Common Modifying Factors for Baseline VOMS Performance 2018 Big Sky Athletic Training Sports Medicine Conference. Disclosure. Objectives 2/13/18

Transcription

1 Common Modifying Factors for Baseline VOMS Performance 2018 Big Sky Athletic Training Sports Medicine Conference Ryan N. Moran, PhD, ATC Disclosure I have no actual or potential conflict of interest in relation to this presentation Objectives 1. Review the current evidence for the implementation of the VOMS tool 2. Discuss findings regarding modifying factors at baseline in youth athletes Sex History of concussion ADHD/LD Headache/migraine disorder 1

2 Modifying Risk Factors Broglio et al., 2014 Modifying Risk Factors Sex Females have been found to report more symptoms at baseline and post-concussion than males (Frommer et. Al., 2011; Blass et al., 2015; Covassin et al., 2006; Covassin et al., 2007) History of Concussion Recent studies have reported no difference on baseline neurocognitive performance between individuals with and without a history of concussion (Tsushima, Geling, Arnold, & Oshiro, 2016; Brown & Guskiewicz, 2007) 2

3 Modifying Risk Factors Attention Deficit-Hyperactivity Disorder (ADHD) and Learning Disability (LD) Individuals with ADHD report more baseline symptoms and greater balance deficits than those without ADHD. (Nelson et al., 2016, Mautner et al., 2015) Individuals with ADHD and/or LD perform worse on baseline neurocognitive assessment and report more symptoms than healthy match controls (Elbin et al.,, 2013; Zuckerman et al.,, 2013) Modifying Risk Factors Headache and Migraine Disorder Headaches and migraines may influence cognitive function and symptoms related to concussion (Register-Mihalik et al., 2007; Solomon et al., 2008, Gill-Gouveia et al., 2016) Vestibular/Ocular Motor Screening (VOMS) The VOMS consists of brief assessments in the following domains Smooth Pursuits Horizontal and Vertical Saccades Convergence and Near Point of Convergence (NPC) Horizontal and Vertical Vestibular Ocular Reflex (VOR) Visual Motion Sensitivity (VMS) Following each VOMS assessment, patients rate symptoms on a scale of 0 (none) to 10 (severe) Headache, dizziness, nausea, and fogginess symptoms 3

4 VOMS background Recent development and implementation of the VOMS has enabled clinicians to assess the vestibular and ocular motor reflex and pathways for evaluation of sport-related concussion (Mucha et al., 2013). VOMS Risk Factors In healthy collegiate athletes, female sex and a history of motion sickness were determined to be risk factors for false-positive scores above clinical cutoff levels (Kontos et al., 2016) Females reported higher symptom provocation scores on the Vestibular Ocular Reflex (VOR) item compared to males, aged 9 to 18 years (Sufrinko et al., 2017) Objective To determine the effects of modifying risk factors of sports-related concussion on baseline VOMS assessment in youth athletes 4

5 Participants Data collected as part of a large sport-related concussion collaboration with 4 youth sport programs A total of 423 youth athletes, aged 8-14 years, completed baseline testing Individuals who reported a diagnosis of a risk factor (history of concussion, ADHD/LD, headache/migraine disorder) were match controlled on sex, age, sport, height, & weight. All individuals with additional diagnosed risk factors and match controls with any risk factors were not matched and included in the analyses Demographics/Diagnoses Sex 278 males, 145 females History of concussion 38 diagnosed, 38 match controls ADHD/LD 30 diagnosed, 30 match controls Headache/migraine disorder 28 diagnosed, 28 match controls Sex Differences 5

6 History of Concussion Differences ADHD/LD Differences Headache/Migraine Disorder Differences 6

7 Summary No differences were reported between male and female youth athletes on baseline VOMS No differences between individuals diagnosed with a history of concussion and healthy match controls Summary Individuals with ADHD/LD reported higher baseline VOMS scores on saccades, convergence, vertical VOR, and VMS items than their healthy match controls Individuals with headache/migraine disorder reported higher baseline VOMS scores on smooth pursuit, convergence, VOR, and VMS than their healthy match controls Limitations Individuals were not pre-screened for any underlying vestibular deficits or dysfunction Match control s results may not be indicative of the general population Risk factors were reported by a parent/legal guardian, dichotomously, as either yes or no to having a diagnosis 7

8 Conclusion This data further reiterates the need for individualized baseline testing for the VOMS This data may further emphasize the need for normative values for individuals with modifying risk factors May indicate special consideration in postconcussion diagnosis and management in individuals with ADHD/LD and headache/migraine disorder Thank You Special thanks to Mr. Jeff Monroe for the continual support and opportunities to attend BSATSMC Thank you to Dr. Jeff Kutcher for the opportunity to present this data at this year s conference. Also, thanks to Dr. Tracey Covassin and Dr. Robert Elbin for this assistance on this project 8