Vestibular physical therapists are often consulted in concussion management due to the presence of visual and vestibular dysfunction following the injury. A multitude of visual and vestibular impairments are frequently observed following concussion and may complicate recovery. This course will review the components of an ocular motor examination following concussion, along with normal and abnormal findings. Demonstrations of techniques for evaluation and video examples of pathological findings will be shown. The implications of abnormal ocular motor findings for recovery will be reviewed.
Anne Mucha is the Coordinator of Vestibular Rehabilitation for the University of Pittsburgh Medical Center Sports Concussion Program and Centers for Rehab Services. She is a board certified clinical specialist in Neurologic Physical Therapy with advanced certification in vestibular rehabilitation. With over 20 years in treating individuals with neurologic conditions, she is also actively involved in clinical research related to the evaluation and management of patients following concussion. Dr. Mucha was recently appointed a member of the CDC panel of experts to develop clinical guidelines for diagnosis and management of mild traumatic brain injury among children and adolescents. She received her Bachelor’s and Advanced Master’s degrees in Physical Therapy from the University of Pittsburgh; and her Doctor of Physical Therapy degree from Temple University. Dr. Mucha is a frequent national lecturer on topics related to concussion and serves as an adjunct faculty member in the School of Health and Rehabilitation Sciences at the University of Pittsburgh.
Susan L. Whitney, DPT, PhD, NCS, ATC, FAPTA received her PhD in motor development/motor learning from the University of Pittsburgh, her professional physical therapy education from Temple University in Philadelphia, PA, and her DPT from MGH Institute of the Health Sciences. Currently, she is a professor in physical therapy in the School of Health and Rehabilitation Sciences. She is the Program Director of the Centers for Rehab Services (CRS) Balance and Vestibular Rehabilitation Center at the University of Pittsburgh Medical Center. Dr. Whitney has authored or co-authored over 90 articles on Medline, most of which relate to vestibular rehabilitation, plus has co-authored a book related to dizziness and balance disorders.
The participant will learn to recognize components of an ocular motor examination in patients following concussion. Dr. Mucha and Dr. Whitney demonstrate how to perform all components of an ocular motor examination in patients following concussion. The participant will learn to identify normal and abnormal findings for each ocular motor examination component.
In this chapter, Dr. Mucha and Dr. Whitney teach the participant how to perform components of the ocular motor exam, including testing of smooth pursuits, saccades, gaze holding, and vergence. The participant will learn how to perform ocular alignment testing and recognize phorias, trophias and skew deviations and identify normal and abnormal findings for the above tests and measures. This chapter provides insight into the relevance of findings in the ocular motor exam and intervention options.
Dr. Whitney and Dr. Mucha discuss the case of a 13-year-old wrestler with a labyrinthine concussion. The boy fell while wrestling and landed on the right parietal area of his skull. There was no LOC but was immediately vertiginous and could not sit or stand. When he was lying down he reported feeling as though he were tilting back and forth from his head to his legs. Dr. Whitney and Dr. Mucha discuss their take on this concussion case.