Neurosensory Screening and Symptom Provocation in Pediatric Mild Traumatic Brain Injury

Bruce Caplan, Jennifer Bogner, Lisa Brenner, James Malec, Andrew R. Mayer, Christopher J. Wertz, Cidney R. Robertson-Benta, Sharvani Pabbathi Reddy, David D. Stephenson, Andrew B. Dodd, Scott J. Oglesbee, Edward J. Bedrick, Christina L. Master, Mathew Grady, Nicholas A. Shaff, Faith M. Hanlon, Richard A. Campbell, John P. Phillips, Roger L. Zemek, Keith Owen YeatesTimothy B. Meier, Rebekah Mannix, John J. Leddy, Kristy B. Arbogast, Grace Park

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Objective: To evaluate diagnostic/prognostic implications of neurosensory testing during the subacute stage in patients with pediatric mild traumatic brain injury (pmTBI). Setting: Recruitment from pediatric emergency department and urgent care clinics, assessment in a controlled environment. Participants: In total, 146 pmTBI patients evaluated 7.4 ± 2.3 days and approximately 4 months postinjury; 104 age/sex-matched healthy controls (HCs) at equivalent time points. Design: Prospective cohort study. Main Measures: Neurosensory examination based on sequence of 10 established tests of vestibular-ocular, oculomotor, vestibulospinal, and visual functioning. Results: The amount of symptom provocation (positive change from pretest symptomatology) was significantly increased in pmTBI relative to HCs on every subtest 1 week postinjury, as were deficits in monocular accommodative amplitude and King-Devick Test errors. However, symptom provocation did not meaningfully alter diagnostic sensitivity/specificity relative to more easily obtained pretest symptom ratings. Evidence of clinically significant symptom provocation 1 week postinjury improved sensitivity (Δ = +12.9%) of identifying patients with persistent postconcussive symptoms 4 months postinjury on an independent symptom measure. Conclusions: The diagnostic sensitivity/specificity of neurosensory testing in acutely concussed youth may be limited at 1 week postinjury as a function of natural recovery occurring in most emergency department cohorts. Neurosensory screening may have greater utility for identifying patients who experience delayed recovery.

Original languageEnglish (US)
Pages (from-to)270-278
Number of pages9
JournalJournal of Head Trauma Rehabilitation
Issue number4
StatePublished - Jul 1 2020


  • assessment
  • concussion
  • ocular motor
  • recovery
  • vestibular
  • vision

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Rehabilitation
  • Clinical Neurology


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