Document Type


Publication Date




Female collegiate soccer and lacrosse athletes are subject to repetitive subconcussive head impacts; defined as “cranial impacts that do not result in known or diagnosed concussion on clinical grounds.” These impacts may result in vestibulo-oculomotor (V-O) system dysfunction. Identifying V-O dysfunction is critical in order to better understand the potential consequences of these impacts.


Retrospectively examine four years of pilot data to:

  1. Describe the evolution of an assessment battery for cleared to play athletes.
  2. Identify the assessment tools most frequently positive in cleared to play athletes and non-athletes.
  3. Provide direction for clinical practice and future research endeavors.


  • 60 Division II female soccer and lacrosse players: 35 soccer, 25 lacrosse
  • 21 non-athletes (2 years)


Each year tests were retained or discontinued depending on their evaluative strength. Alternate tests were added to capture a given or different domain. The following shows the evolution of assessments (additions bolded):

  • Year One: non-instrumental (clinical) Dynamic Visual Acuity (cDVA), Head Impulse Test (HIT), Head Shake Nystagmus Test (HSN), Y-Balance Test, Balance Error Scoring System (BESS)
  • Year Two: cDVA, HIT, HSN, Y-Balance Test, BESS, Near Point Convergence (NPC)
  • Year Three: cDVA, NPC, HIT, HSN, Trail-Making Test (TMT) A and B
  • Year Four: cDVA, NPC, TMT, 40-yard dash with and without head turns, T-agility Test


  • Difference in V-O system function in athletes compared to non-athletes in first two years of data collection: 14/21 athletes had at least one positive test; 1/25 non-athletes had at least one positive test
  • The cDVA and the NPC tests were most frequently positive tests across four years
  • Repeat participants showed signs of V-O system dysfunction based on cDVA an NPC testing
  • No significant results found with cognition, balance, or performance testing


  • Athletes had a much higher incidence of positive V-O tests than non-athletes
  • Over half of cleared to play athletes had a positive V-O test; cDVA and NPC most frequently positive
  • Highly trained athletes may require more challenging and sensitive assessment tools to identify cognitive and performance deficits

Clinical Relevance

  • Many cleared to play female collegiate athletes may be playing in the presence of V-O deficits
  • Using specific V-O assessments may better identify athletes with V-O dysfunction and lead to subsequent treatment intervention
  • Continued research needed to develop an optimal assessment battery to guide baseline, return to play, and intervention decisions



To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.