search
Back to results

The Effect of Binasal Occlusion on Balance Following a Concussion

Primary Purpose

Concussion Post Syndrome

Status
Unknown status
Phase
Not Applicable
Locations
Study Type
Interventional
Intervention
Binasal occlusion
No binasal occlusion
Sponsored by
University of Ottawa
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Concussion Post Syndrome focused on measuring Balance, Dual-task, King-Devick Test, Saccades, Binasal Occlusion

Eligibility Criteria

18 Years - 65 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

Forty adults with persistent symptoms one month or more following a concussion will be recruited for the study. Individuals will be considered eligible if they have been diagnosed with a concussion as defined in the 2016 Berlin consensus statement (McCrory et al., 2017) as a traumatic brain injury induced by biomechanics forces, which was caused by either a direct or indirect blow to the head, face, neck or elsewhere on the body with an impulsive force transmitted to the head, which may or may not have involved loss of consciousness, and included one or more of the following clinical domains:

  • Symptoms (e.g. headache, nausea, fatigue, feeling like in a fog, difficulty concentrating or remembering, and/or emotional lability)
  • Physical signs (e.g. loss of consciousness, amnesia, neurological deficit);
  • Balance impairment (e.g. gait unsteadiness)
  • Behavioural changes (e.g. irritability)
  • Cognitive impairment (e.g. slowed reaction times)
  • Sleep/wake disturbance (e.g. somnolence, drowsiness) Participants must also meet the following inclusion criteria: (1) aged 18-65 years; (2) sustained the concussion 4 or more weeks ago; (3) report persistent dizziness or balance problems not accounted for by a pre-existing musculoskeletal, neurological, or vestibular condition; (4) have normal vision or visual impairments that can be corrected with contact lenses; (5) are proficient in English or French; (6) are able to provide informed consent.

Exclusion Criteria:

  • Do not meet criteria stipulated in the inclusion criteria

Sites / Locations

    Arms of the Study

    Arm 1

    Arm 2

    Arm Type

    Experimental

    Active Comparator

    Arm Label

    Binasal occlusion

    No binasal occlusion

    Arm Description

    Participants will be fitted with glasses covered with occlusive tape from the inner canthi to the nasal border on each lens.

    Participants will be fitted with non-occluded glasses.

    Outcomes

    Primary Outcome Measures

    Postural sway
    The primary outcome of interest is the mean medial/lateral and anterior/posterior velocity of centre of pressure, in addition to the 95% ellipse during different conditions of static balance. The minimal clinical difference considered to demonstrate a change in postural sway is 5cm based on previous validation of the Balance TrackS force plate in a concussed population.

    Secondary Outcome Measures

    Time to completion of the King-Devick Test (KDT)
    The KDT is a vision-based test of rapid number naming speed that acts as a proxy measure for saccadic eye movement. The KDT consists of a demonstration card, plus a series of 3 increasingly more difficult test cards of variably spaced single digit numbers. Following completion of the demonstration card, participants are asked to read each test card from left to right, top to bottom, as quickly as possible without errors. A summary score of the test is recorded as the total time to complete all 3 test cards, measured in seconds. Time to completion for the KDT will be recorded. Any increase in time compared with a control condition, or any uncorrected errors are considered a significant change.
    Saccadic eye movement
    Saccadic eye movement will be assessed with a Tobii™ Pro wearable eye tracker. Tobii™ Pro wearable eye tracker uses infrared video-oculography to analyze patterns of eye movement in terms of fixations and saccades. Longer, more complicated visual tasks, such as rapid number naming, require longer processing times. The number of saccades completed during each balance condition will be recorded by the Tobii™ Pro.
    Post-concussion symptom score (PCSS)
    The PCSS is a standardized and easily administered 22-item self-report symptom scale that measures the severity of each symptom experienced that day. Symptoms are reported on a 7-point Likert scale, with 0 and 6 representing anchoring points from the absence of symptoms to the presence of severe symptoms. Results are conveyed as the total symptom score and range from 0-132, with a higher score associated with a higher level of symptoms. Total scores demonstrate high internal consistency in a concussion population (α=0.93), with a 6.8 point change (80% CI) associated with a clinical change in symptoms.
    Neck Disability Index (NDI)
    The NDI is the most commonly used self-report outcome measure for neck pain. The index is a simple and quickly administered 10-item questionnaire measured on a 6-point Likert scale from 0=no disability to 5 = full disability. Scores range from 0-50, with 50 representing the highest level of disability. Clinically important difference have been reported with a 5-7 point change in score depending on whether the pain was of musculoskeletal or neural origin.
    Dizziness Handicap Inventory (DHI)
    The DHI is a self-report measure of disability associated with dizziness. Internal consistency is high for total scores (α = 0.89). The presence of dizziness-related disability is scored as no (0), sometimes (2), or yes (4). Scores range from 0-100, with a higher score reflecting a greater disability associated with dizziness. Cut-off scores exist for mild (16-34), moderate (36-52), and severe (54+) disability, with an 18-point change in score considered clinically meaningful.

    Full Information

    First Posted
    November 9, 2017
    Last Updated
    October 29, 2018
    Sponsor
    University of Ottawa
    search

    1. Study Identification

    Unique Protocol Identification Number
    NCT03355339
    Brief Title
    The Effect of Binasal Occlusion on Balance Following a Concussion
    Official Title
    The Effect of Binasal Occlusion on Balance Following a Concussion
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    October 2018
    Overall Recruitment Status
    Unknown status
    Study Start Date
    November 2018 (Anticipated)
    Primary Completion Date
    September 2019 (Anticipated)
    Study Completion Date
    September 2019 (Anticipated)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Principal Investigator
    Name of the Sponsor
    University of Ottawa

    4. Oversight

    Studies a U.S. FDA-regulated Drug Product
    No
    Studies a U.S. FDA-regulated Device Product
    No
    Data Monitoring Committee
    No

    5. Study Description

    Brief Summary
    This study evaluates the effect of binasal occlusion (BNO) glasses on balance and eye movement in adults with dizziness after a concussion. Participants will stand on a force plate while rapidly reading a series of numbers both with and without the BNO glasses. It is thought that the BNO glasses will improve both balance and the time to read the numbers.
    Detailed Description
    While most individuals will recover within the first month after concussion, a significant number will continue to experience dizziness, balance problems, cognitive deficits, and vision problems. Single-task measures of static balance may not be sensitive enough, however, to capture mild postural changes still associated with incomplete recovery. Increasingly there is an interest in dual-task paradigms of balance assessment as a more accurate representation of functional postural control associated with activities of daily living and sport participation. Binasal occlusion (BNO) has been proposed as a means of providing visual stabilization to improve postural control in individuals with vision-related balance problems following a concussion.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Concussion Post Syndrome
    Keywords
    Balance, Dual-task, King-Devick Test, Saccades, Binasal Occlusion

    7. Study Design

    Primary Purpose
    Treatment
    Study Phase
    Not Applicable
    Interventional Study Model
    Crossover Assignment
    Masking
    None (Open Label)
    Allocation
    Randomized
    Enrollment
    40 (Anticipated)

    8. Arms, Groups, and Interventions

    Arm Title
    Binasal occlusion
    Arm Type
    Experimental
    Arm Description
    Participants will be fitted with glasses covered with occlusive tape from the inner canthi to the nasal border on each lens.
    Arm Title
    No binasal occlusion
    Arm Type
    Active Comparator
    Arm Description
    Participants will be fitted with non-occluded glasses.
    Intervention Type
    Device
    Intervention Name(s)
    Binasal occlusion
    Intervention Description
    Binasal occlusion glasses
    Intervention Type
    Device
    Intervention Name(s)
    No binasal occlusion
    Intervention Description
    Non-occluded glasses
    Primary Outcome Measure Information:
    Title
    Postural sway
    Description
    The primary outcome of interest is the mean medial/lateral and anterior/posterior velocity of centre of pressure, in addition to the 95% ellipse during different conditions of static balance. The minimal clinical difference considered to demonstrate a change in postural sway is 5cm based on previous validation of the Balance TrackS force plate in a concussed population.
    Time Frame
    After one month post-injury. Data collection will occur in one single session per participant upon enrolment in the study.
    Secondary Outcome Measure Information:
    Title
    Time to completion of the King-Devick Test (KDT)
    Description
    The KDT is a vision-based test of rapid number naming speed that acts as a proxy measure for saccadic eye movement. The KDT consists of a demonstration card, plus a series of 3 increasingly more difficult test cards of variably spaced single digit numbers. Following completion of the demonstration card, participants are asked to read each test card from left to right, top to bottom, as quickly as possible without errors. A summary score of the test is recorded as the total time to complete all 3 test cards, measured in seconds. Time to completion for the KDT will be recorded. Any increase in time compared with a control condition, or any uncorrected errors are considered a significant change.
    Time Frame
    After one month post-injury. Data collection will occur in one single session per participant upon enrolment in the study.
    Title
    Saccadic eye movement
    Description
    Saccadic eye movement will be assessed with a Tobii™ Pro wearable eye tracker. Tobii™ Pro wearable eye tracker uses infrared video-oculography to analyze patterns of eye movement in terms of fixations and saccades. Longer, more complicated visual tasks, such as rapid number naming, require longer processing times. The number of saccades completed during each balance condition will be recorded by the Tobii™ Pro.
    Time Frame
    After one month post-injury. Data collection will occur in one single session per participant upon enrolment in the study.
    Title
    Post-concussion symptom score (PCSS)
    Description
    The PCSS is a standardized and easily administered 22-item self-report symptom scale that measures the severity of each symptom experienced that day. Symptoms are reported on a 7-point Likert scale, with 0 and 6 representing anchoring points from the absence of symptoms to the presence of severe symptoms. Results are conveyed as the total symptom score and range from 0-132, with a higher score associated with a higher level of symptoms. Total scores demonstrate high internal consistency in a concussion population (α=0.93), with a 6.8 point change (80% CI) associated with a clinical change in symptoms.
    Time Frame
    After one month post-injury. Data collection will occur in one single session per participant upon enrolment in the study.
    Title
    Neck Disability Index (NDI)
    Description
    The NDI is the most commonly used self-report outcome measure for neck pain. The index is a simple and quickly administered 10-item questionnaire measured on a 6-point Likert scale from 0=no disability to 5 = full disability. Scores range from 0-50, with 50 representing the highest level of disability. Clinically important difference have been reported with a 5-7 point change in score depending on whether the pain was of musculoskeletal or neural origin.
    Time Frame
    After one month post-injury. Data collection will occur in one single session per participant upon enrolment in the study.
    Title
    Dizziness Handicap Inventory (DHI)
    Description
    The DHI is a self-report measure of disability associated with dizziness. Internal consistency is high for total scores (α = 0.89). The presence of dizziness-related disability is scored as no (0), sometimes (2), or yes (4). Scores range from 0-100, with a higher score reflecting a greater disability associated with dizziness. Cut-off scores exist for mild (16-34), moderate (36-52), and severe (54+) disability, with an 18-point change in score considered clinically meaningful.
    Time Frame
    After one month post-injury. Data collection will occur in one single session per participant upon enrolment in the study.

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    18 Years
    Maximum Age & Unit of Time
    65 Years
    Accepts Healthy Volunteers
    No
    Eligibility Criteria
    Inclusion Criteria: Forty adults with persistent symptoms one month or more following a concussion will be recruited for the study. Individuals will be considered eligible if they have been diagnosed with a concussion as defined in the 2016 Berlin consensus statement (McCrory et al., 2017) as a traumatic brain injury induced by biomechanics forces, which was caused by either a direct or indirect blow to the head, face, neck or elsewhere on the body with an impulsive force transmitted to the head, which may or may not have involved loss of consciousness, and included one or more of the following clinical domains: Symptoms (e.g. headache, nausea, fatigue, feeling like in a fog, difficulty concentrating or remembering, and/or emotional lability) Physical signs (e.g. loss of consciousness, amnesia, neurological deficit); Balance impairment (e.g. gait unsteadiness) Behavioural changes (e.g. irritability) Cognitive impairment (e.g. slowed reaction times) Sleep/wake disturbance (e.g. somnolence, drowsiness) Participants must also meet the following inclusion criteria: (1) aged 18-65 years; (2) sustained the concussion 4 or more weeks ago; (3) report persistent dizziness or balance problems not accounted for by a pre-existing musculoskeletal, neurological, or vestibular condition; (4) have normal vision or visual impairments that can be corrected with contact lenses; (5) are proficient in English or French; (6) are able to provide informed consent. Exclusion Criteria: Do not meet criteria stipulated in the inclusion criteria
    Central Contact Person:
    First Name & Middle Initial & Last Name or Official Title & Degree
    Jacquie J van Ierssel, PT, MSc
    Phone
    613-562-5800
    Ext
    7099
    Email
    jminn044@uottawa.ca
    First Name & Middle Initial & Last Name or Official Title & Degree
    Jennifer O'Neil, PT, MSc
    Phone
    613-562-5800
    Ext
    7099
    Email
    joneil@uottawa.ca
    Overall Study Officials:
    First Name & Middle Initial & Last Name & Degree
    Heidi Sveistrup, PhD
    Organizational Affiliation
    University of Ottawa
    Official's Role
    Principal Investigator

    12. IPD Sharing Statement

    Plan to Share IPD
    No
    Citations:
    PubMed Identifier
    15809571
    Citation
    Broglio SP, Tomporowski PD, Ferrara MS. Balance performance with a cognitive task: a dual-task testing paradigm. Med Sci Sports Exerc. 2005 Apr;37(4):689-95. doi: 10.1249/01.mss.0000159019.14919.09.
    Results Reference
    background
    PubMed Identifier
    24284947
    Citation
    Chang JO, Levy SS, Seay SW, Goble DJ. An alternative to the balance error scoring system: using a low-cost balance board to improve the validity/reliability of sports-related concussion balance testing. Clin J Sport Med. 2014 May;24(3):256-62. doi: 10.1097/JSM.0000000000000016.
    Results Reference
    background
    PubMed Identifier
    22900490
    Citation
    Ciuffreda KJ, Yadav NK, Ludlam DP. Effect of binasal occlusion (BNO) on the visual-evoked potential (VEP) in mild traumatic brain injury (mTBI). Brain Inj. 2013;27(1):41-7. doi: 10.3109/02699052.2012.700088. Epub 2012 Aug 17.
    Results Reference
    background
    PubMed Identifier
    28792441
    Citation
    Ciuffreda KJ, Yadav NK, Ludlam DP. Binasal Occlusion (BNO), Visual Motion Sensitivity (VMS), and the Visually-Evoked Potential (VEP) in mild Traumatic Brain Injury and Traumatic Brain Injury (mTBI/TBI). Brain Sci. 2017 Aug 9;7(8):98. doi: 10.3390/brainsci7080098.
    Results Reference
    background
    PubMed Identifier
    27936960
    Citation
    Degani AM, Santos MM, Leonard CT, Rau TF, Patel SA, Mohapatra S, Danna-Dos-Santos A. The effects of mild traumatic brain injury on postural control. Brain Inj. 2017;31(1):49-56. doi: 10.1080/02699052.2016.1225982. Epub 2016 Dec 12.
    Results Reference
    background
    PubMed Identifier
    30202552
    Citation
    Galetta KM, Liu M, Leong DF, Ventura RE, Galetta SL, Balcer LJ. The King-Devick test of rapid number naming for concussion detection: meta-analysis and systematic review of the literature. Concussion. 2015 Sep 10;1(2):CNC8. doi: 10.2217/cnc.15.8. eCollection 2016 Mar.
    Results Reference
    background
    PubMed Identifier
    25742059
    Citation
    Galetta KM, Morganroth J, Moehringer N, Mueller B, Hasanaj L, Webb N, Civitano C, Cardone DA, Silverio A, Galetta SL, Balcer LJ. Adding Vision to Concussion Testing: A Prospective Study of Sideline Testing in Youth and Collegiate Athletes. J Neuroophthalmol. 2015 Sep;35(3):235-41. doi: 10.1097/WNO.0000000000000226.
    Results Reference
    background
    Citation
    Gallop S. A variation on the use of binasal occlusion glasses - a case study. Journal of Behavioural Optometry 9(2): 31-35, 1998.
    Results Reference
    background
    Citation
    Gallop S. Viewpoint 4 Binasal Occlusion - Immediate , Sustainable Symptomatic Relief. Optometry & Visual Performance 9(2):31-35, 2014.
    Results Reference
    background
    PubMed Identifier
    27104048
    Citation
    Goble DJ, Manyak KA, Abdenour TE, Rauh MJ, Baweja HS. AN INITIAL EVALUATION OF THE BTRACKS BALANCE PLATE AND SPORTS BALANCE SOFTWARE FOR CONCUSSION DIAGNOSIS. Int J Sports Phys Ther. 2016 Apr;11(2):149-55.
    Results Reference
    background
    PubMed Identifier
    2317323
    Citation
    Jacobson GP, Newman CW. The development of the Dizziness Handicap Inventory. Arch Otolaryngol Head Neck Surg. 1990 Apr;116(4):424-7. doi: 10.1001/archotol.1990.01870040046011.
    Results Reference
    background
    PubMed Identifier
    26291632
    Citation
    Hunt AW, Mah K, Reed N, Engel L, Keightley M. Oculomotor-Based Vision Assessment in Mild Traumatic Brain Injury: A Systematic Review. J Head Trauma Rehabil. 2016 Jul-Aug;31(4):252-61. doi: 10.1097/HTR.0000000000000174.
    Results Reference
    background
    PubMed Identifier
    28455363
    Citation
    Kamins J, Bigler E, Covassin T, Henry L, Kemp S, Leddy JJ, Mayer A, McCrea M, Prins M, Schneider KJ, Valovich McLeod TC, Zemek R, Giza CC. What is the physiological time to recovery after concussion? A systematic review. Br J Sports Med. 2017 Jun;51(12):935-940. doi: 10.1136/bjsports-2016-097464. Epub 2017 Apr 28.
    Results Reference
    background
    PubMed Identifier
    22149161
    Citation
    Kleffelgaard I, Roe C, Soberg HL, Bergland A. Associations among self-reported balance problems, post-concussion symptoms and performance-based tests: a longitudinal follow-up study. Disabil Rehabil. 2012;34(9):788-94. doi: 10.3109/09638288.2011.619624. Epub 2011 Dec 9.
    Results Reference
    background
    PubMed Identifier
    21712482
    Citation
    Lau BC, Kontos AP, Collins MW, Mucha A, Lovell MR. Which on-field signs/symptoms predict protracted recovery from sport-related concussion among high school football players? Am J Sports Med. 2011 Nov;39(11):2311-8. doi: 10.1177/0363546511410655. Epub 2011 Jun 28.
    Results Reference
    background
    PubMed Identifier
    18608358
    Citation
    Levac D, DeMatteo C, Hanna S, Wishart L. Intra-individual variability in recovery from paediatric acquired brain injury: relationship to outcomes at 1 year. Dev Neurorehabil. 2008 Jul;11(3):195-203. doi: 10.1080/17518420802055177.
    Results Reference
    background
    PubMed Identifier
    17361669
    Citation
    Lovell MR, Iverson GL, Collins MW, Podell K, Johnston KM, Pardini D, Pardini J, Norwig J, Maroon JC. Measurement of symptoms following sports-related concussion: reliability and normative data for the post-concussion scale. Appl Neuropsychol. 2006;13(3):166-74. doi: 10.1207/s15324826an1303_4.
    Results Reference
    background
    PubMed Identifier
    19521015
    Citation
    MacDermid JC, Walton DM, Avery S, Blanchard A, Etruw E, McAlpine C, Goldsmith CH. Measurement properties of the neck disability index: a systematic review. J Orthop Sports Phys Ther. 2009 May;39(5):400-17. doi: 10.2519/jospt.2009.2930.
    Results Reference
    background
    PubMed Identifier
    25871303
    Citation
    Marshall S, Bayley M, McCullagh S, Velikonja D, Berrigan L, Ouchterlony D, Weegar K; mTBI Expert Consensus Group. Updated clinical practice guidelines for concussion/mild traumatic brain injury and persistent symptoms. Brain Inj. 2015;29(6):688-700. doi: 10.3109/02699052.2015.1004755. Epub 2015 Apr 14.
    Results Reference
    background
    PubMed Identifier
    26156977
    Citation
    Master CL, Scheiman M, Gallaway M, Goodman A, Robinson RL, Master SR, Grady MF. Vision Diagnoses Are Common After Concussion in Adolescents. Clin Pediatr (Phila). 2016 Mar;55(3):260-7. doi: 10.1177/0009922815594367. Epub 2015 Jul 7.
    Results Reference
    background
    PubMed Identifier
    28390513
    Citation
    McCrea MA, Nelson LD, Guskiewicz K. Diagnosis and Management of Acute Concussion. Phys Med Rehabil Clin N Am. 2017 May;28(2):271-286. doi: 10.1016/j.pmr.2016.12.005. Epub 2017 Mar 1.
    Results Reference
    background
    PubMed Identifier
    28446457
    Citation
    McCrory P, Meeuwisse W, Dvorak J, Aubry M, Bailes J, Broglio S, Cantu RC, Cassidy D, Echemendia RJ, Castellani RJ, Davis GA, Ellenbogen R, Emery C, Engebretsen L, Feddermann-Demont N, Giza CC, Guskiewicz KM, Herring S, Iverson GL, Johnston KM, Kissick J, Kutcher J, Leddy JJ, Maddocks D, Makdissi M, Manley GT, McCrea M, Meehan WP, Nagahiro S, Patricios J, Putukian M, Schneider KJ, Sills A, Tator CH, Turner M, Vos PE. Consensus statement on concussion in sport-the 5th international conference on concussion in sport held in Berlin, October 2016. Br J Sports Med. 2017 Jun;51(11):838-847. doi: 10.1136/bjsports-2017-097699. Epub 2017 Apr 26. No abstract available.
    Results Reference
    background
    PubMed Identifier
    27789036
    Citation
    O'Connor SM, Baweja HS, Goble DJ. Validating the BTrackS Balance Plate as a low cost alternative for the measurement of sway-induced center of pressure. J Biomech. 2016 Dec 8;49(16):4142-4145. doi: 10.1016/j.jbiomech.2016.10.020. Epub 2016 Oct 20.
    Results Reference
    background
    PubMed Identifier
    28270437
    Citation
    Patricios J, Fuller GW, Ellenbogen R, Herring S, Kutcher JS, Loosemore M, Makdissi M, McCrea M, Putukian M, Schneider KJ. What are the critical elements of sideline screening that can be used to establish the diagnosis of concussion? A systematic review. Br J Sports Med. 2017 Jun;51(11):888-894. doi: 10.1136/bjsports-2016-097441. Epub 2017 Mar 7.
    Results Reference
    background
    Citation
    Proctor A. Traumatic brain injury and binasal occlusion. Optometry and Vision Development, 40(1): 45-50, 2009.
    Results Reference
    background
    PubMed Identifier
    27752515
    Citation
    Rizzo JR, Hudson TE, Dai W, Birkemeier J, Pasculli RM, Selesnick I, Balcer LJ, Galetta SL, Rucker JC. Rapid number naming in chronic concussion: eye movements in the King-Devick test. Ann Clin Transl Neurol. 2016 Sep 1;3(10):801-811. doi: 10.1002/acn3.345. eCollection 2016 Oct.
    Results Reference
    background
    PubMed Identifier
    28451603
    Citation
    Rochefort C, Walters-Stewart C, Aglipay M, Barrowman N, Zemek R, Sveistrup H. Balance Markers in Adolescents at 1 Month Postconcussion. Orthop J Sports Med. 2017 Mar 17;5(3):2325967117695507. doi: 10.1177/2325967117695507. eCollection 2017 Mar.
    Results Reference
    background
    PubMed Identifier
    22889928
    Citation
    Scoppa F, Capra R, Gallamini M, Shiffer R. Clinical stabilometry standardization: basic definitions--acquisition interval--sampling frequency. Gait Posture. 2013 Feb;37(2):290-2. doi: 10.1016/j.gaitpost.2012.07.009. Epub 2012 Aug 11.
    Results Reference
    background
    PubMed Identifier
    28859119
    Citation
    Subotic A, Ting WK, Cusimano MD. Characteristics of the King-Devick test in the assessment of concussed patients in the subacute and later stages after injury. PLoS One. 2017 Aug 31;12(8):e0183092. doi: 10.1371/journal.pone.0183092. eCollection 2017.
    Results Reference
    background
    PubMed Identifier
    24564831
    Citation
    Yadav NK, Thiagarajan P, Ciuffreda KJ. Effect of oculomotor vision rehabilitation on the visual-evoked potential and visual attention in mild traumatic brain injury. Brain Inj. 2014;28(7):922-9. doi: 10.3109/02699052.2014.887227. Epub 2014 Feb 24.
    Results Reference
    background
    PubMed Identifier
    23303474
    Citation
    Zemek RL, Farion KJ, Sampson M, McGahern C. Prognosticators of persistent symptoms following pediatric concussion: a systematic review. JAMA Pediatr. 2013 Mar 1;167(3):259-65. doi: 10.1001/2013.jamapediatrics.216.
    Results Reference
    background
    Links:
    URL
    http://www.tobiipro.com
    Description
    Tobii Pro

    Learn more about this trial

    The Effect of Binasal Occlusion on Balance Following a Concussion

    We'll reach out to this number within 24 hrs