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Prospective Changes in Vestibular and Ocular Motor Impairment After Concussion

Elbin, R. J., PhD; Sufrinko, Alicia, PhD; Anderson, Morgan N., MS; Mohler, Samantha, MS; Schatz, Philip, PhD; Covassin, Tracey, PhD; Mucha, Anne, DPT; Collins, Michael W., PhD; Kontos, Anthony P., PhD

Journal of Neurologic Physical Therapy: July 2018 - Volume 42 - Issue 3 - p 142–148
doi: 10.1097/NPT.0000000000000230
Research Articles

Background and Purpose: The utility of prospective changes on the Vestibular/Ocular Motor Screening (VOMS) assessment are unknown, and 2 methods of scoring are published in the literature. Total scores are the total symptom scores for each VOMS component, and change scores are the difference between the pretest total symptom score and component total symptom scores. This study documented prospective changes in vestibular and ocular motor impairments and symptoms in high school athletes with concussion using the total and change scoring methods and compared the percentage of scores over clinical cutoffs using the total and change scoring methods for the VOMS.

Methods: Sixty-three athletes (15.53 ± 1.06 years) completed the VOMS at baseline (ie, preinjury), 1 to 7 days, and 8 to 14 days after concussion. A series of repeated-measures multivariate analyses of variance were conducted on total and change scores. A 2-way repeated-measures analysis of variance was performed on the near-point convergence distance. A series of χ2 analyses compared scores exceeding clinical cutoffs between the total and change scoring methods.

Results: Total scoring revealed impairments (Wilks λ = 0.39, F 16,47 = 4.54, P < 0.001, η2 = 0.61) on all VOMS components at 1 to 7 and 8 to 14 days compared to baseline. Change scoring revealed postinjury impairments compared with baseline (Wilks λ = 0.58, F 14,49 = 2.52, P = 0.009, η2 = 0.42) on all components at 1 to 7 days; however, impairments at 8 to 14 days were revealed only for the vertical vestibular oculomotor reflex and vestibular motor sensitivity components. Total scoring identified significantly more scores over cutoffs at 1 to 7 days (χ1,63 2 = 5.97, P = 0.02) compared with change scores.

Discussion and Conclusions: Both total and change scoring methods on the VOMS are useful for identifying impairments following concussion.

Video Abstract available for more insights from the authors (see Supplemental Digital Content 1,

Department of Health, Human Performance and Recreation (R.J.E., S.M.), Office for Sport Concussion Research, University of Arkansas, Fayetteville; UPMC Sports Medicine Concussion Program (A.S., A.M., M.W.C., A.P.K.), Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Psychology (P.S.), Saint Joseph's University, Philadelphia, Pennsylvania; Department of Kinesiology (M.N.A, T.C.), Michigan State University, East Lansing; and UPMC Centers for Rehabilitation Services (A.M.), Pittsburgh, Pennsylvania.

Correspondence: R. J. Elbin, PhD, Department of Health, Human Performance and Recreation, Office for Sport Concussion Research, University of Arkansas, 155 Stadium Dr, Fayetteville, AR 77203 (

Dr Collins is a shareholder of ImPACT Applications, Inc; Dr Schatz is a consultant for ImPACT Applications, Inc; and all authors have indicated they have no financial relationships relevant to this article to disclose.

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (

© 2018 Academy of Neurologic Physical Therapy, APTA