Academic Difficulty and Vision Symptoms in Children with Concussion.
Academic difficulty is reported in children with prolonged post-concussive symptoms. Despite growing evidence that vestibular-ocular and vision-specific dysfunction are common in children after concussion, vision is rarely mentioned in return-to-learn protocols. The purpose of this project was to evaluate a cohort of children with prolonged post-concussive symptoms to determine if vision symptoms are associated with those reporting academic difficulty.



Data were obtained from the Children's of Alabama Concussion Clinic REDCap dataset from the period January 2007 to October 2013. From this dataset of 1033 concussion events, a cohort of 276 children aged 5 to 18 years with three or more concussion-related symptoms present for 10 days or more was identified. A cross-sectional cohort study was undertaken to evaluate the association of concussion symptoms, SCAT2 scores, and demographic and concussion severity markers to reported educational difficulty among children with prolonged post-concussive symptoms. Univariate and multivariate logistic regression techniques were used to model the association of reported educational difficulty to self-reported vision abnormalities.



Mean age was 13.8 years. Median time since the concussive event was 21 days, with 33% (95/276) reporting their concussion more than 30 days before data collection. Academic difficulty was reported by 29% (79/270) and vision abnormalities in 46% (128/274). After model reduction, vision symptoms (OR 2.17, 95% CI 1.02, 4.62), hearing disturbance (OR 2.39, 95% CI 1.06, 5.36), and concentration difficulty (OR 21.62, 95% CI 9.50, 44.47) remained associated with academic difficulty. For those with symptoms 30 days or more after concussion, only vision (OR 3.15, 95% CI 1.06, 9.38) and concentration difficulty (OR 15.33, 95% CI 4.99, 47.05) remained statistically significant.



Vision problems were commonly reported in children with concussions and were independently associated with those reporting academic difficulty. Comprehensive vision assessment should be considered in children reporting academic difficulty and in the development of return-to-learn protocols.
*OD, MSPH, FAAO †OD, MBA, FAAO ‡PhD §MD ‖MEd. ATC/L **MD, MPH, CAQSM ††PT, PhD Department of Optometry and Vision Science (MWS, KKW, SDL, CB), Department of Ophthalmology (LED), School of Medicine/Pediatric Neurosurgery (JJ), Department of Pediatrics, Division of Pediatric Rehabilitation Medicine (RDD, ES), UAB Sports Medicine at Children's of Alabama (MHH, DF, SJG), and Department of Physical Therapy (JBC), University of Alabama at Birmingham, Birmingham, Alabama.
Mark W
MW
Swanson
Katherine K
KK
Weise
Laura E
LE
Dreer
James
J
Johnston
Richard D
RD
Davis
Drew
D
Ferguson
Matthew Heath
MH
Hale
Sara J
SJ
Gould
Jennifer B
JB
Christy
Claudio
C
Busettini
Sarah D
SD
Lee
Erin
E
Swanson
D000293:Adolescent; D001924:Brain Concussion / Q000150:complications*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007859:Learning Disabilities / Q000175:diagnosis / Q000209:etiology*; D008297:Male; D038223:Post-Concussion Syndrome / Q000175:diagnosis / Q000209:etiology*; D057566:Self Report; D011795:Surveys and Questionnaires; D014786:Vision Disorders / Q000175:diagnosis / Q000209:etiology*
Paediatr Child Health. 2014 Mar;19(3):153-65
24665227
Optom Vis Sci. 2009 Jul;86(7):817-25
19521270
Clin J Sport Med. 2016 Mar;26(2):115-9
25961156
MMWR Morb Mortal Wkly Rep. 2011 Oct 7;60(39):1337-42
21976115
Optometry. 2009 Aug;80(8):419-24
19635432
Brain Inj. 2013;27(1):1-9
23252433
Otolaryngol Head Neck Surg. 2015 Jun;152(6):1133-9
25820582
Pediatr Neurol. 2015 Aug;53(2):108-18
26088839
J Pediatr. 2014 Dec;165(6):1207-15
25262302
JAMA Pediatr. 2013 Feb;167(2):156-61
23247384
J Am Optom Assoc. 1999 May;70(5):301-8
10457707
Pediatrics. 2010 Aug;126(2):e374-81
20660554
J Head Trauma Rehabil. 2000 Apr;15(2):783-91
10739967
Mil Med. 2014 Nov;179(11):1212-7
25373043
Am J Sports Med. 2015 Dec;43(12):3055-61
26453625
Clin J Sport Med. 2016 Jan;26(1):46-52
25706663
Pediatrics. 2013 Nov;132(5):948-57
24163302
J Rehabil Res Dev. 2007;44(7):929-36
18075950
Clin Pediatr (Phila). 2015 Sep;54(10):961-8
26084537
J Athl Train. 2015 Nov;50(11):1174-81
26540099
J Neurosurg Pediatr. 2015 Sep;16(3):248-55
26031619
Clin Pediatr (Phila). 2015 Jul;54(8):783-92
25601958
J Pediatr. 2015 May;166(5):1221-5
25748568
Phys Ther Sport. 2013 May;14(2):e1-e13
23664041
Med Sci Sports Exerc. 2013 Jun;45(6):1030-7
23274602
Pediatrics. 2013 Jul;132(1):8-17
23753087
J Athl Train. 2014 Mar-Apr;49(2):245-65
24601910
Clin Pediatr (Phila). 2016 May;55(5):452-8
26063756
PM R. 2016 Mar;8(3):241-8
26226207
J Int Neuropsychol Soc. 2006 Jan;12(1):111-8
16433950
J Nerv Ment Dis. 2015 Nov;203(11):813-9
26461480
Am J Sports Med. 2014 Oct;42(10):2479-86
25106780
Clin Pediatr (Phila). 2016 Mar;55(3):260-7
26156977
Phys Sportsmed. 2009 Jun;37(2):141-59
20048521
Pediatrics. 2010 Sep;126(3):597-615
20805152