Smooth Pursuit and Saccades after Sport-Related Concussion

Murray, Nicholas G.; Szekely, Brian; Islas, Arthur; Munkasy, Barry A.; Gore, Russell K.; Berryhill, Marian E.; Reed-Jones, Rebecca J.

doi:10.1089/neu.2019.6595

Cited by 35 publications

(33 citation statements)

References 62 publications

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“…Several authors have reported significant postconcussive deficits in vertical saccades. 23 , 25 , 30 , 45 It is unclear why vertical saccade metrics were not statistically significant classifiers in our study. Small sample size combined with the relatively conservative Bonferonni method of correcting for multiple comparisons may have obscured a statistically significant group difference.…”

Section: Discussioncontrasting

confidence: 64%

“…Moreover, the reliability of reaction time measures on the device used in our study was quite robust among noninjured young adults, with most intraclass correlation coefficients above 0.75. 54 Because visual reaction time and other eye movement performance metrics are faster and more accurate in athletes than nonathletes 23 and decline with advancing age, [54][55][56] our results may not be generalizable to older or nonathlete populations. Furthermore, although observers were not masked to patient grouping, neither ET nor cognitive testing are subjective measures, likely limiting the effect of observer bias.…”

Section: Limitationsmentioning

confidence: 99%

“…[18][19][20] Computerized ET can provide objective measures of SPEM (slow eye movements used to track a moving target) and saccades (rapid movements used to look from 1 target to another). 9,10,18,[21][22][23][24][25][26][27][28][29][30][31][32][33] SPEM metrics have been identified as accurate concussion classifiers, 29,34,35 but the discriminatory accuracy of non-SPEMs and the contribution of attention and memory to eye movement performance have not, to our knowledge, been evaluated. Addressing these gaps would be crucial for identifying the ET metrics most likely to provide added value in the evaluation of concussion.…”

Section: Introductionmentioning

confidence: 99%

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Classification of Comprehensive Neuro-Ophthalmologic Measures of Postacute Concussion

et al. 2021

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IMPORTANCE Symptom-based methods of concussion diagnosis in contact sports result in underdiagnosis and repeated head injury exposure, increasing the risk of long-term disability. Measures of neuro-ophthalmologic (NO) function have the potential to serve as objective aids, but their diagnostic utility is unknown. OBJECTIVE To identify NO measures that accurately differentiate athletes with and without concussion. DESIGN, SETTING, AND PARTICIPANTS This cohort study was conducted among athletes with and without concussion who were aged 17 to 22 years between 2016 and 2017. Eye movements and cognitive function were measured a median of 19 days after injury among patients who had an injury meeting the study definition of concussion while playing a sport (retrospectively selected from a concussion clinic), then compared with a control group of participants without concussion (enrolled from 104 noncontact collegiate athlete volunteers without prior head injury). Data analysis was conducted from November 2019 through May 2020. EXPOSURE Concussion. MAIN OUTCOMES AND MEASURES Classification accuracy of clinically important discriminator eye-tracking (ET) metrics. Participants' eye movements were evaluated with a 12-minute ET procedure, yielding 42 metrics related to smooth pursuit eye movement (SPEM), saccades, dynamic visual acuity, and reaction time. Clinically important discriminator metrics were defined as those with significantly different group differences and area under the receiver operator characteristic curves (AUROCs) of at least 0.70. RESULTS A total of 34 participants with concussions (mean [SD] age, 19.7 [2.4] years; 20 [63%] men) and 54 participants without concussions (mean [SD] age, 20.8 [2.2] years; 31 [57%] men) completed the study. Six ET metrics (ie, simple reaction time, discriminate reaction time, discriminate visual reaction speed, choice visual reaction speed, and reaction time on 2 measures of dynamic visual acuity 2) were found to be clinically important; all were measures of reaction time, and none were related to SPEM. Combined, these 6 metrics had an AUROC of 0.90 (95% CI, 0.80-0.99), a sensitivity of 77.8%, and a specificity of 92.6%. The 6 metrics remained significant on sensitivity testing. CONCLUSIONS AND RELEVANCE In this study, ET measures of slowed visual reaction time had high classification accuracy for concussion. Accurate, objective measures of NO function have the potential to improve concussion recognition and reduce the disability associated with underdiagnosis.

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Section: Discussioncontrasting

confidence: 64%

Section: Limitationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Classification of Comprehensive Neuro-Ophthalmologic Measures of Postacute Concussion

et al. 2021

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“…For example, saccadic eye movement training in web game playing is often used to reduce the abnormal occurrence, such as longer anti-saccade latencies and lower pro-saccade accuracy [42]. In addition, it has been used after a sports-related concussion to restore saccadic amplitude and velocity [61].…”

Section: Common Regarded Gaze Parameters Within Sports-related Purposesmentioning

confidence: 99%

Application of eye-tracking systems integrated into immersive virtual reality and possible transfer to the sports sector - A systematic review

Pastel

Marlok

Bandow

et al. 2022

Multimed Tools Appl

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In recent years, Virtual Reality (VR) has become a valuable tool in rehabilitation and sports training applications. New technologies offer opportunities to combine various systems and use them for sports-related scientific purposes. For instance, examining the visual perception of athletes within a standardized environment could be helpful to understand the differences between novices and experts in their visual behavior and could further reveal possible training applications for enhancing athletes’ visual attention. The current systematic literature review thematizes the importance of eye-tracking (ET) systems’ usage integrated into head-mounted displays (HMDs) in virtual environments for further inclusion in sports-related usage. An overview of possible implementations is given, and additional recommendations for using the combined technic regarding sports are made. Although only one study examined gaze behavior during sports activity within a standardized virtual environment, 38 relevant papers were identified using the ET systems integrated into the HMDs, which ideas can be transferred to the sports sector. The increased usability and fidelity in the virtual environment enabled through the combined technology were illustrated, and different approaches were listed in using and calculating gaze parameters. This literature review examines the possibility of integrating ET in VR, which can be further used to improve usability, interaction methods, image presentation, and visual perception analyses within future physical training scenarios. The compiled studies have shown that the existing methods are feasible due to the performance of the integrated ET systems but still need to be improved for practical use.

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“…Murray et al [26] SPEM after concussion Case-control (N=36) Abnormalities in SPEM amplitude and velocity were associated with concussion vs control groups.…”

Section: Smooth Pursuit Eye Movement Dysfunctionmentioning

confidence: 99%

Oculomotor examination and treatment for concussion

Morrow¹,

Craton²

2021

Neuro Neurosurg

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Background: Individuals who have sustained concussion frequently develop impairments in oculomotor function. Some providers have attempted to improve these impairments and aid the overall recovery from concussion by prescribing vision therapy.Objective: To review and assess the validity of common clinical oculomotor findings and subsequent vision therapy for concussion.Methods: A literature review was conducted via OVID MEDLINE and ePub databases. Three hundred and sixty-three records were obtained. Results were pared down to include only those with adequate power and relevance to the study questions. Eleven studies on examination and 2 studies on treatments met inclusion criteria.Results: There is reasonable evidence to support the use of near-point convergence, pursuits, and saccades (when computerized) aiding the diagnosis of concussion. Adequately powered randomized controlled trials do not exist to support of the use of vision therapy for the treatment of concussion. Conclusions:Oculomotor examination findings are useful in clinical practice to aid the diagnosis of concussion, but further research using adequately powered randomized controlled trials are required to clarify the efficacy of vision therapy in the treatment of concussion.

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Smooth Pursuit and Saccades after Sport-Related Concussion

Cited by 35 publications

References 62 publications

Classification of Comprehensive Neuro-Ophthalmologic Measures of Postacute Concussion

Classification of Comprehensive Neuro-Ophthalmologic Measures of Postacute Concussion

Application of eye-tracking systems integrated into immersive virtual reality and possible transfer to the sports sector - A systematic review

Oculomotor examination and treatment for concussion

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