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Treleaven D, Lamontagne A, Grilli L, Friedman D, Gagnon I. Altered Oculomotor and Vestibulo-ocular Function in Children and Adolescents Postconcussion. J Head Trauma Rehabil 2024; 39:E237-E246. [PMID: 37862137 DOI: 10.1097/htr.0000000000000898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023]
Abstract
OBJECTIVE To document (1) oculomotor (OM) and vestibulo-ocular (VO) function in children with concussion who were symptomatic at the time of assessment and to compare it with that in children with concussion who were clinically recovered (asymptomatic) and in children with no concussive injury, and (2) the extent to which OM and VO function relates to postconcussion symptom severity in injured children. SETTING Participants were recruited from a concussion clinic or the community. PARTICIPANTS A total of 108 youth with concussion (72 symptomatic; 36 recovered) and 79 healthy youth (aged 9-18 years). Youth with concussion were included if aged 9 to 18 years, had no previous concussion within the last 12 months, less than 90 days since injury, and no known existing visual disorders or learning disabilities. STUDY DESIGN A prospective cross-sectional study. MAIN MEASURES All participants were tested for OM and VO function with a commercial virtual reality (VR) eye-tracking system (Neuroflex ® , Montreal,Québec, Canada). Participants in the concussion group who completed the postconcussion symptoms were scored with the Post-Concussion Symptom Inventory. RESULTS There was a significant group effect for vergence during smooth pursuit ( F2,176 = 10.90; P < .05), mean latency during saccades ( F2,171 = 5.99; P = .003), and mean response delay during antisaccades ( F2,177 = 9.07; P < .05), where children with symptomatic concussion showed poorer performance than clinically recovered and healthy children. Similar results were found in VO for average vestibular ocular reflex gain in the horizontal leftward ( F2,168 = 7; P = .001) and rightward directions ( F2,163 = 13.08; P < .05) and vertical upward ( F2,147 = 7.60; P = .001) and downward directions ( F2,144 = 13.70; P < .05). Mean saccade error was positively correlated to total Post-Concussion Symptom Inventory scores in younger clinically recovered children. CONCLUSION VR eye tracking may be an effective tool for identifying OM and VO deficits in the subacute phase (<90 days) postconcussion.
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Affiliation(s)
- Dakota Treleaven
- Author Affiliations: Integrated Program in Neuroscience, Faculty of Medicine and Health Sciences, McGill University, Montreal, Québec, Canada (Ms Treleaven); School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, Québec, Canada (Dr Lamontagne); Jewish Rehabilitation Hospital-CISSS Laval site, Centre de Recherche Interdisciplinaire en Réadaptation du Montréal Métropolitain (CRIR), Montréal, Québec, Canada (Dr Lamontagne); Montreal Children's Hospital, McGill University Health Centre, Montreal, Québec, Canada (Mss Grilli and Friedman); and School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, Trauma Center, Montreal Children's Hospital, McGill University Health Center, Montreal, Québec, Canada (Dr Gagnon)
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Onodera H, Mogamiya T, Yatabe K, Fujiya H, Murata H. Recovery Process for Sports-Related Concussion Assessed with Precise Ocular Motility. Sports Med Int Open 2024; 8:a21831077. [PMID: 38812957 PMCID: PMC11135402 DOI: 10.1055/a-2183-1077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 09/26/2023] [Indexed: 05/31/2024] Open
Abstract
Ocular motility has been linked to Sports Concussion Assessment Tool 5 scores. However, the link between ocular motility changes and assessment result changes remains unclear. Hence, we investigated that potential link in patients with sports-related concussions. We retrospectively included participants aged≥18 years who were diagnosed with a sports-related concussion. They underwent smooth pursuit eye movement assessment for allocation to the good improvement (rate of fundamental frequency≥15%) or minor improvement (<15%) groups. Sports Concussion Assessment Tool 5 scores were determined at baseline and two weeks later, and score changes were compared between the groups. Thirteen men (mean±standard deviation age: 20.6±5.0 years) were included: eight (19.0±4.5 years) in the good improvement group and five (20.6±5.7 years) in the minor improvement group. Symptom number (median=2.0 vs. 0.0), symptom severity (median=22.0 vs. 3.0), single-leg stance (median=4.0 vs. 0.5), tandem stance (median=1.0 vs. 0.0), and total errors (median=5.0 vs. 0.5) were worse (all p<0.05) in the minor improvement group. Smooth pursuit eye movement improvements measured using eye-tracking technology was linked to symptom recovery in patients with sports-related concussions. Therefore, ocular motility may be an objective indicator of sports-related concussions. Future studies with more patients are needed to confirm these findings.
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Affiliation(s)
- Hidetaka Onodera
- Department of Neurosurgery, St. Marianna University School of Medicine
Yokohama City Seibu Hospital, Kanagawa, Japan
| | - Takuma Mogamiya
- Department of Rehabilitation Medicine, St. Marianna University School
of Medicine, Yokohama City Seibu Hospital, Kanagawa, Japan
| | - Kanaka Yatabe
- Department of Sports Medicine, St. Marianna University School of
Medicine, Kawasaki, Japan
| | - Hiroto Fujiya
- Department of Sports Medicine, St. Marianna University School of
Medicine, Kawasaki, Japan
| | - Hidetoshi Murata
- Department of Neurosurgery, St. Marianna University School of Medicine,
Kawasaki, Japan
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Nieboer W, Ghiani A, de Vries R, Brenner E, Mann DL. Eye Tracking to Assess the Functional Consequences of Vision Impairment: A Systematic Review. Optom Vis Sci 2023; 100:861-875. [PMID: 38165789 DOI: 10.1097/opx.0000000000002088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2024] Open
Abstract
BACKGROUND Eye tracking is a promising method for objectively assessing functional visual capabilities, but its suitability remains unclear when assessing the vision of people with vision impairment. In particular, accurate eye tracking typically relies on a stable and reliable image of the pupil and cornea, which may be compromised by abnormalities associated with vision impairment (e.g., nystagmus, aniridia). OBJECTIVES This study aimed to establish the degree to which video-based eye tracking can be used to assess visual function in the presence of vision impairment. DATA SOURCES A systematic review was conducted using PubMed, EMBASE, and Web of Science databases, encompassing literature from inception to July 2022. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS, AND INTERVENTIONS Studies included in the review used video-based eye tracking, included individuals with vision impairment, and used screen-based tasks unrelated to practiced skills such as reading or driving. STUDY APPRAISAL AND SYNTHESIS METHODS The included studies were assessed for quality using the Strengthening the Reporting of Observational Studies in Epidemiology assessment tool. Data extraction and synthesis were performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS Our analysis revealed that five common tests of visual function were used: (i) fixation stability, (ii) smooth pursuit, (iii) saccades, (iv) free viewing, and (v) visual search. The studies reported considerable success when testing individuals with vision impairment, yielding usable data from 96.5% of participants. LIMITATIONS There was an overrepresentation of conditions affecting the optic nerve or macula and an underrepresentation of conditions affecting the anterior segment or peripheral retina. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS The results offer promise for the use of eye tracking to assess the visual function of a considerable proportion of those with vision impairment. Based on the findings, we outline a framework for how eye tracking can be used to test visual function in the presence of vision impairment.
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Affiliation(s)
| | - Andrea Ghiani
- Department of Human Movement Sciences, Amsterdam Movement Sciences and Institute of Brain and Behaviour Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Ralph de Vries
- Medical Library, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Eli Brenner
- Department of Human Movement Sciences, Amsterdam Movement Sciences and Institute of Brain and Behaviour Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - David L Mann
- Department of Human Movement Sciences, Amsterdam Movement Sciences and Institute of Brain and Behaviour Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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Theis J, Chen AM, Burgher AP, Greenspan LD, Morgenstern A, Salzano AD, Yap TP, Scheiman M, Roberts TL. Ocular motor disorders in children and adults with mTBI: a scoping review protocol. BMJ Open 2023; 13:e073656. [PMID: 37857540 PMCID: PMC10603508 DOI: 10.1136/bmjopen-2023-073656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 09/28/2023] [Indexed: 10/21/2023] Open
Abstract
INTRODUCTION Ocular motor function is susceptible to neurological injury because it requires a large portion of brain circuitry including every lobe of the brain, brainstem, thalamus, basal ganglia, cerebellum, cranial nerves and visual tracts. While reports of a high frequency of ocular motor dysfunctions after mild traumatic brain injury (mTBI) span multidisciplinary journals, there is no scoping review of the signs, diagnostic assessments and criteria, and appropriate management of ocular motor disorders post-mTBI. Post-mTBI ocular motor dysfunction has been reported to respond to active treatment. The objective of this scoping review is to map the available evidence on the diagnostic assessment and treatment modalities currently used in the management of mTBI-related ocular motor disorders in children and adults. This scoping review also aims to identify gaps in the current literature and provide suggestions for future research. METHODS AND ANALYSIS This review will include populations with reported concussion and/or mTBI without restrictions on age, race, sex or time since injury. The review will evaluate the reported symptoms related to ocular motor dysfunction, types of assessments and diagnostic criteria used, reported treatments, and the level of evidence supporting the reported treatments. This review will exclude literature on brain injury of non-traumatic aetiology and moderate/severe traumatic brain injury. Ocular motor dysfunction after mTBI appears in journals across multiple disciplines. Thus, multiple databases will be evaluated including Pubmed, Embase, PEDro, OVID, Clinical Key, Google Scholar and REHABDATA. Literature will be searched from inception to present day. Evidence sources will include experimental study designs including randomised controlled trials, non-randomised controlled trials and interrupted time-series. Additionally, analytical observational studies including prospective and retrospective cohort studies, case series, cross-sectional studies and clinical practice guidelines will be considered for inclusion. Data will be extracted on clinical presentation, frequency, assessment, diagnostic criteria management strategies and outcomes of concussion and mTBI-related ocular motor disorders. ETHICS AND DISSEMINATION This scoping review will use data from existing publications and does not require ethical approval by an institutional review board. Results will be disseminated through publication in a peer-reviewed scientific journal and presented at relevant conferences and as part of future workshops with professionals involved with diagnosis and management of patients with mTBI.
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Affiliation(s)
- Jacqueline Theis
- Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences F Edward Hébert School of Medicine, Bethesda, Maryland, USA
- Concussion Care Centre of Virginia, Richmond, Virginia, USA
| | - Angela M Chen
- Southern California College of Optometry, Marshall B Ketchum University, Fullerton, California, USA
| | - Allegra P Burgher
- Southern California College of Optometry, Marshall B Ketchum University, Fullerton, California, USA
| | - Lynn D Greenspan
- Salus University Pennsylvania College of Optometry, Elkins Park, Pennsylvania, USA
| | - Andrew Morgenstern
- Department of Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Aaron D Salzano
- College of Optometry, Pacific University, Forest Grove, Oregon, USA
| | | | - Mitchell Scheiman
- Salus University Pennsylvania College of Optometry, Elkins Park, Pennsylvania, USA
| | - Tawna L Roberts
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Stanford, California, USA
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5
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Dutta P. Characteristics of binocular vision and oculomotor function among sports-concussed athletes. Indian J Ophthalmol 2023; 71:2076-2082. [PMID: 37203084 PMCID: PMC10391497 DOI: 10.4103/ijo.ijo_1932_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
Purpose To compare the binocular vision and oculomotor function between sports-concussed athletes and aged-matched controls. Methods Thirty mild concussed athletes were recruited and compared with aged-matched controls. All the participants underwent a comprehensive ocular assessment followed by an oculomotor assessment which included tests for accommodation, vergence, eye movements, and reading parameters. Results Three categories of oculomotor-based deficits were found: convergence insufficiency (40%), accommodative insufficiency (25%), and oculomotor-based reading dysfunctions (20%). A statistically significant reduction in the mean ± SD of the following parameters was noted in concussed athletes v/s controls:- binocular accommodative amplitude: 7.13 ± 1.59 v/s 15.35 ± 2.95 (P < 0.001), convergence amplitude: 14.23 ± 5.00 v/s 5.65 ± 0.90 (P < 0.001), positive fusional vergence for distance: 21.17 ± 8.97 v/s 31.32 ± 6.23 (P < 0.001), vergence facility: 6.47 ± 1.47 v/s 11.84 ± 1.00 (P < 0.001), accommodative facility: 7.10 ± 4.57 v/s 11.67 ± 1.83 (P < 0.001), reading speed: 66.97 ± 17.82 v/s 144.13 ± 24.45 (P = 0.03) and Developmental Eye Movement ratio: 1.40 ± 0.19 v/s 1.17 ± 0.06 (P < 0.001). Conclusion Concussions caused by sports have a considerable impact on binocular vision and oculomotor parameters. These findings have substantial therapeutic implications in terms of establishing a periodic screening program for athletes so that essential therapy can be provided for a better outcome.
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Affiliation(s)
- Pritam Dutta
- Department of Optometry, Chandraprabha Eye Hospital, Jorhat, Assam, India
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Vernau BT, Haider MN, Fleming A, Leddy JJ, Willer BS, Storey EP, Grady MF, Mannix R, Meehan W, Master CL. Exercise-Induced Vision Dysfunction Early After Sport-Related Concussion Is Associated With Persistent Postconcussive Symptoms. Clin J Sport Med 2023:00042752-990000000-00111. [PMID: 37015066 DOI: 10.1097/jsm.0000000000001145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
OBJECTIVE The purpose of this study was to determine if exercise-induced vision dysfunction [reduced performance and/or symptom exacerbation on a post-exercise King-Devick (KD) test] in adolescents early after sport-related concussion was associated with increased risk of persistent post-concussive symptoms (PPCS, recovery >28 days). We used exercise as a provocative maneuver before the KD test, hypothesizing that concussed adolescents with exercise-induced vision dysfunction would be more likely to develop PPCS. DESIGN Secondary analysis of data from a multi-center, randomized clinical trial comparing KD test performance before and after the Buffalo Concussion Treadmill Test in adolescents within 10 days of sport-related concussion who were randomized to aerobic exercise or placebo stretching program. SETTING Three university-associated sports medicine clinical programs. PARTICIPANTS Ninety-nine adolescents with sport-related concussion (exercise group: n = 50, 15.3 ± 1 years, 60% M, 22% with PPCS; stretching group: n = 49, 15.9 ± 1 years, 65% M, 35% with PPCS) tested a mean of 6 ± 2 days from injury. INDEPENDENT VARIABLE King-Devick test performed immediately before and 2 minutes after Buffalo Concussion Treadmill Test. MAIN OUTCOME MEASURE Persistent post-concussive symptoms. RESULTS Adolescents who demonstrated exercise-induced vision dysfunction upon initial evaluation developed PPCS at a significantly greater rate when compared with adolescents who did not (71% vs 34%, P < 0.001). Exercise-induced vision dysfunction corresponded to a relative risk of 3.13 for PPCS. CONCLUSIONS Adolescents with exercise-induced vision dysfunction had a 3-fold greater relative risk of developing PPCS than those without exercise-induced vision dysfunction.
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Affiliation(s)
- Brian T Vernau
- Minds Matter Concussion Program, Division of Orthopedics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | | | | | - Barry S Willer
- Psychiatry, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York
| | - Eileen P Storey
- Minds Matter Concussion Program, Division of Orthopedics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Matthew F Grady
- Minds Matter Concussion Program, Division of Orthopedics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rebekah Mannix
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts; and
- Harvard Medical School, Boston, Massachusetts
| | - William Meehan
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts; and
- Harvard Medical School, Boston, Massachusetts
| | - Christina L Master
- Minds Matter Concussion Program, Division of Orthopedics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Mani R, Asper L, Arunachalam V, Khuu SK. The impact of traumatic brain injury on inhibitory control processes assessed using a delayed antisaccade task. Neurosci Lett 2023; 797:137081. [PMID: 36690058 DOI: 10.1016/j.neulet.2023.137081] [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: 06/20/2022] [Revised: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 01/22/2023]
Abstract
It has been well established that traumatic brain injury (TBI) can affect cognitive function such as attention, working memory and executive functions. In the present study, we further investigated TBI-related changes in cognitive functions by investigating the ability to reorient visuospatial attention using a modified antisaccade task. Performing an antisaccade requires disengaging attention, inhibiting a reflexive saccade, and then engaging attention to execute a voluntary saccade in a direction opposite to a peripheral target. Particularly we quantified the time (latency), and accuracy (directional and disinhibition errors) of 26 TBI and 33 normal participants in making an antisaccade after a variable period of delay (0, 0.0625, 0.125, 0.250, 0.500 or 1.0 s). Changing the delay period allowed to systematically quantify the temporal and spatial characteristics of preparing and initiating an antisaccade and whether this process is affected by TBI. TBI participants took longer (approximately 33-66 ms for variable delays) to generate correct delayed antisaccades and showed increased directional errors (2-11 % for variable delays) and increased disinhibition prosaccade errors (2-6 % for variable delays) compared to controls. However, both groups made similar disinhibition antisaccade errors. These findings indicate that TBI participants required a longer time to process information, and a possible poorer response inhibition and poor spatial information processing due to head injury.
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Affiliation(s)
- Revathy Mani
- School of Optometry and Vision Science, University of New South Wales, Sydney, NSW, Australia.
| | - Lisa Asper
- School of Optometry and Vision Science, University of New South Wales, Sydney, NSW, Australia.
| | - Valarmathi Arunachalam
- Department of Optometry, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Sieu K Khuu
- School of Optometry and Vision Science, University of New South Wales, Sydney, NSW, Australia.
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Snegireva N, Derman W, Patricios J, Welman KE. Blink duration is increased in concussed youth athletes: a validity study using eye tracking in male youth and adult athletes of selected contact sports. Physiol Meas 2022; 43. [PMID: 35709708 DOI: 10.1088/1361-6579/ac799b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 06/16/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Diagnosing a sports-related concussion (SRC) remains challenging, and research into diagnostic tools is limited. This study investigated whether selected eye tracking variables would be a valid tool to diagnose and monitor SRC in adult and youth participants in selected contact sports, such as Rugby Union (rugby) and football (soccer). METHODS This prospective cohort study, with 70 concussed and 92 non-concussed adult and youth athletes, assessed the validity of five previously selected eye tracking variables for SRC diagnostics and management. The performance between concussed and age-matched control (non-concussed) athletes, as well as between three successive testing sessions in the concussed athletes were compared. Self-paced saccade count in adult group; blink duration in the memory-guided saccade and sinusoidal smooth pursuit tasks, proportion of antisaccade errors, and gain of diagonal smooth pursuit in the youth group were assessed. RESULTS The youth concussed group had higher blink duration in the fast memory-guided saccades task (p = 0.001, η2 = 0.17) and a tendency for higher blink duration in the sinusoidal smooth pursuit task (p = 0.016, η2 = 0.06) compared to the youth control group. In both tasks the blink duration in the concussed youth group decreased from session 1 to session 2 by 24% and 18%, accordingly, although statistical significance was not reached. The concussed adult group demonstrated a lower number of self-paced saccades compared to controls (p = 0.05, η2 = 0.09), which gradually increased, with the largest difference between session 1 and session 3 (p = 0.02). CONCLUSIONS Blink duration in youth athletes holds promise as a valid metric for concussion diagnostics and monitoring. It is recommended to focus future studies on comparing eye tracking performance within the same concussed athletes over time rather than comparing them to healthy controls.
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Affiliation(s)
- Nadja Snegireva
- Sports Science, Stellenbosch University Faculty of Medicine and Health Sciences, Suidwal Road, Coetzenburg, Cape Town, Western Cape, 7601, SOUTH AFRICA
| | - Wayne Derman
- Institute of Sport and Exercise Medicine, Stellenbosch University Faculty of Medicine and Health Sciences, Francie Van Zijl Dr, Parow, Cape Town, Western Cape, 7505, SOUTH AFRICA
| | - Jon Patricios
- Wits Institute for Sport and Health, University of the Witwatersrand Faculty of Health Sciences, 27 St Andrews Rd, Parktown, Johannesburg, Gauteng, 2193, SOUTH AFRICA
| | - Karen Estelle Welman
- Sports Science, Stellenbosch University Faculty of Medicine and Health Sciences, Suidwal Road, Coetzenburg, Cape Town, Western Cape, 7601, SOUTH AFRICA
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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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Amgalan A, Maher AS, Imms P, Ha MY, Fanelle TA, Irimia A. Functional Connectome Dynamics After Mild Traumatic Brain Injury According to Age and Sex. Front Aging Neurosci 2022; 14:852990. [PMID: 35663576 PMCID: PMC9158471 DOI: 10.3389/fnagi.2022.852990] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 04/05/2022] [Indexed: 11/17/2022] Open
Abstract
Neural and cognitive deficits after mild traumatic brain injury (mTBI) are paralleled by changes in resting state functional correlation (FC) networks that mirror post-traumatic pathophysiology effects on functional outcomes. Using functional magnetic resonance images acquired both acutely and chronically after injury (∼1 week and ∼6 months post-injury, respectively), we map post-traumatic FC changes across 136 participants aged 19-79 (52 females), both within and between the brain's seven canonical FC networks: default mode, dorsal attention, frontoparietal, limbic, somatomotor, ventral attention, and visual. Significant sex-dependent FC changes are identified between (A) visual and limbic, and between (B) default mode and somatomotor networks. These changes are significantly associated with specific functional recovery patterns across all cognitive domains (p < 0.05, corrected). Changes in FC between default mode, somatomotor, and ventral attention networks, on the one hand, and both temporal and occipital regions, on the other hand, differ significantly by age group (p < 0.05, corrected), and are paralleled by significant sex differences in cognitive recovery independently of age at injury (p < 0.05, corrected). Whereas females' networks typically feature both significant (p < 0.036, corrected) and insignificant FC changes, males more often exhibit significant FC decreases between networks (e.g., between dorsal attention and limbic, visual and limbic, default-mode and somatomotor networks, p < 0.0001, corrected), all such changes being accompanied by significantly weaker recovery of cognitive function in males, particularly older ones (p < 0.05, corrected). No significant FC changes were found across 35 healthy controls aged 66-92 (20 females). Thus, male sex and older age at injury are risk factors for significant FC alterations whose patterns underlie post-traumatic cognitive deficits. This is the first study to map, systematically, how mTBI impacts FC between major human functional networks.
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Affiliation(s)
- Anar Amgalan
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, United States
| | - Alexander S. Maher
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, United States
| | - Phoebe Imms
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, United States
| | - Michelle Y. Ha
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, United States
| | - Timothy A. Fanelle
- Corwin D. Denney Research Center, Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, United States
| | - Andrei Irimia
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, United States
- Corwin D. Denney Research Center, Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, United States
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11
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Kaae C, Cadigan K, Lai K, Theis J. Vestibulo-ocular dysfunction in mTBI: Utility of the VOMS for evaluation and management – A review. NeuroRehabilitation 2022; 50:279-296. [DOI: 10.3233/nre-228012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Individuals who have suffered a concussion/mild traumatic brain injury (mTBI) frequently report symptoms associated with vestibular and/or oculomotor dysfunction (VOD) like dizziness, nausea, fatigue, brain fog, headache, gait and neurocognitive impairments which are associated with the development of chronic symptoms. The Vestibular/Ocular Motor Screening (VOMS) tool has been established as a reliable and clinically relevant complement to use alongside a battery of post-concussion tests to improve screening and referral for further evaluation and treatment of VOD. OBJECTIVES: This paper will review the pathoanatomy and symptomatology of common vestibular and oculomotor disorders after concussion, as well as the utility of the VOMS to assist in diagnosis, referral, and management. METHODS: Primary articles were identified using a search via PubMed, Google Scholar, OneSearch, and CINAHL. Search key terms were combinations of “mild traumatic brain injury” or “concussion” or “pursuit” or “accommodation” or “vergence” or “convergence insufficiency” or “saccades” or “vestibulo-ocular reflex” or “vestibular ocular motor screen” or “vestibular rehabilitation”, or “vision rehabilitation” including adult and pediatric populations that were published in print or electronically from 1989 to 2021 in English. Classic papers on anatomy of eye movements, vestibular system and pathological changes in mTBI were also included, regardless of publication date. RESULTS: Objective impairments are commonly found during testing of smooth pursuit, saccades, vergence, accommodation, vestibular ocular reflex, and visual motion sensitivity after mTBI. These deficits can be actively treated with vestibular physical therapy and oculomotor/neuro-optometric vision therapy. VOMS is an efficient and reliable tool that can be used by all healthcare and rehabilitation providers to aid in diagnosis of post-concussion VOD, to help facilitate the decision to refer for further evaluation and treatment to expedite symptomatic post-concussion recovery. CONCLUSIONS: VOD is common after concussion in acute, post-acute, and chronic phases. Once areas of impairments are identified through proper assessment, clinicians can maximize recovery by referring to vestibular physical therapy and/or neuro-optometry to design a targeted treatment program to address individual deficits.
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Affiliation(s)
- Cristen Kaae
- Kaiser Permanente Medical Center, Vallejo, CA, USA
| | | | - Katherine Lai
- Kaiser Permanente Medical Center, Oakland, CA, USA
- Herbert Wertheim School of Optometry & Vision Science at the University of California, Berkeley, CA, USA
| | - Jacqueline Theis
- Herbert Wertheim School of Optometry & Vision Science at the University of California, Berkeley, CA, USA
- Virginia Neuro-Optometry at Concussion Care Centre of Virginia, Richmond VA, USA
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12
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Mani R, Ngo S, Walz J, Khuu SK. Evaluating the extent of change in near point of convergence in traumatic brain injury: a systematic review and meta-analysis. Brain Inj 2022; 36:306-320. [DOI: 10.1080/02699052.2022.2034188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Revathy Mani
- School of Optometry and Vision Science, The University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Steven Ngo
- School of Optometry and Vision Science, The University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Jacinta Walz
- School of Optometry and Vision Science, The University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Sieu K. Khuu
- School of Optometry and Vision Science, The University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
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13
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Lirani-Silva E, Stuart S, Parrington L, Campbell K, King L. Saccade and Fixation Eye Movements During Walking in People With Mild Traumatic Brain Injury. Front Bioeng Biotechnol 2021; 9:701712. [PMID: 34805104 PMCID: PMC8602343 DOI: 10.3389/fbioe.2021.701712] [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: 04/28/2021] [Accepted: 10/15/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Clinical and laboratory assessment of people with mild traumatic brain injury (mTBI) indicate impairments in eye movements. These tests are typically done in a static, seated position. Recently, the use of mobile eye-tracking systems has been proposed to quantify subtle deficits in eye movements and visual sampling during different tasks. However, the impact of mTBI on eye movements during functional tasks such as walking remains unknown. Objective: Evaluate differences in eye-tracking measures collected during gait between healthy controls (HC) and patients in the sub-acute stages of mTBI recovery and to determine if there are associations between eye-tracking measures and gait speed. Methods: Thirty-seven HC participants and 67individuals with mTBI were instructed to walk back and forth over 10-m, at a comfortable self-selected speed. A single 1-min trial was performed. Eye-tracking measures were recorded using a mobile eye-tracking system (head-mounted infra-red Tobbii Pro Glasses 2, 100 Hz, Tobii Technology Inc. VA, United States). Eye-tracking measures included saccadic (frequency, mean and peak velocity, duration and distance) and fixation measurements (frequency and duration). Gait was assessed using six inertial sensors (both feet, sternum, right wrist, lumbar vertebrae and the forehead) and gait velocity was selected as the primary outcome. General linear model was used to compare the groups and association between gait and eye-tracking outcomes were explored using partial correlations. Results: Individuals with mTBI showed significantly reduced saccade frequency (p = 0.016), duration (p = 0.028) and peak velocity (p = 0.032) compared to the HC group. No significant differences between groups were observed for the saccade distance, fixation measures and gait velocity (p > 0.05). A positive correlation was observed between saccade duration and gait velocity only for participants with mTBI (p = 0.025). Conclusion: Findings suggest impaired saccadic eye movement, but not fixations, during walking in individuals with mTBI. These findings have implications in real-world function including return to sport for athletes and return to duty for military service members. Future research should investigate whether or not saccade outcomes are influenced by the time after the trauma and rehabilitation.
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Affiliation(s)
- Ellen Lirani-Silva
- Balance Disorders Laboratory, Department of Neurology, Oregon Health and Science University, Portland, OR, United States
| | - Samuel Stuart
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle Upon Tyne, United Kingdom.,Northumbria Healthcare NHS Foundation Trust, North Shields, United Kingdom
| | - Lucy Parrington
- Balance Disorders Laboratory, Department of Neurology, Oregon Health and Science University, Portland, OR, United States.,Veterans Affairs Portland Oregon Health Care System, Portland, OR, United States
| | - Kody Campbell
- Balance Disorders Laboratory, Department of Neurology, Oregon Health and Science University, Portland, OR, United States.,Veterans Affairs Portland Oregon Health Care System, Portland, OR, United States
| | - Laurie King
- Balance Disorders Laboratory, Department of Neurology, Oregon Health and Science University, Portland, OR, United States.,Veterans Affairs Portland Oregon Health Care System, Portland, OR, United States
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14
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Mooney SWJ, Alam NM, Prusky GT. Tracking-Based Interactive Assessment of Saccades, Pursuits, Visual Field, and Contrast Sensitivity in Children With Brain Injury. Front Hum Neurosci 2021; 15:737409. [PMID: 34776907 PMCID: PMC8586078 DOI: 10.3389/fnhum.2021.737409] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 10/07/2021] [Indexed: 11/15/2022] Open
Abstract
Visual deficits in children that result from brain injury, including cerebral/cortical visual impairment (CVI), are difficult to assess through conventional methods due to their frequent co-occurrence with cognitive and communicative disabilities. Such impairments hence often go undiagnosed or are only determined through subjective evaluations of gaze-based reactions to different forms, colors, and movements, which limits any potential for remediation. Here, we describe a novel approach to grading visual health based on eye movements and evidence from gaze-based tracking behaviors. Our approach—the “Visual Ladder”—reduces reliance on the user’s ability to attend and communicate. The Visual Ladder produces metrics that quantify spontaneous saccades and pursuits, assess visual field responsiveness, and grade spatial visual function from tracking responses to moving stimuli. We used the Ladder to assess fourteen hospitalized children aged 3 to 18 years with a diverse range of visual impairments and causes of brain injury. Four children were excluded from analysis due to incompatibility with the eye tracker (e.g., due to severe strabismus). The remaining ten children—including five non-verbal children—were tested multiple times over periods ranging from 2 weeks to 9 months, and all produced interpretable outcomes on at least three of the five visual tasks. The results suggest that our assessment tasks are viable in non-communicative children, provided their eyes can be tracked, and hence are promising tools for use in a larger clinical study. We highlight and discuss informative outcomes exhibited by each child, including directional biases in eye movements, pathological nystagmus, visual field asymmetries, and contrast sensitivity deficits. Our findings indicate that these methodologies will enable the rapid, objective classification and grading of visual impairments in children with CVI, including non-verbal children who are currently precluded from most vision assessments. This would provide a much-needed differential diagnostic and prognostic tool for CVI and other impairments of the visual system, both ocular and cerebral.
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Affiliation(s)
- Scott W J Mooney
- Burke Neurological Institute, White Plains, NY, United States.,Blythedale Children's Hospital, Valhalla, NY, United States
| | - Nazia M Alam
- Burke Neurological Institute, White Plains, NY, United States.,Blythedale Children's Hospital, Valhalla, NY, United States
| | - Glen T Prusky
- Burke Neurological Institute, White Plains, NY, United States.,Blythedale Children's Hospital, Valhalla, NY, United States.,Weill Cornell Medicine, New York, NY, United States
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15
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Dubé C, Jin Y, Powers BG, Li G, Labelle A, Rivers MS, Gumboc IM, Bussières AE. Vision Evaluation Tools for Adults With Acquired Brain Injury: A Scoping Review. The Canadian Journal of Occupational Therapy 2021; 88:340-351. [PMID: 34658251 PMCID: PMC8640270 DOI: 10.1177/00084174211042955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background. Unrecognized visual deficits (VDs) following an acquired brain
injury (ABI) may impact clients’ rehabilitation. Little is known about evaluation tools
used in vision rehabilitation. Purpose. To systematically explore the
literature describing evaluation tools used for VD on adults with ABI.
Method. Using a scoping review methodology, we searched in MEDLINE(Ovid),
Embase, CINAHL, PsycINFO, and the grey literature from inception to 2020. Quantitative and
thematic analyses were performed. Findings. Of the 83 studies reporting on 86
evaluation tools, 47% used multiple tools to assess VD. Tools were mostly used by
occupational therapists and psychologists to evaluate intermediate, intermediate to high,
and high-level visual skills. Clinicians tend to select specific tools that focus on
different levels of the hierarchy of visual skills. Implications. Future
research should investigate the optimal timeframe for assessment of VD and the
psychometric properties of tools to ensure comprehensive VD evaluation.
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Affiliation(s)
- Camille Dubé
- Corresponding author: Camille Dubé,
McGill University Faculty of Medicine, School of Physical and Occupational Therapy, 3654
Prom Sir-William-Osler, Hosmer House 205, Montreal, QC H3G 1Y5, Canada.
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16
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Abstract
Traumatic brain injury (TBI) is a common neurological condition that results from an external force altering normal brain function, whether temporarily or permanently. A concussion is one type of TBI. TBIs vary greatly in severity, which concomitantly creates tremendous variability in their manifestation. The fingerprint of TBI is damage to the frontal areas of the brain, which, with sufficient magnitude, results in impairment of a person's ability to regulate cognition, emotion, and behavior. These consequences of TBI make recognition in the context of treating behavioral health conditions of utmost importance. TBI not only causes behavioral health problems but also produces associated deficits that can undermine the effectiveness of treatment for a behavioral health condition. This overview delineates key characteristics of TBI and describes its association with behavioral health conditions. Mechanisms underlying the relationship between TBI and behavioral health are presented, and a series of recommendations for professionals are proposed. This article is intended to raise awareness about TBI and simultaneously introduce key concepts for accommodating the effects of TBI in behavioral health care.
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Affiliation(s)
- John D Corrigan
- Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus
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17
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Walz JA, Mani R, Alnawmasi MM, Khuu SK. Visuospatial Attention Allocation as an Indicator of Cognitive Deficit in Traumatic Brain Injury: A Systematic Review and Meta-Analysis. Front Hum Neurosci 2021; 15:675376. [PMID: 34354575 PMCID: PMC8329082 DOI: 10.3389/fnhum.2021.675376] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 06/23/2021] [Indexed: 01/02/2023] Open
Abstract
Traumatic Brain Injury (TBI) is defined by changes in brain function resulting from external forces acting on the brain and is typically characterized by a host of physiological and functional changes such as cognitive deficits including attention problems. In the present study, we focused on the effect of TBI on the ability to allocate attention in vision (i.e., the use of endogenous and exogenous visual cues) by systematically reviewing previous literature on the topic. We conducted quantitative synthesis of 16 selected studies of visual attention following TBI, calculating 80 effect size estimates. The combined effect size was large (g = 0.79, p < 0.0001) with medium heterogeneity (I2 = 68.39%). Subgroup analyses revealed an increase in deficit with moderate-to-severe and severe TBI as compared to mild TBI [F(2, 76) = 24.14, p < 0.0001]. Task type was another key source of variability and subgroup analyses indicated that higher order attention processes were severely affected by TBI [F(2, 77) = 5.66, p = 0.0051). Meta-regression analyses revealed significant improvement in visual attention deficit with time [p(mild) = 0.031, p(moderate-to-severe) = 0.002, p(severe) < 0.0001]. Taken together, these results demonstrate that visual attention is affected by TBI and that regular assessment of visual attention, using a systematic attention allocation task, may provide a useful clinical measure of cognitive impairment and change after TBI.
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Affiliation(s)
- Jacinta A Walz
- School of Optometry and Vision Science, The University of New South Wales, Sydney, NSW, Australia
| | - Revathy Mani
- School of Optometry and Vision Science, The University of New South Wales, Sydney, NSW, Australia
| | - Mohammed M Alnawmasi
- School of Optometry and Vision Science, The University of New South Wales, Sydney, NSW, Australia
| | - Sieu K Khuu
- School of Optometry and Vision Science, The University of New South Wales, Sydney, NSW, Australia
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18
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Williamson JR, Sturim D, Vian T, Lacirignola J, Shenk TE, Yuditskaya S, Rao HM, Talavage TM, Heaton KJ, Quatieri TF. Using Dynamics of Eye Movements, Speech Articulation and Brain Activity to Predict and Track mTBI Screening Outcomes. Front Neurol 2021; 12:665338. [PMID: 34295299 PMCID: PMC8289895 DOI: 10.3389/fneur.2021.665338] [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: 02/10/2021] [Accepted: 06/09/2021] [Indexed: 11/24/2022] Open
Abstract
Repeated subconcussive blows to the head during sports or other contact activities may have a cumulative and long lasting effect on cognitive functioning. Unobtrusive measurement and tracking of cognitive functioning is needed to enable preventative interventions for people at elevated risk of concussive injury. The focus of the present study is to investigate the potential for using passive measurements of fine motor movements (smooth pursuit eye tracking and read speech) and resting state brain activity (measured using fMRI) to complement existing diagnostic tools, such as the Immediate Post-concussion Assessment and Cognitive Testing (ImPACT), that are used for this purpose. Thirty-one high school American football and soccer athletes were tracked through the course of a sports season. Hypotheses were that (1) measures of complexity of fine motor coordination and of resting state brain activity are predictive of cognitive functioning measured by the ImPACT test, and (2) within-subject changes in these measures over the course of a sports season are predictive of changes in ImPACT scores. The first principal component of the six ImPACT composite scores was used as a latent factor that represents cognitive functioning. This latent factor was positively correlated with four of the ImPACT composites: verbal memory, visual memory, visual motor speed and reaction speed. Strong correlations, ranging between r = 0.26 and r = 0.49, were found between this latent factor and complexity features derived from each sensor modality. Based on a regression model, the complexity features were combined across sensor modalities and used to predict the latent factor on out-of-sample subjects. The predictions correlated with the true latent factor with r = 0.71. Within-subject changes over time were predicted with r = 0.34. These results indicate the potential to predict cognitive performance from passive monitoring of fine motor movements and brain activity, offering initial support for future application in detection of performance deficits associated with subconcussive events.
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Affiliation(s)
- James R Williamson
- Human Health and Performance Systems, MIT Lincoln Laboratory, Lexington, MA, United States
| | - Doug Sturim
- Human Health and Performance Systems, MIT Lincoln Laboratory, Lexington, MA, United States
| | - Trina Vian
- Counter-WMD Systems, MIT Lincoln Laboratory, Lexington, MA, United States
| | - Joseph Lacirignola
- Counter-WMD Systems, MIT Lincoln Laboratory, Lexington, MA, United States
| | - Trey E Shenk
- Advanced RF Techniques & Systems, MIT Lincoln Laboratory, Lexington, MA, United States
| | - Sophia Yuditskaya
- Human Health and Performance Systems, MIT Lincoln Laboratory, Lexington, MA, United States
| | - Hrishikesh M Rao
- Human Health and Performance Systems, MIT Lincoln Laboratory, Lexington, MA, United States
| | - Thomas M Talavage
- Electrical and Computer Engineering/Biomedical Engineering, Purdue University, West Lafayette, IN, United States
| | - Kristin J Heaton
- Military Performance Division, U.S. Army Research Institute of Environmental Medicine, Natick, MA, United States
| | - Thomas F Quatieri
- Human Health and Performance Systems, MIT Lincoln Laboratory, Lexington, MA, United States
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19
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Rao HM, Yuditskaya S, Williamson JR, Vian TR, Lacirignola JJ, Shenk TE, Talavage TM, Heaton KJ, Quatieri TF. Using Oculomotor Features to Predict Changes in Optic Nerve Sheath Diameter and ImPACT Scores From Contact-Sport Athletes. Front Neurol 2021; 12:584684. [PMID: 33746869 PMCID: PMC7969804 DOI: 10.3389/fneur.2021.584684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 01/28/2021] [Indexed: 11/13/2022] Open
Abstract
There is mounting evidence linking the cumulative effects of repetitive head impacts to neuro-degenerative conditions. Robust clinical assessment tools to identify mild traumatic brain injuries are needed to assist with timely diagnosis for return-to-field decisions and appropriately guide rehabilitation. The focus of the present study is to investigate the potential for oculomotor features to complement existing diagnostic tools, such as measurements of Optic Nerve Sheath Diameter (ONSD) and Immediate Post-concussion Assessment and Cognitive Testing (ImPACT). Thirty-one high school American football and soccer athletes were tracked through the course of a sports season. Given the high risk of repetitive head impacts associated with both soccer and football, our hypotheses were that (1) ONSD and ImPACT scores would worsen through the season and (2) oculomotor features would effectively capture both neurophysiological changes reflected by ONSD and neuro-functional status assessed via ImPACT. Oculomotor features were used as input to Linear Mixed-Effects Regression models to predict ONSD and ImPACT scores as outcomes. Prediction accuracy was evaluated to identify explicit relationships between eye movements, ONSD, and ImPACT scores. Significant Pearson correlations were observed between predicted and actual outcomes for ONSD (Raw = 0.70; Normalized = 0.45) and for ImPACT (Raw = 0.86; Normalized = 0.71), demonstrating the capability of oculomotor features to capture neurological changes detected by both ONSD and ImPACT. The most predictive features were found to relate to motor control and visual-motor processing. In future work, oculomotor models, linking neural structures to oculomotor function, can be built to gain extended mechanistic insights into neurophysiological changes observed through seasons of participation in contact sports.
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Affiliation(s)
- Hrishikesh M Rao
- Human Health & Performance Systems Group, Massachusetts Institute of Technology Lincoln Laboratory, Lexington, MA, United States
| | - Sophia Yuditskaya
- Human Health & Performance Systems Group, Massachusetts Institute of Technology Lincoln Laboratory, Lexington, MA, United States
| | - James R Williamson
- Human Health & Performance Systems Group, Massachusetts Institute of Technology Lincoln Laboratory, Lexington, MA, United States
| | - Trina R Vian
- Counter-Weapons of Mass Destruction Systems Group, Massachusetts Institute of Technology Lincoln Laboratory, Lexington, MA, United States
| | - Joseph J Lacirignola
- Counter-Weapons of Mass Destruction Systems Group, Massachusetts Institute of Technology Lincoln Laboratory, Lexington, MA, United States
| | - Trey E Shenk
- Advanced Radio Frequency Techniques & Systems Group, Massachusetts Institute of Technology Lincoln Laboratory, Lexington, MA, United States
| | - Thomas M Talavage
- Department of Biomedical Engineering, Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States.,Department of Electrical and Computer Engineering, Purdue University, West Lafayette, IN, United States
| | - Kristin J Heaton
- Military Performance Division, U.S. Army Research Institute of Environmental Medicine, Natick, MA, United States
| | - Thomas F Quatieri
- Human Health & Performance Systems Group, Massachusetts Institute of Technology Lincoln Laboratory, Lexington, MA, United States
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20
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Feller CN, Goldenberg M, Asselin PD, Merchant-Borna K, Abar B, Jones CMC, Mannix R, Kawata K, Bazarian JJ. Classification of Comprehensive Neuro-Ophthalmologic Measures of Postacute Concussion. JAMA Netw Open 2021; 4:e210599. [PMID: 33656530 PMCID: PMC7930925 DOI: 10.1001/jamanetworkopen.2021.0599] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE Symptom-based methods of concussion diagnosis in contact sports result in underdiagnosis and repeated head injury exposure, increasing the risk of long-term disability. Measures of neuro-ophthalmologic (NO) function have the potential to serve as objective aids, but their diagnostic utility is unknown. OBJECTIVE To identify NO measures that accurately differentiate athletes with and without concussion. DESIGN, SETTING, AND PARTICIPANTS This cohort study was conducted among athletes with and without concussion who were aged 17 to 22 years between 2016 and 2017. Eye movements and cognitive function were measured a median of 19 days after injury among patients who had an injury meeting the study definition of concussion while playing a sport (retrospectively selected from a concussion clinic), then compared with a control group of participants without concussion (enrolled from 104 noncontact collegiate athlete volunteers without prior head injury). Data analysis was conducted from November 2019 through May 2020. EXPOSURE Concussion. MAIN OUTCOMES AND MEASURES Classification accuracy of clinically important discriminator eye-tracking (ET) metrics. Participants' eye movements were evaluated with a 12-minute ET procedure, yielding 42 metrics related to smooth pursuit eye movement (SPEM), saccades, dynamic visual acuity, and reaction time. Clinically important discriminator metrics were defined as those with significantly different group differences and area under the receiver operator characteristic curves (AUROCs) of at least 0.70. RESULTS A total of 34 participants with concussions (mean [SD] age, 19.7 [2.4] years; 20 [63%] men) and 54 participants without concussions (mean [SD] age, 20.8 [2.2] years; 31 [57%] men) completed the study. Six ET metrics (ie, simple reaction time, discriminate reaction time, discriminate visual reaction speed, choice visual reaction speed, and reaction time on 2 measures of dynamic visual acuity 2) were found to be clinically important; all were measures of reaction time, and none were related to SPEM. Combined, these 6 metrics had an AUROC of 0.90 (95% CI, 0.80-0.99), a sensitivity of 77.8%, and a specificity of 92.6%. The 6 metrics remained significant on sensitivity testing. CONCLUSIONS AND RELEVANCE In this study, ET measures of slowed visual reaction time had high classification accuracy for concussion. Accurate, objective measures of NO function have the potential to improve concussion recognition and reduce the disability associated with underdiagnosis.
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Affiliation(s)
- Christina N. Feller
- University of Rochester School of Medicine and Dentistry, Rochester, New York
- Medical College of Wisconsin, Milwaukee
| | | | - Patrick D. Asselin
- University of Rochester School of Medicine and Dentistry, Rochester, New York
- Department of Pediatrics, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kian Merchant-Borna
- Department of Emergency Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Beau Abar
- Department of Emergency Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Courtney Marie Cora Jones
- Department of Emergency Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Rebekah Mannix
- Department of Pediatrics, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Keisuke Kawata
- Department of Kinesiology, Indiana University, Bloomington
| | - Jeffrey J. Bazarian
- Department of Emergency Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York
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21
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Kornguth S, Rylander HG, Smith S, Campbell J, Steffensen S, Arnold D, Athey A, Rutledge JN. Approaches for Monitoring Warfighter Blast-related Exposures in Training to Develop Effective Safety Standards. Mil Med 2021; 186:515-522. [PMID: 33499537 PMCID: PMC7980484 DOI: 10.1093/milmed/usaa426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 08/04/2020] [Accepted: 11/01/2020] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Traumatic brain injuries are of concern to the sports and military communities because of the age of the participants and costly burden to society. To markedly reduce the impact of traumatic brain injury and its sequela (TBI-S), it is necessary to determine the initial vulnerability of individuals as well as identify new technologies that indicate early signs of TBI-S. MATERIALS AND METHODS Currently, diverse methods have been used by the authors and others in laboratory settings to reveal early signs of persistent TBI-S including simulation modeling of the effect of rapid deceleration on the deviatoric strain (shear force) imposed on specific brain regions, auditory evoked potential (AEP) measurements to determine injury to the auditory cortex optokinetic nystagmus (OKN) measures sensitive to vestibular trauma, and optical coherence tomography (OCT) measures that reveal changes in central visual function obtained noninvasively by examination of the retina. RESULTS Simulation studies provided technical information on maximal deviatoric strain at the base of the sulci and interface of gray and white matter consistent with results from neuropathology and from magnetic resonance imaging. The AEP and OKN reveal measurable injury to similar regions below the Sylvian fissure including auditory cortex and midbrain, and the OCT reveals changes to the retina consistent with forceful deceleration effects. CONCLUSIONS The studies and results are consistent with prior work demonstrating that noninvasive tests may be sensitive to the presence of TBI-S, potentially in the training field as advances in the portability of test instruments are underway. When combined with baseline data gathered from individuals in quantitative form, key variances can emerge. Therefore, it is hypothesized that AEP, OKN, and OCT, taken together, may yield faster objective and quantitative neurophysiological measures serving as a "signature" of neural injury and more indicative of potentially persistent TBI-S-recommending larger scale longitudinal studies.
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Affiliation(s)
- Steven Kornguth
- Department of Neurology, The University of Texas Dell Medical School, Austin, TX, 78712, USA
| | - Henry G Rylander
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX, 78712, USA
| | - Spencer Smith
- Department of Neurology, The University of Texas Dell Medical School, Austin, TX, 78712, USA
| | - Julia Campbell
- Department of Neurology, The University of Texas Dell Medical School, Austin, TX, 78712, USA
| | - Steve Steffensen
- Department of Neurology, The University of Texas Dell Medical School, Austin, TX, 78712, USA
| | - David Arnold
- Department of Neurology, The University of Texas Dell Medical School, Austin, TX, 78712, USA
| | - Alex Athey
- Department of Neurology, The University of Texas Dell Medical School, Austin, TX, 78712, USA
| | - J Neal Rutledge
- Department of Neurology, The University of Texas Dell Medical School, Austin, TX, 78712, USA
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22
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Gallagher V, Vesci B, Mjaanes J, Breiter H, Chen Y, Herrold A, Reilly J. Eye movement performance and clinical outcomes among female athletes post-concussion. Brain Inj 2020; 34:1674-1684. [PMID: 33103479 DOI: 10.1080/02699052.2020.1830173] [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: 10/23/2022]
Abstract
BACKGROUND Most post-concussion eye movement (EM) research involves predominantly male samples. We evaluated pro- (PRO; reflexive shift of visual attention to target) and anti- (ANTI; executive control of visual attention away from target) computer-based saccade task performance among female, collegiate athletes with recent concussion (CON) versus healthy-control athletes (HC). We evaluated the relationship between EM performance and post-concussion outcomes. We hypothesized ANTI performance would differ among CON and HC due to greater executive control demands, and that EM performance (both tasks) would be associated with clinical outcomes in CON. METHODS 16 CON (assessed 4-10 days post-injury [M = 6.87, SD = 2.15 days]) and 16 age-matched HC athletes were recruited. General linear mixed modeling and Pearson's correlations were used. RESULTS On ANTI, CON demonstrated higher error rate [F(1,2863) = 12.650, p<.001] and shorter latency on error trials [F(1,469) = 5.976, p=.015] relative to HC. Multiple EM measures were associated with clinical outcomes: PRO duration predicted days to symptom remission (r=.44, p <.05); ANTI error rate was associated with symptom burden on the day of testing (r=.27, p <.05). CONCLUSION This study demonstrates promising utility of EM measures to detect cognitive control and sensorimotor effects of concussion among female athletes and their use as a prognostic indicators of recovery.
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Affiliation(s)
- Virginia Gallagher
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine , Chicago, Illinois, USA
| | - Brian Vesci
- Department of Sports Medicine, Northwestern University , Evanston, Illinois, USA
| | - Jeffrey Mjaanes
- Department of Sports Medicine, Northwestern University , Evanston, Illinois, USA
| | - Hans Breiter
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine , Chicago, Illinois, USA.,Warren Wright Adolescent Center, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine , Chicago, Illinois, USA
| | - Yufen Chen
- Center for Translational Imaging, Department of Radiology, Northwestern University Feinberg School of Medicine , Chicago, Illinois, USA
| | - Amy Herrold
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine , Chicago, Illinois, USA.,Research Health Scientist, Edward Hines, Jr. VA Hospital , Hines IL, Oregon, USA
| | - James Reilly
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine , Chicago, Illinois, USA
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Arnoldi K. Traumatic Brain Injury in Children: Do the Eyes Have It? The Orthoptic Evaluation of Traumatic Brain Injury. J Binocul Vis Ocul Motil 2020; 70:122-127. [PMID: 33275080 DOI: 10.1080/2576117x.2020.1792030] [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: 06/26/2020] [Revised: 06/29/2020] [Accepted: 06/30/2020] [Indexed: 06/12/2023]
Abstract
Because the neuropathological changes caused by mild traumatic brain injury (mTBI) more often manifest as functional impairments than structural abnormalities, the clinical diagnosis of mTBI may rely too heavily on a combination of history and self-reported symptoms. The mechanism of injury in mild traumatic brain injury (mTBI) predicts that supranuclear pathways controlling eye movement systems would be vulnerable to damage, and diagnostic tests of these systems would be high-yield. In fact, tests of oculomotor function have proven to be highly sensitive in detecting neurological soft signs, but may require expensive, specialized equipment. Fortunately, Certified Orthoptists (COs) are skilled at the evaluation of accommodative dysfunction, abnormalities of saccades, smooth pursuit, and vestibular eye movements, and vergence errors using standard ophthalmic equipment. Because COs are accustomed to adapting the sensorimotor exam to infants and pre-verbal children, they are able to modify or design objective methods, the results of which may be difficult for the patient with a functional overlay to decipher and deceive. When the patient with a history of mTBI presents to the ophthalmologist with visual symptoms and a normal routine eye exam, it is important to order a sensorimotor examination by a CO to confirm the diagnosis.
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Affiliation(s)
- Kyle Arnoldi
- Ira G. Ross Eye Institute, University at Buffalo , Buffalo, New York
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24
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Abstract
OBJECTIVE Concussion is the most common type of brain injury in both pediatric and adult populations and can potentially result in persistent postconcussion symptoms. Objective assessment of physiologic "mild" traumatic brain injury in concussion patients remains challenging. This study evaluates an automated eye-tracking algorithm as a biomarker for concussion as defined by its symptoms and the clinical signs of convergence insufficiency and accommodation dysfunction in a pediatric population. DESIGN Cross-sectional case-control study. SETTING Primary care. PATIENTS Concussed children (N = 56; mean age = 13 years), evaluated at a mean of 22-week post-injury, compared with 83 uninjured controls. INDEPENDENT VARIABLES Metrics comparing velocity and conjugacy of eye movements over time were obtained and were compared with the correlation between Acute Concussion Evaluation (ACE) scores, convergence, and accommodation dysfunction. MAIN OUTCOME MEASURES Subjects' eye movements recorded with an automated eye tracker while they watched a 220-second cartoon film clip played continuously while moving within an aperture. RESULTS Twelve eye-tracking metrics were significantly different between concussed and nonconcussed children. A model to classify concussion as diagnosed by its symptoms assessed using the ACE achieved an area under the curve (AUC) = 0.854 (71.9% sensitivity, 84.4% specificity, a cross-validated AUC = 0.789). An eye-tracking model built to identify near point of convergence (NPC) disability achieved 95.8% specificity and 57.1% sensitivity for an AUC = 0.810. Reduced binocular amplitude of accommodation had a Spearman correlation of 0.752(P value <0.001) with NPC. CONCLUSION Eye tracking correlated with concussion symptoms and detected convergence and accommodative abnormalities associated with concussion in the pediatric population. It demonstrates utility as a rapid, objective, noninvasive aid in the diagnosis of concussion.
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Effects of Mild Traumatic Brain Injury on Stereopsis Detected by a Virtual Reality System: Attempt to Develop a Screening Test. J Med Biol Eng 2020. [DOI: 10.1007/s40846-020-00542-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Abstract
Purpose
The study aimed to evaluate stereopsis as a surrogate marker for post-concussion oculomotor function to develop an objective test that can reliably and quickly detect mild traumatic brain injuries (TBI).
Methods
The cohort of this prospective clinical study included 30 healthy subjects (mean age 25 ± 2 years) and 30 TBI patients (43 ± 22 years) comprising 11 patients with moderate TBI and 19 patients with mild TBI. The healthy subjects were examined once, whereas the TBI patients were examined immediately after hospitalization, at 1 week, and at 2 months. A virtual reality (VR) program displayed three-dimensional rendering of four rotating soccer balls over VR glasses in different gaze directions. The subjects were instructed to select the ball that appeared to be raised from the screen as quickly as possible via remote control. The response times and fusion abilities in different gaze directions were recorded.
Results
The correlation between stereopsis and TBI severity was significant. The response times of the moderate and mild TBI groups were significantly longer than those of the healthy reference group. The response times of the moderate TBI group were significantly longer than those of the mild TBI group. The response times at follow-up examinations were significantly shorter than those immediately after hospitalization. Fusion ability was primarily defective in the gaze direction to the right (90°) and left (270° and 315°).
Conclusions
TBI patients showed impaired stereopsis. Measuring stereopsis in different positions of the visual field using VR can be effective for rapid concussion assessment.
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Horan B, Heckenberg R, Maruff P, Wright B. Development of a new virtual reality test of cognition: assessing the test-retest reliability, convergent and ecological validity of CONVIRT. BMC Psychol 2020; 8:61. [PMID: 32532362 PMCID: PMC7291630 DOI: 10.1186/s40359-020-00429-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 06/05/2020] [Indexed: 01/26/2023] Open
Abstract
Background Technological advances provide an opportunity to refine tools that assess central nervous system performance. This study aimed to assess the test-retest reliability and convergent and ecological validity of a newly developed, virtual-reality, concussion assessment tool, ‘CONVIRT’, which uses eye-tracking technology to assess visual processing speed, and manual reaction time (pushing a button on a riding crop) to assess attention and decision-making. CONVIRT was developed for horse jockeys, as of all sportspersons, they are most at risk of concussion. Methods Participants (N = 165), were assessed with CONVIRT, which uses virtual reality to give the user the experience of riding a horse during a horserace. Participants were also assessed with standard Cogstate computer-based concussion measures in-between two completions of the CONVIRT battery. The physiological arousal induced by the test batteries were assessed via measures of heart rate and heart rate variability (LF/HF ratio). Results Satisfactory test-retest reliability and convergent validity with Cogstate attention and decision-making subtests and divergent validity in visual processing speed measures were observed. CONVIRT also increased heart rate and LF/HF ratio, which may better approximate participant arousal levels in their workplace. Conclusions CONVIRT may be a reliable and valid tool to assess elements of cognition and CNS disruption. The increased ecological validity may also mean better informed ‘return-to-play’ decisions and stronger industry acceptance due to the real-world meaningfulness of the assessment. However, before this can be achieved, the sensitivity of the CONVIRT battery needs to be demonstrated.
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Affiliation(s)
- Ben Horan
- School of Engineering, Deakin University, Geelong, VIC, 3216, Australia
| | - Rachael Heckenberg
- School of Psychology and Public Health, La Trobe University, Wodonga, Victoria, 3690, Australia
| | - Paul Maruff
- The Florey Institute, The University of Melbourne, Parkville, VIC, 3052, Australia
| | - Bradley Wright
- School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, 3086, Australia.
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Snegireva N, Derman W, Patricios J, Welman KE. Awareness and Perceived Value of Eye Tracking Technology for Concussion Assessment among Sports Medicine Clinicians: A Multinational Study. PHYSICIAN SPORTSMED 2020; 48:165-172. [PMID: 31322973 DOI: 10.1080/00913847.2019.1645577] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Objective: The awareness of concussion as a serious and frequently occurring sports injury and its management has evolved significantly. One viable objective diagnostic tool is eye tracking technology. The authors hypothesized that while clinicians may be aware that assessing eye movements in concussed athletes can be beneficial, it is possible that, due to the novelty of the eye tracking technology and limited exposure, only a few actually use it in their practice. The study aimed to assess the awareness of eye movement deficits associated with concussion amongst sports medicine clinicians and to determine the utilization and perceptions of the eye tracking technology for concussion diagnosis.Methods: An online 18-question survey was distributed internationally from January until December 2017 and completed by 171 sports medicine clinicians (sport physicians, therapists, general practitioners, neuropsychologists) from 32 countries.Results: Respondents indicated that subjectivity of assessments remained a major limitation of established diagnostic tools. Eye tracking technology, despite its potential to attenuate this limitation, was only used by 12% of respondents. To diagnose concussion, 77% did not use any eye movement assessment tools other than own clinical assessment. With the exception of abnormal pupil light reflex, which was checked by 68%, eye movement deficits were inspected by less than half of the respondents (46.3 ± 12%).Conclusion: Even among sports medicine clinicians who regularly attend to patients with concussions, there is insufficient awareness that concussion can lead to abnormal eye tracking behavior. Lack of exposure to the sensitive eye tracking equipment may be a limiting factor for using eye movement metrics for concussion diagnostics. Facilitating the awareness of objective methods, like eye tracking technology, may help assure the appropriate continuum of identification and treatment for concussed athletes. Increasing educational opportunities and practical experience of clinicians regarding concussive symptoms and potential innovative technology is strongly advocated.
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Affiliation(s)
- Nadja Snegireva
- Movement Laboratory, Department of Sport Science, Stellenbosch University, Stellenbosch, South Africa
| | - Wayne Derman
- Institute of Sport and Exercise Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,International Olympic Committee (IOC) Research Centre, Cape Town, South Africa
| | - Jon Patricios
- Wits Institute for Sport and Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Karen E Welman
- Movement Laboratory, Department of Sport Science, Stellenbosch University, Stellenbosch, South Africa
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Abstract
Over the last decade, numerous concussion evidence-based clinical practice guidelines (CPGs), consensus statements, and clinical guidance documents have been published. These documents have typically focused on the diagnosis of concussion and medical management of individuals post concussion, but provide little specific guidance for physical therapy management of concussion and its associated impairments. Further, many of these guidance documents have targeted specific populations in specific care contexts. The primary purpose of this CPG is to provide a set of evidence-based recommendations for physical therapist management of the wide spectrum of patients who have experienced a concussive event. J Orthop Sports Phys Ther 2020;50(4):CPG1-CPG73. doi:10.2519/jospt.2020.0301.
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29
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Analysis of Facial Information for Healthcare Applications: A Survey on Computer Vision-Based Approaches. INFORMATION 2020. [DOI: 10.3390/info11030128] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
This paper gives an overview of the cutting-edge approaches that perform facial cue analysis in the healthcare area. The document is not limited to global face analysis but it also concentrates on methods related to local cues (e.g., the eyes). A research taxonomy is introduced by dividing the face in its main features: eyes, mouth, muscles, skin, and shape. For each facial feature, the computer vision-based tasks aiming at analyzing it and the related healthcare goals that could be pursued are detailed.
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30
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Stuart S, Parrington L, Martini D, Peterka R, Chesnutt J, King L. The Measurement of Eye Movements in Mild Traumatic Brain Injury: A Structured Review of an Emerging Area. Front Sports Act Living 2020; 2:5. [PMID: 33345000 PMCID: PMC7739790 DOI: 10.3389/fspor.2020.00005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 01/08/2020] [Indexed: 11/13/2022] Open
Abstract
Mild traumatic brain injury (mTBI), or concussion, occurs following a direct or indirect force to the head that causes a change in brain function. Many neurological signs and symptoms of mTBI can be subtle and transient, and some can persist beyond the usual recovery timeframe, such as balance, cognitive or sensory disturbance that may pre-dispose to further injury in the future. There is currently no accepted definition or diagnostic criteria for mTBI and therefore no single assessment has been developed or accepted as being able to identify those with an mTBI. Eye-movement assessment may be useful, as specific eye-movements and their metrics can be attributed to specific brain regions or functions, and eye-movement involves a multitude of brain regions. Recently, research has focused on quantitative eye-movement assessments using eye-tracking technology for diagnosis and monitoring symptoms of an mTBI. However, the approaches taken to objectively measure eye-movements varies with respect to instrumentation, protocols and recognition of factors that may influence results, such as cognitive function or basic visual function. This review aimed to examine previous work that has measured eye-movements within those with mTBI to inform the development of robust or standardized testing protocols. Medline/PubMed, CINAHL, PsychInfo and Scopus databases were searched. Twenty-two articles met inclusion/exclusion criteria and were reviewed, which examined saccades, smooth pursuits, fixations and nystagmus in mTBI compared to controls. Current methodologies for data collection, analysis and interpretation from eye-tracking technology in individuals following an mTBI are discussed. In brief, a wide range of eye-movement instruments and outcome measures were reported, but validity and reliability of devices and metrics were insufficiently reported across studies. Interpretation of outcomes was complicated by poor study reporting of demographics, mTBI-related features (e.g., time since injury), and few studies considered the influence that cognitive or visual functions may have on eye-movements. The reviewed evidence suggests that eye-movements are impaired in mTBI, but future research is required to accurately and robustly establish findings. Standardization and reporting of eye-movement instruments, data collection procedures, processing algorithms and analysis methods are required. Recommendations also include comprehensive reporting of demographics, mTBI-related features, and confounding variables.
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Affiliation(s)
- Samuel Stuart
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, United Kingdom
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States
- Veterans Affairs Portland Health Care System, Portland, OR, United States
| | - Lucy Parrington
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States
- Veterans Affairs Portland Health Care System, Portland, OR, United States
| | - Douglas Martini
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States
- Veterans Affairs Portland Health Care System, Portland, OR, United States
| | - Robert Peterka
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States
- Veterans Affairs Portland Health Care System, Portland, OR, United States
- National Center for Rehabilitative Auditory Research, Veterans Affairs Portland Health Care System, Portland, OR, United States
| | - James Chesnutt
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, United States
- Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR, United States
| | - Laurie King
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States
- Veterans Affairs Portland Health Care System, Portland, OR, United States
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31
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Gordon EM, May GJ, Nelson SM. MRI-based measures of intracortical myelin are sensitive to a history of TBI and are associated with functional connectivity. Neuroimage 2019; 200:199-209. [PMID: 31203023 PMCID: PMC6703948 DOI: 10.1016/j.neuroimage.2019.06.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 05/29/2019] [Accepted: 06/12/2019] [Indexed: 01/31/2023] Open
Abstract
Traumatic brain injuries (TBIs) induce persistent behavioral and cognitive deficits via diffuse axonal injury. Axonal injuries are often examined in vivo using diffusion MRI, which identifies damaged and demyelinated regions in deep white matter. However, TBI patients can exhibit impairment in the absence of diffusion-measured abnormalities, suggesting that axonal injury and demyelination may occur outside the deep white matter. Importantly, myelinated axons are also present within the cortex. Cortical myelination cannot be measured using diffusion imaging, but can be mapped in-vivo using the T1-w/T2-w ratio method. Here, we conducted the first work examining effects of TBI on intracortical myelin in living humans by applying myelin mapping to 46 US Military Veterans with a history of TBI. We observed that myelin maps could be created in TBI patients that matched known distributions of cortical myelin. After controlling for age and presence of blast injury, the number of lifetime TBIs was associated with reductions in the T1-w/T2-w ratio across the cortex, most significantly in a highly-myelinated lateral occipital region corresponding with the human MT+ complex. Further, the T1-w/T2-w ratio in this MT+ region predicted resting-state functional connectivity of that region. By contrast, a history of blast TBI did not affect the T1-w/T2-w ratio in either a diffuse or focal pattern. These findings suggest that intracortical myelin, as measured using the T1-w/T2-w ratio, may be a TBI biomarker that is anatomically complementary to diffusion MRI. Thus, myelin mapping could potentially be combined with diffusion imaging to improve MRI-based diagnostic tools for TBI.
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Affiliation(s)
- Evan M Gordon
- VISN 17 Center of Excellence for Research on Returning War Veterans, 4800 Memorial Dr, 151-C, Waco, TX, 76711, USA; Center for Vital Longevity, School of Behavioral and Brain Sciences, University of Texas at Dallas, 1600 Viceroy Dr #800, Dallas, TX, 75235, USA; Department of Psychology and Neuroscience, Baylor University, Baylor Sciences Building Suite B.309, Waco, TX, 76706, USA.
| | - Geoffrey J May
- VISN 17 Center of Excellence for Research on Returning War Veterans, 4800 Memorial Dr, 151-C, Waco, TX, 76711, USA; Center for Vital Longevity, School of Behavioral and Brain Sciences, University of Texas at Dallas, 1600 Viceroy Dr #800, Dallas, TX, 75235, USA; Department of Psychology and Neuroscience, Baylor University, Baylor Sciences Building Suite B.309, Waco, TX, 76706, USA; Department of Psychiatry and Behavioral Science, Texas A&M Health Science Center, College of Medicine, 8441 Riverside Parkway, Bryan, TX, 77807, USA
| | - Steven M Nelson
- VISN 17 Center of Excellence for Research on Returning War Veterans, 4800 Memorial Dr, 151-C, Waco, TX, 76711, USA; Center for Vital Longevity, School of Behavioral and Brain Sciences, University of Texas at Dallas, 1600 Viceroy Dr #800, Dallas, TX, 75235, USA; Department of Psychology and Neuroscience, Baylor University, Baylor Sciences Building Suite B.309, Waco, TX, 76706, USA; Department of Psychiatry and Behavioral Science, Texas A&M Health Science Center, College of Medicine, 8441 Riverside Parkway, Bryan, TX, 77807, USA
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Legarreta AD, Mummareddy N, Yengo-Kahn AM, Zuckerman SL. On-field assessment of concussion: clinical utility of the King-Devick test. Open Access J Sports Med 2019; 10:115-121. [PMID: 31686924 PMCID: PMC6709031 DOI: 10.2147/oajsm.s171815] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 08/01/2019] [Indexed: 11/23/2022] Open
Abstract
Sport-related concussion (SRC) is an important public health concern with up to 3.8 million SRCs occurring each year. As the incidence and rate of SRC increases, reliable and valid tools for diagnosis and management are needed. The King-Devick (K-D) test assesses a patient’s visual function based on reading a series of numbers as well as counting both time to completion and errors. Its rapid administration time and simplicity make the K-D test a potentially useful SRC diagnostic tool, though limitations exist in baseline testing and what constitutes an abnormal score. Additionally, the K-D tests should never be used in isolation to diagnose a concussion, but rather as one test in conjunction with additional clinical measures, as part of an individualized approach to each patient. The current review examines the clinical utility of the K-D test.
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Affiliation(s)
- Andrew D Legarreta
- Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Nishit Mummareddy
- Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Aaron M Yengo-Kahn
- Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, TN, USA.,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Scott L Zuckerman
- Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, TN, USA.,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
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Olczak M, Poniatowski ŁA, Niderla-Bielińska J, Kwiatkowska M, Chutorański D, Tarka S, Wierzba-Bobrowicz T. Concentration of microtubule associated protein tau (MAPT) in urine and saliva as a potential biomarker of traumatic brain injury in relationship with blood–brain barrier disruption in postmortem examination. Forensic Sci Int 2019; 301:28-36. [DOI: 10.1016/j.forsciint.2019.05.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 04/23/2019] [Accepted: 05/03/2019] [Indexed: 02/06/2023]
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Visual Deficits and Dysfunctions Associated with Traumatic Brain Injury: A Systematic Review and Meta-analysis. Optom Vis Sci 2019; 96:542-555. [DOI: 10.1097/opx.0000000000001407] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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Stuart S, Parrington L, Martini D, Popa B, Fino PC, King LA. Validation of a velocity-based algorithm to quantify saccades during walking and turning in mild traumatic brain injury and healthy controls. Physiol Meas 2019; 40:044006. [PMID: 30943463 PMCID: PMC7608620 DOI: 10.1088/1361-6579/ab159d] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Saccadic (fast) eye movements are a routine aspect of neurological examination and are a potential biomarker of mild traumatic brain injury (mTBI). Objective measurement of saccades has become a prominent focus of mTBI research, as eye movements may be a useful assessment tool for deficits in neural structures or processes. However, saccadic measurement within mobile infra-red (IR) eye-tracker raw data requires a valid algorithm. The objective of this study was to validate a velocity-based algorithm for saccade detection in IR eye-tracking raw data during walking (straight ahead and while turning) in people with mTBI and healthy controls. APPROACH Eye-tracking via a mobile IR Tobii Pro Glasses 2 eye-tracker (100 Hz) was performed in people with mTBI (n = 10) and healthy controls (n = 10). Participants completed two walking tasks: straight walking (walking back and forth for 1 min over a 10 m distance), and walking and turning (turns course included 45°, 90° and 135° turns). Five trials per subject, for one-hundred total trials, were completed. A previously reported velocity-based saccade detection algorithm was adapted and validated by assessing agreement between algorithm saccade detections and the number of correct saccade detections determined from manual video inspection (ground truth reference). MAIN RESULTS Compared with video inspection, the IR algorithm detected ~97% (n = 4888) and ~95% (n = 3699) of saccades made by people with mTBI and controls, respectively, with excellent agreement to the ground truth (intra-class correlation coefficient2,1 = .979 to .999). SIGNIFICANCE This study provides a simple yet highly robust algorithm for the processing of mobile eye-tracker raw data in mTBI and controls. Future studies may consider validating this algorithm with other IR eye-trackers and populations.
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Affiliation(s)
- Samuel Stuart
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States of America. Veterans Affairs Portland Health Care System, Portland, OR, United States of America. Author to whom any correspondence should be addressed
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Corti SJ, Pizzimenti NM, McCarthy MT, Essad KM, Kutcher JS. Comparing the Acute Presentation of Sport-Related Concussion in the Pediatric and Adult Populations. J Child Neurol 2019; 34:262-267. [PMID: 30669942 DOI: 10.1177/0883073818825031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Despite growing research on concussion, there is minimal evidence comparing the acute presentation of concussion between pediatric and adult patients. This cross-sectional study compares injury characteristics, symptoms, and neurologic examination in sport-related concussion based on age. Patients presenting to an outpatient sports neurology clinic for initial assessment of concussion within 7 days of injury were divided into 2 groups, 18 and older (n = 28) and 17 and younger (n = 107). There were no significant differences between pediatric and adult patients in any score of the Sport Concussion Assessment Tool-3rd Edition symptom scale, neurologic examination category, pertinent elements of past medical history, or characteristics of the concussion. The pediatric group had higher average hours of sleep (8.1 ± 0.3 vs 7.1 ± 0.58; P = .03) and were less likely to wake refreshed (36.3% vs 65%; P = .02). The initial presentation of concussion within 7 days of injury will likely not differ by age, specifically 18 and older versus 17 and younger.
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Affiliation(s)
| | | | | | - Kate M Essad
- 1 The Sports Neurology Clinic, Brighton, MI, USA
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37
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Snegireva N, Derman W, Patricios J, Welman KE. Eye tracking technology in sports-related concussion: a systematic review and meta-analysis. Physiol Meas 2018; 39:12TR01. [DOI: 10.1088/1361-6579/aaef44] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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38
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Landry AP, Ting WKC, Zador Z, Sadeghian A, Cusimano MD. Using artificial neural networks to identify patients with concussion and postconcussion syndrome based on antisaccades. J Neurosurg 2018; 131:1235-1242. [PMID: 30497186 DOI: 10.3171/2018.6.jns18607] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 06/27/2018] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Artificial neural networks (ANNs) have shown considerable promise as decision support tools in medicine, including neurosurgery. However, their use in concussion and postconcussion syndrome (PCS) has been limited. The authors explore the value of using an ANN to identify patients with concussion/PCS based on their antisaccade performance. METHODS Study participants were prospectively recruited from the emergency department and head injury clinic of a large teaching hospital in Toronto. Acquaintances of study participants were used as controls. Saccades were measured using an automated, portable, head-mounted device preprogrammed with an antisaccade task. Each participant underwent 100 trials of the task and 11 saccade parameters were recorded for each trial. ANN analysis was performed using the MATLAB Neural Network Toolbox, and individual saccade parameters were further explored with receiver operating characteristic (ROC) curves and a logistic regression analysis. RESULTS Control (n = 15), concussion (n = 32), and PCS (n = 25) groups were matched by age and level of education. The authors examined 11 saccade parameters and found that the prosaccade error rate (p = 0.04) and median antisaccade latency (p = 0.02) were significantly different between control and concussion/PCS groups. When used to distinguish concussion and PCS participants from controls, the neural networks achieved accuracies of 67% and 72%, respectively. This method was unable to distinguish study patients with concussion from those with PCS, suggesting persistence of eye movement abnormalities in patients with PCS. The authors' observations also suggest the potential for improved results with a larger training sample. CONCLUSIONS This study explored the utility of ANNs in the diagnosis of concussion/PCS based on antisaccades. With the use of an ANN, modest accuracy was achieved in a small cohort. In addition, the authors explored the pearls and pitfalls of this novel approach and identified important future directions for this research.
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Affiliation(s)
- Alexander P Landry
- 1Injury Prevention Research Office, St. Michael's Hospital
- 2Faculty of Medicine, University of Toronto
| | | | - Zsolt Zador
- 1Injury Prevention Research Office, St. Michael's Hospital
| | | | - Michael D Cusimano
- 1Injury Prevention Research Office, St. Michael's Hospital
- 2Faculty of Medicine, University of Toronto
- 4Division of Neurosurgery, Department of Surgery, St. Michael's Hospital; and
- 5Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Paniccia M, Taha T, Keightley M, Thomas S, Verweel L, Murphy J, Wilson K, Reed N. Autonomic Function Following Concussion in Youth Athletes: An Exploration of Heart Rate Variability Using 24-hour Recording Methodology. J Vis Exp 2018:58203. [PMID: 30295657 PMCID: PMC6235273 DOI: 10.3791/58203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Participation in organized sports makes a significant contribution to youth development, but places youth at a higher risk for sustaining a concussion. To date, return-to-activity decision-making has been anchored in the monitoring of self-reported concussion symptoms and neurocognitive testing. However, multi-modal assessments that corroborate objective physiological measures with traditional subjective symptom reporting are needed and can be valuable. Heart rate variability (HRV) is a non-invasive physiological indicator of the autonomic nervous system, capturing the reciprocal interplay between the sympathetic and parasympathetic nervous systems. There is a dearth of literature exploring the effect of concussion on HRV in youth athletes, and developmental differences preclude the application of adult findings to a pediatric population. Further, the current state of HRV methodology has primarily included short-term (5-15 min) recordings, by using resting state or short-term physical exertion testing to elucidate changes following concussion. The novelty in utilizing a 24 h recording methodology is that it has the potential to capture natural variation in autonomic function, directly related to the activities a youth athlete performs on a regular basis. Within a prospective, longitudinal research setting, this novel approach to quantifying autonomic function can provide important information regarding the recovery trajectory, alongside traditional self-report symptom measures. Our objectives regarding a 24 h recording methodology were to (1) evaluate the physiological effects of a concussion in youth athletes, and (2) describe the trajectory of physiological change, while considering the resolution of self-reported post-concussion symptoms. To achieve these objectives, non-invasive sensor technology was implemented. The raw beat-to-beat time intervals captured can be transformed to derive time domain and frequency domain measures, which reflect an individual's ability to adapt and be flexible to their ever-changing environment. By using non-invasive heart rate technology, autonomic function can be quantified outside of a traditional controlled research setting.
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Affiliation(s)
- Melissa Paniccia
- Concussion Centre, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital;
| | - Tim Taha
- Faculty of Kinesiology and Physical Education, University of Toronto
| | - Michelle Keightley
- Concussion Centre, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital; Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto
| | - Scott Thomas
- Faculty of Kinesiology and Physical Education, University of Toronto
| | - Lee Verweel
- Concussion Centre, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital
| | - James Murphy
- Concussion Centre, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital
| | - Katherine Wilson
- Concussion Centre, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital
| | - Nick Reed
- Concussion Centre, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital; Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto; Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto
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Mani R, Asper L, Khuu SK. Deficits in saccades and smooth-pursuit eye movements in adults with traumatic brain injury: a systematic review and meta-analysis. Brain Inj 2018; 32:1315-1336. [PMID: 29913089 DOI: 10.1080/02699052.2018.1483030] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
PURPOSE To conduct a review of literature and quantify the effect that traumatic brain injury (TBI) has on oculomotor functions (OM). METHODS A systematic review and meta-analysis was conducted from papers that objectively measured saccades and smooth-pursuit eye movements in mild and severe TBI. RESULTS The overall impact of TBI on OM functions was moderate and significant with an effect size of 0.42 from 181 OM case-control comparisons. The heterogeneity, determined using the random effect model, was found to be significant (Q (180) = 367, p < 0.0001, I2 = 51) owing to the variety of OM functions (reflexive saccades, antisaccades, memory-guided saccades, self-paced saccades and pursuits) measured and varying post-injury periods.The overall effect on OM functions were similar in mild and severe TBI despite differences in combined effect size of various OM functions. OM functions involving complex cognitive skills such as antisaccades (in mild and severe TBI) and memory-guided saccades (in mild TBI) were the most adversely affected, suggesting that OM deficits may be associated with cognitive deficits in TBI. CONCLUSION TBI often results in long-standing OM deficits. Experimental measures of OM assessment reflect neural integrity and may provide a sensitive and objective biomarker to detect OM deficits following TBI.
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Affiliation(s)
- Revathy Mani
- a School of Optometry and Vision Science , The University of New South Wales (UNSW) , Sydney , Australia
| | - Lisa Asper
- a School of Optometry and Vision Science , The University of New South Wales (UNSW) , Sydney , Australia
| | - Sieu K Khuu
- a School of Optometry and Vision Science , The University of New South Wales (UNSW) , Sydney , Australia
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Taghdiri F, Varriano B, Tartaglia MC. Assessment of Oculomotor Function in Patients With Postconcussion Syndrome: A Systematic Review. J Head Trauma Rehabil 2018; 32:E55-E67. [PMID: 28195951 DOI: 10.1097/htr.0000000000000286] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Concussion and its associated sequel, postconcussion syndrome (PCS), have a debilitating impact on the lives of concussed patients. However, a diagnostic biomarker for this condition is lacking. Recently, there has been a surge of interest in using oculomotor function testing as an objective assessment of patients with PCS. OBJECTIVES To systematically synthesize, appraise, and summarize all published empirical studies that have assessed alteration of oculomotor functions in patients with PCS. METHODS Medline, Embase, PsychINFO, and CINAHL databases searched up to July 2016 for studies that used oculomotor function assessment in patients with postconcussion symptoms. RESULTS The search identified 1637 citations, and finally 8 case-control studies were included. Of these, 5 studies used a similar task with a target moving in a circular trajectory. Three other studies measured conventional oculomotor tasks such as saccade, vergence, and smooth pursuit eye movements. CONCLUSIONS Currently, there is limited support for the recommendation of oculomotor function assessments for diagnosis and identification of patients with PCS following head trauma. Therefore, more rigorous studies assessing oculomotor function changes in patients with PCS are warranted.
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Affiliation(s)
- Foad Taghdiri
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Canada (Mr Taghdiri, Ms Varriano, and Dr Tartaglia); and Division of Neurology, University Health Network, Toronto Western Hospital, Canada (Dr Tartaglia)
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Simpson-Jones ME, Hunt AW. Vision rehabilitation interventions following mild traumatic brain injury: a scoping review. Disabil Rehabil 2018; 41:2206-2222. [DOI: 10.1080/09638288.2018.1460407] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Mary E. Simpson-Jones
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Canada
| | - Anne W. Hunt
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Canada
- Clinical Study Investigator Bloorview Research Institute, Toronto, Canada
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Fuller GW, Cross MJ, Stokes KA, Kemp SPT. King-Devick concussion test performs poorly as a screening tool in elite rugby union players: a prospective cohort study of two screening tests versus a clinical reference standard. Br J Sports Med 2018; 53:1526-1532. [DOI: 10.1136/bjsports-2017-098560] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2018] [Indexed: 12/19/2022]
Abstract
BackgroundThe King-Devick (KD) test is an objective clinical test of eye movements that has been used to screen for concussion. We characterised the accuracy of the KD test and the World Rugby Head Injury Assessment (HIA-1) screening tools as methods of off-field evaluation for concussion after a suspicious head impact event.MethodsA prospective cohort study was performed in elite English rugby union competitions between September 2016 and May 2017. The study population comprised consecutive players identified with a head impact event with the potential to result in concussion. The KD test was administered off-field, alongside the World Rugby HIA-1 screening tool, and the results were compared with the preseason baseline. Accuracy was measured against a reference standard of confirmed concussion, based on the clinical judgement of the team doctor after serial assessments.Results145 head injury events requiring off-field medical room screening assessments were included in the primary analysis. The KD test demonstrated a sensitivity of 60% (95% CI 49.0 to 70) and a specificity of 39% (95% CI 26 to 54) in identifying players subsequently diagnosed with concussion. Area under the receiver operating characteristic curve for prolonged KD test times was 0.51 (95% CI 0.41 to 0.61). The World Rugby HIA-1 off-field screening tool sensitivity did not differ significantly from the KD test (sensitivity 75%, 95% CI 66 to 83, P=0.08), but specificity was significantly higher (91%, 95% CI 82 to 97, P<0.001). Although combining the KD test and the World Rugby HIA-1 multimodal screening assessment achieved a significantly higher sensitivity of 93% (95% CI 86% to 97%), there was a significantly lower specificity of 33% (95% CI 21% to 48%), compared with the HIA-1 test alone.ConclusionsThe KD test demonstrated limited accuracy as a stand-alone remove-from-play sideline screening test for concussion. As expected with the addition of any parallel test, combination of the KD test with the HIA-1 off-field screening tool provided improved sensitivity in identifying concussion, but at the expense of markedly lower specificity. These results suggest that it is unlikely that the KD test will be incorporated into multimodal off-field screening assessments for concussion at the present time.
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Evans LP, Newell EA, Mahajan M, Tsang SH, Ferguson PJ, Mahoney J, Hue CD, Vogel EW, Morrison B, Arancio O, Nichols R, Bassuk AG, Mahajan VB. Acute vitreoretinal trauma and inflammation after traumatic brain injury in mice. Ann Clin Transl Neurol 2018; 5:240-251. [PMID: 29560370 PMCID: PMC5846452 DOI: 10.1002/acn3.523] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 11/30/2017] [Accepted: 12/01/2017] [Indexed: 12/16/2022] Open
Abstract
Objective Limited attention has been given to ocular injuries associated with traumatic brain injury (TBI). The retina is an extension of the central nervous system and evaluation of ocular damage may offer a less‐invasive approach to gauge TBI severity and response to treatment. We aim to characterize acute changes in the mouse eye after exposure to two different models of TBI to assess the utility of eye damage as a surrogate to brain injury. Methods A model of blast TBI (bTBI) using a shock tube was compared to a lateral fluid percussion injury model (LFPI) using fluid pressure applied directly to the brain. Whole eyes were collected from mice 3 days post LFPI and 24 days post bTBI and were evaluated histologically using a hematoxylin and eosin stain. Results bTBI mice showed evidence of vitreous detachment in the posterior chamber in addition to vitreous hemorrhage with inflammatory cells. Subretinal hemorrhage, photoreceptor degeneration, and decreased cellularity in the retinal ganglion cell layer was also seen in bTBI mice. In contrast, eyes of LFPI mice showed evidence of anterior uveitis and subcapsular cataracts. Interpretation We demonstrated that variations in the type of TBI can result in drastically different phenotypic changes within the eye. As such, molecular and phenotypic changes in the eye following TBI may provide valuable information regarding the mechanism, severity, and ongoing pathophysiology of brain injury. Because vitreous samples are easily obtained, molecular changes within the eye could be utilized as biomarkers of TBI in human patients.
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Affiliation(s)
- Lucy P Evans
- Medical Scientist Training Program University of Iowa Iowa City Iowa.,Department of Pediatrics University of Iowa Iowa City Iowa
| | | | - MaryAnn Mahajan
- Omics Laboratory Department of Ophthalmology Stanford University Palo Alto California
| | - Stephen H Tsang
- Bernard and Shirlee Brown Glaucoma Laboratory and Barbara Donald Jonas Laboratory of Regenerative Medicine Columbia University New York New York.,Edward S. Harkness Eye Institute Columbia University New York New York.,Departments of Ophthalmology, Pathology & Cell Biology Institute of Human Nutrition Columbia University New York New York
| | | | | | - Christopher D Hue
- Department of Biomedical Engineering Columbia University New York New York
| | - Edward W Vogel
- Department of Biomedical Engineering Columbia University New York New York
| | - Barclay Morrison
- Department of Biomedical Engineering Columbia University New York New York
| | - Ottavio Arancio
- Department of Pathology & Cell Biology Taub Institute Columbia University New York New York
| | - Russell Nichols
- Department of Pathology & Cell Biology Taub Institute Columbia University New York New York
| | | | - Vinit B Mahajan
- Omics Laboratory Department of Ophthalmology Stanford University Palo Alto California.,Palo Alto Veterans Administration Palo Alto California
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Matuseviciene G, Johansson J, Möller M, Godbolt AK, Pansell T, Deboussard CN. Longitudinal changes in oculomotor function in young adults with mild traumatic brain injury in Sweden: an exploratory prospective observational study. BMJ Open 2018; 8:e018734. [PMID: 29431132 PMCID: PMC5829871 DOI: 10.1136/bmjopen-2017-018734] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To assess (1) whether visual disturbances can be demonstrated with objective measures more often in patients with mild traumatic brain injury (mTBI) than in orthopaedic controls and non-injured controls, (2) whether such objectively demonstrated disturbances change over time and (3) whether self-reported visual symptoms after mTBI correlate with objectively measurable changes in visuomotor performance. DESIGN A prospective, controlled, observational study, with assessments planned 7-10 and 75-100 days after injury. SETTING Emergency department of a general hospital in Sweden. PARTICIPANTS 15 patients with mTBI, 15 patients with minor orthopaedic injury, 15 non-injured controls, aged 18-40 years. OUTCOME MEASURES Visual examination, including assessment of visual acuity, accommodation, eye alignment, saccades and stereoacuity. Symptom assessment using Convergence Insufficiency Symptoms Survey (CISS) and Rivermead PostConcussion Symptoms Questionnaire. RESULTS Assessments were performed 4-13 and 81-322 days after injury (extended time frames for logistical reasons). No statistically significant difference was found between the mTBI and control groups regarding saccade performance and stereoacuity at any time point. The accommodative amplitude was significantly lower in the mTBI group compared with non-injured controls at baseline. 6 out of 13 patients with mTBI had accommodative insufficiency at follow-up. Near point of convergence in the mTBI group was receded at baseline and improved statistically significantly at follow-up. At baseline, patients with mTBI had significantly higher CISS score than orthopaedic and non-injured controls. For patients with mTBI, the CISS score correlated with fusional vergence. CONCLUSION There were some transient measurable visual changes regarding convergence in patients with mTBI during the subacute period after the injury. Our findings of persistence of accommodative insufficiency in a considerable proportion of patients with mTBI suggest that this visual function should not be overlooked in clinical assessment.
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Affiliation(s)
- Giedre Matuseviciene
- Division of Rehabilitation Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Jan Johansson
- Department of Clinical Neuroscience, Eye and Vision, Karolinska Institutet, Stockholm, Sweden
| | - Marika Möller
- Division of Rehabilitation Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Alison K. Godbolt
- Division of Rehabilitation Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Tony Pansell
- Department of Clinical Neuroscience, Eye and Vision, Karolinska Institutet, Stockholm, Sweden
| | - Catharina Nygren Deboussard
- Division of Rehabilitation Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
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Patricios J, Fuller GW, Ellenbogen R, Herring S, Kutcher JS, Loosemore M, Makdissi M, McCrea M, Putukian M, Schneider KJ. What are the critical elements of sideline screening that can be used to establish the diagnosis of concussion? A systematic review. Br J Sports Med 2017; 51:888-894. [PMID: 28270437 DOI: 10.1136/bjsports-2016-097441] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND Sideline detection is the first and most significant step in recognising a potential concussion and removing an athlete from harm. This systematic review aims to evaluate the critical elements aiding sideline recognition of potential concussions including screening tools, technologies and integrated assessment protocols. DATA SOURCES Bibliographic databases, grey literature repositories and relevant websites were searched from 1 January 2000 to 30 September 2016. A total of 3562 articles were identified. STUDY SELECTION Original research studies evaluating a sideline tool, technology or protocol for sports-related concussion were eligible, of which 27 studies were included. DATA EXTRACTION A standardised form was used to record information. The QUADAS-2 and Newcastle-Ottawa tools were used to rate risk of bias. Strength of evidence was assessed using the Grades of Recommendation, Assessment, Development and Evaluation Working Group system. DATA SYNTHESIS Studies assessing symptoms, the King-Devick test and multimodal assessments reported high sensitivity and specificity. Evaluations of balance and cognitive tests described lower sensitivity but higher specificity. However, these studies were at high risk of bias and the overall strength of evidence examining sideline screening tools was very low. A strong body of evidence demonstrated that head impact sensors did not provide useful sideline concussion information. Low-strength evidence suggested a multimodal, multitime-based concussion evaluation process incorporating video review was important in the recognition of significant head impact events and delayed onset concussion. CONCLUSION In the absence of definitive evidence confirming the diagnostic accuracy of sideline screening tests, consensus-derived multimodal assessment tools, such as the Sports Concussion Assessment Tool, are recommended. Sideline video review may improve recognition and removal from play of athletes who have sustained significant head impact events. Current evidence does not support the use of impact sensor systems for real-time concussion identification.
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Affiliation(s)
- Jon Patricios
- Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.,Department of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Gordon Ward Fuller
- Centre for Urgent and Emergency Care Research, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Richard Ellenbogen
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Stanley Herring
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA.,Departments of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA.,Orthopedics and Sports Medicine, University of Washington, Seattle, Washington, USA
| | - Jeffrey S Kutcher
- The Sports Neurology Clinic at the CORE Institute, Brighton, Michigan, USA
| | - Mike Loosemore
- Institute of Sport Exercise and Health, University College London, London, UK
| | - Michael Makdissi
- Florey Institute of Neuroscience and Mental Health, Austin Campus, Melbourne Brain Centre, Heidelberg, Victoria, Australia.,Olympic Park Sports Medicine Centre, Melbourne, Victoria, Australia
| | - Michael McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Margot Putukian
- Director of Athletic Medicine, Princeton University, Princeton, New Jersey, USA
| | - Kathryn J Schneider
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Alberta, Canada
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Sussman ES, Ho AL, Pendharkar AV, Ghajar J. Clinical evaluation of concussion: the evolving role of oculomotor assessments. Neurosurg Focus 2017; 40:E7. [PMID: 27032924 DOI: 10.3171/2016.1.focus15610] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Sports-related concussion is a change in brain function following a direct or an indirect force to the head, identified in awake individuals and accounting for a considerable proportion of mild traumatic brain injury. Although the neurological signs and symptoms of concussion can be subtle and transient, there can be persistent sequelae, such as impaired attention and balance, that make affected patients particularly vulnerable to further injury. Currently, there is no accepted definition or diagnostic criteria for concussion, and there is no single assessment that is accepted as capable of identifying all patients with concussion. In this paper, the authors review the available screening tools for concussion, with particular emphasis on the role of visual function testing. In particular, they discuss the oculomotor assessment tools that are being investigated in the setting of concussion screening.
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Affiliation(s)
- Eric S Sussman
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | - Allen L Ho
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | - Arjun V Pendharkar
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | - Jamshid Ghajar
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
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49
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Devick S. Comment on article: King-Devick test reference values and associations with balance measures in high school American football players. Scand J Med Sci Sports 2016; 26:593-4. [PMID: 27122448 DOI: 10.1111/sms.12691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2016] [Indexed: 12/01/2022]
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50
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Carrick FR, Oggero E, Pagnacco G, Wright CHG, Machado C, Estrada G, Pando A, Cossio JC, Beltrán C. Eye-Movement Training Results in Changes in qEEG and NIH Stroke Scale in Subjects Suffering from Acute Middle Cerebral Artery Ischemic Stroke: A Randomized Control Trial. Front Neurol 2016; 7:3. [PMID: 26834698 PMCID: PMC4722822 DOI: 10.3389/fneur.2016.00003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 01/08/2016] [Indexed: 11/25/2022] Open
Abstract
Context Eye-movement training (EMT) can induce altered brain activation and change the functionality of saccades with changes of the brain in general. Objective To determine if EMT would result in changes in quantitative electroencephalogram (qEEG) and NIH Stroke Scale (NIHSS) in patients suffering from acute middle cerebral artery (MCA) infarction. Our hypothesis is that there would be positive changes in qEEG and NIHSS after EMT in patients suffering from acute MCA ischemic stroke. Design Double-blind randomized controlled trial. Setting and participants Thirty-four subjects with acute MCA ischemic stroke treated at university affiliated hospital intensive care unit. Interventions Subjects were randomized into a “control” group treated only with aspirin (125 mg/day) and a “treatment” group treated with aspirin (125 mg/day) and a subject-specific EMT. Main outcome measures Delta–alpha ratio, power ratio index, and the brain symmetry index calculated by qEEG and NIHSS. Results There was strong statistical and substantive significant improvement in all outcome measures for the group of stroke patients undergoing EMT. Such improvement was not observed for the “control” group, and there were no adverse effects. Conclusion The addition of EMT to a MCA ischemic stroke treatment paradigm has demonstrated statistically significant changes in outcome measures and is a low cost, safe, and effective complement to standard treatment.
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Affiliation(s)
- Frederick Robert Carrick
- Neurology, Carrick Institute, Cape Canaveral, FL, USA; Global Clinical Scholars Research Training Program (GCSRT), Harvard Medical School, Boston, MA, USA; Institute of Neurology and Neurosurgery, Havana, Cuba; Bedfordshire Centre for Mental Health Research, University of Cambridge, Cambridge, UK
| | - Elena Oggero
- Neurology, Carrick Institute, Cape Canaveral, FL, USA; Electrical and Computer Engineering, University of Wyoming, Laramie, WY, USA
| | - Guido Pagnacco
- Neurology, Carrick Institute, Cape Canaveral, FL, USA; Electrical and Computer Engineering, University of Wyoming, Laramie, WY, USA
| | - Cameron H G Wright
- Neurology, Carrick Institute, Cape Canaveral, FL, USA; Electrical and Computer Engineering, University of Wyoming, Laramie, WY, USA
| | - Calixto Machado
- Neurology, Carrick Institute, Cape Canaveral, FL, USA; Institute of Neurology and Neurosurgery, Havana, Cuba
| | - Genco Estrada
- Institute of Neurology and Neurosurgery , Havana , Cuba
| | | | - Juan C Cossio
- Institute of Neurology and Neurosurgery , Havana , Cuba
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