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Vision and Vestibular System Dysfunction Predicts Prolonged Concussion Recovery in Children
Christina L Master1,2, Stephen R Master3, Douglas J Wiebe4
1Division of Orthopaedics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Insights
Vision and vestibular problems are common in children with concussion and predict longer recovery times. Early assessment of these issues is crucial for timely intervention and rehabilitation.
Area of Science:
- Pediatric neurology
- Sports medicine
- Ophthalmology
Background:
- Concussion is common in children, with up to one-third experiencing prolonged symptoms beyond four weeks.
- Vision and vestibular dysfunction frequently occur post-concussion, but their predictive value for recovery duration is unclear.
Purpose of the Study:
- To identify specific vision or vestibular problems that predict prolonged recovery in pediatric concussion patients.
- To investigate factors associated with delayed presentation for concussion care.
Main Methods:
- Retrospective cohort study of 432 pediatric patients (ages 5-18) treated at a subspecialty concussion program.
- Assessed vision and vestibular dysfunction at initial presentation.
- Defined prolonged recovery by clinical discharge criteria, including symptom resolution and return to normal activities.
Main Results:
- 88% of patients presented with vision or vestibular problems.
- Provocable symptoms with vestibulo-ocular reflex (VOR) and smooth pursuits, along with abnormal balance and accommodative amplitude (AA), predicted longer recovery times.
- History of motion sickness was linked to vestibular dysfunction; younger age, public insurance, and headache were associated with delayed care.
Conclusions:
- Vision and vestibular deficits are significant predictors of prolonged concussion recovery in children.
- Comprehensive assessments including smooth pursuits, saccades, near point of convergence (NPC), and accommodative amplitude (AA) are essential.
- Early identification and targeted interventions, including accommodations and rehabilitation, are vital for optimizing recovery.
Objective:
Up to one-third of children with concussion have prolonged symptoms lasting beyond 4 weeks. Vision and vestibular dysfunction is common after concussion. It is unknown whether such dysfunction predicts prolonged recovery. We sought to determine which vision or vestibular problems predict prolonged recovery in children.
Design:
A retrospective cohort of pediatric patients with concussion.
Setting:
A subspecialty pediatric concussion program.
Patients (Or Participants):
Four hundred thirty-two patient records were abstracted.
Assessment Of Risk Factors:
Presence of vision or vestibular dysfunction upon presentation to the subspecialty concussion program.
Main Outcome Measures:
The main outcome of interest was time to clinical recovery, defined by discharge from clinical follow-up, including resolution of acute symptoms, resumption of normal physical and cognitive activity, and normalization of physical examination findings to functional levels.
Results:
Study subjects were 5 to 18 years (median = 14). A total of 378 of 432 subjects (88%) presented with vision or vestibular problems. A history of motion sickness was associated with vestibular dysfunction. Younger age, public insurance, and presence of headache were associated with later presentation for subspecialty concussion care. Vision and vestibular problems were associated within distinct clusters. Provocable symptoms with vestibulo-ocular reflex (VOR) and smooth pursuits and abnormal balance and accommodative amplitude (AA) predicted prolonged recovery time.
Conclusions:
Vision and vestibular problems predict prolonged concussion recovery in children. A history of motion sickness may be an important premorbid factor. Public insurance status may represent problems with disparities in access to concussion care. Vision assessments in concussion must include smooth pursuits, saccades, near point of convergence (NPC), and accommodative amplitude (AA). A comprehensive, multidomain assessment is essential to predict prolonged recovery time and enable active intervention with specific school accommodations and targeted rehabilitation.
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