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Cade A, Turnbull PRK. Classification of short and long term mild traumatic brain injury using computerized eye tracking. Sci Rep 2024; 14:12686. [PMID: 38830966 PMCID: PMC11148176 DOI: 10.1038/s41598-024-63540-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 05/29/2024] [Indexed: 06/05/2024] Open
Abstract
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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Affiliation(s)
- Alice Cade
- School of Optometry and Vision Science, The University of Auckland, Private Bag 92019, Auckland, 1023, New Zealand.
- New Zealand College of Chiropractic, Auckland, New Zealand.
| | - Philip R K Turnbull
- School of Optometry and Vision Science, The University of Auckland, Private Bag 92019, Auckland, 1023, New Zealand
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Treleaven D, Lamontagne A, Grilli L, Friedman D, Gagnon I. Altered Oculomotor and Vestibulo-ocular Function in Children and Adolescents Postconcussion. J Head Trauma Rehabil 2023:00001199-990000000-00114. [PMID: 37862137 DOI: 10.1097/htr.0000000000000898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023]
Abstract
OBJECTIVE To document (1) oculomotor (OM) and vestibulo-ocular (VO) function in children with concussion who were symptomatic at the time of assessment and to compare it with that in children with concussion who were clinically recovered (asymptomatic) and in children with no concussive injury, and (2) the extent to which OM and VO function relates to postconcussion symptom severity in injured children. SETTING Participants were recruited from a concussion clinic or the community. PARTICIPANTS A total of 108 youth with concussion (72 symptomatic; 36 recovered) and 79 healthy youth (aged 9-18 years). Youth with concussion were included if aged 9 to 18 years, had no previous concussion within the last 12 months, less than 90 days since injury, and no known existing visual disorders or learning disabilities. STUDY DESIGN A prospective cross-sectional study. MAIN MEASURES All participants were tested for OM and VO function with a commercial virtual reality (VR) eye-tracking system (Neuroflex®, Montreal,Québec, Canada). Participants in the concussion group who completed the postconcussion symptoms were scored with the Post-Concussion Symptom Inventory. RESULTS There was a significant group effect for vergence during smooth pursuit (F2,176 = 10.90; P < .05), mean latency during saccades (F2,171 = 5.99; P = .003), and mean response delay during antisaccades (F2,177 = 9.07; P < .05), where children with symptomatic concussion showed poorer performance than clinically recovered and healthy children. Similar results were found in VO for average vestibular ocular reflex gain in the horizontal leftward (F2,168 = 7; P = .001) and rightward directions (F2,163 = 13.08; P < .05) and vertical upward (F2,147 = 7.60; P = .001) and downward directions (F2,144 = 13.70; P < .05). Mean saccade error was positively correlated to total Post-Concussion Symptom Inventory scores in younger clinically recovered children. CONCLUSION VR eye tracking may be an effective tool for identifying OM and VO deficits in the subacute phase (<90 days) postconcussion.
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Affiliation(s)
- Dakota Treleaven
- Integrated Program in Neuroscience, Faculty of Medicine and Health Sciences, McGill University, Montreal, Québec, Canada (Ms Treleaven); School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, Québec, Canada (Dr Lamontagne); Jewish Rehabilitation Hospital-CISSS Laval site, Centre de Recherche Interdisciplinaire en Réadaptation du Montréal Métropolitain (CRIR), Montréal, Québec, Canada (Dr Lamontagne); Montreal Children's Hospital, McGill University Health Centre, Montreal, Québec, Canada (Mss Grilli and Friedman); and School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, Trauma Center, Montreal Children's Hospital, McGill University Health Center, Montreal, Québec, Canada (Dr Gagnon)
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Sandri Heidner G, O'Connell C, Domire ZJ, Rider P, Mizelle C, Murray NP. Concussed Neural Signature is Substantially Different than Fatigue Neural Signature in Non-concussed Controls. J Mot Behav 2023; 55:302-312. [PMID: 36990462 DOI: 10.1080/00222895.2023.2194852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
Traumatic brain injuries can result in short-lived and long-lasting neurological impairment. Identifying the correct recovery timeframe is challenging, as balance-based metrics may be negatively impacted if testing is performed soon after exercise. Thirty-two healthy controls and seventeen concussed individuals performed a series of balance challenges, including virtual reality optical flow perturbation. The control group completed a backpacking protocol to induce moderate fatigue. Concussed participants had lower spectral power in the motor cortex and central sulcus when compared to fatigued controls. Moreover, concussed participants experienced a decrease in overall theta band spectral power while fatigued controls showed an increase in theta band spectral power. This neural signature may be useful to distinguish between concussed and non-concussed fatigued participants in future assessments.
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Affiliation(s)
- Gustavo Sandri Heidner
- Department of Kinesiology, East Carolina University, Greenville, NC, USA
- Department of Kinesiology, Montclair State University, Montclair, NJ, USA
| | - Caitlin O'Connell
- Department of Kinesiology, East Carolina University, Greenville, NC, USA
| | - Zachary J Domire
- Department of Kinesiology, East Carolina University, Greenville, NC, USA
| | - Patrick Rider
- Department of Kinesiology, East Carolina University, Greenville, NC, USA
| | - Chris Mizelle
- Department of Kinesiology, East Carolina University, Greenville, NC, USA
| | - Nicholas P Murray
- Department of Kinesiology, East Carolina University, Greenville, NC, USA
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Ettenhofer ML, Hungerford LD, Agtarap S. Multimodal Neurocognitive Screening of Military Personnel With a History of Mild Traumatic Brain Injury Using the Bethesda Eye & Attention Measure. J Head Trauma Rehabil 2021; 36:447-455. [PMID: 33935223 DOI: 10.1097/htr.0000000000000683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate a neurocognitive eye tracking task, the Bethesda Eye & Attention Measure (BEAM), for use in cognitive screening of patients with a history of mild traumatic brain injury (TBI). SETTING US military TBI rehabilitation clinic. DESIGN/PARTICIPANTS Cross-sectional study of 191 military personnel receiving outpatient services related to history of mild TBI. Main measures: BEAM; neuropsychological screening measures of attention, processing speed, executive function, and memory. RESULTS Medium effect sizes were found for partial correlations (controlling for age) between key BEAM metrics and neuropsychological screening tests. Linear regression analyses demonstrated that BEAM saccadic eye movements and manual (button press) metrics each provided complementary value in measurement of cognitive performance, above and beyond effects of demographic factors and clinical characteristics. CONCLUSION This study provides initial support for the use of BEAM neurocognitive eye tracking in cognitive screening of adults with a history of mild TBI. BEAM saccadic metrics appear to be particularly well-suited for the assessment of visual attention. Study findings also highlight opportunities for greater cognitive sensitivity or testing efficiency that may be missed by tests measuring only one response modality at a time.
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Affiliation(s)
- Mark L Ettenhofer
- DHA Traumatic Brain Injury Center of Excellence, Silver Spring, Maryland (Drs Ettenhofer, Hungerford, and Agtarap); Naval Medical Center San Diego, San Diego, California (Drs Ettenhofer, Hungerford, and Agtarap); General Dynamics Information Technology, Falls Church, Virginia (Drs Ettenhofer, Hungerford, and Agtarap); University of California, San Diego, La Jolla, California (Dr Ettenhofer); and Uniformed Services University of the Health Sciences, Bethesda, Maryland (Dr Ettenhofer)
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Assessing the utility of a virtual-reality neuropsychological test battery, 'CONVIRT', in detecting alcohol-induced cognitive impairment. Behav Res Methods 2020; 53:1115-1123. [PMID: 32989723 DOI: 10.3758/s13428-020-01485-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2020] [Indexed: 11/08/2022]
Abstract
New technologies such as virtual reality (VR) and eye-tracking software have paved the way for more sophisticated and ecologically valid measures of cognitive function. Testing the sensitivity and reliability of such measurements in response to acute alcohol intoxication provides a first step in establishing how these measures may operate in relation to cognitive impairments observed post-concussion. Healthy young adults (N = 54, M = 20.65, SD = 2.06, 30 females) completed the CONVIRT test battery (manual simple and choice reaction-time and saccade reaction-time) at three breath alcohol concentration (BrAC) levels: 0.00%T1, 0.05%T2, 0.08%T3. Participants consumed alcoholic beverages at 30-min intervals, with BrAC monitored at 15-min intervals using a breathalyser. All three CONVIRT measures were sensitive to changes in cognitive performance induced by alcohol at BrAC levels at or exceeding 0.05%. A composite measure was also sensitive to alcohol intoxication (Cohen's d = .85 at BrAC = 0.05%; d = 1.20 at BrAC = 0.08%). Strong test-retest reliability was observed (all r < .80), with no gender differences noted. CONVIRT measures were reliable and detected dose-dependent changes in alcohol-induced cognitive impairment. Potentially, the ecologically valid measures may assist in better quantifying the effects of conditions such as concussion, on cognitive performance.
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Horan B, Heckenberg R, Maruff P, Wright B. Development of a new virtual reality test of cognition: assessing the test-retest reliability, convergent and ecological validity of CONVIRT. BMC Psychol 2020; 8:61. [PMID: 32532362 PMCID: PMC7291630 DOI: 10.1186/s40359-020-00429-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 06/05/2020] [Indexed: 01/26/2023] Open
Abstract
Background Technological advances provide an opportunity to refine tools that assess central nervous system performance. This study aimed to assess the test-retest reliability and convergent and ecological validity of a newly developed, virtual-reality, concussion assessment tool, ‘CONVIRT’, which uses eye-tracking technology to assess visual processing speed, and manual reaction time (pushing a button on a riding crop) to assess attention and decision-making. CONVIRT was developed for horse jockeys, as of all sportspersons, they are most at risk of concussion. Methods Participants (N = 165), were assessed with CONVIRT, which uses virtual reality to give the user the experience of riding a horse during a horserace. Participants were also assessed with standard Cogstate computer-based concussion measures in-between two completions of the CONVIRT battery. The physiological arousal induced by the test batteries were assessed via measures of heart rate and heart rate variability (LF/HF ratio). Results Satisfactory test-retest reliability and convergent validity with Cogstate attention and decision-making subtests and divergent validity in visual processing speed measures were observed. CONVIRT also increased heart rate and LF/HF ratio, which may better approximate participant arousal levels in their workplace. Conclusions CONVIRT may be a reliable and valid tool to assess elements of cognition and CNS disruption. The increased ecological validity may also mean better informed ‘return-to-play’ decisions and stronger industry acceptance due to the real-world meaningfulness of the assessment. However, before this can be achieved, the sensitivity of the CONVIRT battery needs to be demonstrated.
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Affiliation(s)
- Ben Horan
- School of Engineering, Deakin University, Geelong, VIC, 3216, Australia
| | - Rachael Heckenberg
- School of Psychology and Public Health, La Trobe University, Wodonga, Victoria, 3690, Australia
| | - Paul Maruff
- The Florey Institute, The University of Melbourne, Parkville, VIC, 3052, Australia
| | - Bradley Wright
- School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, 3086, Australia.
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Suleiman A, Lithgow BJ, Anssari N, Ashiri M, Moussavi Z, Mansouri B. Correlation between Ocular and Vestibular Abnormalities and Convergence Insufficiency in Post-Concussion Syndrome. Neuroophthalmology 2020; 44:157-167. [PMID: 32395167 PMCID: PMC7202416 DOI: 10.1080/01658107.2019.1653325] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 07/23/2019] [Accepted: 08/05/2019] [Indexed: 12/23/2022] Open
Abstract
The vestibular and oculomotor/visual systems are commonly affected in post-concussion syndrome (PCS). Convergence insufficiency (CI) is the most common ocular abnormality after concussion. Electrovestibulography (EVestG) is a relatively new non-invasive method that measures the peripheral vestibular responses; it has shown abnormal vestibular responses in a PCS. Here, we report the results of investigating the correlation between the vestibular and oculomotor systems in PCS population using EVestG and CI measures. Forty-eight PCS patients were tested using EVestG, out of which 20 also completed the Rivermead post-concussion questionnaire (RPQ). An EVestG feature (Field Potential (FP)-area) was extracted from the stationary part of the EVestG signals. A neuro-ophthalmologist (author BM) measured participants' CI at near vision using cross-cover examination and a prism-bar. Results indicate: (1) vestibular abnormality (i.e. FP-area) and CI values are significantly correlated in PCS (R = 0.68, p < .01), and (2) there are significant correlations between severity of concussion (i.e. RPQ3) and CI (R = 0.70, p < .01) and between RPQ3 and FP-area (R = -0.56, p < .02). To the best of our knowledge, this is the first study that objectively demonstrates a significant positive correlation between the CI and vestibular systems' abnormality. These findings are scientifically important as they help localise the pathology of PCS, and are clinically valuable as they help physicians in their decision-making about PCS diagnosis and rehabilitation strategies.
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Affiliation(s)
- Abdelbaset Suleiman
- Biomedical Engineering Program, University of Manitoba, Winnipeg, MB, Canada
| | - Brian J. Lithgow
- Biomedical Engineering Program, University of Manitoba, Winnipeg, MB, Canada
- Monash Alfred Psychiatry Research Center, Monash University, Melbourne, Australia
| | - Neda Anssari
- Department of Internal Medicine, Section of Neurology, University of Manitoba, Winnipeg, MB, Canada
- Department of Internal Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada
| | - Mehrangiz Ashiri
- Biomedical Engineering Program, University of Manitoba, Winnipeg, MB, Canada
| | - Zahra Moussavi
- Biomedical Engineering Program, University of Manitoba, Winnipeg, MB, Canada
| | - Behzad Mansouri
- Biomedical Engineering Program, University of Manitoba, Winnipeg, MB, Canada
- Department of Internal Medicine, Section of Neurology, University of Manitoba, Winnipeg, MB, Canada
- Department of Ophthalmology, University of Manitoba, Winnipeg, MB, Canada
- iScope Concussion and Pain Clinic, Toronto, ON, Canada
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Taghdiri F, Multani N, Ozzoude M, Tarazi A, Khodadadi M, Wennberg R, Mikulis D, Green R, Colella B, Davis K, Blennow K, Zetterberg H, Tator C, Tartaglia M. Neurofilament‐light in former athletes: a potential biomarker of neurodegeneration and progression. Eur J Neurol 2020; 27:1170-1177. [DOI: 10.1111/ene.14251] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 04/02/2020] [Indexed: 01/16/2023]
Affiliation(s)
- F. Taghdiri
- Tanz Centre for Research in Neurodegenerative Diseases University of Toronto OntarioTorontoCanada
| | - N. Multani
- Tanz Centre for Research in Neurodegenerative Diseases University of Toronto OntarioTorontoCanada
| | - M. Ozzoude
- Tanz Centre for Research in Neurodegenerative Diseases University of Toronto OntarioTorontoCanada
| | - A. Tarazi
- Division of Neurology Krembil Neuroscience Centre Toronto OntarioCanada
- Canadian Concussion Centre Toronto Western Hospital Krembil Brain Institute University Health Network TorontoCanada
| | - M. Khodadadi
- Canadian Concussion Centre Toronto Western Hospital Krembil Brain Institute University Health Network TorontoCanada
| | - R. Wennberg
- Division of Neurology Krembil Neuroscience Centre Toronto OntarioCanada
- Canadian Concussion Centre Toronto Western Hospital Krembil Brain Institute University Health Network TorontoCanada
- Institute of Medical Science University of Toronto Toronto OntarioCanada
| | - D. Mikulis
- Canadian Concussion Centre Toronto Western Hospital Krembil Brain Institute University Health Network TorontoCanada
- Institute of Medical Science University of Toronto Toronto OntarioCanada
- Division of Neuroradiology Joint Department of Medical Imaging University Health Network Toronto OntarioCanada
| | - R. Green
- Canadian Concussion Centre Toronto Western Hospital Krembil Brain Institute University Health Network TorontoCanada
- Department of Rehabilitation Sciences University of Toronto Toronto OntarioCanada
| | - B. Colella
- Canadian Concussion Centre Toronto Western Hospital Krembil Brain Institute University Health Network TorontoCanada
- Department of Rehabilitation Sciences University of Toronto Toronto OntarioCanada
| | - K.D. Davis
- Canadian Concussion Centre Toronto Western Hospital Krembil Brain Institute University Health Network TorontoCanada
- Institute of Medical Science University of Toronto Toronto OntarioCanada
- Department of Surgery University of Toronto Toronto OntarioCanada
- Division of Brain, Imaging and Behaviour‐systems Neuroscience Krembil Brain Institute University Health Network Toronto Ontario Canada
| | - K. Blennow
- Institute of Neuroscience and Physiology Department of Psychiatry and Neurochemistry The Sahlgrenska Academy at the University of Gothenburg MölndalSweden
- Clinical Neurochemistry Laboratory Sahlgrenska University Hospital Mölndal Sweden
| | - H. Zetterberg
- Institute of Neuroscience and Physiology Department of Psychiatry and Neurochemistry The Sahlgrenska Academy at the University of Gothenburg MölndalSweden
- Clinical Neurochemistry Laboratory Sahlgrenska University Hospital Mölndal Sweden
- Department of Neurodegenerative Disease UCL Institute of Neurology Queen Square LondonUK
- UK Dementia Research Institute at UCL University College London London UK
| | - C. Tator
- Canadian Concussion Centre Toronto Western Hospital Krembil Brain Institute University Health Network TorontoCanada
- Division of Neurosurgery Toronto Western Hospital Krembil Brain Institute University Health Network Toronto Canada
| | - M.C. Tartaglia
- Tanz Centre for Research in Neurodegenerative Diseases University of Toronto OntarioTorontoCanada
- Division of Neurology Krembil Neuroscience Centre Toronto OntarioCanada
- Canadian Concussion Centre Toronto Western Hospital Krembil Brain Institute University Health Network TorontoCanada
- Institute of Medical Science University of Toronto Toronto OntarioCanada
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Mani R, Asper L, Khuu SK. Deficits in saccades and smooth-pursuit eye movements in adults with traumatic brain injury: a systematic review and meta-analysis. Brain Inj 2018; 32:1315-1336. [PMID: 29913089 DOI: 10.1080/02699052.2018.1483030] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
PURPOSE To conduct a review of literature and quantify the effect that traumatic brain injury (TBI) has on oculomotor functions (OM). METHODS A systematic review and meta-analysis was conducted from papers that objectively measured saccades and smooth-pursuit eye movements in mild and severe TBI. RESULTS The overall impact of TBI on OM functions was moderate and significant with an effect size of 0.42 from 181 OM case-control comparisons. The heterogeneity, determined using the random effect model, was found to be significant (Q (180) = 367, p < 0.0001, I2 = 51) owing to the variety of OM functions (reflexive saccades, antisaccades, memory-guided saccades, self-paced saccades and pursuits) measured and varying post-injury periods.The overall effect on OM functions were similar in mild and severe TBI despite differences in combined effect size of various OM functions. OM functions involving complex cognitive skills such as antisaccades (in mild and severe TBI) and memory-guided saccades (in mild TBI) were the most adversely affected, suggesting that OM deficits may be associated with cognitive deficits in TBI. CONCLUSION TBI often results in long-standing OM deficits. Experimental measures of OM assessment reflect neural integrity and may provide a sensitive and objective biomarker to detect OM deficits following TBI.
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Affiliation(s)
- Revathy Mani
- a School of Optometry and Vision Science , The University of New South Wales (UNSW) , Sydney , Australia
| | - Lisa Asper
- a School of Optometry and Vision Science , The University of New South Wales (UNSW) , Sydney , Australia
| | - Sieu K Khuu
- a School of Optometry and Vision Science , The University of New South Wales (UNSW) , Sydney , Australia
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Taghdiri F, Chung J, Irwin S, Multani N, Tarazi A, Ebraheem A, Khodadadi M, Goswami R, Wennberg R, Mikulis D, Green R, Davis K, Tator C, Eizenman M, Tartaglia MC. Decreased Number of Self-Paced Saccades in Post-Concussion Syndrome Associated with Higher Symptom Burden and Reduced White Matter Integrity. J Neurotrauma 2018; 35:719-729. [DOI: 10.1089/neu.2017.5274] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Affiliation(s)
- Foad Taghdiri
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan Chung
- Department of Electrical and Computer Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Samantha Irwin
- Department of Neurology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Namita Multani
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Ontario, Canada
| | - Apameh Tarazi
- Division of Neurology, Toronto Western Hospital, Krembil Neuroscience Centre, University Health Network, Toronto, Ontario, Canada
- Canadian Concussion Centre, Toronto Western Hospital, Krembil Neuroscience Centre, University Health Network, Toronto, Ontario, Canada
| | - Ahmed Ebraheem
- Canadian Concussion Centre, Toronto Western Hospital, Krembil Neuroscience Centre, University Health Network, Toronto, Ontario, Canada
| | - Mozghan Khodadadi
- Canadian Concussion Centre, Toronto Western Hospital, Krembil Neuroscience Centre, University Health Network, Toronto, Ontario, Canada
| | - Ruma Goswami
- Canadian Concussion Centre, Toronto Western Hospital, Krembil Neuroscience Centre, University Health Network, Toronto, Ontario, Canada
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Richard Wennberg
- Division of Neurology, Toronto Western Hospital, Krembil Neuroscience Centre, University Health Network, Toronto, Ontario, Canada
- Canadian Concussion Centre, Toronto Western Hospital, Krembil Neuroscience Centre, University Health Network, Toronto, Ontario, Canada
| | - David Mikulis
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Canadian Concussion Centre, Toronto Western Hospital, Krembil Neuroscience Centre, University Health Network, Toronto, Ontario, Canada
- Division of Neuroradiology, Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada
| | - Robin Green
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Canadian Concussion Centre, Toronto Western Hospital, Krembil Neuroscience Centre, University Health Network, Toronto, Ontario, Canada
- Department of Rehabilitation Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Karen Davis
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Canadian Concussion Centre, Toronto Western Hospital, Krembil Neuroscience Centre, University Health Network, Toronto, Ontario, Canada
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Charles Tator
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Canadian Concussion Centre, Toronto Western Hospital, Krembil Neuroscience Centre, University Health Network, Toronto, Ontario, Canada
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
- Division of Neurosurgery, Toronto Western Hospital, Krembil Neuroscience Centre, University Health Network, Toronto, Ontario, Canada
| | - Moshe Eizenman
- Department of Electrical and Computer Engineering, University of Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology, University of Toronto, Toronto, Ontario, Canada
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Maria Carmela Tartaglia
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Division of Neurology, Toronto Western Hospital, Krembil Neuroscience Centre, University Health Network, Toronto, Ontario, Canada
- Canadian Concussion Centre, Toronto Western Hospital, Krembil Neuroscience Centre, University Health Network, Toronto, Ontario, Canada
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
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