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Alkhachroum A, Aklepi G, Sarafraz A, Robayo LE, Manolovitz BM, Blandino CF, Arwari B, Sobczak E, Bass DH, Ghamasaee P, Samano D, Massad N, Kottapally M, Merenda A, Dib S, Jagid JR, Dietrich WD, Rundek T, O'Phelan K, Claassen J, Walker MF. Covert Tracking to Visual Stimuli in Comatose Patients With Traumatic Brain Injury. Neurology 2023; 101:489-494. [PMID: 37076304 PMCID: PMC10513885 DOI: 10.1212/wnl.0000000000207302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 03/02/2023] [Indexed: 04/21/2023] Open
Abstract
OBJECTIVES This study investigated video eye tracking (VET) in comatose patients with traumatic brain injury (TBI). METHODS We recruited healthy participants and unresponsive patients with TBI. We surveyed the patients' clinicians on whether the patient was tracking and performed the Coma Recovery Scale-Revised (CRS-R). We recorded eye movements in response to motion of a finger, a face, a mirror, and an optokinetic stimulus using VET glasses. Patients were classified as covert tracking (tracking on VET alone) and overt tracking (VET and clinical examination). The ability to obey commands was evaluated at 6-month follow-up. RESULTS We recruited 20 healthy participants and 10 patients with TBI. The use of VET was feasible in all participants and patients. Two patients demonstrated covert tracking (CRS-R of 6 and 8), 2 demonstrated overt tracking (CRS-R of 22 and 11), and 6 patients had no tracking (CRS-R of 8, 6, 5, 7, 6, and 7). Five of 56 (9%) tracking assessments were missed on clinical examination. All patients with tracking recovered consciousness at follow-up, whereas only 2 of 6 patients without tracking recovered at follow-up. DISCUSSION VET is a feasible method to measure covert tracking. Future studies are needed to confirm the prognostic value of covert tracking.
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Affiliation(s)
- Ayham Alkhachroum
- From the Department of Neurology (A.A., G.A., B.M.M., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.), University of Miami; Jackson Memorial Hospital (A.A., G.A., C.F.B., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.); University of Miami Center for Computational Science (A.S.); Neuroscience Graduate Program (L.E.R.), The Miami Project to Cure Paralysis (L.E.R., W.D.D.), Department of Kinesiology and Sport Sciences (B.A.), and Department of Neurosurgery (J.R.J., W.D.D.), University of Miami, FL; Department of Neurology (J.C.), Columbia University, New York, NY; and Department of Neurology (M.F.W.), Case Western Reserve University, Louis Stokes Cleveland VA Medical Center, OH.
| | - Gabriela Aklepi
- From the Department of Neurology (A.A., G.A., B.M.M., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.), University of Miami; Jackson Memorial Hospital (A.A., G.A., C.F.B., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.); University of Miami Center for Computational Science (A.S.); Neuroscience Graduate Program (L.E.R.), The Miami Project to Cure Paralysis (L.E.R., W.D.D.), Department of Kinesiology and Sport Sciences (B.A.), and Department of Neurosurgery (J.R.J., W.D.D.), University of Miami, FL; Department of Neurology (J.C.), Columbia University, New York, NY; and Department of Neurology (M.F.W.), Case Western Reserve University, Louis Stokes Cleveland VA Medical Center, OH
| | - Amin Sarafraz
- From the Department of Neurology (A.A., G.A., B.M.M., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.), University of Miami; Jackson Memorial Hospital (A.A., G.A., C.F.B., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.); University of Miami Center for Computational Science (A.S.); Neuroscience Graduate Program (L.E.R.), The Miami Project to Cure Paralysis (L.E.R., W.D.D.), Department of Kinesiology and Sport Sciences (B.A.), and Department of Neurosurgery (J.R.J., W.D.D.), University of Miami, FL; Department of Neurology (J.C.), Columbia University, New York, NY; and Department of Neurology (M.F.W.), Case Western Reserve University, Louis Stokes Cleveland VA Medical Center, OH
| | - Linda E Robayo
- From the Department of Neurology (A.A., G.A., B.M.M., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.), University of Miami; Jackson Memorial Hospital (A.A., G.A., C.F.B., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.); University of Miami Center for Computational Science (A.S.); Neuroscience Graduate Program (L.E.R.), The Miami Project to Cure Paralysis (L.E.R., W.D.D.), Department of Kinesiology and Sport Sciences (B.A.), and Department of Neurosurgery (J.R.J., W.D.D.), University of Miami, FL; Department of Neurology (J.C.), Columbia University, New York, NY; and Department of Neurology (M.F.W.), Case Western Reserve University, Louis Stokes Cleveland VA Medical Center, OH
| | - Brian M Manolovitz
- From the Department of Neurology (A.A., G.A., B.M.M., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.), University of Miami; Jackson Memorial Hospital (A.A., G.A., C.F.B., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.); University of Miami Center for Computational Science (A.S.); Neuroscience Graduate Program (L.E.R.), The Miami Project to Cure Paralysis (L.E.R., W.D.D.), Department of Kinesiology and Sport Sciences (B.A.), and Department of Neurosurgery (J.R.J., W.D.D.), University of Miami, FL; Department of Neurology (J.C.), Columbia University, New York, NY; and Department of Neurology (M.F.W.), Case Western Reserve University, Louis Stokes Cleveland VA Medical Center, OH
| | - Carlos F Blandino
- From the Department of Neurology (A.A., G.A., B.M.M., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.), University of Miami; Jackson Memorial Hospital (A.A., G.A., C.F.B., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.); University of Miami Center for Computational Science (A.S.); Neuroscience Graduate Program (L.E.R.), The Miami Project to Cure Paralysis (L.E.R., W.D.D.), Department of Kinesiology and Sport Sciences (B.A.), and Department of Neurosurgery (J.R.J., W.D.D.), University of Miami, FL; Department of Neurology (J.C.), Columbia University, New York, NY; and Department of Neurology (M.F.W.), Case Western Reserve University, Louis Stokes Cleveland VA Medical Center, OH
| | - Brian Arwari
- From the Department of Neurology (A.A., G.A., B.M.M., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.), University of Miami; Jackson Memorial Hospital (A.A., G.A., C.F.B., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.); University of Miami Center for Computational Science (A.S.); Neuroscience Graduate Program (L.E.R.), The Miami Project to Cure Paralysis (L.E.R., W.D.D.), Department of Kinesiology and Sport Sciences (B.A.), and Department of Neurosurgery (J.R.J., W.D.D.), University of Miami, FL; Department of Neurology (J.C.), Columbia University, New York, NY; and Department of Neurology (M.F.W.), Case Western Reserve University, Louis Stokes Cleveland VA Medical Center, OH
| | - Evie Sobczak
- From the Department of Neurology (A.A., G.A., B.M.M., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.), University of Miami; Jackson Memorial Hospital (A.A., G.A., C.F.B., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.); University of Miami Center for Computational Science (A.S.); Neuroscience Graduate Program (L.E.R.), The Miami Project to Cure Paralysis (L.E.R., W.D.D.), Department of Kinesiology and Sport Sciences (B.A.), and Department of Neurosurgery (J.R.J., W.D.D.), University of Miami, FL; Department of Neurology (J.C.), Columbia University, New York, NY; and Department of Neurology (M.F.W.), Case Western Reserve University, Louis Stokes Cleveland VA Medical Center, OH
| | - Danielle H Bass
- From the Department of Neurology (A.A., G.A., B.M.M., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.), University of Miami; Jackson Memorial Hospital (A.A., G.A., C.F.B., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.); University of Miami Center for Computational Science (A.S.); Neuroscience Graduate Program (L.E.R.), The Miami Project to Cure Paralysis (L.E.R., W.D.D.), Department of Kinesiology and Sport Sciences (B.A.), and Department of Neurosurgery (J.R.J., W.D.D.), University of Miami, FL; Department of Neurology (J.C.), Columbia University, New York, NY; and Department of Neurology (M.F.W.), Case Western Reserve University, Louis Stokes Cleveland VA Medical Center, OH
| | - Pardis Ghamasaee
- From the Department of Neurology (A.A., G.A., B.M.M., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.), University of Miami; Jackson Memorial Hospital (A.A., G.A., C.F.B., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.); University of Miami Center for Computational Science (A.S.); Neuroscience Graduate Program (L.E.R.), The Miami Project to Cure Paralysis (L.E.R., W.D.D.), Department of Kinesiology and Sport Sciences (B.A.), and Department of Neurosurgery (J.R.J., W.D.D.), University of Miami, FL; Department of Neurology (J.C.), Columbia University, New York, NY; and Department of Neurology (M.F.W.), Case Western Reserve University, Louis Stokes Cleveland VA Medical Center, OH
| | - Daniel Samano
- From the Department of Neurology (A.A., G.A., B.M.M., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.), University of Miami; Jackson Memorial Hospital (A.A., G.A., C.F.B., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.); University of Miami Center for Computational Science (A.S.); Neuroscience Graduate Program (L.E.R.), The Miami Project to Cure Paralysis (L.E.R., W.D.D.), Department of Kinesiology and Sport Sciences (B.A.), and Department of Neurosurgery (J.R.J., W.D.D.), University of Miami, FL; Department of Neurology (J.C.), Columbia University, New York, NY; and Department of Neurology (M.F.W.), Case Western Reserve University, Louis Stokes Cleveland VA Medical Center, OH
| | - Nina Massad
- From the Department of Neurology (A.A., G.A., B.M.M., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.), University of Miami; Jackson Memorial Hospital (A.A., G.A., C.F.B., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.); University of Miami Center for Computational Science (A.S.); Neuroscience Graduate Program (L.E.R.), The Miami Project to Cure Paralysis (L.E.R., W.D.D.), Department of Kinesiology and Sport Sciences (B.A.), and Department of Neurosurgery (J.R.J., W.D.D.), University of Miami, FL; Department of Neurology (J.C.), Columbia University, New York, NY; and Department of Neurology (M.F.W.), Case Western Reserve University, Louis Stokes Cleveland VA Medical Center, OH
| | - Mohan Kottapally
- From the Department of Neurology (A.A., G.A., B.M.M., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.), University of Miami; Jackson Memorial Hospital (A.A., G.A., C.F.B., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.); University of Miami Center for Computational Science (A.S.); Neuroscience Graduate Program (L.E.R.), The Miami Project to Cure Paralysis (L.E.R., W.D.D.), Department of Kinesiology and Sport Sciences (B.A.), and Department of Neurosurgery (J.R.J., W.D.D.), University of Miami, FL; Department of Neurology (J.C.), Columbia University, New York, NY; and Department of Neurology (M.F.W.), Case Western Reserve University, Louis Stokes Cleveland VA Medical Center, OH
| | - Amedeo Merenda
- From the Department of Neurology (A.A., G.A., B.M.M., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.), University of Miami; Jackson Memorial Hospital (A.A., G.A., C.F.B., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.); University of Miami Center for Computational Science (A.S.); Neuroscience Graduate Program (L.E.R.), The Miami Project to Cure Paralysis (L.E.R., W.D.D.), Department of Kinesiology and Sport Sciences (B.A.), and Department of Neurosurgery (J.R.J., W.D.D.), University of Miami, FL; Department of Neurology (J.C.), Columbia University, New York, NY; and Department of Neurology (M.F.W.), Case Western Reserve University, Louis Stokes Cleveland VA Medical Center, OH
| | - Salim Dib
- From the Department of Neurology (A.A., G.A., B.M.M., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.), University of Miami; Jackson Memorial Hospital (A.A., G.A., C.F.B., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.); University of Miami Center for Computational Science (A.S.); Neuroscience Graduate Program (L.E.R.), The Miami Project to Cure Paralysis (L.E.R., W.D.D.), Department of Kinesiology and Sport Sciences (B.A.), and Department of Neurosurgery (J.R.J., W.D.D.), University of Miami, FL; Department of Neurology (J.C.), Columbia University, New York, NY; and Department of Neurology (M.F.W.), Case Western Reserve University, Louis Stokes Cleveland VA Medical Center, OH
| | - Jonathan R Jagid
- From the Department of Neurology (A.A., G.A., B.M.M., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.), University of Miami; Jackson Memorial Hospital (A.A., G.A., C.F.B., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.); University of Miami Center for Computational Science (A.S.); Neuroscience Graduate Program (L.E.R.), The Miami Project to Cure Paralysis (L.E.R., W.D.D.), Department of Kinesiology and Sport Sciences (B.A.), and Department of Neurosurgery (J.R.J., W.D.D.), University of Miami, FL; Department of Neurology (J.C.), Columbia University, New York, NY; and Department of Neurology (M.F.W.), Case Western Reserve University, Louis Stokes Cleveland VA Medical Center, OH
| | - W Dalton Dietrich
- From the Department of Neurology (A.A., G.A., B.M.M., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.), University of Miami; Jackson Memorial Hospital (A.A., G.A., C.F.B., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.); University of Miami Center for Computational Science (A.S.); Neuroscience Graduate Program (L.E.R.), The Miami Project to Cure Paralysis (L.E.R., W.D.D.), Department of Kinesiology and Sport Sciences (B.A.), and Department of Neurosurgery (J.R.J., W.D.D.), University of Miami, FL; Department of Neurology (J.C.), Columbia University, New York, NY; and Department of Neurology (M.F.W.), Case Western Reserve University, Louis Stokes Cleveland VA Medical Center, OH
| | - Tatjana Rundek
- From the Department of Neurology (A.A., G.A., B.M.M., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.), University of Miami; Jackson Memorial Hospital (A.A., G.A., C.F.B., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.); University of Miami Center for Computational Science (A.S.); Neuroscience Graduate Program (L.E.R.), The Miami Project to Cure Paralysis (L.E.R., W.D.D.), Department of Kinesiology and Sport Sciences (B.A.), and Department of Neurosurgery (J.R.J., W.D.D.), University of Miami, FL; Department of Neurology (J.C.), Columbia University, New York, NY; and Department of Neurology (M.F.W.), Case Western Reserve University, Louis Stokes Cleveland VA Medical Center, OH
| | - Kristine O'Phelan
- From the Department of Neurology (A.A., G.A., B.M.M., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.), University of Miami; Jackson Memorial Hospital (A.A., G.A., C.F.B., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.); University of Miami Center for Computational Science (A.S.); Neuroscience Graduate Program (L.E.R.), The Miami Project to Cure Paralysis (L.E.R., W.D.D.), Department of Kinesiology and Sport Sciences (B.A.), and Department of Neurosurgery (J.R.J., W.D.D.), University of Miami, FL; Department of Neurology (J.C.), Columbia University, New York, NY; and Department of Neurology (M.F.W.), Case Western Reserve University, Louis Stokes Cleveland VA Medical Center, OH
| | - Jan Claassen
- From the Department of Neurology (A.A., G.A., B.M.M., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.), University of Miami; Jackson Memorial Hospital (A.A., G.A., C.F.B., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.); University of Miami Center for Computational Science (A.S.); Neuroscience Graduate Program (L.E.R.), The Miami Project to Cure Paralysis (L.E.R., W.D.D.), Department of Kinesiology and Sport Sciences (B.A.), and Department of Neurosurgery (J.R.J., W.D.D.), University of Miami, FL; Department of Neurology (J.C.), Columbia University, New York, NY; and Department of Neurology (M.F.W.), Case Western Reserve University, Louis Stokes Cleveland VA Medical Center, OH
| | - Mark F Walker
- From the Department of Neurology (A.A., G.A., B.M.M., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.), University of Miami; Jackson Memorial Hospital (A.A., G.A., C.F.B., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.); University of Miami Center for Computational Science (A.S.); Neuroscience Graduate Program (L.E.R.), The Miami Project to Cure Paralysis (L.E.R., W.D.D.), Department of Kinesiology and Sport Sciences (B.A.), and Department of Neurosurgery (J.R.J., W.D.D.), University of Miami, FL; Department of Neurology (J.C.), Columbia University, New York, NY; and Department of Neurology (M.F.W.), Case Western Reserve University, Louis Stokes Cleveland VA Medical Center, OH
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