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O. Eisman1, A. Crampton2, E. Teel3, K. Schneider4,5,6, M. Katz-Leurer7, M. Chevignard8,9, M. Beauchamp10,11, C. Debert12, I. Gagnon1,2,3
1Mcgill University, Research Institute of the McGill University Health Center, Montreal, Canada, 2Mcgill University, School of Physical and Occupational Therapy, Montreal, Canada, 3Mcgill University, Montreal Children’s Hospital, Montreal, Canada, 4University of Calgary, Alberta Children’s Hospital Research Institute, Calgary, Canada, 5University of Calgary, Hotchkiss Brain Institute, Calgary, Canada, 6University of Calgary, Sport Injury Prevention Research Centre, Faculty of Kinesiology, Calgary, Canada, 7University of Tel-Aviv, Physical Therapy Department, Tel-Aviv, Israel, 8Saint Maurice Hospitals, Rehabilitation Department for Children with Acquired Neurological Injury and Outreach Team for children and Adolescents with Acquired Brain Injury, Saint Maurice, France, 9Sorbonne Université, Laboratoire d’Imagerie Biomédicale, Paris, France, 10Ste-Justine Hospital Research Center, ABC’s Laboratory, Montreal, Canada, 11University of Montreal, Department of Psychology, Montreal, Canada, 12University of Calgary, Department of Clinical Neurosciences, Calgary, Canada
Background: Mild traumatic brain injury (mTBI) is common in the pediatric and adolescent population in North America, with approximately 850,000 pediatric mTBIs diagnosed yearly. Common subjective symptoms reported following mTBI are dizziness and vision impairments, resulting in some cases from vestibulo-ocular reflex (VOR) dysfunction. Impaired VOR in pediatric mTBI has shown to increase concussion recovery time, which can impact school performance, sports and recreation participation, as well as overall quality of life. VOR can be assessed functionally by testing dynamic visual acuity. Tests measuring dynamic visual acuity (DVA) are often used in the mTBI population to help clinicians assess behavioral VOR (The ability to maintain gaze stable in order to read and identify visual surroundings while the head is moving). Presently, it is unclear if long-standing clinical or computerized measures of DVA are preferable when assessing VOR in the pediatric population.
Purpose: To determine to what extent clinical and computerized measurements of DVA are related in children and adolescents within 21 days of having sustained an mTBI.
Methods: Demographic information (age, sex, previous concussion(s), duration of symptoms, personal history of migraines, learning disability, sports involvement), cervical screen, clinical DVA, and computerized DVA measures were included in the assessment. Clinical DVA was assessed using a validated clinical DVA test protocol and tumbling E chart. Computerized DVA was assessed using NeuroCom’s InVision system and protocol. LogMAR change values (SA-DVA, from head rotations performed at 120 degrees/second) were used in clinical DVA and computerized DVA. For our computerized measure, separate calculations for right and left DVA were obtained. Pearson product moment correlations were run to assess relationship between clinical and computerized DVA measures (left and right analyzed separately).
Results: Left and right computerized DVA were not significantly correlated with clinical DVA (Left: r= -0.06556, p=0.699; Right: r: = 0.10264, p=0.545). Left and right computerized DVA measures were significantly correlated (r = 0.72268, p<0.0001).
Conclusion(s): Clinical and computerized DVA assessments are not significantly correlated in children and adolescents seen within 21 days post-concussion, possibly providing clinicians and researchers with different information. Such differences may stem from differences in the way head rotations are performed in both assessments (active in computerized vs. active assisted in clinical). As active assisted head rotations are known to better isolate VOR contributions to DVA from other contributing systems, the lack of correlation between these two test protocols may arise from this important difference. Other explanations could lie in the algorithmic approach to optotype presentation in the computerized test vs. the standard tumbling E progression in the clinical test.
Implications: The lack of relationship between these clinical and computerized DVA assessments after concussion in the pediatric and adolescent population may highlight the need to determine which cut-off value is most valid for each method of evaluation. As DVA measures are beneficial in identifying abnormalities in the VOR function, future research should continue to clarify the underlying reason for the observed differences in DVA tests outlined in this study. This will assist clinicians in choosing the optimal assessment strategy for DVA in pediatric mTBI patients.
Funding, acknowledgements: Study was funded by FRQS and CIHR in the context of an EraNET Neuron initiative.
Keywords: DVA, Clinical, Computerized
Topic: Paediatrics
Did this work require ethics approval? Yes
Institution: MUCH
Committee: Pediatrics REB
Ethics number: MP-37-2018-3373
All authors, affiliations and abstracts have been published as submitted.
