Diagnostic Tests for Concussion

Ventura, Rachel E.; Jancuska, Jeffrey M.; Balcer, Laura J.; Galetta, Steven

doi:10.1097/wno.0000000000000223

Cited by 82 publications

(31 citation statements)

References 96 publications

(91 reference statements)

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“…Eye movements are increasingly being studied in mild traumatic brain injury (mTBI) (commonly referred to as concussion; Thiagarajan et al, 2011;Ventura et al, 2015;Hunt et al, 2016;Snegireva et al, 2018), as eye-tracking protocols can be used to detect subtle deficits in cognitive, motor and visual processes that may occur following a head injury (Liversedge and Findlay, 2000;Maruta et al, 2010a). Detection of mTBI and monitoring of recovery of subtle impairments is not always possible with conventional means, such as neuroimaging (Eierud et al, 2014) or clinical assessments (McCrea et al, 2015).…”

Section: Introductionmentioning

confidence: 99%

The Measurement of Eye Movements in Mild Traumatic Brain Injury: A Structured Review of an Emerging Area

Stuart

Parrington

Martini

et al. 2020

Front. Sports Act. Living

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Mild traumatic brain injury (mTBI), or concussion, occurs following a direct or indirect force to the head that causes a change in brain function. Many neurological signs and symptoms of mTBI can be subtle and transient, and some can persist beyond the usual recovery timeframe, such as balance, cognitive or sensory disturbance that may pre-dispose to further injury in the future. There is currently no accepted definition or diagnostic criteria for mTBI and therefore no single assessment has been developed or accepted as being able to identify those with an mTBI. Eye-movement assessment may be useful, as specific eye-movements and their metrics can be attributed to specific brain regions or functions, and eye-movement involves a multitude of brain regions. Recently, research has focused on quantitative eye-movement assessments using eye-tracking technology for diagnosis and monitoring symptoms of an mTBI. However, the approaches taken to objectively measure eye-movements varies with respect to instrumentation, protocols and recognition of factors that may influence results, such as cognitive function or basic visual function. This review aimed to examine previous work that has measured eye-movements within those with mTBI to inform the development of robust or standardized testing protocols. Medline/PubMed, CINAHL, PsychInfo and Scopus databases were searched. Twenty-two articles met inclusion/exclusion criteria and were reviewed, which examined saccades, smooth pursuits, fixations and nystagmus in mTBI compared to controls. Current methodologies for data collection, analysis and interpretation from eye-tracking technology in individuals following an mTBI are discussed. In brief, a wide range of eye-movement instruments and outcome measures were reported, but validity and reliability of devices and metrics were insufficiently reported across studies. Interpretation of outcomes was complicated by poor study reporting of demographics, mTBI-related features (e.g., time since injury), and few studies considered the influence that cognitive or visual functions may have on eye-movements. The reviewed evidence suggests that eye-movements are impaired in mTBI, but future research is required to accurately Stuart et al. Measurement of Eye-Movements in mTBI and robustly establish findings. Standardization and reporting of eye-movement instruments, data collection procedures, processing algorithms and analysis methods are required. Recommendations also include comprehensive reporting of demographics, mTBI-related features, and confounding variables.

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Section: Introductionmentioning

confidence: 99%

The Measurement of Eye Movements in Mild Traumatic Brain Injury: A Structured Review of an Emerging Area

Stuart

Parrington

Martini

et al. 2020

Front. Sports Act. Living

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“…4–7 These reports are consistent with the suggestion that future studies should evaluate the value of incorporating vision-based testing into sideline diagnosis and long-term clinical assessments as a supplement to the medical diagnosis of concussion. 8 …”

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confidence: 99%

King-Devick and Pre-season Visual Function in Adolescent Athletes

et al. 2017

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Purpose The King-Devick Test (KD) has been studied as a remove-from-play sideline test in college-age athletes and older; however, studies in younger athletes are limited. A cross-sectional study of the KD and other vision correlates was completed on school-aged athletes during pre-season physicals for a variety of sports to determine the repeatability of the KD. The study also evaluated how convergence, alignment, or pupil function contributed to a slower King-Devick baseline reading. Methods 785 athletes underwent vision screenings in a hospital or school setting by trained/certified staff as part of pre-season physicals. 619 had KD testing completed per the manufacturer’s suggested protocol and repeated. Other baseline vision testing included visual acuity, Modified Thorington testing for alignment, convergence testing, and pupil function using the NeurOptics (NPI-200) NPi. Results The mean fastest, error-minimized KD time for all participants was 43.9 seconds(s) (sd±11.6, range 24–120). Median KD time got faster (+) with age (p <.0001). The inter-class correlation coefficient for all scores was 0.92. The absolute mean time difference for any two tests was 3.5s (sd±2.5, range 0–23). There was no association between the best KD time and reduced NPC (p=0.63), Modified Thorington measure of alignment (p = 0.55), or NPi pupil function (p=0.79). The Bland Altman repeated measure limits of agreement was ±6.5s for those in the 10th–12th grades, and ±10.2s for those in 6th–9th grades. Conclusions King-Devick score in junior high and high-school athletes is variable but gets faster and more repeatable with increasing age. The KD does not correlate significantly with reduced convergence, alignment, or pupil function. Based on grouped data, a slowing of 10 seconds for younger athletes and 6 seconds for older athletes on a second administration represents a true difference in testing speed. Within-player variability should be considered when removal-from-play decisions are influenced by KD results.

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“…The concussion knowledge base of parents before and after the initiative can be evaluated in order to improve educational materials and ensure appropriate language readability for maximal effectiveness. Also, while the utility of the K-D test to identify concussion has been widely studied [21,22,26,27,35,36], the reliability of the SAC, timed tandem gait, and Symptom Evaluation in youth athletes requires further study. Novel sideline tests for vision, balance and cognition may also emerge.…”

Section: Discussionmentioning

confidence: 99%

“…A few youth sports programs have begun to examine the ability of parents to administer simple sideline tests; these tests have proven to be accurate in predicting concussion, and at minimum start conversations regarding injury [20][21][22]. This suggests that if parents are adequately informed on concussion protocols, they can be effectively empowered to assist with recognizing the signs and symptoms and to ensure that injured athletes are removed from play.…”

Section: Introductionmentioning

confidence: 99%

Parents Take-On Concussion: Advances in Sideline Research and Culture in Youth Sports

Johnson¹

2017

J Sports Med Ther

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Identifying concussion and initiating removal from play is challenging for even the most diligent youth sports organizations. Empowering parents to implement removal from play protocols and sideline testing may be the most practical plan at community levels to protect young athletes. We developed paradigms for community-based youth sports teams that incorporated both standard concussion protocols and research investigations. The research studies were designed to determine how sideline tests of vision, cognition and balance augment the capacity for parents and other responsible adults to identify youth athletes with concussion in ice hockey, football, lacrosse and cheerleading. Research-based sideline tests were performed at pre-season baseline sessions and during the season at the time of injury or as soon as symptoms were recognized by trained volunteer parent team testers. The combination of standard concussion protocols and research studies were performed for 510 athletes, aged 5-17 years, over 2.5 years through 5 athletic seasons. To implement the protocols and studies, approximately 80 student volunteers and parents were educated and trained on early concussion recognition and on baseline and sideline test administration. Over 80% of parent-identifi ed head injuries were physician-confi rmed concussions. Of the sideline tests performed, over two-thirds were administered within 24 hours of injury; the rest were performed within an average of 2.6 days post-injury since some athletes had delayed development of symptoms. Removal from play guidelines and standard concussion evaluation protocols were maintained in the context of the sideline testing research investigations. Based on this observational study, parents of youth athletes can be successfully empowered to perform rapid sideline tests in the context of existing concussion protocols. Implementation of objective testing may improve concussion identifi cation and shift the culture of advocacy and responsibility towards parent groups to promote safety of young athletes. Ongoing investigations will further examine the impact of these programs on concussion management in youth sports.

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Diagnostic Tests for Concussion

Cited by 82 publications

References 96 publications

The Measurement of Eye Movements in Mild Traumatic Brain Injury: A Structured Review of an Emerging Area

The Measurement of Eye Movements in Mild Traumatic Brain Injury: A Structured Review of an Emerging Area

King-Devick and Pre-season Visual Function in Adolescent Athletes

Parents Take-On Concussion: Advances in Sideline Research and Culture in Youth Sports

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