量化儿科轻度创伤性脑损伤后临床医生实施的前庭眼反射和眼动功能测量与患者报告结局之间的关系。

Quantifying the Relationship Between Clinician-Administered Measures of Vestibulo-Ocular Reflex and Oculomotor Function and Patient-Reported Outcome After Pediatric Mild Traumatic Brain Injury.

作者信息

Crampton Adrienne, Langevin Pierre, Schneider Kathryn J, Grilli Lisa, Chevignard Mathilde, Katz-Leurer Michal, Beauchamp Miriam H, Debert Chantel, Gagnon Isabelle J

机构信息

Author 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).

出版信息

J Head Trauma Rehabil. 2025;40(4):E320-E328. doi: 10.1097/HTR.0000000000001021. Epub 2025 Jul 1.

DOI:10.1097/HTR.0000000000001021

PMID:39888704

Abstract

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.

摘要

背景

在小儿轻度创伤性脑损伤（mTBI）中，前庭眼反射（VOR）和动眼神经（OM）功能异常的发生率很高，但对于这些损伤如何影响日常功能却缺乏了解。

目的

确定在mTBI后31天内，临床医生对VOR和OM功能的测量与儿童和青少年患者报告的活动受限水平和参与受限程度之间的关联程度。

设计

横断面设计。

设置

三级护理儿童医院。

参与者

年龄在7至17.99岁之间的mTBI患者。

程序

在受伤后31天内，对参与者进行一系列VOR和OM测试。

结果测量

头晕残障量表（DHI）和加的夫视觉能力问卷（CVAQ）用于测量患者报告的头晕和视觉障碍。采用前庭/眼动筛查工具（VOMS）、摇头试验、计算机化动态视力（DVA）测试和视频摇头试验来评估VOR和OM功能。

分析

线性回归分析临床医生对VOR和OM功能的测量与患者报告的功能结果之间的关联。

结果

样本包括100名青少年（54.4%为女性；平均年龄13.92[2.63]岁；受伤后的平均时间：18.26[6.16]天）。发现（1）DHI评分与年龄（1.773[0.473 - 3.073]，P = 0.01）、VOR症状激发（18.499[11.312 - 25.686]，P≤0.001）和DVA（-29.433[-59.206至-2.60]，P = 0.03）之间存在关联；（2）CVAQ评分与版本症状激发（0.796[0.185 - 1.406]，P = 0.01）之间存在关联。在VOMS表现中发现了高比例的异常（高达56.7%）。