It may surprise many clinicians to learn that the presence of DIZZINESS at the time of injury appears to be more important in predicting a slower recovery than other factors such as loss of consciousness, vomiting, seizures or headache.1
Why is dizziness such an important predictor?
Dizziness is often a symptom attributed to vestibular system dysfunction. Clinicians should have an understanding of the vestibulo-ocular system to properly evaluate and manage children and adults after concussion. Patients with vestibular impairment are often more symptomatic and require additional consideration when prescribing exercises or other activities involving movement.
Role of oculomotor examination
While most physical therapists are comfortable performing an upper or lower quarter exam or assessing for orthopedic injuries, many are not familiar with the key elements of assessing vestibular function. Even fewer therapists are comfortable performing an oculomotor examination.
Recent evidence suggests that, in addition to vestibular evaluation, visual examination is also an important component of comprehensive assessment following a concussion.2-5 At a minimum, patients with concussion should be examined visually for:
- Convergence and accommodative deficits
- Vestibular issues such as benign paroxysmal positional vertigo (BPPV), balance impairment, VOR deficits, and problems with visual-vestibular interaction6
Vestibular and oculomotor problems following concussion may prolong recovery time. Yet, once identified, these deficits often respond to treatment. The ability to identify and effectively treat vestibular and visual problems is key to effective concussion management.
- Lau BC, Kontos AP, Collins MW, Mucha A, Lovell MR. Which on-field signs/symptoms predict protracted recovery from sport-related concussion among high school football players? The American journal of sports medicine. 2011;39:2311-2318.
- Ventura RE, Jancuska JM, Balcer LJ, Galetta SL. Diagnostic tests for concussion: is vision part of the puzzle? Journal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society. 2015;35:73-81.
- Maruta J, Ghajar J. Detecting eye movement abnormalities from concussion. Progress in neurological surgery. 2014;28:226-233.
- Tjarks BJ, Dorman JC, Valentine VD, et al. Comparison and utility of King-Devick and ImPACT(R) composite scores in adolescent concussion patients. J Neurol Sci. 2013;334:148-153.
- Heitger MH, Jones RD, Macleod AD, Snell DL, Frampton CM, Anderson TJ. Impaired eye movements in post-concussion syndrome indicate suboptimal brain function beyond the influence of depression, malingering or intellectual ability. Brain. 2009;132:2850-2870.
- Gurley JM, Hujsak BD, Kelly JL. Vestibular rehabilitation following mild traumatic brain injury.NeuroRehabilitation. 2013;32:519-528.