Pre- and post-season visio-vestibular function in healthy adolescent athletes

ABSTRACT

Objective

To evaluate pre – to post-season differences in individual subtests of the Visio-Vestibular Examination (VVE) in healthy middle and high school athletes.

Methods

This prospective cohort study recruited participants from a private suburban United States secondary school. Participants completed a demographic questionnaire prior to the start of their season. A proxy for head impact exposure was estimated by incorporating previously published head impact frequencies by team and sport. The VVE was completed pre – and post-season and consisted of 9 subtests: smooth pursuit, horizontal/vertical saccades and gaze stability, binocular convergence, left/right monocular accommodation, and complex tandem gait. Generalized estimating equations were employed to assess the relative risk of an abnormal VVE outcome based on testing session (pre – vs. post-season).

Results

Participants included middle and high school athletes (n = 115; female = 59 (51.3%); median age at first assessment = 14.9 years, [IQR = 13.6, 16.0]) during 2017/18 – 2019/20 school years. During pre-season testing, accommodation (10.0%) and complex tandem gait (9.2%) had the largest proportion of abnormal outcomes, while smooth pursuits (10.6%) and convergence (9.5%) had the largest proportion of abnormal outcomes post-season. When assessing the effect of testing session on the relative risk of any abnormal VVE subtest, there were no significant findings (P ≥ 0.25). Additionally, there were no significant effects of testing session when adjusting for estimated head impact exposure for any VVE subtest (P ≥ 0.25).

Conclusions

Visio-vestibular function as measured by the VVE does not change from pre – to post-season in otherwise healthy adolescent athletes. Our findings suggest that the VVE may be stable and robust to typical neurodevelopment occurring in this dynamic age group and help inform post-injury interpretation of visio-vestibular impairments.

KEYWORDS:

• (5-10): oculomotor
• vision
• concussion
• sport
• balance
• gait

Supplemental Material

Supplemental data for this article can be accessed here

Acknowledgments

We thank Ronni S. Kessler, MS, Fairuz Mohammed, MS, MPH, Ari Fish, BS, Shelly Sharma, BA, Taylor Valerio, Anne Mozel and Julia Vanni, BS, of Children’s Hospital of Philadelphia for their contribution to data collection for this study. In addition, the authors thank the students and parents from the Shipley School for their participation. The authors appreciate the support from the Shipley School administration and athletic department: Steve Piltch, Michael Turner, Mark Duncan, Katelyn Taylor, Dakota Carroll, Kimberly Shaud, and Kayleigh Jenkins.

Conflict of Interest

The authors have no conflicts to disclose

Disclosure statement

No potential conflict of interest was reported by the author(s).