Basic Neuro-Optometric Diagnostic Tests for Mild Traumatic Brain Injury/Concussion: A Narrative Review, Perspective, Proposed Techniques and Protocols

2018 ◽  
pp. 157-169
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Diagnostic Test ◽  
Mild Traumatic Brain Injury ◽  
Diagnostic Tests ◽  
Test Battery ◽  
Narrative Review ◽  
Diagnostic Process ◽  
Clinical Tests ◽  
Scientific Rationale

Vision problems are common in individuals with mild traumatic brain injury (mTBI)/concussion. However, a global conceptualization of the diagnostic process remains incomplete and practitioner dependent. Thus, a comprehensive diagnostic test battery is proposed to assist in the management of these patients. This battery includes a range of basic clinical tests of a sensory and motor nature, with all having a clinical and scientific rationale. These tests have been used by the authors for many years, with good success, and furthermore they have been found to be clinically useful and insightful.

Advanced Neuro-Optometric Diagnostic Tests for Mild Traumatic Brain Injury/Concussion: A Narrative Review, Proposed Techniques and Protocols

2019 ◽  
pp. 19-30
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Diagnostic Test ◽  
Mild Traumatic Brain Injury ◽  
Diagnostic Tests ◽  
Level Of Care ◽  
Advanced Level ◽  
Visual Deficits ◽  
The Past ◽  
Scientific Rationale

A range of visual deficits and related visual symptoms are common in those afflicted with mild traumatic brain injury (mTBI/concussion). Several basic neuro-optometric, diagnostic test protocols have been proposed over the past decade. However, none have specifically addressed and focused upon an advanced level of care. Thus, a comprehensive set of advanced, diagnostic vision tests of a sensory and motor nature is proposed, with all having a clinical and scientific rationale. These tests have been used by the authors for many years, with good success and providing important clinical insights into this population.

scholarly journals Examining the Subacute Effects of Mild Traumatic Brain Injury Using a Traditional and Computerized Neuropsychological Test Battery

2021 ◽  
Vol 38 (1) ◽  
pp. 74-85
Author(s):  
Rune Hatlestad Karlsen ◽  
Simen Berg Saksvik ◽  
Jonas Stenberg ◽  
Astri Johansen Lundervold ◽  
Alexander Olsen ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Neuropsychological Test ◽  
Test Battery ◽  
Neuropsychological Test Battery

scholarly journals Sensorimotor conflict tests in an immersive virtual environment reveal subclinical impairments in mild traumatic brain injury

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Hrishikesh M. Rao ◽  
Tanya Talkar ◽  
Gregory Ciccarelli ◽  
Michael Nolan ◽  
Anne O’Brien ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Virtual Environment ◽  
Mild Traumatic Brain Injury ◽  
Brain Injuries ◽  
Clinical Tests ◽  
Immersive Virtual Environment ◽  
Average Accuracy ◽  
Patient Reported ◽  
Huge Impact

Abstract Current clinical tests lack the sensitivity needed for detecting subtle balance impairments associated with mild traumatic brain injury (mTBI). Patient-reported symptoms can be significant and have a huge impact on daily life, but impairments may remain undetected or poorly quantified using clinical measures. Our central hypothesis was that provocative sensorimotor perturbations, delivered in a highly instrumented, immersive virtual environment, would challenge sensory subsystems recruited for balance through conflicting multi-sensory evidence, and therefore reveal that not all subsystems are performing optimally. The results show that, as compared to standard clinical tests, the provocative perturbations illuminate balance impairments in subjects who have had mild traumatic brain injuries. Perturbations delivered while subjects were walking provided greater discriminability (average accuracy ≈ 0.90) than those delivered during standing (average accuracy ≈ 0.65) between mTBI subjects and healthy controls. Of the categories of features extracted to characterize balance, the lower limb accelerometry-based metrics proved to be most informative. Further, in response to perturbations, subjects with an mTBI utilized hip strategies more than ankle strategies to prevent loss of balance and also showed less variability in gait patterns. We have shown that sensorimotor conflicts illuminate otherwise-hidden balance impairments, which can be used to increase the sensitivity of current clinical procedures. This augmentation is vital in order to robustly detect the presence of balance impairments after mTBI and potentially define a phenotype of balance dysfunction that enhances risk of injury.

Assessment of Three Clinical Tests for Evaluation of Concussion/Mild Traumatic Brain Injury

2021 ◽  
pp. 43-49
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
High Probability ◽  
Visual Motion ◽  
Critical Flicker Fusion ◽  
Clinical Tests ◽  
Test Specificity ◽  
Detection And Diagnosis ◽  
Flicker Fusion

A focus of both basic and clinical research on concussion/mild traumatic brain injury has been to ascertain which test, or combination of tests, is best for its detection. In the present retrospective analysis, three potential clinical tests were evaluated to determine which one, or combination, best differentiated between visually-symptomatic concussed (n=52) versus asymptomatic non-concussed (n=24) patients. The three tests were: distance horizontal vergence facility, peripheral visual motion, and critical flicker fusion. Each test was found to differentiate the two groups. The peripheral visual motion test was the best, with a sensitivity of 93.8% and a specificity of 83.3%. When this test was combined with the distance horizontal vergence facility test, specificity remained the same whereas sensitivity increased to 94.4%. Addition of the critical flicker fusion test did not affect these values. Thus, of the three, the combination of the peripheral visual motion and distance horizontal vergence facility tests has a high probability of assisting in concussion detection and diagnosis.

Active Rehabilitation After Childhood and Adolescent Mild Traumatic Brain Injury: a Narrative Review and Clinical Practice Implications

2019 ◽  
Vol 7 (1) ◽  
pp. 15-22
Author(s):  
Jason A. Hugentobler ◽  
Catherine Quatman-Yates ◽  
Nathan K. Evanson ◽  
Andrea Paulson ◽  
Caitlin Chicoine ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Clinical Practice ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Narrative Review ◽  
Active Rehabilitation

Vision-Based Concussion/Mild Traumatic Brain Injury Diagnostic Tests/Biomarkers: An Update and Reappraisal

2019 ◽  
pp. 187-193
Keyword(s):  
Public Health ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Diagnostic Tests ◽  
Clinical Environment ◽  
Sensory Motor ◽  
Educational Implications ◽  
Detection And Diagnosis

Detection and diagnosis of concussion/mild traumatic brain injury (C/mTBI) has a multitude of general vocational and avocational, as well as public health and educational, implications. A relatively short, focused, updated, highyield set of subjective and objective clinical vision tests are proposed that we and others have found to be assistive in the process. These vision tests are of a sensory, motor, and/or perceptual nature, many of which are relatively easy to implement in the standard, clinical environment.

Post-traumatic headache due to mild traumatic brain injury: Current knowledge and future directions

Cephalalgia ◽  
2020 ◽  
pp. 033310242097018
Author(s):  
Todd J Schwedt
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Diagnostic Criteria ◽  
Mild Traumatic Brain Injury ◽  
Current Knowledge ◽  
Research Priorities ◽  
Narrative Review ◽  
Future Research ◽  
Persistent Symptoms ◽  
Post Traumatic

Background/objective Post-traumatic headache is one of the most common and persistent symptoms following mild traumatic brain injury. The objective of this narrative review is to provide an update on the diagnostic criteria, clinical presentation, epidemiology, pathophysiology, and treatment of post-traumatic headache, and to identify future research priorities. Methods This is a narrative review of the literature regarding post-traumatic headache attributed to mild traumatic brain injury. Results Onset of post-traumatic headache within 7 days of injury is the only evidence for a causal relationship between the injury and the headache included in the diagnostic criteria. Post-traumatic headache often resolves within the first few days of onset, whereas it persists for at least 3 months in 30–50%. The majority of insights into post-traumatic headache pathophysiology come from pre-clinical animal studies and human imaging studies, which implicate structural, functional, metabolic, and neuroinflammatory mechanisms for post-traumatic headache. There is a paucity of quality evidence for how to best treat post-traumatic headache. Conclusions Although meaningful progress has been made in the post-traumatic headache field, priorities for future research are numerous, including the optimization of diagnostic criteria, a greater understanding of post-traumatic headache pathophysiology, identifying mechanisms and predictors for post-traumatic headache persistence, and identifying safe, well-tolerated, effective therapies.

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