Document Type

Thesis - Open Access

Award Date

2018

Degree Name

Master of Science (MS)

Department / School

Health and Nutritional Sciences

First Advisor

Bernadette L. Olson

Keywords

VOMS, SCAT5©, Sideline Assessment, Near Point Convergence, Sport-Related Concussion

Abstract

Objective: The purpose of this study was to develop, implement and determine the general effectiveness of a novel battery of ocular tests referred to as the Rapid Ocular Screening Test (ROST) that can be performed efficiently on the sideline and is based on our current understanding of the physiological effects of blunt head trauma on ocular functioning.
Background: Assessment of ocular function following a suspected head-injury has been recognized as an important adjunct to a concussion evaluation protocol; however, sideline-screening recommendations currently do not include a comprehensive set of ocular functioning tests. Three high school student athletes who suffered a traumatic brain injury during sport participation were evaluated using a standard accepted sideline assessment and a novel ocular screening tool (ROST). The participants were removed from activity, given instructions for rest and recovery, and reported for a followup post-concussion screening by a licensed athletic trainer within 72 hours of the injury.
Differential Diagnosis: Sport-related concussion.
Diagnostic Test and Results: All 3 participants had equal pupil reactions and vertical eye tracking with no vertical nystagmus. Two participants had significant symptomology while 1 participant reported only headache and dizziness; all participants reported headache and dizziness. All participants reported increased symptomology following saccades. The ROST demonstrated positive findings in number of symptoms, symptom severity and an increase in symptoms during horizontal saccades for all participants. All 3 participants reported headache and dizziness as the primary symptoms. Two participants also demonstrated increased symptoms following vertical saccades and 1 participant demonstrated impairment with smooth pursuit. Two individuals had at least 1 near point convergence (NPC) measure greater than 5 centimeters; however, on average 1 person had a mean over 5 centimeters. Additionally, all participants that were sideline tested also tested “positive” for a SRC at 24-72 hours using the combination of the immediate post-concussion assessment and cognitive test (ImPACT®), balance error scoring system (BESS), and King- Devick (KD).
Uniqueness: Healthcare providers who assess student-athletes following blunt head trauma during an athletic event have a responsibility to keep student-athletes safe from further harm; however, they also do not want to keep a student-athlete out of participation if no injury exists. Being able to assess a SRC within the first 15-30 minutes, without the benefit of a biomarker, can be very challenging. The findings of this study demonstrate the addition of an ocular screening may improve a clinician’s ability to accurately determine if a SRC exists when assessing an injured player on the sideline in order to make a better decision on behalf of the safety and well being of the participant.
Conclusions: Our findings suggest the addition symptom evaluation with saccades and near point convergence (NPC) may aid in the recognition of a sport-related concussion during a sideline assessment. Our findings also reiterate the importance of a thorough symptom examination. It is recommended that clinicians use a combination of these tools to accurately diagnose a SRC on the sideline within 15-30 minutes following the trauma event.


Library of Congress Subject Headings

Brain -- Concussion -- Diagnosis.
High school athletes -- Wounds and injuries.
Sports injuries.
Eye -- Examinations.

Description

Includes bibliographical references (pages 35-39)

Format

application/pdf

Number of Pages

53

Publisher

South Dakota State University

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Rights Statement

In Copyright