Center for Injury Research and Prevention

Concussion's Vestibular Deficits Are Common, May Predict Slower Recovery

April 30, 2015

Moderator Introduction: Today, we introduce our readers to Tina Master. Dr. Master is a Sports Medicine clinician at CHOP with an expert focus on pediatric and youth concussion. She is a member of CIRP@CHOP's MInds Matter: Improving Pediatric Concussion Management research team.

eye exam

For clinicians to be better able to recognize and treat specific concussion symptoms as well as predict recovery outcomes, we need to first capture and describe the diversity and variability of pediatric concussions in a methodical way.  Along with my fellow concussion researchers at CHOP, I have been involved in a line of research at CIRP called Characteristics of Concussion in Youth. Our most recent publication, in the March issue of the Journal of Pediatrics, looks at vestibular deficits in pediatric patients. We wanted to record the prevalence of vestibular deficits and what recovery looks like for patients that exhibit them at initial evaluation.

Perhaps I should back up and define what I mean by “vestibular deficits”. We rely on our vestibular system in the brain and inner ear to help us visually track and focus, regulating our body’s movement through space and time and helping us maintain balance.  I call it our body’s “steadycam” because it keeps our visual field stable. Simple tests at initial clinical evaluation, including balancing while walking toe-to-heel and focusing on the doctor’s finger while nodding their heads, can help us identify vestibular deficits.

In our study of patients seen at CHOP’s sports medicine clinic, we conducted a detailed review of 247 patients, ages 5 to 18 years, randomly chosen from among 3,740 eligible visits seen in 2010-2011. Among this group, 81% exhibited vestibular deficits-- meaning these kids lost their balance while walking or broke their gaze while nodding.  These patients took significantly longer to return to school (median 59 days vs. 6 days) or be fully cleared (median 106 days vs. 29 days) than those patients without vestibular deficits. Patients with a history of three or more previous concussions had more vestibular deficits and longer recovery times.

Additionally, patients with vestibular deficits scored more poorly on computerized neurocognitive testing and they took longer to recover from neurocognitive deficits. In a concussion injury, brains cells stretch, causing them to not function properly.  This can result in a patient having symptoms such as difficulty concentrating, remembering and feeling mentally foggy or slow. Computerized testing can help measure these neurocognitive deficits as part of a clinical evaluation, but is only one of the tools in the toolbox used to help diagnose and manage concussion

This study reinforces that concussions in children and youth are complex. They require comprehensive clinical diagnosis, as well as a customized management plan for recovery that involves initial rest followed by a gradual return to activity. What do I mean by customized?  We know that vestibular deficits make it difficult to do simple everyday things like focusing on a chalkboard and taking notes at school, so special school accommodations for these patients are important to recovery. Participating in sports too soon, before getting the “all-clear” from their physician, is dangerous because an athlete with vestibular deficits has slower reaction time and problems with balance, putting him or her at risk for subsequent injury. 

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