Quantifying the Relationship Between Clinician-Administered Measures of Vestibulo-Ocular Reflex and Oculomotor Function and Patient-Reported Outcome After Pediatric Mild Traumatic Brain Injury.

Abstract

Background: In pediatric mild traumatic brain injury (mTBI), high rates of abnormalities are observed in vestibulo-ocular reflex (VOR) and oculomotor (OM) function, but there is a lack of understanding of how these impairments may affect daily functioning.

Objectives: To determine the extent to which clinician-administered measures of VOR and OM function are associated with patient-reported levels of activity limitations and participation restriction in children and adolescents within 31 days post-mTBI.

Design: Cross-sectional design.

Setting: Tertiary care pediatric hospital.

Participants: Participants with mTBI aged 7 to 17.99 years.

Procedures: Participants were assessed on a battery of VOR and OM tests within 31 days of injury.

Outcome measures: The Dizziness Handicap Inventory (DHI) and Cardiff Visual Ability Questionnaire (CVAQ) measured patient-reported dizziness and visual disability. The vestibular/ocular motor screening tool (VOMS), Head Thrust Test, computerized Dynamic Visual Acuity (DVA) Test, and video Head Impulse Test were administered to assess VOR and OM function.

Analysis: Linear regression examined the associations between clinician-administered measures of VOR and OM function and patient-reported functional outcomes.

Results: The sample consisted of 100 youth (54.4% female; mean age 13.92 [2.63]; mean time since injury: 18.26 [6.16] days). Associations were found between (1) DHI score and age (1.773 [0.473-3.073], P = .01), VOR symptom provocation (18.499 [11.312-25.686], P ≤ .001), and DVA (-29.433 [-59.206 to -2.60], P = .03); and (2) CVAQ score and version symptom provocation (0.796 [0.185-1.406], P = .01). High abnormal proportions (up to 56.7%) were found in VOMS performance.

Discussion: The symptom provocation induced by VOR and OM tasks was associated with patient-reported dizziness and visual disability outcomes, highlighting the detrimental impact of symptoms on daily functioning.

Implications: The findings of this study will assist clinicians when interpreting patient-reported measures of activity limitation and participation restriction.