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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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Del Rossi G. Examination of Near Point of Convergence Scores in High-School Athletes: Implications for Identifying Binocular Vision Dysfunction After Concussion Injury. Clin J Sport Med 2022; 32:e451-e456. [PMID: 36083330 DOI: 10.1097/jsm.0000000000000995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 10/19/2021] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To identify normative near point of convergence (NPC) data for healthy high-school-aged athletes (13-19 years old) and determine the percentage of individuals with NPC scores that fall outside the currently accepted clinical cutoff value of 5 cm. Another objective was to determine the relationship between sex, concussion history, and attention deficit disorder/attention deficit hyperactivity disorder (ADD/ADHD) with NPC scores, if any. DESIGN Case series. SETTING High-school sports medicine clinic. PATIENTS OR PARTICIPANTS Near point of convergence was assessed in 718 high-school student athletes (141 females and 577 males) with an average age of 15.96 ± 1.16 years. INTERVENTIONS None. MAIN OUTCOME MEASURES An accommodation convergence ruler was used to measure NPC. Near point of convergence scores were repeated a total of 3 times and the mean used for all statistical analyses. RESULTS The NPC scores for all participants averaged 3.58 cm, and the intraclass correlation coefficient for the 3 repeated measurements was 0.956. Approximately 20% of mean NPC scores were above the accepted upper limit of 5 cm. Although a statistically significant effect for sex was identified, the difference between them was considered clinically insignificant. No relationship between NPC and history of concussion or ADD/ADHD was identified. CONCLUSIONS Results indicate that in high-school-aged subjects, approximately 20% of individuals may have NPC values that fall outside the current critical cutoff value and may lead to incorrect diagnosis of ocular dysfunction. In addition, NPC does not seem to be affected by the history of concussion or a diagnosis of ADD/ADHD.
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Rauchman SH, Albert J, Pinkhasov A, Reiss AB. Mild-to-Moderate Traumatic Brain Injury: A Review with Focus on the Visual System. Neurol Int 2022; 14:453-470. [PMID: 35736619 PMCID: PMC9227114 DOI: 10.3390/neurolint14020038] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/23/2022] [Accepted: 05/25/2022] [Indexed: 02/01/2023] Open
Abstract
Traumatic Brain Injury (TBI) is a major global public health problem. Neurological damage from TBI may be mild, moderate, or severe and occurs both immediately at the time of impact (primary injury) and continues to evolve afterwards (secondary injury). In mild (m)TBI, common symptoms are headaches, dizziness and fatigue. Visual impairment is especially prevalent. Insomnia, attentional deficits and memory problems often occur. Neuroimaging methods for the management of TBI include computed tomography and magnetic resonance imaging. The location and the extent of injuries determine the motor and/or sensory deficits that result. Parietal lobe damage can lead to deficits in sensorimotor function, memory, and attention span. The processing of visual information may be disrupted, with consequences such as poor hand-eye coordination and balance. TBI may cause lesions in the occipital or parietal lobe that leave the TBI patient with incomplete homonymous hemianopia. Overall, TBI can interfere with everyday life by compromising the ability to work, sleep, drive, read, communicate and perform numerous activities previously taken for granted. Treatment and rehabilitation options available to TBI sufferers are inadequate and there is a pressing need for new ways to help these patients to optimize their functioning and maintain productivity and participation in life activities, family and community.
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Affiliation(s)
- Steven H. Rauchman
- The Fresno Institute of Neuroscience, Fresno, CA 93730, USA
- Correspondence:
| | - Jacqueline Albert
- Department of Medicine, Biomedical Research Institute, NYU Long Island School of Medicine, Mineola, NY 11501, USA; (J.A.); (A.B.R.)
| | - Aaron Pinkhasov
- Department of Psychiatry, NYU Long Island School of Medicine, Mineola, NY 11501, USA;
| | - Allison B. Reiss
- Department of Medicine, Biomedical Research Institute, NYU Long Island School of Medicine, Mineola, NY 11501, USA; (J.A.); (A.B.R.)
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Hecimovich M, King D, Murphy M, Koyama K. An investigation into the measurement properties of the King-Devick Eye Tracking system. JOURNAL OF CONCUSSION 2022. [DOI: 10.1177/20597002221082865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives Eye tracking has been gaining increasing attention as a possible assessment and monitoring tool for concussion. The King-Devick test (K-DT) was expanded to include an infrared video-oculography-based eye tracker (K-D ET). Therefore, the aim was to provide evidence on the reliability of the K-D ET system under an exercise condition. Methods Participants (N = 61; 26 male, 35 female; age range 19-25) were allocated to an exercise or sedentary group. Both groups completed a baseline K-D ET measurement and then either two 10-min exercise or sedentary interventions with repeated K-D ET measurements between interventions. Results The test-retest reliability of the K-D ET ranged from good to excellent for the different variables measured. The mean ± SD of the differences for the total number of saccades was 1.04 ± 4.01 and there was an observable difference (p = 0.005) in the trial number. There were no observable differences for the intervention (p = 0.768), gender (p = 0.121) and trial (p = 0.777) for average saccade’s velocity. The mean ± SD of the difference of the total fixations before and after intervention across both trials was 1.04 ± 3.63 and there was an observable difference in the trial number (p = 0.025). The mean ± SD of the differences for the Inter-Saccadic Interval and the fixation polyarea before and after intervention across both trials were 1.86 ± 22.99 msec and 0.51 ± 59.11 mm2 and no observable differences for the intervention, gender and trial. Conclusion The results provide evidence on the reliability of the K-D ET, and the eye-tracking components and demonstrate the relationship between completion time and other variables of the K-D ET system. This is vital as the use of the K-DT may be increasing and the combination of the K-DT and eye tracking as one single package highlights the need to specifically measure the reliability of this combined unit.
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Affiliation(s)
- M. Hecimovich
- Division of Athletic Training, University of Northern Iowa, Cedar Falls, Iowa, USA
| | - D. King
- Sports Performance Research Institute New Zealand (SPRINZ) at AUT Millennium, Faculty of Health and Environmental Science, Auckland University of Technology, Auckland, New Zealand
- Traumatic Brain injury Network (TBIN), Auckland University of Technology, Auckland, New Zealand
- Department of Science and Technology, University of New England, Sydney, Australia
| | - M. Murphy
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
- SportsMed Subiaco, St John of God Health Care, Subiaco, Western Australia, Australia
| | - K. Koyama
- Department of Rehabilitation Medicine, Gunma University Graduate School of Medicine
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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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Comparing Patient- and Clinician-Administered Near Point of Convergence After Concussion. J Sport Rehabil 2021; 30:1187-1190. [PMID: 34552034 DOI: 10.1123/jsr.2021-0051] [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: 02/11/2021] [Revised: 06/13/2021] [Accepted: 06/16/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE (1) To compare patient- and clinician-administered measurements of near point of convergence (NPC) distance including the percentage of patients exceeding clinical cutoffs among concussed adolescents and (2) to assess the reliability of patient- and clinician-measured NPC distances. METHODS A total of 762 patients (mean = 15.51, SD = 3.09 y) within 30 days of concussion participated. The NPC distance was measured consecutively with the patient and clinician controlling the fixation target. The differences between patient (PT) and clinician (CLIN) measurements and cases exceeding cutoffs (ie, ≥5 cm) were examined with a series of t tests and chi-square tests, respectively. Intraclass correlation coefficients and unbiased estimate of reliability were performed. RESULTS The NPC measurements were similar, t(761) = -.26, P = .79, between the PT (mean = 3.52, SD = 3.77 cm) and CLIN (mean = 3.54, SD = 3.97 cm) conditions. The number of measurements that exceeded cutoffs was similar among the PT (2.5%; 19/762) and CLIN conditions (3%; 23/762) (P = .10), and the number of measurements classified as abnormal/invalid was also similar among the PT (2.5%; 19/762) and CLIN conditions (3%; 23/762) (P = .10). There was excellent reliability between the methods (intraclass correlation coefficients = .85, unbiased estimate of reliability = .92). CONCLUSION The findings support the application of this assessment in clinical settings where the clinician may not have direct contact with their patient and rely on the patient (eg, telehealth).
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Gowrisankaran S, Shah AS, Roberts TL, Wiecek E, Chinn RN, Hawash KK, O'Brien MJ, Howell DR, Meehan WP, Raghuram A. Association between post-concussion symptoms and oculomotor deficits among adolescents. Brain Inj 2021; 35:1218-1228. [PMID: 34383619 DOI: 10.1080/02699052.2021.1959065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To examine the association between Post-Concussion Symptom Scale (PCSS) scores, Convergence Insufficiency Symptom Survey (CISS) scores, and oculomotor deficits post-concussion. METHODS Records of adolescent patients examined in a multidisciplinary concussion clinic between July 2014 and May 2019 were reviewed. PCSS and CISS scores, results of eye examination and oculomotor assessment, concussion history, and demographics were abstracted. RESULTS One hundred and forty patient records (median age, 15.3 years; 52 males, presented 109 days (median) from their most recent concussion) met inclusion criteria. Mean total scores on PCSS and CISS were 46.67 ± 25.89 and 27.13 ± 13.22, respectively, and were moderately correlated with each other (r = 0.53, p < .001). Oculomotor deficits were observed in 123 (88%) patients. Step-wise linear regression identified increased PCSS total score to be significantly associated with decreased amplitude of accommodation (p < .001). Increased CISS total score was significantly associated with receded near point of convergence, developmental eye movement test error scores, and cause of concussion. CONCLUSION High PCSS scores may indicate an accommodation deficit and thus prompt an oculomotor assessment in patients following a concussion. Using the CISS and a detailed oculomotor assessment may reveal underlying oculomotor deficits, which may benefit from treatment.
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Affiliation(s)
| | - Ankoor S Shah
- Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Tawna L Roberts
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Emily Wiecek
- Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Ryan N Chinn
- Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Karameh K Hawash
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Neurology, Harvard Medical School, Boston, Massachusetts, USA
| | - Michael J O'Brien
- Micheli Center for Sports Injury Prevention, Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, Massachusetts, USA.,Brain Injury Center, Boston Children's Hospital, Boston, Massachusetts, USA
| | - David R Howell
- Sports Medicine Center, Children's Hospital Colorado, Aurora, Colorado, USA.,Department of Orthopedics, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
| | - William P Meehan
- Micheli Center for Sports Injury Prevention, Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, Massachusetts, USA.,Brain Injury Center, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Aparna Raghuram
- Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
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Kaufman MW, Su CA, Trivedi NN, Lee MK, Nelson GB, Cupp SA, Voos JE. The Current Status of Concussion Assessment Scales: A Critical Analysis Review. JBJS Rev 2021; 9:01874474-202106000-00001. [PMID: 34101673 DOI: 10.2106/jbjs.rvw.20.00108] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Concussion is a complex pathophysiologic process that affects the brain; it is induced by biomechanical forces, with alteration in mental status with or without loss of consciousness. » Concussion assessment tools may be broadly categorized into (1) screening tests such as the SAC (Standardized Assessment of Concussion), the BESS (Balance Error Scoring System), and the King-Devick (KD) test; (2) confirmatory tests including the SCAT (Sport Concussion Assessment Tool), the ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing), and the VOMS (Vestibular Oculomotor Screening); and (3) objective examinations such as brain network activation (BNA) analysis, imaging studies, and physiologic markers. » The KD, child SCAT3 (cSCAT3), child ImPACT (cImPACT), and VOMS tests may be used to evaluate for concussion in the pediatric athlete. » Future work with BNA, functional magnetic resonance imaging, diffusion tensor imaging, and serum biomarkers may provide more objective assessment of concussion, neurologic injury, and subsequent recovery.
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Affiliation(s)
| | - Charles A Su
- Departments of Orthopaedic Surgery (C.A.S., N.N.T., G.B.N., S.A.C., and J.E.V.) and Family Medicine (S.A.C.), University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Nikunj N Trivedi
- Departments of Orthopaedic Surgery (C.A.S., N.N.T., G.B.N., S.A.C., and J.E.V.) and Family Medicine (S.A.C.), University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Michelle K Lee
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, Ohio
| | - Grant B Nelson
- Departments of Orthopaedic Surgery (C.A.S., N.N.T., G.B.N., S.A.C., and J.E.V.) and Family Medicine (S.A.C.), University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Sean A Cupp
- Departments of Orthopaedic Surgery (C.A.S., N.N.T., G.B.N., S.A.C., and J.E.V.) and Family Medicine (S.A.C.), University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - James E Voos
- Departments of Orthopaedic Surgery (C.A.S., N.N.T., G.B.N., S.A.C., and J.E.V.) and Family Medicine (S.A.C.), University Hospitals Cleveland Medical Center, Cleveland, Ohio
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Murray NG, Szekely B, Islas A, Munkasy B, Gore R, Berryhill M, Reed-Jones RJ. Smooth Pursuit and Saccades after Sport-Related Concussion. J Neurotrauma 2020; 37:340-346. [PMID: 31524054 PMCID: PMC7059002 DOI: 10.1089/neu.2019.6595] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Smooth pursuit eye movements (SPEMs) and saccadic eye movements are both commonly impaired following sport-related concussion (SRC). Typical oculomotor assessments measure individual eye movements in a series of restrictive tests designed to isolate features such as response times. These measures lack ecological validity for athletes because athletes are adept at simple tasks designed for the general population. Yet, because eye movement metrics are sensitive and well-characterized neuroanatomically, it would be valuable to test whether athletes exhibit abnormal eye movements with more challenging tasks. To address this gap in knowledge, we collected eye-tracking data during a sport-like task to gain insight on gaze behavior during active self-motion. SPEMs and saccadic eye movements were recorded during a sport-like visual task within 24-48 h following SRC. Thirty-six Division I student-athletes were divided into SRC and control (CON) groups. All participants completed two blocks of the Wii Fit© soccer heading game (WF) while wearing a monocular infrared eye tracker. Eye movement classification systems quantified saccadic amplitude (SA), velocity (SV), and count (SC); as well as SPEM velocity (SPV) and amplitude (SPA). Separate Mann-Whitney U tests evaluated SPA and SC and found no significant effects (SPA, p = 0.11; SC, p = 0.10). A multi-variate analysis of variance (MANOVA) for remaining variables revealed SPV was significantly greater in CON (p < 0.05), but the SRC group had greater SA and SV (p < 0.05). These findings suggest that during a sport-like task, to maintain foveation SRC subjects used larger amplitude, faster saccades, but exhibited slower SPEMs. Measuring oculomotor function during ecologically valid, sport-like tasks may serve as a concussion biomarker and provide insights into eye movement control after SRC.
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Affiliation(s)
- Nicholas G. Murray
- School of Community Health Sciences, University of Nevada, Reno, Nevada
- Neuromechanics Laboratory, University of Nevada, Reno, Nevada
| | - Brian Szekely
- Neuromechanics Laboratory, University of Nevada, Reno, Nevada
- Psychology Department, University of Nevada, Reno, Nevada
| | - Arthur Islas
- School of Medicine, University of Nevada, Reno, Nevada
| | - Barry Munkasy
- Department of Health Sciences and Kinesiology, Georgia Southern University, Statesboro, Georgia
| | - Russell Gore
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia
- Complex Concussion Clinic, Shepherd Center, Atlanta, Georgia
| | - Marian Berryhill
- Programs in Cognitive and Brain Sciences and Neuroscience, Psychology Department, University of Nevada, Reno, Nevada
| | - Rebecca J. Reed-Jones
- Department of Applied Human Sciences, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
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Moran RN, Covassin T, Elbin RJ. Sex Differences on Vestibular and Ocular Motor Assessment in Youth Athletes. J Athl Train 2019; 54:445-448. [PMID: 31013113 DOI: 10.4085/1062-6050-220-18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT The Vestibular/Ocular Motor Screening (VOMS) is a newly developed measure that evaluates vestibular and ocular motor symptom provocation after sport-related concussion. The effects of sex on baseline VOMS scores in youth athletes have not been established. OBJECTIVE To examine sex differences on baseline VOMS assessment among youth athletes. RESULTS No sex differences were demonstrated between male and female youth athletes on individual VOMS items (P range = .07-.98). Female sex was not associated with increased odds for VOMS scores over clinical-cutoff levels (range: odds ratio = 0.64; 95% confidence interval = 0.35, 1.15; P = .13; odds ratio = 0.91; 95% confidence interval = 0.48, 1.71; P = .77). CONCLUSIONS No sex differences were present on baseline VOMS scores in youth athletes, nor was sex a risk factor for an abnormal VOMS score. These findings highlight the need for continual baseline and postconcussion assessments using multifaceted assessment strategies.
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Affiliation(s)
| | | | - R J Elbin
- University of Arkansas, Fayetteville
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Moran RN, Covassin T, Elbin RJ, Gould D, Nogle S. Reliability and Normative Reference Values for the Vestibular/Ocular Motor Screening (VOMS) Tool in Youth Athletes. Am J Sports Med 2018. [PMID: 29513549 DOI: 10.1177/0363546518756979] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The Vestibular/Ocular Motor Screening (VOMS) measure is a newly developed vestibular and ocular motor symptom provocation screening tool for sport-related concussions. Baseline data, psychometric properties, and reliability of the VOMS are needed to further understand the applications of this tool, especially in the youth population, where research is scarce. PURPOSE To establish normative data and document the internal consistency and false-positive rate of the VOMS in a sample of nonconcussed youth athletes. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS A total of 423 youth athletes (male = 278, female = 145) between the ages of 8 and 14 years completed baseline VOMS screening before the start of their respective sport seasons. Internal consistency was measured with Cronbach α and inter-item correlations. RESULTS Approximately 60% of youth athletes reported no symptom provocation on baseline VOMS assessment, with 9% to 13% scoring over the cutoff levels (score of ≥2 for any individual VOMS symptom, near point convergence distance of ≥5 cm). The VOMS displayed a high internal consistency (Cronbach α = .97) at baseline among youth athletes. CONCLUSION The current findings provide preliminary support for the implementation of VOMS baseline assessment into clinical practice, due to a high internal consistency, strong relationships between VOMS items, and a low false-positive rate at baseline in youth athletes.
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Affiliation(s)
- Ryan N Moran
- Athletic Training Research Lab, Department of Health Science, University of Alabama, Tuscaloosa, Alabama, USA
| | - Tracey Covassin
- Sports Injury Research Lab, Department of Kinesiology, Michigan State University, East Lansing, Michigan, USA
| | - R J Elbin
- Department of Health, Human Performance, and Recreation, University of Arkansas, Fayetteville, Arkansas, USA
| | - Dan Gould
- Institute for the Study of Youth Sports, Michigan State University, East Lansing, Michigan, USA
| | - Sally Nogle
- Sports Injury Research Lab, Department of Kinesiology, Michigan State University, East Lansing, Michigan, USA
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Meng Y, Bottenfield B, Bolding M, Liu L, Adams ML. Sensing Passive Eye Response to Impact Induced Head Acceleration Using MEMS IMUs. IEEE TRANSACTIONS ON BIOMEDICAL CIRCUITS AND SYSTEMS 2018; 12:182-191. [PMID: 29377806 DOI: 10.1109/tbcas.2017.2766565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The eye may act as a surrogate for the brain in response to head acceleration during an impact. Passive eye movements in a dynamic system are sensed by microelectromechanical systems (MEMS) inertial measurement units (IMU) in this paper. The technique is validated using a three-dimensional printed scaled human skull model and on human volunteers by performing drop-and-impact experiments with ribbon-style flexible printed circuit board IMUs inserted in the eyes and reference IMUs on the heads. Data are captured by a microcontroller unit and processed using data fusion. Displacements are thus estimated and match the measured parameters. Relative accelerations and displacements of the eye to the head are computed indicating the influence of the concussion causing impacts.
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Visual Dysfunctions at Different Stages after Blast and Non-blast Mild Traumatic Brain Injury. Optom Vis Sci 2017; 94:7-15. [PMID: 26889821 DOI: 10.1097/opx.0000000000000825] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To assess the prevalence of visual dysfunctions and associated symptoms in war fighters at different stages after non-blast- or blast-induced mild traumatic brain injury (mTBI). METHODS A comprehensive retrospective review of the electronic health records of 500 U.S. military personnel with a diagnosis of deployment-related mTBI who received eye care at the Landstuhl Regional Medical Center. For analysis, the data were grouped by mechanism of injury, and each group was further divided in three subgroups based on the number of days between injury and initial eye examination. RESULTS The data showed a high frequency of visual symptoms and visual dysfunctions. However, the prevalence of visual symptoms and visual dysfunctions did not differ significantly between mechanism of injury and postinjury stage, except for eye pain and diplopia. Among visual symptoms, binocular dysfunctions were more common, including higher near vertical phoria, reduced negative fusional vergence break at near, receded near point of convergence, decreased stereoacuity, and reduced positive relative accommodation. CONCLUSIONS The lack of difference in terms of visual sequelae between subgroups (blast vs. nonblast) suggests that research addressing the assessment and management of mTBI visual sequelae resulting from civilian nonblast events is relevant to military personnel where combat injury results primarily from a blast event.
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Murray NG, D'Amico NR, Powell D, Mormile ME, Grimes KE, Munkasy BA, Gore RK, Reed-Jones RJ. ASB clinical biomechanics award winner 2016: Assessment of gaze stability within 24-48hours post-concussion. Clin Biomech (Bristol, Avon) 2017; 44:21-27. [PMID: 28292694 DOI: 10.1016/j.clinbiomech.2017.03.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 02/10/2017] [Accepted: 03/02/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Approximately 90% of athletes with concussion experience a certain degree of visual system dysfunction immediately post-concussion. Of these abnormalities, gaze stability deficits are denoted as among the most common. Little research quantitatively explores these variables post-concussion. As such, the purpose of this study was to investigate and compare gaze stability between a control group of healthy non-injured athletes and a group of athletes with concussions 24-48hours post-injury. METHODS Ten collegiate NCAA Division I athletes with concussions and ten healthy control collegiate athletes completed two trials of a sport-like antisaccade postural control task, the Wii Fit Soccer Heading Game. During play all participants were instructed to minimize gaze deviations away from a central fixed area. Athletes with concussions were assessed within 24-48 post-concussion while healthy control data were collected during pre-season athletic screening. Raw ocular point of gaze coordinates were tracked with a monocular eye tracking device (240Hz) and motion capture during the postural task to determine the instantaneous gaze coordinates. This data was exported and analyzed using a custom algorithm. Independent t-tests analyzed gaze resultant distance, prosaccade errors, mean vertical velocity, and mean horizontal velocity. FINDINGS Athletes with concussions had significantly greater gaze resultant distance (p=0.006), prosaccade errors (p<0.001), and horizontal velocity (p=0.029) when compared to healthy controls. INTERPRETATION These data suggest that athletes with concussions had less control of gaze during play of the Wii Fit Soccer Heading Game. This could indicate a gaze stability deficit via potentially reduced cortical inhibition that is present within 24-48hours post-concussion.
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Affiliation(s)
- Nicholas G Murray
- School of Health and Kinesiology, College of Health and Human Sciences, Georgia Southern University, Statesboro, GA, United States.
| | - Nathan R D'Amico
- Department of Health, Human Performance, and Recreation, Office for Sport Concussion Research, University of Arkansas, Fayetteville, AR, United States
| | - Douglas Powell
- School of Health Studies, University of Memphis, Memphis, TN, United States
| | - Megan E Mormile
- School of Health and Kinesiology, College of Health and Human Sciences, Georgia Southern University, Statesboro, GA, United States
| | - Katelyn E Grimes
- School of Health and Kinesiology, College of Health and Human Sciences, Georgia Southern University, Statesboro, GA, United States
| | - Barry A Munkasy
- School of Health and Kinesiology, College of Health and Human Sciences, Georgia Southern University, Statesboro, GA, United States
| | - Russell K Gore
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Emory University, Atlanta, GA, United States
| | - Rebecca J Reed-Jones
- Department of Applied Human Sciences, Faculty of Science, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
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Abstract
OBJECTIVES Objective measures to diagnose and to monitor improvement of symptoms following mild traumatic brain injury (mTBI) are lacking. Computerized eye tracking has been advocated as a rapid, user friendly, and field-ready technique to meet this need. DESIGN Eye-tracking data collected via a head-mounted, video-based binocular eye tracker was used to examine saccades, fixations, and smooth pursuit movement in military Service Members with postconcussive syndrome (PCS) and asymptomatic control subjects in an effort to determine if eye movement differences could be found and quantified. PARTICIPANTS Sixty Military Service Members with PCS and 26 asymptomatic controls. OUTCOME MEASURES The diagnosis of mTBI was confirmed by the study physiatrist's history, physical examination, and a review of any medical records. Various features of saccades, fixation and smooth pursuit eye movements were analyzed. RESULTS Subjects with symptomatic mTBI had statistically larger position errors, smaller saccadic amplitudes, smaller predicted peak velocities, smaller peak accelerations, and longer durations. Subjects with symptomatic mTBI were also less likely to follow a target movement (less primary saccades). In general, symptomatic mTBI tracked the stepwise moving targets less accurately, revealing possible brain dysfunction. CONCLUSIONS A reliable, standardized protocol that appears to differentiate mTBI from normals was developed for use in future research. This investigation represents a step toward objective identification of those with PCS. Future studies focused on increasing the specificity of eye movement differences in those with PCS are needed.
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Thiagarajan P, Ciuffreda KJ. Effect of oculomotor rehabilitation on accommodative responsivity in mild traumatic brain injury. ACTA ACUST UNITED AC 2015; 51:175-91. [PMID: 24933717 DOI: 10.1682/jrrd.2013.01.0027] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 08/15/2013] [Indexed: 11/05/2022]
Abstract
Accommodative dysfunction is a common oculomotor sequelae of mild traumatic brain injury (mTBI). This study evaluated a range of dynamic (objective) and static (subjective) measures of accommodation in 12 nonstrabismic individuals with mTBI and near vision-related symptoms before and after oculomotor training (OMT) and placebo (P) training (6 wk, two sessions per week, 3 h of training each). Following OMT, the dynamics of accommodation improved markedly. Clinically, there was a significant increase in the maximum accommodative amplitude both monocularly and binocularly. In addition, the near vision symptoms reduced along with improved visual attention. None of the measures were found to change significantly following P training. These results provide evidence for a significant positive effect of the accommodatively based OMT on accommodative responsivity. Such improvement is suggestive of oculomotor learning, demonstrating considerable residual brain-visual system plasticity in the adult compromised brain.
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Affiliation(s)
- Preethi Thiagarajan
- Retina Foundation of the Southwest, 9600 N Central Expy, Ste 200, Dallas, TX 75231.
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17
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Yadav NK, Ciuffreda KJ. Objective assessment of visual attention in mild traumatic brain injury (mTBI) using visual-evoked potentials (VEP). Brain Inj 2014; 29:352-65. [DOI: 10.3109/02699052.2014.979229] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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18
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Mucha A, Collins MW, Elbin R, Furman JM, Troutman-Enseki C, DeWolf RM, Marchetti G, Kontos AP. A Brief Vestibular/Ocular Motor Screening (VOMS) assessment to evaluate concussions: preliminary findings. Am J Sports Med 2014; 42:2479-86. [PMID: 25106780 PMCID: PMC4209316 DOI: 10.1177/0363546514543775] [Citation(s) in RCA: 484] [Impact Index Per Article: 48.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Vestibular and ocular motor impairments and symptoms have been documented in patients with sport-related concussions. However, there is no current brief clinical screen to assess and monitor these issues. PURPOSE To describe and provide initial data for the internal consistency and validity of a brief clinical screening tool for vestibular and ocular motor impairments and symptoms after sport-related concussions. STUDY DESIGN Cross-sectional study; Level of evidence, 2. METHODS Sixty-four patients, aged 13.9 ± 2.5 years and seen approximately 5.5 ± 4.0 days after a sport-related concussion, and 78 controls were administered the Vestibular/Ocular Motor Screening (VOMS) assessment, which included 5 domains: (1) smooth pursuit, (2) horizontal and vertical saccades, (3) near point of convergence (NPC) distance, (4) horizontal vestibular ocular reflex (VOR), and (5) visual motion sensitivity (VMS). Participants were also administered the Post-Concussion Symptom Scale (PCSS). RESULTS Sixty-one percent of patients reported symptom provocation after at least 1 VOMS item. All VOMS items were positively correlated to the PCSS total symptom score. The VOR (odds ratio [OR], 3.89; P < .001) and VMS (OR, 3.37; P < .01) components of the VOMS were most predictive of being in the concussed group. An NPC distance ≥5 cm and any VOMS item symptom score ≥2 resulted in an increase in the probability of correctly identifying concussed patients of 38% and 50%, respectively. Receiver operating characteristic curves supported a model including the VOR, VMS, NPC distance, and ln(age) that resulted in a high predicted probability (area under the curve = 0.89) for identifying concussed patients. CONCLUSION The VOMS demonstrated internal consistency as well as sensitivity in identifying patients with concussions. The current findings provide preliminary support for the utility of the VOMS as a brief vestibular/ocular motor screen after sport-related concussions. The VOMS may augment current assessment tools and may serve as a single component of a comprehensive approach to the assessment of concussions.
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Affiliation(s)
| | | | | | | | | | | | | | - Anthony P. Kontos
- Address correspondence to: Anthony P. Kontos, PhD, UPMC Sports Medicine Concussion Program, University of Pittsburgh Medical Center, 3200 South Water Street, Pittsburgh, PA 15203, USA,
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Yadav NK, Ciuffreda KJ. Effect of binasal occlusion (BNO) and base-in prisms on the visual-evoked potential (VEP) in mild traumatic brain injury (mTBI). Brain Inj 2014; 28:1568-80. [DOI: 10.3109/02699052.2014.939718] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Naveen K. Yadav
- Department of Biological and Vision Sciences, SUNY State College of Optometry
New York City, NYUSA
| | - Kenneth J. Ciuffreda
- Department of Biological and Vision Sciences, SUNY State College of Optometry
New York City, NYUSA
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20
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Poltavski DV, Biberdorf D. Screening for lifetime concussion in athletes: importance of oculomotor measures. Brain Inj 2014; 28:475-85. [PMID: 24702485 DOI: 10.3109/02699052.2014.888771] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
HYPOTHESIS/OBJECTIVE The purpose of the present study was to determine the utility of oculomotor-based evaluation protocols in screening for lifetime concussion incidence in elite hockey players. METHODS Forty-two Division I collegiate male and female hockey players were evaluated using the guidelines of an overall oculomotor-based diagnostic clinical test protocol for the mTBI population. The sensitivity of the collected measures to lifetime concussion was then compared with the corresponding sensitivity of measures of neuropsychological functioning (ImPACT) often used with athletes for acute concussion diagnosis. RESULTS This model showed that a hockey player with a Near Point of Fixation Disparity (NPFD) equal to or greater than 15 cm, Visagraph comprehension rate less than 85% and the total score on part A of an ADHD questionnaire equal to or greater than 11 was on average 10.72-times more likely to have previously suffered a concussion than an athlete with lower values on the NPFD and ADHD questionnaire and a higher comprehension rate on the Visagraph. None of the IMPACT baseline assessment measures were significantly predictive of the individual's concussion history. CONCLUSION The study provides a relatively sensitive screening tool to assess the probability of previous concussion(s) in an athlete. This model may allow athletic personnel to address in a timely manner the risks associated with repeat concussions and to develop individualized concussion management protocols.
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Affiliation(s)
- Dmitri V Poltavski
- Department of Psychology, University of North Dakota , Grand Forks, ND , USA and
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Yadav NK, Thiagarajan P, Ciuffreda KJ. Effect of oculomotor vision rehabilitation on the visual-evoked potential and visual attention in mild traumatic brain injury. Brain Inj 2014; 28:922-9. [DOI: 10.3109/02699052.2014.887227] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Yadav NK, Ciuffreda KJ. Optimization of the pattern visual evoked potential (VEP) in the visually-normal and mild traumatic brain injury (mTBI) populations. Brain Inj 2013; 27:1631-42. [PMID: 24111626 DOI: 10.3109/02699052.2013.844856] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PRIMARY OBJECTIVE The purpose of this study was to assess the effect of check size (CS) and contrast (C) on VEP amplitude and latency in visually-normal (VN) and in mild traumatic brain injury (mTBI) adults to develop an optimized test protocol in each group. RESEARCH DESIGN AND METHODS Subjects were comprised of VN (n = 19) and individuals with mTBI (n = 16). Full-field, pattern VEP testing was employed with three different CSs (10, 20 and 40 min arc) and at two C levels (20 and 85%). RESULTS There was a significant effect of CS and C on the VEP amplitude and latency in both groups. The 20 min arc CS at both contrast levels produced the largest VEP amplitude, in conjunction with normative latency values, in both populations. There was a significant differential effect of CS and C on VEP responses in the visually symptomatic vs. asymptomatic mTBI sub-groups. A significant correlation was found between time since their most recent brain injury and VEP amplitude for the 20 min arc CS at low contrast. CONCLUSIONS Use of the 20 min arc CS at both contrast levels represents an optimized clinical VEP test protocol in both the VN and mTBI groups. This protocol is rapid, high yield, and targeted for each diagnostic group.
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Affiliation(s)
- Naveen K Yadav
- SUNY State College of Optometry, Department of Biological and Vision Sciences , New York City, NY , USA
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Thiagarajan P, Ciuffreda KJ. Effect of oculomotor rehabilitation on vergence responsivity in mild traumatic brain injury. ACTA ACUST UNITED AC 2013; 50:1223-40. [DOI: 10.1682/jrrd.2012.12.0235] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Revised: 06/11/2013] [Indexed: 11/05/2022]
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Ciuffreda KJ, Yadav NK, Ludlam DP. Effect of binasal occlusion (BNO) on the visual-evoked potential (VEP) in mild traumatic brain injury (mTBI). Brain Inj 2012; 27:41-7. [DOI: 10.3109/02699052.2012.700088] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ciuffreda KJ, Ludlam DP. Objective diagnostic and interventional vision test protocol for the mild traumatic brain injury population. ACTA ACUST UNITED AC 2011; 82:337-9. [DOI: 10.1016/j.optm.2011.03.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Thiagarajan P, Ciuffreda KJ, Ludlam DP. Vergence dysfunction in mild traumatic brain injury (mTBI): a review. Ophthalmic Physiol Opt 2011; 31:456-68. [DOI: 10.1111/j.1475-1313.2011.00831.x] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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