The effect of retinal defocus on simple eye-hand and eye-foot reaction time in traumatic brain injury (TBI)

Methodological Problems With Online Concussion Testing

Reaction time testing is widely used in online computerized concussion assessments, and most concussion studies utilizing the metric have demonstrated varying degrees of difference between concussed and non-concussed individuals. The problem with most of these online concussion assessments is that they predominantly rely on consumer grade technology. Typical administration of these reaction time tests involves presenting a visual stimulus on a computer monitor and prompting the test subject to respond as quickly as possible via keypad or computer mouse. However, inherent delays and variabilities are introduced to the reaction time measure by both computer and associated operating systems that the concussion assessment tool is installed on. The authors hypothesized systems that are typically used to collect concussion reaction time data would demonstrate significant errors in reaction time measurements. To remove human bias, a series of experiments was conducted robotically to assess timing errors introduced by reaction time tests under four different conditions. In the first condition, a visual reaction time test was conducted by flashing a visual stimulus on a computer monitor. Detection was via photodiode and mechanical response was delivered via computer mouse. The second condition employed a mobile device for the visual stimulus, and the mechanical response was delivered to the mobile device's touchscreen. The third condition simulated a tactile reaction time test, and mechanical response was delivered via computer mouse. The fourth condition also simulated a tactile reaction time test, but response was delivered to a dedicated device designed to store the interval between stimulus delivery and response, thus bypassing any problems hypothesized to be introduced by computer and/or computer software. There were significant differences in the range of responses recorded from the four different conditions with the reaction time collected from visual stimulus on a mobile device being the worst and the device with dedicated hardware designed for the task being the best. The results suggest that some of the commonly used visual tasks on consumer grade computers could be (and have been) introducing significant errors for reaction time testing and that dedicated hardware designed for the reaction time task is needed to minimize testing errors.

An Accurate Measure of Reaction Time can Provide Objective Metrics of Concussion

There have been numerous reports of neurological assessments of post-concussed athletes and many deploy some type of reaction time assessment. However, most of the assessment tools currently deployed rely on consumer-grade computer systems to collect this data. In a previous report, we demonstrated the inaccuracies that typical computer systems introduce to hardware and software to collect these metrics with robotics (Holden et al, 2020). In that same report, we described the accuracy of a tactile based reaction time test (administered with the Brain Gauge) as approximately 0.3 msec and discussed the shortcoming of other methods for collecting reaction time. The latency errors introduced with those alternative methods were reported as high as 400 msec and the system variabilities could be as high as 80 msec, and these values are several orders of magnitude above the control values previously reported for reaction time (200-220msec) and reaction time variability (10-20 msec). In this report, we examined the reaction time and reaction time variability from 396 concussed individuals and found that there were significant differences in the reaction time metrics obtained from concussed and non-concussed individuals for 14-21 days post-concussion. A survey of the literature did not reveal comparable sensitivity in reaction time testing in concussion studies using alternative methods. This finding was consistent with the prediction put forth by Holden and colleagues with robotics testing of the consumer grade computer systems that are commonly utilized by researchers conducting reaction time testing on concussed individuals. The significant difference in fidelity between the methods commonly used by concussion researchers is attributed to the differences in accuracy of the measures deployed and/or the increases in biological fidelity introduced by tactile based reaction times over visually administered reaction time tests. Additionally, while most of the commonly used computerized testing assessment tools require a pre-season baseline test to predict a neurological insult, the tactile based methods reported in this paper did not utilize any baselines for comparisons. The reaction time data reported was one test of a battery of tests administered to the population studied, and this is the first of a series of papers that will examine each of those tests independently.  

Force Irregularity Following Maximal Effort: The After-Peak Reduction

Irregularities in force output are present throughout human movement and can impair task performance. We investigated the presence of a large force discontinuity (after-peak reduction, APR) that appeared immediately following peak in maximal effort ramp contractions performed with the thumb adductor and ankle dorsiflexor muscles in 25 young adult participants (76% males, 24% females; M age 24.4 years, SD = 7.1). The after-peak reduction displayed similar parameters in both muscle groups with comparable drops in force during the after-peak reduction minima (thumb adductor: 27.5 ± 7.5% maximal voluntary contraction; ankle dorsiflexor: 25.8 ± 6.2% maximal voluntary contraction). A trend for the presence of fewer after-peak reductions with successive ramp trials was observed, suggesting a learning effect. Further investigation should explore underlying neural mechanisms contributing to the after-peak reduction.