Using Cervical Spine Proprioception and Vestibular/Oculomotor Assessments to Identify Return-to-Play Clearance Prognosis After Adolescent Concussion

Abstract

Context: Clinical assessments of the cervical spine and vestibular/oculomotor systems may inform return-to-play (RTP) clearance time after concussion and inform individualized concussion prognosis. Our objective was to investigate whether cervical spine and vestibular/oculomotor clinical assessments were associated with RTP clearance time after concussion.

Design: Prospective cohort study.

Methods: Adolescents ages 13-18 years within 3 weeks of concussion completed assessments of symptom severity using the Post-Concussion Symptom Inventory, cervical spine proprioception (head repositioning accuracy [HRA]), and symptom provocation with vestibular/oculomotor testing (visio-vestibular exam [VVE]; assesses smooth pursuits, saccades, vestibulo-ocular reflex, and motion sensitivity). HRA was performed with eyes closed and involved patients relocating their head to a neutral starting position after right/left rotation and cervical spine flexion/extension. The mean distance (distance between center position and each self-reported center point) across 12 trials was used in analysis as the measure of HRA error. For VVE, we used the number of tests that provoked symptoms for analysis. We then monitored participants until they received RTP clearance from their physician. We used multivariable linear regression with RTP clearance time (days from concussion to RTP clearance) as the outcome, HRA error and number of positive VVE subtests as predictors, adjusting for covariates.

Results: We assessed 68 participants (age = 15.8 (1.4) y, 59% female, mean = 11.0 (3.8) d of postconcussion). After adjusting for age, sex, concussion history, initial symptom severity (Post-Concussion Symptom Inventory score), and days from concussion to assessment, neither HRA error (hazard ratio = 0.89; 95% confidence interval, 0.71-1.12; P = .34) or number of positive VVE subtests (hazard ratio = 1.06; 95% confidence interval, 0.91-1.24; P = .47) were associated with RTP clearance time.

Conclusions: Cervical spine proprioception and vestibular/oculomotor symptom provocation evaluated within 3 weeks of injury were not associated with RTP clearance time, potentially reflecting the complexity and multifaceted nature of RTP decisions.

Keywords: brain injury; clinical recovery; neck; sports injury.