Utility of a multimodal neurophysiologic assessment tool in distinguishing between individuals with and without a history of mild traumatic brain injury

Abstract

Abstract-This was a preliminary validation study of a multimodal concussion assessment battery incorporating eye-tracking, balance, and neurocognitive tests using a new hardware platform, the Computerized Brain Injury Assessment System. Using receiver-operating characteristics analyses, (1) we identified a subset of the most discriminating neurophysiological assessment tests, involving smooth pursuit eye movement tracking errors, corrective saccade counts, a balance score ratio sensitive to vestibular balance performance, and two neurocognitive tests of response speed and memory/incidental learning; (2) we demonstrated the enhancement in discriminatory capability of detecting concussion-related deficits through the combination of the identified subset of assessments; and (3) we demonstrated the effectiveness of a robust and readily implemented global scoring approach for both eye track and balance assessment tests. These results are significant in introducing a comprehensive solution for concussion assessment that incorporates an economical, compact, and mobile hardware system as well as an assessment battery that is multimodal and time efficient and whose efficacy has been demonstrated on a preliminary basis. This represents a significant step toward the goal of a system capable of making a dependable return-to-play/ duty determination based on concussion likelihood.

<p>Physiological Vibration Acceleration (Phybrata) Sensor Assessment of Multi-System Physiological Impairments and Sensory Reweighting Following Concussion</p>

“…153 Results matching the ROC diagnostic performance of the present phybrata approach have generally required multivariate composite models that combine data from various balance, eye tracking, neurocognitive, and other tests to generate more complex multimodal concussion biomarkers. [178][179][180][181][182] It is expected that the above ROC diagnostic performance of the phybrata sensor may be further enhanced by segmenting patients according to age. CDP-based studies of the age-dependent maturation of sensory systems have revealed that generalized postural stability increases with age but does not reach adult levels until the age of 16 years or later.…”

Neurocognitive Assessment Tools for Military Personnel With Mild Traumatic Brain Injury: Scoping Literature Review

“…This has the potential to amplify the risk for impaired performance, making mission failure more likely, and endangering the safety of self and others [10,11]. Neurocognitive assessments for those who have sustained mTBIs are needed to (1) provide information on function in a timely fashion, (2) assist with diagnoses of mTBIs and/or impaired cognitive functioning, and (3) provide health care professionals with the tools needed to understand and monitor phases of recovery after injury for better-informed clearance for a return to work, duty, and other activities [12]. Measurement of neurobehavioral and cognitive functioning after mTBIs, often referred to as neuropsychological testing, is considered a component of best practice mTBI management.…”

“…Rather, they are in-depth assessments that address behavior, emotional status, and cognitive domains as well as neuropsychological symptoms. Neuropsychological assessments may or may not provide diagnostic information on mental health conditions, mTBIs, or learning disabilities; however, their diagnostic properties are still widely debated within the research [12].…”

“…Diagnosing mTBIs on an individual basis has, to date, not been possible using a single traditional or computerized assessment. This diagnostic challenge can be attributed, in part, to large variations in baseline neurophysiological function and the presence of transient interferences such as learning effects, fatigue, anxiety, and unrelated states of mental alertness or illnesses [12]. Furthermore, although NCATs are being used in clinical settings and their utility in mTBI management is currently the subject of study, there is a lack of published literature on the use of these assessments among patients with other conditions known to adversely affect cognitive functioning [15].…”

Phybrata Sensors and Machine Learning for Enhanced Neurophysiological Diagnosis and Treatment

“…Current gold-standard solutions to achieve the above ROC diagnostic performance require multivariate composite models that combine data from multiple time-consuming and expensive tests such as computerized dynamic posturography, eye tracking, and neuro-cognitive assessments to generate more complex multimodal concussion biomarkers [32,35,[74][75][76]. The above ROC analyses utilized extensive manual feature inspection and statistical data analysis to select features in the phybrata signals that are predictive of specific physiological impairments and were limited to digital biomarkers derived from Eo and Ec phybrata powers [58] to quantify and monitor the progression of these impairments.…”