Screening Scale of Oculomotor Symptoms in Traumatic Brain Injury Patients to Facilitate Referrals to Neuro-Ophthalmologists for Rehabilitation

Background: Oculomotor dysfunction (OMD) is observed in perhaps 10% to 30% of motorists injured in high impact car accidents. A screening tool for signs of OMD is needed to facilitate systematic evaluations of such patients for potential referral to neuro-ophthalmologists for rehabilitation.

Method: A perusal of neuro-opthalmological case reports and OMD literature led to the development of a 15 item scale. This Oculomotor Scale was administered to 29 survivors of high impact motor vehicle accidents (MVAs) who complained about OMD signs and to 30 normal controls. The patients’ scores were also available on the Rivermead measure of the post-concussion syndrome, the Post-MVA Neurological Symptoms (PMNS) scale, the Insomnia Severity Index, and ratings of pain, depression, and anxiety.

Results: Criterion validity of the Oculomotor Scale is demonstrated by its very satisfactory capacity to differentiate the patients reporting OMD signs from the normal controls (point biserial coefficient =.87, p<.001). Convergent validity of the scale is shown by its significant and large correlations to Rivermead post-concussive scores (r=.70, p<.001) and to the PMNS measure of post-accident neuropsychological symptoms (r=.65, p<.001).

Discussion and Conclusions: The Oculomotor Scale has not been designed for independent diagnosing of oculomotor dysfunction (OMD): it is intended only as a brief screening scale for family physicians or medical psychologists, in order to facilitate a referral for the thorough professional assessment by specialized rehabilitative neuro-ophthalmologists. Hopefully, the availability of this screening scale would increase the number of referrals of such patients with post-accident oculomotor dysfunction for beneficial specialized assessment and therapies by rehabilitative neuro-ophthalmologists.

Keywords: oculomotor dysfunction, visual tracking, oculomotor scale, post-concussion syndrome, whiplash syndrome.