Cheever Kelly M, McDevitt Jane, Tierney Ryan, Wright W Geoffrey
Temple University, Kinesiology, Philadelphia, United States.
Temple University, Neuromotor Sciences Program, Philadelphia, United States.
Int J Sports Med. 2018 Feb;39(2):141-147. doi: 10.1055/s-0043-118339. Epub 2017 Nov 30.
Vestibular and oculomotor testing is emerging as a valuable assessment in sport-related concussion (SRC). However, their usefulness for tracking recovery and guiding return-to-play decisions remains unclear. Therefore the purpose of this study was to evaluate their clinical usefulness for tracking SRC recovery. Vestibular and oculomotor assessments were used to measure symptom provocation in an acute group (n=21) concussed≤10 days, prolonged symptoms group (n=10) concussed ≥16 days (median=84 days), healthy group (n=58) no concussions in >6 months. Known-groups approach was used with three groups at three time points (initial, 2-week and 6-week follow-up). Provoked symptoms for Gaze-Stabilization (GST), Rapid Eye Horizontal (REH), Optokinetic Stimulation (OKS), Smooth-Pursuit Slow (SPS) and Fast (SPF) tests, total combined symptoms scores and near point convergence (NPC) distance were significantly greater at initial assessment in both injury groups compared to controls. Injury groups improved on the King-Devick test and combined symptom provocation scores across time. The acute group improved over time on REH and SPF tests, while the prolonged symptoms group improved on OKS. A regression model (REH, OKS, GST) was 90% accurate discriminating concussed from healthy. Vestibular and ocular motor tests give valuable insight during recovery. They can prove beneficial in concussion evaluation given the modest equipment, training and time requirements. The current study demonstrates that when combined, vestibular and oculomotor clinical tests aid in the detection of deficits following a SRC. Additionally, tests such as NPC, GST, REH, SPS, SPF OKS and KD provide valuable information to clinicians throughout the recovery process and may aid in return to play decisions.
前庭和动眼神经测试正在成为运动相关脑震荡（SRC）的一项有价值的评估方法。然而，它们在跟踪恢复情况和指导重返比赛决策方面的有用性仍不明确。因此，本研究的目的是评估它们在跟踪SRC恢复情况方面的临床实用性。在前庭和动眼神经评估中，对急性组（n = 21，脑震荡≤10天）、症状持续组（n = 10，脑震荡≥16天，中位数 = 84天）、健康组（n = 58，6个月内无脑震荡）进行症状激发测量。采用已知组方法，在三个时间点（初始、2周和6周随访）对三组进行研究。与对照组相比，在初始评估时，注视稳定（GST）、快速水平眼动（REH）、视动刺激（OKS）、平稳跟踪慢速（SPS）和快速（SPF）测试的激发症状、总综合症状评分以及近点集合（NPC）距离在两个损伤组中均显著更高。损伤组在King - Devick测试和综合症状激发评分方面随时间有所改善。急性组在REH和SPF测试中随时间有所改善，而症状持续组在OKS测试中有所改善。一个回归模型（REH、OKS、GST）区分脑震荡患者和健康人的准确率为90%。前庭和眼动测试在恢复过程中提供了有价值的见解。鉴于所需设备、培训和时间要求适中，它们在脑震荡评估中可能是有益的。当前研究表明，前庭和动眼神经临床测试相结合有助于检测SRC后的缺陷。此外，诸如NPC、GST、REH、SPS、SPF、OKS和KD等测试在整个恢复过程中为临床医生提供了有价值的信息，并可能有助于重返比赛决策。
