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Cade A, Turnbull PRK. Classification of short and long term mild traumatic brain injury using computerized eye tracking. Sci Rep 2024; 14:12686. [PMID: 38830966 PMCID: PMC11148176 DOI: 10.1038/s41598-024-63540-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 05/29/2024] [Indexed: 06/05/2024] Open
Abstract
Accurate, and objective diagnosis of brain injury remains challenging. This study evaluated useability and reliability of computerized eye-tracker assessments (CEAs) designed to assess oculomotor function, visual attention/processing, and selective attention in recent mild traumatic brain injury (mTBI), persistent post-concussion syndrome (PPCS), and controls. Tests included egocentric localisation, fixation-stability, smooth-pursuit, saccades, Stroop, and the vestibulo-ocular reflex (VOR). Thirty-five healthy adults performed the CEA battery twice to assess useability and test-retest reliability. In separate experiments, CEA data from 55 healthy, 20 mTBI, and 40 PPCS adults were used to train a machine learning model to categorize participants into control, mTBI, or PPCS classes. Intraclass correlation coefficients demonstrated moderate (ICC > .50) to excellent (ICC > .98) reliability (p < .05) and satisfactory CEA compliance. Machine learning modelling categorizing participants into groups of control, mTBI, and PPCS performed reasonably (balanced accuracy control: 0.83, mTBI: 0.66, and PPCS: 0.76, AUC-ROC: 0.82). Key outcomes were the VOR (gaze stability), fixation (vertical error), and pursuit (total error, vertical gain, and number of saccades). The CEA battery was reliable and able to differentiate healthy, mTBI, and PPCS patients reasonably well. While promising, the diagnostic model accuracy should be improved with a larger training dataset before use in clinical environments.
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Affiliation(s)
- Alice Cade
- School of Optometry and Vision Science, The University of Auckland, Private Bag 92019, Auckland, 1023, New Zealand.
- New Zealand College of Chiropractic, Auckland, New Zealand.
| | - Philip R K Turnbull
- School of Optometry and Vision Science, The University of Auckland, Private Bag 92019, Auckland, 1023, New Zealand
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Onodera H, Mogamiya T, Yatabe K, Fujiya H, Murata H. Recovery Process for Sports-Related Concussion Assessed with Precise Ocular Motility. Sports Med Int Open 2024; 8:a21831077. [PMID: 38812957 PMCID: PMC11135402 DOI: 10.1055/a-2183-1077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 09/26/2023] [Indexed: 05/31/2024] Open
Abstract
Ocular motility has been linked to Sports Concussion Assessment Tool 5 scores. However, the link between ocular motility changes and assessment result changes remains unclear. Hence, we investigated that potential link in patients with sports-related concussions. We retrospectively included participants aged≥18 years who were diagnosed with a sports-related concussion. They underwent smooth pursuit eye movement assessment for allocation to the good improvement (rate of fundamental frequency≥15%) or minor improvement (<15%) groups. Sports Concussion Assessment Tool 5 scores were determined at baseline and two weeks later, and score changes were compared between the groups. Thirteen men (mean±standard deviation age: 20.6±5.0 years) were included: eight (19.0±4.5 years) in the good improvement group and five (20.6±5.7 years) in the minor improvement group. Symptom number (median=2.0 vs. 0.0), symptom severity (median=22.0 vs. 3.0), single-leg stance (median=4.0 vs. 0.5), tandem stance (median=1.0 vs. 0.0), and total errors (median=5.0 vs. 0.5) were worse (all p<0.05) in the minor improvement group. Smooth pursuit eye movement improvements measured using eye-tracking technology was linked to symptom recovery in patients with sports-related concussions. Therefore, ocular motility may be an objective indicator of sports-related concussions. Future studies with more patients are needed to confirm these findings.
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Affiliation(s)
- Hidetaka Onodera
- Department of Neurosurgery, St. Marianna University School of Medicine
Yokohama City Seibu Hospital, Kanagawa, Japan
| | - Takuma Mogamiya
- Department of Rehabilitation Medicine, St. Marianna University School
of Medicine, Yokohama City Seibu Hospital, Kanagawa, Japan
| | - Kanaka Yatabe
- Department of Sports Medicine, St. Marianna University School of
Medicine, Kawasaki, Japan
| | - Hiroto Fujiya
- Department of Sports Medicine, St. Marianna University School of
Medicine, Kawasaki, Japan
| | - Hidetoshi Murata
- Department of Neurosurgery, St. Marianna University School of Medicine,
Kawasaki, Japan
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3
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Snegireva N, Derman W, Patricios J, Welman KE. Blink duration is increased in concussed youth athletes: a validity study using eye tracking in male youth and adult athletes of selected contact sports. Physiol Meas 2022; 43. [PMID: 35709708 DOI: 10.1088/1361-6579/ac799b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 06/16/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Diagnosing a sports-related concussion (SRC) remains challenging, and research into diagnostic tools is limited. This study investigated whether selected eye tracking variables would be a valid tool to diagnose and monitor SRC in adult and youth participants in selected contact sports, such as Rugby Union (rugby) and football (soccer). METHODS This prospective cohort study, with 70 concussed and 92 non-concussed adult and youth athletes, assessed the validity of five previously selected eye tracking variables for SRC diagnostics and management. The performance between concussed and age-matched control (non-concussed) athletes, as well as between three successive testing sessions in the concussed athletes were compared. Self-paced saccade count in adult group; blink duration in the memory-guided saccade and sinusoidal smooth pursuit tasks, proportion of antisaccade errors, and gain of diagonal smooth pursuit in the youth group were assessed. RESULTS The youth concussed group had higher blink duration in the fast memory-guided saccades task (p = 0.001, η2 = 0.17) and a tendency for higher blink duration in the sinusoidal smooth pursuit task (p = 0.016, η2 = 0.06) compared to the youth control group. In both tasks the blink duration in the concussed youth group decreased from session 1 to session 2 by 24% and 18%, accordingly, although statistical significance was not reached. The concussed adult group demonstrated a lower number of self-paced saccades compared to controls (p = 0.05, η2 = 0.09), which gradually increased, with the largest difference between session 1 and session 3 (p = 0.02). CONCLUSIONS Blink duration in youth athletes holds promise as a valid metric for concussion diagnostics and monitoring. It is recommended to focus future studies on comparing eye tracking performance within the same concussed athletes over time rather than comparing them to healthy controls.
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Affiliation(s)
- Nadja Snegireva
- Sports Science, Stellenbosch University Faculty of Medicine and Health Sciences, Suidwal Road, Coetzenburg, Cape Town, Western Cape, 7601, SOUTH AFRICA
| | - Wayne Derman
- Institute of Sport and Exercise Medicine, Stellenbosch University Faculty of Medicine and Health Sciences, Francie Van Zijl Dr, Parow, Cape Town, Western Cape, 7505, SOUTH AFRICA
| | - Jon Patricios
- Wits Institute for Sport and Health, University of the Witwatersrand Faculty of Health Sciences, 27 St Andrews Rd, Parktown, Johannesburg, Gauteng, 2193, SOUTH AFRICA
| | - Karen Estelle Welman
- Sports Science, Stellenbosch University Faculty of Medicine and Health Sciences, Suidwal Road, Coetzenburg, Cape Town, Western Cape, 7601, SOUTH AFRICA
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McDonald MA, Holdsworth SJ, Danesh-Meyer HV. Eye Movements in Mild Traumatic Brain Injury: Ocular Biomarkers. J Eye Mov Res 2022; 15:10.16910/jemr.15.2.4. [PMID: 36439911 PMCID: PMC9682364 DOI: 10.16910/jemr.15.2.4] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023] Open
Abstract
Mild traumatic brain injury (mTBI, or concussion), results from direct and indirect trauma to the head (i.e. a closed injury of transmitted forces), with or without loss of consciousness. The current method of diagnosis is largely based on symptom assessment and clinical history. There is an urgent need to identify an objective biomarker which can not only detect injury, but inform prognosis and recovery. Ocular motor impairment is argued to be ubiquitous across mTBI subtypes and may serve as a valuable clinical biomarker with the recent advent of more affordable and portable eye tracking technology. Many groups have positively correlated the degree of ocular motor impairment to symptom severity with a minority attempting to validate these findings with diffusion tract imaging and functional MRI. However, numerous methodological issues limit the interpretation of results, preventing any singular ocular biomarker from prevailing. This review will comprehensively describe the anatomical susceptibility, clinical measurement, and current eye tracking literature surrounding saccades, smooth pursuit, vestibulo-ocular reflex, vergence, pupillary light reflex, and accommodation in mTBI.
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Affiliation(s)
- Matthew A McDonald
- Department of Ophthalmology, University of Auckland, New Zealand
- Mātai Medical Research Institute, Gisborne, New Zealand
| | - Samantha J Holdsworth
- Department of Anatomy and Medical Imaging, University of Auckland, New Zealand
- Mātai Medical Research Institute, Gisborne, New Zealand
| | - Helen V Danesh-Meyer
- Department of Ophthalmology, University of Auckland, New Zealand
- Eye Institute, Auckland, New Zealand
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Cade A, Turnbull PR. Clinical testing of mild traumatic brain injury using computerised eye-tracking tests. Clin Exp Optom 2022; 105:680-686. [PMID: 35021960 DOI: 10.1080/08164622.2021.2018915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Traumatic brain injury (TBI) refers to the alteration of typical brain function that occurs following a blow to the head. Even a mild case of traumatic brain injury (mTBI) can lead to long-term impairment, so accurate and timely detection is vital. Visual symptoms are common following mTBI, so while it may seem to fall outside their typical scope of practice, optometrists are ideally qualified to assess the visual impacts and help with the diagnosis of mTBI. Given that mTBI is challenging to objectively diagnose and has no universally accepted diagnostic criteria, clinicians can lack confidence in diagnosing mTBI, and be hesitant in becoming involved in the management of such patients. The development of easily quantifiable techniques using eye tracking as an objective diagnostic tool provides practitioners with an easier pathway into the field, assigning numerical values to parameters which are difficult to assess using conventional optometric tests. As this evolving technology becomes increasingly integrated into optometric clinical settings, the potential for it to identify deficits accurately and reliably in patients following mTBI, and to monitor both their recovery and the effectiveness of potential treatments will increase. This paper provides an overview of clinical tests, relevant to optometrists, that can uncover oculomotor, attentional, and exteroceptive deficits following a mTBI, so that an optometrist with an interest in eye tracking can play a role in the detection and monitoring of mTBI symptoms.
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Affiliation(s)
- Alice Cade
- School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
| | - Philip Rk Turnbull
- School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
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Battaglini L, Ghiani A. Motion behind occluder: Amodal perception and visual motion extrapolation. VISUAL COGNITION 2021. [DOI: 10.1080/13506285.2021.1943094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Luca Battaglini
- Department of General Psychology, University of Padova, Padova, Italy
- Department of Physics and Astronomy “Galileo Galilei”, University of Padova, Padova, Italy
| | - Andrea Ghiani
- Department of General Psychology, University of Padova, Padova, Italy
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Wolf A, Ueda K. Contribution of Eye-Tracking to Study Cognitive Impairments Among Clinical Populations. Front Psychol 2021; 12:590986. [PMID: 34163391 PMCID: PMC8215550 DOI: 10.3389/fpsyg.2021.590986] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 05/07/2021] [Indexed: 11/29/2022] Open
Abstract
In the field of psychology, the merge of decision-theory and neuroscientific methods produces an array of scientifically recognized paradigms. For example, by exploring consumer’s eye-movement behavior, researchers aim to deepen the understanding of how patterns of retinal activation are being meaningfully transformed into visual experiences and connected with specific reactions (e.g., purchase). Notably, eye-movements provide knowledge of one’s homeostatic balance and gatekeep information that shape decisions. Hence, vision science investigates the quality of observed environments determined under various experimental conditions. Moreover, it answers questions on how human process visual stimuli and use gained information for a successful strategy to achieve certain goals. While capturing cognitive states with the support of the eye-trackers progresses at a relatively fast pace in decision-making research, measuring the visual performance of real-life tasks, which require complex cognitive skills, is tentatively translated into clinical experiments. Nevertheless, the potential of the human eye as a highly valuable source of biomarkers has been underlined. In this article, we aim to draw readers attention to decision-making experimental paradigms supported with eye-tracking technology among clinical populations. Such interdisciplinary approach may become an important component that will (i) help in objectively illustrating patient’s models of beliefs and values, (ii) support clinical interventions, and (iii) contribute to health services. It is possible that shortly, eye-movement data from decision-making experiments will grant the scientific community a greater understanding of mechanisms underlining mental states and consumption practices that medical professionals consider as obsessions, disorders or addiction.
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Affiliation(s)
- Alexandra Wolf
- JSPS International Research Fellow, Research Center for Applied Perceptual Science, Kyushu University, Fukuoka, Japan
| | - Kazuo Ueda
- Unit of Perceptual Psychology, Dept. Human Science, Research Center for Applied Perceptual Science, Division of Auditory and Visual Perception Research, Research and Development Center for Five-Sense Devices, Kyushu University, Fukuoka, Japan
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Allen CM, Halsey L, Topcu G, Rier L, Gascoyne LE, Scadding JW, Furlong PL, Dunkley BT, das Nair R, Brookes MJ, Evangelou N. Magnetoencephalography abnormalities in adult mild traumatic brain injury: A systematic review. Neuroimage Clin 2021; 31:102697. [PMID: 34010785 PMCID: PMC8141472 DOI: 10.1016/j.nicl.2021.102697] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/28/2021] [Accepted: 05/06/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND The global incidence of traumatic brain injuries is rising, with at least 80% being classified as mild. These mild injuries are not visible on routine clinical imaging. The potential clinical role of a specific imaging biomarker be it diagnostic, prognostic or directing and monitoring progress of personalised treatment and rehabilitation has driven the exploration of several new neuroimaging modalities. This systematic review examined the evidence for magnetoencephalography (MEG) to provide an imaging biomarker in mild traumatic brain injury (mTBI). METHODS Our review was prospectively registered on PROSPERO: CRD42019151387. We searched EMBASE, MEDLINE, trial registers, PsycINFO, Cochrane Library and conference abstracts and identified 37 papers describing MEG changes in mTBI eligible for inclusion. Since meta-analysis was not possible, based on the heterogeneity of reported outcomes, we provide a narrative synthesis of results. RESULTS The two most promising MEG biomarkers are excess resting state low frequency power, and widespread connectivity changes in all frequency bands. These may represent biomarkers with potential for diagnostic application, which reflect time sensitive changes, or may be capable of offering clinically relevant prognostic information. In addition, the rich data that MEG produces are well-suited to new methods of machine learning analysis, which is now being actively explored. INTERPRETATION MEG reveals several promising biomarkers, in the absence of structural abnormalities demonstrable with either computerised tomography or magnetic resonance imaging. This review has not identified sufficient evidence to support routine clinical use of MEG in mTBI currently. However, verifying MEG's potential would help meet an urgent clinical need within civilian, sports and military medicine.
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Affiliation(s)
- Christopher M Allen
- Mental Health and Clinical Neurosciences Academic Unit, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH, United Kingdom.
| | - Lloyd Halsey
- Mental Health and Clinical Neurosciences Academic Unit, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH, United Kingdom
| | - Gogem Topcu
- Mental Health and Clinical Neurosciences Academic Unit, School of Medicine, University of Nottingham, Jubilee Campus, Nottingham NG8 1BB, United Kingdom
| | - Lukas Rier
- Sir Peter Mansfield Imaging Centre, School of Physics & Astronomy, University of Nottingham, University Park, Nottingham NG7 2RD, United Kingdom
| | - Lauren E Gascoyne
- Sir Peter Mansfield Imaging Centre, School of Physics & Astronomy, University of Nottingham, University Park, Nottingham NG7 2RD, United Kingdom
| | - John W Scadding
- National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, United Kingdom
| | - Paul L Furlong
- College of Health and Life Sciences, Institute of Health and Neurodevelopment, Aston University, The Aston Triangle, Birmingham B4 7ET, United Kingdom
| | - Benjamin T Dunkley
- Department of Medical Imaging, University of Toronto. 263 McCaul Street, Toronto M5T 1W7, Canada
| | - Roshan das Nair
- Mental Health and Clinical Neurosciences Academic Unit, School of Medicine, University of Nottingham, Jubilee Campus, Nottingham NG8 1BB, United Kingdom
| | - Matthew J Brookes
- Sir Peter Mansfield Imaging Centre, School of Physics & Astronomy, University of Nottingham, University Park, Nottingham NG7 2RD, United Kingdom
| | - Nikos Evangelou
- Mental Health and Clinical Neurosciences Academic Unit, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH, United Kingdom
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9
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Benassi M, Frattini D, Garofalo S, Bolzani R, Pansell T. Visuo-motor integration, vision perception and attention in mTBI patients. Preliminary findings. PLoS One 2021; 16:e0250598. [PMID: 33905440 PMCID: PMC8078787 DOI: 10.1371/journal.pone.0250598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 04/11/2021] [Indexed: 11/19/2022] Open
Abstract
Patients with mild traumatic brain injuries (mTBI) often report difficulties in motor coordination and visuo-spatial attention. However, the consequences of mTBI on fine motor and visuo-motor coordination are still not well understood. We aimed to evaluate whether mTBI had a concomitant effect on fine motor ability and visuo-motor integration and whether this is related to visual perception and visuo-spatial attention impairments, including patients at different symptoms stage. Eleven mTBI patients (mean age 22.8 years) and ten healthy controls participated in the study. Visuo-motor integration of fine motor abilities and form recognition were measured with the Beery-Buktenica Developmental Test of Visual-Motor Integration test, motion perception was evaluated with motion coherence test, critical flicker fusion was measured with Pocket CFF tester. Visuo-spatial was assessed with the Ruff 2 & 7 Selection Attention Test. mTBI patients showed reduced visuo-motor integration, form recognition, and motor deficits as well as visuo-spatial attention impairment, while motion perception and critical flicker fusion were not impaired. These preliminary findings suggest that the temporary brain insults deriving from mTBI compromise fine motor skills, visuomotor integration, form recognition, and visuo-spatial attention. The impairment in visuo-motor coordination was associated with speed in visuo-attention and correlated with symptoms severity while motor ability was correlated with time since concussion. Given the strong correlation between visuomotor coordination and symptom severity, further investigation with a larger sample seems warranted. Since there appeared to be differences in motor skills with respect to symptom stage, further research is needed to investigate symptom profiles associated with visuomotor coordination and fine motor deficits in mTBI patients.
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Affiliation(s)
| | - Davide Frattini
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Sara Garofalo
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Roberto Bolzani
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Tony Pansell
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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10
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Rehabilitation of visual disorders. HANDBOOK OF CLINICAL NEUROLOGY 2021; 178:361-386. [PMID: 33832686 DOI: 10.1016/b978-0-12-821377-3.00015-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
While there is a long history of rehabilitation for motor deficits following cerebral lesions, less is known about our ability to improve visual deficits. Vision therapy, prisms, occluders, and filters have been advocated for patients with mild traumatic brain injury, on the premise that some of their symptoms may reflect abnormal visual or ocular motor function, but the evidence for their efficacy is modest. For hemianopia, attempts to restore vision have had unimpressive results, though it appears possible to generate blindsight through training. Strategic approaches that train more efficient use of visual search in hemianopia have shown consistent benefit in visual function, while prism aids may help some patients. There are many varieties of alexia. Strategic adaptation of saccades can improve hemianopic alexia, but there has been less work and mixed results for pure alexia, neglect dyslexia, attentional dyslexia, and the central dyslexias. A number of approaches have been tried in prosopagnosia, with recent studies of small groups suggesting that face perception of prosopagnosic subjects can be enhanced through perceptual learning.
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11
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Huang MX, Huang CW, Harrington DL, Nichols S, Robb-Swan A, Angeles-Quinto A, Le L, Rimmele C, Drake A, Song T, Huang JW, Clifford R, Ji Z, Cheng CK, Lerman I, Yurgil KA, Lee RR, Baker DG. Marked Increases in Resting-State MEG Gamma-Band Activity in Combat-Related Mild Traumatic Brain Injury. Cereb Cortex 2021; 30:283-295. [PMID: 31041986 DOI: 10.1093/cercor/bhz087] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 03/29/2019] [Accepted: 04/01/2019] [Indexed: 01/08/2023] Open
Abstract
Combat-related mild traumatic brain injury (mTBI) is a leading cause of sustained impairments in military service members and veterans. Recent animal studies show that GABA-ergic parvalbumin-positive interneurons are susceptible to brain injury, with damage causing abnormal increases in spontaneous gamma-band (30-80 Hz) activity. We investigated spontaneous gamma activity in individuals with mTBI using high-resolution resting-state magnetoencephalography source imaging. Participants included 25 symptomatic individuals with chronic combat-related blast mTBI and 35 healthy controls with similar combat experiences. Compared with controls, gamma activity was markedly elevated in mTBI participants throughout frontal, parietal, temporal, and occipital cortices, whereas gamma activity was reduced in ventromedial prefrontal cortex. Across groups, greater gamma activity correlated with poorer performances on tests of executive functioning and visuospatial processing. Many neurocognitive associations, however, were partly driven by the higher incidence of mTBI participants with both higher gamma activity and poorer cognition, suggesting that expansive upregulation of gamma has negative repercussions for cognition particularly in mTBI. This is the first human study to demonstrate abnormal resting-state gamma activity in mTBI. These novel findings suggest the possibility that abnormal gamma activities may be a proxy for GABA-ergic interneuron dysfunction and a promising neuroimaging marker of insidious mild head injuries.
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Affiliation(s)
- Ming-Xiong Huang
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Radiology, University of California, San Diego, CA, USA
| | - Charles W Huang
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Deborah L Harrington
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Radiology, University of California, San Diego, CA, USA
| | - Sharon Nichols
- Department of Neuroscience, University of California, San Diego, CA, USA
| | - Ashley Robb-Swan
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Radiology, University of California, San Diego, CA, USA
| | - Annemarie Angeles-Quinto
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Radiology, University of California, San Diego, CA, USA
| | - Lu Le
- ASPIRE Center, VASDHS Residential Rehabilitation Treatment Program, San Diego, CA, USA
| | - Carl Rimmele
- ASPIRE Center, VASDHS Residential Rehabilitation Treatment Program, San Diego, CA, USA
| | - Angela Drake
- Cedar Sinai Medical Group Chronic Pain Program, Beverly Hills, CA, USA
| | - Tao Song
- Department of Radiology, University of California, San Diego, CA, USA
| | - Jeffrey W Huang
- Department of Computer Science, Columbia University, New York, NY, USA
| | - Royce Clifford
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California, San Diego, CA, USA.,VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA
| | - Zhengwei Ji
- Department of Radiology, University of California, San Diego, CA, USA
| | - Chung-Kuan Cheng
- Department of Computer Science and Engineering, University of California, San Diego, CA, USA
| | - Imanuel Lerman
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA
| | - Kate A Yurgil
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA.,VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA.,Department of Psychological Sciences, Loyola University, New Orleans, LA, USA
| | - Roland R Lee
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Radiology, University of California, San Diego, CA, USA
| | - Dewleen G Baker
- Radiology, Research, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, University of California, San Diego, CA, USA.,VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA
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12
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Portnova GV, Girzhova IN, Martynova OV. Residual and compensatory changes of resting‐state EEG in successful recovery after moderate TBI. BRAIN SCIENCE ADVANCES 2021. [DOI: 10.26599/bsa.2020.9050025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Purpose: Even in years after recovery from moderate traumatic brain injury (moderate TBI), patients complain about residual cognitive impairment and fatigue. We hypothesized that non‐linear and linear resting‐state electroencephalography (rsEEG) features might also reflect neural underpinnings of these deficits. Methods: We analyzed a 10‐minute rsEEG in 77 moderate TBI‐survivors and 151 healthy volunteers after cognitive and psychological assessment. The rsEEG analysis included linear measures, such as power spectral density and peak alpha frequency, and non‐linear parameters such as Higuchi fractal dimension, envelope frequency, and Hjorth complexity. Results: The patients with moderate TBI had higher scores for fatigue and sleepiness and lower scores for mood and life satisfaction than controls. The behavioral test for directed attention showed a smaller and non‐significant between‐group difference. In rsEEG patterns, moderate TBI‐group had significantly higher deltaand theta‐rhythm power, which correlated with higher sleepiness and fatigue scores. The higher beta and lower alpha power were associated with a higher attention level in moderate TBI patients. Non‐linear rsEEG features were significantly higher in moderate TBI patients than in healthy controls but correlated with sleepiness and fatigue scores in both controls and patients. Conclusion: The rsEEG patterns may reflect compensatory processes supporting directed attention and residual effect of moderate TBI causing subjective fatigue in patients even after full physiological recovery.
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Affiliation(s)
- Galina V. Portnova
- Institute of Higher Nervous Activity and Neurophysiology of the Russian Academy of Science, Moscow 117485, Russia
- The Pushkin State Russian Language Institute, Moscow 117485, Russia
| | | | - Olga V. Martynova
- Institute of Higher Nervous Activity and Neurophysiology of the Russian Academy of Science, Moscow 117485, Russia
- Centre for Cognition and Decision Making, Institute for Cognitive Neuroscience, National Research University Higher School of Economics, Moscow 109028, Russia
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13
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Gunasekaran P, Fraser CL, Hodge C. The learning effect of the King-Devick test in semi-professional rugby union athletes. J Neurol Sci 2020; 419:117168. [PMID: 33038568 DOI: 10.1016/j.jns.2020.117168] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/21/2020] [Accepted: 09/30/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Abnormalities of eye movement and visual processing are common in traumatic brain injury. The King-Devick test (KDT) has been widely used in the detection and recovery of concussion. Current recommendations propose performing the initial test at baseline and then repeating annually to account for potential learning effects. In practice, this may still account for large deviations. The aim of this study was to determine the number of trials needed for a player to achieve a ceiling effect and to determine the validity of the existing protocol requiring two tests at baseline. METHODS One hundred and eighty-three semi-professional male rugby union players (median age = 22.5 (21.0-25.3) years) were recruited. Over the duration, all athletes performed the KDT on an iPad, under standardised baseline procedures and then repeated the test based on availability during weekly in-season training. RESULTS The improvement through each repeated trial was 0.60 ± 0.1 s (P < 0.001). The ceiling effect was determined at 30 trials. A median difference of 4.2 s (range 0-14.9) was calculated between the initial and best trial overall, although the greatest difference occurred within the first eight attempts. There was a significant positive correlation between the initial test value and the difference between first and fastest time (P < 0.001, r = 0.455). CONCLUSION We have shown continuous improvement with repeated attempts which suggests that administrators ideally should continue to perform the KDT over the duration of the season to optimise the value of the test.
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Affiliation(s)
- Premkumar Gunasekaran
- Discipline of Orthoptics, Graduate School of Health, University of Technology Sydney, NSW, Australia.
| | - Clare L Fraser
- Save Sight Institute, Discipline of Ophthalmology, Faculty of Health and Medicine, The University of Sydney, NSW, Australia.
| | - Christopher Hodge
- Discipline of Orthoptics, Graduate School of Health, University of Technology Sydney, NSW, Australia; Save Sight Institute, Discipline of Ophthalmology, Faculty of Health and Medicine, The University of Sydney, NSW, Australia.
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14
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Barton JJS, Ranalli PJ. Vision Therapy: Ocular Motor Training in Mild Traumatic Brain Injury. Ann Neurol 2020; 88:453-461. [DOI: 10.1002/ana.25820] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 05/28/2020] [Accepted: 06/07/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Jason J. S. Barton
- Departments of Medicine (Neurology), Ophthalmology and Visual Sciences, and PsychologyUniversity of British Columbia Vancouver British Columbia Canada
| | - Paul J. Ranalli
- Departments of Medicine (Neurology), Ophthalmology and Visual Sciences, and Oto‐LaryngologyUniversity of Toronto Toronto Ontario Canada
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15
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Snegireva N, Derman W, Patricios J, Welman KE. Awareness and Perceived Value of Eye Tracking Technology for Concussion Assessment among Sports Medicine Clinicians: A Multinational Study. PHYSICIAN SPORTSMED 2020; 48:165-172. [PMID: 31322973 DOI: 10.1080/00913847.2019.1645577] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Objective: The awareness of concussion as a serious and frequently occurring sports injury and its management has evolved significantly. One viable objective diagnostic tool is eye tracking technology. The authors hypothesized that while clinicians may be aware that assessing eye movements in concussed athletes can be beneficial, it is possible that, due to the novelty of the eye tracking technology and limited exposure, only a few actually use it in their practice. The study aimed to assess the awareness of eye movement deficits associated with concussion amongst sports medicine clinicians and to determine the utilization and perceptions of the eye tracking technology for concussion diagnosis.Methods: An online 18-question survey was distributed internationally from January until December 2017 and completed by 171 sports medicine clinicians (sport physicians, therapists, general practitioners, neuropsychologists) from 32 countries.Results: Respondents indicated that subjectivity of assessments remained a major limitation of established diagnostic tools. Eye tracking technology, despite its potential to attenuate this limitation, was only used by 12% of respondents. To diagnose concussion, 77% did not use any eye movement assessment tools other than own clinical assessment. With the exception of abnormal pupil light reflex, which was checked by 68%, eye movement deficits were inspected by less than half of the respondents (46.3 ± 12%).Conclusion: Even among sports medicine clinicians who regularly attend to patients with concussions, there is insufficient awareness that concussion can lead to abnormal eye tracking behavior. Lack of exposure to the sensitive eye tracking equipment may be a limiting factor for using eye movement metrics for concussion diagnostics. Facilitating the awareness of objective methods, like eye tracking technology, may help assure the appropriate continuum of identification and treatment for concussed athletes. Increasing educational opportunities and practical experience of clinicians regarding concussive symptoms and potential innovative technology is strongly advocated.
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Affiliation(s)
- Nadja Snegireva
- Movement Laboratory, Department of Sport Science, Stellenbosch University, Stellenbosch, South Africa
| | - Wayne Derman
- Institute of Sport and Exercise Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,International Olympic Committee (IOC) Research Centre, Cape Town, South Africa
| | - Jon Patricios
- Wits Institute for Sport and Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Karen E Welman
- Movement Laboratory, Department of Sport Science, Stellenbosch University, Stellenbosch, South Africa
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16
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Ettenhofer ML, Gimbel SI, Cordero E. Clinical validation of an optimized multimodal neurocognitive assessment of chronic mild TBI. Ann Clin Transl Neurol 2020; 7:507-516. [PMID: 32207241 PMCID: PMC7187705 DOI: 10.1002/acn3.51020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 03/02/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Previous laboratory-based studies have shown that neurocognitive eye-tracking metrics are sensitive to chronic effects of mild traumatic brain injury (mTBI), even in individuals with normal performance on traditional neuropsychological measures. In this study, we sought to replicate and extend these findings in a military medical environment. We expected that metrics from the multimodal Fusion n-Back test would successfully distinguish chronic mTBI participants from controls, particularly eye movement metrics from the more cognitively challenging "1-Back" subtest. METHODS We compared performance of participants with chronic mTBI (n = 46) and controls (n = 33) on the Fusion n-Back test and a battery of conventional neuropsychological tests. Additionally, we examined test reliability and the impact of potential confounds to neurocognitive assessment. RESULTS Our results supported hypotheses; Fusion 1-Back metrics were successful in multimodal (saccadic and manual) classification of chronic mTBI versus control. In contrast, conventional neuropsychological measures could not distinguish these groups. Additional findings demonstrated the reliability of Fusion n-Back test metrics and provided evidence that saccadic metrics are resistant to confounding influences of age, intelligence, and psychiatric symptoms. INTERPRETATION The Fusion n-Back test could provide advantages in differential diagnosis for complex brain injury populations. Additionally, the rapid administration of this test could be valuable for screening patients in clinical settings where longer test batteries are not feasible.
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Affiliation(s)
- Mark L Ettenhofer
- Uniformed Services University of the Health Sciences, Bethesda, Maryland.,Defense and Veterans Brain Injury Center, Silver Spring, Maryland.,Naval Medical Center San Diego, San Diego, California.,University of California, San Diego, California
| | - Sarah I Gimbel
- Naval Medical Center San Diego, San Diego, California.,General Dynamics Information Technology, Falls Church, Virginia
| | - Evelyn Cordero
- Naval Medical Center San Diego, San Diego, California.,Henry M. Jackson Foundation, Bethesda, Maryland
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17
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Stuart S, Parrington L, Martini D, Peterka R, Chesnutt J, King L. The Measurement of Eye Movements in Mild Traumatic Brain Injury: A Structured Review of an Emerging Area. Front Sports Act Living 2020; 2:5. [PMID: 33345000 PMCID: PMC7739790 DOI: 10.3389/fspor.2020.00005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 01/08/2020] [Indexed: 11/13/2022] Open
Abstract
Mild traumatic brain injury (mTBI), or concussion, occurs following a direct or indirect force to the head that causes a change in brain function. Many neurological signs and symptoms of mTBI can be subtle and transient, and some can persist beyond the usual recovery timeframe, such as balance, cognitive or sensory disturbance that may pre-dispose to further injury in the future. There is currently no accepted definition or diagnostic criteria for mTBI and therefore no single assessment has been developed or accepted as being able to identify those with an mTBI. Eye-movement assessment may be useful, as specific eye-movements and their metrics can be attributed to specific brain regions or functions, and eye-movement involves a multitude of brain regions. Recently, research has focused on quantitative eye-movement assessments using eye-tracking technology for diagnosis and monitoring symptoms of an mTBI. However, the approaches taken to objectively measure eye-movements varies with respect to instrumentation, protocols and recognition of factors that may influence results, such as cognitive function or basic visual function. This review aimed to examine previous work that has measured eye-movements within those with mTBI to inform the development of robust or standardized testing protocols. Medline/PubMed, CINAHL, PsychInfo and Scopus databases were searched. Twenty-two articles met inclusion/exclusion criteria and were reviewed, which examined saccades, smooth pursuits, fixations and nystagmus in mTBI compared to controls. Current methodologies for data collection, analysis and interpretation from eye-tracking technology in individuals following an mTBI are discussed. In brief, a wide range of eye-movement instruments and outcome measures were reported, but validity and reliability of devices and metrics were insufficiently reported across studies. Interpretation of outcomes was complicated by poor study reporting of demographics, mTBI-related features (e.g., time since injury), and few studies considered the influence that cognitive or visual functions may have on eye-movements. The reviewed evidence suggests that eye-movements are impaired in mTBI, but future research is required to accurately and robustly establish findings. Standardization and reporting of eye-movement instruments, data collection procedures, processing algorithms and analysis methods are required. Recommendations also include comprehensive reporting of demographics, mTBI-related features, and confounding variables.
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Affiliation(s)
- Samuel Stuart
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, United Kingdom
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States
- Veterans Affairs Portland Health Care System, Portland, OR, United States
| | - Lucy Parrington
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States
- Veterans Affairs Portland Health Care System, Portland, OR, United States
| | - Douglas Martini
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States
- Veterans Affairs Portland Health Care System, Portland, OR, United States
| | - Robert Peterka
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States
- Veterans Affairs Portland Health Care System, Portland, OR, United States
- National Center for Rehabilitative Auditory Research, Veterans Affairs Portland Health Care System, Portland, OR, United States
| | - James Chesnutt
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, United States
- Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR, United States
| | - Laurie King
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States
- Veterans Affairs Portland Health Care System, Portland, OR, United States
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18
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Bader F, Kochen WR, Kraus M, Wiener M. The dissociation of temporal processing behavior in concussion patients: Stable motor and dynamic perceptual timing. Cortex 2019; 119:215-230. [DOI: 10.1016/j.cortex.2019.04.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 03/07/2019] [Accepted: 04/25/2019] [Indexed: 02/07/2023]
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Spadoni AD, Huang M, Simmons AN. Emerging Approaches to Neurocircuits in PTSD and TBI: Imaging the Interplay of Neural and Emotional Trauma. Curr Top Behav Neurosci 2019; 38:163-192. [PMID: 29285732 PMCID: PMC8896198 DOI: 10.1007/7854_2017_35] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI) commonly co-occur in general and military populations and have a number of overlapping symptoms. While research suggests that TBI is risk factor for PTSD and that PTSD may mediate TBI-related outcomes, the mechanisms of these relationships are not well understood. Neuroimaging may help elucidate patterns of neurocircuitry both specific and common to PTSD and TBI and thus help define the nature of their interaction, refine diagnostic classification, and may potentially yield opportunities for targeted treatments. In this review, we provide a summary of some of the most common and the most innovative neuroimaging approaches used to characterize the neural circuits associated with PTSD, TBI, and their comorbidity. We summarize the state of the science for each disorder and describe the few studies that have explicitly attempted to characterize the neural substrates of their shared and dissociable influence. While some promising targets in the medial frontal lobes exist, there is not currently a comprehensive understanding of the neurocircuitry mediating the interaction of PTSD and TBI. Future studies should exploit innovative neuroimaging approaches and longitudinal designs to specifically target the neural mechanisms driving PTSD-TBI-related outcomes.
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Affiliation(s)
- Andrea D Spadoni
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA.
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA.
| | - Mingxiong Huang
- Radiology and Research Services, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA
| | - Alan N Simmons
- Research Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
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20
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Working memory load improves diagnostic performance of smooth pursuit eye movement in mild traumatic brain injury patients with protracted recovery. Sci Rep 2019; 9:291. [PMID: 30670708 PMCID: PMC6342945 DOI: 10.1038/s41598-018-36286-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 11/14/2018] [Indexed: 11/09/2022] Open
Abstract
Smooth pursuit eye movements have been investigated as a diagnostic tool for mild traumatic brain injury (mTBI). However, the degree to which smooth pursuit differentiates mTBI patients from healthy controls (i.e. its diagnostic performance) is only moderate. Our goal was to establish if simultaneous performance of smooth pursuit and a working memory task increased the diagnostic performance of pursuit metrics following mTBI. We integrated an n-back task with two levels of working memory load into a pursuit target, and tested single- and dual-task pursuit in mTBI patients and healthy controls. We assessed pursuit using measures of velocity accuracy, positional accuracy and positional variability. The mTBI group had higher pursuit variability than the control group in all conditions. Performing a concurrent 1-back task decreased pursuit variability for both the mTBI and control groups. Performing a concurrent 2-back task produced differential effects between the groups: Pursuit variability was significantly decreased in the control group, but not in the mTBI group. Diagnostic indices were improved when pursuit was combined with the 2-back task, and increased by 20% for the most sensitive variable. Smooth pursuit with simultaneous working memory load may be a superior diagnostic tool for mTBI than measuring smooth pursuit alone.
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21
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Snegireva N, Derman W, Patricios J, Welman KE. Eye tracking technology in sports-related concussion: a systematic review and meta-analysis. Physiol Meas 2018; 39:12TR01. [DOI: 10.1088/1361-6579/aaef44] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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22
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Ettenhofer ML, Hershaw JN, Engle JR, Hungerford LD. Saccadic impairment in chronic traumatic brain injury: examining the influence of cognitive load and injury severity. Brain Inj 2018; 32:1740-1748. [PMID: 30183381 DOI: 10.1080/02699052.2018.1511067] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Previous research suggests that saccadic eye movements can be uniquely sensitive to impairment in chronic traumatic brain injury (TBI). This study was conducted to examine saccadic eye movements across varying levels of cognitive load and TBI history/severity. We hypothesized that saccadic impairment in chronic mild and moderate-severe TBI would be most pronounced under conditions of high cognitive load. METHODS In total, 61 participants (including n = 20 with chronic mild TBI, n = 15 with chronic moderate-severe TBI, and 26 uninjured controls) completed a battery of conventional neuropsychological tests and the Fusion n-Back Test, which measures manual and saccadic response time (RT) across varying cognitive load and cueing conditions. RESULTS Consistent with our hypotheses, chronic mild and moderate-severe TBI were associated with substantial saccadic impairment under conditions of high cognitive load. Participants with moderate-severe TBI also demonstrated saccadic impairment at low levels of cognitive load. TBI groups and uninjured controls did not differ significantly on manual metrics or conventional neuropsychological measures. CONCLUSIONS This study provides additional support for the value of eye tracking for enhanced assessment of TBI. Additionally, findings suggest that TBI is associated with greatest susceptibility to oculomotor interference under high levels of cognitive load.
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Affiliation(s)
- Mark L Ettenhofer
- a Defense and Veterans Brain Injury Center , Silver Spring , MD , USA.,b Department of Physical Medicine and Rehabilitation , Naval Medical Center San Diego , San Diego , CA , USA.,c Department of Medical and Clinical Psychology , Uniformed Services University of the Health Sciences , Bethesda , MD , USA.,d Department of Psychiatry , University of California, San Diego , San Diego , CA , USA
| | - Jamie N Hershaw
- c Department of Medical and Clinical Psychology , Uniformed Services University of the Health Sciences , Bethesda , MD , USA.,e Henry M. Jackson Foundation , Bethesda , MD , USA
| | | | - Lars D Hungerford
- a Defense and Veterans Brain Injury Center , Silver Spring , MD , USA.,b Department of Physical Medicine and Rehabilitation , Naval Medical Center San Diego , San Diego , CA , USA
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23
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Mani R, Asper L, Khuu SK. Deficits in saccades and smooth-pursuit eye movements in adults with traumatic brain injury: a systematic review and meta-analysis. Brain Inj 2018; 32:1315-1336. [PMID: 29913089 DOI: 10.1080/02699052.2018.1483030] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
PURPOSE To conduct a review of literature and quantify the effect that traumatic brain injury (TBI) has on oculomotor functions (OM). METHODS A systematic review and meta-analysis was conducted from papers that objectively measured saccades and smooth-pursuit eye movements in mild and severe TBI. RESULTS The overall impact of TBI on OM functions was moderate and significant with an effect size of 0.42 from 181 OM case-control comparisons. The heterogeneity, determined using the random effect model, was found to be significant (Q (180) = 367, p < 0.0001, I2 = 51) owing to the variety of OM functions (reflexive saccades, antisaccades, memory-guided saccades, self-paced saccades and pursuits) measured and varying post-injury periods.The overall effect on OM functions were similar in mild and severe TBI despite differences in combined effect size of various OM functions. OM functions involving complex cognitive skills such as antisaccades (in mild and severe TBI) and memory-guided saccades (in mild TBI) were the most adversely affected, suggesting that OM deficits may be associated with cognitive deficits in TBI. CONCLUSION TBI often results in long-standing OM deficits. Experimental measures of OM assessment reflect neural integrity and may provide a sensitive and objective biomarker to detect OM deficits following TBI.
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Affiliation(s)
- Revathy Mani
- a School of Optometry and Vision Science , The University of New South Wales (UNSW) , Sydney , Australia
| | - Lisa Asper
- a School of Optometry and Vision Science , The University of New South Wales (UNSW) , Sydney , Australia
| | - Sieu K Khuu
- a School of Optometry and Vision Science , The University of New South Wales (UNSW) , Sydney , Australia
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24
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Taghdiri F, Varriano B, Tartaglia MC. Assessment of Oculomotor Function in Patients With Postconcussion Syndrome: A Systematic Review. J Head Trauma Rehabil 2018; 32:E55-E67. [PMID: 28195951 DOI: 10.1097/htr.0000000000000286] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Concussion and its associated sequel, postconcussion syndrome (PCS), have a debilitating impact on the lives of concussed patients. However, a diagnostic biomarker for this condition is lacking. Recently, there has been a surge of interest in using oculomotor function testing as an objective assessment of patients with PCS. OBJECTIVES To systematically synthesize, appraise, and summarize all published empirical studies that have assessed alteration of oculomotor functions in patients with PCS. METHODS Medline, Embase, PsychINFO, and CINAHL databases searched up to July 2016 for studies that used oculomotor function assessment in patients with postconcussion symptoms. RESULTS The search identified 1637 citations, and finally 8 case-control studies were included. Of these, 5 studies used a similar task with a target moving in a circular trajectory. Three other studies measured conventional oculomotor tasks such as saccade, vergence, and smooth pursuit eye movements. CONCLUSIONS Currently, there is limited support for the recommendation of oculomotor function assessments for diagnosis and identification of patients with PCS following head trauma. Therefore, more rigorous studies assessing oculomotor function changes in patients with PCS are warranted.
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Affiliation(s)
- Foad Taghdiri
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Canada (Mr Taghdiri, Ms Varriano, and Dr Tartaglia); and Division of Neurology, University Health Network, Toronto Western Hospital, Canada (Dr Tartaglia)
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26
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Kenzie ES, Parks EL, Bigler ED, Lim MM, Chesnutt JC, Wakeland W. Concussion As a Multi-Scale Complex System: An Interdisciplinary Synthesis of Current Knowledge. Front Neurol 2017; 8:513. [PMID: 29033888 PMCID: PMC5626937 DOI: 10.3389/fneur.2017.00513] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 09/13/2017] [Indexed: 12/14/2022] Open
Abstract
Traumatic brain injury (TBI) has been called "the most complicated disease of the most complex organ of the body" and is an increasingly high-profile public health issue. Many patients report long-term impairments following even "mild" injuries, but reliable criteria for diagnosis and prognosis are lacking. Every clinical trial for TBI treatment to date has failed to demonstrate reliable and safe improvement in outcomes, and the existing body of literature is insufficient to support the creation of a new classification system. Concussion, or mild TBI, is a highly heterogeneous phenomenon, and numerous factors interact dynamically to influence an individual's recovery trajectory. Many of the obstacles faced in research and clinical practice related to TBI and concussion, including observed heterogeneity, arguably stem from the complexity of the condition itself. To improve understanding of this complexity, we review the current state of research through the lens provided by the interdisciplinary field of systems science, which has been increasingly applied to biomedical issues. The review was conducted iteratively, through multiple phases of literature review, expert interviews, and systems diagramming and represents the first phase in an effort to develop systems models of concussion. The primary focus of this work was to examine concepts and ways of thinking about concussion that currently impede research design and block advancements in care of TBI. Results are presented in the form of a multi-scale conceptual framework intended to synthesize knowledge across disciplines, improve research design, and provide a broader, multi-scale model for understanding concussion pathophysiology, classification, and treatment.
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Affiliation(s)
- Erin S. Kenzie
- Systems Science Program, Portland State University, Portland, OR, United States
| | - Elle L. Parks
- Systems Science Program, Portland State University, Portland, OR, United States
| | - Erin D. Bigler
- Department of Psychology and Neuroscience Center, Brigham Young University, Provo, UT, United States
| | - Miranda M. Lim
- Sleep Disorders Clinic, Division of Hospital and Specialty Medicine, Veterans Affairs Portland Health Care System, Portland, OR, United States
- Departments of Neurology, Medicine, and Behavioral Neuroscience, and Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, OR, United States
| | - James C. Chesnutt
- TBI/Concussion Program, Orthopedics & Rehabilitation and Family Medicine, Oregon Health & Science University, Portland, OR, United States
| | - Wayne Wakeland
- Systems Science Program, Portland State University, Portland, OR, United States
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Huang CW, Huang MX, Ji Z, Swan AR, Angeles AM, Song T, Huang JW, Lee RR. High-resolution MEG source imaging approach to accurately localize Broca’s area in patients with brain tumor or epilepsy. Clin Neurophysiol 2016; 127:2308-16. [DOI: 10.1016/j.clinph.2016.02.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Revised: 12/15/2015] [Accepted: 02/09/2016] [Indexed: 11/28/2022]
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Girgis F, Pace J, Sweet J, Miller JP. Hippocampal Neurophysiologic Changes after Mild Traumatic Brain Injury and Potential Neuromodulation Treatment Approaches. Front Syst Neurosci 2016; 10:8. [PMID: 26903824 PMCID: PMC4746250 DOI: 10.3389/fnsys.2016.00008] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 01/25/2016] [Indexed: 12/22/2022] Open
Abstract
Traumatic brain injury (TBI) is the leading cause of death and disability in individuals below age 45, and five million Americans live with chronic disability as a result. Mild TBI (mTBI), defined as TBI in the absence of major imaging or histopathological defects, is responsible for a majority of cases. Despite the lack of overt morphological defects, victims of mTBI frequently suffer lasting cognitive deficits, memory difficulties, and behavioral disturbances. There is increasing evidence that cognitive and memory dysfunction is related to subtle physiological changes that occur in the hippocampus, and these impact both the phenotype of deficits observed and subsequent recovery. Therapeutic modulation of physiological activity by means of medications commonly used for other indications or brain stimulation may represent novel treatment approaches. This review summarizes the present body of knowledge regarding neurophysiologic changes that occur in the hippocampus after mTBI, as well as potential targets for therapeutic modulation of neurologic activity.
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Affiliation(s)
- Fady Girgis
- Department of Neurosurgery, University Hospitals Case Medical Center, Case Western Reserve University Cleveland, OH, USA
| | - Jonathan Pace
- Department of Neurosurgery, University Hospitals Case Medical Center, Case Western Reserve University Cleveland, OH, USA
| | - Jennifer Sweet
- Department of Neurosurgery, University Hospitals Case Medical Center, Case Western Reserve University Cleveland, OH, USA
| | - Jonathan P Miller
- Department of Neurosurgery, University Hospitals Case Medical Center, Case Western Reserve University Cleveland, OH, USA
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Astafiev SV, Zinn KL, Shulman GL, Corbetta M. Exploring the physiological correlates of chronic mild traumatic brain injury symptoms. NEUROIMAGE-CLINICAL 2016; 11:10-19. [PMID: 26909324 PMCID: PMC4732189 DOI: 10.1016/j.nicl.2016.01.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 12/31/2015] [Accepted: 01/04/2016] [Indexed: 12/14/2022]
Abstract
We report on the results of a multimodal imaging study involving behavioral assessments, evoked and resting-state BOLD fMRI, and DTI in chronic mTBI subjects. We found that larger task-evoked BOLD activity in the MT+/LO region in extra-striate visual cortex correlated with mTBI and PTSD symptoms, especially light sensitivity. Moreover, higher FA values near the left optic radiation (OR) were associated with both light sensitivity and higher BOLD activity in the MT+/LO region. The MT+/LO region was localized as a region of abnormal functional connectivity with central white matter regions previously found to have abnormal physiological signals during visual eye movement tracking (Astafiev et al., 2015). We conclude that mTBI symptoms and light sensitivity may be related to excessive responsiveness of visual cortex to sensory stimuli. This abnormal sensitivity may be related to chronic remodeling of white matter visual pathways acutely injured. We report a multimodal imaging study of symptoms in chronic mTBI. Higher BOLD activity in the MT +/LO region correlated with mTBI symptoms. Higher FA near the left optic radiation was associated with light sensitivity.
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Affiliation(s)
- Serguei V Astafiev
- Department of Neurology, Washington University in St. Louis, 660 S. Euclid Ave, Campus Box 8225, St. Louis, MO 63110, USA.
| | - Kristina L Zinn
- Department of Neurology, Washington University in St. Louis, 660 S. Euclid Ave, Campus Box 8225, St. Louis, MO 63110, USA.
| | - Gordon L Shulman
- Department of Neurology, Washington University in St. Louis, 660 S. Euclid Ave, Campus Box 8225, St. Louis, MO 63110, USA.
| | - Maurizio Corbetta
- Department of Neurology, Washington University in St. Louis, 660 S. Euclid Ave, Campus Box 8225, St. Louis, MO 63110, USA.
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Bourne SK, Duhaime AC. Transient Horizontal Gaze Palsy in a One-Month-Old Boy after a Fall. Pediatr Neurosurg 2016; 51:42-7. [PMID: 26636750 DOI: 10.1159/000441680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 10/13/2015] [Indexed: 11/19/2022]
Abstract
A 1-month-old boy was evaluated after a fall from a height of 3 feet and found to have right parietal skull fracture as well as right and left frontal traumatic hemorrhage. Ten days after the injury, he represented with a persistent left gaze preference. Further workup including MRI and EEG determined that this finding was most likely due to a small, focal, left-frontal eye field lesion. We review the horizontal gaze pathway and demonstrate that this is present at this very young age, and that a very focal and relatively minor injury can cause gaze disturbance.
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Affiliation(s)
- Sarah K Bourne
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Mass., USA
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