Swanson Mark W, Weise Katherine K, Dreer Laura E, Johnston James, Davis Richard D, Ferguson Drew, Hale Matthew Heath, Gould Sara J, Christy Jennifer B, Busettini Claudio, Lee Sarah D, Swanson Erin
*OD, MSPH, FAAO †OD, MBA, FAAO ‡PhD §MD ‖MEd. ATC/L **MD, MPH, CAQSM ††PT, PhD Department of Optometry and Vision Science (MWS, KKW, SDL, CB), Department of Ophthalmology (LED), School of Medicine/Pediatric Neurosurgery (JJ), Department of Pediatrics, Division of Pediatric Rehabilitation Medicine (RDD, ES), UAB Sports Medicine at Children's of Alabama (MHH, DF, SJG), and Department of Physical Therapy (JBC), University of Alabama at Birmingham, Birmingham, Alabama.
Optom Vis Sci. 2017 Jan;94(1):60-67. doi: 10.1097/OPX.0000000000000977.
Academic difficulty is reported in children with prolonged post-concussive symptoms. Despite growing evidence that vestibular-ocular and vision-specific dysfunction are common in children after concussion, vision is rarely mentioned in return-to-learn protocols. The purpose of this project was to evaluate a cohort of children with prolonged post-concussive symptoms to determine if vision symptoms are associated with those reporting academic difficulty.
Data were obtained from the Children's of Alabama Concussion Clinic REDCap dataset from the period January 2007 to October 2013. From this dataset of 1033 concussion events, a cohort of 276 children aged 5 to 18 years with three or more concussion-related symptoms present for 10 days or more was identified. A cross-sectional cohort study was undertaken to evaluate the association of concussion symptoms, SCAT2 scores, and demographic and concussion severity markers to reported educational difficulty among children with prolonged post-concussive symptoms. Univariate and multivariate logistic regression techniques were used to model the association of reported educational difficulty to self-reported vision abnormalities.
Mean age was 13.8 years. Median time since the concussive event was 21 days, with 33% (95/276) reporting their concussion more than 30 days before data collection. Academic difficulty was reported by 29% (79/270) and vision abnormalities in 46% (128/274). After model reduction, vision symptoms (OR 2.17, 95% CI 1.02, 4.62), hearing disturbance (OR 2.39, 95% CI 1.06, 5.36), and concentration difficulty (OR 21.62, 95% CI 9.50, 44.47) remained associated with academic difficulty. For those with symptoms 30 days or more after concussion, only vision (OR 3.15, 95% CI 1.06, 9.38) and concentration difficulty (OR 15.33, 95% CI 4.99, 47.05) remained statistically significant.
Vision problems were commonly reported in children with concussions and were independently associated with those reporting academic difficulty. Comprehensive vision assessment should be considered in children reporting academic difficulty and in the development of return-to-learn protocols.
有研究报告称，患有长期脑震荡后症状的儿童存在学业困难。尽管越来越多的证据表明，前庭眼反射和视力特异性功能障碍在儿童脑震荡后很常见，但在重返学习方案中很少提及视力问题。本项目的目的是评估一组患有长期脑震荡后症状的儿童，以确定视力症状是否与报告有学业困难的儿童相关。
数据来自2007年1月至2013年10月阿拉巴马州儿童医院脑震荡诊所的REDCap数据集。从这个包含1033次脑震荡事件的数据集中，确定了一组276名5至18岁的儿童，他们出现了三种或更多与脑震荡相关的症状，且持续10天或更长时间。进行了一项横断面队列研究，以评估脑震荡症状、SCAT2评分以及人口统计学和脑震荡严重程度指标与患有长期脑震荡后症状儿童报告的教育困难之间的关联。使用单变量和多变量逻辑回归技术对报告的教育困难与自我报告的视力异常之间的关联进行建模。
平均年龄为13.8岁。自脑震荡事件发生后的中位时间为21天，33%（95/276）的儿童报告其脑震荡发生在数据收集前30多天。29%（79/270）的儿童报告有学业困难，46%（128/274）的儿童有视力异常。在模型简化后，视力症状（比值比2.17，95%置信区间1.02，4.62）、听力障碍（比值比2.39，95%置信区间1.06，5.36）和注意力不集中（比值比21.62，95%置信区间9.50，44.47）仍然与学业困难相关。对于那些在脑震荡后30天或更长时间出现症状的儿童，只有视力（比值比3.15，95%置信区间1.06，9.38）和注意力不集中（比值比15.33，95%置信区间4.99，47.05）在统计学上仍然显著。
脑震荡儿童普遍报告有视力问题，且与报告有学业困难的儿童独立相关。对于报告有学业困难的儿童以及在制定重返学习方案时，应考虑进行全面的视力评估。
