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Quantifying the Relationship Between Clinician-Administered Measures of Vestibulo-Ocular Reflex and Oculomotor
Adrienne Crampton1, Pierre Langevin, Kathryn J Schneider
1Author Affiliations: School of Physical and Occupational Therapy, McGill University, Montréal, Québec, Canada (Drs Crampton, Langevin, and Gagnon); Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Alberta, Canada (Dr Schneider); Alberta Children's Hospital Research Institute, University of Calgary, Alberta, Canada (Dr Schneider); Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (Dr Schneider); Montreal Children's Hospital-McGill, University Health Centre, Montréal, Québec, Canada (Ms Grilli and Dr Gagnon); Laboratoire d'Imagerie Biomédicale, Sorbonne Université, CNRS, INSERM, Paris, France (Dr Chevignard); GRC 24 HaMCRe, Handicap Moteur et Cognitif et Réadaptation, Sorbonne Université, Paris, France (Dr Chevignard); Rehabilitation Department for Children with Acquired Neurological Injury and Outreach Team for children and Adolescents with Acquired Brain Injury, Saint Maurice Hospitals, Saint Maurice, France (Dr Chevignard); Physical Therapy Department, University of Tel-Aviv, Tel-Aviv, Israel (Dr Katz-Leurer); ABC's Laboratory, Ste-Justine Hospital Research Center, Montréal, Québec, Canada (Dr Beauchamp); Department of Psychology, University of Montréal, Montréal, Québec, Canada (Dr Beauchamp); Department of Clinical Neuroscience, University of Calgary, Alberta, Canada (Dr Debert); School of Rehabilitation Science, Faculty of Medicine, Université Laval, Quebec City, Canada (Dr Langevin); and Physio Interactive, Clinique Cortex, Quebec City, Canada (Dr Langevin).
Insights
Vestibulo-ocular reflex (VOR) and oculomotor (OM) impairments in pediatric mild traumatic brain injury (mTBI) correlate with patient-reported dizziness and visual disability. These findings aid clinicians in understanding functional impacts post-injury.
Area of Science:
- Neurology
- Pediatrics
- Ophthalmology
Background:
- Pediatric mild traumatic brain injury (mTBI) often presents with vestibulo-ocular reflex (VOR) and oculomotor (OM) dysfunction.
- The impact of these VOR and OM impairments on daily functioning in children remains poorly understood.
Purpose of the Study:
- To investigate the association between objective VOR and OM function measures and patient-reported activity limitations within 31 days post-mTBI.
- To determine how VOR and OM deficits relate to participation restrictions in pediatric mTBI patients.
Main Methods:
- A cross-sectional study was conducted at a tertiary care pediatric hospital.
- 100 participants aged 7-17.99 years with mTBI were assessed within 31 days of injury.
- Clinician-administered VOR/OM tests (VOMS, Head Thrust, DVA, vHIT) and patient-reported outcomes (DHI, CVAQ) were used.
Main Results:
- Associations were found between Dizziness Handicap Inventory (DHI) scores and VOR symptom provocation, and dynamic visual acuity (DVA).
- Cardiff Visual Ability Questionnaire (CVAQ) scores were linked to VOR symptom provocation.
- High rates of VOMS abnormalities (up to 56.7%) were observed.
Conclusions:
- Symptom provocation from VOR and OM tasks significantly correlates with patient-reported dizziness and visual disability.
- These findings underscore the detrimental effect of VOR/OM symptoms on daily functioning in pediatric mTBI.
- The study provides valuable insights for clinicians interpreting patient-reported functional outcomes in pediatric mTBI.
Background:
In pediatric mild traumatic brain injury (mTBI), high rates of abnormalities are observed in vestibulo-ocular reflex (VOR) and oculomotor (OM) function, but there is a lack of understanding of how these impairments may affect daily functioning.
Objectives:
To determine the extent to which clinician-administered measures of VOR and OM function are associated with patient-reported levels of activity limitations and participation restriction in children and adolescents within 31 days post-mTBI.
Design:
Cross-sectional design.
Setting:
Tertiary care pediatric hospital.
Participants:
Participants with mTBI aged 7 to 17.99 years.
Procedures:
Participants were assessed on a battery of VOR and OM tests within 31 days of injury.
Outcome Measures:
The Dizziness Handicap Inventory (DHI) and Cardiff Visual Ability Questionnaire (CVAQ) measured patient-reported dizziness and visual disability. The vestibular/ocular motor screening tool (VOMS), Head Thrust Test, computerized Dynamic Visual Acuity (DVA) Test, and video Head Impulse Test were administered to assess VOR and OM function.
Analysis:
Linear regression examined the associations between clinician-administered measures of VOR and OM function and patient-reported functional outcomes.
Results:
The sample consisted of 100 youth (54.4% female; mean age 13.92 [2.63]; mean time since injury: 18.26 [6.16] days). Associations were found between (1) DHI score and age (1.773 [0.473-3.073], P = .01), VOR symptom provocation (18.499 [11.312-25.686], P ≤ .001), and DVA (-29.433 [-59.206 to -2.60], P = .03); and (2) CVAQ score and version symptom provocation (0.796 [0.185-1.406], P = .01). High abnormal proportions (up to 56.7%) were found in VOMS performance.
Discussion:
The symptom provocation induced by VOR and OM tasks was associated with patient-reported dizziness and visual disability outcomes, highlighting the detrimental impact of symptoms on daily functioning.
Implications:
The findings of this study will assist clinicians when interpreting patient-reported measures of activity limitation and participation restriction.
