Saccadic impairment in chronic traumatic brain injury: examining the influence of cognitive load and injury severity

Ettenhofer, Mark L.; Hershaw, Jamie; Engle, James R.; Hungerford, Lars

doi:10.1080/02699052.2018.1511067

Cited by 13 publications

(24 citation statements)

References 66 publications

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“…Importantly, the types of eye movements that are most strongly impacted by mTBI are those that most heavily rely upon effective cognitive processing, as opposed to measures of basic neuromotor function 14,18,27‐29 . In particular, previous research conducted by our group 14,15 and others 28‐30 has shown enhanced sensitivity of eye movements to effects of mTBI under conditions of increased cognitive load. Many oculomotor metrics are also less impacted by age, education, or intelligence, relative to conventional neuropsychological measures 20,31,32 …”

Section: Introductionmentioning

confidence: 99%

“…Comprehensive neuropsychological evaluation is a widely accepted approach for identification of functional neural impairment; 11 however, this approach generally returns “normal” results beyond 90 days postinjury 12‐15 . This raises questions about the value of neuropsychological assessment for the mTBI patient who seeks treatment after symptoms have become chronic.…”

Section: Introductionmentioning

confidence: 99%

“…Measures of oculomotor performance show considerable potential to improve assessment of mTBI. Several studies have shown that mTBI has a negative impact on eye movements, 14‐19 particularly with multiple injuries or persistent post–concussive symptoms 14,20,21 . Eye movement abnormalities in TBI could be related to the broad network of regions that must communicate effectively to acquire and integrate information from the visual environment 22 .…”

Section: Introductionmentioning

confidence: 99%

“…Concurrent measurement of multiple response modalities while an examinee completes a cognitive test may provide a means for improved assessment of chronic mTBI 31 . In previous studies, 14‐15,31,33,34 our group has developed and validated methods to assess saccadic eye movements and manual motor performance in response to varying levels of cognitive load. This study extends this line of research using a more advanced system optimized to be clinically feasible for assessment of TBI in real‐world medical environments.…”

Section: Introductionmentioning

confidence: 99%

“…This study extends this line of research using a more advanced system optimized to be clinically feasible for assessment of TBI in real‐world medical environments. Based on recent findings, we hypothesized that the Fusion n‐Back test 15 – particularly, saccadic metrics derived from the more cognitively challenging 1‐Back subtest – would outperform conventional neuropsychological measures in distinguishing participants with chronic mTBI from controls.…”

Section: Introductionmentioning

confidence: 99%

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Clinical validation of an optimized multimodal neurocognitive assessment of chronic mild TBI

Ettenhofer

Gimbel

Cordero

2020

Ann Clin Transl Neurol

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Objective: Previous laboratory-based studies have shown that neurocognitive eye-tracking metrics are sensitive to chronic effects of mild traumatic brain injury (mTBI), even in individuals with normal performance on traditional neuropsychological measures. In this study, we sought to replicate and extend these findings in a military medical environment. We expected that metrics from the multimodal Fusion n-Back test would successfully distinguish chronic mTBI participants from controls, particularly eye movement metrics from the more cognitively challenging "1-Back" subtest. Methods: We compared performance of participants with chronic mTBI (n = 46) and controls (n = 33) on the Fusion n-Back test and a battery of conventional neuropsychological tests. Additionally, we examined test reliability and the impact of potential confounds to neurocognitive assessment. Results: Our results supported hypotheses; Fusion 1-Back metrics were successful in multimodal (saccadic and manual) classification of chronic mTBI versus control. In contrast, conventional neuropsychological measures could not distinguish these groups. Additional findings demonstrated the reliability of Fusion n-Back test metrics and provided evidence that saccadic metrics are resistant to confounding influences of age, intelligence, and psychiatric symptoms. Interpretation: The Fusion n-Back test could provide advantages in differential diagnosis for complex brain injury populations. Additionally, the rapid administration of this test could be valuable for screening patients in clinical settings where longer test batteries are not feasible.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Clinical validation of an optimized multimodal neurocognitive assessment of chronic mild TBI

Ettenhofer

Gimbel

Cordero

2020

Ann Clin Transl Neurol

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Vision Therapy: Ocular Motor Training in Mild Traumatic Brain Injury

Barton

Ranalli

2020

Annals of Neurology

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Vision therapy in the form of ocular motor training is increasingly used to treat visual complaints, particularly in the setting of persistent symptoms after mild traumatic brain injury (mTBI). In this review, we discuss the rationale behind this intervention and the evidence for its utility. Although the efficacy of exercises for primary convergence insufficiency is plausible and supported by data, there is not yet strong evidence of benefit for the post‐traumatic variant. It is not established that abnormalities in fixation, pursuit, and saccades in mTBI are the cause of post‐concussive symptoms, or that these abnormalities arise from ocular motor damage rather than being secondary effects of cognitive problems with attention or executive control. The few studies to date have significant methodological weaknesses. More substantial evidence is required before vision therapy can be accepted as a useful tool in the rehabilitation of patients with brain trauma. ANN NEUROL 2020;88:453–461

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The cognitive basis for virtual reality rehabilitation of upper-extremity motor function after neurotraumas

Dewil,

Kuptchik,

Liu

et al. 2023

J Multimodal User Interfaces

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This paper aims to present previous works in augmented sensory guidance for motor learning and psychophysiological factors and contextualize how these approaches may facilitate greater optimization of motor rehabilitation after neurotraumas with virtual reality. Through library resources at Stevens Institute of Technology, we searched for related works using multiple electronic databases and search engines with a medical focus (detailed in the paper). Searches were for articles published between 1980 and 2023 examining upper extremity rehabilitation, virtual reality, cognition, and modes and features of sensory feedback (specific search terms detailed in the paper). Strategic activation of sensory modalities for augmented guidance using virtual reality may improve motor training to develop further skill retention in persons suffering from impulsive neurological damage. Features with unique motor learning characteristics to consider with augmented feedback signals include representation, timing, complexity, and intermittency. Furthermore, monitoring psychophysiological factors (e.g., sense of agency, cognitive loading, attention) that represent mental and psychological processes may assist in critically evaluating novel designs in computerized rehabilitation. Virtual reality approaches should better incorporate augmented sensory feedback and leverage psychophysiological factors to advance motor rehabilitation after neurotraumas.

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Saccadic impairment in chronic traumatic brain injury: examining the influence of cognitive load and injury severity

Abstract: This study provides additional support for the value of eye tracking for enhanced assessment of TBI. Additionally, findings suggest that TBI is associated with greatest susceptibility to oculomotor interference under high levels of cognitive load.

Cited by 13 publications

References 66 publications

Clinical validation of an optimized multimodal neurocognitive assessment of chronic mild TBI

Clinical validation of an optimized multimodal neurocognitive assessment of chronic mild TBI

Vision Therapy: Ocular Motor Training in Mild Traumatic Brain Injury

The cognitive basis for virtual reality rehabilitation of upper-extremity motor function after neurotraumas

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