Clinical testing of mild traumatic brain injury using computerised eye-tracking tests

Cade, Alice; Turnbull, Philip

doi:10.1080/08164622.2021.2018915

Cited by 3 publications

(6 citation statements)

References 97 publications

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“…During fixation testing, vertical error was of importance, which may also implicate cervical spine injury. Previous research showed that vibration to the cervical spine in mTBI worsened vertical fixation error, but a manual therapy aimed at reducing proprioceptive dysfunction in the spine after head injury improved vertical error 37 . These data suggest that just augmenting proprioceptive drive from the post-head-injured spine is not the key for improving fixation, but that reducing disordered proprioception is crucial.…”

Section: Most Informative Tests Outcomesmentioning

confidence: 94%

“…Six tests with previously established diagnostic value in differentiating mTBI 32 , 37 , were used in this study. Egocentric localisation .…”

Section: Methodsmentioning

confidence: 99%

“…Baseline data from 55 control, 20 mTBI, and 40 PPCS participants were pooled from baseline measures across three other studies that used the same CEA battery and test regime.The first assessedthe test-retest reliability of the CEA tests in healthy people, the second assessed the effects of a vibratory intervention on the cervical spine in controls and mTBI, and the third was a randomised controlled interventional trial for people with PPCS 37 . All data used for this study were pre-intervention (i.e., baseline) measures from participants.…”

Section: Trial Design and Participantsmentioning

confidence: 99%

“…Eye tracking has been used to highlight many defects in those with mTBI, including poorer fixation 24 , increased gaze-error during pursuit movements 25 , increased saccade latency 26,27 , reduced vestibulo-ocular reflex (VOR) gain 28 , poorer performance on the Stroop test 29 , and higher egocentric localisation errors 30,31 , but no one test is diagnostic. Therefore, a comprehensive battery of computerized eye tracking assessments (CEAs) would seem to be ideally positioned to objectively detect mTBI after an injury 32 . Previous researchers have created eye tracking batteries that are sensitive and specific to identifying mTBI 33 , but they require restrained participants or skilled clinicians to operate and are either expensive or no longer unavailable [34][35][36] .…”

mentioning

confidence: 99%

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Classification of short and long term mild traumatic brain injury using computerized eye tracking

Cade,

Turnbull

2024

Sci Rep

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Accurate, and objective diagnosis of brain injury remains challenging. This study evaluated useability and reliability of computerized eye-tracker assessments (CEAs) designed to assess oculomotor function, visual attention/processing, and selective attention in recent mild traumatic brain injury (mTBI), persistent post-concussion syndrome (PPCS), and controls. Tests included egocentric localisation, fixation-stability, smooth-pursuit, saccades, Stroop, and the vestibulo-ocular reflex (VOR). Thirty-five healthy adults performed the CEA battery twice to assess useability and test–retest reliability. In separate experiments, CEA data from 55 healthy, 20 mTBI, and 40 PPCS adults were used to train a machine learning model to categorize participants into control, mTBI, or PPCS classes. Intraclass correlation coefficients demonstrated moderate (ICC > .50) to excellent (ICC > .98) reliability (p < .05) and satisfactory CEA compliance. Machine learning modelling categorizing participants into groups of control, mTBI, and PPCS performed reasonably (balanced accuracy control: 0.83, mTBI: 0.66, and PPCS: 0.76, AUC-ROC: 0.82). Key outcomes were the VOR (gaze stability), fixation (vertical error), and pursuit (total error, vertical gain, and number of saccades). The CEA battery was reliable and able to differentiate healthy, mTBI, and PPCS patients reasonably well. While promising, the diagnostic model accuracy should be improved with a larger training dataset before use in clinical environments.

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Section: Most Informative Tests Outcomesmentioning

confidence: 94%

“…Six tests with previously established diagnostic value in differentiating mTBI 32 , 37 , were used in this study. Egocentric localisation .…”

Section: Methodsmentioning

confidence: 99%

Section: Trial Design and Participantsmentioning

confidence: 99%

mentioning

confidence: 99%

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Classification of short and long term mild traumatic brain injury using computerized eye tracking

Cade,

Turnbull

2024

Sci Rep

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“…Assessments of the oculomotor function appear to be a promising direction for the early diagnosis of SRC 14,31,33 and may be promising tools to aid in the pursuit of rehabilitation services. 4,40 While advantageous, some persons may experience VR sickness (ie, dizziness and nausea) while engaging in VR due to the virtual environment or the type of equipment used to present the stimuli. 5,17,34,36 In fact, up to 67% of adults may experience mild-to-severe symptoms of VR sickness, 5 with women being more likely to experience VR sickness compared with men.…”

mentioning

confidence: 99%

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

Pavilionis

Adhanom

Moran

et al. 2023

Sports Health: A Multidisciplinary Approach

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Background: Virtual reality (VR) has been explored to improve baseline and postinjury assessments in sport-related concussion (SRC). Some experience symptoms related to VR, unrelated to concussion. This may deter use of vestibular/ocular motor screening (VOMS) using VR. Baseline VR VOMS symptomatology differentiates baseline from overall symptomatology. Hypothesis: There will be no difference between current clinical manual VOMS (MAN), a clinical prototype (PRO), and VR for symptom provocation change score (SPCS) and near point of convergence (NPC) average score in a healthy population and sex differences among the 3 modes of administration. Study Design: Cohort study. Level of Evidence: Level 3. Methods: A total of 688 National Collegiate Athletic Association Division I student-athletes completed VOMS using 3 methods (MAN, N = 111; female athletes, N = 47; male athletes, N = 64; average age, 21 years; PRO, N = 365; female athletes, N = 154; male athletes, N = 211; average age, 21 years; VR, N = 212; female athletes, N = 78; male athletes, N = 134; average age = 20 years) over a 3-year period (2019-2021) during annual baseline testing. Exclusion criteria were as follows: self-reported motion sickness in the past 6 months, existing or previous neurological insult, attention deficit hyperactivity disorder, learning disabilities, or noncorrected vision impairment. Administration of MAN followed the current clinical protocols, PRO used a novel prototype, and VR used an HTC Vive Pro Eye head mounted display. Symptom provocation was compared using Mann-Whitney U tests across each VOMS subtest with total SPCS and NPC average by each method. Results: MAN had significantly ( P < 0.01) more baseline SPCS (MAN = 0.466 ± 1.165, PRO = 0.163 ± 0.644, VR = 0.161 ± 0.933) and significantly ( P < 0.01) and more SPCS (MAN = 0.396 ± 1.081, PRO = 0.128 ± 0.427, VR = 0.48 ± 0.845) when compared with PRO and VR. NPC average measurements for VR (average, 2.99 ± 0.684 cm) were significantly greater than MAN (average, 2.91 ± 3.35 cm; P < 0.01; Cohen’s d = 0.03) and PRO (average, 2.21 ± 1.81 cm; P < 0.01; Cohen’s d = 0.57). For sex differences, female athletes reported greater SPCS with PRO (female athletes, 0.29 ± 0.87; male athletes, 0.06 ± 0.29; P < 0.01) but not in VR or MAN. Conclusion: Using a VR system to administer the VOMS may not elicit additional symptoms, resulting in fewer false positives and is somewhat stable between sexes. Clinical Relevance: VOMS may allow for standardization among administrators and reduce possible false positives.

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Assessment of Oculomotor Functions as a Biomarker in Mild Traumatic Brain Injury

Lunkova,

Chen,

Saluja

et al. 2024

Neurotrauma Reports

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Clinical testing of mild traumatic brain injury using computerised eye-tracking tests

Cited by 3 publications

References 97 publications

Classification of short and long term mild traumatic brain injury using computerized eye tracking

Classification of short and long term mild traumatic brain injury using computerized eye tracking

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

Assessment of Oculomotor Functions as a Biomarker in Mild Traumatic Brain Injury

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