Concussion Recovery Phase Affects Vestibular and Oculomotor Symptom Provocation.

Area of Science:

• Neurology
• Sports Medicine
• Ophthalmology

Background:

• Vestibular and oculomotor testing are increasingly recognized for assessing sport-related concussion (SRC).
• Their utility in monitoring recovery and informing return-to-play decisions requires further investigation.
• This study aims to clarify the clinical usefulness of these tests in SRC recovery.

Purpose of the Study:

• To evaluate the clinical usefulness of vestibular and oculomotor assessments in tracking recovery from sport-related concussion.
• To determine if these tests can differentiate between concussed individuals and healthy controls.
• To assess the potential of these tests in guiding return-to-play decisions.

Main Methods:

• A known-groups approach was employed with three groups: acute SRC (n=21), prolonged symptoms SRC (n=10), and healthy controls (n=58).
• Vestibular and oculomotor assessments, including Gaze-Stabilization (GST), Rapid Eye Horizontal (REH), Optokinetic Stimulation (OKS), Smooth-Pursuit Slow (SPS), and Fast (SPF) tests, were administered at initial assessment, 2-week, and 6-week follow-ups.
• Symptom provocation, combined symptom scores, and near point convergence (NPC) distance were measured. The King-Devick (KD) test was also used.

Main Results:

• Both SRC groups exhibited significantly greater symptom provocation and larger NPC distances compared to controls at initial assessment.
• Injury groups showed improvement over time in King-Devick test scores and combined symptom provocation.
• A regression model using REH, OKS, and GST achieved 90% accuracy in discriminating concussed individuals from healthy controls.

Conclusions:

• Combined vestibular and oculomotor clinical tests are valuable for detecting post-SRC deficits.
• These tests offer crucial insights throughout the concussion recovery process.
• Vestibular and oculomotor assessments, including NPC, GST, REH, SPS, SPF, OKS, and KD, can aid clinicians in return-to-play decisions.