Development and Validation of a Mobile Application to Detect Visual Dysfunction Following Mild Traumatic Brain Injury

Abstract

Introduction Following mild traumatic brain injury, visual dysfunction is a common occurrence, yet the condition often goes undiagnosed. A mobile application was developed to measure aspects of visual acuity and oculomotor function. The aim of this project was to validate the newly developed suite of outcomes conducive for use in the field to detect visual dysfunction. Materials and Methods A custom mobile application was developed on an Apple iPad using iOS operating system software version 11.0 in Objective C to measure near point of convergence (NPC), distance visual acuity, reading fluency, and self-rated convergence insufficiency (CI). To determine construct validity, 50 healthy young adults were administered NPC and distance visual acuity assessments using the iPad and standard clinical approaches. A ruler measurement was obtained simultaneous to the iPad NPC measurement to determine measurement accuracy. All testing was administered by a licensed optometrist and the order of testing (iPad versus clinical) was randomized. Results The correlation coefficient between the iPad and clinical measurements of NPC was 0.893, while iPad and ruler measurement was 0.947. Modest accordance was found between iPad and wall chart measures assessing distance visual acuity. A ceiling effect was evident with use of a wall chart to determine distance visual acuity. Healthy young adults scored a mean (SD) of 13.0 (7.4) on the Convergence Insufficiency Symptom Survey. Reading fluency was highly variable with a mean (SD) of 291 (119) words per minute. Conclusions iPad measures of NPC were highly correlated with clinical measures, while visual acuity measured with the iPad showed modest correlation. Nonetheless, the suite of visual assessments provide value as screening tools, and when used in combination with reading fluency assessment and self-reported CI may be effective in identifying visual dysfunction following mild traumatic brain injury.

eHealth tools to assess the neurological function for research, in absence of the neurologist – a systematic review, part I (software)

“…The main clinical characteristics of the tools are reported in Table 1 , according to the neurological function assessed: 19 tools assessing the cognitive function [ 15 – 33 ]; six tools assessing the motor function [ 34 – 39 ]; two tools assessing cranial nerve function [ 42 , 43 ]; and nine tools assessing gait and coordination [ 44 – 52 ]. In this table, the tools are organised by symptom or sign assessed (i.e.…”

“…Healthy vs PD patients, against gold standard UPDRS + two mechanical tappers HC: 53.4 (14.8); PD: 65.4 (9.0) 144 participants (2 groups) Kinematic measurements: total distance finger movement, inter-tap distance, inter-tap dwelling Sentient Tracking of Parkinson’s (STOP) [ 41 ] Hand Tremor Intensity Partially validated. PD patients, against UPDRS-II general score and Tremor item on UPDRS Range – 52–73 11 participants (1 group) Measures for tremor intensity Visual acuity tools Linder et al [ 42 ] Visual Impairment in mTBI Validated. Healthy participants, against clinical/ruler measurements (reading point of convergence, reading fluency and comprehension) 21.9 (2.0) 50 participants (1 group) Numerical scores for static and dynamic visual acuity, and other mentioned tasks StrokeVision [ 43 ] Visual Acuity in Stroke Validated.…”

“…A total of 26 tools (62%) were available in English [ 15 – 22 , 25 , 27 – 31 , 36 , 37 , 39 – 44 , 53 , 56 – 58 ], with only 4 (10%) of the tools being available in more than one language [ 20 , 29 , 31 , 44 ]. Only 18 tools (43%) were validated in a given population [ 17 , 18 , 25 , 26 , 29 – 32 , 37 , 38 , 40 , 42 – 44 , 51 , 52 , 54 , 56 ] and another 10 (24%) partially validated against similar measures [ 15 , 16 , 20 , 21 , 23 , 36 , 39 , 41 , 45 , 58 ]. Most tools were available on mobile software (e.g., a tablet or smartphone), with at least 5 (12%) being mobile smartphone applications that were compatible with both Android OS and iOS platforms [ 19 , 25 , 29 , 44 , 45 ].…”

“…The remaining studies disclosed no external funding or had no source of funding information available, with at least 6 tools still accessible [ 27 , 33 , 45 , 46 , 51 , 54 ]. All of the 17 tools that were found to have proprietary licensing (i.e., owned by a private entity or corporation) were still accessible at the time of this review [ 15 , 16 , 19 , 21 , 25 , 27 – 29 , 41 , 42 , 44 – 46 , 50 , 51 , 54 , 55 ]. One tool had a license belonging to a Non-Profit Organisation [ 53 ], and 3 tools were open source [ 24 , 38 , 40 ], all still accessible at the time of data collection.…”

Virtual Reality Application for Vestibular/Ocular Motor Screening: Current Clinical Protocol Versus a Novel Prototype

“…To the authors' best knowledge, no tools exist to aid in standardizing the administration of the VOMS to reduce overall administrator error and record accurate symptoms beyond an NPC ruler, 3,32 which is a custom-created device not sold commercially, 32 and augmented reality. 22 It is important to explore how tools that attempt to standardize the VOMS may be used to inform clinical practice. However, these should be properly vetted using baseline data before determining efficacy and safety.…”