title: A Positive Vestibular/Ocular Motor Screening (VOMS) Is Associated With Increased Recovery Time After Sports-Related Concussion in Youth and Adolescent Athletes.
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.
  
  
  OBJECTIVE
  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).
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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.
authors: Sports Concussion Research Group, Department of Kinesiology, Texas Christian University, Fort Worth, Texas, USA.|Texas Health Ben Hogan Sports Medicine Concussion Center, Fort Worth, Texas, USA.|Texas Health Ben Hogan Sports Medicine, Fort Worth, Texas, USA.
authors: Anthony J
authors: AJ
authors: Anzalone
authors: Sports Concussion Research Group, Department of Kinesiology, Texas Christian University, Fort Worth, Texas, USA.|Texas Health Ben Hogan Sports Medicine Concussion Center, Fort Worth, Texas, USA.|Texas Health Ben Hogan Sports Medicine, Fort Worth, Texas, USA.
authors: Damond
authors: D
authors: Blueitt
authors: Sports Concussion Research Group, Department of Kinesiology, Texas Christian University, Fort Worth, Texas, USA.|Texas Health Ben Hogan Sports Medicine Concussion Center, Fort Worth, Texas, USA.|Texas Health Ben Hogan Sports Medicine, Fort Worth, Texas, USA.
authors: Tami
authors: T
authors: Case
authors: Sports Concussion Research Group, Department of Kinesiology, Texas Christian University, Fort Worth, Texas, USA.|Texas Health Ben Hogan Sports Medicine Concussion Center, Fort Worth, Texas, USA.|Texas Health Ben Hogan Sports Medicine, Fort Worth, Texas, USA.
authors: Tiffany
authors: T
authors: McGuffin
authors: Sports Concussion Research Group, Department of Kinesiology, Texas Christian University, Fort Worth, Texas, USA.|Texas Health Ben Hogan Sports Medicine Concussion Center, Fort Worth, Texas, USA.|Texas Health Ben Hogan Sports Medicine, Fort Worth, Texas, USA.
authors: Kalyssa
authors: K
authors: Pollard
authors: Sports Concussion Research Group, Department of Kinesiology, Texas Christian University, Fort Worth, Texas, USA.|Texas Health Ben Hogan Sports Medicine Concussion Center, Fort Worth, Texas, USA.|Texas Health Ben Hogan Sports Medicine, Fort Worth, Texas, USA.
authors: J Craig
authors: JC
authors: Garrison
authors: Sports Concussion Research Group, Department of Kinesiology, Texas Christian University, Fort Worth, Texas, USA.|School of Recreation, Health, and Tourism, George Mason University, Manassas, Virginia, USA.
authors: Margaret T
authors: MT
authors: Jones
authors: Sports Concussion Research Group, Department of Kinesiology, Texas Christian University, Fort Worth, Texas, USA.|College of Business, University of North Texas, Denton, Texas, USA.
authors: Robert
authors: R
authors: Pavur
authors: Sports Concussion Research Group, Department of Kinesiology, Texas Christian University, Fort Worth, Texas, USA.|Texas Health Ben Hogan Sports Medicine Concussion Center, Fort Worth, Texas, USA.|Texas Health Ben Hogan Sports Medicine, Fort Worth, Texas, USA.
authors: Stephanie
authors: S
authors: Turner
authors: Sports Concussion Research Group, Department of Kinesiology, Texas Christian University, Fort Worth, Texas, USA.|Texas Health Ben Hogan Sports Medicine Concussion Center, Fort Worth, Texas, USA.|Texas Health Ben Hogan Sports Medicine, Fort Worth, Texas, USA.
authors: Jonathan M
authors: JM
authors: Oliver
mesh_terms: D000293:Adolescent; D001265:Athletic Injuries / Q000175:diagnosis / Q000209:etiology; D001924:Brain Concussion / Q000175:diagnosis* / Q000209:etiology; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D009460:Neurologic Examination / Q000379:methods*; D015835:Ocular Motility Disorders / Q000175:diagnosis* / Q000209:etiology; D011379:Prognosis; D012189:Retrospective Studies; D015837:Vestibular Diseases / Q000175:diagnosis* / Q000209:etiology; D055815:Young Adult
keywords: concussion; ocular motor; symptoms; vestibular