By: Nick Pfeifer, EdM, ATC
As an AT, telling a patient that they have a concussion is great – but, that doesn’t tell them what you are going to DO about their concussion. The more specific you can be, the more actionable your information will be.
ATs should be screening their concussed patients for vestibular and ocular dysfunctions. It’s that simple. It’s safe. It’s quick. It’s easy. And best of all, it’s POWERFUL. Any dysfunction uncovered throughout the screening becomes the entry point to an individualized rehabilitation program. Then, the screening can be repeated to assess readiness for discharge. This is that powerful. One tool can help diagnose, treat and discharge patients with vestibular and ocular dysfunction.
These systems are so important for us as humans. We are constantly taking information from our surroundings to help inform our actions. If we think about it as a painting, the vestibular system provides us with the broad-brush strokes – it orients us to movement, positioning and balance. The visual system on the other hand, is like the fine detail of the painting – it uses our eyes to show us the specifics with clarity. These two systems work in perfect harmony to show us the painting of our place in the world around us. When there is trauma from a concussion however, something in that painting gets interrupted and suddenly our picture is not as clear.
Screening these systems is easy. All you need is a tape measure, a metronome (hello free app in the app store!), and a target (a tongue depressor works great) with a small letter written on it (about 14-point font). That’s it. The screening intends to challenge the vestibular and ocular systems to see if there is any symptom provocation when that stress is introduced. If any of the 5 domains elicit symptom provocation (>/= 2), then that is determined to be a positive finding. And now your assessment has informed your rehab. If smooth pursuits cause the symptom spike, then the rehab program can be built around that movement/action. As rehab is completed and the patient improves, their performance on that assessment will improve as well. That’s what I love about this tool, every piece of information holds great value.
ATs have supreme access to the patients we provide care for. Getting this screening completed after 48-72 hours of rest following a concussion is ideal. That way rehab can be started as the patient’s body is ready to accept it. This keeps them active. This keeps them engaged. This helps them get better faster. We have the skill set to impact outcomes. Vestibular and ocular rehab is no different.
Get out there and get screening, happy VOMS-ing!
Links to a few of those great papers to deepen one’s understanding of this concept:
Downloadable VOMS assessment and instructions
Nick Pfeifer, EdM, ATC and Josh Beard, MA, ATC discuss VOMS
A Brief VOMS assessment tool from PMC
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