scholarly journals The clinical utility of using involuntary eye movements to assess concussion

Neurology ◽  
2018 ◽  
Vol 91 (23 Supplement 1) ◽  
pp. S10.1-S10
Author(s):  
Heeter Kathleen ◽  
Jacob Thayer ◽  
Port Nicholas

Critical decisions are made daily about whether to bench athletes who might have suffered a concussion or mild traumatic brain injury (mTBI). The low-level damage underlying mTBI has been difficult to measure, especially during competition when assessments are made quickly utilizing primarily subjective symptoms. The ideal instrument would be (1) sensitive to low-level diffuse damage, (2) easily and rapidly administered on the sidelines, and (3) unaffected by human bias or sandbagged baselines. Based on a body of research documenting the sensitivity of oculomotor movements (e.g., saccades and smooth pursuits) to mTBI damage, we have constructed 5 Sideline Eye Trackers and are evaluating their clinical use for quick, objective and accurate assessment of mTBI. Current enrollment of athletes is over 1,200, including the entire IU athletic department and several local schools. All enrollees complete a 6-minute, pre-season, baseline oculomotor exam consisting of 2 saccade, 2 pursuit, and 1 ocular following task. Balance is simultaneously measured using a portable balance board. Anyone suspected by the team physician of having a concussion during the season repeats this exam 3 additional times: (1) immediately post-injury (minutes), (2) at the time of being cleared for return-to-play, and (3) as far post-injury as possible (months). To provide 2 separate measures of test-retest variability, 2 control groups are also being studied: (1) within-sport non-concussed matched control group, and (2) non-concussion prone cross-country athletes. Athletes with mTBI show significant deficits in both saccadic and pursuit function compared to their baseline (p = 0.0001). Drift in the center of pressure measure (balance) is also significantly affected in many subjects. Signal detection theory yields a specificity & sensitivity of greater than 85% of 69 concussed athletes. Measuring oculomotor dysfunction in athletes with a 6-minute task may be a promising tool for the diagnosis and management of mTBI.

2003 ◽  
Vol 98 (2) ◽  
pp. 296-301 ◽  
Author(s):  
Mark R. Lovell ◽  
Michael W. Collins ◽  
Grant L. Iverson ◽  
Melvin Field ◽  
Joseph C. Maroon ◽  
...  

Object. A computerized neuropsychological test battery was conducted to evaluate memory dysfunction and self-reporting of symptoms in a group of high school athletes who had suffered concussion. Methods. Neuropsychological performance prior to and following concussion was compared with the test performance of an age-matched control group. Potentially important diagnostic markers of concussion severity are discussed and linked to recovery within the 1st week of injury. Conclusions. High school athletes who had suffered mild concussion demonstrated significant declines in memory processes relative to a noninjured control group. Statistically significant differences between preseason and postinjury memory test results were still evident in the concussion group at 4 and 7 days postinjury. Self-reported neurological symptoms such as headache, dizziness, and nausea resolved by Day 4. Duration of on-field mental status changes such as retrograde amnesia and posttraumatic confusion was related to the presence of memory impairment at 36 hours and 4 and 7 days post-injury and was also related to slower resolution of self-reported symptoms. The results of this study suggest that caution should be exercised in returning high school athletes to the playing field following concussion. On-field mental status changes appear to have prognostic utility and should be taken into account when making return-to-play decisions following concussion. Athletes who exhibit on-field mental status changes for more than 5 minutes have longer-lasting postconcussion symptoms and memory decline.


Author(s):  
Charles M. Schneider ◽  
Ajay K. Verma ◽  
Tamanna T. K. Munia ◽  
Mark Romanick ◽  
Kouhyar Tavakolian ◽  
...  

Maintaining upright stance is a complex process, it requires appropriate functioning of a postural control system which consists of inputs from somatosensory, vestibular, musculoskeletal, and proprioceptive systems as well as from several brain regions [1–4]. A concussion is defined as a brain injury caused due to unexpected acceleration/deceleration of the head causing temporary alteration of brain function and it is a prevalent source of injury to football athletes [1]. With the altered function of the brain, the ability to maintain postural equilibrium becomes challenging due to the inability of individuals to respond promptly to stressors, thus, making maintenance of postural equilibrium rather difficult for individuals with a concussion. Effects of concussion on postural ability are shown to last up to three days post injury [5]. Postural stability test, therefore, can be performed to make a valid return to play (RTP) decision, pre-mature RTP is shown to have been catastrophic due to its potential to permanently impair previously affected region/functioning [1,5]. Postural sway data (center of pressure, COP) is traditionally analyzed to study the postural control. Therefore, COP can provide critical information regarding individual’s ability to maintain upright stance post injury. A more sensitive concussion assessment tool based on electroencephalogram (EEG) is used to accurately track effects of concussion [6]. However, sophisticated electrode placement requirement inhibits its immediate applicability. In current preliminary research, we attempt to differentiate athletes with a history of concussion (experimental) from healthy (control) using postural data. In order to do so, a concept of empirical mode decomposition (EMD) was adopted. EMD has shown evidence in the literature to infer vital information pertaining to the complex underlying physiological phenomenon [4, 7–8]. In the current research, the resultant COP (COPr) was decomposed into its finite set of band-limited signals termed as intrinsic mode functions (IMFs) [8], a set of linear and nonlinear features were extracted from COPr and its IMfs. Lastly, a test of significance was conducted to infer the potential of postural data for differentiating concussed from healthy athletes.


2006 ◽  
Vol 76 (1) ◽  
pp. 28-33 ◽  
Author(s):  
Yukari Egashira ◽  
Shin Nagaki ◽  
Hiroo Sanada

We investigated the change of tryptophan-niacin metabolism in rats with puromycin aminonucleoside PAN-induced nephrosis, the mechanisms responsible for their change of urinary excretion of nicotinamide and its metabolites, and the role of the kidney in tryptophan-niacin conversion. PAN-treated rats were intraperitoneally injected once with a 1.0% (w/v) solution of PAN at a dose of 100 mg/kg body weight. The collection of 24-hour urine was conducted 8 days after PAN injection. Daily urinary excretion of nicotinamide and its metabolites, liver and blood NAD, and key enzyme activities of tryptophan-niacin metabolism were determined. In PAN-treated rats, the sum of urinary excretion of nicotinamide and its metabolites was significantly lower compared with controls. The kidneyα-amino-β-carboxymuconate-ε-semialdehyde decarboxylase (ACMSD) activity in the PAN-treated group was significantly decreased by 50%, compared with the control group. Although kidney ACMSD activity was reduced, the conversion of tryptophan to niacin tended to be lower in the PAN-treated rats. A decrease in urinary excretion of niacin and the conversion of tryptophan to niacin in nephrotic rats may contribute to a low level of blood tryptophan. The role of kidney ACMSD activity may be minimal concerning tryptophan-niacin conversion under this experimental condition.


Author(s):  
VARSHA PALLED ◽  
DR. JITENDRA RAO ◽  
DR. RAGHUWAR DAYAL SINGH ◽  
DR. SHUCHI TRIPATHI ◽  
DR. KALPANA SINGH ◽  
...  

The purpose of this study was to evaluate whether Low-Level Laser Therapy (LLLT) improves the healing of the implant surgical site with clinical and biochemical parameters.Thirty patients with an edentulous space spanning a single tooth were selected. The patients were randomly allocated to two groups - the control group and the test group. The test group received laser energy at a power of 2J/cm 2 with a total of 4-6J energy over each implant. Clinical parameters (Implant Stability Quotient, probing index, modified sulcus bleeding index)and osteoprotegerin (OPG) were assessed at baseline and follow-up intervals (2 weeks, 6 weeks, and 3 months).The test group showed significantly higher implant stability quotient compared to thecontrol group at 2 weeks(57.93±3.95 and 35.67±3.08; p<0.01) and 3months(58.86±3.75 and 67.06±3.78; p<0.01). A significant rise in OPG levels of the test group(686.30±125.36pg/ml at baseline and 784.25±108.30pg/ml at 3months;p<0.01) was seen contrary to significant decline in the control group (839.50±249.08pg/ml at baseline,415.30±78.39pg/ml at 3months;p<0.01). Within the limitations of the study, the study suggests that the healing of peri-implant hard and soft tissues may be enhanced with the use of LLLT as an explicit modality during the post-operative period.


Author(s):  
E.V. Prosekova ◽  
A.I. Turyanskaya ◽  
N.G. Plekhova ◽  
M.S. Dolgopolov ◽  
V.A. Sabynych

Расширение спектра изучаемых клонов Тхелперов определило более сложные иммунные механизмы реализации аллергического воспаления. Цель. Характеристика показателей и взаимосвязей цитокинового профиля сыворотки и субпопуляционного состава Тлимфоцитов периферической крови у детей с бронхиальной астмой и аллергическим ринитом. Материалы и методы. Проведено комплексное обследование 150 детей в возрасте 311 лет с верифицированным диагнозом бронхиальной астмы, аллергического ринита и 30 здоровых сверстников. Иммунологические параметры крови оценивали методом проточной цитометрии, концентрации интерлейкинов и IgE в сыворотке крови определяли методом твердофазного иммуноферментного анализа. При статистической обработке использовали программы Statistica 10 с критическим уровнем значимости р0,05. Результаты. У детей с аллергическими заболеваниями в сыворотке крови определены высокие уровни содержания интерлейкинов4, 8, 13, 17А, сопоставимый с показателями группы контроля уровень IL17F и низкое содержание IFNy. При бронхиальной астме и аллергическом рините у детей выявлено увеличение количества CD3CD8CD45RO, CD3CD8CD45RACD45RO Тлимфоцитов и CD3CD4 Тхелперов и повышение количество Th17 при снижении CD3CD4CD45RO клеток памяти. В группе здоровых детей популяция Th17 составляла 9,491,6, у детей с аллергическими заболеваниями количество данных клеток было значимо выше 14,50,77 (р0,001). Анализ сывороточного содержания цитокинов у детей с изолированным течением БА и в сочетании с аллергическим ринитом выявил разнонаправленные корреляции, отличающиеся по силе и направленности от таковых в группе здоровых детей. Заключение. У детей при изолированном течении бронхиальной астмы и в сочетании с аллергическим ринитом выявлены: сопоставимое с показателями здоровых детей количество CD3CD4 Тклеток, дисбаланс в субпопуляционном составе Тхелперов за счет преобладания Th2 и Th17, активация синтеза IL17A, IL4, IL8, IL13, низкий уровень сывороточного IFNy, изменения силы и направленности взаимосвязей цитокинового профиля и спектра субпопуляций Тлимфоцитов.Expansion of the range of examined Thelper clones has determined more complex immune mechanisms for the implementation of allergic inflammation. Objective. To characterize the parameters and relationships between the serum cytokine profile and Tlymphocyte subpopulation in peripheral blood of children with bronchial asthma and allergic rhinitis. Materials and methods. 150 children aged between 311 years old with bronchial asthma, and allergic rhinitis and 30 healthy volunteers were examined. Immunological parameters were assessed by flow cytometry, the concentration of serum interleukins and IgE were determined by means of enzymelinked immunosorbent assay. Statistical analysis was performed with Statistica 10 program with a critical level of significance p0.05. Results. High levels of interleukins 4, 8, 13, 17A were determined, IL7F level was not significantly different from that in control group and low level of IFNy was found in the serum of children with allergic diseases. The number of CD3CD8CD45RO, CD3CD8CD45RACD45RO Tlymphocytes, CD3CD4 Thelper cells and Th17 were increased and at the same time CD3CD4CD45RO memory cells were decreased In bronchial asthma and allergic rhinitis children. Number of Th17 cells in healthy children was 9.491.6, in allergic children it was significantly higher 14.50.77 (p0.001). Analyses of serum cytokine count in children with isolated BA and in association with allergic rhinitis revealed multidirectional correlations differing in strength and direction from those in the group of healthy children. Conclusion. In children with isolated bronchial asthma and associated with allergic rhinitis the following parameters were found: CD3CD4 Tcells count was comparable to that in healthy children, the imbalance of Thelper subpopulation: prevalence of Th2 and Th17, activation of IL17A, IL4, IL8, IL13 synthesis and low level of serum IFNy.


2019 ◽  
Vol 65 (6) ◽  
pp. 825-831
Author(s):  
Lyudmila Belskaya ◽  
Viktor Kosenok

Currently, the urgent task is to search for new biomarkers as a promising tool for early detection and monitoring of breast cancer. The aim of the study was to study the level of cytokines in the saliva of patients with breast cancer. In the case-control study volunteers participated, which were divided into 3 groups: the main (breast cancer, n = 43), the comparison group (fibroadenoma, n = 32) and the control group (conditionally healthy, n = 39). All participants were questioned; biochemical examination of saliva, histological verification of the diagnosis was carried out. Intergroup differences are estimated by a nonparametric criterion. It is shown that in the context of breast cancer, the level of cytokines (IL-2, IL-4, IL-6, IL-10 and IL-18) is increasing, except for IL-8, the content of which decreases compared to the control group. When the disease progresses by the nature of the dynamics, the parameters are divided into two groups: IL-2, IL-4, IL-18 and IL-6, IL-8, IL-10. For the first group of cytokines, there was a decrease in content during the transition from the early stages to the more common ones. For the second group, when passing from stages T1-2N0M0 to T1-2NjM0, the level of cytokines remains practically constant. In the future, the level of cytokines is observed for stage T3_4N0_2M0, and for IL-2, IL-4 and IL-10, the level of cytokines reaches values corresponding to early stages, whereas for IL-6, IL-8 and IL-18 in the same direction, a significant increase in indicators was noted. Additionally, the IL-6/IL-8 ratio was calculated depending on the tumor size, as well as the presence / absence of metastasis. It is shown that this ratio is statistically significantly increased in the advanced stages of the disease. Particularly interesting is the increase in this ratio in saliva at the initial stages of the disease.


2012 ◽  
Vol 25 (3) ◽  
pp. 583-594 ◽  
Author(s):  
Lidiane Teles de Menezes ◽  
Paulo Henrique Ferreira de Araujo Barbosa ◽  
Abraão Souza Costa ◽  
Anderson Castro Mundim ◽  
Gabrielly Craveiro Ramos ◽  
...  

INTRODUCTION: Although baropodometric analysis has been published since the 1990s, only now it is found a considerable number of studies showing different uses in the rehabilitation. OBJECTIVE: To amplify the use of this technology, this research aimed to analyze baropodometric records during upright position of subjects with hemiparesis, describing a way to define weight-bearing profiles in this population. METHOD: 20 healthy subjects were matched by gender and age with 12 subjects with chronic spastic hemiparesis. This control group was formed to establish the limits of symmetry during weight-bearing distribution in the hemiparesis group. Next, hemiparesis group was submitted to procedures to measure baropodometric records used to provide variables related to the weight-bearing distribution, the arch index and the displacements in the center of pressure (CoP). Data were used to compare differences among kinds of weight-bearing distribution (symmetric, asymmetric toward non-paretic or paretic foot) and coordination system for CoP displacements. RESULTS: Hemiparesis group was compounded by eight symmetrics, eight asymmetrics toward non-paretic foot and four asymmetric toward paretic foot. Significant differences in the weight-bearing distributions between non-predominantly and predominantly used foot did not promote differences in the other baropodometric records (peak and mean of pressure, and support area). Mainly in the asymmetry toward non-paretic foot it was observed significant modifications of the baropodometric records. CONCLUSION: Baropodometric technology can be used to analyze weight-bearing distribution during upright position of subjects with hemiparesis, detecting different kinds of weight-bearing profiles useful to therapeutic programs and researches involving subjects with this disability.


2021 ◽  
Vol 11 (8) ◽  
pp. 3608
Author(s):  
Adrian Góralczyk ◽  
Marcin Mostowy ◽  
Michał Ebisz ◽  
Robert F. LaPrade ◽  
Aleksandra Sibilska ◽  
...  

Purpose: To present the arthroscopic “PCL envelope lack sign” (PELS) and to calculate its diagnostic characteristics in chronic PCL insufficiency. Methods: Recordings of knee arthroscopies performed in a single clinic between April 2015 to March 2020 were retrospectively evaluated, searching for the “PCL envelope”. It was defined as a “soft tissue cuff coursing around the PCL tibial attachment, visible with the arthroscope positioned between the PCL, medial femoral condyle and posterior horn of the medial meniscus at the level of its shiny white fibers”. PELS was defined as “the PCL adhering to the proximal tibia adjacent to the medial meniscal posterior root attachment, inability to observe the normal space between the PCL and posterior tibia and no soft tissue cuff around the PCL tibial attachment”. Inclusion criteria were possibility to evaluate the PELS presence on recordings. Patients who underwent PCL reconstruction were assigned to the study group. The rest of the patients were controls. Criteria to operate on symptomatic PCL patients were at least 5 mm of posterior instability in physical examination and at least 6 months post-injury. Results: Out of 614 available recordings, 592 patients (205 females, 387 males; mean age 45.2 years, SD = 14.36, range 14–81) were included: 38 in the study group and 554 in the control group. In the study group, PELS was positive in 36 of 38 cases (94.7%). In the control group, PELS was negative in 554 PCL-efficient patients (100%). Calculated PELS sensitivity was 94.7%, specificity 100%, positive predictive value 100%, negative predictive value 99.6%. The PELS was present significantly more often in PCL-insufficient patients, p < 0.001. Conclusions: The PCL envelope lack sign was found to be a highly effective tool to arthroscopically confirm chronic PCL insufficiency, and should be considered a direct sign of chronic posterior knee instability.


2021 ◽  
Vol 9 (3) ◽  
pp. 232596712198998
Author(s):  
Joseph S. Tramer ◽  
Lafi S. Khalil ◽  
Patrick Buckley ◽  
Alexander Ziedas ◽  
Patricia A. Kolowich ◽  
...  

Background:Women’s National Basketball Association (WNBA) players have a greater incidence of lower extremity injury compared with male players, yet no data exist on functional outcomes after Achilles tendon rupture (ATR).Purpose:To evaluate the effect of Achilles tendon repair on game utilization, player performance, and career longevity in WNBA athletes.Study Design:Cohort study; Level of evidence, 3.Methods:WNBA players from 1997 to 2019 with a history of ATR (n = 12) were matched 1:2 to a healthy control group. Player characteristics, game utilization, and in-game performance data were collected for each athlete, from which the player efficiency rating (PER) was calculated. Statistical analysis was performed comparing postinjury data to preinjury baseline as well as cumulative career data. Changes at each time point relative to the preinjury baseline were also compared between groups.Results:Of the 12 players with ATR, 10 (83.3%) returned to play at the WNBA level at a mean (±SD) of 12.5 ± 3.3 months. Four players participated in only 1 WNBA season after injury. There were no differences in characteristics between the 10 players who returned to play after injury and the control group. After return to play, the WNBA players demonstrated a significant decrease in game utilization compared with preinjury, playing in 6.0 ± 6.9 fewer games, starting in 12.7 ± 15.4 fewer games, and playing 10.2 ± 9.1 fewer minutes per game ( P < .05 for all). After the index date of injury, the players with Achilles repair played 2.1 ± 1.2 more years in the WNBA, while control players played 5.35 ± 3.2 years ( P < .01) Additionally, the players with Achilles repair had a significant decrease in PER in the year after injury compared with preinjury (7.1 ± 5.3 vs 11.0 ± 4.4; P = .02). The reduction in game utilization and decrease in PER in these players was maintained when compared with the matched controls ( P < .05 for both).Conclusion:The majority of WNBA players who sustained ATR were able to return to sport after their injury; however, their career longevity was shorter than that of healthy controls. There was a significant decrease in game utilization and performance in the year after return to play compared with healthy controls.


Author(s):  
María del Mar Moreno-Muñoz ◽  
Fidel Hita-Contreras ◽  
María Dolores Estudillo-Martínez ◽  
Agustín Aibar-Almazán ◽  
Yolanda Castellote-Caballero ◽  
...  

Background: Abdominal Hypopressive Training (AHT) provides postural improvement, and enhances deep trunk muscle activation. However, until recently, there was a lack of scientific literature supporting these statements. The major purpose of this study was to investigate the effect of AHT on posture control and deep trunk muscle function. Methods: 125 female participants aged 18–60 were randomly allocated to the Experimental Group (EG), consisting of two sessions of 30 min per week for 8 weeks of AHT, or the Control Group (CG), who did not receive any treatment. Postural control was measured with a stabilometric platform to assess the static balance and the activation of deep trunk muscles (specifically the Transverse Abdominal muscle (TrA)), which was measured by real-time ultrasound imaging. Results: The groups were homogeneous at baseline. Statistical differences were identified between both groups after intervention in the Surface of the Center of Pressure (CoP) Open-Eyes (S-OE) (p = 0.001, Cohen’s d = 0.60) and the Velocity of CoP under both conditions; Open-Eyes (V-OE) (p = 0.001, Cohen´s d = 0.63) and Close-Eyes (V-CE) (p = 0.016, Cohen´s d = 0.016), with the EG achieving substantial improvements. Likewise, there were statistically significant differences between measurements over time for the EG on S-OE (p < 0.001, Cohen´s d = 0.99); V-OE (p = 0.038, Cohen´s d = 0.27); V-CE (p = 0.006, Cohen´s d = 0.39), anteroposterior movements of CoP with Open-Eyes (RMSY-OE) (p = 0.038, Cohen´s d = 0.60) and activity of TrA under contraction conditions (p < 0.001, Cohen´s d = 0.53). Conclusions: The application of eight weeks of AHT leads to positive outcomes in posture control, as well as an improvement in the deep trunk muscle contraction in the female population.


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