PRESS-NEWS.org - Press Release Distribution
PRESS RELEASES DISTRIBUTION

Visio-vestibular examination is critical part of diagnosing concussion in young athletes

CHOP researchers recommend specific updates to clinical examinations to improve initial diagnosis

2021-04-15
(Press-News.org) Philadelphia, April 15, 2021 - Early and accurate diagnosis leads to optimal recovery from concussion. Over the past year across a series of studies, the Minds Matter Concussion Program research team at Children's Hospital of Philadelphia (CHOP) has systematically evaluated the use of the visio-vestibular examination (VVE) and its ability to enhance concussion diagnosis and management. The latest of these studies published online today in the Clinical Journal of Sports Medicine.

The VVE involves a series of brief eye movement and balance tests intended to identify deficits in brain function involving the visual and vestibular systems. Researchers found that the VVE presents several advantages over current clinical measures, moving beyond subjective symptoms with a rapid, repeatable and quantifiable clinical exam. The team also found that the VVE is easy to administer across various clinical settings where children are initially seen following head injury when a concussion is suspected. In doing so, researchers believe there is the opportunity to ensure the diagnosis is made accurately and soon after injury to improve outcomes for all youth who suffer a concussion.

"There is growing evidence that visual, vestibular, and balance impairments are common after concussion, and these impairments have been linked to worse outcomes, including a delayed return to school and sports," says lead investigator Christina L. Master, MD, a sports medicine pediatrician and co-director of the Minds Matter Concussion Program at CHOP. "Recently, we have focused our efforts on developing objective measures of impaired eye movement and pupil response as physiological biomarkers of concussion. In this line of research, we also wanted to see if this simple and rapid clinical exam could provide diagnostic utility for a variety of providers outside the specialist setting."

Across four different studies published over the past year, the CHOP research team make a strong case for the implementation of the VVE across a variety of practice settings: In this most recent study, the researchers focused on the assessment of saccadic eye function, which involves assessing the level of symptom provocation with rapid eye movements between two fixed objects, and gaze stability, where symptoms are assessed with head movement while the eyes are fixed on a stationary object. Previously, these assessments were performed up to 10 repetitions in a traditional screening, but this study showed that raising the number of repetitions to 20 increased the sensitivity of the test. This more demanding task provides a more rigorous 'stress test' for the brain and can help to identify subtle deficits that may go unnoticed in regular clinical assessments and avoids the ceiling effect of a test that is too easy. A second study compared clinical and device-based metrics to measure gait and balance in the diagnosis of concussion. The study found that the complex tandem gait used in the VVE performed as well as, if not slightly better than, a biomechanical force plate device for assessing deficits in concussion. The most challenging component of the complex tandem gait from the VVE - having the subject walk backward with his or her eyes closed - had the highest sensitivity for diagnosing a concussion of any of the clinical balance tests. Another study established the reliability of VVE among providers in a pediatric emergency department in patients presenting after a head injury. The individual elements of the VVE showed fair to moderate agreement between providers and moderate to substantial agreement within the same provider, especially when used with adolescents. When comparing abnormalities on exam between patients with and without a final diagnosis of a concussion, the researchers found each additional abnormal examination element more than doubled the odds of a concussion diagnosis. A final study showed that patients who were immediately diagnosed with a concussion in the emergency department were significantly more likely to have received a VVE during that visit compared with patients who were evaluated in the ED for a head injury, but not diagnosed with a concussion until later at a subsequent medical visit. The patients who received these early and appropriate diagnoses were nearly three times less likely to experience prolonged symptoms, suggesting that a VVE can improve both diagnostic accuracy as well as patient outcomes.

"With its ease-of-administration, the visio-vestibular examination can be conducted in multiple care settings where children are initially seen with head injury to effectively diagnose concussion," says co-author Daniel J. Corwin, MD, MSCE, an emergency medicine physician, associate director of research in the Division of Emergency Medicine at CHOP, and Minds Matter Concussion Program researcher. "This is particularly important since many concussed youth are diagnosed outside of the specialty setting where these tests were initially developed. Our previous research also underscores how early and accurate diagnosis can improve outcomes in children."

With training and clinical support tools, pediatricians, emergency medicine clinicians, and advanced practice practitioners are able to conduct the VVE assessments for saccades, gaze stability, and tandem gait in a repeatable manner in the workflow of a high-volume acute care setting.

"Health care professionals have new important considerations for evaluating and managing sports-related concussion," Master said. "The visio-vestibular examination is an inexpensive, feasible, and readily available means by which concussions can be more accurately diagnosed, thereby improving outcomes for these vulnerable patients. In doing so, we have the opportunity to shorten the time to diagnosis and treatment to improve outcomes for all youth who suffer a concussion."

INFORMATION:

This work was supported by the Pennsylvania Department of Health and the National Institute of Neurological Disorders and Stroke of the National Institutes of Health under award number R01NS097549.

Storey et al, "Assessment of saccades and gaze stability in the diagnosis of pediatric concussion." Clin J Sport Med, online April 13, 2021. DOI: 10.1097/JSM.0000000000000897.

Corwin et al. "Clinical and Device-based Metrics of Gait and Balance in Diagnosing Youth Concussion." Med Sci Sports Exerc. March 2020. DOI: 10.1249/MSS.0000000000002163.

Corwin et al. "Reliability of the visio-vestibular examination for concussion among providers in a pediatric emergency department." Am J Emer Med. September 2020. DOI: 10.1016/j.ajem.2020.06.020.

Corwin et al. "Characteristics and Outcomes for Delayed Diagnosis of Concussion in Pediatric Patients Presenting to the Emergency Department." J Emerg Med. December 2020. DOI: 10.1016/j.jemermed.2020.09.017.

About Children's Hospital of Philadelphia: Children's Hospital of Philadelphia was founded in 1855 as the nation's first pediatric hospital. Through its long-standing commitment to providing exceptional patient care, training new generations of pediatric healthcare professionals, and pioneering major research initiatives, Children's Hospital has fostered many discoveries that have benefited children worldwide. Its pediatric research program is among the largest in the country. In addition, its unique family-centered care and public service programs have brought the 595-bed hospital recognition as a leading advocate for children and adolescents. For more information, visit http://www.chop.edu.



ELSE PRESS RELEASES FROM THIS DATE:

No increase in brain health problems in middle age for men who played football in high school

2021-04-15
April 15, 2021 - Decades after their days on the gridiron, middle-aged men who played football in high school are not experiencing greater problems with concentration, memory, or depression compared to men who did not play football, reports a study in Clinical Journal of Sport Medicine. The journal is published in the Lippincott portfolio by Wolters Kluwer. "Men who played high-school football did not report worse brain health compared with those who played other contact sports, noncontact sports, or did not participate in sports during high school," according to the new research, led by Grant L. Iverson, PhD, of Harvard Medical School. The study offers reassurance that playing high-school football is not, in itself, a risk factor for cognitive or mood ...

CityU biologists discover super-enhancers that switch on breast cancer genes

CityU biologists discover super-enhancers that switch on breast cancer genes
2021-04-15
Triple-negative breast cancer (TNBC) is an aggressive type of breast cancer with a high fatality rate. Currently, chemotherapy is the major treatment option, but the clinical result is unsatisfactory. A research team led by biologists at City University of Hong Kong (CityU) has identified and characterised a set of specific super-enhancers that stimulate the activity of the related critical cancer genes. The research has also discovered that the deletion of certain specific super-enhancers can reduce tumour cell growth. The latest findings may help discover new effective drug targets for TNBC patients to improve their survival chance. Traditionally, cancer research ...

Counting pedestrians to make pedestrians count

2021-04-15
A key portion of MIT's campus overlaps with Kendall Square, the bustling area in East Cambridge where students, residents, and tech employees scurry around in between classes, meetings, and meals. Where are they all going? Is there a way to make sense of this daily flurry of foot traffic? In fact, there is: MIT Associate Professor Andres Sevtsuk has made Kendall Square the basis of a newly published model of pedestrian movement that could help planners and developers better grasp the flow of foot traffic in all cities. Sevtsuk's work emphasizes the functionality of a neighborhood's elements, above and beyond its physical form, making the model one that could be ...

Making waves in oceanography

Making waves in oceanography
2021-04-15
A new scientific discovery in Australia by Flinders University has recorded for the first time how ghost currents and sediments can 'undo' the force of gravity. The new theory, just published in the Journal of Marine Systems, helps explain obscure events in which suspended sediment particles mysteriously move upward, not downward, on the slope of submarine canyons of the deep sea. While this activity seems to contradict the laws of gravity, Flinders University physical oceanographer Associate Professor Jochen Kaempf has found an answer, devising the first scientific explanation of the observed upslope sediment transport. "To put it simply, the vehicle of this transport are currents that, while carrying ...

With impressive accuracy, dogs can sniff out coronavirus

With impressive accuracy, dogs can sniff out coronavirus
2021-04-15
Many long for a return to a post-pandemic "normal," which, for some, may entail concerts, travel, and large gatherings. But how to keep safe amid these potential public health risks? One possibility, according to a new study, is dogs. A proof-of-concept investigation published today in the journal PLOS ONE suggests that specially trained detection dogs can sniff out COVID-19-positive samples with 96% accuracy. "This is not a simple thing we're asking the dogs to do," says Cynthia Otto, senior author on the work and director of the University of Pennsylvania School of Veterinary Medicine Working Dog Center. "Dogs have to ...

Novak Djokovic now has a tiny new snail species named after him

Novak Djokovic now has a tiny new snail species named after him
2021-04-15
Do freshwater snails make good tennis players? One of them certainly has the name for it. Enter Travunijana djokovici, a new species of aquatic snail named after famous Serbian ten­nis player Novak Djokovic. Slovak biospeleologist Jozef Grego and Montenegrin zoologist Vladimir Pesic of the University of Montenegro discovered the new snail in a karstic spring near Podgorica, the capital of Montenegro, during a field trip in April 2019. Their scientific article, published in the open-access, peer-reviewed journal Subterranean Biology, says they named it after Djokovic "to acknowledge his inspiring enthusiasm and energy." "To discover some of the world's rarest animals that inhabit the unique underground habitats of the Dinaric karst, to reach inaccessible cave and spring habitats ...

Norovirus clusters are resistant to environmental stresses and UV disinfection, new study finds

Norovirus clusters are resistant to environmental stresses and UV disinfection, new study finds
2021-04-15
WASHINGTON (April 15, 2021) -- Clusters of a virus known to cause stomach flu are resistant to detergent and ultraviolet disinfection, according to new research co-led by END ...

German National HPC Centre provides resources to look for cracks in the standard model

German National HPC Centre provides resources to look for cracks in the standard model
2021-04-15
Since the 1970s, the Standard Model of Physics has served as the basis from which particle physics are investigated. Both experimentalists and theoretical physicists have tested the Standard Model's accuracy, and it has remained the law of the land when it comes to understanding how the subatomic world behaves. This week, cracks formed in that foundational set of assumptions. Researchers of the "Muon g-2" collaboration from the Fermi National Accelerator Laboratory (FNAL) in the United States published further experimental findings that show that muons--heavy subatomic relatives of electrons--may have a larger "magnetic moment" than earlier Standard Model estimates had predicted, indicating that an unknown particle or force might be influencing ...

The architect of genome folding

The architect of genome folding
2021-04-15
The DNA molecule is not naked in the nucleus. Instead, it is folded in a very organized way by the help of different proteins to establish a unique spatial organization of the genetic information. This 3D spatial genome organization is fundamental for the regulation of our genes and has to be established de novo by each individual during early embryogenesis. Researchers at the MPI of Immunobiology and Epigenetics in Freiburg in collaboration with colleagues from the Friedrich Mischer Institute in Basel now reveal a yet unknown and critical role of the protein HP1a in the 3D genome re-organization after fertilisation. The study published in the scientific journal Nature identifies HP1a as an epigenetic regulator that is involved in establishing ...

Potential impact of pass/fail USMLE Step 1 scoring on radiology residency applications

Potential impact of pass/fail USMLE Step 1 scoring on radiology residency applications
2021-04-15
Leesburg, VA, April 15, 2021--A Scientific E-Poster to be presented at the 2021 ARRS Virtual Annual Meeting found that as the United States Medical Licensing Examination (USMLE) Step 1 transitions from a numerical score to pass or fail--as early as January 2022--radiology residency program directors will likely rely on USMLE Step 2 Clinical Knowledge (CK) scores as an objective and standardized metric to screen applicants. "However," wrote lead investigator Rebecca Zhang of the University of Maryland School of Medicine in Baltimore, "program directors remain unsure whether they will ...

LAST 30 PRESS RELEASES:

Scientists unlock secrets behind flowering of the king of fruits

Texas A&M researchers illuminate the mysteries of icy ocean worlds

Prosthetic material could help reduce infections from intravenous catheters

Can the heart heal itself? New study says it can

Microscopic discovery in cancer cells could have a big impact

Rice researchers take ‘significant leap forward’ with quantum simulation of molecular electron transfer

Breakthrough new material brings affordable, sustainable future within grasp

How everyday activities inside your home can generate energy

Inequality weakens local governance and public satisfaction, study finds

Uncovering key molecular factors behind malaria’s deadliest strain

UC Davis researchers help decode the cause of aggressive breast cancer in women of color

Researchers discovered replication hubs for human norovirus

SNU researchers develop the world’s most sensitive flexible strain sensor

Tiny, wireless antennas use light to monitor cellular communication

Neutrality has played a pivotal, but under-examined, role in international relations, new research shows

Study reveals right whales live 130 years — or more

Researchers reveal how human eyelashes promote water drainage

Pollinators most vulnerable to rising global temperatures are flies, study shows

DFG to fund eight new research units

Modern AI systems have achieved Turing's vision, but not exactly how he hoped

Quantum walk computing unlocks new potential in quantum science and technology

Construction materials and household items are a part of a long-term carbon sink called the “technosphere”

First demonstration of quantum teleportation over busy Internet cables

Disparities and gaps in breast cancer screening for women ages 40 to 49

US tobacco 21 policies and potential mortality reductions by state

AI-driven approach reveals hidden hazards of chemical mixtures in rivers

Older age linked to increased complications after breast reconstruction

ESA and NASA satellites deliver first joint picture of Greenland Ice Sheet melting

Early detection model for pancreatic necrosis improves patient outcomes

Poor vascular health accelerates brain ageing

[Press-News.org] Visio-vestibular examination is critical part of diagnosing concussion in young athletes
CHOP researchers recommend specific updates to clinical examinations to improve initial diagnosis