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Berneshawi AR, Seyedmadani K, Goel R, Anderson MR, Tyson TL, Akay YM, Akay M, Leung LSB, Stone LS. Oculometric biomarkers of visuomotor deficits in clinically asymptomatic patients with systemic lupus erythematosus undergoing long-term hydroxychloroquine treatment. FRONTIERS IN OPHTHALMOLOGY 2024; 4:1354892. [PMID: 39104603 PMCID: PMC11298511 DOI: 10.3389/fopht.2024.1354892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 05/10/2024] [Indexed: 08/07/2024]
Abstract
Introduction This study examines a set of oculomotor measurements, or "oculometric" biomarkers, as potential early indicators of visual and visuomotor deficits due to retinal toxicity in asymptomatic Systemic Lupus Erythematosus (SLE) patients on long-term hydroxychloroquine (HCQ) treatment. The aim is to identify subclinical functional impairments that are otherwise undetectable by standard clinical tests and to link them to structural retinal changes. Methods We measured oculomotor responses in a cohort of SLE patients on chronic HCQ therapy using a previously established behavioral task and analysis technique. We also examined the relationship between oculometrics, OCT measures of retinal thickness, and standard clinical perimetry measures of visual function in our patient group using Bivariate Pearson Correlation and a Linear Mixed-Effects Model (LMM). Results Significant visual and visuomotor deficits were found in 12 asymptomatic SLE patients on long-term HCQ therapy compared to a cohort of 17 age-matched healthy controls. Notably, six oculometrics were significantly different. The median initial pursuit acceleration was 22%, steady-state pursuit gain 16%, proportion smooth 7%, and target speed responsiveness 31% lower, while catch-up saccade amplitude was 46% and fixation error 46% larger. Excluding the two patients with diagnosed mild toxicity, four oculometrics, all but fixation error and proportion smooth, remained significantly impaired compared to controls. Across our population of 12 patients (24 retinae), we found that pursuit latency, initial acceleration, steady-state gain, and fixation error were linearly related to retinal thickness even when age was accounted for, while standard measures of clinical function (Mean Deviation and Pattern Standard Deviation) were not. Discussion Our data show that specific oculometrics are sensitive early biomarkers of functional deficits in SLE patients on HCQ that could be harnessed to assist in the early detection of HCQ-induced retinal toxicity and other visual pathologies, potentially providing early diagnostic value beyond standard visual field and OCT evaluations.
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Affiliation(s)
- Andrew R. Berneshawi
- Ophthalmology Department, Stanford University School of Medicine, Stanford, CA, United States
| | - Kimia Seyedmadani
- Research Operations and Integration Laboratory, Johnson Space Center, National Aeronautics and Space Administration, Houston, TX, United States
- Biomedical Engineering Department, University of Houston, Houston, TX, United States
| | - Rahul Goel
- San Jose State University Foundation, San Jose, CA, United States
- Human Systems Integration Division, Ames Research Center, National Aeronautics and Space Administration, Moffett Field, CA, United States
| | - Mark R. Anderson
- Human Systems Integration Division, Ames Research Center, National Aeronautics and Space Administration, Moffett Field, CA, United States
- Arctic Slope Regional Corporation (ASRC) Federal Data Solutions, Moffett Field, CA, United States
| | - Terence L. Tyson
- Human Systems Integration Division, Ames Research Center, National Aeronautics and Space Administration, Moffett Field, CA, United States
| | - Yasmin M. Akay
- Biomedical Engineering Department, University of Houston, Houston, TX, United States
| | - Metin Akay
- Biomedical Engineering Department, University of Houston, Houston, TX, United States
| | - Loh-Shan B. Leung
- Ophthalmology Department, Stanford University School of Medicine, Stanford, CA, United States
| | - Leland S. Stone
- Human Systems Integration Division, Ames Research Center, National Aeronautics and Space Administration, Moffett Field, CA, United States
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Chen J, Zhou L, Jiang C, Chen Z, Zhang L, Zhou H, Kang W, Jiang X, Li Y, Luo N, Yao M, Niu M, Chen S, Zuo XN, Li L, Liu J. Impaired Ocular Tracking and Cortical Atrophy in Idiopathic Rapid Eye Movement Sleep Behavior Disorder. Mov Disord 2022; 37:972-982. [PMID: 35107831 DOI: 10.1002/mds.28931] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 12/14/2021] [Accepted: 12/17/2021] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Idiopathic rapid eye movement sleep behavior disorder (iRBD) is a prodromal stage of synucleinopathies. Patients with synucleinopathies frequently display eye movement abnormalities. However, whether patients with iRBD have eye movement abnormalities remains unknown. OBJECTIVE The aim of this study was to assess eye movement abnormalities and related gray matter alterations and explore whether such abnormalities can serve as biomarkers to indicate phenoconversion to synucleinopathies in iRBD. METHODS Forty patients with iRBD with early disease progression and 35 healthy control subjects participated in a 15-minute ocular-tracking task that evaluated their control of eye movement abilities. They also underwent clinical assessments for olfactory function, nonmotor symptoms, and autonomic symptoms, all of which are biomarkers to predict phenoconversion to synucleinopathies in iRBD. A subgroup of the participants (20 patients with iRBD and 20 healthy control subjects) also participated in structural magnetic resonance imaging. RESULTS The ocular-tracking ability in patients with iRBD was inferior to that of healthy control subjects in two aspects: pursuit initiation and steady-state tracking. Cortical thinning in the right visual area V4 in patients with iRBD is coupled with impaired pursuit initiation. Furthermore, prolonged pursuit initiation in patients with iRBD exhibits a trend of correlation with olfactory loss, the earliest biomarker that develops prior to other prodromal biomarkers. CONCLUSIONS We found ocular-tracking abnormalities in patients with iRBD even early in their disease progression that have not been reported before. These abnormalities are coupled with atrophy of brain areas involved in the perception of object motion and might indicate phenoconversion to synucleinopathies in iRBD. © 2022 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Jing Chen
- Faculty of Arts and Science, New York University Shanghai, Shanghai, China
- NYU-ECNU Institute of Brain and Cognitive Science at New York University Shanghai, Shanghai, China
- Key Laboratory of Brain Functional Genomics, East China Normal University, Shanghai, China
| | - Liche Zhou
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chao Jiang
- Developmental Population Neuroscience Research Center, IDG/McGovern Institute for Brain Research, State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
| | - Zhichun Chen
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lina Zhang
- Department of Biostatistics, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haiyan Zhou
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenyan Kang
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xufeng Jiang
- Department of Nuclear Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuanyuan Li
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ningdi Luo
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mengsha Yao
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mengyue Niu
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shengdi Chen
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xi-Nian Zuo
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Li Li
- Faculty of Arts and Science, New York University Shanghai, Shanghai, China
- NYU-ECNU Institute of Brain and Cognitive Science at New York University Shanghai, Shanghai, China
- Key Laboratory of Brain Functional Genomics, East China Normal University, Shanghai, China
| | - Jun Liu
- Department of Neurology and Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Tyson TL, Flynn-Evans EE, Stone LS. Differential saccade-pursuit coordination under sleep loss and low-dose alcohol. Front Neurosci 2022; 16:1067722. [PMID: 36874639 PMCID: PMC9978352 DOI: 10.3389/fnins.2022.1067722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 12/07/2022] [Indexed: 02/18/2023] Open
Abstract
Introduction Ocular tracking of a moving object requires tight coordination between smooth pursuit and saccadic eye movements. Normally, pursuit drives gaze velocity to closely match target velocity, with residual position offsets corrected by catch-up saccades. However, how/if common stressors affect this coordination is largely unknown. This study seeks to elucidate the effects of acute and chronic sleep loss, and low-dose alcohol, on saccade-pursuit coordination, as well as that of caffeine. Methods We used an ocular tracking paradigm to assess three metrics of tracking (pursuit gain, saccade rate, saccade amplitude) and to compute "ground lost" (from reductions in steady-state pursuit gain) and "ground recouped" (from increases in steady-state saccade rate and/or amplitude). We emphasize that these are measures of relative changes in positional offsets, and not absolute offset from the fovea. Results Under low-dose alcohol and acute sleep loss, ground lost was similarly large. However, under the former, it was nearly completely recouped by saccades, whereas under the latter, compensation was at best partial. Under chronic sleep restriction and acute sleep loss with a caffeine countermeasure, the pursuit deficit was dramatically smaller, yet saccadic behavior remained altered from baseline. In particular, saccadic rate remained significantly elevated, despite the fact that ground lost was minimal. Discussion This constellation of findings demonstrates differential impacts on saccade-pursuit coordination with low-dose alcohol impacting only pursuit, likely through extrastriate cortical pathways, while acute sleep loss not only disrupts pursuit but also undermines saccadic compensation, likely through midbrain/brainstem pathways. Furthermore, while chronic sleep loss and caffeine-mitigated acute sleep loss show little residual pursuit deficit, consistent with uncompromised cortical visual processing, they nonetheless show an elevated saccade rate, suggesting residual midbrain and/or brainstem impacts.
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Affiliation(s)
- Terence L Tyson
- Visuomotor Control Laboratory, Human Systems Integration Division, NASA Ames Research Center, Moffett Field, CA, United States
| | - Erin E Flynn-Evans
- Fatigue Countermeasures Laboratory, Human Systems Integration Division, NASA Ames Research Center, Moffett Field, CA, United States
| | - Leland S Stone
- Visuomotor Control Laboratory, Human Systems Integration Division, NASA Ames Research Center, Moffett Field, CA, United States
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Abstract
Hitting a baseball, one of the most difficult skills in all of sports, requires complex hand-eye coordination, but its link with basic visuomotor capabilities remains largely unknown. Here we examined basic visuomotor skills of baseball players and demographically matched nonathletes by measuring their ocular-tracking and manual-control performance. We further investigated how these two capabilities relate to batting performance in baseball players. Compared to nonathletes, baseball players showed better ocular-tracking and manual-control capabilities, which remain unchanged with increasing baseball experience. Both, however, become more correlated with batting accuracy with increasing experience. Ocular-tracking performance is predictive of batting skill, accounting for ≥ 70% of the variance in batting performance across players with ≥ 10 years of experience. A simple linear additive-noise cascade model with shared front-end visual noise that limits batting performance can explain many of our results. Our findings show that fundamental visuomotor capabilities can predict the complex, learned skill of baseball batting.
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Affiliation(s)
- Rongrong Chen
- Department of Psychology, The University of Hong Kong, Hong Kong SAR.,Division of Science & Technology, Beijing Normal University-Hong Kong Baptist University United International College, Zhuhai, PRC.,
| | - Leland S Stone
- Human Systems Integrations Division, NASA Ames Research Center, Moffett Field, CA, USA.,
| | - Li Li
- Department of Psychology, The University of Hong Kong, Hong Kong SAR.,Faculty of Arts and Science, New York University Shanghai, Shanghai, PRC.,NYU-ECNU Institute of Brain and Cognitive Science at New York University Shanghai, Shanghai, PRC.,
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Quantification of smooth pursuit dysfunction in multiple sclerosis. Mult Scler Relat Disord 2021; 54:103073. [PMID: 34214878 DOI: 10.1016/j.msard.2021.103073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 05/31/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Smooth pursuit dysfunction is common in MS, but rarely quantified and may be missed on exam. METHODS NeuroFitONE™ smooth pursuit performance measures were compared between MS (n = 20) and healthy control (n = 19) participants. RESULTS Compared to controls, MS patients had lower proportion of smooth pursuit (0.63 vs. 0.73; p = 0.047), increased directional (10.1 vs. 8°; p = 0.014) and speed noise (4.3 vs. 3.1°/sec; p = 0.021) and reduced initiation acceleration (96.83 vs. 115.33°/sec2; p = 0.061). Significant univariate correlations with clinical scores (EDSS, T25-FW) were observed. CONCLUSION Smooth pursuit dysfunction in MS can be readily quantified and distinguishes MS eyes from healthy controls.
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Tyson TL, Feick NH, Cravalho PF, Flynn-Evans EE, Stone LS. Dose-dependent sensorimotor impairment in human ocular tracking after acute low-dose alcohol administration. J Physiol 2020; 599:1225-1242. [PMID: 33332605 PMCID: PMC7898833 DOI: 10.1113/jp280395] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 10/13/2020] [Indexed: 11/08/2022] Open
Abstract
Key points Oculomotor behaviours are commonly used to evaluate sensorimotor disruption due to ethanol (EtOH). The current study demonstrates the dose‐dependent impairment in oculomotor and ocular behaviours across a range of ultra‐low BACs (<0.035%). Processing of target speed and direction, as well as pursuit eye movements, are significantly impaired at 0.015% BAC, suggesting impaired neural activity within brain regions associated with the visual processing of motion. Catch‐up saccades during steady visual tracking of the moving target compensate for the reduced vigour of smooth eye movements that occurs with the ingestion of low‐dose alcohol. Saccade dynamics start to become ‘sluggish’ at as low as 0.035% BAC. Pupillary light responses appear unaffected at BAC levels up to 0.065%.
Abstract Changes in oculomotor behaviours are often used as metrics of sensorimotor disruption due to ethanol (EtOH); however, previous studies have focused on deficits at blood‐alcohol concentrations (BACs) above about 0.04%. We investigated the dose dependence of the impairment in oculomotor and ocular behaviours caused by EtOH administration across a range of ultra‐low BACs (≤0.035%). We took repeated measures of oculomotor and ocular performance from sixteen participants, both pre‐ and post‐EtOH administration. To assess the neurological impacts across a wide range of brain areas and pathways, our protocol measured 21 largely independent performance metrics extracted from a range of behavioural responses ranging from ocular tracking of radial step‐ramp stimuli, to eccentric gaze holding, to pupillary responses evoked by light flashes. Our results show significant impairment of pursuit and visual motion processing at 0.015% BAC, reflecting degraded neural processing within extrastriate cortical pathways. However, catch‐up saccades largely compensate for the tracking displacement shortfall caused by low pursuit gain, although there still is significant residual retinal slip and thus degraded dynamic acuity. Furthermore, although saccades are more frequent, their dynamics are more sluggish (i.e. show lower peak velocities) starting at BAC levels as low as 0.035%. Small effects in eccentric gaze holding and no effect in pupillary response dynamics were observed at levels below 0.07%, showing the higher sensitivity of the pursuit response to very low levels of blood alcohol, under the conditions of our study. Oculomotor behaviours are commonly used to evaluate sensorimotor disruption due to ethanol (EtOH). The current study demonstrates the dose‐dependent impairment in oculomotor and ocular behaviours across a range of ultra‐low BACs (<0.035%). Processing of target speed and direction, as well as pursuit eye movements, are significantly impaired at 0.015% BAC, suggesting impaired neural activity within brain regions associated with the visual processing of motion. Catch‐up saccades during steady visual tracking of the moving target compensate for the reduced vigour of smooth eye movements that occurs with the ingestion of low‐dose alcohol. Saccade dynamics start to become ‘sluggish’ at as low as 0.035% BAC. Pupillary light responses appear unaffected at BAC levels up to 0.065%.
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Affiliation(s)
- Terence L Tyson
- Visuomotor Control Laboratory, Human Systems Integration Division, NASA Ames Research Center, Moffett Field, CA, USA
| | | | | | - Erin E Flynn-Evans
- Fatigue Countermeasures Laboratory, Human Systems Integration Division, NASA Ames Research Center, Moffett Field, CA, USA
| | - Leland S Stone
- Visuomotor Control Laboratory, Human Systems Integration Division, NASA Ames Research Center, Moffett Field, CA, USA
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Stone LS, Tyson TL, Cravalho PF, Feick NH, Flynn-Evans EE. Distinct pattern of oculomotor impairment associated with acute sleep loss and circadian misalignment. J Physiol 2019; 597:4643-4660. [PMID: 31389043 PMCID: PMC6852126 DOI: 10.1113/jp277779] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 06/20/2019] [Indexed: 11/29/2022] Open
Abstract
Key points Inadequate sleep and irregular work schedules have not only adverse consequences for individual health and well‐being, but also enormous economic and safety implications for society as a whole. This study demonstrates that visual motion processing and coordinated eye movements are significantly impaired when performed after sleep loss and during the biological night, and thus may be contributing to human error and accidents. Because affected individuals are often unaware of their sensorimotor and cognitive deficits, there is a critical need for non‐invasive, objective indicators of mild, yet potentially unsafe, impairment due to disrupted sleep or biological rhythms. Our findings show that a set of eye‐movement measures can be used to provide sensitive and reliable indicators of such mild neural impairments.
Abstract Sleep loss and circadian misalignment have long been known to impair human cognitive and motor performance with significant societal and health consequences. It is well known that human reaction time to a visual cue is impaired following sleep loss and circadian misalignment, but it has remained unclear how more complex visuomotor control behaviour is altered under these conditions. In this study, we measured 14 parameters of the voluntary ocular tracking response of 12 human participants (six females) to systematically examine the effects of sleep loss and circadian misalignment using a constant routine 24‐h acute sleep‐deprivation paradigm. The combination of state‐of‐the‐art oculometric and sleep‐research methodologies allowed us to document, for the first time, large changes in many components of pursuit, saccades and visual motion processing as a function of time awake and circadian phase. Further, we observed a pattern of impairment across our set of oculometric measures that is qualitatively different from that observed previously with other mild neural impairments. We conclude that dynamic vision and visuomotor control exhibit a distinct pattern of impairment linked with time awake and circadian phase. Therefore, a sufficiently broad set of oculometric measures could provide a sensitive and specific behavioural biomarker of acute sleep loss and circadian misalignment. We foresee potential applications of such oculometric biomarkers assisting in the assessment of readiness‐to‐perform higher risk tasks and in the characterization of sub‐clinical neural impairment in the face of a multiplicity of potential risk factors, including disrupted sleep and circadian rhythms. Inadequate sleep and irregular work schedules have not only adverse consequences for individual health and well‐being, but also enormous economic and safety implications for society as a whole. This study demonstrates that visual motion processing and coordinated eye movements are significantly impaired when performed after sleep loss and during the biological night, and thus may be contributing to human error and accidents. Because affected individuals are often unaware of their sensorimotor and cognitive deficits, there is a critical need for non‐invasive, objective indicators of mild, yet potentially unsafe, impairment due to disrupted sleep or biological rhythms. Our findings show that a set of eye‐movement measures can be used to provide sensitive and reliable indicators of such mild neural impairments.
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Affiliation(s)
- Leland S Stone
- Visuomotor Control Laboratory, Human Systems Integration Division, NASA Ames Research Center, Moffett Field, CA, USA
| | - Terence L Tyson
- Visuomotor Control Laboratory, Human Systems Integration Division, NASA Ames Research Center, Moffett Field, CA, USA
| | | | | | - Erin E Flynn-Evans
- Fatigue Countermeasures Laboratory, Human Systems Integration Division, NASA Ames Research Center, Moffett Field, CA, USA
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Kellar D, Newman S, Pestilli F, Cheng H, Port NL. Comparing fMRI activation during smooth pursuit eye movements among contact sport athletes, non-contact sport athletes, and non-athletes. NEUROIMAGE-CLINICAL 2018. [PMID: 29541575 PMCID: PMC5849867 DOI: 10.1016/j.nicl.2018.01.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Objectives Though sub-concussive impacts are common during contact sports, there is little consensus whether repeat blows affect brain function. Using a "lifetime exposure" rather than acute exposure approach, we examined oculomotor performance and brain activation among collegiate football players and two control groups. Our analysis examined whether there are group differences in eye movement behavioral performance and in brain activation during smooth pursuit. Methods Data from 21 off-season Division I football "starters" were compared with a) 19 collegiate cross-country runners, and b) 11 non-athlete college students who were SES matched to the football player group (total N = 51). Visual smooth pursuit was performed while undergoing fMRI imaging via a 3 Tesla scanner. Smooth pursuit eye movements to three stimulus difficulty levels were measured with regard to RMS error, gain, and lag. Results No meaningful differences were found for any of the standard analyses used to assess smooth pursuit eye movements. For fMRI, greater activation was seen in the oculomotor region of the cerebellar vermis and areas of the FEF for football players as compared to either control group, who did not differ on any measure. Conclusion Greater cerebellar activity among football players while performing an oculomotor task could indicate that they are working harder to compensate for some subtle, long-term subconcussive deficits. Alternatively, top athletes in a sport requiring high visual motor skill could have more of their cerebellum and FEF devoted to oculomotor task performance regardless of subconcussive history. Overall, these results provide little firm support for an effect of accumulated subconcussion exposure on brain function.
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Affiliation(s)
- Derek Kellar
- Department of Psychological and Brain Sciences, Indiana University, 1101 E 10th St., Bloomington, IN, United States
| | - Sharlene Newman
- Department of Psychological and Brain Sciences, Indiana University, 1101 E 10th St., Bloomington, IN, United States
| | - Franco Pestilli
- Department of Psychological and Brain Sciences, Indiana University, 1101 E 10th St., Bloomington, IN, United States
| | - Hu Cheng
- Department of Psychological and Brain Sciences, Indiana University, 1101 E 10th St., Bloomington, IN, United States
| | - Nicholas L Port
- Department of Psychological and Brain Sciences, Indiana University, 1101 E 10th St., Bloomington, IN, United States.
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Regan PM, Bleiberg J, Onge PS, Temme L. Feasibility of using normobaric hypoxic stress in mTBI research. Concussion 2017; 2:CNC44. [PMID: 30202585 PMCID: PMC6094798 DOI: 10.2217/cnc-2017-0008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 03/15/2017] [Indexed: 11/21/2022] Open
Abstract
Studies of mild traumatic brain injury (mTBI) recovery generally assess patients in unstressed conditions that permit compensation for impairments through increased effort expenditure. This possibility may explain why a subgroup of individuals report persistent mTBI symptoms yet perform normally on objective assessment. Accordingly, the development and utilization of stress paradigms may be effective for enhancing the sensitivity of mTBI assessment. Previous studies, discussed here, indirectly but plausibly support the use of normobaric hypoxia as a stressor in uncovering latent mTBI symptoms due to the overlapping symptomatology induced by both normobaric hypoxia and mTBI. Limited studies by our group and others further support this plausibility through proof-of-concept demonstrations that hypoxia reversibly induces disproportionately severe impairments of oculomotor, pupillometric, cognitive and autonomic function in mTBI individuals.
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Affiliation(s)
- Patrick M Regan
- National Intrepid Center of Excellence (NICoE), Walter Reed National Military Medical Center, Bethesda, MD, USA
- Laulima Government Solutions LLC, Orlando, FL 32826, USA
- National Intrepid Center of Excellence (NICoE), Walter Reed National Military Medical Center, Bethesda, MD, USA
- Laulima Government Solutions LLC, Orlando, FL 32826, USA
| | - Joseph Bleiberg
- National Intrepid Center of Excellence (NICoE), Walter Reed National Military Medical Center, Bethesda, MD, USA
- National Intrepid Center of Excellence (NICoE), Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Paul St Onge
- U.S. Army Aeromedical Research Laboratory, Fort Rucker, AL 36362, USA
- Laulima Government Solutions LLC, Orlando, FL 32826, USA
- U.S. Army Aeromedical Research Laboratory, Fort Rucker, AL 36362, USA
- Laulima Government Solutions LLC, Orlando, FL 32826, USA
| | - Leonard Temme
- U.S. Army Aeromedical Research Laboratory, Fort Rucker, AL 36362, USA
- U.S. Army Aeromedical Research Laboratory, Fort Rucker, AL 36362, USA
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Barker F, Cockerham G, Goodrich G, Hartwick A, Kardon R, Mick AB, Swanson M. Brain Injury Impact on the Eye and Vision. Optom Vis Sci 2017; 94:4-6. [PMID: 28009763 DOI: 10.1097/opx.0000000000001001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Felix Barker
- Rock Hill, South Carolina Palo Alto, California Union City, California Columbus, Ohio Iowa City, Iowa San Francisco, California Birmingham, Alabama
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