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Ong J, Carrabba NV, Waisberg E, Zaman N, Memon H, Panzo N, Lee VA, Sarker P, Vogt AZ, Laylani N, Tavakkoli A, Lee AG. Dynamic Visual Acuity, Vestibulo-Ocular Reflex, and Visual Field in National Football League (NFL) Officiating: Physiology and Visualization Engineering for 3D Virtual On-Field Training. Vision (Basel) 2024; 8:35. [PMID: 38804356 PMCID: PMC11130928 DOI: 10.3390/vision8020035] [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: 03/28/2024] [Revised: 05/10/2024] [Accepted: 05/16/2024] [Indexed: 05/29/2024] Open
Abstract
The ability to make on-field, split-second decisions is critical for National Football League (NFL) game officials. Multiple principles in visual function are critical for accuracy and precision of these play calls, including foveation time and unobstructed line of sight, static visual acuity, dynamic visual acuity, vestibulo-ocular reflex, and sufficient visual field. Prior research has shown that a standardized curriculum in these neuro-ophthalmic principles have demonstrated validity and self-rated improvements in understanding, confidence, and likelihood of future utilization by NFL game officials to maximize visual performance during officiating. Virtual reality technology may also be able to help optimize understandings of specific neuro-ophthalmic principles and simulate real-life gameplay. Personal communication between authors and NFL officials and leadership have indicated that there is high interest in 3D virtual on-field training for NFL officiating. In this manuscript, we review the current and past research in this space regarding a neuro-ophthalmic curriculum for NFL officials. We then provide an overview our current visualization engineering process in taking real-life NFL gameplay 2D data and creating 3D environments for virtual reality gameplay training for football officials to practice plays that highlight neuro-ophthalmic principles. We then review in-depth the physiology behind these principles and discuss strategies to implement these principles into virtual reality for football officiating.
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Affiliation(s)
- Joshua Ong
- Department of Ophthalmology and Visual Sciences, University of Michigan Kellogg Eye Center, Ann Arbor, MI 48105, USA
| | | | - Ethan Waisberg
- Department of Ophthalmology, University of Cambridge, Cambridge CB2 1TN, UK
- Moorfields Eye Hospital, NHS Foundation Trust, London EC1V 2PD, UK
| | - Nasif Zaman
- Human-Machine Perception Laboratory, Department of Computer Science and Engineering, University of Nevada, Reno, NV 89557, USA
| | - Hamza Memon
- Texas A&M School of Medicine, Bryan, TX 77807, USA
| | | | - Virginia A Lee
- Department of Biology, University of Virginia, Charlottesville, VA 22903, USA
| | - Prithul Sarker
- Human-Machine Perception Laboratory, Department of Computer Science and Engineering, University of Nevada, Reno, NV 89557, USA
| | - Ashtyn Z Vogt
- Dean McGee Eye Institute, University of Oklahoma College of Medicine, Oklahoma City, OK 73104, USA
| | - Noor Laylani
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Alireza Tavakkoli
- Human-Machine Perception Laboratory, Department of Computer Science and Engineering, University of Nevada, Reno, NV 89557, USA
| | - Andrew G Lee
- Texas A&M School of Medicine, Bryan, TX 77807, USA
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX 77030, USA
- The Houston Methodist Research Institute, Houston Methodist Hospital, Houston, TX 77030, USA
- Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medicine, New York, NY 10065, USA
- Department of Ophthalmology, University of Texas Medical Branch, Galveston, TX 77555, USA
- University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
- Center for Space Medicine, Baylor College of Medicine, Houston, TX 77030, USA
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Kontos AP, Zynda AJ, Minerbi A. Comparison of Vestibular/Ocular Motor Screening (VOMS) and Computerized Eye-tracking to Identify Exposure to Repetitive Head Impacts. Mil Med 2024:usae065. [PMID: 38531077 DOI: 10.1093/milmed/usae065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/06/2024] [Accepted: 02/15/2024] [Indexed: 03/28/2024] Open
Abstract
INTRODUCTION Military service members (SMs) are exposed to repetitive head impacts (RHIs) in combat and training that are purported to adversely affect brain health, including cognition, behavior, and function. Researchers have reported that RHI from blast-related exposure may affect both vestibular and ocular function, which in turn may be related to symptomology. As such, an examination of the effects of RHI on exposed military SMs should incorporate these domains. To date, researchers have not compared groups of exposed special operations forces (SOF) operators on combined clinical vestibular/ocular and eye-tracker-based outcomes. Therefore, the primary purpose of this study was to compare participant-reported symptoms and performance on the Vestibular/Ocular Motor Screening (VOMS) tool with performance on the computerized RightEye tracking system between SOF operators exposed to blast-related RHI and healthy controls without blast-related exposure. In addition, the study aimed to compare subgroups of snipers and breachers exposed to RHI to controls on the preceding metrics, as well as identify a subset of individual (demographic) factors, participant-reported symptoms, and performance metrics on VOMS and RightEye that best identify SOF operators exposed to RHI from unexposed controls. MATERIALS AND METHODS The study involved a cross-sectional design including 25 Canadian SOF SMs comprised of breachers (n = 9), snipers (n = 9), and healthy, unexposed controls (n = 7). The former 2 groups were combined into an RHI group (n = 18) and compared to controls (n = 7). Participants provided demographics and completed a self-reported concussion-related symptom report via the Military Acute Concussion Evaluation 2, the VOMS, and RightEye computerized eye-tracking assessments. Independent samples t-tests and ANOVAs were used to compare the groups on the outcomes, with receiver operating characteristic curve and area under the curve (AUC) analyses to identify predictors of blast exposure. This study was approved by the Defence Research Development Canada Human Research Ethics Committee and the Canadian Forces Surgeon General/Special Forces Command. RESULTS The results from t-tests supported group differences for age (P = .012), participant-reported symptoms (P = .006), and all VOMS items (P range = <.001-.02), with the RHI group being higher than healthy controls on all variables. ANOVA results supported group differences among snipers, breachers, and controls for age (P = .01), RightEye saccades (P = .04), participant-reported total symptom severity (P = .03), and VOMS total scores (P = .003). The results of the receiver operating characteristic curve analyses supported age (AUC = 0.81), Military Acute Concussion Evaluation 2 participant-reported total symptom severity (AUC = 0.87), and VOMS total scores (AUC = 0.92) as significant predictors of prior blast exposure. CONCLUSIONS Participant-reported concussion symptoms, VOMS scores, and age were useful in identifying SOF operators exposed to RHI from controls. RightEye metrics were not useful in differentiating RHI groups from controls. Differences between snipers and breachers warrant further research. Overall, the findings suggest that VOMS may be a useful tool for screening for the effects of exposure to RHI in SOF operators. Future investigations should be conducted on a larger sample of military SMs, consider additional factors (e.g., RHI exposure levels, medical history, and sex), and include additional assessment domains (e.g., balance, cognitive, and psychological).
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Affiliation(s)
- Anthony P Kontos
- University of Pittsburgh, Department of Orthopaedic Surgery, Concussion Research Laboratory, Pittsburgh, PA 15203, USA
| | - Aaron J Zynda
- University of Pittsburgh, Department of Orthopaedic Surgery, Concussion Research Laboratory, Pittsburgh, PA 15203, USA
| | - Amir Minerbi
- Institute for Pain Medicine, Rambam Health Campus, Haifa 3200003, Israel
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Kirazli G, Emekci T, Inceoglu F, Pistav Akmese P, Celebisoy N. An evaluation of the test-retest reliability of the functional head impulse test in healthy young adults. Eur Arch Otorhinolaryngol 2023; 280:5339-5343. [PMID: 37341762 DOI: 10.1007/s00405-023-08063-0] [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: 03/23/2023] [Accepted: 06/09/2023] [Indexed: 06/22/2023]
Abstract
AIM To determine the test and retest reliability of the functional head impulse test (fHIT) in healthy young adults. MATERIALS AND METHODS Thirty-three healthy participants (17 women, 16 men) aged 18-30 years were included in the study. Each participant underwent the fHIT twice, 1 week apart, by the same experienced clinician. Intraclass correlation coefficients (ICCs) were used to determine test-retest reliability. RESULTS There was no statistically significant difference between the results of total percentage of correct answer (CA%) of the fHIT obtained in session 1 and session 2 measurements in the lateral, anterior, and posterior semicircular canals (SCCs) (p > 0.05). ICC values for test-retest reliability were found to range from 0.619 to 0.665 for the three semicircular canals (SCCs). CONCLUSION The test-retest reliability of the fHIT device was moderate. Attention, cognition, and fatigue may be the factors reducing reliability. In the diagnosis, follow-up, and rehabilitation processes of vestibular diseases in clinics, changes in the fHIT CA% can be used to assess vestibulo-ocular reflex (VOR) functionality.
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Affiliation(s)
- Gulce Kirazli
- Department of Audiology, Faculty of Health Sciences, Ege University, Izmir, Turkey
| | - Tugba Emekci
- Department of Audiology, Faculty of Health Sciences, Gülhane University of Health Sciences, Ankara, Turkey
| | - Feyza Inceoglu
- Department of Biostatistics, Faculty of Medicine, Malatya Turgut Ozal University, Malatya, Turkey
| | - Pelin Pistav Akmese
- Department of Audiology, Faculty of Health Sciences, Ege University, Izmir, Turkey.
| | - Nese Celebisoy
- Department of Neurology, Faculty of Medicine, Ege University, Izmir, Turkey
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Crampton A, Schneider KJ, Grilli L, Chevignard M, Katz-Leurer M, Beauchamp MH, Debert C, Gagnon IJ. Determining the Agreement Between Common Measures Related to Vestibulo-ocular Reflex Function After a Mild Traumatic Brain Injury in Children and Adolescents. Arch Rehabil Res Clin Transl 2022; 4:100217. [PMID: 36123987 PMCID: PMC9482028 DOI: 10.1016/j.arrct.2022.100217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A battery of complementary tests is needed to assess vestibulo-ocular reflex (VOR) in pediatric mild traumatic brain injury (mTBI). This battery should include both symptom- and performance-based measures. Best practice recommendation is needed for such a battery in clinical settings. Cervical injury presence may influence symptoms induced during VOR testing. There is value of assessing for cervical injury post pediatric mTBI.
Objective To (1) determine the level of agreement between symptom provocation and performance-based tests of vestibulo-ocular reflex (VOR) function after pediatric mild traumatic brain injury (mTBI) and (2) describe the level of symptom provocation induced by a VOR task in individuals with and without cervical findings. Design Cross-sectional. Setting This study was conducted at a tertiary care pediatric hospital. Participants A total of 101 participants (N=101) aged 6-18 years within 3 weeks of mTBI diagnosis were included (54.5% female; mean age, 13.92±2.63 years; mean time since injury at assessment, 18.26±6.16 days). Interventions None. Main Outcome Measures Symptom provocation (Vestibular/Ocular Motor Screening tool), performance (clinician-observed VOR performance, head thrust test [HTT], computerized dynamic visual acuity test, video head impulse test), and cervical impairment (cervical flexion-rotation test, range of motion test, self-reported neck pain). Agreement was evaluated using Cohen's κ statistic. Results No outcomes demonstrated agreement with symptom provocation (κ=−0.15 to 0.14). Fair agreement demonstrated between clinician-observed VOR performance and HTT (κ=0.32), with little to no agreement demonstrated between other measures. Proportions reporting test-induced dizziness and headache were greater among individuals with cervical findings (29.1%-41.8%) than without (2.3%-6.8%). Conclusions Findings support that symptom provocation and performance-based tests measure different constructs and thus have distinct roles when assessing VOR function. Findings suggest results from measures of symptom provocation may be influenced by coexisting cervical impairments, underlining the value of assessing for cervical injury after pediatric mTBI.
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Crampton A, Schneider KJ, Grilli L, Chevignard M, Katz-Leurer M, Beauchamp MH, Debert C, Gagnon IJ. Characterizing the evolution of oculomotor and vestibulo-ocular function over time in children and adolescents after a mild traumatic brain injury. Front Neurol 2022; 13:904593. [PMID: 35928133 PMCID: PMC9344998 DOI: 10.3389/fneur.2022.904593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 06/28/2022] [Indexed: 11/30/2022] Open
Abstract
Background Impairments to oculomotor (OM) and vestibulo-ocular reflex (VOR) function following pediatric mTBI have been demonstrated but are poorly understood. Such impairments can be associated with more negative prognosis, affecting physical and mental wellbeing, emphasizing the need to more fully understand how these evolve. Objectives to determine i) the extent to which performance on clinical and computerized tests of OM and VOR function varies over time in children and adolescents at 21 days, 3-, and 6-months post-mTBI; ii) the proportion of children and adolescents with mTBI presenting with abnormal scores on these tests at each timepoint. Design Prospective longitudinal design. Setting Tertiary care pediatric hospital. Participants 36 participants with mTBI aged 6 to18. Procedures Participants were assessed on a battery of OM and VOR tests within 21 days, at 3- and 6-months post injury. Outcome measures Clinical measures: Vestibular/ocular motor screening tool (VOMS) (symptom provocation and performance); Computerized measures: reflexive saccade test (response latency), video head impulse test (VOR gain), and dynamic visual acuity test (LogMAR change). Analysis Generalized estimating equations (parameter estimates and odd ratios) estimated the effect of time. Proportions above and below normal cut-off values were determined. Results Our sample consisted of 52.8% females [mean age 13.98 (2.4) years, assessed on average 19.07 (8–33) days post-injury]. Older children performed better on visual motion sensitivity (OR 1.43, p = 0.03) and female participants worse on near point of convergence (OR 0.19, p = 0.03). Change over time (toward recovery) was demonstrated by VOMS overall symptom provocation (OR 9.90, p = 0.012), vertical smooth pursuit (OR 4.04, p = 0.03), voluntary saccade performance (OR 6.06, p = 0.005) and right VOR gain (0.068, p = 0.013). Version performance and VOR symptom provocation showed high abnormal proportions at initial assessment. Discussion Results indicate impairments to the VOR pathway may be present and driving symptom provocation. Vertical smooth pursuit and saccade findings underline the need to include these tasks in test batteries to comprehensively assess the integrity of OM and vestibular systems post-mTBI. Implications Findings demonstrate 1) added value in including symptom and performance-based measures in when OM and VOR assessments; 2) the relative stability of constructs measured beyond 3 months post mTBI.
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Affiliation(s)
- Adrienne Crampton
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
- *Correspondence: Adrienne Crampton
| | - Kathryn J. Schneider
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Lisa Grilli
- Montreal Children's Hospital-McGill University Health Centre, Montreal, QC, Canada
| | - Mathilde Chevignard
- Laboratoire d'Imagerie Biomédicale, LIB, CNRS, INSERM, Sorbonne Université, Paris, France
- GRC 24 Handicap Moteur et Cognitif et Réadaptation, Sorbonne Université, Paris, France
- Rehabilitation Department for Children With Acquired Neurological Injury and Outreach Team for Children and Adolescents With Acquired Brain Injury, Saint Maurice Hospitals, Saint Maurice, France
| | | | - Miriam H. Beauchamp
- Ste-Justine Hospital Research Centre, Montreal, QC, Canada
- Department of Psychology, University of Montreal, Montreal, QC, Canada
| | - Chantel Debert
- Department of Clinical Neuroscience, University of Calgary, Calgary, AB, Canada
| | - Isabelle J. Gagnon
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
- Montreal Children's Hospital-McGill University Health Centre, Montreal, QC, Canada
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A Comparison of Generalized and Individualized Vestibular Rehabilitation Therapy in a Military TBI Sample. J Head Trauma Rehabil 2022; 37:380-389. [PMID: 35452022 DOI: 10.1097/htr.0000000000000777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare clinical outcomes between active duty service members receiving generalized versus individualized vestibular rehabilitation treatment (GVRT and IVRT, respectively) for persistent vestibular-related symptoms following mild traumatic brain injury (mTBI). SETTING An outpatient TBI rehabilitation clinic. PARTICIPANTS Fifty-seven participants with persistent vestibular-related symptoms following mTBI were randomly assigned to the GVRT (n = 28) or IVRT (n = 29) group, stratified by dizziness-related impairment severity. Forty-two participants (n = 21 per group) completed the posttreatment evaluation and were included in analyses. DESIGN We employed a single-site, randomized, pre-/posttest experimental design. The GVRT program consisted of eight 45-minute group-based treatment sessions and IVRT consisted of three 30-minute one-on-one treatment sessions both to be completed within 8 weeks. Group assignment was not blinded to study personnel or participants. Research evaluations were completed approximately 2 weeks prior to treatment initiation and following treatment completion. MAIN MEASURES Outcome measures included Dizziness Handicap Inventory (DHI) and Activities-specific Balance Confidence Scale (ABC) total scores, Sensory Organization Test (SOT) composite equilibrium and sensory input ratio scores, Head Shake SOT (HS-SOT) conditions 2 and 5, and horizontal and vertical Dynamic Visual Acuity. Separate mixed-effects models were used to compare clinical outcomes between the GVRT and IVRT groups. RESULTS Both groups demonstrated significant improvement from pre- to posttreatment on self-reported dizziness-related impairment (DHI [F(1,41) = 16.28, P < .001]) and balance performance with and without head movement (composite equilibrium score [F(1,41) = 16.58, P < .001, effect size [ES] = 0.43], somatosensory [F(1,41) = 6.79, P = .013, ES = 0.26], visual [F(1,41) = 6.49, P = .015, ES = 0.29], vestibular [F(1,41) = 22.31, P < .001, ES = 0.55], and HS-SOT condition 5 [F(1,38) = 23.98, P < .001, ES = 0.64]). Treatment effects did not differ between groups on any of the outcome measures. CONCLUSIONS We provide preliminary evidence that differences in clinical outcomes do not exist between participants receiving generalized versus individualized VR. Further research is needed to determine comparative effectiveness between these 2 treatment approaches for persistent vestibular-related symptoms following mTBI.
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Crampton A, Garat A, Shepherd HA, Chevignard M, Schneider KJ, Katz-Leurer M, Gagnon IJ. Evaluating the Vestibulo-Ocular Reflex Following Traumatic Brain Injury: A Scoping Review. Brain Inj 2021; 35:1496-1509. [PMID: 34495773 DOI: 10.1080/02699052.2021.1972450] [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: 10/20/2022]
Abstract
Purpose:To identify the tests and tools used to evaluate vestibulo-ocular reflex (VOR) function after traumatic brain injury (TBI) in all age groups and across TBI severity.Methods: An electronic search was conducted to include relevant peer-reviewed literature published up to November 2019. Studies included those done with humans, of all ages, and had assessments of oculomotor and/or vestibulo-ocular function in TBI.Results: Of the articles selected (N = 48), 50% were published in 2018/2019. A majority targeted mild TBI, with equal focus on non-computerized versus computerized measures of VOR. Computerized assessment tools used were videonystagmography, dynamic visual acuity/gaze stability, rotary chair, and caloric irrigation. Non-computerized tests included the head thrust, dynamic visual acuity, gaze stability, head shaking nystagmus, rotary chair tests and the vestibular/oculomotor screening tool. High variability in administration protocols were identified. Namely: testing environment, distances/positioning/equipment used, active/passive state, procedures, rotation frequencies, and variables observed.Conclusions: There is a rapid growth of literature incorporating VOR tests in mild TBI but moderate and severe TBI continues to be under-represented. Determining how to pair a clinical test with a computerized tool and developing standardized protocols when administering tests will help in developing an optimal battery assessing the VOR in TBI.
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Affiliation(s)
- Adrienne Crampton
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - A Garat
- Sorbonne Université, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale, Paris, France.,Sorbonne Université, GRC 24 Handicap Moteur et Cognitif et Réadaptation, Paris, France
| | - H A Shepherd
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Alberta, Canada
| | - M Chevignard
- Sorbonne Université, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale, Paris, France.,Sorbonne Université, GRC 24 Handicap Moteur et Cognitif et Réadaptation, Paris, France.,Rehabilitation Department for Children with Acquired Neurological Injury and Outreach Team for Children and Adolescents with Acquired Brain Injury, Saint Maurice Hospitals, Saint Maurice, France
| | - K J Schneider
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Alberta, Canada
| | - M Katz-Leurer
- Physical Therapy Department, University of Tel-Aviv, Tel-Aviv, Israel
| | - I J Gagnon
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada.,Montreal Children's Hospital-McGill University Health Centre, Montreal, Canada
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Emekci T, Erbek HS. The relationship between functional head impulse test and age in healthy individuals. J Vestib Res 2021; 32:123-134. [PMID: 34120922 DOI: 10.3233/ves-210040] [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: 11/15/2022]
Abstract
BACKGROUND fHIT is an easily applicable test battery that indirectly evaluates the vestibulo-ocular reflex (VOR) from a functional perspective. AIMS/OBJECTIVES The aim of this study was to Individuals determine the correlation between age and the percentage of correct answers (% CA) obtained in the functional head impulse test (fHIT) in healthy individuals. MATERIAL AND METHODS A total of 105 volunteers, 50 males and 55 females, between the ages of 18 and 70 years, participated in the study. A Beon Solution fHIT system (Zero Branco (TV), Italy) was used in the study. RESULTS In our study, a decrease in the mean % CA was observed in all semicircular canals (SCCs) with increasing age. Between age and mean % CA, a significant negative moderate (-0.311) correlation was observed in lateral SCCs, and a significant negative low (-0.257) correlation was observed in posterior SCCs (p < 0.05). In anterior SCCs, there was no statistically significant relationship between age and mean % CA (p > 0.05). CONCLUSIONS The present study performed in a healthy population will be helpful in terms of making comparisons in studies to be conducted in various vestibular diseases. It will also be a guide for identifying pathological consequences in vestibular diseases.
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Affiliation(s)
- Tuğba Emekci
- Necmettin Erbakan University, Faculty of Medicine ENT Clinic, Konya, Turkey
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Rogers C. Perspectives: Evaluation of Older Adult Cochlear Implant Candidates for Fall Risk in a Developing Country Setting. Front Neurol 2021; 12:678773. [PMID: 34122319 PMCID: PMC8187949 DOI: 10.3389/fneur.2021.678773] [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: 03/10/2021] [Accepted: 04/14/2021] [Indexed: 11/13/2022] Open
Abstract
Dizziness, vertigo, and falls are common in older adults. Data suggest that cochlear implant candidates are no different and could be argued to be at elevated risk due to the presence of hearing loss and likely vestibular involvement. Perspectives contextualizes current testing and screening paradigms for vestibular deficits and fall risk and suggests a protocol suitable for use in developing country settings.
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Affiliation(s)
- Christine Rogers
- Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Linder SM, Koop MM, Tucker D, Guzi K, Gray DC, Alberts JL. Development and Validation of a Mobile Application to Detect Visual Dysfunction Following Mild Traumatic Brain Injury. Mil Med 2021; 186:584-591. [PMID: 33499531 DOI: 10.1093/milmed/usaa360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/11/2020] [Accepted: 09/22/2020] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Following mild traumatic brain injury, visual dysfunction is a common occurrence, yet the condition often goes undiagnosed. A mobile application was developed to measure aspects of visual acuity and oculomotor function. The aim of this project was to validate the newly developed suite of outcomes conducive for use in the field to detect visual dysfunction. MATERIALS AND METHODS A custom mobile application was developed on an Apple iPad using iOS operating system software version 11.0 in Objective C to measure near point of convergence (NPC), distance visual acuity, reading fluency, and self-rated convergence insufficiency (CI). To determine construct validity, 50 healthy young adults were administered NPC and distance visual acuity assessments using the iPad and standard clinical approaches. A ruler measurement was obtained simultaneous to the iPad NPC measurement to determine measurement accuracy. All testing was administered by a licensed optometrist and the order of testing (iPad versus clinical) was randomized. RESULTS The correlation coefficient between the iPad and clinical measurements of NPC was 0.893, while iPad and ruler measurement was 0.947. Modest accordance was found between iPad and wall chart measures assessing distance visual acuity. A ceiling effect was evident with use of a wall chart to determine distance visual acuity. Healthy young adults scored a mean (SD) of 13.0 (7.4) on the Convergence Insufficiency Symptom Survey. Reading fluency was highly variable with a mean (SD) of 291 (119) words per minute. CONCLUSIONS iPad measures of NPC were highly correlated with clinical measures, while visual acuity measured with the iPad showed modest correlation. Nonetheless, the suite of visual assessments provide value as screening tools, and when used in combination with reading fluency assessment and self-reported CI may be effective in identifying visual dysfunction following mild traumatic brain injury.
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Affiliation(s)
- Susan M Linder
- Department of Physical Medicine and Rehabilitation, Cleveland Clinic, Cleveland, OH 44195, USA.,Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Mandy Miller Koop
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Diane Tucker
- Cole Eye Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Karen Guzi
- Department of Emergency Medicine, Cleveland Clinic, Cleveland, OH 44195, USA.,Case Western Reserve University School of Nursing, Samson Pavilion, Cleveland, OH 44106, USA
| | - Daniel C Gray
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Jay L Alberts
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH 44195, USA.,Department of biomedical engineering and the center for Neurologic Restoration, Cleveland Clinic, Cleveland, OH 44195, USA
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Cochrane GD, Christy JB, Kicker ET, Kailey RP, England BK. Inter-rater and test-retest reliability of computerized clinical vestibular tools. J Vestib Res 2021; 31:365-373. [PMID: 33646190 DOI: 10.3233/ves-201522] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Clinical vestibular technology is rapidly evolving to improve objective assessments of vestibular function. Understanding the reliability and expected score ranges of emerging clinical vestibular tools is important to gauge how these tools should be used as clinical endpoints. OBJECTIVE The objective of this study was to evaluate inter-rater and test-retest reliability intraclass correlation coefficients (ICCs) of four vestibular tools and to determine expected ranges of scores through smallest real difference (SRD) measures. METHODS Sixty healthy graduate students completed two 1-hour sessions, at most a week apart, consisting of two video head-impulse tests (vHIT), computerized dynamic visual acuity (cDVA) tests, and a smartphone-assisted bucket test (SA-SVV). Thirty students were tested by different testers at each session (inter-rater) and 30 by the same tester (test-retest). ICCs and SRDs were calculated for both conditions. RESULTS Most measures fell within the moderate ICC range (0.50-0.75). ICCs were higher for cDVA in the inter-rater subgroup and higher for vHITs in the test-retest subgroup. CONCLUSIONS Measures from the four tools evaluated were moderately reliable. There may be a tester effect on reliabilities, specifically vHITs. Further research should repeat these analyses in a patient population and explore methodological differences between vHIT systems.
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Affiliation(s)
- Graham D Cochrane
- Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham AL, USA
| | - Jennifer B Christy
- Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham AL, USA
| | - Ethan T Kicker
- Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham AL, USA
| | - Ryan P Kailey
- Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham AL, USA
| | - Brandon K England
- Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham AL, USA
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12
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Bliss RA, Long A, Anderson C, Niederee A, Arellanes H, Quinlin K. Gaze stabilization function does not predict injury incidence among collegiate athletes. TRANSLATIONAL SPORTS MEDICINE 2021. [DOI: 10.1002/tsm2.228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Rebecca A. Bliss
- Department of Physical Therapy University of Saint Mary Leavenworth KS USA
| | - Addie Long
- Department of Physical Therapy University of Saint Mary Leavenworth KS USA
| | - Chloe Anderson
- Department of Physical Therapy University of Saint Mary Leavenworth KS USA
| | - Allison Niederee
- Department of Physical Therapy University of Saint Mary Leavenworth KS USA
| | - Hannah Arellanes
- Department of Physical Therapy University of Saint Mary Leavenworth KS USA
| | - Kelly Quinlin
- Athletic Department Northwest Missouri State University Maryville MO USA
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13
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Mahfuz MM, Millar JL, Schubert MC. Repeated video head impulse testing in patients is a stable measure of the passive vestibulo-ocular reflex. J Otol 2020; 16:128-137. [PMID: 34220981 PMCID: PMC8241694 DOI: 10.1016/j.joto.2020.12.002] [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: 08/06/2020] [Revised: 12/15/2020] [Accepted: 12/15/2020] [Indexed: 10/29/2022] Open
Abstract
Objectives The video head impulse test (vHIT) is used as a measure of compensation yet it's stability in patients with vestibular pathology is unknown. Methods 144 patients (n = 72 female, mean 54.46 ± 15.8 years) were grouped into one of three primary diagnoses (Peripheral, Central, or Mixed). Subjects were further categorized based on sex (male versus female), ear (left versus right; ipsilesional versus contralesional), age (six groups ranging from 19 to 84 years), and duration between visits (five groups, mean 191.46 ± SE 29.42 days, median 55.5 days). The gain of the VOR during passive head rotation was measured for each semicircular canal (horizontal, anterior, posterior). Results There was no difference in the VOR gain within any semicircular canal between the two visits (horizontal: p = 0.179; anterior: p = 0.628; posterior: p = 0.613). However, the VOR gain from the horizontal canals was higher than the vertical canals for each visit (p < 0.001). Patients diagnosed with peripheral vestibular pathology had significantly lower (p ≤ 0.001) horizontal semicircular canal gains at each visit. There was no difference in VOR gain between sex (p = 0.215) or age groupings (p = 0.331). Test-retest reliability of vHIT in patient subjects is good (ICC = 0.801) and the VOR gain values across two separate visits were significant and positively correlated (r = 0.67) regardless of sex, ear, age, or duration between visits. Conclusion The vHIT is a stable measure of VOR gain over two different times across a variety of vestibular patients with no influence of age or sex.
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Affiliation(s)
- M Muntaseer Mahfuz
- Laboratory of Vestibular NeuroAdaptation, Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Jennifer L Millar
- Laboratory of Vestibular NeuroAdaptation, Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University, Baltimore, MD, 21205, USA.,Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Michael C Schubert
- Laboratory of Vestibular NeuroAdaptation, Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University, Baltimore, MD, 21205, USA.,Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, 21205, USA
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14
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Massingale S, Alexander A, Gerkin R, Leddon C, McQueary E, Allred RC, Pardini JE. Gaze stability in the elite athlete: A normative observational study. J Vestib Res 2019; 29:221-228. [PMID: 31476191 DOI: 10.3233/ves-190678] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND The ability to clearly perceive an object while the head is in motion is important in athletics, as it relates to performance and potentially to injury prevention. Normative data for healthy adults on measures of gaze stability have been established. However, data for elite athletes is scarce. OBJECTIVE To describe performance of elite athletes on computerized gaze stability testing and establish normative data for reference. METHODS Data were acquired via retrospective chart review. 134 male professional baseball players completed computerized Visual Acuity, Visual Perception Time and Gaze Stability Tests as part of a multi-modal baseline testing session. RESULTS Performance of all athletes was superior to general population norms reported in the literature. There were no significant differences between the optimal and suboptimal consistency groups or between English-speaking and non- or limited-English speaking players. CONCLUSIONS Similar to prior studies with smaller samples that have examined GST in athletes, we found high levels of GST performance in professional baseball players relative to normative data for the general population. Normative data for elite athletes was established using this healthy sample. This study underscores the importance of understanding the unique abilities of elite athletes when providing therapy after injury.
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Affiliation(s)
- Shelly Massingale
- Banner University Medical Center Sports Medicine and Concussion Program, Phoenix, AZ, USA
| | - Amy Alexander
- Banner University Medical Center Sports Medicine and Concussion Program, Phoenix, AZ, USA
| | - Richard Gerkin
- Banner University Medical Center-Phoenix, Phoenix, AZ, USA
| | | | - Elizabeth McQueary
- Banner University Medical Center Sports Medicine and Concussion Program, Phoenix, AZ, USA
| | - Richard Cameron Allred
- Banner University Medical Center Sports Medicine and Concussion Program, Phoenix, AZ, USA
| | - Jamie E Pardini
- Banner University Medical Center Sports Medicine and Concussion Program, Phoenix, AZ, USA
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15
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Welgampola MS, Young AS, Pogson JM, Bradshaw AP, Halmagyi GM. Dizziness demystified. Pract Neurol 2019; 19:492-501. [PMID: 31326945 DOI: 10.1136/practneurol-2019-002199] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2019] [Indexed: 11/03/2022]
Abstract
Four vestibular presentations caused by six different disorders constitute most of the neuro-otology cases seen in clinical practice. 'Acute vestibular syndrome' refers to a first-ever attack of acute, spontaneous, isolated vertigo and there are two common causes: vestibular neuritis / labyrinthitis and cerebellar infarction. Recurrent positional vertigo is most often caused by benign paroxysmal positional vertigo and less commonly is central in origin. Recurrent spontaneous vertigo has two common causes: Ménière's disease and vestibular migraine. Lastly, chronic vestibular insufficiency (imbalance) results from bilateral, or severe unilateral, peripheral vestibular impairment. These six disorders can often be diagnosed on the basis of history, examination, audiometry, and in some cases, basic vestibular function testing. Here we show that most common neuro-otological problems can be readily managed by general neurologists.
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Affiliation(s)
- Miriam S Welgampola
- Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Central Clinical School, University of Sydney, Camperdown, New South Wales, Australia
| | - Allison S Young
- Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Central Clinical School, University of Sydney, Camperdown, New South Wales, Australia
| | - Jacob M Pogson
- Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Central Clinical School, University of Sydney, Camperdown, New South Wales, Australia
| | - Andrew P Bradshaw
- Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Central Clinical School, University of Sydney, Camperdown, New South Wales, Australia
| | - G Michael Halmagyi
- Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Central Clinical School, University of Sydney, Camperdown, New South Wales, Australia
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Yetiser S, Ince D. Dynamic visual acuity in benign paroxysmal positional vertigo. Acta Otolaryngol 2018; 138:987-992. [PMID: 30776264 DOI: 10.1080/00016489.2018.1498595] [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: 10/27/2022]
Abstract
BACKGROUND Head motions cause transient vertigo in patients with benign paroxysmal positional vertigo (BPPV) and may reduce visual ability. OBJECTIVES The aim is to investigate the clinical utility of dynamic visual acuity (DVA) test in those patients. MATERIAL AND METHODS Thirty patients, 11 with lateral canal BPPV (6 geotropic and 5 ageotropic), and 19 with posterior canal BPPV, were evaluated with DVA test during rapid horizontal (left and right) and vertical (up and down) head movements. Patients were asked to identify the direction of the letter C, ranging from 1.0 to 0.0 logMAR, while moving their heads. The orientation of the optotype was randomly changed by a computer-generated program. Ten subjects were served as control. Data were analyzed with a one-way ANOVA. p Value <.01 was considered significant. RESULTS Patients with LC and PC BPPV had significant DVA loss as compared with control subjects (p < .01). However, no significant difference was found in vDVA between patients with LC and PC BPPV, or in hDVA between ipsilesional and contralesional head rotation in patients with LC or PC BPPV (LC: p = .755, PC: p = .765). CONCLUSIONS Patients with BPPV may have impaired visual acuity, particularly during acute onset condition. Present study indicated that DVA test was not helpful for differentiation of the pathologic and normal ears.
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Affiliation(s)
- Sertac Yetiser
- Department of ORL and HNS, Anadolu Medical Center, Kocaeli, Turkey
| | - Dilay Ince
- Department of ORL and HNS, Anadolu Medical Center, Kocaeli, Turkey
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Swanenburg J, Wild K, Straumann D, de Bruin ED. Exergaming in a Moving Virtual World to Train Vestibular Functions and Gait; a Proof-of-Concept-Study With Older Adults. Front Physiol 2018; 9:988. [PMID: 30108511 PMCID: PMC6080593 DOI: 10.3389/fphys.2018.00988] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 07/05/2018] [Indexed: 12/29/2022] Open
Abstract
Background: The use of Exergames designed to improve physical and cognitive functioning is relatively new in rehabilitation. Exergaming allows the training of skills, the handling of tools, and procedures; however, often, the potential of these aspects are not assessed before they are adopted in clinical settings. This study aimed at exploring the effects of exergaming on vestibular functions and gait in healthy community dwelling older adults using a proof-of-concept study design registered under ClinicalTrials.gov NCT03160352. Methods: A pre-test-post-test one-group study design comprising 10 older adults (mean age of 73.5 ± 7.6 years, four males) investigated the feasibility of eight exergaming training sessions (for 160 min) and the effects on dynamic visual acuity (DVA), functional gait assessment (FGA), and extended timed get-up-and-go (ETGUG). The simulator sickness questionnaire (SSQ) and the game scores were evaluated for the feasibility of the intervention. Wilcoxon test and Cohen's d (d) were chosen to test for differences and for effect size estimation. Results: Exergaming led to a significantly improved DVA (z = -2.50, p = 0.01, d = 1.35) with improvements in 9 out of 10 participants. In addition, the FGA significantly improved with a large effect size (z = -2.25, p = 0.02, d = 1.17). Specifically, component tasks such as walking with horizontal head turns (p = 0.03), gait with a narrow base of support (p = 0.03), ambulating backward (p = 0.05) significantly improved. The ETGUG component task Gait initiation significantly improved (p = 0.04). No change was found in gait speed and SSQ. The game scores of the participants improved continuously during the course of the intervention for every game. Discussion: This proof-of-concept study suggests that the use of exergaming that requires active stepping movements and that contains moving game projection is feasible and facilitates gaze stability during head movements in healthy community dwelling older adults. Aspects of functional gait and gait initiation also improved. Future research aimed at testing this exergaming intervention in patients suffering from vestibular impairments is warranted.
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Affiliation(s)
- Jaap Swanenburg
- Physiotherapy and Occupational Therapy Research Center, Directorate of Research and Education, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Integrative Spinal Research (ISR), Department of Chiropractic Medicine, Balgrist University Hospital, Zurich, Switzerland
| | - Karin Wild
- Department Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland
| | - Dominik Straumann
- Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Eling D de Bruin
- Department Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland.,Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
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Abstract
PURPOSE OF REVIEW In the last decades, researchers suggested that clinical assessment of labyrinthine function in detail became easy thanks to video head impulse tests (VHITs), vestibular evoked myogenic potential test (VEMP) and video-oculography (VOG). It has been argued that they can replace electronystagmography, the caloric and rotatory chair tests. This review addresses the latest evaluations of these tests and the opportunities they offer, but also the limitations in clinical practice. RECENT FINDINGS The VHIT and suppression head impulse test (SHIMP) are under ideal circumstances able to accurately identify deficits of the VOR in 3D. However, in a relevant part of the patient population, pupil tracking is inaccurate, video-goggles slip and VOR quantification is problematic. The dissociation between the VHIT and caloric test suggests that these tests are complementary. A new 3D-VOG technique claims to quantify eye torsion better than before, opening multiple diagnostic possibilities. VEMPs remain difficult to standardize. Variability in normal cervical vestibular-evoked myogenic potential amplitude is large. VEMPs become smaller or absent with age, raising questions of whether there is a lower normal limit at all. Recent research shows that the labyrinth is directly stimulated in the MRI offering new opportunities for diagnostics and research. SUMMARY In clinical practice, the VHIT, SHIMP, VEMP and new 3D-VOG techniques improve diagnostic power. Unfortunately, technical issues or variability prevent reliable quantitative evaluation in a part of the regular patient population. The traditional caloric and rotatory chair test can still be considered as valuable complementary tests.
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