Horizontal and vertical self-paced saccades as a diagnostic marker of traumatic brain injury

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Abstract

Aim:

Eye tracking tests to measure horizontal and vertical saccades as a proxy for neural deficits associated with traumatic brain injury (TBI) were evaluated in the present study.

Methodology:

A total of 287 participants reporting either no TBI, mild, moderate or severe TBI participated in a suite of eye tracking tests to measure horizontal and vertical saccadic performance.

Results:

The horizontal saccades test offered a sensitivity of 0.77 and a specificity of 0.78, similarly the vertical saccades tests offered a sensitivity of 0.64 and a specificity of 0.65.

Conclusion:

The results indicated that using eye-tracking technology to measure these metrics offers an objective, reliable and quantifiable way of differentiating between individuals with different severities of TBI, and those without a TBI.

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Most cited references 34

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Impaired eye movements in post-concussion syndrome indicate suboptimal brain function beyond the influence of depression, malingering or intellectual ability.

Walton Jones, Daniel Anderson, D Snell … (2009)

Post-concussion syndrome (PCS) can affect up to 20%-30% of patients with mild closed head injury (mCHI), comprising incomplete recovery and debilitating persistence of post-concussional symptoms. Eye movements relate closely to the functional integrity of the injured brain and eye movement function is impaired post-acutely in mCHI. Here, we examined whether PCS patients continue to show disparities in eye movement function at 3-5 months following mCHI compared with patients with good recovery. We hypothesized that eye movements might provide sensitive and objective functional markers of ongoing cerebral impairment in PCS. We compared 36 PCS participants (adapted World Health Organization guidelines) and 36 individually matched controls (i.e. mCHI patients of similar injury severity but good recovery) on reflexive, anti- and self-paced saccades, memory-guided sequences and smooth pursuit. All completed neuropsychological testing and health status questionnaires. Mean time post-injury was 140 days in the PCS group and 163 days in the control group. The PCS group performed worse on anti-saccades, self-paced saccades, memory-guided sequences and smooth pursuit, suggesting problems in response inhibition, short-term spatial memory, motor-sequence programming, visuospatial processing and visual attention. This poorer oculomotor performance included several measures beyond conscious control, indicating that subcortical functionality in the PCS group was poorer than expected after mCHI. The PCS group had poorer neuropsychological function (memory, complex attention and executive function). Analysis of covariance showed oculomotor differences to be practically unaffected by group disparities in depression and estimated intellectual ability. Compared with neuropsychological tests, eye movements were more likely to be markedly impaired in PCS cases with high symptom load. Poorer eye movement function, and particularly poorer subcortical oculomotor function, correlated more with post-concussive symptom load and problems on activities of daily living whilst poorer neuropsychological function exhibited slightly better correlations with measures of mental health. Our findings that eye movement function in PCS does not follow the normal recovery path of eye movements after mCHI are indicative of ongoing cerebral impairment. Whilst oculomotor and neuropsychological tests partially overlapped in identifying impairment, eye movements showed additional dysfunction in motor/visuospatial areas, response inhibition, visual attention and subcortical function. Poorer subconscious oculomotor function in the PCS group supports the notion that PCS is not merely a psychological entity, but also has a biological substrate. Measurement of oculomotor function may be of value in PCS cases with a high symptom load but an otherwise unremarkable assessment profile. Routine oculomotor testing should be feasible in centres with existing access to this technology.

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Cognitive processes involved in smooth pursuit eye movements.

G.R. Barnes (2008)

Ocular pursuit movements allow moving objects to be tracked with a combination of smooth movements and saccades. The principal objective is to maintain smooth eye velocity close to object velocity, thus minimising retinal image motion and maintaining acuity. Saccadic movements serve to realign the image if it falls outside the fovea, the area of highest acuity. Pursuit movements are often portrayed as voluntary but their basis lies in processes that sense retinal motion and can induce eye movements without active participation. The factor distinguishing pursuit from such reflexive movements is the ability to select and track a single object when presented with multiple stimuli. The selective process requires attention, which appears to raise the gain for the selected object and/or suppress that associated with other stimuli, the resulting competition often reducing pursuit velocity. Although pursuit is essentially a feedback process, delays in motion processing create problems of stability and speed of response. This is countered by predictive processes, probably operating through internal efference copy (extra-retinal) mechanisms using short-term memory to store velocity and timing information from prior stimulation. In response to constant velocity motion, the initial response is visually driven, but extra-retinal mechanisms rapidly take over and sustain pursuit. The same extra-retinal mechanisms may also be responsible for generating anticipatory smooth pursuit movements when past experience creates expectancy of impending object motion. Similar, but more complex, processes appear to operate during periodic pursuit, where partial trajectory information is stored and released in anticipation of expected future motion, thus minimising phase errors associated with motion processing delays.

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The King-Devick test as a determinant of head trauma and concussion in boxers and MMA fighters.

K M Galetta, J. Barrett, Andrew M Allen … (2011)

Sports-related concussion has received increasing attention as a cause of short- and long-term neurologic symptoms among athletes. The King-Devick (K-D) test is based on measurement of the speed of rapid number naming (reading aloud single-digit numbers from 3 test cards), and captures impairment of eye movements, attention, language, and other correlates of suboptimal brain function. We investigated the K-D test as a potential rapid sideline screening for concussion in a cohort of boxers and mixed martial arts fighters.

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Author and article information

Journal

Journal ID (nlm-ta): Concussion

Journal ID (iso-abbrev): Concussion

Journal ID (publisher-id): CNC

Title: Concussion

Publisher: Future Medicine Ltd (London, UK )

ISSN (Electronic): 2056-3299

Publication date (Electronic, pub): 25 July 2019

Publication date (Electronic, collection): August 2019

Publication date PMC-release: 25 July 2019

Volume: 4

Issue: 1

Electronic Location Identifier: CNC60

Affiliations

[1 ]RightEye LLC, 7979 Old Georgetown Rd, Suite 801, Bethesda, MD 20814, USA

[2 ]University of the West of England, Department of Psychology, Bristol, Coldharbour Lane, Bristol, BS16 1QY, UK

[3 ]East Carolina University, College of Health & Human Performance, Minges Coliseum 166, Greenville, NC 27858, USA

[4 ]Emory University, Health Sciences, 201 Dowman Dr, Atlanta, GA 30322, USA

Author notes

[* ]Author for correspondence: Tel.: +44 117 328 3132; claire-marie.roberts@ 123456uwe.ac.uk

Author information

Claire-Marie Roberts https://orcid.org/0000-0002-0693-4037

Article

DOI: 10.2217/cnc-2019-0001

PMC ID: 6714073

PubMed ID: 31467684

SO-VID: 66f91e81-792a-406a-911f-dbf61e98be76

License:

This work is licensed under the Creative Commons Attribution 4.0 License

History

Date received : 27 January 2019

Date accepted : 10 June 2019

Date: 25 July 2019

Page count

Pages: 12

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Horizontal and vertical self-paced saccades as a diagnostic marker of traumatic brain injury

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Most cited references 34

Impaired eye movements in post-concussion syndrome indicate suboptimal brain function beyond the influence of depression, malingering or intellectual ability.

Cognitive processes involved in smooth pursuit eye movements.

The King-Devick test as a determinant of head trauma and concussion in boxers and MMA fighters.

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Cited by 17

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