Concussions and VOMIT

The title did grab your attention, didn’t it? Chances are you’d remember the acronym VOMIT: Visual Ocular Motor Impairment Testing, if there were such a thing. It does, after all, engender a visceral feeling. Perhaps too visceral, you might say, to be in good taste. Thankfully instead you can remember the VOMS (Visual Ocular Motor Screening) – a valuable assessment tool to evaluate concussions. Thanks to our buddy, Dr. Curt Baxstrom, for reminding us of the importance of pairing concepts in the VOMS with the K-D Test.

The individual that most people associate with development of the VOMS is Michael “Micky” Collins, Ph.D., clinical and executive director of the UPMC (University of Pittsburgh Medical Center) Sports Medicine Concussion Program. Here is a nice PowerPoint presentation that reviews background information on visual-vestibular interaction that lies at the heart of the VOMS, and here is the article published in the American Journal of Sports Medicine on the VOMS last October by Collins and his group.

The VOMS consists of the following tests, found in the appendix of the article:

Vestibular/Ocular Motor Test:	Not Tested	Headache 0-10	Dizziness 0-10	Nausea 0-10	Fogginess 0-10	Comments
BASELINE SYMPTOMS:	N/A
Smooth Pursuits
Saccades – Horizontal
Saccades – Vertical
Convergence (Near Point)						(Near Point in cm): Measure 1: ______ Measure 2:______ Measure 3:______
VOR – Horizontal
VOR – Vertical
Visual Motion Sensitivity Test

The basic idea is to record baseline symptoms on a scale of 0 – 10 prior to testing, and then re-record the symptoms following the testing. The supplemental material in the appendices of the article goes into detail about how to conduct the tests, and defines abnormal findings. It is designed to be used on individuals between 9 and 40 years of age. Abnormal findings or provocation of symptoms with any test may indicate dysfunction, and should trigger a referral to the appropriate health care professional for more detailed assessment and management.

2 thoughts on “Concussions and VOMIT”

Thanks for sharing this Len. Interesting that they talk about the K-D not assessing accom and vergence. Optometry is getting on the same page as Mickey Collins (and vice versa), which is a good place to be. No one is driving concussion policy as much as Dr. Collins. The VOMS is used routinely by PT’s and concussion docs near my office and is a great opportunity for optometric referrals. It doesn’t take long for all professionals involved to see that we are the go to profession for the visual piece. The PT’s are doing VT, and while some of their cases resolve with their “VT lite”, many do not. And that’s where optometry comes in of course.