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Characterizing the evolution of oculomotor and vestibulo-ocular function over time in children and adolescents after
Adrienne Crampton1, Kathryn J Schneider2,3,4, Lisa Grilli5
1School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada.
Insights
Pediatric mild traumatic brain injury (mTBI) can cause lasting oculomotor (OM) and vestibulo-ocular reflex (VOR) impairments. This study tracked OM/VOR function over six months, revealing improvements but persistent deficits in some children.
Area of Science:
- Pediatric neurology
- Neuro-ophthalmology
- Vestibular rehabilitation
Background:
- Pediatric mild traumatic brain injury (mTBI) frequently leads to oculomotor (OM) and vestibulo-ocular reflex (VOR) dysfunctions.
- These impairments are poorly understood but associated with poorer outcomes, impacting children's well-being.
- Understanding the longitudinal evolution of OM and VOR function post-mTBI is crucial for prognosis and management.
Purpose of the Study:
- To assess the temporal variation in OM and VOR function using clinical and computerized tests in children and adolescents post-mTBI.
- To determine the prevalence of abnormal OM and VOR test scores at 21 days, 3 months, and 6 months following mTBI.
Main Methods:
- A prospective longitudinal study involving 36 pediatric participants (aged 6-18) with mTBI.
- Participants underwent assessments using the Vestibular/Ocular Motor Screening (VOMS) tool, reflexive saccade testing, video head impulse testing (vHIT), and dynamic visual acuity (DVA) testing at 21 days, 3 months, and 6 months post-injury.
- Statistical analysis employed generalized estimating equations to evaluate changes over time and determine proportions of abnormal scores.
Main Results:
- Significant improvements in VOMS symptom provocation, vertical smooth pursuit, voluntary saccade performance, and right VOR gain were observed over the 6-month period.
- Older children showed better visual motion sensitivity, while females exhibited poorer near point of convergence.
- High proportions of abnormal scores were noted for version performance and VOR symptom provocation at the initial assessment, suggesting persistent early deficits.
Conclusions:
- Impairments in the VOR pathway likely contribute to symptom provocation following pediatric mTBI.
- The inclusion of vertical smooth pursuit and saccade testing is recommended for comprehensive OM and vestibular assessment post-mTBI.
- OM and VOR measures demonstrate relative stability beyond 3 months post-mTBI, highlighting the value of symptom and performance-based assessments.
Background:
Impairments to oculomotor (OM) and vestibulo-ocular reflex (VOR) function following pediatric mTBI have been demonstrated but are poorly understood. Such impairments can be associated with more negative prognosis, affecting physical and mental wellbeing, emphasizing the need to more fully understand how these evolve.
Objectives:
to determine i) the extent to which performance on clinical and computerized tests of OM and VOR function varies over time in children and adolescents at 21 days, 3-, and 6-months post-mTBI; ii) the proportion of children and adolescents with mTBI presenting with abnormal scores on these tests at each timepoint.
Design:
Prospective longitudinal design.
Setting:
Tertiary care pediatric hospital.
Participants:
36 participants with mTBI aged 6 to18.
Procedures:
Participants were assessed on a battery of OM and VOR tests within 21 days, at 3- and 6-months post injury.
Outcome Measures:
Clinical measures: Vestibular/ocular motor screening tool (VOMS) (symptom provocation and performance); Computerized measures: reflexive saccade test (response latency), video head impulse test (VOR gain), and dynamic visual acuity test (LogMAR change).
Analysis:
Generalized estimating equations (parameter estimates and odd ratios) estimated the effect of time. Proportions above and below normal cut-off values were determined.
Results:
Our sample consisted of 52.8% females [mean age 13.98 (2.4) years, assessed on average 19.07 (8-33) days post-injury]. Older children performed better on visual motion sensitivity (OR 1.43, p = 0.03) and female participants worse on near point of convergence (OR 0.19, p = 0.03). Change over time (toward recovery) was demonstrated by VOMS overall symptom provocation (OR 9.90, p = 0.012), vertical smooth pursuit (OR 4.04, p = 0.03), voluntary saccade performance (OR 6.06, p = 0.005) and right VOR gain (0.068, p = 0.013). Version performance and VOR symptom provocation showed high abnormal proportions at initial assessment.
Discussion:
Results indicate impairments to the VOR pathway may be present and driving symptom provocation. Vertical smooth pursuit and saccade findings underline the need to include these tasks in test batteries to comprehensively assess the integrity of OM and vestibular systems post-mTBI.
Implications:
Findings demonstrate 1) added value in including symptom and performance-based measures in when OM and VOR assessments; 2) the relative stability of constructs measured beyond 3 months post mTBI.
