Diagnostic Tests for Concussions: Is Vision Part of the Puzzle?

The Centers for Disease Control and Prevention have estimated that 1.4- 3.8 million sports-related mild traumatic brain injures (mTBI) annually in the United States. Not including mTBI not reported or ones seen in the out-patient setting. Sustaining one concussion during a sports season gives an athlete a 3 times greater risk for a second concussion. This article seeks to look at the visual impairments associated with concussions. This can help both with screening and monitoring the recovery of mTBI. In summary concussions and mTBI can have multiple of effects on the visual system. The authors of this article suggest adding a visual component to the current sideline tests in identifying sports-related concussions. See full article 

Exercise Prescription Patterns in Patients Treated with Vestibular Rehabilitation After Concussion

In individuals post-concussion, 23-81% report of dizziness. It has been estimated that persistent dizziness after mild traumatic brain injury varies from 16-18% three-months post concussion.  Previous studies have shown that vestibular rehabilitation reduces dizziness and improves overall balance for individuals with a head injury. The purpose of this study was to describe exercise prescription patterns in patients treated with vestibular rehabilitation. A total of 104 participants (mean age of 24) received a computer-generated home exercise program of vestibular rehabilitation exercises after being diagnosed with a concussion. The range of interventions were from 7-181 days post-concussion with a median of  33 days. A range of 2-13 visits from a physical therapists with at least 3 years experience in vestibular physical therapy (mean of 4 visits).  The computer-generated exercise handout program (Visual Health Information, WA, USA)  was reviewed by one of the authors and modified and progressed by a physical therapist.

The 5 main exercise categories are: eye-head coordination, sitting balance, standing static balance, standing dynamic balance, and ambulation. Based on the exercises that were prescribed, it was found that most of the impairments in this cohort of patients were in the domains of eye-head coordination, standing static balance, and ambulation. Possible implications for findings suggest that impairments in the eye-head coordination could be caused by a disruption in the Vestibulo-ocular reflex (VOR) or reflect increased symptoms with head and eye movement. In this current study 95% of patients were found to have impairments in eye-head coordination. In this current study, they found 88% of participants to have impairments in standing static balance at least 6 days after concussion. This could cause implications of slower gait velocity, shorter stride length, and wider step width. In the current sample 76% of participants had impairments in ambulation. Other important findings in regards to clinical decision making found that physical therapists did not address the ambulation impairments in the first visit, instead their initial focus was the eye-head coordination category. Clinical reasoning is further discussed in the article. In summary, this article has found that expert clinicians prescribe comparable exercises for patients post-concussion with the aforementioned impairments to an individual with unilateral vestibular hypo-function. This further highlights the importance of the vestibular system in post-concussion individuals and an idea of a preferred prescription patterns. See full study.