Determining the clinical performance of dynamic visual acuity test (DVAT) in the concussion assessment battery

Background: Dizziness and visual complaints are common symptoms reported post-concussion. Dynamic visual acuity test (DVAT) is emerging as a useful assessment for identification of head injuries and monitoring recovery; however, the clinical performance of DVAT in the concussion battery is currently unknown. Purpose: The first aim of this study was to determine the clinical performance of DVAT as a stand-alone test to identify symptomatic and asymptomatic athletes diagnosed with a concussion. The second aim of this study was to determine the clinical performance of DVAT in combination with other vestibular/balance measures, neurocognitive, and symptom report to identify symptomatic and asymptomatic athletes diagnosed with a concussion. The third aim of this study was to examine the effects of background noise and a complex visual background on DVAT performance in healthy collegiate athletes. Methods: To address aims one and two, a retrospective analysis of post-concussion vestibular, balance and neurocognitive testing was completed. Receiver-operating characteristic curve and area under the curve were used to determine the clinical performance (i.e., sensitivity/specificity) of individual and combined measures to accurately identify athletes diagnosed with a concussion. To address aim three, healthy athletes completed DVAT twice, once in the control environment and once in the experimental environment (background noise and a complex visual background). A dependent sample t-test was used to compare DVAT performance in the control and experimental condition. Results: As a stand-alone measure, DVAT clinical performance was not considered significant for any of the groups. When DVAT was combined with the traditional concussion protocol (BESS, ImPACT) the clinical performance improved. When DVAT replaced the BESS in the protocol, clinical performance did not change. Further, results from specific aim three revealed that background noise and a complex visual background did not affect DVAT performance. Discussion: Findings from this study suggest that DVAT could be used in the concussion assessment protocol; however, at this time DVAT should not replace BESS in the acute phase, but may have clinical use for monitoring recovery. Further, DVAT may serve as a more alternative in the sideline environment to avoid any wait time in making return to play decisions