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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.
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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
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Nakamura K, Fuchigami T, Morioka S. Eye movement training and gaze analysis for a patient with binocular diplopia after traumatic brain injury: a case report. J Med Case Rep 2023; 17:551. [PMID: 38110994 PMCID: PMC10726626 DOI: 10.1186/s13256-023-04221-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 10/16/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Patients with traumatic brain injury often develop sequelae such as eye movement disorders, including diplopia. Eye movement training is effective in diplopia management. However, few longitudinal follow-up studies have been conducted from the subacute disease stage, owing to the complexity of methods for quantifying diplopia. CASE PRESENTATION The patient is a 30-year-old Japanese man who presented with diplopia and underwent eye movement training for approximately 4 weeks. The angle of diplopia, distance of abduction of the eye, gaze analysis, and self-assessment of diplopia using Holmes' diplopia questionnaire were evaluated. The degree of diplopia increased from 12° to 40° on the right side. The distance of eye abduction increased from 10.4 to 12.8 mm. The self-assessment score improved from 76 to 12 points. Analysis of gaze transition revealed a reduction in the error between the target and gaze. CONCLUSION Eye movement training was successful in ameliorating the symptoms of diplopia in the patient with binocular diplopia. Furthermore, for patients with diplopia symptoms, it was suggested that the oculomotor approach to eye movement training should not only focus on the direction of the diplopia but also on the direction opposite to the diplopia (the weak side).
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Affiliation(s)
- Kaneharu Nakamura
- Department of Rehabilitation, Eishinkai Kishiwada Rehabilitation Hospital, 2-8-10, Kanmatsucho, Kishiwada, Osaka, 596-0827, Japan
- Stroke Rehabilitation Research Laboratory, Eishinkai Kishiwada Rehabilitation Hospital, Kishiwada, Osaka, Japan
| | - Takeshi Fuchigami
- Department of Rehabilitation, Eishinkai Kishiwada Rehabilitation Hospital, 2-8-10, Kanmatsucho, Kishiwada, Osaka, 596-0827, Japan.
- Stroke Rehabilitation Research Laboratory, Eishinkai Kishiwada Rehabilitation Hospital, Kishiwada, Osaka, Japan.
- Neurorehabilitation Research Center, Kio University, Kitakatsuragi-gun, Nara, Japan.
| | - Shu Morioka
- Stroke Rehabilitation Research Laboratory, Eishinkai Kishiwada Rehabilitation Hospital, Kishiwada, Osaka, Japan
- Neurorehabilitation Research Center, Kio University, Kitakatsuragi-gun, Nara, Japan
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De Luigi AJ, Bell KR, Bramhall JP, Choe M, Dec K, Finnoff JT, Halstead M, Herring SA, Matuszak J, Raksin PB, Swanson J, Millett C. Consensus statement: An evidence-based review of exercise, rehabilitation, rest, and return to activity protocols for the treatment of concussion and mild traumatic brain injury. PM R 2023; 15:1605-1642. [PMID: 37794736 DOI: 10.1002/pmrj.13070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/24/2023] [Accepted: 07/28/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND Early diagnosis and appropriate management of concussion/mild traumatic brain injury (mTBI) is critical for preventing poor outcomes and minimizing health care burden. Current clinical guidelines for concussion management focus mostly on diagnosis and return to cognitive and physical activity but provide limited guidance on the use of specific therapeutic interventions. OBJECTIVE To systematically review the available evidence on therapeutic interventions for concussion/mTBI and develop an evidence-based consensus statement on the use of these interventions in clinical practice. LITERATURE SURVEY A systematic literature search was performed first in 2018 and 2019, and again in 2022, to identify relevant original research on these interventions. A total of 6303 articles were retrieved through the systematic literature search and screened for inclusion. Eighty articles met inclusion criteria and were included in this review and consensus process. METHODOLOGY A multispecialty panel was convened to explore management of concussion/mTBI. Interventions evaluated included rest, exercise, rehabilitation, and return to activity (RTA) protocols. Studies were assessed for relevance and methodologic quality and were voted upon to develop an evidence-based consensus statement on the therapeutic appropriateness of these interventions for concussion/mTBI. A meta-analysis was not performed. SYNTHESIS There was sufficient evidence to recommend exercise as an appropriate therapy for adolescents with acute concussion/mTBI. In other age groups and for other therapeutic modalities, although some studies demonstrated benefits for some of the interventions, mixed results and study limitations prevented the panel from drawing firm conclusions on the efficacy of those interventions. The panel found evidence of detrimental effects from strict rest and high-intensity physical activity. CONCLUSIONS The panel recommended exercise as an appropriate therapy for acute concussion in adolescents. The evidence on other therapeutic interventions for concussion/mTBI remains limited to small randomized controlled trials and observational studies of moderate to low quality. The panel found no strong evidence to support or recommend against the other evaluated interventions but found most interventions to be safe when used judiciously and in consideration of individual patient needs. High-quality randomized studies with sufficient power are needed to evaluate the effects of rest, rehabilitation, and RTA protocols for the management of concussion/mTBI.
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Affiliation(s)
- Arthur J De Luigi
- Department Chair of Physical Medicine & Rehabiltation, Medical Director of Sports Medicine, Mayo Clinic, Scottsdale, Arizona, USA
| | - Kathleen R Bell
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | | | - Katherine Dec
- Virginia Commonwealth University, Richmond, Virginia, USA
| | - Jonathan T Finnoff
- United States Olympic and Paralympic Committee, Colorado Springs, Colorado, USA
- Department of Physical Medicine and Rehabilitation, University of Colorado, Denver, Colorado, USA
| | - Mark Halstead
- Washington University Sports Medicine, St Louis, Missouri, USA
| | - Stanley A Herring
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Jason Matuszak
- Sports Medicine, Excelsior Orthopaedics, Buffalo, New York, USA
| | - P B Raksin
- John H. Stroger Jr Hospital of Cook County (formerly Cook County Hospital), Rush University Medical Center, Chicago, Illinois, USA
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Wheeler S, Acord-Vira A. Occupational Therapy Practice Guidelines for Adults With Traumatic Brain Injury. Am J Occup Ther 2023; 77:7704397010. [PMID: 37624997 DOI: 10.5014/ajot.2023.077401] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2023] Open
Abstract
IMPORTANCE Occupational therapy practitioners are uniquely qualified to address the occupational needs of people with traumatic brain injury (TBI) and their caregivers to maximize participation, health, and well-being. OBJECTIVE These Practice Guidelines are informed by systematic reviews of the effectiveness of interventions that address impairments and skills to improve the occupational performance of people with TBI, as well as interventions for caregivers of people with TBI. The purpose of these guidelines is to summarize the current evidence available to assist clinicians' clinical decision-making in providing interventions for people with TBI and their caregivers. METHOD We reviewed six systematic reviews and synthesized the results into clinical recommendations to be used in occupational therapy clinical practice. RESULTS Sixty-two articles served as the basis for the clinical recommendations. CONCLUSIONS AND RECOMMENDATIONS Strong to moderate evidence supports multimodal sensory stimulation, unimodal auditory stimulation, physical activity, virtual reality, cognitive interventions, vision therapy, goal-focused interventions, individual and group training and education, and caregiver supports. Occupational therapy practitioners should incorporate these interventions into individual and group sessions to maximize recovery and promote occupational participation. Additional interventions are also available, based on emerging evidence and expert opinion, including prevention approaches, complexity of injury, and the use of occupation-based performance assessments. What This Article Adds: These Practice Guidelines provide a summary of evidence in clinical recommendations tables supporting occupational therapy interventions that address impairments resulting from and skills to improve occupational performance after TBI. The guidelines also include case study examples and evidence graphics for practitioners to use to support clinical reasoning when selecting interventions that address the goals of the person with TBI and their caregiver's needs.
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Affiliation(s)
- Steven Wheeler
- Steven Wheeler, PhD, OTR/L, FAOTA, CBIS, is Professor and Chair of Occupational Therapy, Division of Occupational Therapy, West Virginia University, Morgantown;
| | - Amanda Acord-Vira
- Amanda Acord-Vira, EdD, OTR/L, FAOTA, CBIS, is Associate Professor of Occupational Therapy, Division of Occupational Therapy, West Virginia University, Morgantown
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Mucha A, Pardini JE, Herring SA, Murphy J, Elbin RJ, Bauer RM, Schmidt JD, Resch JE, Broshek DK. Persisting symptoms after concussion: Considerations for active treatment. PM R 2022; 15:663-673. [PMID: 36507616 DOI: 10.1002/pmrj.12931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 11/04/2022] [Accepted: 11/23/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Anne Mucha
- UPMC Centers for Rehab Services, UPMC Sports Medicine Concussion Program, Pittsburgh, Pennsylvania, USA
| | - Jamie E Pardini
- Departments of Internal Medicine and Neurology, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, USA
| | - Stanley A Herring
- Departments of Rehabilitation Medicine, Orthopaedics and Sports Medicine and Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Justin Murphy
- Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - R J Elbin
- Department of Health, Human Performance and Recreation, University of Arkansas, Fayetteville, Arkansas, USA
| | - Russell M Bauer
- Department of Clinical & Health Psychology, University of Florida Department of Clinical & Health Psychology, Gainesville, Florida, USA
| | - Julianne D Schmidt
- UGA Concussion Research Laboratory, Department of Kinesiology, University of Georgia, Athens, Georgia, USA
| | - Jacob E Resch
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia, USA
| | - Donna K Broshek
- Department of Psychiatry & Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, Virginia, USA
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Kaldenberg J, Newman R, Jimenez C, Walker M. Vision Therapy Interventions to Support Occupational Performance for People With Traumatic Brain Injury With Visual Symptoms (June 2013-October 2020). Am J Occup Ther 2022; 76:23917. [PMID: 36165888 DOI: 10.5014/ajot.2022/76s2006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Systematic Review Briefs provide a summary of the findings from systematic reviews developed in conjunction with the American Occupational Therapy Association's Evidence-Based Practice Program. Each Systematic Review Brief summarizes the evidence on a theme related to a systematic review topic. This Systematic Review Brief presents findings from the systematic review on the effectiveness of interventions that address visual impairments and visual perception to improve occupational performance for adults with traumatic brain injury.
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Affiliation(s)
- Jennifer Kaldenberg
- Jennifer Kaldenberg, DrPH, MSA, OTR/L, SCLV, FAOTA, is Interim OTD Program DirectorClinical Associate Professor, Boston University College of Health & Rehabilitation Sciences: Sargent College
| | - Robin Newman
- Robin Newman, OTD, MA, OTR/L, CLT, FAOTA, is Clinical Assistant Professor, Boston University College of Health & Rehabilitation Sciences: Sargent College
| | - Christine Jimenez
- Christine Jimenez, OTS, is a graduate student at Boston University College of Health & Rehabilitation Sciences: Sargent College
| | - Mary Walker
- Mary Walker, OTS, is a graduate student at Boston University College of Health & Rehabilitation Sciences: Sargent College
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Abstract
BACKGROUND: Post-traumatic headache is the most common sequela of brain injury and can last months or years after the damaging event. Many headache types are associated with visual concerns also known to stem from concussion. OBJECTIVES: To describe the various headache types seen after head injury and demonstrate how they impact or are impacted by the visual system. METHODS: We will mirror the International Classification of Headache Disorders (ICHD) format to demonstrate the variety of headaches following brain injury and relate correlates to the visual pathways. The PubMed database was searched using terms such as headache, head pain, vision, concussion, traumatic brain injury, glare, visuomotor pathways. RESULTS: Every type of headache described in the International Classification of Headache Disorders Edition III can be initiated or worsened after head trauma. Furthermore, there is very often a direct or indirect impact upon the visual system for each of these headaches. CONCLUSION: Headaches of every described type in the ICHD can be caused by brain injury and all are related in some way to the afferent, efferent or association areas of the visual system.
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Affiliation(s)
- Patrick T. Quaid
- Head of Optometry, VUE Cubed Vision Therapy Clinics, ON, Canada
- College of Optometrists of Ontario (Regulatory Body), ON, Canada
| | - Eric L. Singman
- Ophthalmology & Visual Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
- Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
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Kujawa K, Żurek A, Gorączko A, Zurek G. Application of High-Tech Solution for Memory Assessment in Patients With Disorders of Consciousness. Front Neurol 2022; 13:841095. [PMID: 35432173 PMCID: PMC9008141 DOI: 10.3389/fneur.2022.841095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 01/31/2022] [Indexed: 11/13/2022] Open
Abstract
Testing cognitive function in patients after severe brain damage is a major clinical challenge. In the absence of both verbal and motor communication, tests commonly used to assess cognitive function are completely or partially undoable for disorders of consciousness patients. The study involved 12 patients with varying degrees of impaired consciousness due to brain damage, with no verbal and motor communication. Memory was assessed in study participants using oculography. Memory tasks were presented in four categories. The total percentage of correctly completed tasks obtained across the group was 39.58%. The most difficult tasks included category C.4 with tasks involving working memory. Regardless of the subjects' level of consciousness, there was no statistically significant difference in the percentage of correct responses obtained in subgroups distinguished by CRS-R score. Eye tracking technology can be successfully used in the assessment of cognitive function, particularly when eye movements are the only channel of communication in individuals after brain damage. We suggest that the cognitive functions of people after brain damage should be further analyzed using eye tracking.
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Affiliation(s)
- Katarzyna Kujawa
- Department of Biostructure, Wroclaw University of Health and Sport Sciences, Wrocław, Poland
- Neurorehabilitation Clinic, Wrocław, Poland
| | - Alina Żurek
- Institute of Psychology, University of Wroclaw, Wrocław, Poland
| | - Agata Gorączko
- Department of Biostructure, Wroclaw University of Health and Sport Sciences, Wrocław, Poland
- Neurorehabilitation Clinic, Wrocław, Poland
| | - Grzegorz Zurek
- Department of Biostructure, Wroclaw University of Health and Sport Sciences, Wrocław, Poland
- *Correspondence: Grzegorz Zurek
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Rytter HM, Graff HJ, Henriksen HK, Aaen N, Hartvigsen J, Hoegh M, Nisted I, Næss-Schmidt ET, Pedersen LL, Schytz HW, Thastum MM, Zerlang B, Callesen HE. Nonpharmacological Treatment of Persistent Postconcussion Symptoms in Adults: A Systematic Review and Meta-analysis and Guideline Recommendation. JAMA Netw Open 2021; 4:e2132221. [PMID: 34751759 PMCID: PMC8579233 DOI: 10.1001/jamanetworkopen.2021.32221] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
IMPORTANCE Persistent (>4 weeks) postconcussion symptoms (PPCS) are challenging for both patients and clinicians. There is uncertainty about the effect of commonly applied nonpharmacological treatments for the management of PPCS. OBJECTIVE To systematically assess and summarize evidence for outcomes related to 7 nonpharmacological interventions for PPCS in adults (aged >18 years) and provide recommendations for clinical practice. DATA SOURCES Systematic literature searches were performed via Embase, MEDLINE, PsycINFO, CINAHL, PEDro, OTseeker, and Cochrane Reviews (via MEDLINE and Embase) from earliest possible publication year to March 3, 2020. The literature was searched for prior systematic reviews and primary studies. To be included, studies had to be intervention studies with a control group and focus on PPCS. STUDY SELECTION A multidisciplinary guideline panel selected interventions based on frequency of use and need for decision support among clinicians, including early information and advice, graded physical exercise, vestibular rehabilitation, manual treatment of neck and back, oculomotor vision treatment, psychological treatment, and interdisciplinary coordinated rehabilitative treatment. To be included, studies had to be intervention studies within the areas of the predefined clinical questions, include a control group, and focus on symptoms after concussion or mild traumatic brain injury. DATA EXTRACTION AND SYNTHESIS Extraction was performed independently by multiple observers. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used for data abstraction and data quality assessment. Included studies were assessed using the Assessment of Multiple Systematic Reviews (AMSTAR) tool and the Cochrane Risk of Bias (randomized clinical trials) tool. Meta-analysis was performed for all interventions where possible. Random-effects models were used to calculate pooled estimates of effects. The level and certainty of evidence was rated and recommendations formulated according to the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework. MAIN OUTCOMES AND MEASURES All outcomes were planned before data collection began according to a specified protocol. The primary outcomes were the collective burden of PPCS and another outcome reflecting the focus of a particular intervention (eg, physical functioning after graded exercise intervention). RESULTS Eleven systematic reviews were identified but did not contribute any primary studies; 19 randomized clinical trials comprising 2007 participants (1064 women [53.0%]) were separately identified and included. Evidence for the 7 interventions ranged from no evidence meeting the inclusion criteria to very low and low levels of evidence. Recommendations were weak for early information and advice, graded physical exercise, vestibular rehabilitation, manual treatment of the neck and back, psychological treatment, and interdisciplinary coordinated rehabilitative treatment. No relevant evidence was identified for oculomotor vision treatment, so the panel provided a good clinical practice recommendation based on consensus. CONCLUSIONS AND RELEVANCE Based on very low to low certainty of evidence or based on consensus, the guideline panel found weak scientific support for commonly applied nonpharmacological interventions to treat PPCS. Results align with recommendations in international guidelines. Intensified research into all types of intervention for PPCS is needed.
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Affiliation(s)
- Hana Malá Rytter
- Danish Concussion Center, Copenhagen, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
- Department of Neurology, Bispebjerg-Frederiksberg University Hospital, Copenhagen, Denmark
| | | | - Henriette K. Henriksen
- Danish Concussion Center, Copenhagen, Denmark
- Center for Rehabilitation of Brain Injury, Copenhagen, Denmark
| | - Nicolai Aaen
- The Danish Concussion Association, Copenhagen, Denmark
| | - Jan Hartvigsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Chiropractic Knowledge Hub, Odense, Denmark
| | - Morten Hoegh
- Musculoskeletal Health and Implementation, Department of Medicine, Aalborg University, Aalborg, Denmark
- Pain Science Educator, Aarhus, Denmark
| | - Ivan Nisted
- Danish College of Optometry, Dania Academy, Randers, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | | | - Henrik Winther Schytz
- Danish Headache Center, Rigshospitalet-Glostrup, University of Copenhagen, Copenhagen, Denmark
| | - Mille Møller Thastum
- Hammel Neurorehabilitation Centre–University Clinic for Neurorehabilitation, Aarhus University, Aarhus, Denmark
| | - Bente Zerlang
- Exercise and Health Training Center, Roskilde Municipality, Roskilde, Denmark
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Poltavski D, Biberdorf D, Praus Poltavski C. Which Comes First in Sports Vision Training: The Software or the Hardware Update? Utility of Electrophysiological Measures in Monitoring Specialized Visual Training in Youth Athletes. Front Hum Neurosci 2021; 15:732303. [PMID: 34690722 PMCID: PMC8527177 DOI: 10.3389/fnhum.2021.732303] [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: 06/28/2021] [Accepted: 09/06/2021] [Indexed: 11/13/2022] Open
Abstract
In the present study we combined popular methods of sports vision training (SVT) with traditional oculomotor protocols of Optometric Vision Therapy (OVT) and electrophysiological indexes of EEG and VEP activity to monitor training progress and changes in performance of youth ice hockey players without the history of concussion. We hypothesized that administration of OVT protocols before SVT training may result in larger performance improvements compared to the reverse order due to the initial strengthening of visual hardware capable of handling greater demands during training of visuomotor integration and information processing skills (visual software). In a cross-over design 53 youth ice hockey players (ages 13-18) were randomly assigned to one of the two training groups. Group one (hardware-software group) completed 5 weeks of oculomotor training first followed by 5 weeks of software training. For group 2 (software-hardware) the order of procedures were reversed. After 10 weeks of training both groups significantly improved their performance on all but one measure of the Nike/Senaptec Sensory station measures. Additionally, the software-hardware training order resulted in significantly lower frontal theta-to-gamma amplitude ratios on the Nike/Senaptec test of Near-Far Quickness as well as in faster P100 latencies. Both training orders also resulted in significant decreases in post-treatment P100 amplitude to transient VEP stimuli as well as decreased theta-gamma ratios for perception span, Go/No-Go and Hand Reaction time. The observed changes in the electrophysiological indexes in the present study are thought to reflect greater efficiency in visual information processing and cognitive resource allocation following 10 weeks of visual training. There is also some evidence of the greater effectiveness of the software-hardware training order possibly due to the improved preparedness of the oculomotor system in the youth athletes for administration of targeted protocols of the Optometric Vision Therapy.
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Affiliation(s)
- Dmitri Poltavski
- Department of Psychology, University of North Dakota, Grand Forks, ND, United States
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Johansson J, Nygren de boussard C, Öqvist seimyr G, Pansell T. The effect of spectacle treatment in patients with mild traumatic brain injury: a pilot study. Clin Exp Optom 2021; 100:234-242. [DOI: 10.1111/cxo.12458] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 06/01/2016] [Accepted: 06/09/2016] [Indexed: 11/30/2022] Open
Affiliation(s)
- Jan Johansson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,
| | | | | | - Tony Pansell
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,
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12
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Rehabilitation of visual disorders. HANDBOOK OF CLINICAL NEUROLOGY 2021; 178:361-386. [PMID: 33832686 DOI: 10.1016/b978-0-12-821377-3.00015-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
While there is a long history of rehabilitation for motor deficits following cerebral lesions, less is known about our ability to improve visual deficits. Vision therapy, prisms, occluders, and filters have been advocated for patients with mild traumatic brain injury, on the premise that some of their symptoms may reflect abnormal visual or ocular motor function, but the evidence for their efficacy is modest. For hemianopia, attempts to restore vision have had unimpressive results, though it appears possible to generate blindsight through training. Strategic approaches that train more efficient use of visual search in hemianopia have shown consistent benefit in visual function, while prism aids may help some patients. There are many varieties of alexia. Strategic adaptation of saccades can improve hemianopic alexia, but there has been less work and mixed results for pure alexia, neglect dyslexia, attentional dyslexia, and the central dyslexias. A number of approaches have been tried in prosopagnosia, with recent studies of small groups suggesting that face perception of prosopagnosic subjects can be enhanced through perceptual learning.
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Barton JJS, Ranalli PJ. Reply to "Letter to the Editor Concerning Barton and Ranalli". Ann Neurol 2020; 89:420-421. [PMID: 33230895 DOI: 10.1002/ana.25970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 11/20/2020] [Accepted: 11/20/2020] [Indexed: 11/10/2022]
Affiliation(s)
- Jason J S Barton
- Departments of Medicine (Neurology), Ophthalmology and Visual Sciences, and Psychology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Paul J Ranalli
- Departments of Medicine (Neurology), Ophthalmology and Visual Sciences, and Otolaryngology, University of Toronto, Toronto, Ontario, Canada
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14
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Ciuffreda KJ. Letter to the Editor Concerning Barton and Ranalli. Ann Neurol 2020; 89:420. [PMID: 33277717 DOI: 10.1002/ana.25971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 11/10/2020] [Accepted: 11/12/2020] [Indexed: 11/08/2022]
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Barton JJS, Ranalli PJ. Vision Therapy: Ocular Motor Training in Mild Traumatic Brain Injury. Ann Neurol 2020; 88:453-461. [DOI: 10.1002/ana.25820] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 05/28/2020] [Accepted: 06/07/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Jason J. S. Barton
- Departments of Medicine (Neurology), Ophthalmology and Visual Sciences, and PsychologyUniversity of British Columbia Vancouver British Columbia Canada
| | - Paul J. Ranalli
- Departments of Medicine (Neurology), Ophthalmology and Visual Sciences, and Oto‐LaryngologyUniversity of Toronto Toronto Ontario Canada
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Reddy AVC, Mani R, Selvakumar A, Hussaindeen JR. Reading eye movements in traumatic brain injury. JOURNAL OF OPTOMETRY 2020; 13:155-162. [PMID: 31784207 PMCID: PMC7301197 DOI: 10.1016/j.optom.2019.10.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 10/11/2019] [Accepted: 10/15/2019] [Indexed: 05/21/2023]
Abstract
PURPOSE The aim of this study was to measure the reading eye movements in subjects with traumatic brain injury (TBI) using ReadAlyzer. ReadAlyzer is an objective eye movement recording device that tracks the eye movements while reading. METHODS Reading eye movements were measured using ReadAlyzer in 30 subjects with TBI (mild, moderate and severe) who had binocular vision and reading related symptoms and 60 asymptomatic controls. RESULTS There was a significant decrease in reading eye movement parameters in subjects with TBI compared to controls. Reading eye movement parameters are represented in median and interquartile range (IQR). Subjects with TBI presented with an increased number of fixations/100 words (median 137, IQR 106-159) and regressions/100 words (24, 12-36), and reduced reading rate (154, 128-173) words per minute. They also had a lesser grade level equivalent (4.0, 3.0-7.0) and reduced comprehension (70, 60-80) percentage compared to controls (Mann-Whitney U test, p<0.05). Reading eye movement parameters were also significantly affected in mild and moderate-severe TBI subjects compared to controls (Kruskal-Wallis test, p<0.05). CONCLUSION Reading eye movement performance using ReadAlyzer was found to be decreased in traumatic brain injury. Reading assessment may serve as a clinical measure to understand the oculomotor system following TBI.
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Affiliation(s)
- Ashwini V C Reddy
- Elite School of Optometry, Sankara Nethralaya, Chennai, Tamil Nadu & Birla Institute of Technology and Science, Pilani, Rajasthan, India; Binocular Vision & Neuro-Optometry Clinic, Sankara Nethralaya, Chennai, Tamil Nadu, India; Srimathi Sundari Subramanian Department of Visual Psychophysics, Sankara Nethralaya, Chennai, Tamil Nadu, India.
| | - Revathy Mani
- Binocular Vision & Neuro-Optometry Clinic, Sankara Nethralaya, Chennai, Tamil Nadu, India; Srimathi Sundari Subramanian Department of Visual Psychophysics, Sankara Nethralaya, Chennai, Tamil Nadu, India.
| | - Ambika Selvakumar
- Department of Neuro-Ophthalmology, Sankara Nethralaya, Chennai, Tamil Nadu, India.
| | - Jameel Rizwana Hussaindeen
- Elite School of Optometry, Sankara Nethralaya, Chennai, Tamil Nadu & Birla Institute of Technology and Science, Pilani, Rajasthan, India; Binocular Vision & Neuro-Optometry Clinic, Sankara Nethralaya, Chennai, Tamil Nadu, India; Srimathi Sundari Subramanian Department of Visual Psychophysics, Sankara Nethralaya, Chennai, Tamil Nadu, India.
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17
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Rochefort C, Legace E, Boulay C, Macartney G, Goulet K, Zemek R, Sveistrup H. Balance Markers and Saccadic Eye-Movement Measures in Adolescents With Postconcussion Syndrome. J Athl Train 2020; 55:475-481. [PMID: 32216658 DOI: 10.4085/1062-6050-548-18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Deficits in both balance and oculomotor function, including impairments in saccadic eye movements, are observed in approximately 30% of patients postconcussion. Whereas balance and saccadic eye movements are routinely assessed separately, growing evidence suggests that they should be assessed concurrently. OBJECTIVE To compare balance measures and saccades between adolescents 1 to 3 months postconcussion and healthy uninjured adolescents. DESIGN Case-control study. SETTING Concussion clinic and 2 private schools. PATIENTS OR OTHER PARTICIPANTS Twenty-five adolescents (10 boys, 15 girls; median [interquartile range (IQR)] age = 14 years [11.5-16 years]) between 1 and 3 months postconcussion (median [IQR] time since injury = 39.5 days [30-56.75 days]) and 33 uninjured adolescents (18 boys, 15 girls; median [IQR] age = 13 years [11.5-14 years]). MAIN OUTCOME MEASURE(S) The center-of-pressure 95% ellipse area and medial-lateral and anterior-posterior velocity and the number of saccades in the dual-task balance conditions including a high cognitive load (cognitive condition), a low cognitive load and a gaze-shifting component (visual condition) or both a high cognitive load and a gaze-shifting component (combined condition). RESULTS Concussion-group participants swayed over larger center-of-pressure ellipse areas in the visual (P = .02; effect size = 0.73) and combined (P = .005; effect size = 0.86) conditions but not in the cognitive condition (P = .07; effect size = 0.50). No group differences were identified for anterior-posterior (F1,56 = 2.57, P = .12) or medial-lateral (F1,56 = 0.157, P = .69) velocity. Concussion-group participants also did not perform more saccades than the control-group participants (F1,56 = 2.04, P = .16). CONCLUSIONS Performing dual-task balance conditions for which the secondary task involved a gaze-shifting component or both a gaze-shifting component and a high cognitive load resulted in greater sway amplitude in adolescents with concussion. However, these larger amounts of postural sway were not associated with increased saccadic eye movements.
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Affiliation(s)
- Coralie Rochefort
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, ON, Canada
| | - Elizabeth Legace
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, ON, Canada
| | | | - Gail Macartney
- Research Institute, Children's Hospital of Eastern Ontario, Ottawa, Canada.,Concussion Clinic, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Kristian Goulet
- Concussion Clinic, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Roger Zemek
- Research Institute, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Heidi Sveistrup
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, ON, Canada.,Bruyère Research Institute and School of Rehabilitation Sciences, University of Ottawa, ON, Canada
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18
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Near Point of Convergence Deficits and Treatment Following Concussion: A Systematic Review. J Sport Rehabil 2020; 29:1179-1193. [PMID: 32131046 DOI: 10.1123/jsr.2019-0428] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 12/28/2019] [Accepted: 01/19/2020] [Indexed: 11/18/2022]
Abstract
CONTEXT Convergence dysfunction following concussion is common. Near point of convergence (NPC) is a quick and easy assessment that may detect oculomotor dysfunction such as convergence insufficiency (CI), but NPC measurements are rarely reported. Convergence dysfunction is treatable in otherwise healthy patients; the effectiveness of oculomotor therapy following concussion is unclear. OBJECTIVES The purpose of this article was to systematically review the literature and answer the following clinical questions: (1) Is performance on NPC negatively affected in patients diagnosed with a concussion compared with pre-injury levels or healthy controls? (2) In patients diagnosed with concussion, what is the effect of oculomotor/vision therapy on NPC break measurements? EVIDENCE ACQUISITION The search was conducted in CINAHL, SPORTDiscus, MEDLINE, and PubMed using terms related to concussion, mild traumatic brain injury, convergence, vision, and rehabilitation. Literature considered for review included original research publications that collected measures of NPC break in concussion patients, with a pretest-posttest comparison or comparison with a healthy control group. A literature review was completed; 242 relevant articles were reviewed, with 18 articles meeting criteria for inclusion in the review. EVIDENCE SYNTHESIS Articles were categorized according to the clinical question they addressed. The patient or participant sample (number, sex, age, and health status), study design, instrumentation, or intervention used, and main results were extracted from each article. CONCLUSIONS The authors' main findings suggest that there is a moderate level of evidence that patients have impaired NPC up to several months postconcussion, and a low level of evidence that impairments can be successfully treated with oculomotor therapy. These findings should be cautiously evaluated; the studies are limited by weak/moderate quality, small sample sizes, varied methodology, and nonrandomized treatment groups. Future research should explore factors affecting convergence postconcussion and include randomized, controlled studies to determine if performing vision therapy improves visual measures and promotes recovery.
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Abstract
Recent applications of eye tracking for diagnosis, prognosis and follow-up of therapy in age-related neurological or psychological deficits have been reviewed. The review is focused on active aging, neurodegeneration and cognitive impairments. The potential impacts and current limitations of using characterizing features of eye movements and pupillary responses (oculometrics) as objective biomarkers in the context of aging are discussed. A closer look into the findings, especially with respect to cognitive impairments, suggests that eye tracking is an invaluable technique to study hidden aspects of aging that have not been revealed using any other noninvasive tool. Future research should involve a wider variety of oculometrics, in addition to saccadic metrics and pupillary responses, including nonlinear and combinatorial features as well as blink- and fixation-related metrics to develop biomarkers to trace age-related irregularities associated with cognitive and neural deficits.
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Affiliation(s)
- Ramtin Z Marandi
- Department of Health Science & Technology, Aalborg University, Aalborg E 9220, Denmark
| | - Parisa Gazerani
- Department of Health Science & Technology, Aalborg University, Aalborg E 9220, Denmark
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20
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Watabe T, Suzuki H, Abe M, Sasaki S, Nagashima J, Kawate N. Systematic review of visual rehabilitation interventions for oculomotor deficits in patients with brain injury. Brain Inj 2019; 33:1592-1596. [PMID: 31455098 DOI: 10.1080/02699052.2019.1658225] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: Secondary to brain injury, many people develop eye movement disorders (oculomotor deficits). To clarify, optimize, and standardize the development of oculomotor rehabilitation programs, we systematically reviewed the literature on vision rehabilitation interventions for oculomotor deficits in brain injury, focusing on those with broad clinical feasibility.Materials and Methods: We searched MEDLINE (PubMed), CENTRAL, Scopus, and CINAHL databases for key title terms "oculomotor", "rehabilitation", or a related term, and "brain injury" or a related term in the title or abstract. We excluded case reports of a single patient, studies of non-oculomotor visual deficits, and articles in which the intervention and assessment methods were not explicitly identified.Results: Nine articles were included, six of which utilized computer-based training programs to elicit characteristic fixation, saccades, pursuit, vergence, and accommodative movements. Within the entire sample, interventions ranged from 3 to 10 weeks, and involved 2 to 5 training sessions per week.Conclusions: Oculomotor rehabilitation interventions showed some efficacy in treating patients with brain injury; however, there were very few studies overall. Several eye movement types - fixation, saccades, pursuit, vergence, and accommodation - can be elicited manually by therapists. We eagerly await the development and implementation of new intervention programs for broad-based clinical practice.
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Affiliation(s)
- Takayuki Watabe
- Rehabilitation Center, Showa University Fujigaoka Rehabilitation Hospital, Kanagawa, Japan.,Department of Occupational Therapy, School of Nursing and Rehabilitation Sciences, Showa University, Kanagawa, Japan
| | - Hisayoshi Suzuki
- Department of Occupational Therapy, School of Nursing and Rehabilitation Sciences, Showa University, Kanagawa, Japan
| | - Marina Abe
- Rehabilitation Center, Showa University Fujigaoka Rehabilitation Hospital, Kanagawa, Japan
| | - Shuichi Sasaki
- Department of Rehabilitation, Kitasato University Hospital, Kanagawa, Japan
| | - Jun Nagashima
- Rehabilitation Center, Showa University Fujigaoka Rehabilitation Hospital, Kanagawa, Japan.,Department of Occupational Therapy, School of Nursing and Rehabilitation Sciences, Showa University, Kanagawa, Japan
| | - Nobuyuki Kawate
- Rehabilitation Medicine, Showa University School of Medicine, Kanagawa, Japan
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21
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Kontos AP, Sufrinko A, Sandel N, Emami K, Collins MW. Sport-related Concussion Clinical Profiles. Curr Sports Med Rep 2019; 18:82-92. [DOI: 10.1249/jsr.0000000000000573] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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22
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Factors Associated with Sport-Related Post-concussion Headache and Opportunities for Treatment. Curr Pain Headache Rep 2018; 22:75. [DOI: 10.1007/s11916-018-0724-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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23
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Wetzel PA, Lindblad AS, Raizada H, James N, Mulatya C, Kannan MA, Villamar Z, Gitchel GT, Weaver LK. Eye Tracking Results in Postconcussive Syndrome Versus Normative Participants. Invest Ophthalmol Vis Sci 2018; 59:4011-4019. [PMID: 30098189 DOI: 10.1167/iovs.18-23815] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Standard physical, neurologic, and neuropsychologic examinations may not detect abnormalities after mild traumatic brain injury (mTBI). An analysis of eye movements may be more sensitive to neurologic dysfunction. Methods We performed eye tracking assessments in 71 active duty and veteran military personnel with persistent postconcussive symptoms (3 months to 5 years after mTBI) and 75 volunteers with no history of brain injury. Both eyes were sampled at 500 Hz and analyzed for various eye measurement parameters during visual tasks involving the saccadic and smooth systems. Results No difference between mTBI and normal participants in main sequence profiles was observed. On the circular task, intersaccadic interval duration was shorter in mTBI compared with normal subjects (horizontal: Cohen's D = -0.65; vertical: Cohen's D = -0.75). For reading, absolute saccadic amplitudes (Cohen's D = -0.76) and average forward saccadic amplitudes were lower (Cohen's D = -0.61). Absolute fixation velocity was higher (Cohen's D = 1.02), and overall fixation durations (Cohen's D = 0.58), regression durations (Cohen's D = 0.49), and forward saccadic durations (Cohen's D=0.54) were longer. mTBI participants had more fixations (Cohen's D = 0.54) and regressions per line (Cohen's D = 0.70) and read fewer lines (Cohen's D = -0.38) than normal subjects. On the horizontal ramp task, mTBI participants had lower weighted smooth pursuit gains (Cohen's D = -0.55). On the horizontal step task, mTBI participants had shorter mean fixation times (Cohen's D = -0.55). Conclusions These results suggest vulnerability of the smooth pursuit and saccadic systems in mTBI. Eye tracking shows promise as an objective, sensitive assessment of damage after mTBI. (ClinicalTrials.gov number, NCT01611194, NCT01925963.).
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Affiliation(s)
- Paul A Wetzel
- Lovelace Biomedical Research, Albuquerque, New Mexico, United States.,Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, Virginia, United States
| | | | - Hardik Raizada
- The Emmes Corporation, Rockville, Maryland, United States
| | - Nathan James
- The Emmes Corporation, Rockville, Maryland, United States
| | | | - Mary A Kannan
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, Virginia, United States
| | - Zoe Villamar
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, Virginia, United States
| | - George T Gitchel
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, Virginia, United States
| | - Lindell K Weaver
- Division of Hyperbaric Medicine, Intermountain Medical Center, Murray, Utah, United States.,Intermountain LDS Hospital, Salt Lake City, Utah, United States.,Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah, United States
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24
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Mani R, Asper L, Khuu SK. Deficits in saccades and smooth-pursuit eye movements in adults with traumatic brain injury: a systematic review and meta-analysis. Brain Inj 2018; 32:1315-1336. [PMID: 29913089 DOI: 10.1080/02699052.2018.1483030] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
PURPOSE To conduct a review of literature and quantify the effect that traumatic brain injury (TBI) has on oculomotor functions (OM). METHODS A systematic review and meta-analysis was conducted from papers that objectively measured saccades and smooth-pursuit eye movements in mild and severe TBI. RESULTS The overall impact of TBI on OM functions was moderate and significant with an effect size of 0.42 from 181 OM case-control comparisons. The heterogeneity, determined using the random effect model, was found to be significant (Q (180) = 367, p < 0.0001, I2 = 51) owing to the variety of OM functions (reflexive saccades, antisaccades, memory-guided saccades, self-paced saccades and pursuits) measured and varying post-injury periods.The overall effect on OM functions were similar in mild and severe TBI despite differences in combined effect size of various OM functions. OM functions involving complex cognitive skills such as antisaccades (in mild and severe TBI) and memory-guided saccades (in mild TBI) were the most adversely affected, suggesting that OM deficits may be associated with cognitive deficits in TBI. CONCLUSION TBI often results in long-standing OM deficits. Experimental measures of OM assessment reflect neural integrity and may provide a sensitive and objective biomarker to detect OM deficits following TBI.
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Affiliation(s)
- Revathy Mani
- a School of Optometry and Vision Science , The University of New South Wales (UNSW) , Sydney , Australia
| | - Lisa Asper
- a School of Optometry and Vision Science , The University of New South Wales (UNSW) , Sydney , Australia
| | - Sieu K Khuu
- a School of Optometry and Vision Science , The University of New South Wales (UNSW) , Sydney , Australia
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25
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Simpson-Jones ME, Hunt AW. Vision rehabilitation interventions following mild traumatic brain injury: a scoping review. Disabil Rehabil 2018; 41:2206-2222. [DOI: 10.1080/09638288.2018.1460407] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Mary E. Simpson-Jones
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Canada
| | - Anne W. Hunt
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Canada
- Clinical Study Investigator Bloorview Research Institute, Toronto, Canada
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26
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Emerson RL, García-Molina A, López Carballo J, García Fernández J, Aparicio-López C, Novo J, Sánchez-Carrión R, Enseñat-Cantallops A, Peña-Casanova J. Visual search in unilateral spatial neglect: The effects of distractors on a dynamic visual search task. APPLIED NEUROPSYCHOLOGY-ADULT 2018; 26:401-410. [PMID: 29469619 DOI: 10.1080/23279095.2018.1434522] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The objective of this study was to examine visual scanning performance in patients with Unilateral Spatial Neglect (USN) in a visual search task. Thirty-one right hemisphere stroke patients with USN were recruited. They performed a dynamic visual search task with two conditions, with and without distractors, while eye movements were monitored with an eye-tracker. The main goal of the task was to select target stimuli that appeared from the top of the screen and moved vertically downward. Target detection and visual scanning percentage were assessed over two hemispaces (right, left) on two conditions (distractor, no distractor). Most Scanned Regions (MSR) were calculated to analyze the areas of the screen where most points of fixation were directed to. Higher target detection rate and visual scanning percentages were found on the right hemispace on both conditions. From the MSRs we found that participants with a center of attention further to the right of the screen also presented smaller overall MSRs. Right hemisphere stroke patients with USN presented not only a significant rightward bias but reduced overall search areas, implying hyperattention does not only restrict search on the horizontal (right-left) axis but the vertical axis (top-bottom) too.
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Affiliation(s)
- Rebeca Lauren Emerson
- a Àrea de Rehabilitació NeuroPiscoSocial, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB , Barcelona , Spain.,b Universitat Autònoma de Barcelona , Barcelona , Bellaterra , Spain.,c Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol , Barcelona , Spain
| | - Alberto García-Molina
- a Àrea de Rehabilitació NeuroPiscoSocial, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB , Barcelona , Spain.,b Universitat Autònoma de Barcelona , Barcelona , Bellaterra , Spain.,c Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol , Barcelona , Spain
| | - Jaume López Carballo
- a Àrea de Rehabilitació NeuroPiscoSocial, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB , Barcelona , Spain.,b Universitat Autònoma de Barcelona , Barcelona , Bellaterra , Spain.,c Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol , Barcelona , Spain
| | - Juan García Fernández
- a Àrea de Rehabilitació NeuroPiscoSocial, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB , Barcelona , Spain.,b Universitat Autònoma de Barcelona , Barcelona , Bellaterra , Spain.,c Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol , Barcelona , Spain
| | - Celeste Aparicio-López
- a Àrea de Rehabilitació NeuroPiscoSocial, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB , Barcelona , Spain.,b Universitat Autònoma de Barcelona , Barcelona , Bellaterra , Spain.,c Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol , Barcelona , Spain
| | - Junquera Novo
- a Àrea de Rehabilitació NeuroPiscoSocial, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB , Barcelona , Spain.,b Universitat Autònoma de Barcelona , Barcelona , Bellaterra , Spain.,c Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol , Barcelona , Spain
| | - Rocío Sánchez-Carrión
- a Àrea de Rehabilitació NeuroPiscoSocial, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB , Barcelona , Spain.,b Universitat Autònoma de Barcelona , Barcelona , Bellaterra , Spain.,c Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol , Barcelona , Spain
| | - Antonia Enseñat-Cantallops
- a Àrea de Rehabilitació NeuroPiscoSocial, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB , Barcelona , Spain.,b Universitat Autònoma de Barcelona , Barcelona , Bellaterra , Spain.,c Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol , Barcelona , Spain
| | - Jordi Peña-Casanova
- d Behavioral Neurology Research Group, Mar Institute of Medical Research Foundation (FIMIM) , Barcelona , Spain.,e Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona , Barcelona , Spain.,f Section of Behavioral Neurology and Dementias, Hospital del Mar, Parc Salut Mar , Barcelona , Spain
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27
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Ciuffreda KJ, Yadav NK, Thiagarajan P, Ludlam DP. A Novel Computer Oculomotor Rehabilitation (COR) Program for Mild Traumatic Brain Injury (mTBI). Brain Sci 2017; 7:brainsci7080099. [PMID: 28792451 PMCID: PMC5575619 DOI: 10.3390/brainsci7080099] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 07/25/2017] [Accepted: 08/04/2017] [Indexed: 11/16/2022] Open
Abstract
Individuals with traumatic brain injury (TBI) manifest a wide range of visual dysfunctions. One of the most prevalent involves the oculomotor system, which includes version, vergence, and accommodation. However, until recently, there has been no comprehensive, computer-based program for remediation of these oculomotor deficits. We present such an oculomotor rehabilitation program that has been tested in a clinical trial in patients having TBI with a high degree of success based on before-and-after objective system recordings, performance measures, and related visual symptomotology. The basic program components include a versatile stimulus package incorporating the attentional paradigm of rapid serial visual presentation (RSVP), the ability to add a visual and/or auditory distractor to the training to increase difficulty level ("task loading"), automated assessment of RSVP errors, and automated assessment of visual performance over the training period. Program limitations and future directions are also considered.
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Affiliation(s)
- Kenneth J Ciuffreda
- Department of Biological and Vision Sciences, State University of New York, College of Optometry, New York, NY 10016, USA.
| | - Naveen K Yadav
- Chicago College of Optometry, Midwestern University, Downers Grove, IL 60515, USA.
| | - Preethi Thiagarajan
- Department of Biological and Vision Sciences, State University of New York, College of Optometry, New York, NY 10016, USA.
| | - Diana P Ludlam
- Department of Biological and Vision Sciences, State University of New York, College of Optometry, New York, NY 10016, USA.
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28
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Rochefort C, Walters-Stewart C, Aglipay M, Barrowman N, Zemek R, Sveistrup H. Balance Markers in Adolescents at 1 Month Postconcussion. Orthop J Sports Med 2017; 5:2325967117695507. [PMID: 28451603 PMCID: PMC5400212 DOI: 10.1177/2325967117695507] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: The Balance Error Scoring System (BESS) shows that balance tends to recover within days after a concussion, whereas measures of the movement of the center of pressure (COP) show that balance deficits can persist up to 1 month after concussion. While approximately 30% of adolescents suffering concussion have functional consequences including balance deficits, evidence of the use of different balance assessments for concussion is limited within this population. Purpose: To compare performance on a series of balance assessments between adolescents with a diagnosed concussion at 1 month postinjury and noninjured control participants within the same age distribution. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Thirty-three adolescents 1 month postconcussion and 33 control participants completed the BESS followed by two, 2-minute trials standing on a Nintendo Wii Balance Board (WBB), during which the COP under their feet was recorded using 2 testing protocols: (1) double-leg stance, eyes open (EO) and (2) double-leg stance, eyes closed (EC). Participants then completed a dual-task condition (DT) with eyes open combining a double-leg stance and a Stroop color and word test while standing on the WBB. Three commonly used COP variables, anterior-posterior (A/P) and mediolateral (M/L) velocity and 95% ellipse, were computed for each condition performed on the WBB. Results: Participants postconcussion swayed over a significantly larger ellipse area compared with the control group in the EO (P = .008), EC (P = .002), and DT (P = .003) conditions and also performed the DT condition with faster COP velocity in the M/L direction (P = .007). No significant group difference was identified for BESS total score. Conclusion: At 1 month postconcussion, participants continued to demonstrate balance deficits in COP control despite scoring similar to controls on the BESS. Simple COP measures of balance may identify subtle impairments not captured by the BESS.
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Affiliation(s)
- Coralie Rochefort
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Coren Walters-Stewart
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Mary Aglipay
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Nick Barrowman
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Roger Zemek
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.,Departments of Pediatrics and Emergency Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Heidi Sveistrup
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada.,School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
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29
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Matuszak JM, McVige J, McPherson J, Willer B, Leddy J. A Practical Concussion Physical Examination Toolbox. Sports Health 2017; 8:260-269. [PMID: 27022058 PMCID: PMC4981071 DOI: 10.1177/1941738116641394] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
CONTEXT With heightened awareness of concussion, there is a need to assess and manage the concussed patient in a consistent manner. Unfortunately, concussion physical examination has not been standardized or supported by evidence. Important questions remain about the physical examination. EVIDENCE ACQUISITION Review of ClinicalKey, Cochrane, MEDLINE, and PubMed prior to July 2015 was performed using search terms, including concussion, mTBI, physical examination, mental status, cranial nerves, reflexes, cervical, vestibular, and oculomotor. The references of the pertinent articles were reviewed for other relevant sources. STUDY DESIGN Clinical review. LEVEL OF EVIDENCE Level 3. RESULTS The pertinent physical examination elements for concussion include evaluation of cranial nerves, manual muscle testing, and deep tendon reflexes; inspecting the head and neck for trauma or tenderness and cervical range of motion; Spurling maneuver; a static or dynamic balance assessment; screening ocular examination; and a mental status examination that includes orientation, immediate and delayed recall, concentration, mood, affect, insight, and judgment. Other examination elements to consider, based on signs, symptoms, or clinical suspicion, include testing of upper motor neurons, cervical strength and proprioception, coordination, pupillary reactivity, and visual acuity; examination of the jaw, temporomandibular joint, and thoracic spine; fundoscopic evaluation; orthostatic vital signs; assessment of dynamic visual acuity; and screening for depression, anxiety, substance abuse disorders, and preinjury psychiatric difficulties. CONCLUSION Various elements of the physical examination, such as screening ocular examination, cervical musculoskeletal examination, static and/or dynamic balance assessment, and mental status examination, appear to have utility for evaluating concussion; however, data on validity are lacking.
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Affiliation(s)
| | | | | | - Barry Willer
- UBMD Orthopaedics and Sports Medicine, Jacobs School of Medicine, University at Buffalo, Buffalo, New York
| | - John Leddy
- UBMD Orthopaedics and Sports Medicine, Jacobs School of Medicine, University at Buffalo, Buffalo, New York
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Dodick D, Starling AJ, Wethe J, Pang Y, Messner LV, Smith C, Master CL, Halker-Singh RB, Vargas BB, Bogle JM, Mandrekar J, Talaber A, Leong D. The Effect of In-School Saccadic Training on Reading Fluency and Comprehension in First and Second Grade Students. J Child Neurol 2017; 32:104-111. [PMID: 28257277 DOI: 10.1177/0883073816668704] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Efficient eye movements provide a physical foundation for proficient reading skills. We investigated the effect of in-school saccadic training on reading performance. In this cross-over design, study participants (n = 327, 165 males; mean age [SD]: 7 y 6 mo [1y 1 mo]) were randomized into treatment and control groups, who then underwent eighteen 20-minute training sessions over 5 weeks using King-Devick Reading Acceleration Program Software. Pre- and posttreatment reading assessments included fluency, comprehension, and rapid number naming performance. The treatment group had significantly greater improvement than the control group in fluency (6.2% vs 3.6%, P = .0277) and comprehension (7.5% vs 1.5%, P = .0002). The high-needs student group significantly improved in fluency ( P < .001) and comprehension ( P < .001). We hypothesize these improvements to be attributed to the repetitive practice of reading-related eye movements, shifting visuospatial attention, and visual processing. Consideration should be given to teaching the physical act of reading within the early education curriculum.
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Affiliation(s)
- David Dodick
- 1 Department of Neurology, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Amaal J Starling
- 1 Department of Neurology, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Jennifer Wethe
- 1 Department of Neurology, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Yi Pang
- 2 Illinois Eye Institute, Chicago, IL, USA
| | | | - Craig Smith
- 3 Bill and Melinda Gates Foundation, Seattle, WA, USA
| | - Christina L Master
- 4 Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Bert B Vargas
- 1 Department of Neurology, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Jamie M Bogle
- 1 Department of Neurology, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Jay Mandrekar
- 5 Division of Biomedical Statistics and Informatics, Mayo Clinic Rochester, Rochester, MN, USA
| | | | - Danielle Leong
- 2 Illinois Eye Institute, Chicago, IL, USA.,6 King-Devick Test, Inc, Oakbrook Terrace, IL, USA
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Collins MW, Kontos AP, Okonkwo DO, Almquist J, Bailes J, Barisa M, Bazarian J, Bloom OJ, Brody D, Cantu R, Cardenas J, Clugston J, Cohen R, Echemendia R, Elbin R, Ellenbogen R, Fonseca J, Gioia G, Guskiewicz K, Heyer R, Hotz G, Iverson GL, Jordan B, Manley G, Maroon J, McAllister T, McCrea M, Mucha A, Pieroth E, Podell K, Pombo M, Shetty T, Sills A, Solomon G, Thomas DG, Valovich McLeod TC, Yates T, Zafonte R. Statements of Agreement From the Targeted Evaluation and Active Management (TEAM) Approaches to Treating Concussion Meeting Held in Pittsburgh, October 15-16, 2015. Neurosurgery 2016; 79:912-929. [PMID: 27741219 PMCID: PMC5119544 DOI: 10.1227/neu.0000000000001447] [Citation(s) in RCA: 137] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Conventional management for concussion involves prescribed rest and progressive return to activity. Recent evidence challenges this notion and suggests that active approaches may be effective for some patients. Previous concussion consensus statements provide limited guidance regarding active treatment. OBJECTIVE To describe the current landscape of treatment for concussion and to provide summary agreements related to treatment to assist clinicians in the treatment of concussion. METHODS On October 14 to 16, 2015, the Targeted Evaluation and Active Management (TEAM) Approaches to Treating Concussion meeting was convened in Pittsburgh, Pennsylvania. Thirty-seven concussion experts from neuropsychology, neurology, neurosurgery, sports medicine, physical medicine and rehabilitation, physical therapy, athletic training, and research and 12 individuals representing sport, military, and public health organizations attended the meeting. The 37 experts indicated their agreement on a series of statements using an audience response system clicker device. RESULTS A total of 16 statements of agreement were supported covering (1) Summary of the Current Approach to Treating Concussion, (2) Heterogeneity and Evolving Clinical Profiles of Concussion, (3) TEAM Approach to Concussion Treatment: Specific Strategies, and (4) Future Directions: A Call to Research. Support (ie, response of agree or somewhat agree) for the statements ranged from to 97% to 100%. CONCLUSION Concussions are characterized by diverse symptoms and impairments and evolving clinical profiles; recovery varies on the basis of modifying factors, injury severity, and treatments. Active and targeted treatments may enhance recovery after concussion. Research is needed on concussion clinical profiles, biomarkers, and the effectiveness and timing of treatments. ABBREVIATIONS ARS, audience response systemCDC, Centers for Disease Control and PreventionDoD, Department of DefensemTBI, mild traumatic brain injuryNCAA, National Collegiate Athletic AssociationNFL, National Football LeagueNIH, National Institutes of HealthRCT, randomized controlled trialRTP, return to playSRC, sport- and recreation-related concussionTBI, traumatic brain injuryTEAM, Targeted Evaluation and Active Management.
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Affiliation(s)
- Michael W. Collins
- Department of Orthopaedic Surgery, UPMC Sports Medicine Concussion Program, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Anthony P. Kontos
- Department of Orthopaedic Surgery, UPMC Sports Medicine Concussion Program, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - David O. Okonkwo
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jon Almquist
- Fairfax Family Practice Comprehensive Concussion Center, Fairfax, Virginia
| | - Julian Bailes
- Department of Neurosurgery, NorthShore University Health System, Chicago, Illinois
| | - Mark Barisa
- Baylor Institute for Rehabilitation, Frisco, Texas
| | - Jeffrey Bazarian
- Department of Emergency Medicine, University of Rochester, Rochester, New York
| | - O. Josh Bloom
- Carolina Sports Concussion Clinic, Cary, North Carolina
| | - David Brody
- Department of Neurology, Washington University, St. Louis, Missouri
| | - Robert Cantu
- Dr. Robert C. Cantu Concussion Center, Emerson Hospital, Boston University, Concord, Massachusetts
| | - Javier Cardenas
- Department of Neurology, Barrow Neurological Institute, Phoenix, Arizona
| | - Jay Clugston
- Community Health and Family Medicine, University of Florida, Gainesville, Florida
| | - Randall Cohen
- Athletics Department, University of Arizona, Tucson, Arizona
| | - Ruben Echemendia
- Psychological and Neurobehavioral Associates, State College, Pennsylvania
| | - R.J. Elbin
- Office for Sports Concussion Research, University of Arkansas, Fayetteville, Arkansas
| | - Richard Ellenbogen
- Department of Neurological Surgery University of Washington, Seattle, Washington
| | - Janna Fonseca
- Carolina Sports Concussion Clinic, Cary, North Carolina
| | - Gerard Gioia
- Division of Neuropsychology, Children’s National Health System, Washington, District of Columbia
| | - Kevin Guskiewicz
- College of Arts and Sciences, University of North Carolina, Chapel Hill, North Carolina
| | - Robert Heyer
- Carolinas Medical Center, Charlotte, North Carolina
| | - Gillian Hotz
- Neuroscience Center, University of Miami Miller School of Medicine, Miami, Florida
| | - Grant L. Iverson
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Barry Jordan
- Neurorehabilitation, Burke Rehabilitation & Research, White Plains, New York
| | - Geoffrey Manley
- Department of Neurological Surgery, University of California at San Francisco, San Francisco, California
| | - Joseph Maroon
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Michael McCrea
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Anne Mucha
- University of Pittsburgh Medical Center Centers for Rehabilitation Services, Pittsburgh, Pennsylvania
| | - Elizabeth Pieroth
- Neurological Institute, NorthShore University Health System, Chicago, Illinois
| | - Kenneth Podell
- Houston Methodist Concussion Center, Houston Methodist Hospital, Houston, Texas
| | - Matthew Pombo
- Department of Orthpoedics, Emory University Healthcare, Atlanta, Georgia
| | - Teena Shetty
- Department of Neurology, Hospital for Special Surgery, Weill Cornell Medical College, New York City, New York
| | - Allen Sills
- Department of Neurosurgery, Vanderbilt University, Vanderbilt Sports Concussion Center, Nashville, Tennessee
| | - Gary Solomon
- Department of Neurosurgery, Vanderbilt University, Vanderbilt Sports Concussion Center, Nashville, Tennessee
| | - Danny G. Thomas
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin
- Pediatric Emergency Medicine, Children’s Hospital of Wisconsin, Wauwatosa, Wisconsin
| | | | - Tony Yates
- Pittsburgh Steelers, Pittsburgh, Pennsylvania
| | - Ross Zafonte
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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Abstract
Concussion is one of the most common injuries in sport and recreation today. Reports of concussion have increased in recent years, likely due to increased societal awareness and the risk of longer-term sequelae. Presently, treatment includes a period of prescribed rest in the acute period following injury, followed by a protocol of graded exertion. Despite an initial period of rest and attempts at a gradual return to play, up to 30% of individuals may have ongoing symptoms past the acute period. The goal of this viewpoint is to introduce the reader to the most common symptoms of concussion and the need for a new, more active paradigm during treatment. J Orthop Sports Phys Ther 2016;46(8):613-616. doi:10.2519/jospt.2016.0607.
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Szczupak M, Hoffer ME, Murphy S, Balaban CD. Posttraumatic dizziness and vertigo. HANDBOOK OF CLINICAL NEUROLOGY 2016; 137:295-300. [PMID: 27638079 DOI: 10.1016/b978-0-444-63437-5.00021-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Traumatic brain injury is an increasingly common public health issue, with the mild variant most clinically relevant for this chapter. Common causes of mild traumatic brain injury (mTBI) include motor vehicle accidents, athletics, and military training/deployment. Despite a range of clinically available testing platforms, diagnosis of mTBI remains challenging. Symptoms are primarily neurosensory, and include dizziness, hearing problems, headaches, cognitive, and sleep disturbances. Dizziness is nearly universally present in all mTBI patients, and is the easiest symptom to objectify for diagnosis. Aside from a thorough history and physical exam, in the near future specialized vestibular function tests will be key to mTBI diagnosis. A battery of oculomotor (antisaccade, predictive saccade) and vestibular tasks (head impulse test) has been demonstrated to sensitively and specifically identify individuals with acute mTBI. Vestibular therapy and rehabilitation have shown improvements for mTBI patients in cognitive function, ability to return to activities of daily living, and ability to return to work. Dizziness, as a contributor to short- and long-term disability following mTBI, is ultimately crucial not only for diagnosis but also for treatment.
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Affiliation(s)
- M Szczupak
- Department of Otolaryngology, Miller School of Medicine, University of Miami, Miami, FL, USA; University of Medicine Sports Medicine and Performance Institute, Miami, FL, USA
| | - M E Hoffer
- Department of Otolaryngology, Miller School of Medicine, University of Miami, Miami, FL, USA; University of Medicine Sports Medicine and Performance Institute, Miami, FL, USA; Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, FL, USA.
| | - S Murphy
- Department of Otolaryngology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - C D Balaban
- Departments of Otolaryngology, Neurobiology, Communication Sciences and Disorders, and Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
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Fimreite V, Ciuffreda KJ, Yadav NK. Effect of luminance on the visually-evoked potential in visually-normal individuals and in mTBI/concussion. Brain Inj 2015; 29:1199-1210. [PMID: 26083046 PMCID: PMC7197393 DOI: 10.3109/02699052.2015.1035329] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To assess quantitatively the effect of luminance on VEP amplitude and latency in visually-normals (VN) and patients with mild traumatic brain injury (mTBI). METHODS VN individuals (n = 20) and those with mTBI (n = 19) participated. Those with mTBI were assessed 1-10 years post-injury (mean = 4.97 years), with the exception of one subject. Pattern VEP testing was employed using the DIOPSYS™ NOVA-TR system, with a 74 cd m-2 baseline luminance. Luminance levels were reduced with five different neutral density (ND) filters (0.5, 1.0, 1.5, 2.0 and 2.5) and compared to the baseline response. All testing was performed under binocular-viewing conditions with full refractive correction in place. RESULTS In both groups, mean VEP amplitude reduced with decrease in luminance (p < 0.05). At each luminance level, the mean VEP amplitude was significantly lower in mTBI than in the VN population (p < 0.05). In both groups, the mean VEP latency increased progressively with reduction in luminance (p < 0.05), with it being significantly higher in mTBI than in the VN population (p < 0.05). CONCLUSIONS High luminance levels produced an optimal VEP response in both populations. VEP amplitude was robust, whereas latency progressively increased in both groups as luminance decreased. The latency increase with decreased luminance was significantly larger in those with mTBI, thus suggesting that latency can be used to differentiate reliably between VN individuals and those with mTBI.
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Affiliation(s)
- Vanessa Fimreite
- a Department of Biological and Vision Sciences , SUNY/State College of Optometry , New York , NY , USA
| | - Kenneth J Ciuffreda
- a Department of Biological and Vision Sciences , SUNY/State College of Optometry , New York , NY , USA
| | - Naveen K Yadav
- a Department of Biological and Vision Sciences , SUNY/State College of Optometry , New York , NY , USA
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Thiagarajan P, Ciuffreda KJ. Short-term persistence of oculomotor rehabilitative changes in mild traumatic brain injury (mTBI): A pilot study of clinical effects. Brain Inj 2015; 29:1475-9. [DOI: 10.3109/02699052.2015.1070905] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Hoffer ME, Schubert MC, Balaban CD. Early Diagnosis and Treatment of Traumatic Vestibulopathy and Postconcussive Dizziness. Neurol Clin 2015; 33:661-8, x. [DOI: 10.1016/j.ncl.2015.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
Concussion is one of the most hotly debated topics in sports medicine today. Research surrounding concussion has experienced significant growth recently, especially in the areas of incidence, assessment, and recovery. However, there is limited research on the most effective rehabilitation approaches for this injury. This review evaluates the current literature for evidence for and against physical and cognitive rest and the emerging areas targeting vestibular, oculomotor, and pharmacologic interventions for the rehabilitation of sport-related concussion.
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An empirical review of treatment and rehabilitation approaches used in the acute, sub-acute, and chronic phases of recovery following sports-related concussion. Curr Treat Options Neurol 2014; 16:320. [PMID: 25261157 DOI: 10.1007/s11940-014-0320-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OPINION STATEMENT Several treatment and rehabilitation approaches for sport-related concussion have been mentioned in recent consensus and position statements. These options range from the more conservative behavioral management approaches to aggressive pharmacological and therapeutic interventions. Moreover, clinical decision-making for sport-related concussion changes as symptoms and impairments persist throughout recovery. The current article provides an empirical review of proposed treatment and rehabilitation options for sport-related concussion during the acute, subacute, and chronic phases of injury.
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