VOMS

VOMS Research

*Mucha A, Collins MW, Elbin R, et al. A Brief Vestibular/Ocular Motor Screening (VOMS) Assessment to Evaluate Concussions. The American Journal of Sports Medicine. 2014;42(10):2479-2486. doi:10.1177/0363546514543775.

*Kontos AP, Sufrinko A, Elbin RJ, Puskar A, Collins MW. Reliability and Associated Risk Factors for Performance on the Vestibular/Ocular Motor Screening (VOMS) Tool in Healthy Collegiate Athletes. The American Journal of Sports Medicine. 2016;44(6):1400-1406. doi:10.1177/0363546516632754.

*Anzalone AJ, Blueitt D, Case T, et al. A Positive Vestibular/Ocular Motor Screening (VOMS) Is Associated With Increased Recovery Time After Sports-Related Concussion in Youth and Adolescent Athletes. The American Journal of Sports Medicine. 2016;45(2):474-479. doi:10.1177/0363546516668624.

*http://natafoundation.org/wp-content/uploads/VOMS-DiCesaro-Kingma-Submission-4-2017.pdf

Exam

-Takes approximately 5-10minutes

-Easily repeatable and objective

-Designed to reassess symptoms after each portion, 5-10 seconds should be given to accomodate

Smooth Pursuits/ "H" Test

-Relatively standard ocular motor test, be sure to go to end ranges for diagonal ocular movement

-Looking for ability of the eye to move smoothly and follow the practitioners finger, nastygmus, and provocation of symptoms

-This test is designed to provoke the ocular motor system

Saccades - Horizontal

-Utilizing practitioners arms 3ft apart and 3ft from the patients head, have them looking from left thumb to right thumb while keeping the head stationary

-Looking for consistent movement and tempo, nastygmus, inability to focus

-Ten repetitions should be performed, then re-assess symptom score after completion

-This test is designed to provoke the ocular motor system

Saccades - Vertical

-Similar to the Horizontal version the practitioner stands with arms 3ft from patients head and arms 3ft apart, the patient will move gaze up and down

-Looking for similar findings to the other tests, the patient will perform ten repetitions and then a follow up symptom score will be taken

-This test is designed to provoke the ocular motor system

Near Point Convergence

-This portion requires a tongue depressor with 3 multi-colored dots (approximately 14pt font), you can make these yourself or purchase the one pictured below (http://www.bernell.com/product/728/Fixation-Devices)

-The subject moves the device toward the tip of the nose and stops when the dot they have focused on shows double, at this point the practitioner measures from the device to the tip of the nose and repeats three times to attain an average

-This test is designed to provoke the eyes ability to utilize convergence as well as the ocular motor system

Accomodation

-This test also requires the tongue depressor, one eye is tested in isolation and a measurement is taken. The subject stops the tongue depressor once the letter they have focused on becomes blurry and a measurement is taken from device to tip of the nose.

Horizontal Vestibular Ocular Reflex (VOR)

-During this test the subject will extend the arm infront of them with their thumb up. The subject will rotate approximately 20° left to right in tune with a metronome (180bps, 4/4), all while keeping their eyes focused on the outstretched thumb. Ten repetitions are to be performed.

Vertical Vestibular Ocular Reflex (VOR)

-Similar to the Horizontal VOR test, the subject outstretches the hand but places the thumb sideways. The subject is then instructed to flex and extend the neck approximately 20° up and down, while keeping their eyes focused on the thumb. The metronome should be set exactly as it was for the HVOR test, and ten repetitions should be demonstraited.

Optokinetic Sensitivity

-Last but not least, during this test the subject starts in the same position as the Horizontal VOR test, but instead of moving the head they rotate the entire body approximately 180°, while continuing to keep eye contact on the outstretched thumb. During this test the metronome is also used (50bpm 4/4), and 5 repetitions are to be performed.