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. 2021 Aug 24;35(10):1218-1228.
doi: 10.1080/02699052.2021.1959065. Epub 2021 Aug 12.

Association between post-concussion symptoms and oculomotor deficits among adolescents

Sowjanya Gowrisankaran  1 , Ankoor S Shah  1   2   3 , Tawna L Roberts  4 , Emily Wiecek  1   3 , Ryan N Chinn  1 , Karameh K Hawash  5   6 , Michael J O'Brien  7   8 , David R Howell  9   10 , William P Meehan 3rd  7   8   11 , Aparna Raghuram  1   3
Affiliations

Association between post-concussion symptoms and oculomotor deficits among adolescents

Sowjanya Gowrisankaran et al. Brain Inj. .

Abstract

Purpose: To examine the association between Post-Concussion Symptom Scale (PCSS) scores, Convergence Insufficiency Symptom Survey (CISS) scores, and oculomotor deficits post-concussion.

Methods: Records of adolescent patients examined in a multidisciplinary concussion clinic between July 2014 and May 2019 were reviewed. PCSS and CISS scores, results of eye examination and oculomotor assessment, concussion history, and demographics were abstracted.

Results: One hundred and forty patient records (median age, 15.3 years; 52 males, presented 109 days (median) from their most recent concussion) met inclusion criteria. Mean total scores on PCSS and CISS were 46.67 ± 25.89 and 27.13 ± 13.22, respectively, and were moderately correlated with each other (r = 0.53, p < .001). Oculomotor deficits were observed in 123 (88%) patients. Step-wise linear regression identified increased PCSS total score to be significantly associated with decreased amplitude of accommodation (p < .001). Increased CISS total score was significantly associated with receded near point of convergence, developmental eye movement test error scores, and cause of concussion.

Conclusion: High PCSS scores may indicate an accommodation deficit and thus prompt an oculomotor assessment in patients following a concussion. Using the CISS and a detailed oculomotor assessment may reveal underlying oculomotor deficits, which may benefit from treatment.

Keywords: Concussion; adolescent; symptom surveys; vision.

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Figures

Figure 1:
Figure 1:
Post Concussion Symptom Scale (PCSS) responses. (A) Mean and standard deviation (SD) for the responses for individual questions on the PCSS questionnaire. (B) Mean and SD for the categories are represented by the dark grey bars. The light grey bar indicates the maximum possible score within each category. The maximum possible score varies between categories, as the number of questions grouped within each category is different.
Figure 2:
Figure 2:
Convergence Insufficiency Symptom Survey (CISS) responses. Mean and standard deviation (SD) for the responses for individual questions on the CISS questionnaire.
Figure 3:
Figure 3:
Scatter plot between the Convergence Insufficiency Symptom Survey (CISS) and Post-Concussion Symptom Scale (PCSS) total scores.
Figure 4:
Figure 4:
Scatter plots between Convergence Insufficiency Symptom Survey (CISS) total score and subtotal scores for each of the categories of symptoms in Post Concussion Symptom Scale (PCSS): Somatic (A), Vestibular (B), Emotional (C), Cognitive (D), Sleep (E), and Vision related (F).
Figure 5:
Figure 5:
(A) Venn diagram of oculomotor deficits observed post-concussion in the adolescent population (n=123). (B) and (C) Subtypes of deficits observed postconcussion in the adolescent population for the vergence and accommodation categories, respectively. CI: Convergence Insufficiency; CD: Convergence Deficit; CE: Convergence Excess; DD: Divergence Deficit; VD: non-specific Vergence Dysfunction; AI: Accommodative Insufficiency; AD: Accommodative Dysfunction; AE: Accommodative Excess; AIF: Accommodative Infacility
See this image and copyright information in PMC

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