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Article

Early, Self-Guided Oculomotor Rehabilitation in Adolescents with Sport-Related Concussion Is Feasible and Effective: A Quasi-Experimental Trial

by
Mohammad N. Haider
1,*,
Jazlyn M. Edwards
2,
Jacob I. McPherson
3,
Krishnamurti A. Rao
4,
John J. Leddy
1 and
Haley M. Chizuk
1
1
UBMD Orthopaedics and Sports Medicine, Department of Orthopaedics, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY 14221, USA
2
PhD Program in Biomedical Sciences, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY 14201, USA
3
Department of Rehabilitation Science, School of Public Health and Health Professions, State University of New York at Buffalo, Buffalo, NY 14214, USA
4
Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY 14203, USA
*
Author to whom correspondence should be addressed.
Appl. Sci. 2025, 15(21), 11330; https://doi.org/10.3390/app152111330
Submission received: 8 September 2025 / Revised: 14 October 2025 / Accepted: 17 October 2025 / Published: 22 October 2025
(This article belongs to the Special Issue Recent Advances in Sports Injuries and Physical Rehabilitation)
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Abstract

Oculomotor dysfunction identified within the first 10 days of sport-related concussion (SRC) is a risk factor for Persisting Post-Concussion Symptoms (PPCS). Oculomotor rehabilitation is the recommended treatment for oculomotor dysfunction from the subacute period onwards. However, there are delays in initiating rehabilitation due to a limited number of specialized providers and associated healthcare costs. Delays in initiating treatment are associated with worse outcomes. We performed a retrospective, quasi-experimental trial to evaluate whether providing instructions for self-guided oculomotor rehabilitation in adolescents with 3 or more abnormal oculomotor findings after SRC (Experimental Arm, n = 27, mean age = 15.50 ± 1.53 years, 63.0% male, 5.74 ± 2.43 days since injury) reduced the number of persisting impairments at 4 weeks compared to a wait-and-see approach (Standard Care Arm, n = 106, mean age = 14.98 ± 1.87 years, 59.4% male, 5.69 ± 2.78 days since injury). A small difference was seen in the incidence of neck tenderness but there were no differences between groups in symptom severity or number of abnormal oculomotor findings at initial presentation. Overall, 50 out of 106 (47.2%) participants in the Standard Care Arm had PPCS compared to 7 out of 27 (25.9%) in the Experimental Arm, which was significantly different (Chi-squared = 3.966, p = 0.046). This corresponds to an absolute risk reduction of 21.3%. Results from our pilot study suggest these treatment guidelines are feasible to incorporate into a busy outpatient practice in a cost-effective manner. Prospectively designed randomized controlled trials are warranted to validate the effectiveness of this treatment.

1. Introduction

Sport-related concussion (SRC) is a mild traumatic brain injury obtained during a sport or recreation-related activity. It leads to a variety of impairments, including post-traumatic headaches, cognitive dysfunction, visual dysfunction, balance problems, exercise intolerance, and affective symptoms [1]. Delayed recovery from SRC is termed Persisting Post-Concussion Symptoms (PPCS) and is defined as being symptomatic for longer than 4 weeks in the athlete population [2]. The signs and symptoms of SRC can be grouped into subtypes to direct treatment [3]. There is substantial overlap between subtypes [4] and patients who fit the profile for more than one subtype often require multiple distinct therapeutic interventions. Visual dysfunction is one of the most common acute and chronic problems of SRC, as well as non-sport related mild, moderate, and severe brain injury [5,6]. A large portion of the brain is devoted to the acquisition, processing and interpretation of vision [7,8,9]. The visual system captures light to convert it into electrical signals. The optic nerves transmit these signals to the brain, and the visual cortex processes these signals and interprets the images. Vision also depends on the coordination of extraocular muscles [10,11], the responsivity of the Autonomic Nervous System (ANS) which controls how much light enters the retina in real time, and the ciliary muscles which aid in accommodation [12,13,14]. It is for these reasons that every comprehensive concussion symptom checklist [15,16] asks about vision problems, and every concussion-focused physical examination protocol includes a brief screen of ocular and oculomotor function [17,18,19]. A prevalence ratio identifies how likely you are to have a condition given a specific finding, and higher positive values are associated with increased risk. A high-quality systematic review [20] concluded that the prevalence ratio for oculomotor problems was the highest versus other findings among individuals who had PPCS.
Etiologies of SRC-related impairments and their treatments differ based on time since injury [21,22]. The acute period is defined as the first 72 h of injury, the sub-acute period is between 3 days and 4 weeks since injury, and the persisting period (i.e., PPCS) is 4 or more weeks since injury [2]. Symptoms in the acute period are hypothesized to be due to an abnormal metabolic cascade and hypoperfusion triggered by stretching of the axon’s cell membrane [23]. Most symptoms, including visual ones, resolve spontaneously within the acute period as the biochemical pathology subsides [2,24]. Athletes with SRC are advised to rest for the first 24–48 h after injury, and begin an active rehabilitation within 72 h of injury [25]. Visual symptoms in the subacute and persistent phase can be due to a variety of causes [26]. Symptoms such as reduced acuity, headaches and dizziness during reading or oculomotor tasks may be due to ANS dysfunction [13,14,27,28] or cognitive fatigue [29]. An exploratory study by Corrado et al. [30] demonstrated that a prescription of early, targeted heart rate aerobic exercise in the sub-acute period onwards was associated with improvement in ocular outcomes. This aerobic exercise treatment was originally developed to restore autonomic function in exercise intolerant athletes with SRC [30,31,32] and additional research is required to understand how it improves ocular function. On this note, it is important to know that ANS imbalance (as measured by electromyography) has also been observed in disorders of the visual system, such as functional lateral deviation and refractive disorders [33].
Abnormal saccadic eye movements, vergence difficulties, and mismatches in gaze may reflect dysfunction in the oculomotor system [5] and visual processing centers [34]. Abnormal extraocular muscle activity can also cause functional visual problems, such as myopia [35]. After acute symptoms stabilize, it is recommended that oculomotor dysfunction be treated with progressive rehabilitation aimed at improving focus, coordination and convergence [36,37,38,39]. However, initiating vision therapy by an outpatient primary care physician can be challenging because it often requires referring to specialty-trained providers who are not widely available [40] and increases healthcare costs that some insurance programs [41] do not cover. This leads to delays in treatment or to deficits being left untreated, both of which can result in persistent visual impairments. These subclinical visual impairments are associated with prolonged or incomplete recovery, episodic migraine-like headaches [42], reduced quality of life, and increased risk of subsequent injuries [43].
To address challenges initiating oculomotor rehabilitation in an outpatient sports setting, our clinical research center developed easy-to-use guidelines to prescribe basic self-guided, oculomotor rehabilitation to athletes with SRC. This study focused on adolescents since this age group has the highest incidence of SRC [44,45]. We implemented this protocol at one sports medicine clinic and compared recovery in a sample of age-, sex-, and oculomotor-impaired matched adolescents with SRC who were seen during the same time period at a sister sports medicine clinic. We hypothesize that fewer adolescents in the experimental arm would have persisting oculomotor impairments 4 weeks after injury.

2. Materials and Methods

This retrospective, quasi-experimental study was reviewed and approved by the University at Buffalo Institutional Review Board. Data for this study were obtained from the UBMD Concussion Patient Registry that collects data from university-affiliated outpatient clinics in Buffalo, Amherst, Orchard Park, and Niagara Falls, NY, USA. Deidentified data were retrospectively extracted for analysis. Data from January 2017–February 2020 were included in these analyses since data collection from February 2020 to the middle of 2021 was impacted by the COVID-19 pandemic and the eye exercise handout was implemented at all clinics from 2022 onwards.

2.1. Study Sample

Patients were included in the analysis if they: (1) were 12–18 years old; (2) seen within 10 days of injury during the enrollment period; (3) had an ICD-10 code of S06.0XXX; (4) were in the active intervention program (i.e., performed a Buffalo Concussion Treadmill Test [BCTT] at their initial visit); and (5) had at least 3 out of 5 oculomotor findings on a concussion-focused physical exam since this is associated with a higher risk of delayed recovery [29]. Patients were excluded if: (1) their current injury was more severe than a SRC, indicated by a Glasgow Coma Scale (GCS) score < 13, lesion on CT or MRI, or focal neurologic sign consistent with intracerebral lesion; (2) their injury involved a loss of consciousness for >30 min or post-traumatic amnesia >24 h; (3) if they had near-point convergence (NPC) beyond 25 cm since oculomotor rehabilitation without prism lenses have been shown to be ineffective in this population [46]; (4) they were unable to exercise due to musculoskeletal injuries (i.e., a fracture) or increased cardiac risk on the Physical Activity Readiness Questionnaire; and (5) they had not performed the BCTT at their initial visit and were not put in the active rehabilitation program.

2.2. Diagnosis of SRC and Clinical Recovery

SRC was diagnosed by experienced sports-medicine physicians using international guidelines [24], including history of concussion symptoms linked to a head injury or injury to another part of the body with force transmitted to the head, and impairments on a concussion-focused clinical examination [47]. Clearance from SRC to start a graduated return to play program was determined by the same study physician if SRC-related symptoms had returned to baseline and a concussion-focused physical exam was within normal limits [48]. Date of clinical recovery was obtained from electronic medical records.

2.3. Clinical Assessments

All physical examinations were performed by board-certified primary care sports medicine physicians, which included assessment of the cervical, oculomotor, and balance subsystems. Concussion symptom severity was assessed using the Post-Concussion Symptom Inventory (PCSI) [49]. The Buffalo Concussion Physical Exam (BCPE) protocol was used as the standardized physical assessment [48]. Directions for the entire physical examination have been published previously [48] and the oculomotor components are summarized below:

2.3.1. Smooth Pursuits

While keeping the head stationary, patients were asked to visually track a target moving slowly in the horizontal direction for 10 repetitions. Movements are limited to 30 degrees from neutral to avoid eliciting end-gaze nystagmus. Smooth pursuits were considered abnormal if there are staccatic (or jerking) eye motion, sustained beats of nystagmus, loss of visual fixation, loss of conjugate vision, corrective (catch-up or back-up) saccades, or symptom provocation (dizziness, nausea, or headache). Test re-test reliability = 0.60 [50], inter-rater reliability = 0.58 [51].

2.3.2. Horizontal and Vertical Repetitive Saccades

Patients were asked to shift their eyes from point to point rapidly in the horizontal and vertical visual planes, switching focus between two targets held at shoulder width for up to 20 repetitions. Repetitive saccades are abnormal if there is delayed initiation of eye movement, slow velocity, inaccurate movements such as over-/under-shooting with greater than one re-fixation saccade, or abnormal symptom provocation of increased headache or dizziness. Test re-test reliability = 0.68–0.75 [50], inter-rater reliability = 0.44 [51].

2.3.3. Vestibulo-Ocular Reflex (VOR)

Patients were asked to focus on a stationary target and turn their head in the horizontal and vertical direction for up to 10 repetitions at a frequency of 3 Hertz. Any inability to maintain visual fixation (i.e., beating back to the center), staccatic eye movements, or symptom provocation, including headache, dizziness, or lightheadedness, are considered abnormal. This test was deferred if patients had significant cervical impairment. Test re-test reliability = 0.79 [50], inter-rater reliability = 0.40 [51].

2.3.4. Near Point of Convergence

NPC (binocular) was measured using a commercially available accommodation ruler with a standard single 20/30 vertical column of letters as the visual target. Measurements were taken by placing the ruler at the nasion and moving the target slowly toward the nose. NPC was identified as the point at which convergence is lost, which occurs if lateral deviation of one eye is observed or patients report splitting of the visual target in two (not blurring of the target). Test re-test reliability = 0.72 [50], inter-rater reliability = 0.70 [51].

2.4. Standard Management Protocol

No intervention occurred within 24 h of injury. All patients were seen weekly for the first 4 weeks before initiating multidisciplinary management and were restricted from sports or other high-risk activities until they had been cleared to begin a 6-stage return-to-play protocol. Consistent with current recommendation for athletes with SRC, patients performed the BCTT at their initial assessment and were provided an aerobic exercise prescription [52]. Over-the-counter medications for symptom management [53] and cervical interventions [54] were initiated from the first visit onwards. Referrals for oculomotor, cognitive, mood, and vestibular interventions were made only if the patient had persisting impairments at 4 weeks.

2.5. Experimental Eye Intervention Protocol

In the experimental intervention clinic, physicians were trained to prescribe eye rehabilitation exercises to adolescents with abnormal oculomotor findings. Physicians identified the abnormalities using a standardized assessment protocol (described below) and a medical assistant explained how to perform them within the same clinic visit and provided a handout to use at home. The experimental eye intervention handout is summarized in Table 1.

2.6. Statistical Analysis

No a priori sample size estimation was performed for this pilot, quasi-experimental trial. Patients were grouped according to the clinic they were seen at. The number of oculomotor physical exam findings was summed, and only patients with 3 or more oculomotor findings were included, which is associated with a high risk of developing PPCS [29]. Demographics and initial clinical characteristics were compared. An independent samples t-test was used to compare continuous variables and chi-squared tests were used for categorical variables. Effect sizes were calculated and interpreted using guidance from Zielinski [55]. For our main outcome measure, we compared recovery during the first 4 weeks of injury using a Kaplan–Meier survival graph and compared recovery time using a Log-rank test. If any significant differences were observed in baseline characteristics, then a Cox Proportional Hazard (PH) model was used to control for any confounders and 95% confidence intervals (CI) were calculated. The incidence of PPCS was compared using a Chi-squared test and absolute risk reduction and number needed to treat (NNT) were calculated. Lastly, even though physicians were requested to ask each patient if they adhered to the at-home eye exercise program on follow-up appointments, this was not a standardized procedure, and most physicians did not record it. Therefore, it is not included in the analysis. A p-value of <0.05 was considered statistically significant and all analyses were performed using SPSS Version 29 ® (IBM Corp, Armonk, NY, USA) [56].

3. Results

Figure 1 below presents the sample inclusion flow chart. Seventy-five percent (270/359) of patients were eligible in the Standard Care Arm compared to 20% (86/424) in the Experimental Arm, which was significantly different (p < 0.001). This difference is elaborated on in the discussion.
Table 2 presents demographics and clinical characteristics of the included sample at the time of initial presentation. Both clinics had a higher proportion of males than females and saw patients approximately 5 days after injury. No differences were seen between groups in any demographics or oculomotor abnormalities, except that patients in the Standard Care Arm had a significantly higher proportion of neck tenderness than the Experimental Arm, but the difference was considered small (Cohen’s d = 0.173).
Figure 2 presents the Kaplan–Meier survival graph of recovery over the first 4 weeks since injury. The recovery time of all adolescent patients with SRC seen within 10 days of injury is also presented to show that there are no obvious differences between the two outpatient clinics (clinic group hazard ratio = 1.164 [0.865, 1.566], p = 0.315). Differences were observed when only patients with greater than 3 abnormal oculomotor findings were compared. The median recovery time without controlling for confounders in the Standard Care Arm was 26 days versus 22 days in the Experimental Arm, which was not significantly different on a Log-rank Test (Chi-squared = 3.699, p = 0.054). When controlling for neck tenderness (neck tenderness hazard ratio = 1.237 [95% CI = 0.775, 1.974], p = 0.373) in a Cox PH model, the Experimental Arm recovered significantly faster than the Standard Care Arm (clinic group hazard ratio = 1.729 [95% CI = 1.019, 2.933], p = 0.042). Total recovery time for the Standard Care Arm was 36.29 ± 29.29 days (range = 8–127) versus 32.04 ± 33.52 days (range = 8–133) for the Experimental Arm, which was not significantly different (p = 0.514, Cohen’s d = 0.141) on an independent samples t-test. Fifty out of 106 (47.2%) participants in the Standard Care Arm had PPCS compared to 7 out of 27 (25.9%) in the Experimental Arm, which was significantly different (Chi-squared = 3.966, p = 0.046). This corresponds to an absolute risk reduction of 21.2% (95% CI = 2.2%, 40.3%) and an NNT of 4.7 (2.5, 4.9).

4. Discussion

This retrospective, quasi-experimental trial has important findings that may help improve the management of adolescents with SRC in an outpatient setting in a cost-effective manner. We compared recovery of patients with SRC seen within 10 days of injury between two sister clinics with similar management protocols except that one clinic prescribed basic, self-guided eye exercises in those who had oculomotor abnormalities on a standard concussion-focused physical examination. We found that providing directions to perform oculomotor rehabilitation in adolescents who had 3 or more oculomotor abnormalities after SRC was feasible and associated with a 21.3% reduction in absolute risk of developing PPCS and requiring referrals for additional therapies. Although we found these instructions to be effective in our sample, this was not a randomized trial and there could be several factors that confound our results (described in limitations). Retrospective studies are only able to identify a correlation, not causality. Therefore, we recommend that a prospective randomized controlled trial validates the effectiveness of this intervention. If validated in future studies, primary care clinicians should consider utilizing these self-guided therapy instructions with adolescents with SRC who may otherwise not receive timely care, such as those in rural areas or for patients with lower socioeconomic status who might not have access to additional healthcare resources. It is crucial to note that this treatment is not meant to replace an experienced physical therapist or for patients with more serious ocular pathologies, such as mismatched pupil size, blindness, unilateral oculomotor paralysis suggestive of cranial nerve pathology, or any sign that is suggestive of a focal neurological lesion or more severe brain injuries [57,58].
Although national and international concussion management guideline statements recommend oculomotor retraining exercises to treat oculomotor dysfunction [2,3,59,60,61], a meta-analysis by Watabe et al. [62] concluded that there is minimal published evidence from randomized trials confirming that they are effective in a brain injury population. Peters [63] conducted a non-randomized study on a cohort of 137 hockey players with SRC. Hockey players with SRC prescribed oculomotor rehabilitation had symptom resolution in 5.8 weeks compared to 12.3 weeks for those who were not. In an observational study of 218 patients with concussion by Gallaway et al. [64], 85% of patients who completed vision therapy had improvements in NPC and concussion symptoms. Lastly, in a small pilot randomized trial (10 participants per group) of formal oculomotor physical therapy, Berryman et al. [65] found that oculomotor rehabilitation treatment was feasible and also recommended conducting a larger randomized trial to validate their findings.
The development of this intervention was guided by physicians and therapists and reviewed by external experts with extensive concussion management experience. It was felt that these exercises would not be effective if patients had substantial convergence insufficiency (i.e., beyond 25 cm from the nasion) since they would be unable to accurately focus on the target. Vision specialists use prism lens to retrain convergence insufficiency in these circumstances [46]. Another one of our goals was to ensure that patients would be able to complete these exercises without purchasing any additional equipment or software. Repetitive saccades, VOR, and NPC retraining can be effectively performed using post-it notes, pens, and a metronome, which can be accessed online or using free phone apps. However, we could not identify a method for patients to complete effective smooth pursuits [66] retraining themselves without the use of any technology because the patient has to focus on a moving target. In layman’s terms, if a patient is moving a target with their own hands, they know where the target is moving and begin moving their eyes according to where they know the target will go. Although this engages the smooth pursuits system, this is not “tracking” and we recommend watching a video where the target is moving itself [66]. Several software are available commercially that can help administer oculomotor exercises, but all of them have a cost which creates a barrier in healthcare access. Free resources with progressive difficulties are available on YouTube. We recommend that clinicians search and review these online resources themselves and select something they are comfortable using.
Future studies should systematically monitor intervention adherence to determine if increased adherence is associated with improved outcomes, which was a major limitation of the current study. Another consideration for future studies is to use a different oculomotor assessment protocol to guide treatment. The current study’s treatment algorithm was based on the BCPE, but future studies should use the modified Vestibular Ocular Motor Screen (mVOMS) [18] protocol to improve generalizability. The mVOMS includes all of the oculomotor assessments from the BCPE with the addition of visual motion sensitivity. An additional benefit of the mVOMS is that it scores symptom worsening on a 0–10 Visual Analog Scale instead of binarily grading if symptom provocation occurred or not. This can limit subjectivity and improve reproducibility. Future studies should also include different age groups and mechanisms of injury.

Limitations

This was not a randomized trial and there may have been several key differences that we could not account for in a retrospective design, such as differences in patient populations, socioeconomic and psychological factors, intake and referral patterns, undocumented treatments, and post-clearance management protocols. We observed a significant difference in the number of eligible patients between clinics, which is a major limitation that can bias our results. This difference occurred because the Standard Care Arm clinic primarily sees referrals from local schools while all work-related injuries and adult patients are referred to the Experimental Arm clinic since only that clinic accepts the workers compensation insurance program. Another major limitation is that we are using clinical recovery as our primary outcome measure. Future studies should consider utilizing eye tracking assessment tools to objectively monitor oculomotor recovery. Additionally, this protocol was implemented in an outpatient setting, which sees patients from the sub-acute period onwards. These results should not be generalized to the acute period, which is typically defined as the first 48–72 h after injury. Another limitation is that our sample only includes athletic adolescents in an outpatient sports setting and does not include non-athletes, children under the age of 12 or adults over the age of 18. There are several differences in presentation and recovery outcomes between methods of injury (sport versus motor vehicle accidents or assault) and age groups [67] so our results cannot be generalized outside of this population. Additionally, younger children may have difficulties following instructions for eye exercises which have to be accounted for.

5. Conclusions

This non-randomized, retrospective study compared recovery from SRC in two outpatient sports medicine clinics with identical management protocols, except that one clinic provided a prescription to do low cost, self-guided eye rehabilitation exercises instead of a wait-and-see approach. We observed a 21% reduction in absolute risk (47.2% vs. 25.9%) of PPCS in adolescents who presented with 3 or more abnormal oculomotor findings within 10 days of injury. We conclude that this treatment plan is feasible in a busy outpatient sports medicine setting and prospective, randomized trials are warranted to validate its effectiveness.

Author Contributions

Conceptualization, M.N.H., J.I.M., J.J.L. and H.M.C.; methodology, M.N.H. and J.M.E.; formal analysis, M.N.H. and K.A.R.; data curation, M.N.H. and J.M.E.; writing—original draft preparation, M.N.H., J.M.E. and K.A.R.; writing—review and editing, M.N.H., J.I.M., J.J.L. and H.M.C. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

The study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Review Board of the University at Buffalo (protocol number: STUDY00005928, approval date = 11 February 2024).

Informed Consent Statement

Patient consent was waived in this retrospective registry-style study which collects deidentified outcomes data from our sports medicine clinics.

Data Availability Statement

Deidentified data can be requested from the lead author at haider@buffalo.edu.

Conflicts of Interest

Mohammad N. Haider has been a paid or unpaid scientific advisor for BlinkCNS Inc., BlinkTBI Inc., Oculogica Inc., Neuromend LLC and Headquarters Health Inc. None of these are mentioned in this manuscript. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Abbreviations

The following abbreviations are used in this manuscript:
SRCSport related concussion
PPCSPersisting post-concussion symptoms
ANSAutonomic nervous system
BCPEBuffalo concussion physical exam
VORVestibular oculomotor reflex
NPCNear point convergence
mVOMSModified vestibular ocular motor screen

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Applsci 15 11330 g001
Figure 1. Sample inclusion flow chart.
Figure 1. Sample inclusion flow chart.
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Applsci 15 11330 g002
Figure 2. Survival graph comparing clinics in the included sample and all patients.
Figure 2. Survival graph comparing clinics in the included sample and all patients.
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Table 1. Take-home instructions for Eye Rehabilitation Exercises.
Table 1. Take-home instructions for Eye Rehabilitation Exercises.
Oculomotor AbnormalityRehabilitation Instructions
Try to do this oculomotor training 2 times daily (morning and evening). You only have to do the eye exercises that your doctor told you to do. We recommend you use a metronome to track your reps. Google’s metronome is a convenient option.
The goal is to improve endurance over time. Once you can complete an individual eye exercise without symptoms and with normal speed, you no longer need to practice these eye exercise.
Smooth PursuitsYou will need a computer with a full-sized monitor (do not use your phone). Search for “smooth pursuits retraining” on Youtube.com and select the videos your clinician has recommended.
Sit with your head about 1.5 feet from the computer screen and start the video. With your head still, follow the moving target with your eyes. Start with the easiest video and progress to next if it does not cause worsening of your symptoms. Do this for at least 1–2 min each time.
Horizontal and Vertical Repetitive SaccadesHorizontal: Put 2 post-it notes with an X on the wall, shoulder width apart. Look back and forth right to left for the recommended repetitions.
Vertical: Place the 2 post-it notes with an X vertical on wall about 12 inches apart. Look up and down for the recommended repetitions.
Make sure to really focus on the X every time you turn. You can try this with small letters as well.
The goal is to be able to do 60 reps in 1 min without worsening your eye symptoms too much. Start with the number of repetitions that cause symptoms plus 3 more repetitions to increase stamina. Take a break and repeat until you have completed 1 min of each activity. Then advance by 3–5 reps every 1–2 days.
VORPut 1 post-it note on the wall in the middle of the 4 post-it notes used above for saccades.
Horizontal: Keep eyes focused on the post-it note and nod up and down for the above time recommended.
Vertical: Shake head left and right while focusing on the target for the above time recommended.
Same as before, make sure to really focus on the X. You can try this with small letters as well.
The goal is to be able to do 30 reps in 1 min without worsening your eye symptoms too much. Start with the number of repetitions that cause symptoms plus 3 more repetitions to increase stamina. Take a break and repeat until you have completed 1 min of each activity. Then advance by 3–5 reps every 1–2 days.
NPCPencil Pushups: Use a pen with letters. Hold the pen an arm’s length away and keep the letters in focus as you bring the pen towards your nose. Once the letters get blurry, continue slowly until the letters become double. Try to keep them single. When they remain double slowly go in reverse back out to arm’s length. Repeat for about one minute.
Table 2. Demographics and clinical characteristics at initial visit.
Table 2. Demographics and clinical characteristics at initial visit.
Standard Care ArmExperimental Armp-ValueEffect Size
Sample size10627--
Age14.98 ± 1.8715.50 ± 1.530.1800.290
Sex59.4% male63.0% male,0.7380.029
Days since injury5.69 ± 2.785.74 ± 2.430.9290.019
Loss of consciousness5 (4.7%)4 (14.8%)0.082 a0.162
Previous Concussion
     056 (52.8%)16 (59.3%)0.8650.098
     128 (26.4%)5 (18.5%)
     219 (17.9%)5 (18.5%)
     3+3 (2.8%)1 (3.7%)
Symptom severity (max = 132)41.33 ± 20.5640.30 ± 23.360.8220.049
Non-oculomotor Clinical Exam
Orthostatic intolerance66 (62.3%)15 (55.6%)0.4510.066
Neck spasm2 (1.9%)1 (3.7%)0.570 a0.049
Neck tenderness62 (58.5%)10 (37.0%)0.046 *0.173
Neck range of motion14 (13.2%)4 (14.8%)0.827 a0.019
Complex tandem gait60 (56.6%)16 (59.3%)0.8030.022
Oculomotor Clinical Exam
Smooth Pursuits96 (90.6%)25 (92.6%)0.7430.028
Horizontal Saccades104 (98.1%)25 (92.6%)0.134 a0.130
Vertical Saccades77 (72.6%)16 (59.3%)0.1760.117
Abnormal NPC (10–25 cm)37 (34.9%)11 (40.7%)0.5730.049
VOR97 (91.5%)22 (81.5%)0.1300.131
* indicate a significant finding at p < 0.05; a indicates a Fishers Exact test was used instead of a Chi-squared test due to small cell sizes; NPC: near-point convergence; VOR: vestibular ocular reflex.
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Haider, M.N.; Edwards, J.M.; McPherson, J.I.; Rao, K.A.; Leddy, J.J.; Chizuk, H.M. Early, Self-Guided Oculomotor Rehabilitation in Adolescents with Sport-Related Concussion Is Feasible and Effective: A Quasi-Experimental Trial. Appl. Sci. 2025, 15, 11330. https://doi.org/10.3390/app152111330

AMA Style

Haider MN, Edwards JM, McPherson JI, Rao KA, Leddy JJ, Chizuk HM. Early, Self-Guided Oculomotor Rehabilitation in Adolescents with Sport-Related Concussion Is Feasible and Effective: A Quasi-Experimental Trial. Applied Sciences. 2025; 15(21):11330. https://doi.org/10.3390/app152111330

Chicago/Turabian Style

Haider, Mohammad N., Jazlyn M. Edwards, Jacob I. McPherson, Krishnamurti A. Rao, John J. Leddy, and Haley M. Chizuk. 2025. "Early, Self-Guided Oculomotor Rehabilitation in Adolescents with Sport-Related Concussion Is Feasible and Effective: A Quasi-Experimental Trial" Applied Sciences 15, no. 21: 11330. https://doi.org/10.3390/app152111330

APA Style

Haider, M. N., Edwards, J. M., McPherson, J. I., Rao, K. A., Leddy, J. J., & Chizuk, H. M. (2025). Early, Self-Guided Oculomotor Rehabilitation in Adolescents with Sport-Related Concussion Is Feasible and Effective: A Quasi-Experimental Trial. Applied Sciences, 15(21), 11330. https://doi.org/10.3390/app152111330

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