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Wolf A, Tripanpitak K, Umeda S, Otake-Matsuura M. Eye-tracking paradigms for the assessment of mild cognitive impairment: a systematic review. Front Psychol 2023; 14:1197567. [PMID: 37546488 PMCID: PMC10399700 DOI: 10.3389/fpsyg.2023.1197567] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/19/2023] [Indexed: 08/08/2023] Open
Abstract
Mild cognitive impairment (MCI), representing the 'transitional zone' between normal cognition and dementia, has become a novel topic in clinical research. Although early detection is crucial, it remains logistically challenging at the same time. While traditional pen-and-paper tests require in-depth training to ensure standardized administration and accurate interpretation of findings, significant technological advancements are leading to the development of procedures for the early detection of Alzheimer's disease (AD) and facilitating the diagnostic process. Some of the diagnostic protocols, however, show significant limitations that hamper their widespread adoption. Concerns about the social and economic implications of the increasing incidence of AD underline the need for reliable, non-invasive, cost-effective, and timely cognitive scoring methodologies. For instance, modern clinical studies report significant oculomotor impairments among patients with MCI, who perform poorly in visual paired-comparison tasks by ascribing less attentional resources to novel stimuli. To accelerate the Global Action Plan on the Public Health Response to Dementia 2017-2025, this work provides an overview of research on saccadic and exploratory eye-movement deficits among older adults with MCI. The review protocol was drafted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Electronic databases were systematically searched to identify peer-reviewed articles published between 2017 and 2022 that examined visual processing in older adults with MCI and reported gaze parameters as potential biomarkers. Moreover, following the contemporary trend for remote healthcare technologies, we reviewed studies that implemented non-commercial eye-tracking instrumentation in order to detect information processing impairments among the MCI population. Based on the gathered literature, eye-tracking-based paradigms may ameliorate the screening limitations of traditional cognitive assessments and contribute to early AD detection. However, in order to translate the findings pertaining to abnormal gaze behavior into clinical applications, it is imperative to conduct longitudinal investigations in both laboratory-based and ecologically valid settings.
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Affiliation(s)
- Alexandra Wolf
- Cognitive Behavioral Assistive Technology (CBAT), Goal-Oriented Technology Group, RIKEN Center for Advanced Intelligence Project (AIP), Tokyo, Japan
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kornkanok Tripanpitak
- Cognitive Behavioral Assistive Technology (CBAT), Goal-Oriented Technology Group, RIKEN Center for Advanced Intelligence Project (AIP), Tokyo, Japan
| | - Satoshi Umeda
- Department of Psychology, Keio University, Tokyo, Japan
| | - Mihoko Otake-Matsuura
- Cognitive Behavioral Assistive Technology (CBAT), Goal-Oriented Technology Group, RIKEN Center for Advanced Intelligence Project (AIP), Tokyo, Japan
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Gil-Casas A, Piñero-Llorens DP, Molina-Martín A. Developmental Eye Movement (DEM) and King-Devick (K-D) Performance in Multiple Sclerosis. Brain Sci 2022; 12:brainsci12070954. [PMID: 35884760 PMCID: PMC9316304 DOI: 10.3390/brainsci12070954] [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: 05/26/2022] [Revised: 07/12/2022] [Accepted: 07/18/2022] [Indexed: 11/19/2022] Open
Abstract
Eye movement disorders have been reported in patients with multiple sclerosis (MS) as saccadic disturbances. Several methods have been described for the assessment of saccades, including the K-D and DEM tests. The performance of these tests also involves attention, language, and other brain areas which have been reported to be altered in MS patients. The aim of the study was to determine how developmental eye movement (DEM) and King-Devick (K-D) tests are affected in MS-patients. It was also to analyze whether a resolved episode of optic neuritis (ON) has a negative influence. Subjects with MS showed worse outcomes (higher times) in DEM test (72 (26) s and a K-D test (56 (22) s compared to healthy subjects (64 (7) s and 55 (11) s, respectively). However, a previous ON episode did not worsen the MS-times of DEM (80 (33) s or of K-D (62 (33) s. Horizontal saccades with the DEM showed differences between subjects with MS (with and without ON) and healthy ones (p < 0.05), whereas no such differences were found in the vertical saccades. According to the DEM instructions, MS patients would present heterogeneous oculomotor and non-visual disturbances. Regarding the K-D test, only the third card (the most complex one) showed differences (p < 0.05) between groups. These tests can capture impairment of attention, language, and other areas that correlate with suboptimal brain function in addition to the oculomotor dysfunctions present in subjects with MS.
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Affiliation(s)
- Amparo Gil-Casas
- Clínica Optomètrica, Foundation Lluís Alcanyís, University of Valencia, 46020 Valencia, Spain;
- Optics and Visual Perception Group (GOPV), Department of Optics, Pharmacology and Anatomy, University of Alicante, 03690 San Vicent del Raspeig, Spain;
| | - David P. Piñero-Llorens
- Optics and Visual Perception Group (GOPV), Department of Optics, Pharmacology and Anatomy, University of Alicante, 03690 San Vicent del Raspeig, Spain;
| | - Ainhoa Molina-Martín
- Optics and Visual Perception Group (GOPV), Department of Optics, Pharmacology and Anatomy, University of Alicante, 03690 San Vicent del Raspeig, Spain;
- Correspondence: ; Tel.: +34-965-903400
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Abstract
OBJECTIVE The King-Devick (K-D) test is a rapid visual screening tool that can assess underlying brain trauma such as concussion via impairments in saccadic rhythm. A new tablet version of the K-D test using randomized numbers is now available, but reliability for this new version and comparison to the traditional K-D test has not yet been reported. Known for learning effects in the test, the aim of this study was to determine test-retest reliability and to compare performance of the new "randomized" version to the "traditional" K-D test version. We hypothesized that the "traditional" K-D test would show a greater rate of improvement with repeat application, compared with the "randomized" K-D test. METHODS Using a cross-sectional, repeated measures design in a healthy university student cohort (n = 96; age 21.6 ± 2.8 years; 49 women, 47 men), participants were required to complete the K-D test twice with a one-week break between testing sessions. Participants were randomly assigned into a "traditional" group, where they completed a test-retest of the established K-D protocol, using the same numbers; or the "randomized" group, where they completed test-retest protocol using 2 different sets of numbers. RESULTS Reliability testing showed a strong intraclass correlation coefficient for both the "traditional" test group (control group; 0.95 [CI: 0.91-0.97]) and the "randomized test group" (0.97 [CI: 0.95-0.98]). However, contrary to our hypothesis, no differences were found between "traditional" and "randomized" groups for baseline (control: 42.5 seconds [CI: 40.2-44.9 s] vs randomized: 41.5 [38.7-44.4], P = 0.23) and repeated testing between groups (control: 40.0 seconds [37.9-42.1 s] vs randomized: 39.5 [36.9-42.0], P = 0.55), with both groups showing improved times with repeated testing (control: 2.1 seconds [CI: 1.1-3.2 seconds] and randomized: 1.9 seconds CI: [0.9-2.9 seconds], P < 0.001). CONCLUSIONS The "randomized" version of the K-D test, using different sets of numbers, demonstrates good reliability that is comparable to the traditional K-D testing protocol that uses the same number sets. However, similar to the "traditional" K-D test, learning effects were also observed in the "randomized" test, suggesting that learning effects are not because of content memorization, but rather familiarity of the test. As a result, although either test format is suitable for sideline concussion screening or return to play decisions, comparison of data should be made to the individual's baseline rather than to normative data sets.
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Borm CDJM, Smilowska K, de Vries NM, Bloem BR, Theelen T. How I do it: The Neuro-Ophthalmological Assessment in Parkinson's Disease. JOURNAL OF PARKINSONS DISEASE 2020; 9:427-435. [PMID: 30958314 PMCID: PMC6597980 DOI: 10.3233/jpd-181523] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Visual disorders like double vision, dry eyes, and visual field deficits are common but frequently missed in Parkinson’s disease. Here, we aim to increase awareness for these visual disorders in Parkinson patients by discussing several common problems that can be easily diagnosed using comprehensive history taking and a basic neuro-ophthalmological examination. We offer practical guidance for the patient interview and physical exam that can facilitate a timelier recognition of visual disorders. Such recognition has immediate therapeutic relevance, because Parkinson patients are strongly dependent on an adequate vision, for example to optimally benefit from visual cueing strategies.
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Affiliation(s)
- Carlijn D J M Borm
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Parkinson Center Nijmegen (ParC) Nijmegen, The Netherlands
| | - Katarzyna Smilowska
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Parkinson Center Nijmegen (ParC) Nijmegen, The Netherlands
| | - Nienke M de Vries
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Parkinson Center Nijmegen (ParC) Nijmegen, The Netherlands
| | - Bastiaan R Bloem
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Parkinson Center Nijmegen (ParC) Nijmegen, The Netherlands
| | - Thomas Theelen
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behavior, Department of Ophthalmology, Nijmegen, The Netherlands
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Rapid picture naming in Parkinson's disease using the Mobile Universal Lexicon Evaluation System (MULES). J Neurol Sci 2020; 410:116680. [PMID: 31945624 DOI: 10.1016/j.jns.2020.116680] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 12/30/2019] [Accepted: 01/08/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The Mobile Universal Lexicon Evaluation System (MULES) is a test of rapid picture naming that captures extensive brain networks, including cognitive, language and afferent/efferent visual pathways. MULES performance is slower in concussion and multiple sclerosis, conditions in which vision dysfunction is common. Visual aspects captured by the MULES may be impaired in Parkinson's disease (PD) including color discrimination, object recognition, visual processing speed, and convergence. The purpose of this study was to compare MULES time scores for a cohort of PD patients with those for a control group of participants of similar age. We also sought to examine learning effects for the MULES by comparing scores for two consecutive trials within the patient and control groups. METHODS MULES consists of 54 colored pictures (fruits, animals, random objects). The test was administered in a cohort of PD patients and in a group of similar aged controls. Wilcoxon rank-sum tests were used to determine statistical significance for differences in MULES time scores between PD patients and controls. Spearman rank-correlation coefficients were calculated to examine the relation between MULES time scores and PD motor symptom severity (UPDRS). Learning effects were assessed using Wilcoxon rank-sum tests. RESULTS Among 51 patients with PD (median age 70 years, range 52-82) and 20 disease-free control participants (median age 67 years, range 51-90), MULES scores were significantly slower (worse performance) in PD patients (median 63.2 s, range 37.3-296.3) vs. controls (median 53.9 s, range 37.5-128.6, P = .03, Wilcoxon rank-sum test). Slower MULES times were associated with increased motor symptom severity as measured by the Unified Parkinson's Disease Rating Scale, Section III (rs = 0.37, P = .02). Learning effects were greater among patients with PD (median improvement of 14.8 s between two MULES trials) compared to controls (median 7.4 s, P = .004). CONCLUSION The MULES is a complex test of rapid picture naming that captures numerous brain pathways including an extensive visual network. MULES performance is slower in patients with PD and our study suggests an association with the degree of motor impairment. Future studies will determine the relation of MULES time scores to other modalities that test visual function and structure in PD.
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Chiang CC, Starling AJ, Buras MR, Golafshar MA, VanderPluym JH. A pilot exploratory study comparing the King-Devick test (KDT) during and between migraine attacks. Cephalalgia 2019; 40:307-312. [PMID: 31660762 DOI: 10.1177/0333102419885381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The King-Devick test is a timed rapid number naming task that involves complex cerebral functions. The objective of this pilot exploratory study is to determine whether there is a difference in the King-Devick test during a migraine attack compared to the interictal phase. METHODS We evaluated 29 adult subjects with migraine with aura or migraine without aura. For each participant, we performed King-Devick tests during migraine attacks and interictal phases. Subjects served as their own controls. RESULTS The King-Devick test was slower during the migraine attack compared to the interictal baseline (median 4.6 sec slower, p < 0.001). The slowing of the King-Devick test during migraine attack was more prominent in those with migraine with aura compared to subjects with migraine without aura (median 7.5 vs. 2.8 sec, p = 0.028). CONCLUSIONS This exploratory, observational study shows changes in the King-Devick test during migraine compared to the interictal phase. Future studies are required to determine if the King-Devick test may be used as a rapid and simple tool to objectively characterize migraine-associated disability.
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Affiliation(s)
| | | | - Matthew R Buras
- Division of Health Sciences Research, Mayo Clinic, Scottsdale, AZ, USA
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Bernstein JPK, Roye S, Weitzner D, Calamia M. Evaluating the construct validity of the King-Devick test in a psychological outpatient clinical sample. APPLIED NEUROPSYCHOLOGY-ADULT 2019; 28:627-632. [PMID: 31612728 DOI: 10.1080/23279095.2019.1678159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The King-Devick test (K-D) has demonstrated sensitivity as a screener measure of ocular motor and cognitive problems. Despite its empirical support in the assessment of patients with certain injuries and disorders (e.g., concussion, reading disorders), less is known about the construct validity of the K-D. This study examined this topic in an outpatient, diagnostically heterogeneous clinical sample. A total of 70 individuals seen for an outpatient psychoeducational evaluation completed the K-D in addition to measures of intellectual abilities, speeded reading ability, simple and sustained attention, and executive functioning. Pearson correlation coefficients revealed that poorer K-D performance was associated with poorer processing speed, speeded reading ability and response time to target stimuli (r = .26-.31, p < .05). K-D performance was unrelated to other intellectual abilities, other aspects of attention, or executive functioning (all p > .05). Results suggest that the K-D demonstrates good convergent and discriminant validity in a heterogeneous outpatient clinical sample including individuals with attention-deficit hyperactivity disorder, specific learning disorders, and a number of different depressive and anxiety disorders. Findings support its wider use as a measure of reading ability and processing speed in clinical contexts.
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Affiliation(s)
- John P K Bernstein
- Department of Psychology, Louisiana State University, Baton Rouge, LA, USA
| | - Scott Roye
- Department of Psychology, Louisiana State University, Baton Rouge, LA, USA
| | - Daniel Weitzner
- Department of Psychology, Louisiana State University, Baton Rouge, LA, USA
| | - Matthew Calamia
- Department of Psychology, Louisiana State University, Baton Rouge, LA, USA
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Heckmann JG, Vachalova I, Lang CJG, Pitz S. Neuro-Ophthalmology at the Bedside: A Clinical Guide. J Neurosci Rural Pract 2019; 9:561-573. [PMID: 30271051 PMCID: PMC6126320 DOI: 10.4103/jnrp.jnrp_145_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Neuro-ophthalmological signs and symptoms are common in the emergency department but are a frequent source of diagnostic uncertainties. However, neuro-ophthalmological signs often allow a precise neuro-topographical localization of the clinical problem. A practical concept is presented how to perform a neuro-ophthalmological examination at the bedside and to interpret key findings under the aspect of emergency medicine with limited resources.
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Affiliation(s)
- Josef G Heckmann
- Department of Neurology, Municipal Hospital, Landshut, Bavaria, Germany
| | - Ivana Vachalova
- Department of Neurology, Municipal Hospital, Landshut, Bavaria, Germany
| | - Christoph J G Lang
- Department of Neurology, University Hospital Erlangen, Erlangen, Germany
| | - Susanne Pitz
- Orbital Center, Bürgerhospital, Frankfurt, Germany
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Pradhan GN, Bogle JM, Cevette MJ, Stepanek J. Discovering Oculometric Patterns to Detect Cognitive Performance Changes in Healthy Youth Football Athletes. JOURNAL OF HEALTHCARE INFORMATICS RESEARCH 2019; 3:371-392. [DOI: 10.1007/s41666-019-00045-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 11/20/2018] [Accepted: 01/07/2019] [Indexed: 10/27/2022]
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Grover ML, Grover LL, Mookadam M, Mi L, Chang YH, Parish J. Examining the Utility of a Novel Neurologic Test in Patients With Obstructive Sleep Apnea: A Pilot Study. J Prim Care Community Health 2019; 10:2150132719886951. [PMID: 31747842 PMCID: PMC6873272 DOI: 10.1177/2150132719886951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Purpose: To test the association between participant King-Devick Test (KDT) times and obstructive sleep apnea (OSA) severity and evaluate for improvement after continuous positive airway pressure (CPAP) treatment. Methods: Study dates January 30 to July 31, 2018. Patients were referred for initial evaluation of sleep disordered breathing concerns. OSA severities were defined by Apnea Hypopnea Index (AHI) results, with ≥15 considered at least moderate OSA. The KDT is an objective physical measure of brain function. We estimated correlation between KDT time and AHI and compared mean KDT time between patients with and without moderate OSA. For the OSA subgroup, we evaluated for potential improvement in KDT after CPAP. Results: We enrolled 60 participants, of whom 35 (58.3%) had OSA with an AHI ≥15. Initial analyses noted no significant KDT time differences between patients based on OSA severity. However, after excluding 3 participants who had baseline neurologic illness, adjusted analyses demonstrated that mean KDT time was significantly prolonged for patients with moderate or greater OSA (AHI ≥15) as compared to those with mild or no sleep apnea (AHI <15); 63.4 seconds (95% CI 58.9-67.8) versus 55.7 seconds (95% CI 50.2-61.1), P = .03. CPAP-treated subjects demonstrated significantly improved KDT test times; 63.5 seconds mean pretreatment versus 55.6 posttreatment; -6.6 seconds mean difference, 95%CI (-12.0, -1.13), P = .02. Conclusion: Neurologic abnormalities in patients with OSA are potentially demonstrable utilizing this objective physical measure. Significant improvement is achieved in patients after CPAP treatment.
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Affiliation(s)
| | | | | | - Lanyu Mi
- Mayo Clinic, Scottsdale, AZ, USA
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Oh AJ, Chen T, Shariati MA, Jehangir N, Hwang TN, Liao YJ. A simple saccadic reading test to assess ocular motor function in cerebellar ataxia. PLoS One 2018; 13:e0203924. [PMID: 30403759 PMCID: PMC6221255 DOI: 10.1371/journal.pone.0203924] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 08/30/2018] [Indexed: 01/09/2023] Open
Abstract
Cerebellar ataxia is a neurological disorder due to dysfunction of the cerebellum that affects coordination of fine movement, gait, and balance. Although ataxic patients commonly exhibit abnormal eye movement and have difficulties with saccadic reading, quantification of ocular motor abilities during reading in the clinical setting is rarely done. In this study, we assess visual performance with simple reading tests that can be used in the clinical setting and performed video infrared oculography in 11 patients with hereditary or acquired cerebellar ataxia and 11 age-matched controls. We found that compared with controls, ataxic patients read significantly slower on regularly and irregularly spaced 120 single-digit number reading tasks (read aloud) (p = 0.02 for both) but not on a word reading task (read silently), although there was large variability on the word reading task. Among the 3 reading tasks, the regularly spaced number reading task had the greatest difference (44%) between ataxic patients and controls. Analysis of oculography revealed that ataxic patients had slower reading speeds on the regularly spaced number reading task because of significantly higher saccade and fixation counts, impairment of small amplitude progressive saccades as well as large amplitude, line-changing saccades, greater fixation dispersion, and irregularity of scan paths and staircase gaze patterns. Our findings show that infrared oculography remains the gold standard in assessment of ocular motor difficulties during reading in ataxic patients. In the absence of this capability in the clinical setting, a simple 120 regularly spaced single-digit saccadic number reading test, which most patients can perform in less than 2 minutes, can be a possible biomarker for ocular motor abilities necessary for reading.
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Affiliation(s)
- Angela Jinsook Oh
- Department of Ophthalmology, Stanford University School of Medicine, Stanford, California, United States of America
| | - Tiffany Chen
- Department of Ophthalmology, Stanford University School of Medicine, Stanford, California, United States of America
| | - Mohammad Ali Shariati
- Department of Ophthalmology, Stanford University School of Medicine, Stanford, California, United States of America
| | - Naz Jehangir
- Department of Ophthalmology, Stanford University School of Medicine, Stanford, California, United States of America
| | - Thomas N. Hwang
- Department of Ophthalmology, Kaiser Permanente Redwood City Medical Center, Redwood City, California, United States of America
| | - Yaping Joyce Liao
- Department of Ophthalmology, Stanford University School of Medicine, Stanford, California, United States of America
- Department of Neurology, Stanford University School of Medicine, Stanford, California, United States of America
- * E-mail:
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Leong D, Morettin C, Messner LV, Steinmetz RJ, Pang Y, Galetta SL, Balcer LJ. Visual Structure and Function in Collision Sport Athletes. J Neuroophthalmol 2018; 38:285-291. [PMID: 28885451 DOI: 10.1097/wno.0000000000000572] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Vision-based measures have been shown to be useful markers in multiple sclerosis (MS), Alzheimer and Parkinson disease. Therefore, these testing paradigms may have applications to populations explaining repetitive head trauma that has been associated with long-term neurodegenerative sequelae. We investigated retinal structure and visual function in professional collision sport athletes compared to age- and race-matched control participants. METHODS In this cross-sectional study, participants underwent spectral-domain optical coherence tomography (OCT) measurements of peripapillary retinal nerve fiber layer (RNFL) and macular ganglion cell complex (GCC = ganglion cell + inner plexiform layers) thickness. High-contrast visual acuity (100% level), low-contrast letter acuity (LCLA) (1.25% and 2.5% levels), and King-Devick Test of rapid number naming performance were administered. Vision-specific quality of life (QOL) measures were assessed. RESULTS Among 46 collision sport athletes (boxing, n = 14; football, n = 29; ice hockey, n = 3) and 104 control participants, average RNFL thickness was a significant predictor of athlete vs control status with athletes demonstrating 4.8-μm of thinning compared to controls (P = 0.01, generalized estimating equation [GEE] models accounting for age and within-subject, intereye correlations). Athlete vs control status was not a predictor of RNFL thickness for the subgroup of football players in this cohort (P = 0.60). Binocular (P = 0.001) and monocular (P = 0.02) LCLA at 2.5% contrast and vision-specific QOL (P = 0.04) were significant predictors of athlete vs control status (GEE models accounting for age and within-subject, intereye correlations). Rapid number naming performance times were not significantly different between the control and athlete groups. CONCLUSIONS This study showed that retinal axonal and neuronal loss is present among collision sport athletes, with most notable differences seen in boxers. These findings are accompanied by reductions in visual function and QOL, similar to patterns observed in multiple sclerosis, Alzheimer and Parkinson diseases. Vision-based changes associated with head trauma exposure that have the potential to be detected in vivo represent a unique opportunity for further study to determine if these changes in collision sport athletes are predictive of future neurodegeneration.
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Affiliation(s)
- Danielle Leong
- Illinois Eye Institute (DL, CM, LVM, RJS, YP), Illinois College of Optometry, Chicago, Illinois; and Departments of Neurology, Ophthalmology, Population Health (SLG, LJB), New York University, New York, New York
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Heick JD, Bay C, Valovich McLeod TC. EVALUATION OF VERTICAL AND HORIZONTAL SACCADES USING THE DEVELOPMENTAL EYE MOVEMENT TEST COMPARED TO THE KING-DEVICK TEST. Int J Sports Phys Ther 2018; 13:808-818. [PMID: 30276013 PMCID: PMC6159500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Oculomotor function is impaired when an individual has a concussion and as such, it is important to identify tests that are able to assess oculomotor impairment. The King-Devick (K-D) test assesses horizontal saccadic eye movement and attention. The Developmental Eye Movement (DEM) test is designed to identify oculomotor dysfunction in children. It measures both horizontal and vertical saccades. The K-D test shows promise as a concussion-screening tool and part of a multifactorial assessment. The DEM has not been tested as a concussion assessment tool, but the neuroanatomical control of horizontal and vertical saccades originates from different areas of the brain, so one might expect to see differences in performance on the K-D and DEM tests when administered to concussed patients. First, it is important to determine if performance on the DEM and K-D tests, particularly with respect to the measurement of vertical and horizontal saccades, is similar in a healthy population.Hypothesis/Purpose: The primary purpose was to evaluate the relationship between horizontal and vertical saccade tests over repeated trials in normal, healthy subjects. A secondary purpose of this study was to determine the number of trials needed to reach a performance plateau for both the DEM and K-D tests.Study Design: This study used a prospective cohort research design. METHODS Forty-two healthy non-concussed participants (22 males, 20 females; mean age, 24.2 ± 2.92 years) completed six repeated trials of both the DEM, and then six trials of the K-D test in a single testing session. Trials within each test were performed in random order and participants were offered short rest breaks as needed between test administrations. RESULTS Results indicated strong correlations, r=.67, or greater, between measurements of horizontal and vertical saccades. Performance plateaued on the K-D at trial three and on the DEM at trial two for both horizontal and vertical saccades. CONCLUSION It appears that the DEM and K-D tests measure similar constructs in healthy individuals and that no additional information is provided by assessment of vertical saccades. Additional studies are required to investigate the usefulness of the DEM in concussed individuals. LEVEL OF EVIDENCE 3: Laboratory study with repeated measures.
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Affiliation(s)
- John D. Heick
- Northern Arizona University, Program in Physical Therapy, Flagstaff, AZ, USA
| | - Curt Bay
- Department of Interdisciplinary Health Sciences, A.T. Still University, Mesa, AZ, USA
| | - Tamara C. Valovich McLeod
- Athletic Training Programs and School of Osteopathic Medicine in Arizona, A.T. Still University, Mesa, AZ, USA
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Abstract
Idiopathic Parkinson's Disease (PD) is characterized by degeneration of dopaminergic and other neurons, leading to motor and non-motor deficits. Abnormal eye movements in PD, including fixations, saccades, and convergence, are well described. However, saccadic reading, which requires serial and alternating saccades and fixations, is not well studied, despite its obvious impact on the quality of life. In this study, we assessed saccadic reading using variations of the King-Devick (KD) test, a rapid single digit number naming test, as a way to assess the ability to make serial left-to-right ocular motor movements necessary for reading. We recruited 42 treated PD patients and 80 age-matched controls and compared their reading times with a variety of measures, including age, duration of disease, Unified Parkinson's Disease Rating Scale (UPDRS), the National Eye Institute 25-Item Visual Functioning Questionnaire 25 (VFQ-25), and Montreal Cognitive assessment (MoCA) test. The subjects performed 4 trials of reading 120 single digit numbers aloud as fast as possible without making errors. In each trial, they read 3 pages (KD1, KD2, and KD3), and each page contained 40 numbers per page in 8 lines with 5 numbers/line. We found that PD patients read about 20% slower than controls on all tests (KD1, 2, and 3 tests) (p < 0.02), and both groups read irregularly spaced numbers slower than regularly spaced numbers. Having lines between numbers to guide reading (KD1 tests) did not impact reading time in both PD and controls, but increased visual crowding as a result of decreased spacing between numbers (KD3 tests) was associated with significantly slower reading times in both PD and control groups. Our study revealed that saccadic reading is slower in PD, but controls and PD patients are both impacted by visuospatial planning challenges posed by increased visual crowding and irregularity of number spacing. Reading time did not correlate with UPDRS or MoCA scores in PD patients but significantly correlated with age, duration of disease, and VFQ-25 scores. The presence of convergence insufficiency did not significantly correlate with reading time in PD patients, although on average there was slower reading time in those with convergence insufficiency by 8 s (p = 0.2613). We propose that a simple reading task using 120 single-digit numbers can be used as a screening tool in the clinical setting to assess functional ocular motor difficulties in Parkinson's disease that can have a profound impact on quality of life.
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Screening Utility of the King-Devick Test in Mild Cognitive Impairment and Alzheimer Disease Dementia. Alzheimer Dis Assoc Disord 2017; 31:152-158. [PMID: 27299935 DOI: 10.1097/wad.0000000000000157] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The King-Devick (K-D) test is a 1 to 2 minute, rapid number naming test, often used to assist with detection of concussion, but also has clinical utility in other neurological conditions (eg, Parkinson disease). The K-D involves saccadic eye and other eye movements, and abnormalities thereof may be an early indicator of Alzheimer disease (AD)-associated cognitive impairment. No study has tested the utility of the K-D in AD and we sought to do so. The sample included 206 [135 controls, 39 mild cognitive impairment (MCI), and 32 AD dementia] consecutive subjects from the Boston University Alzheimer's Disease Center registry undergoing their initial annual evaluation between March 2013 and July 2015. The K-D was administered during this period. Areas under the receiver operating characteristic curves generated from logistic regression models revealed the K-D test distinguished controls from subjects with cognitive impairment (MCI and AD dementia) [area under the curve (AUC)=0.72], MCI (AUC=0.71) and AD dementia (AUC=0.74). K-D time scores between 48 and 52 seconds were associated with high sensitivity (>90.0%) and negative predictive values (>85.0%) for each diagnostic group. The K-D correlated strongly with validated attention, processing speed, and visual scanning tests. The K-D test may be a rapid and simple effective screening tool to detect cognitive impairment associated with AD.
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16
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Anderson HD, Biely SA. Baseline King-Devick scores for adults are not generalizable; however, age and education influence scores. Brain Inj 2017; 31:1813-1819. [PMID: 29115854 DOI: 10.1080/02699052.2017.1346283] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To establish normative values for the King-Devick (K-D) test to be used as a reference for determining impairment related to concussion when individual baseline scores are lacking. METHOD Baseline K-D scores were collected for 243 participants aged 18-86. RESULTS The mean age of subjects was 40.46; range 18-86 years. The mean time was 42.2 seconds; 26.19-75.96 seconds. There was a relationship (r = 0.376) between K-D score and age; scores increased (worsened) with age. There was also a relationship between score and education with scores decreasing as education increased (r = -0.194; p = 0.002). The K-D score was not influenced by sex or concussion history. A regression equation using education and age to predict K-D time explained 0.418 of the variance in K-D test time. CONCLUSION Although this research established a relationship between K-D score and age and education, the range in scores was too broad to establish normative values. In the absence of a baseline score, the use of a regression equation considering age and education level may provide some indication of expected score. However, the most reliable use of the test as a screen for impairment following concussion involves the use of a baseline test.
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Affiliation(s)
- Heather Dillon Anderson
- a Division of Nursing and Health Sciences, Physical Therapy Department , Neumann University , Aston , PA , USA
| | - Scott A Biely
- a Division of Nursing and Health Sciences, Physical Therapy Department , Neumann University , Aston , PA , USA
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17
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Dodick D, Starling AJ, Wethe J, Pang Y, Messner LV, Smith C, Master CL, Halker-Singh RB, Vargas BB, Bogle JM, Mandrekar J, Talaber A, Leong D. The Effect of In-School Saccadic Training on Reading Fluency and Comprehension in First and Second Grade Students. J Child Neurol 2017; 32:104-111. [PMID: 28257277 DOI: 10.1177/0883073816668704] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Efficient eye movements provide a physical foundation for proficient reading skills. We investigated the effect of in-school saccadic training on reading performance. In this cross-over design, study participants (n = 327, 165 males; mean age [SD]: 7 y 6 mo [1y 1 mo]) were randomized into treatment and control groups, who then underwent eighteen 20-minute training sessions over 5 weeks using King-Devick Reading Acceleration Program Software. Pre- and posttreatment reading assessments included fluency, comprehension, and rapid number naming performance. The treatment group had significantly greater improvement than the control group in fluency (6.2% vs 3.6%, P = .0277) and comprehension (7.5% vs 1.5%, P = .0002). The high-needs student group significantly improved in fluency ( P < .001) and comprehension ( P < .001). We hypothesize these improvements to be attributed to the repetitive practice of reading-related eye movements, shifting visuospatial attention, and visual processing. Consideration should be given to teaching the physical act of reading within the early education curriculum.
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Affiliation(s)
- David Dodick
- 1 Department of Neurology, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Amaal J Starling
- 1 Department of Neurology, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Jennifer Wethe
- 1 Department of Neurology, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Yi Pang
- 2 Illinois Eye Institute, Chicago, IL, USA
| | | | - Craig Smith
- 3 Bill and Melinda Gates Foundation, Seattle, WA, USA
| | - Christina L Master
- 4 Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Bert B Vargas
- 1 Department of Neurology, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Jamie M Bogle
- 1 Department of Neurology, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Jay Mandrekar
- 5 Division of Biomedical Statistics and Informatics, Mayo Clinic Rochester, Rochester, MN, USA
| | | | - Danielle Leong
- 2 Illinois Eye Institute, Chicago, IL, USA.,6 King-Devick Test, Inc, Oakbrook Terrace, IL, USA
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18
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Howitt S, Brommer R, Fowler J, Gerwing L, Payne J, DeGraauw C. The utility of the King-Devick test as a sideline assessment tool for sport-related concussions: a narrative review. THE JOURNAL OF THE CANADIAN CHIROPRACTIC ASSOCIATION 2016; 60:322-329. [PMID: 28065993 PMCID: PMC5178017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE The objective of this paper is to review existing literature surrounding the utility of the King-Devick test which is a commonly used sideline assessment tool for sport-related concussions. METHODS A review of the literature was performed using MEDLINE, CINHAL, and SportDiscus databases. The search was performed from the beginning of the record through November 16th, 2015. RESULTS This search strategy yielded 27 articles from aforementioned databases. Further searching in The Cochrane Library with King-Devick AND Concuss* search terms yielded one additional article, summing a total of 28 articles. After removal of duplicates and implementation of the inclusion/exclusion criteria, 8 articles for extensively reviewed. CONCLUSION This narrative review suggests that the King-Devick test is an efficient sideline assessment tool for sport-related concussions. However, we recommend that the King-Devick should be used as a sideline screening tool, not a concussion diagnosis tool at this time. A proper baseline time including multiple tests may be recommended to negate the learning affect and to have a reliable baseline in which to measure from for future reference. A three second difference appears appropriate to identify the possibility of concussion and to remove an athlete from play. At this time, the athlete should be monitored and further evaluated as symptoms are sometimes delayed. We suggest that further research may be useful to better determine the efficacy of the K-D test in detecting concussions across a broader range of athletes and sports. We also suggest further research may investigate the K-D test a potential return-to-play tool for clinicians and medical personnel.
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Cobbs L, Hasanaj L, Amorapanth P, Rizzo JR, Nolan R, Serrano L, Raynowska J, Rucker JC, Jordan BD, Galetta SL, Balcer LJ. Mobile Universal Lexicon Evaluation System (MULES) test: A new measure of rapid picture naming for concussion. J Neurol Sci 2016; 372:393-398. [PMID: 27856005 DOI: 10.1016/j.jns.2016.10.044] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Revised: 09/25/2016] [Accepted: 10/26/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study introduces a rapid picture naming test, the Mobile Universal Lexicon Evaluation System (MULES), as a novel, vision-based performance measure for concussion screening. The MULES is a visual-verbal task that includes 54 original photographs of fruits, objects and animals. We piloted MULES in a cohort of volunteers to determine feasibility, ranges of picture naming responses, and the relation of MULES time scores to those of King-Devick (K-D), a rapid number naming test. METHODS A convenience sample (n=20, age 34±10) underwent MULES and K-D (spiral bound, iPad versions). Administration order was randomized; MULES tests were audio-recorded to provide objective data on temporal variability and ranges of picture naming responses. RESULTS Scores for the best of two trials for all tests were 40-50s; average times required to name each MULES picture (0.72±0.14s) was greater than those needed for each K-D number ((spiral: 0.33±0.05s, iPad: 0.36±0.06s, 120 numbers), p<0.0001, paired t-test). MULES scores showed the greatest degree of improvement between trials (9.4±4.8s, p<0.0001 for trials 1 vs. 2), compared to K-D (spiral 1.5±3.3s, iPad 1.8±3.4s). Shorter MULES times demonstrated moderate and significant correlations with shorter iPad but not spiral K-D times (r=0.49, p=0.03). CONCLUSION The MULES test is a rapid picture naming task that may engage more extensive neural systems than more commonly used rapid number naming tasks. Rapid picture naming may require additional processing devoted to color perception, object identification, and categorization. Both tests rely on initiation and sequencing of saccadic eye movements.
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Affiliation(s)
- Lucy Cobbs
- Department of Neurology, New York University School of Medicine, New York, NY, USA.
| | - Lisena Hasanaj
- Department of Neurology, New York University School of Medicine, New York, NY, USA.
| | - Prin Amorapanth
- Department of Physical Medicine and Rehabilitation, New York University School of Medicine, New York, NY, USA.
| | - John-Ross Rizzo
- Department of Physical Medicine and Rehabilitation, New York University School of Medicine, New York, NY, USA.
| | - Rachel Nolan
- Department of Neurology, New York University School of Medicine, New York, NY, USA.
| | - Liliana Serrano
- Department of Neurology, New York University School of Medicine, New York, NY, USA.
| | - Jenelle Raynowska
- Department of Neurology, New York University School of Medicine, New York, NY, USA.
| | - Janet C Rucker
- Department of Neurology, New York University School of Medicine, New York, NY, USA; Department of Ophthalmology, New York University School of Medicine, New York, NY, USA.
| | | | - Steven L Galetta
- Department of Neurology, New York University School of Medicine, New York, NY, USA; Department of Ophthalmology, New York University School of Medicine, New York, NY, USA.
| | - Laura J Balcer
- Department of Neurology, New York University School of Medicine, New York, NY, USA; Department of Population Health, New York University School of Medicine, New York, NY, USA; Department of Ophthalmology, New York University School of Medicine, New York, NY, USA.
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20
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Walsh DV, Capó-Aponte JE, Beltran T, Cole WR, Ballard A, Dumayas JY. Assessment of the King-Devick® (KD) test for screening acute mTBI/concussion in warfighters. J Neurol Sci 2016; 370:305-309. [DOI: 10.1016/j.jns.2016.09.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 09/08/2016] [Accepted: 09/08/2016] [Indexed: 10/21/2022]
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21
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Yu CY, Lee T, Shariati MA, Santini V, Poston K, Liao YJ. Abnormal eye movement behavior during reading in Parkinson's disease. Parkinsonism Relat Disord 2016; 32:130-132. [PMID: 27592009 PMCID: PMC10635678 DOI: 10.1016/j.parkreldis.2016.08.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 06/21/2016] [Accepted: 08/09/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Reading difficulties are common in Parkinson's disease (PD) but not well studied. We report a case of reading difficulties in a 40-year-old man with 6-year history of PD on dopamine replacement therapy. METHODS We performed detailed neuro-ophthalmic examination and assessment of reading with and without infrared oculography. RESULTS Clinical examination revealed visual acuity of 20/20, no evidence of vision loss, and normal eye movement and ocular alignment with normal saccades, pursuit, and normal convergence. During King-Devick test, a rapid number reading task performed on a book, patient had normal number reading speed. More detailed study of number and word reading using infrared oculography revealed that while this patient had normal speed and eye movement behavior during number reading, he had dramatic slowing and eye movement abnormality during word reading. The slower reading speed during word reading was due to increased number of progressive saccades, smaller saccade amplitudes, increased number of regressive saccades, and longer fixation durations. CONCLUSIONS This case nicely illustrated the importance of comprehensive neuro-ophthalmic evaluations in Parkinson's disease and shows that reading difficulties can arise even when there is good visual acuity, ocular motor abilities necessary to read, and accommodation. In this case, reading difficulty was due to higher order ocular motor planning or cognitive abilities involved in word reading since the patient had no difficulty with ocular motor planning while reading numbers. These findings may have important implications towards our understanding of PD and can serve to spark further research in this important area.
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Affiliation(s)
- Caroline Y Yu
- Department of Ophthalmology, Stanford University School of Medicine, Stanford, CA, USA
| | - Timothy Lee
- Department of Ophthalmology, Stanford University School of Medicine, Stanford, CA, USA
| | - M Ali Shariati
- Department of Ophthalmology, Stanford University School of Medicine, Stanford, CA, USA
| | - Veronica Santini
- Department of Ophthalmology, Stanford University School of Medicine, Stanford, CA, USA
| | - Kathleen Poston
- Department of Ophthalmology, Stanford University School of Medicine, Stanford, CA, USA
| | - Y Joyce Liao
- Department of Ophthalmology, Stanford University School of Medicine, Stanford, CA, USA.
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22
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Galetta KM, Liu M, Leong DF, Ventura RE, Galetta SL, Balcer LJ. The King-Devick test of rapid number naming for concussion detection: meta-analysis and systematic review of the literature. Concussion 2015; 1:CNC8. [PMID: 30202552 PMCID: PMC6114024 DOI: 10.2217/cnc.15.8] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 07/07/2015] [Indexed: 01/23/2023] Open
Abstract
Background: Vision encompasses a large component of the brain's pathways, yet is not represented in current sideline testing. Objectives: We performed a meta-analysis of published data for a vision-based test of rapid number naming (King-Devick [K-D] test). Studies & methods: Pooled and meta-analysis of 15 studies estimated preseason baseline K-D scores and sensitivity/specificity for identifying concussed versus nonconcussed control athletes. Result: Baseline K-D (n = 1419) showed a weighted estimate of 43.8 s (95% CI: 40.2, 47.5; I2 = 0.0%; p=0.85 – indicating very little heterogeneity). Sensitivity was 86% (96/112 concussed athletes had K-D worsening; 95% CI: 78%, 92%); specificity was 90% (181/202 controls had no worsening; 95% CI: 85%, 93%). Conclusion: Rapid number naming adds to sideline assessment and contributes a critical dimension of vision to sports-related concussion testing.
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Affiliation(s)
- Kristin M Galetta
- Department of Neurology, University of Pennsylvania School of Medicine, 3400 Spruce Street, Philadelphia, PA 19104, USA.,Department of Neurology, University of Pennsylvania School of Medicine, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Mengling Liu
- Department of Population Health, NYU School of Medicine, 240 East 38th Street, 20th Floor, New York, NY 10016, USA.,Department of Population Health, NYU School of Medicine, 240 East 38th Street, 20th Floor, New York, NY 10016, USA
| | - Danielle F Leong
- Illinois College of Optometry, 3241 S Michigan Ave, Chicago, IL 60616, USA.,Illinois College of Optometry, 3241 S Michigan Ave, Chicago, IL 60616, USA
| | - Rachel E Ventura
- Department of Neurology, NYU School of Medicine, 240 East 38th Street, 20th Floor, New York, NY 10016, USA.,Department of Neurology, NYU School of Medicine, 240 East 38th Street, 20th Floor, New York, NY 10016, USA
| | - Steven L Galetta
- Department of Neurology, University of Pennsylvania School of Medicine, 3400 Spruce Street, Philadelphia, PA 19104, USA.,Department of Neurology, NYU School of Medicine, 240 East 38th Street, 20th Floor, New York, NY 10016, USA.,Department of Ophthalmology, NYU School of Medicine, 240 East 38th Street, 20th Floor, New York, NY 10016, USA.,Department of Neurology, University of Pennsylvania School of Medicine, 3400 Spruce Street, Philadelphia, PA 19104, USA.,Department of Neurology, NYU School of Medicine, 240 East 38th Street, 20th Floor, New York, NY 10016, USA.,Department of Ophthalmology, NYU School of Medicine, 240 East 38th Street, 20th Floor, New York, NY 10016, USA
| | - Laura J Balcer
- Department of Neurology, NYU School of Medicine, 240 East 38th Street, 20th Floor, New York, NY 10016, USA.,Department of Biostatistics & Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA.,Department of Neurology, NYU School of Medicine, 240 East 38th Street, 20th Floor, New York, NY 10016, USA.,Department of Biostatistics & Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA
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23
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King D, Hume P, Gissane C, Clark T. Use of the King-Devick test for sideline concussion screening in junior rugby league. J Neurol Sci 2015; 357:75-9. [PMID: 26152829 DOI: 10.1016/j.jns.2015.06.069] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 06/03/2015] [Accepted: 06/29/2015] [Indexed: 11/24/2022]
Abstract
AIM To determine whether the King-Devick (K-D) test used as a sideline test in junior rugby league players over 12 matches in a domestic competition season could identify witnessed and incidentally identified episodes of concussion. METHODS A prospective observational cohort study of a club level junior rugby league team (n=19) during the 2014 New Zealand competition season involved every player completing two pre-competition season baseline trials of the K-D test. Players removed from match participation, or who reported any signs or symptoms of concussion were assessed on the sideline with the K-D test and referred for further medical assessment. Players with a pre- to post-match K-D test difference >3s were referred for physician evaluation. RESULTS The baseline test-retest reliability of the K-D test was high (rs=0.86; p<0.0001). Seven concussions were medically identified in six players who recorded pre- to post-match K-D test times greater than 3s (mean change of 7.4s). Post-season testing of players demonstrated improvement of K-D time scores consistent with learning effects of using the K-D test (67.7s vs. 62.2s). DISCUSSION Although no witnessed concussions occurred during rugby play, six players recorded pre- to post-match changes with a mean delay of 4s resulting in seven concussions being subsequently confirmed post-match by health practitioners. All players were medically managed for a return to sports participation. CONCLUSION The K-D test was quickly and easily administered making it a practical sideline tool as part of the continuum of concussion assessment tools for junior rugby league players.
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Affiliation(s)
- 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; Department of Paramedicine, School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, New Zealand.
| | - P Hume
- Sports Performance Research Institute New Zealand (SPRINZ) at AUT Millennium, Faculty of Health and Environmental Science, Auckland University of Technology, Auckland, New Zealand
| | - C Gissane
- School of Sport Health and Applied Science, St. Mary's University, Twickenham, Middlesex, United Kingdom
| | - T Clark
- Australian College of Physical Education, Faculty of Human Performance, Sydney Olympic Park, New South Wales, Australia
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24
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The King–Devick test was useful in management of concussion in amateur rugby union and rugby league in New Zealand. J Neurol Sci 2015; 351:58-64. [DOI: 10.1016/j.jns.2015.02.035] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Revised: 02/18/2015] [Accepted: 02/19/2015] [Indexed: 12/26/2022]
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25
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Leong DF, Balcer LJ, Galetta SL, Evans G, Gimre M, Watt D. The King-Devick test for sideline concussion screening in collegiate football. JOURNAL OF OPTOMETRY 2015; 8:131-9. [PMID: 25649742 PMCID: PMC4401827 DOI: 10.1016/j.optom.2014.12.005] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 12/03/2014] [Accepted: 12/03/2014] [Indexed: 05/30/2023]
Abstract
PURPOSE Sports-related concussion has received increasing attention as a result of neurologic sequelae seen among athletes, highlighting the need for a validated, rapid screening tool. The King-Devick (K-D) test requires vision, eye movements, language function and attention in order to perform and has been proposed as a promising tool for assessment of concussion. We investigated the K-D test as a sideline screening tool in a collegiate cohort to determine the effect of concussion. METHODS Athletes (n=127, mean age 19.6±1.2 years) from the Wheaton College football and men's and women's basketball teams underwent baseline K-D testing at pre-season physicals for the 2012-2013 season. K-D testing was administered immediately on the sidelines for football players with suspected head injury during regular games and changes compared to baseline were determined. Post-season testing was also performed to compare non-concussed athletes' test performance. RESULTS Concussed athletes (n=11) displayed sideline K-D scores that were significantly higher (worse) than baseline (36.5±5.6s vs. 31.3±4.5s, p<0.005, Wilcoxon signed-rank test). Post-season testing demonstrated improvement of scores and was consistent with known learning effects (35.1±5.2s vs. 34.4±5.0s, p<0.05, Wilcoxon signed-rank test). Test-retest reliability was analyzed between baseline and post-season administrations of the K-D test resulting in high levels of test-retest reliability (intraclass correlation coefficient (ICC)=0.95 [95% Confidence Interval 0.85-1.05]). CONCLUSIONS The data show worsening of K-D test scores following concussion further supporting utility of the K-D test as an objective, reliable and effective sideline visual screening tool to help identify athletes with concussion.
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Affiliation(s)
| | - Laura J Balcer
- Departments of Neurology, Ophthalmology and Population Health New York University School of Medicine, New York, NY, USA
| | - Steven L Galetta
- Departments of Neurology, Ophthalmology and Population Health New York University School of Medicine, New York, NY, USA
| | - Greg Evans
- Wheaton College Sports Medicine, Wheaton, IL, USA
| | | | - David Watt
- Wheaton College Sports Medicine, Wheaton, IL, USA
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26
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Leong DF, Master CL, Messner LV, Pang Y, Smith C, Starling AJ. The effect of saccadic training on early reading fluency. Clin Pediatr (Phila) 2014; 53:858-64. [PMID: 24790022 DOI: 10.1177/0009922814532520] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Eye movements are necessary for the physical act of reading and have been shown to relate to underlying cognitive and visuoattentional processes during reading. The purpose of this study was to determine the effect of saccadic training using the King-Devick remediation software on reading fluency. METHODS In this prospective, single-blinded, randomized, crossover trial, a cohort of elementary students received standardized reading fluency testing pre- and posttreatment. Treatment consisted of in-school training 20 minutes per day, 3 days per week for 6 weeks. RESULTS The treatment group had significantly higher reading fluency scores after treatment (P < .001), and posttreatment scores were significantly higher than the control group (P < .005). CONCLUSION Saccadic training can significantly improve reading fluency. We hypothesize that this improvement in reading fluency is a result of rigorous practice of eye movements and shifting visuospatial attention, which are vital to the act of reading.
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Affiliation(s)
| | - Christina L Master
- Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Leonard V Messner
- Illinois Eye Institute, Illinois College of Optometry, Chicago, IL, USA
| | - Yi Pang
- Illinois Eye Institute, Illinois College of Optometry, Chicago, IL, USA
| | - Craig Smith
- Aegis Creative, Lakewood, CO, USA Bill and Melinda Gates Foundation, Seattle, WA, USA
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