One of the outcomes of the 2012 Consensus Statement on Concussion in Sport was a question as to whether vision testing could help improve the sideline identification of concussion. Since that point, researchers have been busy investigating the usefulness of different types of vision testing. From simple timed reading tasks like the King-Devick Test to more sophisticated analyses such as instrumented eye tracking – there’s been strong indication from the research world that while this type of testing alone cannot provide a comprehensive evaluation of concussion, it may provide additional utility to the current consensus gold standard tests.
Why test vision?
The concept behind vision testing is that when a concussive injury occurs, the integration of sensory information in the brain from the visual, vestibular, and motor systems (called “sensorimotor integration”) is impaired. While the visual system provides the brain the ability to process visual details in the environment, the vestibular system provides our brain information on head position and movement to maintain the control of vision and upright balance. Impairments to these systems can be in the form of delayed or inappropriate responses, or even the inability to perform normal sensory-dependent tasks, for example transitioning from walking on a cement sidewalk to grass. Testing these brain functions for impairment using simple tasks can lead to aggravation of common post-concussion symptoms, and thus exposing the underlying concussive injury.
What is VOMS?
As with any type of concussion testing, comprehensive testing of vision offers the most thorough way to successfully uncover an injury. The Vestibular/Ocular Motor Screening (VOMS) is a fairly recently developed protocol that does just this. VOMS tests 5 common vestibular/ocular motor tasks and then assesses the changes in common post-concussion symptoms. The 5 mini-tests are as follows:
- Smooth pursuit: tests the ability to follow a moving target while seated
- Saccades (pronounced sahˈkäd) : tests the ability to rapidly fixate between two stationary points
- Near point of convergence: tests the ability to view an approaching target without double vision
- Vestibulo-ocular reflex (VOR): tests the ability to stabilize vision as the head moves
- Visual motion sensitivity: tests the ability to rotate the entire body as a unit from left to right
At the end of each mini-test, the athlete is asked to rate the following symptoms on a scale of 1-10: headache, dizziness, nausea, and fogginess.
The initial study on VOMS was published in the American Journal of Sports Medicine in 2014 by Mucha and colleagues, demonstrating its internal consistency and sensitivity in identifying concussed patients. Since then, numerous investigations have been published, including those concluding that: VOMS measures unique aspects of vestibular function not tested by the King-Devick test with good reliability (Yorke et al., 2016), higher VOMS scores are associated with longer recovery times in concussed athletes (Anzalone et al., 2016), and VOMS displays an acceptable false-positive rate among healthy Division I college student-athletes (Kontos et al., 2016).
To continue to providing the most innovative solutions in concussion care, HeadCheck Health has been working hard to develop and test VOMS as an additional testing module to our comprehensive sideline concussion testing and management app. As a company, we believe this reflects our mission to bridge the gap between the latest scientific research and the sideline. If your team would like to help us test the VOMS module ahead of the official release, please shoot us a quick email at info at headcheckhealth dot com. If not, keep your eyes peeled for the upcoming release and let us know if there are other modules you would be interested in adding!
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