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Gaze Stabilization Test Asymmetry Score as an Indicator of Previous Concussion in a Cohort of Collegiate Football Players

Honaker, Julie A. PhD; Criter, Robin E. AuD; Patterson, Jessie N. MS; Jones, Sherri M. PhD

Clinical Journal of Sport Medicine: July 2015 - Volume 25 - Issue 4 - p 361–366
doi: 10.1097/JSM.0000000000000138
Original Research

Objective: Vestibular dysfunction may lead to decreased visual acuity with head movements, which may impede athletic performance and result in injury. The purpose of this study was to test the hypothesis that athletes with history of concussion would have differences in gaze stabilization test (GST) as compared with those without a history of concussion.

Design: Cross-sectional, descriptive.

Setting: University Athletic Medicine Facility.

Participants: Fifteen collegiate football players with a history of concussion, 25 collegiate football players without a history of concussion.

Intervention: Participants completed the dizziness handicap inventory (DHI), static visual acuity, perception time test, active yaw plane GST, stability evaluation test (SET), and a bedside oculomotor examination.

Main Outcome Measures: Independent samples t test was used to compare GST, SET, and DHI scores per group, with Bonferroni-adjusted alpha at P < 0.01. Receiver operating characteristic curve analysis and area under the curve (AUC) were used to assess the clinical performance of the GST and SET.

Results: Athletes with previous concussion had a larger GST asymmetry score [mean (M) = 12.40, SD = 9.09] than those without concussion (M = 4.92, SD = 4.67; t (18.70) = −2.955, P = 0.008, 95% CI, −12.79 to −2.18, d = −1.37). Clinical performance of the GST (AUC = 0.77) was better than the SET (AUC = 0.61).

Conclusions: Results suggest peripheral vestibular or vestibular–visual interaction deficits in collegiate athletes with a history of concussion. The results support further research on the use of GST for sport-related concussion evaluation and monitoring.

Clinical Relevance: Inclusion of objective vestibular tests in the concussion protocol may reveal the presence of peripheral vestibular or visual–vestibular deficits. Therefore, the GST may add an important perspective on the effects of concussion.

Department of Special Education and Communication Disorders, University of Nebraska-Lincoln, Lincoln, Nebraska.

Corresponding Author: Julie A. Honaker, PhD, Department of Special Education and Communication Disorders, University of Nebraska-Lincoln, 271 Barkley Center, Lincoln, NE 68583-0738 (

Supported by grant from the Department of Defense (to J.A.H. and S.M.J.) and from the American Academy of Audiology (to R.E.C.).

J. A. Honaker has received consulting payment from Celerion, Inc. S. M. Jones has received travel reimbursement and honorarium for lectures from the National Institutes of Health, National Institute on Deafness and other Communication Disorders, Legacy Health Systems, Stanford University, and Case Western Reserve University and travel expense reimbursement for the Auditory and Vestibular Dysfunction Research Enhancement Award Program. In addition, she is currently receiving royalties from Plural Publishing for a textbook she co-authored. This work was not supported by a grant; the authors disclosed current funding related to the topic, but the funding did not support the project. The remaining authors report no conflicts of interest.

Presented at the Annual Meeting of the Association for Research in Otolaryngology; February 18, 2013; Baltimore, Maryland.

Received September 09, 2013

Accepted June 12, 2014

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