A - 13 Examining Exposure to Stimulating Environments and Avoidance Behavior in Post-Concussion Vestibular/Ocular Motor Impairment and Anxiety

Abstract Purpose Examine exposure to everyday environments and avoidance behaviors in patients with post-concussion vestibular/ocular motor symptoms and impairments and clinical levels of state anxiety. Method Patients (13–25 yrs) seeking care for a concussion within one week of injury completed an in-clinic vestibular/ocular motor screening assessment, self-reported anxiety inventory, at their first visit and enrolled in an ecological momentary assessment (EMA) study on their smartphones. Participants were administered four symptom and environment surveys each day for the next seven days (7:30 a.m., 10:30 a.m., 3:00 p.m., and 8:00 p.m.). Patients were classified as having vestibular/ocular motor impairments and clinical levels of anxiety from self-reported in-clinic measures using established cutoffs. Environmental exposure data (frequency of exposure) and visual analog scale ratings of avoidance behaviors (0–100 pts) from the EMA protocol were used as outcomes. Results 73 patients (M = 17.04, SD = 3.09 yrs) were enrolled in the study. Of these, 80% (56/70) exhibited vestibular/ocular motor impairments, and 40% (28/70) had clinical levels of anxiety. Vestibular/ocular motor impairment was associated with less frequent exposure to stimulating environments (15% less exposure), regardless of the presence/absence of elevated anxiety. Elevated anxiety was associated with more frequent exposure to rest/quiet environments (12% more exposure, p’s < 0.05) and higher ratings of avoidance of symptom-provoking exposures (16pts, p < 0.01). Conclusions Patients with post-concussion vestibular/ocular motor impairment and anxiety should be monitored for actively avoiding therapeutic, symptom-provoking environments.