New research addresses sports-related concussions in kids

The national discussion around concussions may center on pro sports like the National Football League, but it has drawn attention to an important fact: Concussions can affect anyone.

That includes youth, of course, and particularly youth who participate in sports. This vulnerable subset of patients is the focus of new research, "Vestibulo-ocular dysfunction in pediatric sports-related concussion," published in the September 2015 edition of the Journal of Neurosurgery: Pediatrics.

The research team sought to identify how common vestibule-ocular dysfunction (VOD) and post-concussion syndrome (PCS) are among children and adolescents who suffer from an acute sports-related concussion. In addition, they examined whether VOD is likely to lead to PCS in these cases. Such data has been lacking in the past, says Keith Smithson, O.D., who practices in Alexandria and Reston, Virginia. Dr. Smithson treats Washington, D.C., and Baltimore's professional sports stars and youth athletes and is a member of the AOA's Sports & Performance Vision.

"When we get referrals, we see a lot of visual symptoms: blurry vision, light sensitivity, problems tracking targets and other issues," Dr. Smithson says. "The importance of a study like this is finding out how many cases have these components so we can help manage them better."

In the study, authors examined 101 patients with a mean age of 14.2 years. Of the total, 77 patients had acute sports-related concussions (SRC), and 24 had indications of PCS. Upon assessment, a significantly higher percentage of patients with PCS (62.5%) than with SRC (28.6%) met the criteria for having VOD. The authors noted that having VOD was a significant risk factor for the development of PCS.

The authors acknowledge further studies are needed to confirm the prevalence of VOD in other pediatric patients with SRC. However, both they, and Dr. Smithson, indicate that the results point to the need for improved diagnosis and therapy for visual symptoms of concussion.

Assessments are improving. For example, sideline tests such as the King-Devick test track visual processing to determine concussion likelihood. The U.S. is paying more attention to the importance of concussion and testing like this. Steven Devick, O.D., attended a conference on concussion diagnosis recently at the White House, where all attendees pledged to do more to educate the public on this important topic.

"I think we need to see more standardization of visual rehabilitation for patients like this," Dr. Smithson says. "That's something we have begun with the BIERM." Dr. Smithson is referring to the AOA Vision Rehabilitation Section'sBrain Injury Electronic Resource Manual, a comprehensive resource designed to aid doctors in evaluating patients with traumatic brain injury. Two volumes of the BIERM are available online now for AOA members; Volume 1A: Traumatic Brain Injury Visual Dysfunction Diagnosis,—and— Volume 1B: Traumatic Brain Injury: Optometric Management and Advanced Topics,   they're a valuable tool for doctors of optometry who want to help meet a growing need.

Beyond that, Dr. Smithson advises his fellow doctors to be open to accepting referrals and having discussions with young athletes, even if that's not their current specialty.

"Sometimes it's just asking the right questions and being aware," he says. I see a concussion patient at least once or twice a day, but that won't be the case for everyone. For others, just be aware that there's an opportunity to get referrals and become an integral part of a multidisciplinary medical management team in this field. When addressing the visual effects of concussion, we as ODs should be the go-to experts."