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Differential Diagnosis of Dizziness Following a Sports-Related Concussion

Reneker, Jennifer Christine
http://orcid.org/0000-0003-3617-5681
http://rave.ohiolink.edu/etdc/view?acc_num=kent1445530345

Abstract Details

2015, PHD, Kent State University, College of Public Health.
Aim 1: Synopsis The primary goal of Aim 1 was to determine if subjects’ dizziness descriptors cluster in a manner that enables differentiation by anatomical location. Latent Class Analysis (LCA) was used to identify latent traits present in a structured symptom history questionnaire including 15 descriptors and 11 triggers of dizziness. The separate analyses of the two components of the subjective history; the descriptors of dizziness and triggers of dizziness, revealed that three classes emerged for each set of variables. Although three classes were identified through LCA within the descriptors, conclusions regarding the ability of these classes to identify a specific anatomical location were unable to be drawn. Similarly, the three classes of triggers were unable to be definitively linked to a specific type of dizziness. Established patterns of dizziness description associated with specific types of dizziness in other populations (i.e. subjects without a concussion) were not observed with this sample of subjects with SRC. The conclusion drawn from this study is that the use of the patient description of dizziness to base the direction of the objective examination may not be a reliable method to approach a patient with a SRC and dizziness. Aim 2: Synopsis The primary goal of Aim 2 was to utilize research and clinical expertise of an invited respondent group to identify objective tests with high clinical utility that should be included in a physical examination to differentiate between the different subtypes of dizziness after a SRC. Specifically, the question posed to the group was: What clinical tests and measures could be included in an assessment to differentiate between cervicogenic and other causes of dizziness in concussed athletes? Through a three round process, including 25 experts from various medical disciplines, 10 tests were identified to have strong clinical utility and 7 were identified as having weak clinical utility. The clinical tests included in the final list of measures with strong clinical utility were tests to identify vestibular and ocular impairments leading to dizziness. Unfortunately, none of the clinical tests used to identify cervical dizziness were regarded as having strong clinical utility. Even though a majority of the respondents were physical therapists, those therapists who were not orthopaedic / manual therapists did not indicate strong clinical utility for any of the cervically-oriented tests. It was concluded that many medical professionals are unfamiliar with tests of the cervical spine and the diagnosis of cervicogenic dizziness. The results of this study highlight the current absence of well-defined, universally understood clinical tests to diagnose cervicogenic dizziness in the presence of concussion. Aim 3: Synopsis Aim 3 used the results of the Delphi from round 2 (in part) to construct and utilize a physical examination of subjects with dizziness after SRC. Each of the 16 clinical tests was regarded as positive or negative, based standard interpretation of the test (e.g. indications of a positive finding). Here, positive findings provided indication of the anatomical location(s) contributing to dizziness. The primary purpose of Aim 3 was to describe the results of this differential objective physical examination in subjects with dizziness after a SRC and determine the relationships between various types of dizziness as identified by the objective examination. Multiple Correspondence Analysis (MCA) was used to graphically represent the results. Within MCA, five dimensions were required to adequately describe the relationships between the response profiles and accounted for > 70% of the inertia. The exploratory MCA revealed that while some tests clustered and identified a common etiology of dizziness, some clusters identified more than one anatomical area within the positive findings. The results of this study indicate that after SRC, an athlete’s dizziness is often multifactorial, potentially originating from multiple anatomical locations, each independently sufficient to cause dizziness.
Vinay Cheruvu, PhD (Committee Co-Chair)
Mark James, PhD (Committee Co-Chair)
Jingzhen Yang, PhD (Committee Member)
Chad Cook, PT, PhD, MBA (Committee Member)
75 p.
Epidemiology; Neurology; Physical Therapy; Public Health; Sports Medicine
Concussion; traumatic brain injury; dizziness; differential diagnosis; Latent Class Analysis; Delphi Method; Multiple Correspondence Analysis

Recommended Citations

Citations

  • Reneker, J. C. (2015). Differential Diagnosis of Dizziness Following a Sports-Related Concussion [Doctoral dissertation, Kent State University]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=kent1445530345

    APA Style (7th edition)

  • Reneker, Jennifer. Differential Diagnosis of Dizziness Following a Sports-Related Concussion. 2015. Kent State University, Doctoral dissertation. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=kent1445530345.

    MLA Style (8th edition)

  • Reneker, Jennifer. "Differential Diagnosis of Dizziness Following a Sports-Related Concussion." Doctoral dissertation, Kent State University, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=kent1445530345

    Chicago Manual of Style (17th edition)

kent1445530345
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© 2015, all rights reserved.
This open access ETD is published by Kent State University and OhioLINK.