Dynamic Visual Acuity Test Research Articles

The Short- and Long-Term Perceptual Learning of Clinical Dynamic Visual Acuity Test.

The purpose of this study was to investigate the short- and long-term learning effect of dynamic visual acuity (DVA) tests. Participants between 18 and 30years with corrected to normal visual acuity were enrolled in this study. Three repeated sessions were performed, with 15 minutes and 15 days' intervals between sessions. Each session included 9 DVA tests of horizontal, vertical, and diagonal motions of E optotypes at 20, 40, and 80degrees per second (dps). The short- and long-term learning effects were analyzed from repeated DVA tests. Of the 58 enrolled participants, the mean age was 23.1 ± 2.1years. DVA significantly varied among motion types and velocities (P < 0.05, respectively). There was a significant short-term learning effect for 20 (P = 0.004), 40 (P < 0.001), and 80 (P = 0.014) dps DVA test of horizontal motion, 40dps DVA test of vertical (P = 0.003), and diagonal motion (P = 0.036). The long-term learning effect was detected in the 40dps diagonal motion DVA test (P = 0.015). The short- and long-term learning effects were positively associated with initial DVA in most combinations of motion type and velocity tests (P < 0.05, respectively). The short- (P = 0.031) and long-term (P = 0.024) learning effect of 80dps horizontal motion DVA test was greater in male than female participants. There is a significant short-term learning effect in the DVA test of various motion types, but the long-term learning effect was rarely observed, and it is greater in participants with worse initial DVA.

Consequences of vestibular hypofunction in children with ADHD/DCD

BackgroundChildren with Attention Deficit Hyperactivity Disorder (ADHD) demonstrate a heterogeneous sensorimotor, emotional, and cognitive profile. Comorbid sensorimotor imbalance, anxiety, and spatial disorientation are particularly prevalent among their non-core symptoms. Studies in other populations presented these three comorbid dysfunctions in the context of vestibular hypofunction. ObjectiveTo test whether there is a subgroup of children with ADHD who have vestibular hypofunction presenting with concomitant imbalance, anxiety, and spatial disorientation. MethodsChildren with ADHD-only (n = 28), ADHD + Developmental Coordination Disorder (ADHD + DCD; n = 38), and Typical Development (TD; n = 19) were evaluated for vestibular function by the Dynamic Visual Acuity test (DVA-t), balance by the Bruininks-Oseretsky Test of motor proficiency (BOT-2), panic anxiety by the Screen for Child Anxiety Related Emotional Disorders questionnaire-Child version (SCARED-C), and spatial navigation by the Triangular Completion test (TC-t). ResultsChildren with ADHD vs. TD presented with a high rate of vestibular hypofunction (65 vs. 0 %), imbalance (42 vs. 0 %), panic anxiety (27 vs. 11 %), and spatial disorientation (30 vs. 5 %). Children with ADHD + DCD contributed more frequent and severe vestibular hypofunction and imbalance than children with ADHD-only (74 vs. 54 %; 58 vs. 21 %, respectively). A concomitant presence of imbalance, anxiety, and spatial disorientation was observed in 33 % of children with ADHD, all sharing vestibular hypofunction. ConclusionsVestibular hypofunction may be the common pathophysiology of imbalance, anxiety, and spatial disorientation in children. These comorbidities are preferentially present in children with ADHD + DCD rather than ADHD-only, thus likely related to DCD rather than to ADHD disorder. Children with this profile may benefit from a vestibular rehabilitation intervention.

The Effect of Oculomotor Exercises With Gaze Stabilization on Hand-Eye Coordination and Reaction Time in Table Tennis Athletes

The purpose of this study was to determine the effect of a 6 week oculomotor exercise program on hand-eye coordination, reaction time, visual perception and dynamic visual acuity with table tennis athletes. 50 table tennis players included in the study were randomly divided in to oculomotor exercise (OMEG, n=25) and control (CG, n=25) groups. While the two groups continued their routine tennis training programs, oculomotor exercises with gaze stabilization were applied to OMEG twice a day for 6 weeks via the WhatsApp application. Plate tapping test was used to evaluate the eye-hand coordination of the participants, reaction time test (number of hits and average reaction time) using the Blazepod device was used to evaluate reaction times, and forms A and B of the Trail Making Test (TMT-A ve TMT-B) were used to evaluate visual perception. Dynamic visual acuity test with powerpoint was used to evaluate the dynamic visual acuity of the participants. The paired t-test and two-sample t-test was executed to examine within and between the groups. The OMEG had significant improvements in hand-eye coordination, visual perception, reaction time and dynamic visual acuity (p

Functional impact of bilateral vestibular loss and the unexplained complaint of oscillopsia.

The vestibulo-ocular reflex (VOR) stabilizes vision during head movements. VOR disorders lead to symptoms such as imbalance, dizziness, and oscillopsia. Despite similar VOR dysfunction, patients display diverse complaints. This study analyses saccades, balance, and spatial orientation in chronic peripheral and central VOR disorders, specifically examining the impact of oscillopsia. Participants involved 15 patients with peripheral bilateral vestibular loss (pBVL), 21 patients with clinically and genetically confirmed Machado-Joseph disease (MJD) who also have bilateral vestibular deficit, and 22 healthy controls. All pBVL and MJD participants were tested at least 9 months after the onset of symptoms and underwent a detailed clinical neuro-otological evaluation at the Dizziness and Eye Movements Clinic of the Meir Medical Center. Among the 15 patients with pBVL and 21 patients with MJD, only 5 patients with pBVL complained of chronic oscillopsia while none of the patients with MJD reported this complaint. Comparison between groups exhibited significant differences in vestibular, eye movements, balance, and spatial orientation. When comparing oscillopsia with no-oscillopsia subjects, significant differences were found in the dynamic visual acuity test, the saccade latency of eye movements, and the triangle completion test. Even though there is a significant VOR gain impairment in MJD with some subjects having less VOR gain than pBVL with reported oscillopsia, no individuals with MJD reported experiencing oscillopsia. This study further supports that subjects experiencing oscillopsia present a real impairment to stabilize the image on the retina, whereas those without oscillopsia may utilize saccade strategies to cope with it and may also rely on visual information for spatial orientation. Finding objective differences will help to understand the causes of the oscillopsia experience and develop coping strategies to overcome it.

Investigation of vestibular function in patients with vestibular neuritis

To optimize the diagnostic algorithm for vestibular neuritis based on an assessment of the sensitivity of clinical methods for studying vestibular function in the recovery period of the disease. A comprehensive assessment of the sensitivity of clinical methods for the study of vestibular function in the acute (up to 14 days: at the time of initial treatment, on the 7th and 14th day) and subacute (up to 3 months: on the 28th and 90th day) periods of the disease in 52 patients with upper vestibular neuritis was carried out. The timing of the processes of restoration of vestibular function after a transferred vestibular neuritis is individual: after 14 days, restoration of vestibular function was recorded in 52% (n=27) patients, after 1 month - in 62% (n=32), after 3 months - in 71% (n=37) patients with upper vestibular neuritis. Statocoordination, statokinetic, oculomotor tests under visual control have the highest sensitivity in the acute period of vestibular neuritis, within up to 7 days from the onset of symptoms. In the subacute period of vestibular neuritis, the study of spontaneous nystagmus and nystagmus in the head shaking test retains high sensitivity only when using special tools (Frenzel goggles or videonystagmography). A decrease in the sensitivity of the head rotation test and the dynamic visual acuity test in the subacute period of vestibular neuritis is associated with the processes of central compensation and the formation of a latent saccade. The sensitivity of clinical tests in patients with vestibular neuritis depends on the timing of the examination.

Spatial memory and learning: investigating the role of dynamic visual acuity.

The vestibular system's contribution to spatial learning and memory abilities may be clarified using the virtual Morris Water Maze Task (vMWMT). This is important because of the connections between the vestibular system and the hippocampus area. However, there is ongoing debate over the role of the vestibular system in developing spatial abilities. This study aimed to evaluate the relationship between Dynamic Visual Acuity (DVA) across three planes and spatial abilities. This cross-sectional study was conducted with 50 healthy adults aged 18 to 55 with normal stress levels and mental health and no neurological, audiological, or vestibular complaints. The Trail-Making Test (TMT) Forms A and B for the assessment of executive functions, the DVA test battery for the evaluation of visual motor functions, and the Virtual Morris Water Maze Test (vMWMT) for the assessment of spatial learning and spatial memory were performed. All participants also underwent the Benton Face Recognition Test (BFRT) and Digit Symbol Substitution Tests (DSST) to assess their relation with spatial memory. DVA values in horizontal (H-DVA), vertical (V-DVA), and sagittal (S-DVA) planes ranged from (-0.26) to 0.36 logMAR, (-0.20) to 0.36 logMAR, and (-0.28) to 0.33 logMAR, respectively. The latency of three planes of DVA was affected by vMWMT (Horizontal, Vertical, and Sagittal; Estimate: 22.733, 18.787, 13.341, respectively p < 0.001). Moreover, a moderately significant correlation was also found, with a value of 0.571 between the Virtual MWM test and BFRT and a value of 0.539 between the DSST (p < 0.001). Spatial abilities in healthy adults were significantly influenced by dynamic visual functions across horizontal, vertical, and sagittal planes. These findings are expected to trigger essential discussions about the mechanisms that connect the vestibular-visual system to the hippocampus. The original vMWMT protocol is likely to serve as a model for future studies utilizing this technology.

Vertical dynamic visual acuity is significantly lower than horizontal dynamic visual acuity

Dynamic visual acuity (DVA) is crucial for the perception of moving objects. While traditional DVA assessment tools predominantly focus on horizontal movements, the evaluation of vertical DVA remains unstandardized. Consequently, the disparities between vertical and horizontal DVAs are yet to be thoroughly investigated. Therefore, we designed a system capable of conducting multidirectional DVA tests and eye movement measurements. During the experiments, the participants identified the gap direction of the Landolt-C ring moving either horizontally or vertically. The speed of movement decelerated from its maximum as a high-speed infrared camera captured the pupil movements of the left eye at 500 fps. We conducted tests on 15 healthy university students (aged 22.7±1.2\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$22.7\\pm 1.2$$\\end{document} years) and measured vertical and horizontal DVAs five times each. DVA was deduced from the Landolt-C ring speed with accurate gap direction responses, and eye movement was assessed based on the total gaze movement distance. The results revealed superior DVA and eye movement in the horizontal direction compared with the vertical direction (p<0.001\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$p < 0.001$$\\end{document}). This highlights the anisotropic characteristics of DVA and eye movement. The proposed system has the potential for multidirectional dynamic vision evaluation and training in clinical scenarios.

Do Oculomotor Exercises Improve Balance, Dynamic Visual Acuity and Performance in Female Volleyball Players? A Randomized Controlled Clinical Trial

Athletes must develop not only their physical and motor capabilities but also their visual and perceptual-cognitive skills to support their performance. This study investigated the effects of oculomotor exercises (OMEs) on elite female volleyball players' dynamic visual acuity (DVA), balance, and vertical jump performance (VJP). Fifty-two female volleyball players were allocated to two groups: the intervention group (IG, n=26) that received OMEs twice a day, six days a week for four weeks in addition to their daily training, and the control group (CG, n=26) that, only continued their daily training. All participants were assessed with the Flamingo Balance Test (FBT), Y Balance Test (YBT), Clinical DVA Test, and Vertical Jump Test (VJT) before and after the study. After the study, FBT, DVA, and YBT posteromedial values in IG improved significantly, but VJP did not change. The results for CG showed no improvements. After the study only FBT score differences were found between the groups. OMEs in volleyball players can help to improve balance by improving DVA and balance. Future research should investigate the effects of volleyball-specific visual training on improving performance skills.

Effect of oculomotor exercises in patients with non-specific chronic neck pain and associated visual complaints.

Neck pain is a common musculoskeletal disorder, the most common type being non-specific chronic neck pain. It usually involves postural or mechanical causes. In Individuals with neck pain, a notable prevalence of visual complaints has been predominantly reported. It can be linked to the mismatch in the cervical afferent output. This study aimed to assess the effect of oculomotor exercises on neck pain, neck disability, gaze stability and visual complaints among individuals with non-specific chronic neck pain and associated visual complaints. A total of 32 individuals with non-specific chronic neck pain and associated visual complaints were equally randomised into two groups. To receive either: stretching to the sternocleidomastoid and anterior scalene along with neck Isometric exercises (Group A, conventional) or the conventional protocol along with oculomotor exercises (Group B, experimental). The protocol was given for three alternate days a week for three weeks, a total of nine sessions. The outcome measures were the Visual Analogue Scale (VAS) for pain, Neck Disability Index (NDI) for disability, Dynamic Visual Acuity (DVA) test for gaze stability and Visual Complaints Index (VCI) for visual complaints. Significant results were seen for the DVA () and VCI (), suggesting improvements in gaze stability and visual complaints using oculomotor exercises. From this study, we highlighted that oculomotor exercises along with conventional treatment led to improvement in visual complaints and gaze stability in patients with non-specific chronic neck pain and associated visual complaints.

The effects of vestibular dysfunction on balance and self-concept in children with cochlear implants.

Children with cochlear implants (CCI) have an increased rate of vestibular dysfunction. Vestibular dysfunction is associated with decreased balance and dynamic visual acuity ability. Hearing loss alone is associated with reduced speech perception and vocabulary in children. In adults, vestibular dysfunction is associated with reduced quality of life; however, similar relationships have not been studied in children with vestibular dysfunction. Therefore, the objective of the present study was to evaluate the effect of hearing loss and vestibular dysfunction on self-concept in CCI (n=33) compared to children with normal hearing (CNH, n=38). It was hypothesized that children with vestibular dysfunction would have reduced self-concept beyond that from hearing loss, secondary to the presence of balance and visual acuity deficits. The Piers-Harris Children's Self-Concept Scale - 2, speech perception, vocabulary, video head impulse test (vHIT), rotary chair, balance using the Bruininks-Oseretsky Test of Motor Proficiency (BOT-2), and dynamic visual acuity (DVA) testing were completed on all participants. In the 34 CCI, 24 had normal vestibular function, 6 had unilateral vestibular dysfunction, and 4 had bilateral vestibular dysfunction. There were no significant mean differences in the Piers-Harris Children's Self-Concept Scale - 2 between groups. A Principal Component Analysis (PCA) was conducted on the predictor variables (average horizontal canal vHIT gain, BOT-2 score, DVA, speech perception, and vocabulary) resulting in two factors; factor 1 represented "vestibular" components (vHIT, BOT-2, and DVA) and factor 2 represented "auditory-language" components (speech perception and vocabulary). In addition to age and gender, the 2 PCA factors were analyzed using multivariate regression with stepwise selection to determine which factors best predicted self-concept. The PCA auditory-language factor was the only significant predictor of self-concept. Auditory-language, not vestibular related factors, contribute to the self-concept of CCI. While adults with vestibular dysfunction have reduced quality of life, it could be that children with vestibular dysfunction have some psychosocial resilience.

Advances in dynamic visual acuity test research.

The dynamic visual acuity test (DVAT) is a functional evaluation tool for the impairment and compensation of the vestibular system, which could reflect the Vestibulo-ocular reflex (VOR) function. We present an overview of DVAT research, displaying recent advances in test methods, application, and influencing factors; and discussing the clinical value of DVAT to provide a reference for clinical application. There are two primary types of DVAT: dynamic-object DVAT and static-object DVAT. For the latter, in addition to the traditional bedside DVAT, there are numerous other approaches, including Computerized DVAT (cDVAT), DVAT on a treadmill, DVAT on a rotary, head thrust DVA (htDVA) and functional head impulse testing (fHIT), gaze shift dynamic visual acuity with walking (gsDVA), translational dynamic visual acuity test (tDVAT), pediatric DVAT. The results of DAVT are affected by subject [occupation, static visual acuity (SVA), age, eyeglass lenses], testing methods, caffeine, and alcohol. DVAT has numerous clinical applications, such as screening for vestibular impairment, assessing vestibular rehabilitation, predicting fall risk, and evaluating ophthalmology-related disorders, vestibular disorders, and central system disorders.

Bilateral peripheral vestibulopathy

Bilateral vestibulopathy is a relatively widespread and at the same time rarely diagnosed cause of chronic postural instability. Numerous toxic factors, dysmetabolic, autoimmune and neurodegenerative processes can lead to this condition. The main clinical manifestations of bilateral vestibulopathy are balance disorders and visual disturbances (oscillopsia), which can significantly increase the risks of falls in such patients. In addition, cognitive and affective disorders, which also reduce the quality of life in patients with bilateral vestibulopathy, have been described and actively studied in recent years. The diagnosis of bilateral vestibulopathy is based on the results of a clinical neurovestibular study, including a dynamic visual acuity test and a Halmagyi test. A video head impulse test, a bithermal caloric test and a sinusoidal rotation test are used as instrumental methods confirming the dysfunction of the peripheral vestibular system. However, they are still not widespread in neurological practice. Treatment of bilateral vestibulopathy is reduced to vestibular rehabilitation. Encouraging results have been obtained in a number of studies using galvanic vestibular stimulation and the use of vestibular implants. In addition, cognitive rehabilitation methods are currently being developed, which presumably can also improve compensation for bilateral vestibular loss.

Adults are not Older-Adolescents: Comparing Clinical Findings among Adolescents and Adults with Persistent Post-Concussive Symptoms

<h3>Research Objectives</h3> To determine if clinical findings related to oculomotor, vestibular, balance, and cervical function differ between adolescents (age 12-17), younger adults (age 20-45), and older adults (age 46-65) with persistent post-concussive symptoms (PPCS). There is limited research on the prevalence of these clinical signs in adults with PPCS and how clinical presentations may differ between adults and adolescents. <h3>Design</h3> Retrospective case-control study. <h3>Setting</h3> Multi-center, community-based, private physical therapy practice specializing in the management of neurologic conditions, including concussion. <h3>Participants</h3> Patients presenting with PPCS (n = 481, mean 197 ± 154 days since injury) were divided into Adolescents (n=103), Younger Adults (n=195), and Older Adults (n=183). Physical assessments were categorized as ocular, cervical and vestibular/balance. <h3>Interventions</h3> Not applicable. <h3>Main Outcome Measures</h3> Prevalence of clinical findings on physical assessment related to oculomotility (smooth pursuits, saccades, near point of convergence [NPC]), vestibular/balance function (vestibulo-ocular reflex, head impulse test, dynamic visual acuity test, Romberg test), and cervical function (cervical range of motion [ROM] limitations, tenderness to palpation). <h3>Results</h3> Younger and older adults had a greater prevalence of NPC impairment (p< 0.001) as well as more abnormal vestibular (VOR [p< 0.001] and Head Impulse Test [p=0.017]) and balance (Romberg Test [p< 0.001]) findings. Adolescents had a higher prevalence of cervical impairments (ROM [p< 0.001] and palpation [p< 0.001]). There were no significant differences observed in ocular, vestibular/balance, or cervical findings between younger and older adults. <h3>Conclusions</h3> In this group of individuals with PPCS, adults demonstrated a different constellation of clinical findings compared to adolescents. Different presentations may inform different approaches to rehabilitation. Prospective evaluation is warranted. <h3>Author(s) Disclosures</h3> Nothing to disclose.

Efficacy of Computerized Visual Tracking Technology Throughout Concussion Recovery: A Case Series

<h3>Research Objectives</h3> To compare results of computerized eye tracking assessments to concussion patient reported outcomes and other objective oculomotor function tests throughout the concussion recovery. <h3>Design</h3> Retrospective case series of three physical therapy plan of cares completed between April 2021 and September 2021. <h3>Setting</h3> Outpatient physical rehabilitation clinic. <h3>Participants</h3> Included three female patients (mean age 34.7 years). Brain injury conditions vary from sub-acute to chronic. Selected via volunteer sample. <h3>Interventions</h3> Manual therapy, postural stabilization, aerobic conditioning, ocular motor training, and balance exercises. Average physical therapy visit count of 15.3. <h3>Main Outcome Measures</h3> RightEye™ Dynamic Visual Acuity (DVA) Test, Concussion Clinical Profile Screen (CCPS), Clinical DVA, Somatosensory Organization Test (SOT), and Vestibular Ocular Motor Screen (VOMS). <h3>Results</h3> All final RightEye™ DVA composite scores declined or had minimal change compared to evaluation scores. Initial VOMS similar findings to initial RightEye™ DVA subdomain scores. CCPS composite and ocular profile scores improved with each re-assessment. Clinical DVA scores improved and within normal limits at final assessments. 2/3 of participants had normal composite scores on SOT at re-evaluation. <h3>Conclusions</h3> In this case series subjective recovery of concussion symptoms did not correlate with performance on computerized ocular motor assessments. There were conflicting results on several other objective tests compared to results of RightEye™ DVA. Some confounding factors that may have impacted scores are co-morbidities of cervical pain, anxiety, depression, and migraine. Even though the assessments did not correlate, it is important to note the tracking assessments and games were engaging and offered repetition. In conclusion, clinicians should not rely on one single measurement for concussion screening and determination of readiness for return to prior activities. More research is needed to determine the efficacy of computerized visual tracking assessments for individuals with complex medical history and post-concussion. <h3>Author(s) Disclosures</h3> The author has nothing to disclose.

Head-Mounted Dynamic Visual Acuity for G-Transition Effects During Interplanetary Spaceflight: Technology Development and Results from an Early Validation Study.

INTRODUCTION: Dynamic visual acuity (DVA) refers to the ability of the eye to discern detail in a moving object and plays an important role whenever rapid physical responses to environmental changes are required, such as while performing tasks onboard a space shuttle. A significant decrease in DVA has previously been noted after astronauts returned from long-duration spaceflight (0.75 eye chart lines, 24 h after returning from space). As part of a NASA-funded, head-mounted multimodal visual assessment system for monitoring vision changes in spaceflight, we elaborate upon the technical development and engineering of dynamic visual acuity assessments with virtual reality (VR) technology as the first step in assessing astronaut performance when undergoing G-transitional effects. We also report results from an early validation study comparing VR DVA assessment with traditional computer based DVA assessment.METHODS: Various VR/AR headsets have been utilized to implement DVA tests. These headsets include HTC Vive Pro Eye system. Epic's game engine UnrealEngine 4 Version 4.24 was used to build the framework and SteamVR was used to experience virtual reality content. Eye tracking technology was used to maintain fixation of the participant. An early validation study with five participants was conducted comparing this technology versus traditional DVA with a laptop.RESULTS: The head-mounted technology developed for assessing DVA changes during G-transitions is fully functional. The results from the early validation study demonstrated that the two DVA tests (laptop-based and VR) indicated a strong association between both methods (Pearson correlation coefficient of 0.91). A Bland-Altman plot was employed to assess levels of agreement, with all data points falling within the limits of agreement.DISCUSSION: The results from this early validation study indicate that head-mounted DVA assessment performs similarly to traditional laptop-based methods and is a promising method for assessing DVA during spaceflight, particularly in G-transitions. Future studies are required for further assessment of validation and reliability of this technology. With its ease of use, accessibility, and portable design, VR DVA has the potential in the near-future to replace conventional methods of assessing DVA. The technology will likely be an important aspect to help monitor functionality and safety during interplanetary missions where astronauts are exposed to G-transitions.Waisberg E, Ong J, Zaman N, Kamran Sa, Lee AG, Tavakkoli A. Head-mounted dynamic visual acuity for G-transition effects during interplanetary spaceflight: technology development and results from an early validation study. Aerosp Med Hum Perform. 2022; 93(11):800-805.

Comparison of exergaming and vestibular training on gaze stability, balance, and gait performance of older adults: A single blind randomized control trial.

To compare the effects of exergaming and vestibular training on gaze stability, balance and gait performance of older adults. The single-blind randomised controlled trial was conducted from August to October 2020 at the Doctor Raza Clinic, Swabi, Pakistan, and comprised individuals of both genders aged 60-75 years. The subjects were randomised into two groups using the sealed envelope method. Group 1 received exergaming, while group 2 received vestibular training 3 days a week for 6 weeks. The outcomes measures were dynamic gait index, time up and go test and non-instrumented dynamic visual acuity test. Data was analysed using SPSS 21. Of the 24 subjects, 12(50%) were in each of the two groups. Overall, there were 16(66%) males and 8(33%) females with a mean age of 66.3±4.36 years. Intra-group improvement was significant compared to the baseline (p<0.05) in both the differences, but inter-group differences across all parameters were non-significant (p>0.05). Both exergaming and vestibular training has similar effects on gaze stability, balance, and gait performance among the older adults. Clinical Trials.gov Identifier: NCT04414462.

Dynamic visual acuity test findings of migraine patients: Observational case-control study

ObjectiveTo evaluate computerized dynamic visual acuity (DVA) test findings among patients with migraine and to determine whether self-motion sensitivity and visually induced migraine symptoms that are seen in migraine patients can be explained by DVA results. MethodsTwenty migraine patients and twenty control subjects were evaluated with DVA test during rapid horizontal (left and right) and vertical (up and down) head movements. The subjects were asked to quickly recognize the direction of the Landolt-C optotype on the monitor while moving their heads. Test began with the largest optotype and progressively decreased in size by 0.1 logMAR until the subject could no answer correctly state the orientation of the optotype. DVA test scores of migraine group and control group were compared. ResultsPatient with migraine had significant DVA loss as compared with control subjects in four positions (left DVA, right DVA, up DVA, down DVA respectively p < 0.001, <0.001 = 0.001 and <0.001). ConclusionMigraine patients were found to have abnormal DVA scores mediated vestibular-ocular reflex. These abnormal DVA findings can explain the pathophysiology of head motion hypersensitivity and visual motion sensitivity that encountered by migraine patients.

Determining the Agreement Between Common Measures Related to Vestibulo-ocular Reflex Function After a Mild Traumatic Brain Injury in Children and Adolescents

ObjectiveTo (1) determine the level of agreement between symptom provocation and performance-based tests of vestibulo-ocular reflex (VOR) function after pediatric mild traumatic brain injury (mTBI) and (2) describe the level of symptom provocation induced by a VOR task in individuals with and without cervical findings. DesignCross-sectional. SettingThis study was conducted at a tertiary care pediatric hospital. ParticipantsA total of 101 participants (N=101) aged 6-18 years within 3 weeks of mTBI diagnosis were included (54.5% female; mean age, 13.92±2.63 years; mean time since injury at assessment, 18.26±6.16 days). InterventionsNone. Main Outcome MeasuresSymptom provocation (Vestibular/Ocular Motor Screening tool), performance (clinician-observed VOR performance, head thrust test [HTT], computerized dynamic visual acuity test, video head impulse test), and cervical impairment (cervical flexion-rotation test, range of motion test, self-reported neck pain). Agreement was evaluated using Cohen's κ statistic. ResultsNo outcomes demonstrated agreement with symptom provocation (κ=−0.15 to 0.14). Fair agreement demonstrated between clinician-observed VOR performance and HTT (κ=0.32), with little to no agreement demonstrated between other measures. Proportions reporting test-induced dizziness and headache were greater among individuals with cervical findings (29.1%-41.8%) than without (2.3%-6.8%). ConclusionsFindings support that symptom provocation and performance-based tests measure different constructs and thus have distinct roles when assessing VOR function. Findings suggest results from measures of symptom provocation may be influenced by coexisting cervical impairments, underlining the value of assessing for cervical injury after pediatric mTBI.

Challenging the Vestibular System Affects Gait Speed and Cognitive Workload in Chronic Mild Traumatic Brain Injury and Healthy Adults.

People with persistent symptoms after mild traumatic brain injury (mTBI) report imbalance during walking with head movements. The purpose of this study was (1) to compare usual walk gait speed to walking with head turns (HT) between people with mTBI and controls, (2) to compare the cognitive workload from usual walk to HT walk between groups, and (3) to examine if gaze stability deficits and mTBI symptoms influence gait speed. Twenty-three individuals (mean age 55.7 ± 9.3 years) with persistent symptoms after mTBI (between 3 months to 2 years post-injury) were compared with 23 age and sex-matched controls. Participants walked a 12-inch wide, 60-foot walkway when looking ahead and when walking with HT to identify letters and their colors. Gait speed during usual walk and HT walk were calculated. Pupillary responses during both walks were converted to the Index of Cognitive Activity (ICA) as a measure of cognitive workload. Gaze stability was examined by the dynamic visual acuity (DVA) test in the yaw plane. The post-concussion symptom scale (PCSS) was used to collect symptom severity. Within group analysis showed that gait speed was lower during HT walk compared to usual walk in the people with mTBI (p < 0.001) as well as in controls (p < 0.001). ICA was higher with HT compared to usual walk in the mTBI group in the right eye (p = 0.01) and left eye (p = 0.001), and in controls in the right eye (p = 0.01) and left eye (p = 0.01). Participants in the mTBI group had slower usual (p < 0.001), and HT gait speed (p < 0.001) compared to controls. No differences were noted in ICA in the right or left eye during usual walk and HT walk between groups (p > 0.05). DVA loss in the yaw plane to the right and left was not different between groups (p > 0.05) and were not correlated with gait speed. PCSS scores were correlated with usual walk (r = −0.50, p < 0.001) and HT gait speed (r = −0.44, p = 0.002). Slower gait speed, poorer stability, and higher cognitive workload during walking with head turns may reduce community participation in people with mTBI and persistent symptoms.

Relationship between dynamic visual acuity and multiple object tracking performance.

We assessed the association between measures of dynamic visual acuity and a multiple object tracking task in physically active young adults. Ninety-four young adults performed the dynamic visual acuity and multiple object tracking tasks. Dynamic visual acuity was measured for horizontal and random walk motion paths at four target speeds (5, 10, 20, and 30°/s). For the multiple object tracking task, participants had to track three out of eight balls for 10 s, and the object speed was adjusted by a staircase procedure. We found that multiple object tracking performance was associated with better identification of horizontally and randomly moving targets in the dynamic visual acuity test (p < .001, r = -.35 [-.52, -.16]; and p < .001, r = -.52 [-.65, -.35]; respectively). This effect was consistent across all target speeds (all p-values<0.05). However, static visual acuity did not correlate with any measure of dynamic visual acuity or multiple object tracking (p > 0.170 in all cases). This study provides novel insights into the association between the ability to identify horizontally and randomly moving targets and track multiple objects. Future studies are needed to determine the potential utility of dynamic visual acuity for talent identification and predicting sports performance in real-game situations.