OBJECTIVE: Dizziness after concussion have been reported in both youths and adults. It is not clear if the dizziness experienced post-concussion is from peripheral or central etiology. New technology has been developed to quickly and easily quantify the magnitude of peripheral vestibular disorders that is non-invasive and acceptable to youths and adults. The purpose of this study was to determine if youths and adults’ post-concussion have evidence of decreased horizontal semicircular canal vestibulo-ocular reflex (VOR) gains as measured with the video head impulse test (vHIT), which would indicate a peripheral vestibular disorder. An additional purpose was to determine if VOR gain scores correlate with functional performance measures. Design: Descriptive cross sectional.
SETTING: Large medical center out-patient concussion program.
PARTICIPANTS: Fifty-six subjects with concussion.
MAIN OUTCOMES/MEASURES: Subjects completed the vHIT testing, the Dizziness Handicap Inventory (DHI), the Vestibular Activities and Participation (VAP) scale, the Pediatric Vestibular Symptom Questionnaire, gait speed assessment, the Dynamic Gait Index (DGI) and a verbal analog scale of symptom provocation before and after the vHIT testing.
RESULTS: There were no abnormal vHIT findings in any subject. Headaches, dizziness and nausea were significantly worse post vHIT testing (p < 0.05). Youths had better DGI and DHI scores than subjects older than 20 (p < 0.05).
CONCLUSION: The vHIT did not detect horizontal semicircular canal weakness in any of the subjects tested. In addition, older adults reported more activity and participation limitations than the younger subjects with concussion.
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References
1.
AlghwiriA., AlghadirA. and WhitneyS.L., The vestibular activities and participation measure and vestibular disorders (vol 23, pg 305, 2013), Journal of Vestibular Research-Equilibrium & Orientation24 (2014), 325–325.
2.
AlghwiriA.A., WhitneyS.L., BakerC.E., SpartoP.J., MarchettiG.F., RogersJ.C. and FurmanJ.M., The development and validation of the vestibular activities and participation measure, Arch Phys Med Rehabil93 (2012), 1822–1831.
3.
AlsalaheenB.A., MuchaA., MorrisL.O., WhitneyS.L., FurmanJ.M., Camiolo-ReddyC.E., CollinsM.W., LovellM.R. and SpartoP.J., Vestibular rehabilitation for dizziness and balance disorders after concussion, Journal of Neurologic Physical Therapy34 (2010), 87–93.
4.
AlsalaheenB.A., WhitneyS.L., MarchettiG.F., FurmanJ.M., KontosA.P., CollinsM.W. and SpartoP.J., Performance of high school adolescents on functional gait and balance measures, Pediatr Phys Ther26 (2014), 191–199.
5.
BartlK., LehnenN., KohlbecherS. and SchneiderE., Head impulse testing using video-oculography, Ann N Y Acad Sci1164 (2009), 331–333.
6.
BellS.L., BarkerF., HeseltonH., MacKenzieE., DewhurstD. and SandersonA., A study of the relationship between the video head impulse test and air calorics, Eur Arch Otorhinolaryngol272 (2015), 1287–1294.
7.
BenjaminiY., DraiD., ElmerG., KafkafiN. and GolaniI., Controlling the false discovery rate in behavior genetics research, Behav Brain Res125 (2001), 279–284.
8.
BroglioS.P., SosnoffJ.J. and FerraraM.S., The relationship of athlete-reported concussion symptoms and objective measures of neurocognitive function and postural control, Clin J Sport Med19 (2009), 377–382.
9.
CorwinD.J., WiebeD.J., ZonfrilloM.R., GradyM.F., RobinsonR.L., GoodmanA.M. and MasterC.L., Vestibular Deficits following Youth Concussion, J Pediatr166 (2015), 1221–1225.
10.
DaviesR.A. and LuxonL.M., Dizziness following head-injury a neurootological study, Journal of Neurology242 (1995), 222–230.
11.
DaviesR.A. and LuxonL.M., Dizziness following head injury: A neuro-otological study, J Neurol242 (1995), 222–230.
12.
EllisM.J., CordingleyD., VisS., ReimerK., LeiterJ. and RussellK., Vestibulo-ocular dysfunction in pediatric sports-related concussion, J Neurosurg Pediatr16 (2015), 248–255.
13.
FrisciaL.A., MorganM.T., SpartoP.J., FurmanJ.M. and WhitneyS.L., Responsiveness of self-report measures in individuals with vertigo, dizziness, and unsteadiness, Otol Neurotol35 (2014), 884–888.
14.
GannonR.P., WillsonG.N., RobertsM.E. and PearseH.J., Auditory and vestibular damage in head injuries at work, Arch Otolaryngol104 (1978), 404–408.
15.
GriesbachG.S., Gomez-PinillaF. and HovdaD.A., Time window for voluntary exercise-induced increases in hippocampal neuroplasticity molecules after traumatic brain injury is severity dependent, J Neurotrauma24 (2007), 1161–1171.
16.
GrillE., BronsteinA., FurmanJ., ZeeD.S. and MullerM., International Classification of Functioning, Disability and Health (ICF) Core Set for patients with vertigo, dizziness and balance disorders, J Vestib Res22 (2012), 261–271.
17.
HamiltonS.S., ZhouG. and BrodskyJ.R., Video head impulse testing (VHIT) in the pediatric population, Int J Pediatr Otorhinolaryngol79 (2015), 1283–1287.
18.
HulseR., HormannK., ServaisJ.J., HulseM. and WenzelA., Clinical experience with video Head Impulse Test in children, Int J Pediatr Otorhinolaryngol79 (2015), 1288–1293.
19.
JacobsonG.P. and NewmanC.W., The development of the Dizziness Handicap Inventory, Arch Otolaryngol Head Neck Surg116 (1990), 424–427.
20.
LannsjoM., af GeijerstamJ.L.,
JohanssonU.,
BringJ. and BorgJ., Prevalence and structure of symptoms at 3 months after mild traumatic brain injury in a national cohort, Brain Inj23 (2009), 213–219.
21.
LauB.C., KontosA.P., CollinsM.W., MuchaA. and LovellM.R., Which on-field signs/symptoms predict protracted recovery from sport-related concussion among high school football players?Am J Sports Med39 (2011), 2311–2318.
22.
LovellM.R., IversonG.L., CollinsM.W., PodellK., JohnstonK.M., PardiniD., PardiniJ., NorwigJ. and MaroonJ.C., Measurement of symptoms following sports-related concussion: Reliability and normative data for the post-concussion scale, Appl Neuropsychol13 (2006), 166–174.
23.
MacdougallH.G. and CurthoysI.S., Plasticity during Vestibular Compensation: The Role of Saccades, Front Neurol3 (2012), 21.
24.
MacDougallH.G., McGarvieL.A., HalmagyiG.M., CurthoysI.S. and WeberK.P., The Video Head Impulse Test (vHIT) detects vertical semicircular canal dysfunction, Plos One8 (2013).
25.
MacDougallH.G., WeberK.P., McGarvieL.A., HalmagyiG.M. and CurthoysI.S., The video head impulse test: Diagnostic accuracy in peripheral vestibulopathy, Neurology73 (2009), 1134–1141.
26.
MahringerA. and RamboldH.A., Caloric test and video-head-impulse: A study of vertigo/dizziness patients in a community hospital, European Archives of Oto-Rhino-Laryngology271 (2014), 463–472.
27.
ManzariL., BurgessA.M., MacDougallH.G., BradshawA.P., HalmagyiG.M. and CurthoysI.S., Clinical application of a new objective test of semicircular canal dynamic function - the Video Head Impulse Test (Vhit), European Journal of Neurology18 (2011), 45–45.
28.
ManzariL., BurgessA.M., MacDougallH.G. and CurthoysI.S., Vestibular function after vestibular neuritis, International Journal of Audiology52 (2013), 713–718.
29.
MararM., McIlvainN.M., FieldsS.K. and ComstockR.D., Epidemiology of concussions among United States high school athletes in 20 sports, Am J Sports Med40 (2012), 747–755.
30.
McCaslinD.L., JacobsonG.P., BennettM.L., GruenwaldJ.M. and GreenA.P., Predictive properties of the video head impulse test: Measures of caloric symmetry and self-report dizziness handicap, Ear Hear35 (2014), e185–e191.
31.
MigliaccioA.A. and CremerP.D., The 2D modified head impulse test: A 2D technique for measuring function in all six semi-circular canals, Journal of Vestibular Research-Equilibrium & Orientation21 (2011), 227–234.
32.
MilonskiJ., PietkiewiczP., BielinskaM., KusmierczykK. and OlszewskiJ., The use of videonystagmography head impulse test (VHIT) in the diagnostics of semicircular canal injuries in patients with vertigo, International Journal of Occupational Medicine and Environmental Health27 (2014), 583–590.
33.
MuchaA., CollinsM.W., ElbinR.J., FurmanJ.M., Troutman-EnsekiC., DeWolfR.M., MarchettiG. and KontosA.P., A Brief Vestibular/Ocular Motor Screening (VOMS) assessment to evaluate concussions: Preliminary findings, Am J Sports Med42 (2014), 2479–2486.
34.
MuellerM., WhitneyS.L., AlghwiriA., AlshebberK., StroblR., AlghadirA., Al-MomaniM.O., FurmanJ.M. and GrillE., Subscales of the Vestibular Activities and Participation questionnaire could be applied across cultures, J Clin Epidemiol (2014).
35.
MurnaneO., MabreyH., PearsonA., ByrdS. and AkinF., Normative data and test-retest reliability of the SYNAPSYS video head impulse test, Journal of the American Academy of Audiology25 (2014), 244–252.
36.
MutluB. and SerbetciogluB., Discussion of the dizziness handicap inventory, J Vestib Res23 (2013), 271–277.
37.
PanT., LiaoK., RoenigkK., DalyJ.J. and WalkerM.F., Static and dynamic postural stability in veterans with combat-related mild traumatic brain injury, Gait Posture42 (2015), 550–557.
38.
PavlouM., WhitneyS., AlkathiryA., HuettM., LuxonL., RaglenE., GodfreyE. and BamiouE., The pediatric vestibular symptom questionnaire- a validation study, The Journal of Pediatrics(in press).
39.
SavolaO. and HillbomM., Early predictors of post-concussion symptoms in patients with mild head injury, Eur J Neurol10 (2003), 175–181.
40.
SchererM.R., ShelhamerM.J. and SchubertM.C., Characterizing high-velocity angular vestibulo-ocular reflex function in service members post-blast exposure, Exp Brain Res208 (2011), 399–410.
41.
TamberA.L., WilhelmsenK.T. and StrandL.I., Measurement properties of the Dizziness Handicap Inventory by cross-sectional and longitudinal designs, Health and Quality of Life Outcomes7 (2009).
42.
TogliaJ.U., RosenbergP.E. and RonisM.L., Posttraumatic dizziness; vestibular, audiologic, and medicolegal aspects, Arch Otolaryngol92 (1970), 485–492.
43.
Valovich McLeodT.C. and
HaleT.D., Vestibular and balance issues following sport-related concussion, Brain Inj29 (2015), 175–184.
44.
WillsonG.N., GannonR.P., ChungD.Y. and MasonK., Auditory and vestibular damage in 100 work-related head injuries, J Laryngol Otol95 (1981), 1213–1219.
45.
WrisleyD.M. and KumarN.A., Functional gait assessment: Concurrent, discriminative, and predictive validity in community-dwelling older adults, Phys Ther90 (2010), 761–773.
46.
ZhouG. and BrodskyJ.R., Objective vestibular testing of children with dizziness and balance complaints following sports-related concussions, Otolaryngol Head Neck Surg152 (2015), 1133–1139.
