Visio-Vestibular Deficits in Healthy Child and Adolescent Athletes

Abstract

Objective: To determine the relationship between patient characteristics and performance on the visio-vestibular examination (VVE) in a cohort of healthy youth athletes and explore the potential association between the VVE and other standardized concussion batteries.

Design: Cross-sectional.

Setting: Suburban middle and high school.

Patients: One hundred ninety subjects age 11 to 18 enrolled before their respective scholastic sport season between August 2017 and March 2020.

Assessment of independent variables: Patient age, sex, concussion history, comorbidities, hours of weekly exercise, Sport Concussion Assessment Tool, 5th edition (SCAT-5), King-Devick (K-D), Postconcussion Symptom Inventory (PCSI).

Main outcome measures: Visio-vestibular examination abnormalities (smooth pursuit, horizontal and vertical saccades, horizontal and vertical gaze stability, convergence, right and left monocular accommodation, complex tandem gait).

Results: Overall, 29.5% of subjects had at least one of 9 VVE elements abnormal, 7.9% at least 2, and 3.2% at least 3. None of 72 comparisons of the VVE elements, when stratified by age, sex, concussion history, history of headaches, attention deficit hyperactivity disorder, learning issues, psychiatric problems, motion sickness, or weekly hours of exercise, reached significance using the Benjamini-Hochberg procedure at a false discovery rate of 5%. There were no significant associations between VVE elements and the SCAT-5, K-D, or PCSI.

Conclusions: The VVE is robust across multiple patient characteristics. Although healthy subjects may have one abnormal element, multiple abnormal elements are a less common feature, making multiple abnormal elements more indicative of concussion, highlighting the use of this assessment in the setting of injury. The VVE tests unique domains when compared with the PCSI, SCAT-5, and K-D.

Figure 1.

Flow diagram of available subjects across all participating sports teams (soccer, basketball, lacrosse, and field hockey) between August 2017 and March 2020, those consenting to provide baseline testing, and those ultimately included in the study sample. *As no information was collected from those declining to participate, we are unable to ascertain the number of athletes who comprised these 427 athlete-seasons. **Five of the six athletes who were ineligible had at least one additional assessment performed either before their injury or after recovery. Therefore, these five subjects had athlete-seasons that were ultimately included in the sample.