Baseline Performance on Concussion Assessments of Athletes Who Are Deaf or Hard of Hearing.

CONTEXT: In the United States, more than 71 000 college students, many of whom participate in athletic programs, are deaf or hard of hearing (D/HoH). Although recent concussion consensus statements have recommended different management for special populations, critical knowledge gaps remain regarding baseline concussion performance in athletes who are D/HoH. OBJECTIVE: To compare baseline concussion assessments between athletes who are D/HoH and athletes who are hearing. DESIGN: Cross-sectional study. SETTING: Collegiate athletic department. PATIENTS OR OTHER PARTICIPANTS: A total of 128 National Collegiate Athletic Association Division III athletes including 64 athletes who are D/HoH (42 who are deaf, 22 who are hard of hearing; age = 21.64 ± 3.23 years, height = 1.70 ± 0.10 m, mass = 80.83 ± 25.24 kg) and 64 athletes who are hearing (age = 19.73 ± 1.13 years, height = 1.76 ± 0.10 m, mass = 78.55 ± 16.95 kg) matched by sex and sport-contact classification. MAIN OUTCOME MEASURES: Participants completed a comprehensive battery of baseline concussion assessments, including symptom inventories (Sport Concussion Assessment Tool 6 symptom evaluation and Brief Symptom Inventory-18), virtual reality-based smooth pursuits, oculomotor function (Vestibular/Ocular Motor Screening), postural control (modified Balance Error Scoring System), instrumented tandem gait, and neurocognitive testing (Immediate Post-Concussion Assessment and Cognitive Testing). RESULTS: No differences were found for Sport Concussion Assessment Tool 6 symptom severity (z = -1.41, P = .16) or total number of symptoms (z = -1.62, P = .11), but athletes who are D/HoH had a higher Brief Symptom Inventory-18 Global Severity Index (z = -2.37, P = .02) compared with athletes who are hearing. Athletes who are D/HoH demonstrated better oculomotor tracking (eg, higher velocity gain and lower saccade percentage, P < .01) and lower Vestibular/Ocular Motor Screening total symptom scores (z = 2.57, P = .01) compared with athletes who are hearing. Additionally, athletes who are D/HoH demonstrated poorer performance in postural control (more modified Balance Error Scoring System errors, z = -5.24, P < .001; slower tandem gait speed, z = 3.65, P < .001) and lower neurocognitive assessment scores (visual and verbal memory and visual-motor speed, P < .001) compared with athletes who are hearing. CONCLUSIONS: Athletes who are D/HoH exhibited distinct performance profiles across multiple baseline concussion domains, likely influenced by sensory adaptations, vestibular differences, and language-related factors. Clinicians should interpret assessment outcomes while considering these unique biopsychosocial characteristics to ensure accurate concussion management for D/HoH populations.