Pediatric Oculomotor Findings during Monocular Videonystagmography: A Developmental Study

2015 ◽  
Vol 26 (08) ◽  
pp. 703-715 ◽  
Author(s):  
Steven M. Doettl ◽  
Patrick N. Plyler ◽  
Devin L. McCaslin ◽  
Nancy L. Schay
Keyword(s):  
Smooth Pursuit ◽  
Repeated Measures ◽  
Saccade Latency ◽  
Test Battery ◽  
Normative Values ◽  
Developmental Study ◽  
Repeated Measures Design ◽  
Adult Participants ◽  
The Impact ◽  
Pursuit Gain

Background: The differential diagnosis of a dizzy patient >4 yrs old is often aided by videonystagmography (VNG) testing to provide a global assessment of peripheral and central vestibular function. Although the value of a VNG evaluation is well-established, it remains unclear if the VNG test battery is as applicable to the pediatric population as it is for adults. Oculomotor testing specifically, as opposed to spontaneous, positional, and caloric testing, is dependent upon neurologic function. Thus, age and corresponding neuromaturation may have a significant effect on oculomotor findings. Purpose: The purpose of this investigation was to describe the effect of age on various tests of oculomotor function during a monocular VNG examination. Specifically, this study systematically characterized the impact of age on saccade tracking, smooth pursuit tracking, and optokinetic (OPK) nystagmus. Research Design: The present study used a prospective, repeated measures design. Study Sample: A total of 62 healthy participants were evaluated. Group 1 consisted of 29 4- to 6-yr-olds. Group 2 consisted of 33 21- to 44-yr-olds. Each participant completed a standard VNG oculomotor test battery including saccades, smooth pursuit, and OPK testing in randomized order using a commercially available system. Data Collection and Analysis: The response metrics saccade latency, accuracy, and speed, smooth pursuit gain, OPK nystagmus gain, speed and asymmetry ratios were collected and analyzed. Results: Significant differences were noted between groups for saccade latency, smooth pursuit gain, and OPK asymmetry ratios. Saccade latency was significantly longer for the pediatric participants compared to the adult participants. Smooth pursuit gain was significantly less for the pediatric participants compared to the adult participants. The pediatric participants also demonstrated increased OPK asymmetry ratios compared to the adult participants. Conclusions: Significant differences were noted between the pediatric and adult participants for saccade latency, smooth pursuit gain, and OPK asymmetry. Saccade latency was significantly longer for the pediatric participants compared to the adult participants. Smooth pursuit gain was significantly less for the pediatric participants compared to the adult participants. The pediatric participants also demonstrated increased OPK asymmetry compared to the adult participants. Caution should be exercised when comparing pediatric test results to adult normative values to avoid “false positive” diagnoses of central vestibular involvement.

Artifact in Pediatric Oculomotor Findings during Videonystagmography: A Retrospective Analysis

2017 ◽  
Vol 28 (04) ◽  
pp. 314-324 ◽  
Author(s):  
Steven M. Doettl ◽  
Patrick N. Plyler ◽  
Devin L. McCaslin
Keyword(s):  
Eye Movements ◽  
Retrospective Analysis ◽  
Smooth Pursuit ◽  
Repeated Measures ◽  
Pediatric Population ◽  
Age Group ◽  
Repeated Measures Design ◽  
Significant Difference ◽  
Artifact Rejection ◽  
The Impact

Background: Accurate measurement of oculomotor function using videonystagmography (VNG) is imperative for diagnosis and management of patients with reported dizziness. The oculomotor evaluation during VNG utilizes video-oculography providing valuable information regarding the central structures and pathways that control eye movements. Artifact may have an effect on the overall validity and reliability of VNG oculomotor tracings and can result from patient and/or recording errors. It is postulated that artifact could occur more frequently in the pediatric population due to both patient and equipment factors. Purpose: The purpose of this study was to systematically evaluate the occurrence and impact of artifact on saccades, smooth pursuit, and optokinetic (OPK) testing in normal pediatric and adult subjects using commercially available clinical VNG equipment and standard clinical protocols for oculomotor testing. Research Design: The present study utilized a retrospective analysis of a repeated measures design. Study Sample: Oculomotor results from a total of 62 participants were analyzed. Portions of these data have been presented in a previous research study. Group 1 consisted of twenty-nine 4- to 6-yr-olds with an average age of 4.86 (SD = 0.88) yr. Group 2 consisted of thirty-three 22- to 44-yr-olds with an average age of 25.2 (SD = 5.34) yr. Data Collection and Analysis: Raw oculomotor recordings were analyzed “offline” by a single masked, trained investigator. Each tracing was evaluated for instances of artifact including eye blinks, eye closure, eyes moving in opposite direction of the target, eye tracking software problems, and overall poor morphology. The number of instances of artifact were noted and recorded for each participant in both groups. Individual eye movements not affected by artifact were included for final analysis. Artifact rejection techniques were also compared. Results: The results indicated increased artifact for the pediatric group for saccade and smooth pursuit testing. Additionally, a significant decrease in instances of artifact was noted with an increase in age in months for both saccade and smooth pursuit findings. OPK results did not indicate any significant difference in instances of artifact between the pediatric and adult groups or any decrease in instances of artifact with increasing age in the pediatric group. Artifact rejection technique did not have a significant effect on oculomotor measures for either age group. Conclusions: Pediatric patients exhibit increased instances of artifact during VNG oculomotor testing, specifically during saccade and smooth pursuit testing, at least for the 4- to 6-yr-old population. A general age effect was also noted in this age group, with decreased artifact noted with increasing age. Artifact rejection technique was not a significant factor suggesting standard compared based strategies may be sufficient for use in the pediatric population. Additional study into the effect of artifact on oculomotor results for infants to age 3 yr and ages 7- to 18-yr-old, in the disordered population, and with additional equipment manufacturers is needed to confirm these results and further describe the impact of artifact on oculomotor findings in the pediatric population.

scholarly journals Normative Values of Saccades and Smooth Pursuit in Children Aged 5 to 17 Years

2020 ◽  
Vol 31 (06) ◽  
pp. 384-392 ◽  
Author(s):  
Solara Sinno ◽  
Fadi Najem ◽  
Kim Smith Abouchacra ◽  
Philippe Perrin ◽  
Georges Dumas
Keyword(s):  
Smooth Pursuit ◽  
Normative Data ◽  
Cross Sectional Study ◽  
Saccade Latency ◽  
Repeated Measure ◽  
Movement Direction ◽  
Normative Values ◽  
Healthy Children ◽  
Cross Sectional ◽  
Pursuit Gain

Abstract Background Pediatric oculomotor function can be evaluated via videonystagmography. Adult normative data for saccades and smooth pursuit tests cannot be used as a benchmark for pediatric patients because children's peripheral and central systems continue to mature throughout adolescence. Purpose The purpose of this study was to establish normative data for saccade and smooth pursuit tests that can be used clinically in the assessment of vestibular and neurological disorders in children, and to investigate the effect of age and eye movement direction (left/right) on tests parameters. Research Design The present study is prospective cross-sectional study. Study Sample A total of 120 healthy children were recruited and equally distributed according to age and gender to each of the following groups: 5-8, 9-11, 12-14, and 15-17 years old. Participants had to pass a comprehensive otological and neurological assessment prior to inclusion in the study. Each subject underwent saccade and smooth pursuit testing. Data Collection and Analysis Saccade latency, velocity and accuracy/precision, and smooth pursuit gain were analyzed across groups using a two-way repeated measure multivariate analysis of variance (MANOVA). Results Saccadic latency was longer in the youngest group aged 5-8 years old (305 ± 48 msec) in comparison to children aged 9-11 years old (276 ± 22 msec) (P = 0.017), 12-14 years old (252 ± 34 msec) (P = 0.001) adolescents 15-17 years (256 ± 33 msec) (P = 0.001). Age did not affect the results of saccadic velocity and accuracy/precision. Saccade parameters (latency, velocity, accuracy/ precision) were not affected by oculomotor direction (left vs. right). Smooth pursuit gain increased from 0.63 in children aged 5-8 years old to 0.85 in children aged 15-17 years (P = 0.0001). The percentage of gain asymmetry was significantly different in the youngest two groups. Conclusion Saccade latency decreased as age increased. Smooth pursuit gains increased with increased age. Saccade velocity and accuracy/precision did not change significantly from ages 5-8 to 15-17 years of age. These data provide normative values for pediatric oculomotor evaluation and suggest that saccade and pursuit pathways may mature at different rates.

scholarly journals The Magic of Music for Improving Psychological Health for Those With Dementia and Their Caregivers

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 830-830
Author(s):  
Stuart MacDonald ◽  
Debra Sheets ◽  
Andre Smith
Keyword(s):  
Psychological Health ◽  
Repeated Measures ◽  
Social Cognitive ◽  
Cognitive Intervention ◽  
Pharmacological Intervention ◽  
Neural Activation ◽  
Psychological Function ◽  
Post Intervention ◽  
Repeated Measures Design ◽  
The Impact

Abstract Arts-based interventions for person’s with dementia and their caregivers represent an inexpensive, non-invasive, and non-pharmacological intervention with the potential to improve psychological function as well as reduce healthcare costs. The paper presents an overview of Voices in Motion (ViM), and the impact of this social-cognitive intervention on changes in psychological function for those with dementia and their caregivers (current n=26 dyads). Choir rehearsals were held on a weekly basis, and included a social discussion component. A range of outcomes (neuropsychological and physiological function, neural activation) were assessed using an intensive repeated measures design that facilitates both between- and within-person analyses, including nuanced evaluation of whether psychological function improves post intervention relative to an individual’s personal average, yielding a conservative within-person test of the benefits of intervention. Discussion focuses on the promise of such interventions for mitigating dementia symptoms and facilitating the psychological health of caregivers.

scholarly journals Face-to-Face Versus Video Assessment of Facial Paralysis: Implications for Telemedicine (Preprint)

2018 ◽  
Author(s):  
Jian Rong Tan ◽  
Susan Coulson ◽  
Melanie Keep
Keyword(s):  
Excellent Agreement ◽  
Repeated Measures ◽  
Facial Nerve Paralysis ◽  
Nerve Paralysis ◽  
Video Assessment ◽  
Face To Face ◽  
Repeated Measures Design ◽  
Grading Systems ◽  
Sydney System ◽  
The Impact

BACKGROUND Patients with facial nerve paralysis (FNP) experience challenges in accessing health care that could potentially be overcome by telemedicine. However, the reliability of telemedicine has yet to be established in this field. OBJECTIVE This study aimed to investigate the consistency between face-to-face and video assessments of patients with FNP by experienced clinicians. METHODS A repeated-measures design was used. A total of 7 clinicians assessed the FNP of 28 patients in a face-to-face clinic using standardized grading systems (the House-Brackmann, Sydney, and Sunnybrook facial grading systems). After 3 months, the same grading systems were used to assess facial palsy in video recordings of the same patients. RESULTS The House-Brackmann system in video assessment had excellent reliability and agreement (intraclass correlation coefficient [ICC]=0.780; principal component analysis [PCA]=87.5%), similar to face-to-face assessment (ICC=0.686; PCA=79.2%). Reliability of the Sydney system was good to excellent, with excellent agreement face-to-face (ICC=0.633 to 0.834; PCA=81.0%-95.2%). However, video assessment of the cervical branch and synkinesis had fair reliability and good agreement (ICC=0.437 to 0.597; PCA=71.4%), whereas that of other branches had good to excellent reliability and excellent agreement (ICC=0.625 to 0.862; PCA=85.7%-100.0%). Reliability of the Sunnybrook system was poor to fair for resting symmetry (ICC=0.195 to 0.498; PCA=91.3%-100.0%) and synkinesis (ICC=−0.037 to 0.637; PCA=69.6%-87.0%) but was good to excellent for voluntary movement (ICC=0.601 to 0.906; PCA=56.5%-91.3%) in face-to-face and video assessments. Bland-Altman plots indicated normal limits of agreement within ±1 between face-to-face and video-assessed scores only for the temporal and buccal branches of the Sydney system and for resting symmetry in the Sunnybrook system. CONCLUSIONS Video assessment of FNP with the House-Brackmann and Sunnybrook systems was as reliable as face-to-face but with insufficient agreement, especially in the assessment of synkinesis. However, video assessment does not account for the impact of real-time interactions that occur during tele-assessment sessions.

scholarly journals Acetazolamide does not alter endurance exercise performance at 3,500-m altitude

2020 ◽  
Vol 128 (2) ◽  
pp. 390-396 ◽  
Author(s):  
Karleigh E. Bradbury ◽  
Beau R. Yurkevicius ◽  
Katherine M. Mitchell ◽  
Kirsten E. Coffman ◽  
Roy M. Salgado ◽  
...  
Keyword(s):  
Sea Level ◽  
Endurance Exercise ◽  
Exercise Performance ◽  
Repeated Measures ◽  
Acute Mountain Sickness ◽  
Time Trial ◽  
Peak Oxygen Consumption ◽  
Repeated Measures Design ◽  
Hypoxic Environment ◽  
The Impact

Acetazolamide (AZ) is a medication commonly used to prevent acute mountain sickness (AMS) during rapid ascent to high altitude. However, it is unclear whether AZ use impairs exercise performance; previous literature regarding this topic is equivocal. The purpose of this study was to evaluate the impact of AZ on time-trial (TT) performance during a 30-h exposure to hypobaric hypoxia equivalent to 3,500-m altitude. Ten men [sea-level peak oxygen consumption (VO2peak): 50.8 ± 6.5 mL·kg−1·min−1; body fat %: 20.6 ± 5.2%] completed 2 30-h exposures at 3,500 m. In a crossover study design, subjects were given 500 mg/day of either AZ or a placebo. Exercise testing was completed 2 h and 24 h after ascent and consisted of 15-min steady-state treadmill walking at 40%–45% sea-level VO2peak, followed by a 2-mile self-paced treadmill TT. AMS was assessed after ~12 h and 22 h at 3,500 m. The incidence of AMS decreased from 40% with placebo to 0% with AZ. Oxygen saturation was higher ( P < 0.05) in AZ versus placebo trials at the end of the TT after 2 h (85 ± 3% vs. 79 ± 3%) and 24 h (86 ± 3% vs. 81 ± 4%). There was no difference in time to complete 2 miles between AZ and PL after 2 h (20.7 ± 3.2 vs. 22.7 ± 5.0 min, P > 0.05) or 24 h (21.5 ± 3.4 vs. 21.1 ± 2.9 min, P > 0.05) of exposure to altitude. Our results suggest that AZ (500 mg/day) does not negatively impact endurance exercise performance at 3,500 m. NEW & NOTEWORTHY To our knowledge, this is the first study to examine the impact of acetazolamide (500 mg/day) versus placebo on self-paced, peak-effort exercise performance using a short-duration exercise test in a hypobaric hypoxic environment with a repeated-measures design. In the present study, acetazolamide did not impact exercise performance after 2-h or 24-h exposure to 3,500-m simulated altitude.

scholarly journals Effect of acute antagonist static stretching on upper-body agonist power

2019 ◽  
Vol 15 (1) ◽  
pp. 53-59
Author(s):  
Dave Elliott ◽  
Dayne Massey
Keyword(s):  
Repeated Measures ◽  
Effective Means ◽  
Upper Body ◽  
Static Stretching ◽  
Repeated Measures Design ◽  
Significant Difference ◽  
Potential Benefits ◽  
Upper Body Power ◽  
The Impact ◽  
Practical Implications

There are many studies showing acute static stretching to be detrimental to power generation. However, the majority have focused upon the impact of stretching the agonist musculature. To date, few have examined the potential benefits of acute antagonist static stretching; none have focused on upper-body power. Utilising a repeated-measures design, 30 male participants were randomly assigned to one of two groups whereupon they performed four bench-throw tests; two control (NO-STRETCH) and two experimental (STRETCH), in a counter-balanced manner. Prior to the experimental measures, participants undertook a series of static antagonist stretches. Mean Pmax (SD) in the NO-STRETCH trials was 862.76 (146)W and 898.50 (144)W, respectively. For STRETCH trial 1, Pmax = 930.10 (146)W and trial 2, Pmax = 953.36 (136)W. When compared to the respective NO-STRETCH trials, antagonist static stretching did have a significant effect on Pmax for both the initial ( P < 0.01, d = 1.33) and the re-stretching procedures ( P < 0.01, d = 1.35). A significant difference was also found between the STRETCH trials ( P < 0.01, d = 0.46). The results have practical implications for those involved in upper-body power activities. Specifically, incorporating upper-body antagonist static stretching into pre-performance routines might offer a simple and effective means of enhancing agonist power.

Adult protection training for community nurses: evaluating knowledge following delivery using participant-favoured training methods

2014 ◽  
Vol 16 (1) ◽  
pp. 17-28 ◽  
Author(s):  
Martin Campbell
Keyword(s):  
Repeated Measures ◽  
Control Group ◽  
Training Methods ◽  
Content Type ◽  
Repeated Measures Design ◽  
Training Activities ◽  
The Impact ◽  
And Training ◽  
Adult Protection ◽  
Adult Support

Purpose – The purpose of this paper is to measure nurses’ knowledge about Adult Support and Protection (Scotland) Act 2007 before and after a one-day training course using participants’ favoured methods of training activities. Design/methodology/approach – A repeated measures design was used to evaluate the impact of a one-day Adult Support and Protection training on pre-training knowledge of community nurses across one NHS area. Participants’ favoured methods of training activities were used in the training. Participants were community nurses working in learning disability, mental health, older people's services, acute services, substance misuse, and accident and emergency. All completed a training needs analysis and training preferences study. Individual and group scores on an Adult Support and Protection knowledge questionnaire were analysed pre- and post-training. Findings – There was a statistically significant increase in scores post-training (Wilcoxon's signed-ranks test). Individual increases ranged from 2.5 to 27.5 per cent, with a mean score of 15 per cent. Evaluation of the impact of nationally approved Adult Support and Protection training is needed and training should take account of participants’ existing knowledge and preferred methods of training delivery to improve the transfer of learning into practice. Research limitations/implications – Participants were self-selecting. Existing knowledge was not controlled for in the sample. No longitudinal follow up to measure retention of any improvements in knowledge. No control group. Training methods used were based on the expressed preferences of 40 nursing staff, but only 18 of these staff participated in the training day. Originality/value – There is a dearth of research in evaluating the impact of the adult protection training on staff knowledge and understanding. Designing training activities and content to take account of participant preferences, and areas where knowledge is weakest may enhance the effectiveness of training in this area. This research was funded as a Queens Nursing Institute Community Project. It builds on a pilot project

scholarly journals Effectiveness of counselling and psychotherapeutic interventions for people with dementia and their families: a systematic review

2020 ◽  
pp. 1-28 ◽  
Author(s):  
Emily Shoesmith ◽  
Alys Wyn Griffiths ◽  
Cara Sass ◽  
Divine Charura
Keyword(s):  
Systematic Review ◽  
Cognitive Impairment ◽  
Repeated Measures ◽  
Mode Of Delivery ◽  
Research Area ◽  
Repeated Measures Design ◽  
Care Givers ◽  
Psychotherapeutic Interventions ◽  
People With Dementia ◽  
The Impact

Abstract As there is currently no cure for dementia, providing psycho-social support is imperative. Counselling and psychotherapeutic interventions offer a way to provide individualised support for people with dementia and their families. However, to date, there has not been a systematic review examining the research evidence for these interventions. This review aimed to examine the following research questions: (1) Are counselling/psychotherapeutic interventions effective for people with dementia?, (2) Are counselling/psychotherapeutic interventions effective for care-givers of people with dementia? and (3) Which modes of delivery are most effective for people with dementia and care-givers of people with dementia? A systematic literature search was conducted in MEDLINE (via PubMed), PsycINFO and CINAHL in March 2019. Keyword searches were employed with the terms ‘dement*’, ‘counsel*’, ‘psychotherapy’, ‘therap*’, ‘care’ and ‘outcome’, for the years 2000–2019. Thirty-one papers were included in the review, from seven countries. Twenty studies were randomised controlled trials (RCTs) or adopted a quasi-experimental design. The remaining studies were qualitative or single-group repeated-measures design. The review identified variation in the counselling/psychotherapeutic approaches and mode of delivery. Most interventions adopted either a problem-solving or cognitive behavioural therapy approach. Mixed effectiveness was found on various outcomes. The importance of customised modifications for people with dementia was highlighted consistently. Understanding the dyadic relationships between people with dementia and their care-givers is essential to offering effective interventions and guidance for practitioners is needed. Information about the cognitive impairment experienced by participants with dementia was poorly reported and is essential in the development of this research area. Future studies should consider the impact of cognitive impairment in developing guidance for counselling/psychotherapeutic intervention delivery for people with dementia.

scholarly journals Imagery rescripting in non-clinical paranoia: a pilot study of the impact on key cognitive and affective processes

2019 ◽  
Vol 48 (1) ◽  
pp. 54-66 ◽  
Author(s):  
Katherine Newman-Taylor ◽  
Pamela McSherry ◽  
Lusia Stopa
Keyword(s):  
Repeated Measures ◽  
Controlled Trial ◽  
Evidence Base ◽  
Traumatic Memories ◽  
Repeated Measures Design ◽  
Affective Processes ◽  
Imagery Rescripting ◽  
The Impact ◽  
Memory Characteristics

AbstractBackground:Paranoia is often accompanied by distressing intrusions associated with traumatic memories, yet one of the best-evidenced interventions, imagery rescripting (IR), is not routinely offered. This is likely to be due to poor understanding of the effects of IR on postulated mechanisms of change as well as the absence of a robust evidence base.Aims:This study aimed to establish proof of principle that IR impacts key cognitive-affective processes associated with distressing intrusions – memory characteristics and self-representations – and level of paranoia.Method:We used a within-subject repeated measures design to examine the effect of single-session IR on memory characteristics (level of intrusions, vividness, distress, encapsulated belief strength, emotion intensity and frequency), self-representation variables, affect and paranoia. Fifteen participants were seen once before and once after the IR session, to gather baseline and follow-up data.Results:As predicted, participants reported reductions in memory characteristics, improved self-esteem and positive affect, and reduced negative affect and paranoia, with large effect sizes. These effects were maintained at follow-up.Conclusions:While a within-subject design is useful for initial exploration of novel interventions, controlled studies are needed to determine causality. This is the first study to examine mechanisms of IR in paranoia. A controlled trial is now warranted.

Training in positive behavioural support: increasing staff self-efficacy and positive outcome expectations

2016 ◽  
Vol 21 (2) ◽  
pp. 95-102 ◽  
Author(s):  
Greg Stocks ◽  
Sean Slater
Keyword(s):  
Self Efficacy ◽  
Repeated Measures ◽  
Outcome Expectations ◽  
Training Model ◽  
Training Programme ◽  
Positive Outcome ◽  
Content Type ◽  
Repeated Measures Design ◽  
Training Programmes ◽  
The Impact

Purpose – The purpose of this paper is to investigate the impact of a six-and-a-half day, Positive Behaviour Support (PBS) informed training course on staff’s self-efficacy and outcome expectations of managing challenging behaviour (CB). Training programmes for other non-psychology staff were deemed necessary due to the high demand for services and the specialist knowledge held by other professionals or carers. Design/methodology/approach – A repeated measures design was used to capture changes in specific self-efficacy and outcome expectations before and after the training programme. A questionnaire methodology was employed. Findings – Staff self-efficacy and positive outcome expectations increased on all four measured variables following training: understanding of CB, working out the functions of CB, developing and implementing a PBS plan, and managing CB for the benefit of the service user. Research limitations/implications – These findings are considered in light of previous research suggesting an impact on staff practice and burnout. Practical implications – The findings suggest that the training model delivers changes in staff cognition and may be useful in other locations where demand for services is likely to increase in the future. Originality/value – This research considers the impact of a medium length PBS training on staff cognition, evidencing the model’s utility in the current service context.

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