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It has been known that vestibular symptoms can persist for several months after concussion. The authors designed this study to assess the effect of chronic concussion (more than one year) on gaze stability and the relationship between deficits in gaze stability and sleep. Their hypotheses were two-fold: a) previous concussion would impair visual acuity with head movement compared to controls; and b) greater loss of dynamic visual acuity would be correlated with poor sleep quality. Seventeen adults aged between 20 and 30 years diagnosed with chronic concussion, most with multiple concussions between one and six, and 17 age and sex-matched controls were recruited. The examination included eye movements, head thrust test (HTT) and visual acuity – static (SVA) and dynamic (DVA). DVA was assessed in the yaw and pitch planes. Participants completed two sleep quality questionnaires (PSQI and ESS). In addition, the concussion group completed the symptom scale, PCSS. Headaches and concentration difficulties were the most common complaints (52.9%) followed by drowsiness (47%) and, in 41% of cases, fatigue, trouble falling asleep, sensitivity to light, and memory difficulties. Eye movements and HTT were normal in all participants. Mean DVA loss in the pitch plane was significantly worse in the concussion vs. control (p = 0.04 significant). There was no statistically significant DVA difference in the yaw plane between the two groups. On sleep quality measures, the concussion group performed significantly worse than controls: lower sleep quality (PSQI p = 0.01) and increased daytime sleepiness (ESS p = 0.01). Furthermore, worse sleep quality measures correlated with poorer mean DVA scores in the pitch plane in the concussion group. The authors concluded that “among young adults, significant differences in DVA loss were found in the chronic stage after concussion, compared to those without a concussion history. Higher loss of dynamic visual acuity was correlated with poor sleep quality and higher daytime sleepiness.” In that sense, the two hypotheses were proved. Limitations such as the small cohort of cases, verbal report of diagnosed concussion and the speed of DVA testing were addressed. No explanation was offered for the difference between DVA in the yaw and pitch planes. I agree with the authors that future studies on the benefits of vestibular rehabilitation and sleep education after concussion are needed.

Gaze stability in young adults with previous concussion history.
D’Silva LJ, Siengsukon CF, Devos H.
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Victor Osei-Lah

Bournemouth, UK.

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