Concussions are a significant concern in both sports and everyday life, often leading to debilitating symptoms that can severely affect an individual’s quality of life. Early and accurate diagnosis is crucial for effective management and preventing a prolonged recovery. The Vestibular Ocular Motor Screening (VOMS) test is a comprehensive yet efficient 5-10 minute assessment that every primary care physician (PCP) or general practitioner (GP) should be familiar with when assessing patients for a suspected concussion. The VOMS test evaluates various aspects of a patient’s vestibular and ocular motor systems. This article will highlight what the VOMS concussion test is, as well as the accessibility and diagnostic utility of the VOMS test. By understanding this screening tool’s practical applications and benefits, PCPs and GPs can enhance their ability to diagnose concussions accurately. 

Understanding Concussions.

A concussion is a type of mild traumatic brain injury (TBI) caused by a blow to the head or body. Common symptoms include headaches, dizziness, visual problems, blurred vision, and sensitivity to light or noise. The impact of concussions on health and daily life can be profound, leading to cognitive impairments and physical limitations. Early and accurate diagnosis is crucial, as it can facilitate appropriate concussion management and recovery, ultimately improving patient outcomes.

Introduction to the VOMS Test.

History and Development of the VOMS Test.

The VOMS test was developed by experts in sports medicine and concussion at UPMC to address the need for a quick yet thorough clinical examination tool for assessing concussion. Lau et al. (2011) found that symptoms such as fogginess, visual issues, and dizziness were often linked to a prolonged recovery post-concussion. As such, there was a need for a screening tool to assess and monitor these vestibular and visual issues. 

VOMS testing evaluates the functionality of these two critical systems impacted by concussions:

  1. Vestibular System: This system is responsible for maintaining balance and spatial orientation. Vestibular-ocular reflex (VOR) and visual motion sensitivity (VMS) tasks help gauge how well the vestibular system functions by assessing the patient’s ability to maintain gaze stability and tolerate motion.
  2. Oculomotor System: This system controls the movements of the eyes. Smooth pursuits, saccades, and convergence tasks assess the efficiency and coordination of eye movements, providing insights into oculomotor function.

Research has demonstrated the VOMS effectiveness in identifying patients with vestibular deficits, and ocular motor symptoms post mild traumatic brain injury. Initially designed for athletes with a sports-related concussion, the utility of VOMS testing has since been recognized in broader medical contexts, including general practice and emergency medicine.

How do you Perform the VOMS Test?

Before the test, clinicians collect baseline scores for the following symptoms: headache, nausea, dizziness, and fogginess. During the test, the clinician observes for poor oculomotor function or if the assessment provokes symptoms. Then, following each maneuver, patients verbally rate their symptom scores for headache, nausea, fogginess, and dizziness to compare to the pre-testing baseline scores. Patients may also report other symptoms like ocular pain, blurred vision, elevated heart rate, anxiety, visual instability, impaired eye movements, etc.

VOMS testing consists of a series of five primary components:

Smooth Pursuit Eye Movements:

Smooth pursuits involve the patient following a slowly moving target with their eyes, which helps assess the ability to track moving objects smoothly.

Saccadic Eye Movements (Horizontal and Vertical):

These tasks require the patient to rapidly switch their gaze between two targets, testing the speed and accuracy of eye movements.


This component measures the patient’s ability to focus on a target as it moves closer to the nose, assessing binocular vision and eye coordination.

Vestibular-Ocular Reflex (VOR):

The patient moves their head while focusing on a stationary target, which evaluates their ability to stabilize their gaze during head movements.

Visual Motion Sensitivity:

Visual motion sensitivity assesses the patient’s tolerance to complex visual environments, where the patient moves their head and eyes in coordination with a moving background, essentially “canceling” their VOR.

Each component is scored based on patient-reported symptom provocation, providing a comprehensive overview of the patient’s vestibulo-ocular system function.

To read a step-by-step guide on how to perform the VOMS, read our past article here.

What is a Positive VOMS Test?

A positive VOMS test indicates that the patient experienced a clinically significant increase in headache, dizziness, nausea, or fogginess during the assessment tasks, indicating potential vestibular or ocular motor impairments associated with concussion. This outcome helps clinicians confirm the diagnosis of a concussion and guides further management and treatment plans. 

Diagnostic Utility of the VOMS Test.

Accuracy and Reliability of the VOMS Test

The VOMS test offers high accuracy and reliability in assessing concussions. Clinical studies have demonstrated that the test is particularly practical in ruling out concussions, with accuracy rates ranging from 92% to 96%. The VOMS also has a relatively low (~10%) false-positive rate. This makes the VOMS test a valuable clinical assessment tool, providing immediate insights into a patient’s condition.

Moran et al. (2018) focused on evaluating the reliability and internal consistency and establishing normative reference values for VOMS testing in youth athletes. Their research involved a large sample of youth athletes and assessed the VOMS tool’s consistency across multiple administrations. The findings demonstrated internal consistency and strong reliability, meaning it produces stable and consistent results when used repeatedly.

Additionally, the study established normative reference values, providing a benchmark for clinicians to interpret VOMS test results in the context of youth athlete populations. These reference values enhance the test’s diagnostic utility, enabling more accurate identification of vestibular and ocular motor dysfunctions associated with concussions in this age group.

Furthermore, Kontos et al. (2021) focused on the test-retest reliability of the VOMS tool in US military personnel. The research involved assessing the consistency of the VOMS test over repeated administrations, which is crucial for their use in clinical and operational settings.

The study sample included a cohort of US military personnel, providing a relevant population given the high incidence of head injuries and the need for reliable concussion assessment tools in this group. The researchers found that the VOMS demonstrated strong “test-retest” reliability. This means that it produced stable and consistent results across multiple testing sessions, reinforcing its utility in reliably monitoring concussion symptoms over time.

Utility of Ruling Out Concussion

The ability to effectively rule out concussions using the VOMS test is of paramount importance in clinical practice. Accurately excluding concussions ensures that patients not suffering from this injury can avoid unnecessary treatments and interventions. For athletes, quick clearance from concussion protocols can mean a faster return to play, minimizing the time spent away from training and competition. In academic settings, students who are accurately diagnosed as concussion-free can return to their studies sooner, reducing the likelihood of falling behind.

Overall, the ability to rule out concussions efficiently preserves healthcare resources, reduces patient anxiety, and supports timely and effective clinical decision-making.

Comparing the VOMS test with Other Assessment Tools for Concussion.

Yorke et al. (2017) investigated the effectiveness of the VOMS test compared to other concussion assessment tools like the Balance Error Scoring System (BESS) and the King Devick test. Their research demonstrated that the VOMS test measured unique aspects of vestibular ocular function that were not measured through the BESS or King Devick test. They concluded that the VOMS should be part of a comprehensive concussion assessment if vestibular dysfunction is suspected.

Similarly, Ferris et al. (2021) examined the predictive accuracy of the Sport Concussion Assessment Tool 3 (SCAT3), BESS, and the VOMS test. The researchers found that the combination of SCAT3 and VOMS together provided superior predictive accuracy, whereas the BESS lacked clinical significance. This further highlights the need for a comprehensive approach, utilizing several screening tests, including the VOMS, when assessing concussed patients.

VOMS testing stands out for its efficiency and comprehensiveness compared to other concussion screening tools. By integrating VOMS testing into routine concussion assessments, clinicians can enhance their ability to make timely and accurate concussion diagnoses, ultimately improving patient care and outcomes.

Benefits of the VOMS Test.

Ease of Administration

One of the key advantages of the VOMS test is its straightforward administration. The tasks are simple to understand and execute, requiring minimal instruction for the patient. This simplicity ensures that the test can be easily incorporated into routine clinical evaluations.

The entire VOMS assessment can be completed within a span of 5-10 minutes. This brief time requirement makes it ideal for busy clinical settings where time efficiency is crucial.

Minimal Equipment Needed

Another benefit of the VOMS test is the minimal equipment required. Typically, a metronome or stopwatch and a target (like a finger or pen) are sufficient for most tasks. This low requirement makes it feasible for various healthcare settings, including those with limited resources.

Training Requirements

Clinicians need to undergo some basic training to administer the VOMS test effectively. Fortunately, the training is not extensive and can be completed relatively quickly because the components are primarily part of a basic neurologic exam. Familiarity with each task’s purpose and the ability to interpret the results are vital competencies that can be acquired through brief educational sessions.

Application in Different Healthcare Settings

The VOMS test’s versatility allows it to be applied in various healthcare settings. In primary care clinics, it serves as a quick screening tool to assess potential concussions. In sports medicine facilities, it aids in evaluating athletes for concussion symptoms post-injury. Emergency departments can use the VOMS test as part of a rapid assessment protocol for head injuries. Its utility in specialized and general medical practices underscores its value as an essential diagnostic aid.


Primary care physicians and general practitioners play a pivotal role in the initial assessment and diagnosis of concussions. Given their frequent contact with patients, they are often the first point of medical consultation following a head injury. The VOMS test serves as a crucial diagnostic tool for identifying patients with vestibular and oculomotor dysfunctions commonly associated with concussions. The VOMS test is highly reliable, with accuracy rates ruling out concussions with 92-96% certainty, giving healthcare providers the confidence to make quick and informed decisions. By incorporating the VOMS test into their diagnostic toolkit, these healthcare providers can swiftly identify concussive symptoms and initiate appropriate clinical management plans, ultimately leading to better patient outcomes.

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  2. Ferris, L. M., Kontos, A. P., […] & Port, N. L. (2021). Predictive accuracy of the Sport Concussion Assessment Tool 3 and Vestibular/Ocular-Motor Screening, individually and in combination: A National Collegiate Athletic Association–Department of Defense Concussion Assessment, Research and Education Consortium analysis. American Journal of Sports Medicine, 49(4).
  3. Lau, B. C., Kontos, A. P., Collins, M. W., Mucha, A., & Lovell, M. R. (2011). Which on-field signs/symptoms predict protracted recovery from sport-related concussion among high school football players? American Journal of Sports Medicine, 39(11), 2311-2318.
  4. Kontos, A. P., Monti, K., Eagle, S. R., Thomasma, E., Holland, C. L., Thomas, D., Bitzer, H. B., Mucha, A., & Collins, M. W. (2021). Test-retest reliability of the Vestibular Ocular Motor Screening (VOMS) tool and modified Balance Error Scoring System (mBESS) in US military personnel. Journal of Science and Medicine in Sport, 24(3), 264-268.
  5. Moran, R. N., Covassin, T., Elbin, R. J., Gould, D., & Nogle, S. (2018). Reliability and normative reference values for the Vestibular/Ocular Motor Screening (VOMS) tool in youth athletes. American Journal of Sports Medicine, 46(6), 1475-1480.
  6. Mucha, A., Collins, M. W., Elbin, R. J., Furman, J. M., Troutman-Enseki, C., DeWolf, R. M., Marchetti, G., & Kontos, A. P. (2014). A brief vestibular/ocular motor screening (VOMS) assessment to evaluate concussions: preliminary findings. American J Sports Med, 42(10), 2479-2486.
  7. Rosenblum, D., Donahue, C., Higgins, H., Brna, M., & Resch, J. (2023). False-Positive Rates, Risk Factors, and Interpretations of the Vestibular Ocular Motor Screen in Collegiate Athletes. Journal of Athletic Training.
  8. Yorke, A. M., Smith, L., Babcock, M., & Alsalaheen, B. (2017). Validity and reliability of the Vestibular/Ocular Motor Screening and associations with common concussion screening tools. Sports Health, 9(2), 174-180.