibular, oculomotor, and balance functions were impaired in children with a current diagnosis of concussion with vestibular and/or ocular symptoms.<h4>Setting</h4>Data were collected in a vestibular/ocular clinical laboratory. Patient participants were recruited from a concussion clinic in a children's hospital.<h4>Participants</h4>Thirty-three children aged 8 to 17 years with a current diagnosis of concussion ...[more]

PMID: 33656474

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Project description:BackgroundConcussion in children is a significant public health burden in the United States with 2.3 million children under the age of 17 years sustaining a concussion in 2022 alone. Children post-concussion experience a wide range of symptoms of vestibular dysfunction. Vestibular rehabilitation therapy (VRT) has been shown to substantially decrease dizziness and improve gait and balance function in adults post-concussion, but limited information is available for children. Purpose: The purpose of this systematic review was to determine the effectiveness of VRT on improving vestibular function, postural control, and gait in children post-concussion.Study designSystematic review.MethodsAn electronic search of MEDLINE and CINAHL was conducted in October 2022 and later updated in April 2024 using MeSH terms and keywords related to vestibular rehabilitation, concussion, and children. Quality appraisal was conducted independently by two reviewers using the Joanna Briggs Institute checklist, the Critical Appraisal Skills Programme checklist and Cochrane risk of bias assessment tool. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were utilized for screening and data extraction.ResultsOverall, twelve studies (three randomized controlled trials, five cohort studies, two case series and two case reports) were included in the review. The Dizziness Handicap Inventory (DHI) was the most frequently utilized measure (five studies). Three studies reported a statistically significant improvement in DHI (change scores = 19-25, p < 0.05), gait speed (F = 38.3, p < 0.001), Balance Error Scoring System (BESS) (change score percentage 12.1 - 52%, p < 0.01), and Activities-specific Balance Confidence (ABC) scale (change = 20-29 points, p <0.01).ConclusionVRT shows promise and may result in symptom improvements in children post-concussion when used as part of a multimodal intervention plan. Further research with larger samples is recommended to make informed decisions about dosage and long-term functional outcomes in children post-concussion.Level of evidence3.

Project description:BackgroundConcussions and mild traumatic brain injuries are the most common causes of physical and cognitive disability worldwide. Concussion can result in post-injury vestibular and balance impairments that can present up to five years post initial concussion event, ultimately affecting many daily and functional activities. While current clinical treatment aims to reduce symptoms, the developing use of technology in everyday life has seen the emergence of virtual reality. Current literature has failed to identify substantial evidence regarding the use of virtual reality in rehabilitation. The primary aim of this scoping review is to identify, synthesise, and assess the quality of studies reporting on the effectiveness of virtual reality for the rehabilitation of vestibular and balance impairments post-concussion. Additionally, this review aims to summarise the volume of scientific literature and identify the knowledge gaps in current research pertaining to this topic.MethodsA scoping review of six databases (PubMed, Embase, CINAHL, ProQuest, SportDiscus, Scopus) and a grey literature (Google Scholar) was conducted using three key concepts (virtual reality, vestibular symptoms, and post-concussion). Data was charted from studies and outcomes were categorised into one of three categories: (1) balance; (2) gait; or (3) functional outcome measures. Critical appraisal of each study was conducted using the Joanna Briggs Institute checklists. A critical appraisal of each outcome measure was also completed utilising a modified GRADE appraisal tool to summarise the quality of evidence. Effectiveness was assessed using calculations of change in performance and change per exposure time.ResultsThree randomised controlled trials, three quasi-experimental studies, three case studies, and one retrospective cohort study were ultimately included, using a thorough eligibility criteria. All studies were inclusive of different virtual reality interventions. The ten studies had a 10-year range and identified 19 different outcome measures.ConclusionThe findings from this review suggests that virtual reality is an effective tool for the rehabilitation of vestibular and balance impairments post-concussion. Current literature shows sufficient but low level of evidence, and more research is necessary to develop a quantitative standard and to better understand appropriate dosage of virtual reality intervention.

Project description:Background and purposeThe utility of prospective changes on the Vestibular/Ocular Motor Screening (VOMS) assessment are unknown, and 2 methods of scoring are published in the literature. Total scores are the total symptom scores for each VOMS component, and change scores are the difference between the pretest total symptom score and component total symptom scores. This study documented prospective changes in vestibular and ocular motor impairments and symptoms in high school athletes with concussion using the total and change scoring methods and compared the percentage of scores over clinical cutoffs using the total and change scoring methods for the VOMS.MethodsSixty-three athletes (15.53 ± 1.06 years) completed the VOMS at baseline (ie, preinjury), 1 to 7 days, and 8 to 14 days after concussion. A series of repeated-measures multivariate analyses of variance were conducted on total and change scores. A 2-way repeated-measures analysis of variance was performed on the near-point convergence distance. A series of χ analyses compared scores exceeding clinical cutoffs between the total and change scoring methods.ResultsTotal scoring revealed impairments (Wilks λ = 0.39, F16,47 = 4.54, P < 0.001, η = 0.61) on all VOMS components at 1 to 7 and 8 to 14 days compared to baseline. Change scoring revealed postinjury impairments compared with baseline (Wilks λ = 0.58, F14,49 = 2.52, P = 0.009, η = 0.42) on all components at 1 to 7 days; however, impairments at 8 to 14 days were revealed only for the vertical vestibular oculomotor reflex and vestibular motor sensitivity components. Total scoring identified significantly more scores over cutoffs at 1 to 7 days (χ1,63 = 5.97, P = 0.02) compared with change scores.Discussion and conclusionsBoth total and change scoring methods on the VOMS are useful for identifying impairments following concussion.Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, http://links.lww.com/JNPT/A230).

Dataset Information

Vestibular, Oculomotor, and Balance Functions in Children With and Without Concussion.

Objective

Setting

Participants

Design

Main outcome measures

Results

Conclusions

Publications

Vestibular, Oculomotor, and Balance Functions in Children With and Without Concussion.

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