Kontos Anthony P, Deitrick Jamie McAllister, Collins Michael W, Mucha Anne
UPMC Sports Medicine Concussion Program/Department of Orthopaedic Surgery and.
UPMC Centers for Rehabilitation Services, University of Pittsburgh, PA.
J Athl Train. 2017 Mar;52(3):256-261. doi: 10.4085/1062-6050-51.11.05.
Vestibular and oculomotor impairment and symptoms may be associated with worse outcomes after sport-related concussion (SRC), including prolonged recovery. In this review, we evaluate current findings on vestibular and oculomotor impairments as well as treatment approaches after SRC, and we highlight areas in which investigation is needed. Clinical researchers have intimated that recovery from SRC may follow certain clinical profiles that affect the vestibular and oculomotor pathways. Identifying clinical profiles may help to inform better treatment and earlier intervention to reduce recovery time after SRC. As such, screening for and subsequent monitoring of vestibular and oculomotor impairment and symptoms are critical to assessing and informing subsequent referral, treatment, and return to play. However, until recently, no brief-screening vestibular and oculomotor tools were available to evaluate this injury. In response, researchers and clinicians partnered to develop the Vestibular/Ocular-Motor Screening, which assesses pursuits, saccades, vestibular ocular reflex, visual motion sensitivity, and convergence via symptom provocation and measurement of near-point convergence. Other specialized tools, such as the King-Devick test for saccadic eye movements and the Dizziness Handicap Inventory for dizziness, may provide additional information regarding specific impairments and symptoms. Tools such as the Vestibular/Ocular-Motor Screening provide information to guide specialized referrals for additional assessment and targeted rehabilitation. Vestibular rehabilitation and visual-oculomotor therapies involve an active, expose-recover approach to reduce impairment and symptoms. Initial results support the effectiveness of both vestibular and visual-oculomotor therapies, especially those that target specific impairments. However, the evidence supporting rehabilitation strategies for both vestibular and oculomotor impairment and symptoms is limited and involves small sample sizes, combined therapies, nonrandomized treatment groups, and lack of controls. Additional studies on the effectiveness of screening tools and rehabilitation strategies for both vestibular and oculomotor impairment and symptoms after SRC are warranted.
前庭和动眼神经功能障碍及症状可能与运动相关脑震荡（SRC）后更差的预后相关，包括恢复时间延长。在本综述中，我们评估了SRC后前庭和动眼神经功能障碍以及治疗方法的当前研究结果，并强调了需要进行研究的领域。临床研究人员暗示，SRC的恢复可能遵循某些影响前庭和动眼神经通路的临床特征。识别临床特征可能有助于为更好的治疗和早期干预提供依据，以减少SRC后的恢复时间。因此，筛查和随后监测前庭和动眼神经功能障碍及症状对于评估和指导后续转诊、治疗及恢复运动至关重要。然而，直到最近，还没有用于评估这种损伤的简短前庭和动眼神经筛查工具。作为回应，研究人员和临床医生合作开发了前庭/眼动筛查，该筛查通过症状激发和近点集合测量来评估跟踪、扫视、前庭眼反射、视觉运动敏感性和集合。其他专门工具，如用于眼跳运动的King-Devick测试和用于头晕的头晕残障量表，可能会提供有关特定功能障碍和症状的额外信息。前庭/眼动筛查等工具可提供信息，以指导进行额外评估和针对性康复的专业转诊。前庭康复和视觉眼动疗法采用积极的暴露-恢复方法来减少功能障碍和症状。初步结果支持前庭和视觉眼动疗法的有效性，尤其是那些针对特定功能障碍的疗法。然而，支持前庭和动眼神经功能障碍及症状康复策略的证据有限，且涉及样本量小、联合疗法、非随机治疗组以及缺乏对照。有必要对SRC后前庭和动眼神经功能障碍及症状的筛查工具和康复策略的有效性进行更多研究。
