1
|
Marusic S, Vyas N, Chinn RN, O'Brien MJ, Roberts TL, Raghuram A. Vergence and accommodation deficits in paediatric and adolescent patients during sub-acute and chronic phases of concussion recovery. Ophthalmic Physiol Opt 2024. [PMID: 38853693 DOI: 10.1111/opo.13346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 05/22/2024] [Accepted: 05/25/2024] [Indexed: 06/11/2024]
Abstract
INTRODUCTION Visual function deficits have been reported in adolescents following concussion. We compared vergence and accommodation deficits in paediatric and adolescent patients at a tertiary medical centre in the sub-acute (15 days to 12 weeks) and chronic (12 weeks to 1 year) phases of concussion recovery. METHODS The study included patients aged 7 to <18 years seen between 2014 and 2021, who had a binocular vision (BV) examination conducted within 15 days and 1 year of their concussion injury. Included patients had to have 0.10 logMAR monocular best-corrected vision or better in both eyes and be wearing a habitual refractive correction. BV examinations at near included measurements of near point of convergence, convergence and divergence amplitudes, vergence facility, monocular accommodative amplitude and monocular accommodative facility. Vergence and accommodation deficits were diagnosed using established clinical criteria. Group differences were assessed using nonparametric statistics and ANCOVA modelling. RESULTS A total of 259 patients were included with 111 in the sub-acute phase and 148 in the chronic phase of concussion recovery. There was no significant difference in the rates of vergence deficits between the two phases of concussion recovery (sub-acute = 48.6%; chronic = 49.3%). There was also no significant difference in the rates of accommodation deficits between the two phases of concussion recovery (sub-acute = 82.0%; chronic = 77.0%). CONCLUSION Patients in both the sub-acute and chronic phases of concussion recovery exhibited a high frequency of vergence and accommodation deficits, with no significant differences between groups. Results indicate that patients exhibiting vision deficits in the sub-acute phase may not resolve without intervention, though a prospective, longitudinal study is required to test the hypothesis.
Collapse
Affiliation(s)
- Sophia Marusic
- Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Neerali Vyas
- Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Ryan N Chinn
- Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Michael J O'Brien
- Micheli Center for Sports Injury Prevention, Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Tawna L Roberts
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Aparna Raghuram
- Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
2
|
Biscardi M, Grossinger Z, Colantonio A, Bayley M, Mollayeva T. Efficacy of restitutive interventions for oculomotor deficits in adults with mild traumatic brain injury: a systematic review and meta-analysis. Brain Inj 2024; 38:499-513. [PMID: 38433498 DOI: 10.1080/02699052.2024.2320163] [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: 07/31/2023] [Accepted: 02/13/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Mild traumatic brain injury (mTBI) can cause persistent symptoms suggestive of oculomotor deficits. This research synthesized evidence on restitutive interventions for reducing oculomotor deficits in adults with mTBI to understand if these interventions have clinical utility for improving recovery. METHODS Medline, EMBASE, CINHAL, PsychInfo, and Scopus, databases were searched for experimental studies published in English. We rated risk of bias (RoB) using recommended tools, and the certainty of the evidence according to GRADE guidelines. We conducted meta-analyses for similar outcomes reported in at least two studies. RESULTS Out of 5,328 citations, 12 studies (seven case series and five crossover design), with a combined sample size of 354 participants; (43% males) met the inclusion criteria and were analyzed. The analysis revealed a trend toward improvement of oculomotor deficits and visual tasks in response to restitutive intervention. None of the studies addressed sex or gender effects. All studies had high RoB, suggesting low certainty in the reported results. DISCUSSION Restitutive interventions may be beneficial for adults with oculomotor deficits after mTBI, however overall certainty of the evidence remains low. Future efforts must include enhancing attention to study methodology and reporting, sex and gender analyses, and reaching a consensus on outcome measures. PROSPERO REGISTRATION NUMBER CRD42022352276.
Collapse
Affiliation(s)
- Melissa Biscardi
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Zane Grossinger
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Angela Colantonio
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Mark Bayley
- Hull Ellis Concussion and Research Clinic, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Tatyana Mollayeva
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| |
Collapse
|
3
|
Sanclemente D, Belair JA, Talekar KS, Roedl JB, Stache S. Return to Play Following Concussion: Role for Imaging? Semin Musculoskelet Radiol 2024; 28:193-202. [PMID: 38484771 DOI: 10.1055/s-0043-1778031] [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: 03/19/2024]
Abstract
This review surveys concussion management, focusing on the use of neuroimaging techniques in return to play (RTP) decisions. Clinical assessments traditionally were the foundation of concussion diagnoses. However, their subjective nature prompted an exploration of neuroimaging modalities to enhance diagnosis and management. Magnetic resonance spectroscopy provides information about metabolic changes and alterations in the absence of structural abnormalities. Diffusion tensor imaging uncovers microstructural changes in white matter. Functional magnetic resonance imaging assesses neuronal activity to reveal changes in cognitive and sensorimotor functions. Positron emission tomography can assess metabolic disturbances using radiotracers, offering insight into the long-term effects of concussions. Vestibulo-ocular dysfunction screening and eye tracking assess vestibular and oculomotor function. Although these neuroimaging techniques demonstrate promise, continued research and standardization are needed before they can be integrated into the clinical setting. This review emphasizes the potential for neuroimaging in enhancing the accuracy of concussion diagnosis and guiding RTP decisions.
Collapse
Affiliation(s)
- Drew Sanclemente
- Medical Student, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jeffrey A Belair
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Kiran S Talekar
- Department of Radiology, Brain Mapping (fMRI and DTI) in Neuroradiology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Johannes B Roedl
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Stephen Stache
- Division of Non-Operative Sports Medicine, Department of Orthopaedics and Family and Community Medicine, Rothman Orthopaedic Institute, Thomas Jefferson University, Sidney Kimmel Medical College, Philadelphia, Pennsylvania
- Department of Orthopaedics and Pediatrics, University Athletics, Drexel University and Drexel College of Medicine, Philadelphia, Pennsylvania
| |
Collapse
|
4
|
Bell CA, Grossman SN, Balcer LJ, Galetta SL. Vision as a piece of the head trauma puzzle. Eye (Lond) 2023; 37:2385-2390. [PMID: 36801966 PMCID: PMC10397310 DOI: 10.1038/s41433-023-02437-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 12/07/2022] [Accepted: 01/31/2023] [Indexed: 02/19/2023] Open
Abstract
Approximately half of the brain's circuits are involved in vision and control of eye movements. Therefore, visual dysfunction is a common symptom of concussion, the mildest form of traumatic brain injury (TBI). Photosensitivity, vergence dysfunction, saccadic abnormalities, and distortions in visual perception have been reported as vision-related symptoms following concussion. Impaired visual function has also been reported in populations with a lifetime history of TBI. Consequently, vision-based tools have been developed to detect and diagnose concussion in the acute setting, and characterize visual and cognitive function in those with a lifetime history of TBI. Rapid automatized naming (RAN) tasks have provided widely accessible and quantitative measures of visual-cognitive function. Laboratory-based eye tracking approaches demonstrate promise in measuring visual function and validating results from RAN tasks in patients with concussion. Optical coherence tomography (OCT) has detected neurodegeneration in patients with Alzheimer's disease and multiple sclerosis and may provide critical insight into chronic conditions related to TBI, such as traumatic encephalopathy syndrome. Here, we review the literature and discuss the future directions of vision-based assessments of concussion and conditions related to TBI.
Collapse
Affiliation(s)
- Carter A Bell
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA
| | - Scott N Grossman
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA
| | - Laura J Balcer
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA
- Department of Ophthalmology, New York University Grossman School of Medicine, New York, NY, USA
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Steven L Galetta
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA.
- Department of Ophthalmology, New York University Grossman School of Medicine, New York, NY, USA.
| |
Collapse
|
5
|
Hutchison MG, Di Battista AP, Pyndiura K, Blanc S, Quaid PT, Richards D. Incidence of Remote Near-Point of Convergence in University Athletes After Sport-Related Concussion. Clin J Sport Med 2023; 33:258-263. [PMID: 36584046 PMCID: PMC10128903 DOI: 10.1097/jsm.0000000000001102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 09/14/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Near-point of convergence (NPC) testing is an attractive screening tool in the sport setting because it is rapid, requires few resources, and is easy to administer. Remote NPC has been reported after sport-related concussion (SRC), although the incidence among a university-aged population is not well defined. The purpose of the study was to examine the incidence of remote NPC after SRC in a cohort of Canadian interuniversity athletes. DESIGN Cross-sequential. SETTING University. PARTICIPANTS One hundred thirty-two university athletes [SRC, n = 68; musculoskeletal (MSK) injury, n = 64] were tested before the beginning of their competitive season and again after their injury. INDEPENDENT VARIABLES Healthy athletes measured preseason were compared with athletes after SRC or MSK injury using both longitudinal and cross-sectional designs. MAIN OUTCOME MEASURES Remote NPC (pass/fail), measured at 6 cm or greater, repeated 3 times. RESULTS After SRC, 22% of athletes failed their test postinjury (95% CI, 14%-33%). Comparatively, in the MSK group, 3% of athletes failed their test postinjury (95% CI, 1%-7%). A direct comparison of both injury groups yielded a mean 19% higher prevalence of failed NPC tests after SRC versus MSK injury (95% CI, 10%-30%). There seems to be no relationship between reported symptom burden and NPC performance after SRC. CONCLUSION Remote NPC occurs in approximately 1 of 5 athletes after SRC and is rarely observed after MSK injury.
Collapse
Affiliation(s)
- Michael G. Hutchison
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto ON, Canada
- David L. MacIntosh Sport Medicine Clinic, Faculty of Kinesiology and Physical Education, University of Toronto, Toronto ON, Canada
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON, Canada
| | - Alex P. Di Battista
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto ON, Canada
- Defence Research and Development Canada, Toronto Research Centre, Toronto, ON, Canada
| | - Kyla Pyndiura
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto ON, Canada
| | - Shirley Blanc
- Complete Eye Care Services, Toronto, ON, Canada; and
| | | | - Doug Richards
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto ON, Canada
| |
Collapse
|
6
|
Donner JR, Corwin DJ, Master CL, Zonfrillo MR. Documented Visio-Vestibular Examination and Anticipatory Guidance for Pediatric Concussion Patients. Pediatr Emerg Care 2023; 39:179-183. [PMID: 36109009 DOI: 10.1097/pec.0000000000002845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Pediatric concussion patients are frequently managed in the primary care or acute care settings. Optimal care includes vision and vestibular assessments, as well as targeted anticipatory guidance for return to school and activity. We aimed to examine clinical practices related to the evaluation and management of concussion patients at children's hospital-based emergency department (ED) and primary care/urgent care settings. METHODS We conducted a retrospective chart review of children aged 5 to 18 years who presented to either the ED or the primary and urgent care settings during a 2-year period. We evaluated 2 concussion management practices: (1) completion of the visio-vestibular examination and (2) provision of anticipatory guidance and follow-up. RESULTS Among patients seen in the ED (n = 500), only 12.4% had at least 1 component of the visio-vestibular examination performed compared with 51.3% of patients (n = 78) in the primary and urgent care settings ( P < 0.05). Regarding anticipatory guidance, 86.2% of ED patients were advised to engage in cognitive rest, and 94.2% were told to physically rest compared with 67.9% and 72.8% in the primary and urgent care settings ( P < 0.05), respectively. Follow-up recommendations were provided similarly for both settings (92.0% in the ED and 85.9% in the primary/urgent care, P = 0.077). CONCLUSIONS Although most pediatric concussion patients receive instructions acutely about cognitive and physical rest, there is opportunity to increase the frequency of visio-vestibular testing in both the ED and the primary care settings. Future efforts should focus on strategies to consistently optimize visio-vestibular assessment given its value in concussion diagnosis.
Collapse
Affiliation(s)
- Julia R Donner
- From the Department of Pediatrics, Hasbro Children's Hospital and the Warren Alpert Medical School of Brown University, Providence, RI
| | | | - Christina L Master
- Sports Medicine and Performance Center, Children's Hospital of Philadelphia and the Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | |
Collapse
|
7
|
Daly E, Pearce AJ, Finnegan E, Cooney C, McDonagh M, Scully G, McCann M, Doherty R, White A, Phelan S, Howarth N, Ryan L. An assessment of current concussion identification and diagnosis methods in sports settings: a systematic review. BMC Sports Sci Med Rehabil 2022; 14:125. [PMID: 35818048 PMCID: PMC9275058 DOI: 10.1186/s13102-022-00514-1] [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: 01/12/2022] [Accepted: 06/23/2022] [Indexed: 12/04/2022]
Abstract
Background Concussion in sport is an ongoing global concern. The head injury assessment (HIA) by the field of play is acknowledged as the first step in recognising and identifying concussion. While previous systematic literature reviews have evaluated the sensitivity of side-line screening tools and assessment protocols, no systematic review has evaluated the research designs and assessments used in a field setting. This systematic review investigated existing screening and diagnostic tools used in research as part of the HIA protocol to identify concussion that are currently used in professional, semi-professional and amateur (club) sports settings. Methods A systematic searching of relevant databases was undertaken for peer-reviewed literature between 2015 and 2020. Results Twenty-six studies met the inclusion criteria. Studies were of moderate to good quality, reporting a variety of designs. The majority of studies were undertaken in professional/elite environments with medical doctors and allied health practitioners (e.g., physical therapists) involved in 88% of concussion assessments. While gender was reported in 24 of the 26 studies, the majority of participants were male (77%). There was also a variety of concussion assessments (n = 20) with the sports concussion assessment tool (SCAT) used in less than half of the included studies. Conclusion The majority of studies investigating concussion HIAs are focused on professional/elite sport. With concussion an issue at all levels of sport, future research should be directed at non-elite sport. Further, for research purposes, the SCAT assessment should also be used more widely to allow for consistency across studies. Supplementary Information The online version contains supplementary material available at 10.1186/s13102-022-00514-1.
Collapse
Affiliation(s)
- Ed Daly
- Department of Sport, Exercise and Nutrition, School of Science and Computing, Atlantic Technological University, Galway, Ireland
| | - Alan J Pearce
- College of Sport, Health and Engineering, La Trobe University, Melbourne, Australia
| | - Emma Finnegan
- Department of Sport, Exercise and Nutrition, School of Science and Computing, Atlantic Technological University, Galway, Ireland
| | - Ciara Cooney
- Department of Sport, Exercise and Nutrition, School of Science and Computing, Atlantic Technological University, Galway, Ireland
| | - Maria McDonagh
- Department of Sport, Exercise and Nutrition, School of Science and Computing, Atlantic Technological University, Galway, Ireland
| | - Grainne Scully
- Department of Sport, Exercise and Nutrition, School of Science and Computing, Atlantic Technological University, Galway, Ireland
| | - Michael McCann
- Atlantic Technological University, Port Road, Letterkenny, Ireland
| | - Rónán Doherty
- Atlantic Technological University, Port Road, Letterkenny, Ireland
| | - Adam White
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, England
| | - Simon Phelan
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, England
| | - Nathan Howarth
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, England
| | - Lisa Ryan
- Department of Sport, Exercise and Nutrition, School of Science and Computing, Atlantic Technological University, Galway, Ireland.
| |
Collapse
|
8
|
Richard J, Lin YS, Wernet L, Kasitinon D, Royston A, Bristow K, Garner D, Argo LR. Is the King-Devick Test a Reliable Tool in Wheelchair Athletes? A Preliminary Prospective Study in Wheelchair Basketball. Clin J Sport Med 2022; 32:e134-e138. [PMID: 32956101 DOI: 10.1097/jsm.0000000000000889] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 08/10/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE (1) To determine the reliability of the King-Devick (KD) test among wheelchair basketball athletes across a season and (2) to compare the KD test time changes among those with and without a clinically suspected concussion. DESIGN Prospective, observational study. SETTING Division 3 college athletics department. PARTICIPANTS Twenty-nine intercollegiate wheelchair basketball athletes. INTERVENTIONS Athletes were prospectively monitored for concussions throughout the 2018 to 2019 season. King-Devick testing was completed preseason, midseason, postseason, and after clinically suspected concussions. MAIN OUTCOME MEASURES Two-way random effects intraclass correlation coefficient (ICC) was calculated. Friedman's test and pairwise comparison with Bonferroni correction were used to compare for change over time. Mean KD times and changes were compared between athletes with and without suspected concussion. RESULTS The KD test demonstrated good test-retest reliability (ICC = 0.826). Among participants without a concussion, there was a significant decrease in the mean KD test time from preseason to midseason (-3.3 seconds; P = 0.0167) and preseason to postseason (-3.3 seconds; P = 0.0167). No change was seen from mid-to-post season. Six athletes had 7 suspected concussions. Each demonstrated an increase in the KD test time, with a mean increase from 44.3 ± 9.5 seconds to 53.7 ± 12.8 seconds. King-Devick test times returned to or below baseline by postseason. CONCLUSIONS The KD test shows good reliability among wheelchair basketball athletes without a concussion. A learning effect is demonstrated initially but plateaus on subsequent testing. Unlike athletes without a concussion, players with a clinically suspected concussion showed an increase in the KD test time.
Collapse
Affiliation(s)
- Joshua Richard
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Yen-Sheng Lin
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Lauren Wernet
- University of Texas at Arlington, Arlington, Texas; and
| | | | - Alexa Royston
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Kristen Bristow
- University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - Lindsay Ramey Argo
- University of Texas Southwestern Medical Center, Dallas, Texas.,WellMed Medical Group, Fort Worth, Texas
| |
Collapse
|
9
|
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
| |
Collapse
|
10
|
Leonard BT, Kontos AP, Marchetti GF, Zhang M, Eagle SR, Reecher HM, Bensinger ES, Snyder VC, Holland CL, Sheehy CK, Rossi EA. Fixational eye movements following concussion. J Vis 2021; 21:11. [PMID: 34940825 PMCID: PMC8709928 DOI: 10.1167/jov.21.13.11] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The purpose of this study was to evaluate fixational eye movements (FEMs) with high spatial and temporal resolution following concussion, where oculomotor symptoms and impairments are common. Concussion diagnosis was determined using current consensus guidelines. A retinal eye-tracking device, the tracking scanning laser ophthalmoscope (TSLO), was used to measure FEMs in adolescents and young adults following a concussion and in an unaffected control population. FEMs were quantified in two fixational paradigms: (1) when fixating on the center, or (2) when fixating on the corner of the TSLO imaging raster. Fixational saccade amplitude in recent concussion patients (≤ 21 days) was significantly greater, on average, in the concussion group (mean = 1.03°; SD = 0.36°) compared with the controls (mean = 0.82°; SD = 0.31°), when fixating on the center of the imaging raster (t = 2.87, df = 82, p = 0.005). These fixational saccades followed the main sequence and therefore also had greater peak velocity (t = 2.86, df = 82, p = 0.006) and peak acceleration (t = 2.80, df = 82, p = 0.006). These metrics significantly differentiated concussed from controls (AUC = 0.67-0.68, minimum p = 0.005). No group differences were seen for the drift metrics in either task or for any of the FEMs metrics in the corner-of-raster fixation task. Fixational saccade amplitudes were significantly different in the concussion group, but only when fixating on the center of the raster. This task specificity suggests that task optimization may improve differentiation and warrants further study. FEMs measured in the acute-to-subacute period of concussion recovery may provide a quick (<3 minutes), objective, sensitive, and accurate ocular dysfunction assessment. Future work should assess the impact of age, mechanism of injury, and post-concussion recovery on FEM alterations following concussion.
Collapse
Affiliation(s)
- Bianca T Leonard
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,
| | - Anthony P Kontos
- Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA.,
| | | | - Min Zhang
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,
| | - Shawn R Eagle
- Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA.,
| | - Hope M Reecher
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,
| | - Ethan S Bensinger
- Vision Science Group, University of California, Berkeley, Berkeley, CA, USA.,
| | - Valerie C Snyder
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,
| | - Cyndi L Holland
- Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA.,
| | - Christy K Sheehy
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA.,
| | - Ethan A Rossi
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Department of Bioengineering, University of Pittsburgh Swanson School of Engineering, Pittsburgh, PA, USA., rossilab.org
| |
Collapse
|
11
|
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.
Collapse
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.
| | | | | | | | | | | | | | | |
Collapse
|
12
|
Abstract
OBJECTIVE The King-Devick (K-D) test is a rapid visual screening tool that can assess underlying brain trauma such as concussion via impairments in saccadic rhythm. A new tablet version of the K-D test using randomized numbers is now available, but reliability for this new version and comparison to the traditional K-D test has not yet been reported. Known for learning effects in the test, the aim of this study was to determine test-retest reliability and to compare performance of the new "randomized" version to the "traditional" K-D test version. We hypothesized that the "traditional" K-D test would show a greater rate of improvement with repeat application, compared with the "randomized" K-D test. METHODS Using a cross-sectional, repeated measures design in a healthy university student cohort (n = 96; age 21.6 ± 2.8 years; 49 women, 47 men), participants were required to complete the K-D test twice with a one-week break between testing sessions. Participants were randomly assigned into a "traditional" group, where they completed a test-retest of the established K-D protocol, using the same numbers; or the "randomized" group, where they completed test-retest protocol using 2 different sets of numbers. RESULTS Reliability testing showed a strong intraclass correlation coefficient for both the "traditional" test group (control group; 0.95 [CI: 0.91-0.97]) and the "randomized test group" (0.97 [CI: 0.95-0.98]). However, contrary to our hypothesis, no differences were found between "traditional" and "randomized" groups for baseline (control: 42.5 seconds [CI: 40.2-44.9 s] vs randomized: 41.5 [38.7-44.4], P = 0.23) and repeated testing between groups (control: 40.0 seconds [37.9-42.1 s] vs randomized: 39.5 [36.9-42.0], P = 0.55), with both groups showing improved times with repeated testing (control: 2.1 seconds [CI: 1.1-3.2 seconds] and randomized: 1.9 seconds CI: [0.9-2.9 seconds], P < 0.001). CONCLUSIONS The "randomized" version of the K-D test, using different sets of numbers, demonstrates good reliability that is comparable to the traditional K-D testing protocol that uses the same number sets. However, similar to the "traditional" K-D test, learning effects were also observed in the "randomized" test, suggesting that learning effects are not because of content memorization, but rather familiarity of the test. As a result, although either test format is suitable for sideline concussion screening or return to play decisions, comparison of data should be made to the individual's baseline rather than to normative data sets.
Collapse
|
13
|
Jasinovic T, Burma JS, Cameron B, Lun V, van Rassel CR, Sutter B, Wiley JP, Schneider KJ. The effect of high-intensity physical exertion on measures of cervical spine, vestibular/ocular-motor screening, and vestibulo-ocular reflex function in university level collision and combative sport athletes. Phys Ther Sport 2021; 51:36-44. [PMID: 34225057 DOI: 10.1016/j.ptsp.2021.06.008] [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] [Received: 06/01/2020] [Revised: 06/18/2021] [Accepted: 06/25/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To examine how high-intensity physical exertion affects clinical measures of cervical spine (CSp), vestibular/ocular motor screen (VOMS), and vestibulo-ocular reflex (VOR) function. DESIGN Case series. SETTING Sports Medicine Centre. PARTICIPANTS A total of 37 athletes consented to participate (22 rugby, 15 wrestling; 9 men, 28 women; median age = 19 years [range 17-23 years]). MAIN OUTCOME MEASURES Outcome measures included tests of CSp (cervical flexor endurance, head perturbation test, cervical flexion rotation test and anterolateral strength), VOR (head thrust test and dynamic visual acuity [DVA]), and a quantified version of the VOMS. These metrics were assessed prior to and after completing the 30-15 Intermittent Fitness Test. Bland-Altman plots and Wilcoxon signed-rank tests were utilized to analyze the data using an alpha of p < 0.004. RESULTS Cervical anterolateral strength (kg) was reduced post-exertion on the left (z = 3.87; p < 0.001), but not on the right between conditions (z = -1.49; p = 0.14). Athletes reported increased dizziness (z = -3.55; p = 0.004) and had reduced DVA following exertion (z = -2.78; p < 0.001). All other metrics were not significantly different following exertion (p > 0.011). CONCLUSION Reduced performance on DVA, decreased left-anterolateral strength, and increased dizziness occurred following high-intensity exertion in varsity collision and combative athletes, which has implications for sideline screening for sport-related concussion.
Collapse
Affiliation(s)
- Tin Jasinovic
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Joel S Burma
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Ben Cameron
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; University of Calgary Sport Medicine Center, Faculty of Kinesiology, Calgary, AB, Canada
| | - Victor Lun
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; University of Calgary Sport Medicine Center, Faculty of Kinesiology, Calgary, AB, Canada
| | - Cody R van Rassel
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Bonnie Sutter
- University of Calgary Sport Medicine Center, Faculty of Kinesiology, Calgary, AB, Canada
| | - J Preston Wiley
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada; University of Calgary Sport Medicine Center, Faculty of Kinesiology, Calgary, AB, Canada
| | - Kathryn J Schneider
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; University of Calgary Sport Medicine Center, Faculty of Kinesiology, Calgary, AB, Canada; Alberta Children's Hospital Research Institute, Cumming School of Medicine, Calgary, AB, Canada.
| |
Collapse
|
14
|
Scheiman M, Grady MF, Jenewein E, Shoge R, Podolak OE, Howell DH, Master CL. Frequency of oculomotor disorders in adolescents 11 to 17 years of age with concussion, 4 to 12 weeks post injury. Vision Res 2021; 183:73-80. [PMID: 33735759 DOI: 10.1016/j.visres.2020.09.011] [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] [Received: 03/11/2020] [Revised: 08/31/2020] [Accepted: 09/03/2020] [Indexed: 10/21/2022]
Abstract
The purpose of the study was to determine the frequency of vision diagnoses after concussion in adolescents and evaluate the sensitivity and specificity of physician-administered screening for detecting convergence and accommodative disorders post-concussion. We enrolled participants 11 to 17 years old, assessed 4 to 12 weeks following a diagnosed concussion. During the initial concussion examination, a sports medicine physician measured the near point of convergence (NPC), monocular accommodative amplitude (AA), and symptoms using the Convergence Insufficiency Symptom Survey (CISS). A comprehensive oculomotor evaluation was performed by an optometrist. One hundred and thirteen adolescents were enrolled, with a mean age of 15.2 years. Seventy-nine of the 113 (70%) participants had at least one oculomotor diagnosis after concussion, with the most common problems being vergence disorders (60%) and accommodative disorders (57%). The most common vergence disorder was convergence insufficiency (35%). Among accommodative disorders, the most common problem was accommodative insufficiency (35%). In all, 47% of the participants had more than one oculomotor diagnosis following concussion. The sensitivity of physician screening using measures of NPC, AA, and CISS for detecting convergence and accommodative insufficiency was 63%, 43%, 48%, respectively. The results of this study provide additional evidence that vision problems are common in adolescents with persistent concussion symptoms in the sub-acute phase 4 to 12 weeks post-concussion, and current physician screening methods using the NPC, AA, or the CISS underperform. Thus, it is prudent that adolescents with post-concussion symptoms lasting more than 4 weeks post injury receive a comprehensive oculomotor examination.
Collapse
Affiliation(s)
- Mitchell Scheiman
- Pennsylvania College of Optometry at Salus University, Elkins Park, PA, United States.
| | - Matthew F Grady
- Divisions of Orthopedics and General Pediatrics, The Children's Hospital of Philadelphia, 3400 Civic Center Boulevard, Philadelphia, PA 19104, United States; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States; Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Erin Jenewein
- Pennsylvania College of Optometry at Salus University, Elkins Park, PA, United States
| | - Ruth Shoge
- Pennsylvania College of Optometry at Salus University, Elkins Park, PA, United States
| | - Olivia E Podolak
- Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - David H Howell
- Children's Hospital Colorado, Sports Medicine Center, University of Colorado School of Medicine, Department of Orthopedics Aurora, CO, United States
| | - Christina L Master
- Divisions of Orthopedics and General Pediatrics, The Children's Hospital of Philadelphia, 3400 Civic Center Boulevard, Philadelphia, PA 19104, United States; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States; Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
| |
Collapse
|
15
|
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.
Collapse
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
| |
Collapse
|
16
|
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
| |
Collapse
|
17
|
Ernst N, Schatz P, Trbovich AM, Emami K, Eagle SR, Mucha A, Collins MW, Kontos AP. Utility of 1 Measurement Versus Multiple Measurements of Near Point of Convergence After Concussion. J Athl Train 2021; 55:850-855. [PMID: 32577736 DOI: 10.4085/1062-6050-431-19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Increased near point of convergence (NPC) distance is a common finding after concussion and is associated with physical symptoms and worsened neurocognitive performance. Vestibular/Ocular Motor Screening measures NPC distance across 3 trials and uses the average measurement to inform clinical care. However, whether 3 trials are necessary, are consistent, or add clinical utility is unknown. OBJECTIVE To investigate the consistency across 3 trials of NPC and establish the classification accuracy (ie, clinical utility) of 1 or 2 trials compared with the standardized average of 3 trials. DESIGN Retrospective cohort study. SETTING Sports medicine clinic and research laboratory. PATIENTS OR OTHER PARTICIPANTS Consecutively enrolled patients aged 10 to 22 years with diagnosed concussions (74% sport related; n = 380). MAIN OUTCOME MEASURE(S) The previously reported clinical cutoff value of ≥5 cm across 3 trials was used. Pearson correlation and intraclass correlation coefficients were used to evaluate agreement between trials and average scores. Reliable change indices (RCIs) using 95% confidence intervals were also calculated. RESULTS The Pearson correlation (r = .98) and intraclass correlation (0.98) coefficients revealed excellent agreement between the first measurement and average NPC distance across 3 measurements. The RCI across all trials was 2 cm. When the first NPC measurement was ≤3 cm or ≥7 cm, agreement existed within the RCI between the first measurement and the average of 3 measurements in 99.6% of cases. When we averaged the first and second measurements, 379/380 (99.7%) participants had the same classification (ie, <5 cm = normal, ≥5 cm = abnormal) as the average NPC distance across 3 measurements. CONCLUSIONS Our findings suggest limited utility of multiple or average NPC distance measurements when the initial NPC distance is outside of RCI clinical cutoffs (ie, ≤3 cm or ≥7 cm). Given the high consistency between the first measurement and average NPC distance across 3 trials, only 1 measurement of NPC distance is warranted unless the first measurement is between 3 and 7 cm.
Collapse
Affiliation(s)
- Nathan Ernst
- Department of Orthopaedic Surgery, University of Pittsburgh, PA.,UPMC Sports Medicine Concussion Program, University of Pittsburgh, PA
| | | | - Alicia M Trbovich
- Department of Orthopaedic Surgery, University of Pittsburgh, PA.,UPMC Sports Medicine Concussion Program, University of Pittsburgh, PA
| | - Kouros Emami
- Department of Orthopaedic Surgery, University of Pittsburgh, PA.,UPMC Sports Medicine Concussion Program, University of Pittsburgh, PA
| | - Shawn R Eagle
- Department of Orthopaedic Surgery, University of Pittsburgh, PA
| | - Anne Mucha
- UPMC Center for Rehab Services, University of Pittsburgh, PA
| | - Michael W Collins
- Department of Orthopaedic Surgery, University of Pittsburgh, PA.,UPMC Sports Medicine Concussion Program, University of Pittsburgh, PA
| | - Anthony P Kontos
- Department of Orthopaedic Surgery, University of Pittsburgh, PA.,UPMC Sports Medicine Concussion Program, University of Pittsburgh, PA
| |
Collapse
|
18
|
Hunfalvay M, Murray NP, Carrick FR. Fixation stability as a biomarker for differentiating mild traumatic brain injury from age matched controls in pediatrics. Brain Inj 2020; 35:209-214. [PMID: 33356610 DOI: 10.1080/02699052.2020.1865566] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Traumatic brain injury (TBI) is an increasingly significant health concern worldwide, compounded by the difficultly in detection and diagnosis. Fortunately, a growing body of research has identified oculomotor behavior, specifically fixations, saccades and smooth pursuit eye movements as a promising endophenotype for neurotrauma. To date, limited research exists using fixation stability in a comparative study to indicate the presence of a mild TBI (mTBI), especially in the pediatric population. METHODS The present study examined data from 91 individuals clinically diagnosed with mTBI and a further 140 age- and gender-matched controls. They all completed the RightEye fixation stability test using a remote eye tracker. Participants were compared on five fixation metrics: Bivariate Contour Ellipse Area (BCEA), Convergence Point, Depth, Disassociated Phoria, and Targeting Displacement. RESULTS Results were analyzed using one-way univariate ANOVAs, ROC analysis, and stepwise logistic regression. BCEA results revealed significant differences between groups with the mTBI group showing a larger gaze spread, indicative of less ability to keep the eyes close to the target without deviating. CONCLUSIONS Fixation stability is detrimentally impacted by mTBI in pediatric patients, and the oculomotor test can be used to differentiate between those with and without an mTBI.
Collapse
Affiliation(s)
| | - Nicholas P Murray
- Department of Kinesiology, East Carolina University, Greensville, NC, USA
| | - Frederick Robert Carrick
- Centre for Mental Health Research in Association, University of Cambridge, Cambridge, UK.,University of Central Florida College of Medicine, Orlando, FL, USA.,MGH Institute of Health Professions, Boston, MA, USA
| |
Collapse
|
19
|
Gunasekaran P, Fraser CL, Hodge C. The learning effect of the King-Devick test in semi-professional rugby union athletes. J Neurol Sci 2020; 419:117168. [PMID: 33038568 DOI: 10.1016/j.jns.2020.117168] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/21/2020] [Accepted: 09/30/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Abnormalities of eye movement and visual processing are common in traumatic brain injury. The King-Devick test (KDT) has been widely used in the detection and recovery of concussion. Current recommendations propose performing the initial test at baseline and then repeating annually to account for potential learning effects. In practice, this may still account for large deviations. The aim of this study was to determine the number of trials needed for a player to achieve a ceiling effect and to determine the validity of the existing protocol requiring two tests at baseline. METHODS One hundred and eighty-three semi-professional male rugby union players (median age = 22.5 (21.0-25.3) years) were recruited. Over the duration, all athletes performed the KDT on an iPad, under standardised baseline procedures and then repeated the test based on availability during weekly in-season training. RESULTS The improvement through each repeated trial was 0.60 ± 0.1 s (P < 0.001). The ceiling effect was determined at 30 trials. A median difference of 4.2 s (range 0-14.9) was calculated between the initial and best trial overall, although the greatest difference occurred within the first eight attempts. There was a significant positive correlation between the initial test value and the difference between first and fastest time (P < 0.001, r = 0.455). CONCLUSION We have shown continuous improvement with repeated attempts which suggests that administrators ideally should continue to perform the KDT over the duration of the season to optimise the value of the test.
Collapse
Affiliation(s)
- Premkumar Gunasekaran
- Discipline of Orthoptics, Graduate School of Health, University of Technology Sydney, NSW, Australia.
| | - Clare L Fraser
- Save Sight Institute, Discipline of Ophthalmology, Faculty of Health and Medicine, The University of Sydney, NSW, Australia.
| | - Christopher Hodge
- Discipline of Orthoptics, Graduate School of Health, University of Technology Sydney, NSW, Australia; Save Sight Institute, Discipline of Ophthalmology, Faculty of Health and Medicine, The University of Sydney, NSW, Australia.
| |
Collapse
|
20
|
Hunfalvay M, Murray NP, Roberts CM, Tyagi A, Barclay KW, Carrick FR. Oculomotor Behavior as a Biomarker for Differentiating Pediatric Patients With Mild Traumatic Brain Injury and Age Matched Controls. Front Behav Neurosci 2020; 14:581819. [PMID: 33281574 PMCID: PMC7690212 DOI: 10.3389/fnbeh.2020.581819] [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: 07/09/2020] [Accepted: 10/07/2020] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE Children have the highest incidence of mild traumatic brain injury (mTBI) in the United States. However, mTBI, specifically pediatric patients with mTBI, are notoriously difficult to detect, and with a reliance on traditional, subjective measurements of eye movements, the subtle but key oculomotor deficits are often missed. OBJECTIVE The purpose of this project is to determine if the combined measurement of saccades, smooth pursuit, fixations and reaction time represent a biomarker for differentiating pediatric patients with mild traumatic brain injury compared to age matched controls. DESIGN This study used cross-sectional design. Each participant took part in a suite of tests collectively labeled the "Brain Health EyeQ" to measure saccades, smooth pursuit, fixations and reaction time. PARTICIPANTS The present study recruited 231 participants - 91 clinically diagnosed with a single incident mTBI in the last 2 days as assessed by both the Glasgow Coma Scale (GCS) and Graded Symptoms Checklist (GSC), and 140 age and gender-matched controls (n = 165 male, n = 66 female, M age = 14.20, SD = 2.78). RESULTS One-way univariate analyses of variance examined the differences in performance on the tests between participants with mTBI and controls. ROC curve analysis examined the sensitivity and specificity of the tests. Results indicated that together, the "Brain Health EyeQ" tests were successfully able to identify participants with mTBI 75.3% of the time, providing further validation to a growing body of literature supporting the use of eye tracking technology for mTBI identification and diagnosis.
Collapse
Affiliation(s)
| | - Nicholas P. Murray
- Department of Kinesiology, East Carolina University, Greensville, NC, United States
| | - Claire-Marie Roberts
- Health and Social Sciences, University of the West of England, Bristol, United Kingdom
| | | | | | - Frederick Robert Carrick
- Centre for Mental Health Research in association with University of Cambridge, Cambridge, United Kingdom
- College of Medicine, University of Central Florida, Orlando, FL, United States
- MGH Institute of Health Professions, Boston, MA, United States
| |
Collapse
|
21
|
Whitney SL, Eagle SR, Marchetti G, Mucha A, Collins MW, Kontos AP. Association of acute vestibular/ocular motor screening scores to prolonged recovery in collegiate athletes following sport-related concussion. Brain Inj 2020; 34:840-845. [DOI: 10.1080/02699052.2020.1755055] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Susan L. Whitney
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Shawn R. Eagle
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Gregory Marchetti
- Department of Physical Therapy, Duquesne University, Pittsburgh, Pennsylvania, USA
| | - Anne Mucha
- Centers for Rehabilitation Service, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Michael W. Collins
- Centers for Rehabilitation Service, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Anthony P. Kontos
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | |
Collapse
|
22
|
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.
Collapse
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
| |
Collapse
|
23
|
Hunfalvay M, Roberts CM, Murray NP, Tyagi A, Barclay KW, Bolte T, Kelly H, Carrick FR. Vertical smooth pursuit as a diagnostic marker of traumatic brain injury. Concussion 2020; 5:CNC69. [PMID: 32266081 PMCID: PMC7136983 DOI: 10.2217/cnc-2019-0013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 12/02/2019] [Indexed: 01/31/2023] Open
Abstract
AIM Neural deficits were measured via the eye tracking of vertical smooth pursuit (VSP) as markers of traumatic brain injury (TBI). The present study evaluated the ability of the eye tracking tests to differentiate between different levels of TBI severity and healthy controls. METHODOLOGY Ninety-two individuals divided into four groups (those with mild, moderate or severe TBI and healthy controls) participated in a computerized test of VSP eye movement using a remote eye tracker. RESULTS The VSP eye tracking test was able to distinguish between severe and moderate levels of TBI but unable to detect differences in the performance of participants with mild TBI and healthy controls. CONCLUSION The eye-tracking technology used to measure VSP eye movements is able to provide a timely and objective method of differentiating between individuals with moderate and severe levels of TBI.
Collapse
Affiliation(s)
- Melissa Hunfalvay
- RightEye LLC, 7979 Old Georgetown Rd, Suite 801, Bethesda, MD 20814, USA
| | - Claire-Marie Roberts
- Department of Psychology, Senior Research Fellow, University of the West of England, Coldharbour Lane, Bristol, BS16 1QY, England
| | - Nicholas P Murray
- Department of Kinesiology, East Carolina University, Minges Coliseum 166, Greensville, NC 27858, USA
| | - Ankur Tyagi
- RightEye LLC, 7979 Old Georgetown Rd, Suite 801, Bethesda, MD 20814, USA
| | - Kyle W Barclay
- Case Western Reserve University, 10501 Streamview Court, Potomac, MD 20854, USA
| | - Takumi Bolte
- RightEye LLC, 7979 Old Georgetown Rd, Suite 801, Bethesda, MD 20814, USA
| | - Hannah Kelly
- Emory University, 201 Dowman Dr, Atlanta, GA 30322, USA
| | - Frederick R Carrick
- Centre for Mental Health Research in association with University of Cambridge, Cambridge UK
- Department of Neurology, University of Central Florida College of Medicine, Orlando, FL 32827, USA
- MGH Institute for Health Professions, Boston, MA, USA
- Carrick Institute, Cape Canaveral, FL 32920, USA
| |
Collapse
|
24
|
McGinnis I, Tierney R, Mansell J, Phillips J. The Effect of Target Speed and Verbal Instruction on NPC Measures in a Young, Healthy, and Active Population. J Eye Mov Res 2019; 12. [PMID: 33828741 PMCID: PMC7880140 DOI: 10.16910/jemr.12.4.5] [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] [Indexed: 11/18/2022] Open
Abstract
Purpose: Evaluate the effect of target speed and verbal instruction on near point of convergence (NPC) measurements in a young, healthy, and active population. Methods: NPC was measured in 20 individuals with three target speeds and two sets of verbal instruction. The target speeds used were 1 cm/s, 3 cm/s, 5 cm/s, and participant self-paced. The verbal instruction given was either to indicate when the target became “double” or “blurry”. Results: Paired-samples t-tests revealed significant differences between 5 cm/s (5.44 ± 2.01) and 1 cm/s (6.72 ± 2.39, p = .003), 3 cm/s (6.10 ± 2.36, p = .030) and self-paced (6.63 ± 2.26, p = .005). A significant difference (p < .001) was also found between the “double” (6.72 ± 2.39) and “blurry” (10.82 ± 3.08) conditions. Conclusion: For young, healthy and active individuals, target speed and verbal instruction matter when measuring NPC.
Collapse
|
25
|
Raghuram A, Cotter SA, Gowrisankaran S, Kanji J, Howell DR, Meehan WP, Shah AS. Postconcussion: Receded Near Point of Convergence is not Diagnostic of Convergence Insufficiency. Am J Ophthalmol 2019; 206:235-244. [PMID: 31004592 DOI: 10.1016/j.ajo.2019.04.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 04/03/2019] [Accepted: 04/04/2019] [Indexed: 11/18/2022]
Abstract
PURPOSE To determine the frequency of occurrence of receded near point of convergence (NPC) in patients with chronic concussion-related symptoms and in those with receded NPC to enumerate the frequency of convergence insufficiency and other oculomotor disorders. DESIGN Retrospective cross-sectional study. METHODS Clinic charts were retrospectively reviewed for the prior 3.5 years to identify all patients < 21 years old who were > 28 days postconcussion, had chronic concussion-related symptoms, had normal visual acuity, and had received a comprehensive sensorimotor examination. The frequency of receded NPC and oculomotor diagnoses were determined. RESULTS Of the 83 eligible patients, 74 (89%) had receded NPC. Of these, 70 (95%) had oculomotor disorders; 30 (41%) had disorders of accommodation only; 21 (28%) had convergence insufficiency and accommodation deficits; and 6 (8%) had convergence insufficiency only. Six (8%) had a convergence deficit other than convergence insufficiency (all with concurrent accommodative disorders); 4 (5%) had both a nonspecific vergence dysfunction and accommodation deficits; 2 (3%) had convergence excess only; and 1 (1%) had both convergence excess and accommodative deficits. CONCLUSION A receded NPC was present in the majority of young patients with chronic postconcussion symptoms. Associated with numerous underlying oculomotor dysfunctions, the clinical finding of a receded NPC is not synonymous with the diagnosis of convergence insufficiency. Because treatment options for the various oculomotor dysfunctions differ, it is prudent that these patients undergo a thorough examination of their vergence and accommodative systems so that an accurate diagnosis can be made and appropriate treatment prescribed.
Collapse
Affiliation(s)
- Aparna Raghuram
- Department of Ophthalmology, Boston Children's Hospital, Boston, MA, USA; Department of Ophthalmology, Harvard Medical School, Boston, MA, USA.
| | - Susan A Cotter
- Southern California College of Optometry, Marshall B. Ketchum University, Fullerton, CA, USA
| | | | - Jameel Kanji
- New England College of Optometry, Boston, MA, USA
| | - David R Howell
- The Micheli Center for Sports Injury Prevention, Waltham, MA, USA; Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, MA, USA; Brain Injury Center, Boston Children's Hospital, Boston, MA, USA
| | - William P Meehan
- The Micheli Center for Sports Injury Prevention, Waltham, MA, USA; Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, MA, USA; Brain Injury Center, Boston Children's Hospital, Boston, MA, USA; Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Ankoor S Shah
- Department of Ophthalmology, Boston Children's Hospital, Boston, MA, USA; Department of Ophthalmology, Harvard Medical School, Boston, MA, USA; Department of Ophthalmology, Massachusetts Eye and Ear, Boston, MA, USA
| |
Collapse
|
26
|
Hunfalvay M, Roberts CM, Murray N, Tyagi A, Kelly H, Bolte T. Horizontal and vertical self-paced saccades as a diagnostic marker of traumatic brain injury. Concussion 2019; 4:CNC60. [PMID: 31467684 PMCID: PMC6714073 DOI: 10.2217/cnc-2019-0001] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: Eye tracking tests to measure horizontal and vertical saccades as a proxy for neural deficits associated with traumatic brain injury (TBI) were evaluated in the present study. Methodology: A total of 287 participants reporting either no TBI, mild, moderate or severe TBI participated in a suite of eye tracking tests to measure horizontal and vertical saccadic performance. Results: The horizontal saccades test offered a sensitivity of 0.77 and a specificity of 0.78, similarly the vertical saccades tests offered a sensitivity of 0.64 and a specificity of 0.65. Conclusion: The results indicated that using eye-tracking technology to measure these metrics offers an objective, reliable and quantifiable way of differentiating between individuals with different severities of TBI, and those without a TBI.
Collapse
Affiliation(s)
- Melissa Hunfalvay
- RightEye LLC, 7979 Old Georgetown Rd, Suite 801, Bethesda, MD 20814, USA
| | - Claire-Marie Roberts
- University of the West of England, Department of Psychology, Bristol, Coldharbour Lane, Bristol, BS16 1QY, UK
| | - Nick Murray
- East Carolina University, College of Health & Human Performance, Minges Coliseum 166, Greenville, NC 27858, USA
| | - Ankur Tyagi
- RightEye LLC, 7979 Old Georgetown Rd, Suite 801, Bethesda, MD 20814, USA
| | - Hannah Kelly
- Emory University, Health Sciences, 201 Dowman Dr, Atlanta, GA 30322, USA
| | - Takumi Bolte
- RightEye LLC, 7979 Old Georgetown Rd, Suite 801, Bethesda, MD 20814, USA
| |
Collapse
|
27
|
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.
Collapse
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
| | | | | | | | | | | |
Collapse
|
28
|
Pearce AJ, Tommerdahl M, King DA. Neurophysiological abnormalities in individuals with persistent post-concussion symptoms. Neuroscience 2019; 408:272-281. [PMID: 31004695 DOI: 10.1016/j.neuroscience.2019.04.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 04/07/2019] [Accepted: 04/08/2019] [Indexed: 10/27/2022]
Abstract
Concussion injury results in a rapid onset of transient neurological impairment that can resolve quickly, or sometimes evolve over time, but usually resolve within seven to 10 days. However, a small but noticeable cohort (~10%) of individuals continues to experience persistent lingering effects, particularly fatigue, recognized as post-concussion symptoms (PCS). This study explored neurophysiological mechanisms in people with persistent PCS. Studies involved using self-report post-concussion fatigue scale, transcranial magnetic stimulation (TMS) and somatosensory stimulation in those with diagnosed PCS (n = 20; 36.1 ± 14.0 yr., 4 female; mean time post-concussion 15.4 ± 7.6 months) to fully recovered individuals (n = 20; 33.8 ± 6.6 yr., 2 female; post-concussion 12.9 ± 6.6 months) and healthy controls (n = 20; 37.7 ± 8.0 yr., 3 female). PCS participants demonstrated a significantly higher self-report fatigue (score: PCS 20.2 [95% CI 17.4-22.9], Recovered 6.2 [3.1-9.3], Control 2.75 [0.6-4.8]). PCS participants showed a worsening of reaction time (F2,57 = 4.214; p = 0.020) and increased reaction time variability (F2,57 = 5.505; p = 0.007). Somatosensory differences were observed for amplitude discrimination (F2,57 = 5.166; p = 0.009), temporal order judgment (F2,57 = 4.606; p = 0.014) and duration discrimination (F2,57 = 6.081; p = 0.004). Increased intracortical inhibition in TMS single pulse suprathreshold stimulation (110%: F2,57 = 6.842; p = 0.002; 130%: F2,57 = 4.900; p = 0.011; 150%: F2,57 = 4.638; p = 0.014; 170%: F2,57 = 9.845; p < 0.001) and paired pulse protocols was also seen (SICI: F2,57 = 23.390; p < 0.001, and LICI: F2,57 = 21.603; p < 0.001). Using non-invasive stimulation techniques, this novel study showed increased cortical inhibition and compromised central information processing, suggesting neural mechanisms underpinning ongoing fatigue, allowing for potential clinical rehabilitation strategies.
Collapse
Affiliation(s)
- Alan J Pearce
- School of Allied Health, La Trobe University, Bundoora, Melbourne, Australia.
| | - Mark Tommerdahl
- Department of Biomedical Engineering, University of North Carolina, Chapel Hill, NC, USA
| | - Doug A King
- Sports Performance Research Institute New Zealand (SPRINZ), Faculty of Health and Environmental Science Auckland University of Technology, Auckland, New Zealand
| |
Collapse
|
29
|
Corbin-Berrigan LA, Kowalski K, Faubert J, Christie B, Gagnon I. Three-dimensional multiple object tracking in the pediatric population: the NeuroTracker and its promising role in the management of mild traumatic brain injury. Neuroreport 2019; 29:559-563. [PMID: 29481522 DOI: 10.1097/wnr.0000000000000988] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
As mild traumatic brain injury (mTBI) affects hundreds of thousands of children and their families each year, investigation of potential mTBI assessments and treatments is an important research target. Three-dimensional multiple object tracking (3D-MOT), where an individual must allocate attention to moving objects within 3D space, is one potentially promising assessment and treatment tool. To date, no research has looked at 3D-MOT in a pediatric mTBI population. Thus, the aim of this study was to examine 3D-MOT learning in children and youth with and without mTBI. Thirty-four participants (mean age=14.69±2.46 years), with and without mTBI, underwent six visits of 3D-MOT. A two-way repeated-measures analysis of variance (ANOVA) showed a significant time effect, a nonsignificant group effect, and a nonsignificant group-by-time interaction on absolute speed thresholds. In contrast, significant group and time effects and a significant group-by-time interaction on normalized speed thresholds were found. Individuals with mTBI showed smaller training gains at visit 2 than healthy controls, but the groups did not differ on the remaining visits. Although youth can significantly improve their 3D-MOT performance following mTBI, similar to noninjured individuals, they show slower speed of processing in the first few training sessions. This preliminary work suggests that using a 3D-MOT paradigm to train visual perception after mTBI may be beneficial for both stimulating recovery and informing return to activity decisions.
Collapse
Affiliation(s)
| | | | | | - Brian Christie
- University of Victoria, Victoria, British Columbia, Canada
| | - Isabelle Gagnon
- School of Physical and Occupational Therapy/Pediatric Emergency Medicine, McGill University.,Trauma/Montreal Children's Hospital, Montréal, Quebec
| |
Collapse
|
30
|
Cochrane GD, Christy JB, Almutairi A, Busettini C, Swanson MW, Weise KK. Visuo-oculomotor Function and Reaction Times in Athletes with and without Concussion. Optom Vis Sci 2019; 96:256-265. [PMID: 30907863 PMCID: PMC6445703 DOI: 10.1097/opx.0000000000001364] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
SIGNIFICANCE Oculomotor tests in concussion commonly show impairment in smooth pursuit and saccadic function. Honing in on the systems likely to be affected by concussion will streamline use of oculomotor function as a supplemental diagnostic and prognostic tool, as well as improve our understanding of the pathophysiology of concussion. PURPOSE This study investigates oculomotor function between concussed and healthy collegiate athletes and determines measurement test-retest reliability of those tools. METHODS Eighty-seven healthy athletes were recruited from a U.S. Division 1 sports university and completed a 30-minute vestibular ocular testing battery in an enclosed rotary chair system equipped with 100-Hz eye-tracking goggles. Forty-three individuals completed the battery twice. Twenty-eight individuals with a current diagnosis of concussion also completed the battery. All participants were aged 18 to 24 years. Bivariate statistical tests examined differences in scores across groups, and intraclass coefficients were computed to test reliability. RESULTS Concussed individuals had significantly longer saccadic, visual, and dual-task reaction times and reduced saccadic accuracy. There was no difference in optokinetic reflex gain, but few concussed individuals tolerated the task. Reaction time latencies and optokinetic gain show moderate test-retest reliability. Smooth pursuit tasks and saccadic accuracies showed poor test-retest reliability. CONCLUSIONS Saccadic latency was the most sensitive oculomotor function to change after concussion and was reliable over time. Saccadic accuracy was significantly lower in the concussed group but had poor retest reliability. Optokinetic gain may warrant more investigation because of its high test-retest reliability and symptom provocation in concussion, despite not showing a significant difference between groups.
Collapse
Affiliation(s)
| | - Jennifer B Christy
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, Alabama
| | - Anwar Almutairi
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, Alabama
| | - Claudio Busettini
- Department of Optometry and Vision Science, University of Alabama at Birmingham, Birmingham, Alabama
- Vision Science Research Center, University of Alabama at Birmingham, Birmingham, Alabama
| | - Mark W Swanson
- Department of Optometry and Vision Science, University of Alabama at Birmingham, Birmingham, Alabama
| | - Katherine K Weise
- Department of Optometry and Vision Science, University of Alabama at Birmingham, Birmingham, Alabama
| |
Collapse
|
31
|
Akhand O, Rizzo JR, Rucker JC, Hasanaj L, Galetta SL, Balcer LJ. History and Future Directions of Vision Testing in Head Trauma. J Neuroophthalmol 2019; 39:68-81. [DOI: 10.1097/wno.0000000000000726] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
32
|
|
33
|
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]
|
34
|
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.
Collapse
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
| |
Collapse
|
35
|
Leddy JJ, Baker JG, Willer B. Active Rehabilitation of Concussion and Post-concussion Syndrome. Phys Med Rehabil Clin N Am 2018; 27:437-54. [PMID: 27154855 DOI: 10.1016/j.pmr.2015.12.003] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Concussion is a physiological brain injury with physical, cognitive, and emotional sequelae. The macrophysiological insult to the brain affects the autonomic nervous system and its control of cerebral blood flow. Most patients recover within 2 weeks, but some do not. Persistence of symptoms beyond the generally accepted time frame for recovery is called post-concussion syndrome (PCS). PCS is not a single entity; it is a group of disorders that requires specific forms of therapy. Rest has been the mainstay of the treatment for concussion and PCS. This article discusses the rationale for the active treatment of concussion and PCS.
Collapse
Affiliation(s)
- John J Leddy
- UBMD Department of Orthopaedics and Sports Medicine, SUNY Buffalo, 160 Farber Hall, Buffalo, NY 14214, USA.
| | - John G Baker
- UBMD Department of Orthopaedics and Sports Medicine and Nuclear Medicine, Jacobs School of Medicine and Biomedical Sciences, School of Social Work, University at Buffalo, Buffalo, NY, USA
| | - Barry Willer
- Department of Psychiatry, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| |
Collapse
|
36
|
Wright WG, Handy JD, Avcu P, Ortiz A, Haran FJ, Doria M, Servatius RJ. Healthy Active Duty Military with Lifetime Experience of Mild Traumatic Brain Injury Exhibits Subtle Deficits in Sensory Reactivity and Sensory Integration During Static Balance. Mil Med 2018; 183:313-320. [DOI: 10.1093/milmed/usx182] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- W Geoffrey Wright
- Neuromotor Sciences Program, College of Public Health, Temple University, 1800 N. Broad St., Philadelphia, PA
- Department of Veterans Affairs, Syracuse Veterans Affairs Medical Center, 800 Irving Ave., Syracuse, NY
| | - Justin D Handy
- Department of Veterans Affairs, Syracuse Veterans Affairs Medical Center, 800 Irving Ave., Syracuse, NY
| | - Pelin Avcu
- Rutgers Biomedical Health Sciences, Stress and Motivated Behavior Institute, Rutgers University, 65 Bergen St., Newark, NJ
| | - Alejandro Ortiz
- Department of Veterans Affairs, Syracuse Veterans Affairs Medical Center, 800 Irving Ave., Syracuse, NY
| | - F Jay Haran
- Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd., Bethesda, MD
| | - Michael Doria
- U.S. Coast Guard Headquarters, 2701 Martin Luther King Jr Ave SE, Washington DC
| | - Richard J Servatius
- Department of Veterans Affairs, Syracuse Veterans Affairs Medical Center, 800 Irving Ave., Syracuse, NY
- Rutgers Biomedical Health Sciences, Stress and Motivated Behavior Institute, Rutgers University, 65 Bergen St., Newark, NJ
| |
Collapse
|
37
|
Oculomotor-Based Vision Assessment in Mild Traumatic Brain Injury: A Systematic Review. J Head Trauma Rehabil 2018; 31:252-61. [PMID: 26291632 DOI: 10.1097/htr.0000000000000174] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this article is to synthesize and appraise the evidence regarding the use of oculomotor-based vision assessment to identify and monitor recovery from mild traumatic brain injury (mTBI). Specific objectives are to (1) identify changes in oculomotor-based vision following mTBI; (2) distinguish methods of assessment; (3) appraise the level and quality of evidence; and, if warranted, (4) determine clinical recommendations for assessment. METHODS A systematic review was undertaken to identify and appraise relevant literature. A search was conducted of 7 databases of peer-reviewed literature from January 1990 to January 2015. Articles were included if study populations were clearly identified as having mTBI and used an assessment of oculomotor-based vision. Articles with pooled data (eg, mTBI and stroke), addressing afferent visual function (eg, visual field deficits) or using single case designs, were excluded. RESULTS Twenty articles were selected for inclusion. Exploratory findings suggest that measurements of saccades, smooth pursuit, and vergence are useful in detecting changes associated with mTBI. Assessment methods included eye tracker protocols, optometric assessment, and the King-Devick test. CONCLUSION The strength of this evidence is not yet sufficient to warrant clinical recommendations. Research using rigorous methods is required to develop reliable, valid, and clinically useful assessment protocols.
Collapse
|
38
|
Abstract
Sport concussion (SC) has emerged as a major health concern in the medical community and general public owing to increased research and media attention, which has primarily focused on male athletes. Female athletes have an equal, if not increased, susceptibility to SC. An ever-growing body of research continues to compare male and female athletes in terms of SC before and after an injury. Clinicians must be cognizant of this literature to make evidence-based clinical decision when providing care to female athletes and discern between dated and/or unsupported claims in terms of SC.
Collapse
Affiliation(s)
- Jacob E Resch
- Department of Kinesiology, University of Virginia, 210 Emmet Street South, Charlottesville, VA 22904, USA.
| | - Amanda Rach
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, 1300 Jefferson Park Avenue, Charlottesville, VA 22908, USA
| | - Samuel Walton
- Department of Kinesiology, University of Virginia, 210 Emmet Street South, Charlottesville, VA 22904, USA
| | - Donna K Broshek
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, 1300 Jefferson Park Avenue, Charlottesville, VA 22908, USA
| |
Collapse
|
39
|
Debacker J, Ventura R, Galetta SL, Balcer LJ, Rucker JC. Neuro-ophthalmologic disorders following concussion. HANDBOOK OF CLINICAL NEUROLOGY 2018; 158:145-152. [PMID: 30482342 DOI: 10.1016/b978-0-444-63954-7.00015-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Visual symptoms, such as photophobia and blurred vision, are common in patients with concussion. Such symptoms may be accompanied by abnormalities of specific eye movements, such as saccades and convergence, or accommodation deficits. The high frequency of visual involvement in concussion is not surprising, since more than half of the brain's pathways are dedicated to vision and eye movement control. These areas include many that are most vulnerable to head trauma, including the frontal and temporal lobes. Vision and eye movement testing is important at the bedside and on the sidelines of athletic events, where brief performance measures that require eye movements, such as rapid number naming, are reliable and sensitive measures for concussion detection. Tests of vision and eye movements are also being explored clinically to identify and monitor patients with symptoms of both sport- and nonsport-related concussion. Evaluation of vision and eye movements can assist in making important decisions after concussion, including the prognosis for symptom recovery, and to direct further visual rehabilitation as necessary.
Collapse
Affiliation(s)
- Julie Debacker
- Department of Neurology, NYU School of Medicine, New York, NY, United States
| | - Rachel Ventura
- Department of Neurology, NYU School of Medicine, New York, NY, United States
| | - Steven L Galetta
- Department of Neurology, NYU School of Medicine, New York, NY, United States; Ophthalmology, NYU School of Medicine, New York, NY, United States
| | - Laura J Balcer
- Department of Neurology, NYU School of Medicine, New York, NY, United States; Ophthalmology, NYU School of Medicine, New York, NY, United States; Population Health, NYU School ofMedicine, New York, NY, United States
| | - Janet C Rucker
- Department of Neurology, NYU School of Medicine, New York, NY, United States; Ophthalmology, NYU School of Medicine, New York, NY, United States.
| |
Collapse
|
40
|
Thomas RE, Alves J, Vaska Mlis MM, Magalhaes R. Therapy and rehabilitation of mild brain injury/concussion: Systematic review. Restor Neurol Neurosci 2017; 35:643-666. [DOI: 10.3233/rnn-170761] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Roger E. Thomas
- Department of Family Medicine, Faculty of Medicine, Health Sciences Centre, University of Calgary, Calgary, AB, Canada
| | - Jorge Alves
- CEREBRO – Brain Health Center, Braga, Portugal
| | | | - Rosana Magalhaes
- Instituto de Psicologia e Ciências da Educação, Universidade Lusíada – Norte (Porto), Porto, Portugal
| |
Collapse
|
41
|
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.
Collapse
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
| |
Collapse
|
42
|
Dhawan PS, Leong D, Tapsell L, Starling AJ, Galetta SL, Balcer LJ, Overall TL, Adler JS, Halker-Singh RB, Vargas BB, Dodick D. King-Devick Test identifies real-time concussion and asymptomatic concussion in youth athletes. Neurol Clin Pract 2017; 7:464-473. [PMID: 29431168 DOI: 10.1212/cpj.0000000000000381] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Sports concussion has an annual incidence of approximately 3.8 million. Over half go unreported and a substantial number may be asymptomatic. A rapid, cost-effective, and reliable tool that facilitates diagnosis of concussion is needed. The King-Devick (K-D) test is a vision-based tool of rapid number naming for assessment of concussion. In this study, we evaluated the utility of the K-D test in real time for identification of symptomatic concussion in youth athletes and to determine if similar impairment (subclinical concussion) exists in youth athletes without an obvious head injury or symptoms. Methods Youth hockey players underwent K-D testing preseason, postseason, and immediately after suspected concussion. Additional testing was performed in a subgroup of nonconcussed athletes immediately before and after a game to determine effects of fatigue on K-D scores. Results Among 141 players tested, 20 had clinically diagnosed concussion. All 20 had immediate postconcussion K-D times >5 seconds from baseline (average 7.3 seconds) and all but 2 had worse postseason scores (46.4 seconds vs 52.4 seconds, p < 0.05, Wilcoxon signed rank test). Nonconcussed athletes saw minimal improvement postseason (43.9 seconds vs 42.1 seconds, p < 0.05) and 51 nonconcussed players assessed before and after a game revealed no significant time change as a result of fatigue. Conclusions Rapid number naming using the K-D test accurately identifies real-time, symptomatic concussion in youth athletes. Scores in concussed players may remain abnormal over time. Athletes should undergo preseason and postseason K-D testing, with additional evaluation real time to inform the assessment of suspected concussion. Classification of Evidence This study provides Class III evidence that the K-D test accurately identifies real-time concussions in youth athletes.
Collapse
Affiliation(s)
- Priya S Dhawan
- Department of Neurology (PSD, LT, AJS, TLO, RBH-S, BBV, DD), Mayo Clinic Arizona, Phoenix; King-Devick Test, Inc. (DL), Oakbrook Terrace, IL; Departments of Neurology (SLG, LJB), Ophthalmology (SLG, LJB), and Population Health (LJB), New York University Langone Medical Center, New York; Departments of Neurology (SLG, LJB) and Biostatistics and Epidemiology (LJB), University of Pennsylvania School of Medicine, Philadelphia; and University of Arizona (JSA), Scottsdale
| | - Danielle Leong
- Department of Neurology (PSD, LT, AJS, TLO, RBH-S, BBV, DD), Mayo Clinic Arizona, Phoenix; King-Devick Test, Inc. (DL), Oakbrook Terrace, IL; Departments of Neurology (SLG, LJB), Ophthalmology (SLG, LJB), and Population Health (LJB), New York University Langone Medical Center, New York; Departments of Neurology (SLG, LJB) and Biostatistics and Epidemiology (LJB), University of Pennsylvania School of Medicine, Philadelphia; and University of Arizona (JSA), Scottsdale
| | - Lisa Tapsell
- Department of Neurology (PSD, LT, AJS, TLO, RBH-S, BBV, DD), Mayo Clinic Arizona, Phoenix; King-Devick Test, Inc. (DL), Oakbrook Terrace, IL; Departments of Neurology (SLG, LJB), Ophthalmology (SLG, LJB), and Population Health (LJB), New York University Langone Medical Center, New York; Departments of Neurology (SLG, LJB) and Biostatistics and Epidemiology (LJB), University of Pennsylvania School of Medicine, Philadelphia; and University of Arizona (JSA), Scottsdale
| | - Amaal J Starling
- Department of Neurology (PSD, LT, AJS, TLO, RBH-S, BBV, DD), Mayo Clinic Arizona, Phoenix; King-Devick Test, Inc. (DL), Oakbrook Terrace, IL; Departments of Neurology (SLG, LJB), Ophthalmology (SLG, LJB), and Population Health (LJB), New York University Langone Medical Center, New York; Departments of Neurology (SLG, LJB) and Biostatistics and Epidemiology (LJB), University of Pennsylvania School of Medicine, Philadelphia; and University of Arizona (JSA), Scottsdale
| | - Steven L Galetta
- Department of Neurology (PSD, LT, AJS, TLO, RBH-S, BBV, DD), Mayo Clinic Arizona, Phoenix; King-Devick Test, Inc. (DL), Oakbrook Terrace, IL; Departments of Neurology (SLG, LJB), Ophthalmology (SLG, LJB), and Population Health (LJB), New York University Langone Medical Center, New York; Departments of Neurology (SLG, LJB) and Biostatistics and Epidemiology (LJB), University of Pennsylvania School of Medicine, Philadelphia; and University of Arizona (JSA), Scottsdale
| | - Laura J Balcer
- Department of Neurology (PSD, LT, AJS, TLO, RBH-S, BBV, DD), Mayo Clinic Arizona, Phoenix; King-Devick Test, Inc. (DL), Oakbrook Terrace, IL; Departments of Neurology (SLG, LJB), Ophthalmology (SLG, LJB), and Population Health (LJB), New York University Langone Medical Center, New York; Departments of Neurology (SLG, LJB) and Biostatistics and Epidemiology (LJB), University of Pennsylvania School of Medicine, Philadelphia; and University of Arizona (JSA), Scottsdale
| | - Trenton L Overall
- Department of Neurology (PSD, LT, AJS, TLO, RBH-S, BBV, DD), Mayo Clinic Arizona, Phoenix; King-Devick Test, Inc. (DL), Oakbrook Terrace, IL; Departments of Neurology (SLG, LJB), Ophthalmology (SLG, LJB), and Population Health (LJB), New York University Langone Medical Center, New York; Departments of Neurology (SLG, LJB) and Biostatistics and Epidemiology (LJB), University of Pennsylvania School of Medicine, Philadelphia; and University of Arizona (JSA), Scottsdale
| | - Jennifer S Adler
- Department of Neurology (PSD, LT, AJS, TLO, RBH-S, BBV, DD), Mayo Clinic Arizona, Phoenix; King-Devick Test, Inc. (DL), Oakbrook Terrace, IL; Departments of Neurology (SLG, LJB), Ophthalmology (SLG, LJB), and Population Health (LJB), New York University Langone Medical Center, New York; Departments of Neurology (SLG, LJB) and Biostatistics and Epidemiology (LJB), University of Pennsylvania School of Medicine, Philadelphia; and University of Arizona (JSA), Scottsdale
| | - Rashmi B Halker-Singh
- Department of Neurology (PSD, LT, AJS, TLO, RBH-S, BBV, DD), Mayo Clinic Arizona, Phoenix; King-Devick Test, Inc. (DL), Oakbrook Terrace, IL; Departments of Neurology (SLG, LJB), Ophthalmology (SLG, LJB), and Population Health (LJB), New York University Langone Medical Center, New York; Departments of Neurology (SLG, LJB) and Biostatistics and Epidemiology (LJB), University of Pennsylvania School of Medicine, Philadelphia; and University of Arizona (JSA), Scottsdale
| | - Bert B Vargas
- Department of Neurology (PSD, LT, AJS, TLO, RBH-S, BBV, DD), Mayo Clinic Arizona, Phoenix; King-Devick Test, Inc. (DL), Oakbrook Terrace, IL; Departments of Neurology (SLG, LJB), Ophthalmology (SLG, LJB), and Population Health (LJB), New York University Langone Medical Center, New York; Departments of Neurology (SLG, LJB) and Biostatistics and Epidemiology (LJB), University of Pennsylvania School of Medicine, Philadelphia; and University of Arizona (JSA), Scottsdale
| | - David Dodick
- Department of Neurology (PSD, LT, AJS, TLO, RBH-S, BBV, DD), Mayo Clinic Arizona, Phoenix; King-Devick Test, Inc. (DL), Oakbrook Terrace, IL; Departments of Neurology (SLG, LJB), Ophthalmology (SLG, LJB), and Population Health (LJB), New York University Langone Medical Center, New York; Departments of Neurology (SLG, LJB) and Biostatistics and Epidemiology (LJB), University of Pennsylvania School of Medicine, Philadelphia; and University of Arizona (JSA), Scottsdale
| |
Collapse
|
43
|
|
44
|
DuPrey KM, Webner D, Lyons A, Kucuk CH, Ellis JT, Cronholm PF. Convergence Insufficiency Identifies Athletes at Risk of Prolonged Recovery From Sport-Related Concussion. Am J Sports Med 2017; 45:2388-2393. [PMID: 28511593 DOI: 10.1177/0363546517705640] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Sensitive and specific screening methods are needed to identify athletes at risk of prolonged recovery after sport-related concussion (SRC). Convergence insufficiency (CI) is a common finding in concussed athletes. PURPOSE To assess the relationship between CI and recovery after SRC at the initial office visit. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS In this retrospective cohort study, 270 athletes (147 male, 123 female), mean ± SD age 14.7 ± 2.0 years (range, 10-21 years), with the diagnosis of SRC who presented for initial office visit between January 2014 and January 2016 were evaluated for near point of convergence (NPC). The athletes were categorized into 2 groups: normal near point of convergence (NPC ≤6 cm), and convergence insufficiency (NPC >6 cm). These athletes were then followed to determine recovery time. RESULTS Athletes presented for initial office visit at a mean of 5.2 ± 4.2 days (range, 1-21 days) after SRC. Half of the athletes had CI after SRC (50.4%; n = 136). Athletes with CI (NPC 12.3 ± 4.7 cm) took significantly longer to recover after SRC, requiring 51.6 ± 53.9 days, compared with athletes with normal NPC (4.1 ± 1.3 cm), who required 19.2 ± 14.7 days ( P < .001). After controlling for potential confounding variables, CI significantly increased the odds of prolonged recovery (≥28 days from injury) by 12.3-fold ( P < .001; 95% confidence interval, 6.6-23.0). CI screening correctly classified 75.2% of our sample with 84.2% sensitivity and 70.0% specificity. The positive predictive value for CI and prolonged recovery was 62.5%, and the negative predictive value was 88.1%. CONCLUSION CI at the initial office visit identified athletes at increased risk of prolonged recovery after SCR. Clinicians should consider measuring NPC in concussed athletes as a quick and inexpensive prognostic screening method.
Collapse
Affiliation(s)
- Kevin M DuPrey
- Department of Sports Medicine, Crozer-Keystone Health System, Springfield, Pennsylvania, USA
| | - David Webner
- Department of Sports Medicine, Crozer-Keystone Health System, Springfield, Pennsylvania, USA
| | - Adam Lyons
- Department of Family and Community Health, Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Crystal H Kucuk
- Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA
| | - Jeffrey T Ellis
- Department of Sports Medicine, Crozer-Keystone Health System, Springfield, Pennsylvania, USA
| | - Peter F Cronholm
- Department of Family and Community Health, Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
45
|
Molloy JH, Murphy I, Gissane C. The King–Devick (K–D) test and concussion diagnosis in semi-professional rugby union players. J Sci Med Sport 2017; 20:708-711. [DOI: 10.1016/j.jsams.2017.02.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 02/06/2017] [Indexed: 10/20/2022]
|
46
|
|
47
|
Oberlander TJ, Olson BL, Weidauer L. Test-Retest Reliability of the King-Devick Test in an Adolescent Population. J Athl Train 2017; 52:439-445. [PMID: 28362161 DOI: 10.4085/1062-6050-52.2.12] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT The King-Devick (KD) test is a screening tool designed to assess cognitive visual impairments, namely saccadic rhythm, postconcussion. Test-retest reliability of the KD in a healthy adolescent population has not yet been established. OBJECTIVE To investigate the overall test-retest reliability of the KD among a sample of healthy adolescents. Additionally, we sought to determine if sex and age influenced reliability. DESIGN Cross-sectional study. SETTING Secondary school. PATIENTS OR OTHER PARTICIPANTS Sixty-eight healthy adolescents, 41 boys (age = 15.4 ± 1.9 years) and 27 girls (age = 15.4 ± 1.9 years). MAIN OUTCOME MEASURE(S) Participants completed the KD (version 1) at 3 testing sessions (days 1, 30, and 45) following standard instructions. We recorded total time to complete the reading of 3 cards for each participant during each testing session. Two-way random-effects intraclass correlation coefficients (ICCs) using single measurements repeated over time and repeatability coefficients were calculated. Linear mixed models were used to determine whether differences existed at each testing time and to examine whether changes that took place among visits were different by sex or age. RESULTS Adolescents who completed the KD demonstrated acceptable reliability (ICC = 0.81; 95% confidence interval = 0.73, 0.87); however, the repeatability coefficient was large (±8.76 seconds). The sample demonstrated improvements between visits 1 and 2 (mean ± standard error = 4.3 ± 0.5 seconds, P < .001) and between visits 2 and 3 (2.4 ± 0.5 seconds, P < .001) for a total improvement of 6.9 seconds over 3 tests. No significant visit-by-sex or visit-by-age interactions were observed. CONCLUSIONS Despite the ICC being clinically acceptable, providers using the KD test for serial assessment of concussion in adolescents should be cautious in interpreting the results due to a large learning effect. Incorporating multiple measures can ensure accurate detection of sport concussion.
Collapse
Affiliation(s)
| | - Bernadette L Olson
- Health and Nutritional Sciences, South Dakota State University, Brookings
| | - Lee Weidauer
- Health and Nutritional Sciences, South Dakota State University, Brookings
| |
Collapse
|
48
|
Sone JY, Kondziolka D, Huang JH, Samadani U. Helmet efficacy against concussion and traumatic brain injury: a review. J Neurosurg 2017; 126:768-781. [DOI: 10.3171/2016.2.jns151972] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Helmets are one of the earliest and most enduring methods of personal protection in human civilization. Although primarily developed for combat purposes in ancient times, modern helmets have become highly diversified to sports, recreation, and transportation. History and the scientific literature exhibit that helmets continue to be the primary and most effective prevention method against traumatic brain injury (TBI), which presents high mortality and morbidity rates in the US. The neurosurgical and neurotrauma literature on helmets and TBI indicate that helmets provide effectual protection against moderate to severe head trauma resulting in severe disability or death. However, there is a dearth of scientific data on helmet efficacy against concussion in both civilian and military aspects. The objective of this literature review was to explore the historical evolution of helmets, consider the effectiveness of helmets in protecting against severe intracranial injuries, and examine recent evidence on helmet efficacy against concussion. It was also the goal of this report to emphasize the need for more research on helmet efficacy with improved experimental design and quantitative standardization of assessments for concussion and TBI, and to promote expanded involvement of neurosurgery in studying the quantitative diagnostics of concussion and TBI. Recent evidence summarized by this literature review suggests that helmeted patients do not have better relative clinical outcome and protection against concussion than unhelmeted patients.
Collapse
Affiliation(s)
- Je Yeong Sone
- 1Department of Neurosurgery, New York University School of Medicine, New York, New York
| | - Douglas Kondziolka
- 1Department of Neurosurgery, New York University School of Medicine, New York, New York
| | - Jason H. Huang
- 2Department of Neurosurgery, Baylor Scott & White Central Division, Temple, Texas; and
| | - Uzma Samadani
- 3Department of Neurosurgery, Hennepin County Medical Center, University of Minnesota, Minneapolis, Minnesota
| |
Collapse
|
49
|
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.
Collapse
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
| |
Collapse
|
50
|
Anzalone AJ, Blueitt D, Case T, McGuffin T, Pollard K, Garrison JC, Jones MT, Pavur R, Turner S, Oliver JM. A Positive Vestibular/Ocular Motor Screening (VOMS) Is Associated With Increased Recovery Time After Sports-Related Concussion in Youth and Adolescent Athletes. Am J Sports Med 2017; 45:474-479. [PMID: 27789472 DOI: 10.1177/0363546516668624] [Citation(s) in RCA: 115] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Vestibular and ocular motor impairments are routinely reported in patients with sports-related concussion (SRC) and may result in delayed return to play (RTP). The Vestibular/Ocular Motor Screening (VOMS) assessment has been shown to be consistent and sensitive in identifying concussion when used as part of a comprehensive examination. To what extent these impairments or symptoms are associated with length of recovery is unknown. PURPOSE To examine whether symptom provocation or clinical abnormality in specific domains of the VOMS results in protracted recovery (time from SRC to commencement of RTP protocol). STUDY DESIGN Cohort study (prognosis); Level of evidence, 2. METHODS A retrospective chart review was conducted of 167 patients (69 girls, 98 boys; mean ± SD age, 15 ± 2 years [range, 11-19 years]) presenting with SRC in 2014. During the initial visit, VOMS was performed in which symptom provocation or clinical abnormality (eg, unsmooth eye movements) was documented by use of a dichotomous scale (0 = not present, 1 = present). The VOMS used in this clinic consisted of smooth pursuits (SMO_PUR), horizontal and vertical saccades (HOR_SAC and VER_SAC), horizontal and vertical vestibular ocular reflex (HOR_VOR and VER_VOR), near point of convergence (NPC), and accommodation (ACCOM). Domains were also categorized into ocular motor (SMO_PUR, HOR_SAC, VER_SAC, NPC, ACCOM) and vestibular (HOR_VOR, VER_VOR). Cox proportional hazard models were used to explore the relationship between the domains and recovery. Alpha was set at P ≤ .05. RESULTS Symptom provocation and/or clinical abnormality in all domains except NPC ( P = .107) and ACCOM ( P = .234) delayed recovery (domain, hazard ratio [95% CI]: SMO_PUR, 0.65 [0.47-0.90], P = .009; HOR_SAC, 0.68 [0.50-0.94], P = .018; VER_SAC, 0.55 [0.40-0.75], P < .001; HOR_VOR, 0.68 [0.49-0.94], P = .018; VER_VOR, 0.60 [0.44-0.83], P = .002). The lowest crude hazard ratio was for ocular motor category (0.45 [0.32-0.63], P < .001). CONCLUSION These data suggest that symptom provocation/clinical abnormality associated with all domains except NPC and ACCOM can delay recovery after SRC in youth and adolescents. Thus, the VOMS not only may augment current diagnostic tools but also may serve as a predictor of recovery time in patients with SRC. The findings of this study may lead to more effective prognosis of concussion in youth and adolescents.
Collapse
Affiliation(s)
- Anthony J Anzalone
- Sports Concussion Research Group, Department of Kinesiology, Texas Christian University, Fort Worth, Texas, USA
- Texas Health Ben Hogan Sports Medicine Concussion Center, Fort Worth, Texas, USA
- Texas Health Ben Hogan Sports Medicine, Fort Worth, Texas, USA
| | - Damond Blueitt
- Sports Concussion Research Group, Department of Kinesiology, Texas Christian University, Fort Worth, Texas, USA
- Texas Health Ben Hogan Sports Medicine Concussion Center, Fort Worth, Texas, USA
- Texas Health Ben Hogan Sports Medicine, Fort Worth, Texas, USA
| | - Tami Case
- Sports Concussion Research Group, Department of Kinesiology, Texas Christian University, Fort Worth, Texas, USA
- Texas Health Ben Hogan Sports Medicine Concussion Center, Fort Worth, Texas, USA
- Texas Health Ben Hogan Sports Medicine, Fort Worth, Texas, USA
| | - Tiffany McGuffin
- Sports Concussion Research Group, Department of Kinesiology, Texas Christian University, Fort Worth, Texas, USA
- Texas Health Ben Hogan Sports Medicine Concussion Center, Fort Worth, Texas, USA
- Texas Health Ben Hogan Sports Medicine, Fort Worth, Texas, USA
| | - Kalyssa Pollard
- Sports Concussion Research Group, Department of Kinesiology, Texas Christian University, Fort Worth, Texas, USA
- Texas Health Ben Hogan Sports Medicine Concussion Center, Fort Worth, Texas, USA
- Texas Health Ben Hogan Sports Medicine, Fort Worth, Texas, USA
| | - J Craig Garrison
- Sports Concussion Research Group, Department of Kinesiology, Texas Christian University, Fort Worth, Texas, USA
- Texas Health Ben Hogan Sports Medicine Concussion Center, Fort Worth, Texas, USA
- Texas Health Ben Hogan Sports Medicine, Fort Worth, Texas, USA
| | - Margaret T Jones
- Sports Concussion Research Group, Department of Kinesiology, Texas Christian University, Fort Worth, Texas, USA
- School of Recreation, Health, and Tourism, George Mason University, Manassas, Virginia, USA
| | - Robert Pavur
- Sports Concussion Research Group, Department of Kinesiology, Texas Christian University, Fort Worth, Texas, USA
- College of Business, University of North Texas, Denton, Texas, USA
| | - Stephanie Turner
- Sports Concussion Research Group, Department of Kinesiology, Texas Christian University, Fort Worth, Texas, USA
- Texas Health Ben Hogan Sports Medicine Concussion Center, Fort Worth, Texas, USA
- Texas Health Ben Hogan Sports Medicine, Fort Worth, Texas, USA
| | - Jonathan M Oliver
- Sports Concussion Research Group, Department of Kinesiology, Texas Christian University, Fort Worth, Texas, USA
- Texas Health Ben Hogan Sports Medicine Concussion Center, Fort Worth, Texas, USA
- Texas Health Ben Hogan Sports Medicine, Fort Worth, Texas, USA
| |
Collapse
|