Adults are not Older-Adolescents: Comparing Clinical Findings among Adolescents and Adults with Persistent Post-Concussive Symptoms

Research Objectives: To determine if clinical findings related to oculomotor, vestibular, balance, and cervical function differ between adolescents (age 12-17), younger adults (age 20-45), and older adults (age 46-65) with persistent post-concussive symptoms (PPCS). There is limited research on the prevalence of these clinical signs in adults with PPCS and how clinical presentations may differ between adults and adolescents.

Design: Retrospective case-control study.

Setting: Multi-center, community-based, private physical therapy practice specializing in the management of neurologic conditions, including concussion.

Participants: Patients presenting with PPCS (n = 481, mean 197 ± 154 days since injury) were divided into Adolescents (n=103), Younger Adults (n=195), and Older Adults (n=183). Physical assessments were categorized as ocular, cervical and vestibular/balance.

Interventions: Not applicable.

Main Outcome Measures: Prevalence of clinical findings on physical assessment related to oculomotility (smooth pursuits, saccades, near point of convergence [NPC]), vestibular/balance function (vestibulo-ocular reflex, head impulse test, dynamic visual acuity test, Romberg test), and cervical function (cervical range of motion [ROM] limitations, tenderness to palpation).

Results: Younger and older adults had a greater prevalence of NPC impairment (p < 0.001) as well as more abnormal vestibular (VOR [p < 0.001] and Head Impulse Test [p=0.017]) and balance (Romberg Test [p < 0.001]) findings. Adolescents had a higher prevalence of cervical impairments (ROM [p < 0.001] and palpation [p < 0.001]). There were no significant differences observed in ocular, vestibular/balance, or cervical findings between younger and older adults.

Conclusions: In this group of individuals with PPCS, adults demonstrated a different constellation of clinical findings compared to adolescents. Different presentations may inform different approaches to rehabilitation. Prospective evaluation is warranted.

Author(s) Disclosures: Nothing to disclose.