Purpose
To determine the incidence of abnormal
near point of convergence (NPC) after acute
concussion in pediatric patients and to describe the clinical course of such patients.
Methods
A retrospective cohort study of 275 pediatric patients 5 to 18 years of age presenting to a tertiary care children’s hospital subspecialty
concussion program with a new
concussion between July 1, 2014 and June 30, 2015 was conducted.
Results
Sixty-seven out of 275 pediatric patients presenting to a subspecialty
concussion referral program were found to have abnormal NPC on physical examination as measured by an accommodative rule. Twenty-six (46%) patients recovered with standard clinical care over a median time frame of 4.5 weeks (range 1–18), including a brief period of cognitive and physical rest followed by gradual return to school and physical activities without any formal interventions. An additional 23 (41%) patients recovered a median of 11 weeks post-injury after referral for formal vestibular therapy, including interventions for abnormal convergence, such as
Brock string and
pencil pushups. Seven (13%) patients with persistent abnormal NPC and concomitant symptoms that necessitated referral for formal office-based
vision therapy with developmental optometry recovered a median of 23 weeks post-injury and a median of 16 weeks after referral to
vision therapy.
Conclusions
Assessment for NPC is a diagnostic entity that warrants consideration in children with
concussion.
Concussion questionnaires may not be sensitive to detect vision symptoms in children, making an accurate assessment for convergence important in the evaluation of
concussion. Some children with abnormal NPC will recover without any formal intervention after
concussion; however, a subset of patients with persistent abnormal NPC after
concussion may benefit from interventions including vestibular and/or
vision therapy.
