Evaluating the Vestibulo-Ocular Reflex Following Traumatic Brain Injury: A Scoping Review

ABSTRACT

Purpose:To identify the tests and tools used to evaluate vestibulo-ocular reflex (VOR) function after traumatic brain injury (TBI) in all age groups and across TBI severity.

Methods: An electronic search was conducted to include relevant peer-reviewed literature published up to November 2019. Studies included those done with humans, of all ages, and had assessments of oculomotor and/or vestibulo-ocular function in TBI.

Results: Of the articles selected (N = 48), 50% were published in 2018/2019. A majority targeted mild TBI, with equal focus on non-computerized versus computerized measures of VOR. Computerized assessment tools used were videonystagmography, dynamic visual acuity/gaze stability, rotary chair, and caloric irrigation. Non-computerized tests included the head thrust, dynamic visual acuity, gaze stability, head shaking nystagmus, rotary chair tests and the vestibular/oculomotor screening tool. High variability in administration protocols were identified. Namely: testing environment, distances/positioning/equipment used, active/passive state, procedures, rotation frequencies, and variables observed.

Conclusions: There is a rapid growth of literature incorporating VOR tests in mild TBI but moderate and severe TBI continues to be under-represented. Determining how to pair a clinical test with a computerized tool and developing standardized protocols when administering tests will help in developing an optimal battery assessing the VOR in TBI.

KEYWORDS:

• Traumatic brain injury
• concussion
• measurement
• vestibulo-ocular reflex
• vision

Acknowledgments

Authors AC and AG contributed to the conceptualization and design of this scoping review. AC and AG drafted the protocol and undertook to complete the study. AC and HS modified the proposal and iteratively adapted the proposal and screening process. AC, AG, and HS completed the screening steps. Drs. Isabelle Gagnon, Kathryn Schneider, Michal Katz-Leurer, and Mathilde Chevignard provided mentorship, aided the development of the research questions and revised the manuscript. Expert health science librarians Jill Boruff and Lucille Kiester provided guidance in developing the search strategy for this scoping review. Colleagues Christophe Alarie and Dr. Elizabeth Teel provided additional support throughout. We acknowledge the support and input of the research team as a whole as well as all stakeholders involved in the consultation phase of this research project. This work was funded by the Canadian Institute of Health Research under grant number EIN 150763; and the Fonds de recherche du Québec under grant number 3679 as part of an ERA-Net NEURON JTC Cofund Program.

Disclosure statement

The authors declare no potential conflicts of interest.

Additional information

Funding

This work was supported by the Canadian institutes of health research [EIN 150763]; Fonds de Recherche du Québec - Santé [3679].