Vestibular/Ocular Motor Screening in Assessing Concussions
Vestibular/Ocular Motor Screening in Assessing Concussions Free Phone Consultation Vestibular and oculomotor impairments are among the most frequent and persistent complications following a sports-related concussion or mild traumatic brain injury (mTBI). Up to 60% to 80% of concussed athletes experience visual symptoms or vestibular dysfunction, such as dizziness, double vision, nausea, or motion sensitivity. Traditional sideline assessment tools—such as cognitive testing (SAC/ImPACT®) or postural stability tests (BESS)—often miss isolated visual and vestibular deficits. The Vestibular/Ocular Motor Screening (VOMS) tool was developed specifically to fill this diagnostic gap by systematically evaluating symptom provocation during specific eye movements and head motion challenges. What Is the VOMS Assessment? The VOMS is a brief, objective clinical screening protocol designed for individuals aged 9 to 73. Prior to testing, patients rate their baseline symptoms across four domains: headache, dizziness, nausea, and fogginess on a 0 to 10 scale. Therapists then administer five specific subtests, recording changes in symptoms and measuring physical movement thresholds: Smooth Pursuits: Tests the ability to smoothly track a slow-moving target horizontally and vertically while keeping the head stationary. Saccades (Horizontal & Vertical): Evaluates rapid eye jumps between two fixed targets spaced 3 feet apart, tested both side-to-side and up-and-down. Near Point of Convergence (NPC): Measures the distance (in centimeters) at which double vision occurs as a target is brought slowly toward the bridge of the nose. Vestibulo-Ocular Reflex (VOR – Horizontal & Vertical): Assesses gaze stability by having the patient rotate their head side-to-side or up-and-down while maintaining focus on a fixed central target. Visual Motion Sensitivity (VMS): Evaluates visual-vestibular integration by having the patient rotate their head, eyes, and torso in unison while focusing on their thumb held at arm’s length. Key Diagnostic Findings & Metrics Landmark clinical studies demonstrate that the VOMS possesses high internal consistency and strong diagnostic sensitivity when screening for sports-related concussions: High Sensitivity for Concussion: Any single VOMS subtest that provocaes an increase in symptom scores (headache, dizziness, nausea, or fogginess) significantly increases the probability of a concussion diagnosis. Near Point of Convergence (NPC) Recession: An abnormal convergence distance of 5 centimeters or greater from the bridge of the nose serves as a primary marker for ocular motor convergence insufficiency post-injury. VOR & VMS Provocation: The VOR and Visual Motion Sensitivity subtests are particularly effective at differentiating concussed athletes from healthy controls, as visual-motion integration is highly vulnerable to head trauma. Clinical Impact on Targeted Concussion Rehabilitation Integrating VOMS into initial post-injury evaluations offers several clinical advantages: Phenotype Subtyping: Helps clinicians differentiate between vestibular-ocular concussions, cervical spine involvement, and anxiety-driven dizziness. Targeted Exercise Prescriptions: Pinpoints exact visual or vestibular deficits early, allowing physical therapists to prescribe immediate, customized gaze stabilization (VOR) and convergence therapy. Safer Return-to-Play Progression: Prevents premature clearance by ensuring an athlete’s visual tracking and motion sensitivity are fully restored alongside cognitive function. See full study. Get Expert Vestibular & Concussion Care in New York City If you or your athlete are experiencing dizziness, eye strain, or motion sensitivity following a head impact, specialized vestibular screening can guide your recovery. Contact Concussion Management of New York at (212) 717-8331 or visit our Manhattan clinic at 109 W. 38th Street, 4th Floor, New York, NY 10018 to schedule an evaluation.