Oculomotor, Vestibular, and Reaction Time Tests in Mild Traumatic Brain Injury

Balaban, Carey D.; Hoffer, Michael E.; Szczupak, Mikhaylo; Snapp, Hillary; Crawford, James; Murphy, Sara; Marshall, Kathryn; Pelusso, Constanza; Knowles, Sean; Kiderman, Alexander

doi:10.1371/journal.pone.0162168

Cited by 58 publications

(60 citation statements)

References 20 publications

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“…We determined that PER and median AS latency were significantly different between concussion/PCS and control groups (Table 3). This result is consistent with results of previous studies that found one or both of these parameters to be affected in concussion or PCS, 3,15,17,18,20,30 though there is considerable heterogeneity in the literature. Not surprisingly, both PER and median AS latency were selected as ANN inputs during sensitivity analysis.…”

Section: Key Saccade Parameterssupporting

confidence: 92%

“…However, eye movements (specifically antisaccades [ASs]) have been shown to be abnormal in concussion and PCS patients and may be useful in the development of objective diagnostic and prognostic tools. 3,[15][16][17][18][19][20]30 Saccades are rapid, conjugate eye movements that serve to transition between 2 areas of focus. We considered 2 subtypes: prosaccades (PSs) and ASs.…”

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confidence: 99%

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Using artificial neural networks to identify patients with concussion and postconcussion syndrome based on antisaccades

Landry

Ting

Zádor

et al. 2019

Journal of Neurosurgery

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OBJECTIVEArtificial neural networks (ANNs) have shown considerable promise as decision support tools in medicine, including neurosurgery. However, their use in concussion and postconcussion syndrome (PCS) has been limited. The authors explore the value of using an ANN to identify patients with concussion/PCS based on their antisaccade performance.METHODSStudy participants were prospectively recruited from the emergency department and head injury clinic of a large teaching hospital in Toronto. Acquaintances of study participants were used as controls. Saccades were measured using an automated, portable, head-mounted device preprogrammed with an antisaccade task. Each participant underwent 100 trials of the task and 11 saccade parameters were recorded for each trial. ANN analysis was performed using the MATLAB Neural Network Toolbox, and individual saccade parameters were further explored with receiver operating characteristic (ROC) curves and a logistic regression analysis.RESULTSControl (n = 15), concussion (n = 32), and PCS (n = 25) groups were matched by age and level of education. The authors examined 11 saccade parameters and found that the prosaccade error rate (p = 0.04) and median antisaccade latency (p = 0.02) were significantly different between control and concussion/PCS groups. When used to distinguish concussion and PCS participants from controls, the neural networks achieved accuracies of 67% and 72%, respectively. This method was unable to distinguish study patients with concussion from those with PCS, suggesting persistence of eye movement abnormalities in patients with PCS. The authors’ observations also suggest the potential for improved results with a larger training sample.CONCLUSIONSThis study explored the utility of ANNs in the diagnosis of concussion/PCS based on antisaccades. With the use of an ANN, modest accuracy was achieved in a small cohort. In addition, the authors explored the pearls and pitfalls of this novel approach and identified important future directions for this research.

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Section: Key Saccade Parameterssupporting

confidence: 92%

mentioning

confidence: 99%

Using artificial neural networks to identify patients with concussion and postconcussion syndrome based on antisaccades

Landry

Ting

Zádor

et al. 2019

Journal of Neurosurgery

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“…Many of the TWS patients also have experienced traumatic brain injury (TBI) and mild TBI (mTBI), which can also produce cognitive dysfunction and dizziness highlighting the role of this comorbidity . TBI and mTBI are a significant health issue which affects service members and veterans during times of both peace and war.…”

Section: Introductionmentioning

confidence: 99%

“…2,3 Video recordings of consenting patients before and after intervention help to further document these obvious alterations in ways that complement standardized neuropsychology testing. [5][6][7][8][9][10][11][12][13][14][15][16][17][18] Other investigators have also explored the relationship between vestibular dysfunction and cognitive dysfunction; [19][20][21][22][23][24][25][26][27][28] however, Gizzi and coworkers used the Neurobehavioral Symptom Inventory, and the Beck Depression Inventory and reported no causal connection between vestibular disorders and cognitive dysfunction. 28 They studied 200 patients with "dizziness""-half with a history of brain trauma and half without.…”

Section: Introductionmentioning

confidence: 99%

“…3,[5][6][7][8][9][10][11][12][13][14][15][16][17][18] Many of the TWS patients also have experienced traumatic brain injury (TBI) and mild TBI (mTBI), which can also produce cognitive dysfunction and dizziness highlighting the role of this comorbidity. 3,21,43,44 TBI and mTBI are a significant health issue which affects service members and veterans during times of both peace and war. The high rate of TBI and blastrelated concussion events resulting from current combat operations directly impacts the health and safety of individual service members and subsequently the level of unit readiness and troop retention.…”

Section: Introductionmentioning

confidence: 99%

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Comorbidities confounding the outcomes of surgery for third window syndrome: Outlier analysis

Wackym

Mackay-Promitas

Demirel

et al. 2017

Laryngoscope Investig Oto

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ObjectivePatients with third window syndrome and superior semicircular canal dehiscence (SSCD) symptoms whose surgical outcomes placed them as outliers were systematically studied to determine comorbidities that were responsible for their poor outcomes due to these confounding factors.Study DesignObservational analytic case‐control study in a tertiary referral center.MethodsTwelve adult patients with clinical SSCD syndrome underwent surgical management and had outcomes that did not resolve all of their subjective symptoms. In addition to one of the neurotologists, 2 neurologists (one specializing in migraine and the other a neuro‐ophthalmologist), and a psychologist clinician‐investigator completed comprehensive evaluations. Neuropsychology test batteries included: the Millon Behavioral Medicine Diagnostic; Patient Health Questionnaire (PHQ‐9) and Generalized Anxiety Disorder Screener (GAD‐7); Adverse Childhood Experiences Scale; the Wide Range Assessment of Memory and Learning, including the 3 domains of verbal memory, visual memory, and attention/concentration; Wechsler Adult Intelligence Scale; and the Delis‐Kaplan Executive Function System. The control cohort was comprised of 17 participants who previously underwent surgery for third window syndrome that resulted in the expected outcomes of resolution of their third window syndrome symptoms and cognitive dysfunction.ResultsThere was a high rate of psychological comorbidity (n = 6) in the outlier cohort; multiple traumatic brain injuries were also a confounding element (n = 10). One patient had elevated cerebrospinal fluid (CSF) pressure requiring ventriculoperitoneal shunting to control the recurrence of dehiscence and one patient with a drug‐induced Parkinson‐like syndrome and idiopathic progressive neurological degenerative process.ConclusionsComponents of the Millon Behavioral Medicine Diagnostic, PHQ‐9 and GAD‐7 results suggest that these instruments would be useful as screening tools preoperatively to identify psychological comorbidities that could confound outcomes. The identification of these comorbid psychological as well as other neurological degenerative disease processes led to alternate clinical management pathways for these patients.Level of Evidence2b.

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Longitudinal Outcomes of Cumulative Impact Exposure on Oculomotor Functioning in Professional Motorsport Drivers

et al. 2023

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ImportanceProfessional motorsport drivers are regularly exposed to biomechanical forces comparable with those experienced by contact and collision sport athletes, and little is known about the potential short-term and long-term neurologic sequelae.ObjectiveTo determine whether cumulative impact exposure is associated with oculomotor functioning in motorsport drivers from the INDYCAR professional open-wheel automobile racing series.Design, Setting, and ParticipantsThis is a longitudinal retrospective cohort study conducted across 3 racing seasons (2017-2019). Statistical analyses were conducted in November 2021. Data were retrieved from a secondary care setting associated with the INDYCAR series. INDYCAR series drivers who participated in 3 professional level racing seasons and were involved in at least 1 contact incident (ie, crash) in 2 of the 3 seasons were included in the study.ExposureCumulative acceleration and deceleration forces and total contact incidents (ie, crashes) measured via accident data recorder third generation chassis and ear accelerometers.Main Outcomes and MeasuresPostseries oculomotor performance, including predictive saccades, vergence smooth pursuit, and optokinetic nystagmus, was measured annually with a head-mounted, clinical eye tracking system (Neurolign Dx 100).ResultsThirteen drivers (mean [SD] age, 29.36 [7.82] years; all men) sustained median resultant acceleration forces of 38.15 g (observed range, 12.01-93.05 g; 95% CI, 30.62-65.81 g) across 81 crashes. A 2-way multivariate analysis of variance did not reveal a statistically significant association between ear and chassis average resultant g forces, total number of contact incidents, and racing season assessed (F9,12 = 0.955; P = .54; Wilks Λ = 0.44).Conclusions and RelevanceIn this cohort study of professional drivers from the INDYCAR series, there were no statistically significant associations among cumulative impact exposure, racing season assessed, and oculomotor performance. Longitudinal studies across racing seasons using multidimensional examination modalities (eg, neurocognitive testing, advanced imaging, biomarkers, and physical examination) are critical to understand potential neurological and neurobehavioral sequelae and long-term consequences of cumulative impact exposure.

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Oculomotor, Vestibular, and Reaction Time Tests in Mild Traumatic Brain Injury

Cited by 58 publications

References 20 publications

Using artificial neural networks to identify patients with concussion and postconcussion syndrome based on antisaccades

Using artificial neural networks to identify patients with concussion and postconcussion syndrome based on antisaccades

Comorbidities confounding the outcomes of surgery for third window syndrome: Outlier analysis

Longitudinal Outcomes of Cumulative Impact Exposure on Oculomotor Functioning in Professional Motorsport Drivers

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