Oculomotor Rehabilitation After Concussion in Adults
Abstract (summary)
Concussions are a major public-health concern, affecting millions worldwide, with 150,000concussions being diagnosed each year in Ontario alone. Visual and vestibular disturbances are frequent, disabling, and often under-recognized and untreated in rehabilitation settings. Although sex and gender are essential considerations for rigorous science and equitable care, their role in oculomotor rehabilitation remains poorly characterized. Evidence for eye-movement therapies is fragmented; early oculomotor/vestibular predictors of recovery in community adults are uncertain, and the feasibility of technology-enabled rehabilitation is understudied. This thesis addressed these gaps through three studies: (1) a synthesis of evidence for oculomotor rehabilitation in adults with concussion; (2) a prospective cohort study examining oculomotor and vestibular symptoms as predictors of four-week recovery in a non-athlete, non-military adult cohort, including sex-based analyses; and (3) a feasibility randomized controlled trial testing a virtual reality–delivered oculomotor program reinforced by home-based exercises versus usual care.
The work comprised three studies. The first, a systematic review and meta-analysis that conformed to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, found directionally positive effects of oculomotor interventions in samples with mild traumatic brain injury/concussions; however, overall certainty was low, as the evidence consisted or derived from small, heterogeneous pre-post intervention studies and no studies incorporated sex and gender considerations in their hypotheses and analyses. This review underscored the need for sufficiently powered randomized controlled trials with consideration of sex and gender, even if exploratory in nature. The second study, a prospective observational cohort assessed within one week of injury, found that nearly half of research participants diagnosed with concussion scored positive on the vestibular-ocular motor screen and fewer than one-third recovered by four weeks. Early visual–vestibular symptoms did not robustly predict recovery, and sex was not significantly associated with four-week outcomes. The third study, a feasibility randomized controlled trial of persons with mild traumatic brain injury, demonstrated that a clinic-based, virtual reality delivered oculomotor program with at-home reinforcement is feasible, safe, and acceptable, with participant-reported benefits over usual care and clear progression signals for a full trial. Together, these studies advance rehabilitation science by clarifying the evidence base, delineating early visual–vestibular symptom patterns and resolutions in community adults, and charting a pragmatic path toward a fully powered randomized trial of technology-enabled oculomotor rehabilitation.
Indexing (details)
Neurosciences;
Health sciences
0566: Health sciences
0317: Neurosciences
