Crampton Adrienne, Schneider Kathryn J, Grilli Lisa, Chevignard Mathilde, Katz-Leurer Michal, Beauchamp Miriam H, Debert Chantel, Gagnon Isabelle J
School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada.
Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada.
Front Neurol. 2022 Jul 19;13:904593. doi: 10.3389/fneur.2022.904593. eCollection 2022.
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.
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.
Prospective longitudinal design.
Tertiary care pediatric hospital.
36 participants with mTBI aged 6 to18.
Participants were assessed on a battery of OM and VOR tests within 21 days, at 3- and 6-months post injury.
Clinical measures (symptom provocation and performance); Computerized measures: (response latency) (VOR gain), and (LogMAR change).
Generalized estimating equations (parameter estimates and odd ratios) estimated the effect of time. Proportions above and below normal cut-off values were determined.
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, = 0.03) and female participants worse on near point of convergence (OR 0.19, = 0.03). Change over time (toward recovery) was demonstrated by VOMS overall symptom provocation (OR 9.90, = 0.012), vertical smooth pursuit (OR 4.04, = 0.03), voluntary saccade performance (OR 6.06, = 0.005) and right VOR gain (0.068, = 0.013). Version performance and VOR symptom provocation showed high abnormal proportions at initial assessment.
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.
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.
小儿轻度创伤性脑损伤（mTBI）后动眼神经（OM）和前庭眼反射（VOR）功能受损已得到证实，但人们对此了解甚少。此类损伤可能与更负面的预后相关，影响身心健康，这凸显了更全面了解其发展过程的必要性。
确定：i）在mTBI后21天、3个月和6个月时，儿童和青少年OM和VOR功能的临床及计算机化测试表现随时间变化的程度；ii）在每个时间点，mTBI儿童和青少年中这些测试得分异常的比例。
前瞻性纵向设计。
三级护理儿科医院。
36名年龄在6至18岁的mTBI患者。
在受伤后21天内、3个月和6个月时，对参与者进行一系列OM和VOR测试。
临床指标（症状激发和表现）；计算机化指标：（反应潜伏期）（VOR增益）和（最小分辨角对数变化）。
广义估计方程（参数估计和比值比）估计时间的影响。确定高于和低于正常临界值的比例。
我们的样本中女性占52.8%[平均年龄13.98（2.4）岁，受伤后平均19.07（8 - 33）天接受评估]。年龄较大的儿童在视觉运动敏感性测试中表现更好（比值比1.43，P = 0.03），女性参与者在集合近点测试中表现更差（比值比0.19，P = 0.03）。VOMS总体症状激发（比值比9.90，P = 0.012）、垂直平稳跟踪（比值比4.04，P = 0.03）、自主扫视表现（比值比6.06，P = 0.005）和右侧VOR增益（0.068，P = 0.013）显示随时间变化（趋向恢复）。初始评估时，眼震表现和VOR症状激发显示出较高的异常比例。
结果表明VOR通路可能存在损伤并引发症状激发。垂直平稳跟踪和扫视结果强调在测试组合中纳入这些任务以全面评估mTBI后OM和前庭系统完整性的必要性。
研究结果表明：1）在进行OM和VOR评估时，纳入基于症状和表现的测量具有附加价值；2）mTBI后3个月以上所测量结构的相对稳定性。
