Oculomotor Function Research Articles

Saccade dysmetria indicates attenuated visual exploration in autism spectrum disorder.

Visual exploration in autism spectrum disorder (ASD) is characterized by attenuated social attention. The underlying oculomotor function during visual exploration is understudied, whereas oculomotor function during restricted viewing suggested saccade dysmetria in ASD by altered pontocerebellar motor modulation. Oculomotor function was recorded using remote eye tracking in 142 ASD participants and 142 matched neurotypical controls during free viewing of naturalistic videos with and without human content. The sample was heterogenous concerning age (6-30years), cognitive ability (60-140 IQ), and male/female ratio (3:1). Oculomotor function was defined as saccade, fixation, and pupil-dilation features that were compared between groups in linear mixed models. Oculomotor function was investigated as ASD classifier and features were correlated with clinical measures. We observed decreased saccade duration (∆M=-0.50, CI [-0.21, -0.78]) and amplitude (∆M=-0.42, CI [-0.12, -0.72]), which was independent of human video content. We observed null findings concerning fixation and pupil-dilation features (POWER=.81). Oculomotor function is a valid ASD classifier comparable to social attention concerning discriminative power. Within ASD, saccade features correlated with measures of restricted and repetitive behavior. We conclude saccade dysmetria as ASD oculomotor phenotype relevant to visual exploration. Decreased saccade amplitude and duration indicate spatially clustered fixations that attenuate visual exploration and emphasize endogenous over exogenous attention. We propose altered pontocerebellar motor modulation as underlying mechanism that contributes to atypical (oculo-)motor coordination and attention function in ASD.

Primate Amygdalo-Nigral Pathway for Boosting Oculomotor Action in Motivating Situations.

SummaryA primary function of the primate amygdala is to modulate behavior based on emotional cues. To study the underlying neural mechanism, we first inactivated the amygdala locally and temporarily by injecting a GABA agonist. Then, saccadic eye movements and gaze were suppressed only on the contralateral side. Next, we performed optogenetic activation after injecting a viral vector into the amygdala. Optical stimulation in the amygdala excited amygdala neurons, whereas optical stimulation of axon terminals in the substantia nigra pars reticulata inhibited nigra neurons. Optical stimulation in either structure facilitated saccades to the contralateral side. These data suggest that the amygdala controls saccades and gaze through the basal ganglia output to the superior colliculus. Importantly, this amygdala-derived circuit mediates emotional context information, whereas the internal basal ganglia circuit mediates object value information. This finding demonstrates a basic mechanism whereby basal ganglia output can be modulated by other areas conveying distinct information.

Effect of a visual tracking intervention on attention and behavior of children with Attention Deficit Hyperactivity Disorder.

Attention deficit hyperactivity disorder is characterized by several cognitive and behavioral problems such as inattention and impulsivity, abnormal control of eye movements and relocation, visual fixation and visuospatial perception. There is a link between core motor functions such as oculomotor function and cognition to the extent that the oculomotor system acts as a mediator between the motor and cognitive functions. Therefore, the effects of eye-tracking intervention were investigated on attention in these children. Thirty - nine boys with ADHD, 6 to 10 years of age were recruited and randomized to receive current occupational therapy (control group), or occupational therapy accompanied with eye-tracking exercises (experimental group). They were evaluated using the Conner's Parent Rating Scale, the Continuous Performance Task-2, and the Test of Visual-Motor Skills-Revised before and after the intervention. Significant improvements in the mean scores of cognitive problems (F=9/22), coping behavior (F=6.03) and hyperactivity (F=9.77) were detected in the posttest between the two groups (p<0.05). Furthermore, in the Continuous Performance Test scores, detectability (F=5.68), omission errors (F=17.89), commission errors (F=19.45), reaction time (F=8.95), variability (F=7.07), and preservation (F=6.33) showed significant differences between control and experimental groups (p<0.01). It appears that eye-tracking interventions designed based on the isolation of neck and eye movement might have an important role in improving cognitive function and coping behaviors in these children. It seems that these exercises could increase eye movement control; improve cognitive function and response inhibition.

OCULOMOTOR FUNCTION IN ADOLESCENT ATHLETES FOLLOWING CONCUSSION

Background:Visual impairments affect up to 90% of patients post-concussion. These impairments may include deficits in fixation accuracy, smooth pursuit, saccadic latencies, vergence, accommodation, and vestibule-ocular reflexes. Quantitative assessment of oculomotor function may provide a sensitive and objective measure of concussion diagnosis and recovery since coordinated eye movements require the use of diverse and widely dispersed areas of the brain. This study quantified oculomotor function over time in adolescents following concussion.Hypothesis/Purpose:We hypothesized that adolescent concussion patients would demonstrate deficits of oculomotor function that would resolve by the time of return to play (RTP) and remain stable after RTP.Methods:13 adolescent athletes diagnosed with mild to moderate concussion (7 male; mean age 15.1, SD 2.1, range 10-17 years) were prospectively evaluated at their initial visit (mean 18, range 4-43 days post-concussion), at the time of clearance to RTP (mean 46, range 12-173 days post-concussion), and one month later (mean 26, range 20-41 days after RTP). 11 controls without past concussion or injury (3 male; mean age 12.3, SD 3.1, range 8-17 years) were also tested at similar time points. Eye tracking was recorded as participants followed a target moving on a screen in predefined patterns related to sinusoid and trapezoid smooth pursuit, vergence, saccade, and anti-saccade. Metrics characterizing the speed, accuracy, and variability of tracking were compared between groups and visits using t-tests and linear mixed-effects regression.Results:At their initial visit, patients tended to have greater overshoot and greater variability in tracking compared with controls (Table 1.1). Overshoot and variability of tracking during sinusoid smooth pursuit (both overall variability and variability of overshoot) decreased from initial visit to RTP (Table 1.2). Undershoot during sinusoid smooth pursuit tended to decrease from RTP to 1-month follow-up. The rate of convergence in the distance vergence task increased while the rate of divergence decreased between these time points.Conclusion:The main oculomotor deficits observed in concussed adolescents related to overshoot and variability of tracking during sinusoid smooth pursuit. These deficits resolved by the time of RTP and generally remained stable or continued improving after RTP. These results suggest that oculomotor function recovers sufficiently under current conservative treatment protocols.Table 1.1.Comparison of concussed patients at initial visit vs. controls ConcussedInitial VisitMean (SD)Control Mean (SD)p-valueSaccade latency0.44 (0.07)0.45 (0.07)0.72Anti-saccade latency0.65 (0.12)0.62 (0.08)0.41Rate of convergence1.44 (0.31)1.51 (0.25)0.62Rate of divergence1.56 (0.17)1.55 (0.24)0.94Sinusoid peak phase lag10.40 (6.75)10.55 (1.80)0.95 Sinusoid mean SD of error 3.19 (1.95) 2.00 (0.91) 0.075 Sinusoid mean overshoot 4.72 (4.23) 2.16 (1.54) 0.075 Sinusoid mean undershoot3.07 (0.91)2.90 (0.29)0.57Sinusoid SD overshoot5.17 (4.84)2.30 (1.80)0.080Sinusoid SD undershoot3.35 (1.11)3.28 (0.38)0.83Sinusoid smooth pursuit involves a target moving in a sinusoidal pattern in a horizontal direction. A full period of movement covers 35.6 degrees over 2.4 seconds.Table 1.2.Change between visits for patients Coef (SE)RTP vs. IVp-valueCoef (SE)Follow-up vs. RTPp-valueSaccade latency0.008 (0.022)0.739-0.034 (0.023)0.139Anti-saccade latency-0.015 (0.045)0.729-0.069 (0.050)0.166Rate of convergence-0.073 (0.088)0.410 0.269 (0.097) 0.005 Rate of divergence-0.021 (0.154)0.889 -0.315 (0.172) 0.068 Sinusoid peak phase lag1.52 (1.97)0.441-1.88 (2.05)0.359Sinusoid mean SD of error -1.04 (0.53) 0.048 0.49 (0.52)0.348Sinusoid mean overshoot -1.97 (0.98) 0.045 0.43 (0.97)0.657Sinusoid mean undershoot-0.02 (0.10)0.818 -0.16 (0.09) 0.080 Sinusoid SD overshoot -2.59 (1.04) 0.013 0.86 (1.02)0.396Sinusoid SD undershoot-0.17 (0.29)0.5690.15 (0.29)0.610Sinusoid smooth pursuit involves a target moving in a sinusoidal pattern in a horizontal direction. A full period of movement covers 35.6 degrees over 2.4 seconds.

Sleep deprivation‐induced oculomotor dysfunction: implications for surgical and medical performance

Sleep deprivation‐induced oculomotor dysfunction: implications for surgical and medical performance

Endonasal interdural pituitary transposition for resection of a posterior clinoid process enchondroma in a patient with Maffucci syndrome.

Maffucci syndrome is an extremely rare disorder characterized by benign enchondromas, skeletal deformities, and cutaneous lesions composed of abnormal blood vessels. Enchondromas rarely arise in the cranial bones. Interdural pituitary transposition is an effective way to gain access to the posterior clinoid, without affecting the function of the pituitary gland. Here, the authors present a case of a posterior clinoid process enchondroma in a patient with Maffucci syndrome. The tumor was resected via an interdural pituitary transposition fashion. Four months postoperatively, the patient’s oculomotor function had recovered to normal and the function of the pituitary gland was preserved intact.The video can be found here: https://youtu.be/EYgVwVZuC4g.

Clinical, ocular motor, and imaging profile of Niemann-Pick type C heterozygosity.

To characterize subclinical abnormalities in asymptomatic heterozygote NPC1 mutation carriers as markers of neurodegeneration. Motor function, cognition, mood, sleep, and smell function were assessed in 20 first-degree heterozygous relatives of patients with Niemann-Pick disease type C (NPC) (13 male, age 52.7 ± 9.9 years). Video-oculography and abdominal ultrasound with volumetry were performed to assess oculomotor function and size of liver and spleen. NPC biomarkers in blood were analyzed. 18F-fluorodesoxyglucose PET was performed (n = 16) to detect patterns of brain hypometabolism. NPC heterozygotes recapitulated characteristic features of symptomatic NPC disease and demonstrated the oculomotor abnormalities typical of NPC. Hepatosplenomegaly (71%) and increased cholestantriol (33%) and plasma chitotriosidase (17%) levels were present. The patients also showed signs seen in other neurodegenerative diseases, including hyposmia (20%) or pathologic screening for REM sleep behavior disorder (24%). Cognitive function was frequently impaired, especially affecting visuoconstructive function, verbal fluency, and executive function. PET imaging revealed significantly decreased glucose metabolic rates in 50% of participants, affecting cerebellar, anterior cingulate, parieto-occipital, and temporal regions, including 1 with bilateral abnormalities. NPC heterozygosity, which has a carrier frequency of 1:200 in the general population, is associated with abnormal brain metabolism and functional consequences. Clinically silent heterozygous gene variations in NPC1 may be a risk factor for late-onset neurodegeneration, similar to the concept of heterozygous GBA mutations underlying Parkinson disease.

Balance Markers and Saccadic Eye-Movement Measures in Adolescents With Postconcussion Syndrome.

Deficits in both balance and oculomotor function, including impairments in saccadic eye movements, are observed in approximately 30% of patients postconcussion. Whereas balance and saccadic eye movements are routinely assessed separately, growing evidence suggests that they should be assessed concurrently. To compare balance measures and saccades between adolescents 1 to 3 months postconcussion and healthy uninjured adolescents. Case-control study. Concussion clinic and 2 private schools. Twenty-five adolescents (10 boys, 15 girls; median [interquartile range (IQR)] age = 14 years [11.5-16 years]) between 1 and 3 months postconcussion (median [IQR] time since injury = 39.5 days [30-56.75 days]) and 33 uninjured adolescents (18 boys, 15 girls; median [IQR] age = 13 years [11.5-14 years]). The center-of-pressure 95% ellipse area and medial-lateral and anterior-posterior velocity and the number of saccades in the dual-task balance conditions including a high cognitive load (cognitive condition), a low cognitive load and a gaze-shifting component (visual condition) or both a high cognitive load and a gaze-shifting component (combined condition). Concussion-group participants swayed over larger center-of-pressure ellipse areas in the visual (P = .02; effect size = 0.73) and combined (P = .005; effect size = 0.86) conditions but not in the cognitive condition (P = .07; effect size = 0.50). No group differences were identified for anterior-posterior (F1,56 = 2.57, P = .12) or medial-lateral (F1,56 = 0.157, P = .69) velocity. Concussion-group participants also did not perform more saccades than the control-group participants (F1,56 = 2.04, P = .16). Performing dual-task balance conditions for which the secondary task involved a gaze-shifting component or both a gaze-shifting component and a high cognitive load resulted in greater sway amplitude in adolescents with concussion. However, these larger amounts of postural sway were not associated with increased saccadic eye movements.

Vestibular Screening in Pediatric Patients with Otitis Media

Otitis media with effusion (OME) is a common cause of vestibular disturbances in children. However, young children often lack the language to express their symptoms, and it is uncommon to screen children for vestibular impairments. The purpose of this study was to develop a screening protocol for children presenting with OME to determine if diagnostic vestibular testing is necessary. Children with normal hearing (NH), sensorineural hearing loss (SNHL), and conductive hearing loss (CHL) due to OME participated in a vestibular screening. There were 30 participants, ages four to eight years, ranging from 48 to 101 months included in the study: 10 with NH, 11 with CHL due to OME, and 9 with SNHL. The vestibular screening consists of patient and parent questionnaires and a functional evaluation. The tests examined coordination, balance, oculomotor function, and nystagmus. Those with CHL were significantly more likely to display abnormal smoothness of pursuit, as measured with observations for rapid tracking, absence of or delayed saccades, and overshoot, than those with NH or SNHL (p = 0.012). Parents of children with CHL due to OME were more likely to report their child experiencing middle ear pressure than the parents of children with NH or SNHL (p = 0.010). In addition, children with CHL were less likely to report hearing loss than those with NH or SNHL. Parent and patient report were not found to be reliable indicators of vestibular disturbances. This pilot study suggests that children with CHL due to OME present with more oculomotor abnormalities than their peers with NH. Further research is necessary to determine validity and reliability of the findings for this present study.

Improvement After Vestibular Rehabilitation Not Explained by Improved Passive VOR Gain.

Gaze stability exercises are a critical component of vestibular rehabilitation for individuals with vestibular hypofunction and many studies reveal the rehabilitation improves functional performance. However, few studies have examined the vestibular physiologic mechanisms (semicircular canal; otolith) responsible for such recovery after patients with vestibular hypofunction complete gaze and gait stability exercises. The purpose of this study was to compare behavioral outcome measures (i.e., visual acuity during head rotation) with physiological measures (i.e., gain of the vestibulo-ocular reflex) of gaze stability following a progressive vestibular rehabilitation program in patients following unilateral vestibular deafferentation surgery (UVD). We recruited n = 43 patients (n = 18 female, mean 52 ± 13 years, range 23–80 years) after unilateral deafferentation from vestibular schwannoma; n = 38 (25 female, mean 46.9 ± 15.9 years, range 22–77 years) age-matched healthy controls for dynamic visual acuity testing, and another n = 28 (14 female, age 45 ± 17, range 20–77 years) healthy controls for video head impulse testing. Data presented is from n = 19 patients (14 female, mean 48.9 ± 14.7 years) with UVD who completed a baseline assessment ~6 weeks after surgery, 5 weeks of vestibular physical therapy and a final measurement. As a group, subjective and fall risk measures improved with a meaningful clinical relevance. Dynamic visual acuity (DVA) during active head rotation improved [mean ipsilesional 38.57% ± 26.32 (n = 15/19)]; mean contralesional 39.96% ± 22.62 (n = 12/19), though not uniformly. However, as a group passive yaw VOR gain (mean ipsilesional pre 0.44 ± 0.18 vs. post 0.44 ± 0.15; mean contralesional pre 0.81 ± 0.19 vs. post 0.85 ± 0.09) did not show any change (p ≥ 0.4) after rehabilitation. The velocity of the overt compensatory saccades during ipsilesional head impulses were reduced after rehabilitation; no other metric of oculomotor function changed (p ≥ 0.4). Preserved utricular function was correlated with improved yaw DVA and preserved saccular function was correlated with improved pitch DVA. Our results suggest that 5 weeks of vestibular rehabilitation using gaze and gait stability exercises improves both subjective and behavioral performance despite absent change in VOR gain in a majority of patients, and that residual otolith function appears correlated with such change.

Neuro-Ophthalmologic Response to Repetitive Subconcussive Head Impacts

Subconcussive head impacts have emerged as a complex public health concern. The oculomotor system is sensitive to brain trauma; however, neuro-ophthalmologic response to subconcussive head impacts remains unclear. To examine whether subconcussive head impacts cause impairments in neuro-ophthalmologic function as measured by the King-Devick test (KDT) and oculomotor function as measured by the near point of convergence. In this randomized clinical trial, adult soccer players were randomized into either a heading group or kicking (control) group. The heading group executed 10 headers with soccer balls projected at a speed of 25 mph. The kicking-control group followed the same protocol but with 10 kicks. Peak linear and rotational head accelerations were assessed with a triaxial accelerometer. The KDT speed and error and near point of convergence were assessed at baseline (preheading or prekicking) and at 0, 2, and 24 hours after heading or kicking. Ten soccer-ball headings or kicks. The primary outcome was the group-by-time interaction of KDT speed at 0 hours after heading or kicking. The secondary outcomes included KDT speed at 2 hours and 24 hours after heading or kicking, KDT error, and near point of convergence. A total of 78 individuals enrolled (heading group, n = 40; kicking-control group, n = 38). Eleven individuals (heading group: 4 women; mean [SD] age, 22.5 [1.0] years; kicking-control group, 3 women and 4 men; mean [SD] age, 20.9 [1.1] years) voluntarily withdrew from the study. Data from 67 participants with a mean (SD) age of 20.6 (1.7) years were eligible for analysis (heading, n = 36; kicking-control, n = 31). Mean (SD) peak linear accelerations and peak rotational accelerations per impact for the heading group were 33.2 (6.8) g and 3.6 (1.4) krad/s2, respectively. Conversely, soccer kicking did not induce a detectable level of head acceleration. Both groups showed improvements in KDT speed (heading group: 0 hours, -1.2 [95% CI, -2.2 to -0.1] seconds; P = .03; 2 hours, -1.3 [95% CI, -2.6 to 0] seconds; P = .05; 24 hours, -3.2 [95% CI, -4.3 to -2.2] seconds; P < .001; kicking-control group: 0 hours, -3.3 [95% CI, -4.1 to -2.5] seconds; P < .001; 2 hours, -4.1 [95% CI, -5.1 to -3.1] seconds; P < .001; 24 hours, -5.2 [95% CI, -6.2 to -4.2] seconds; P < .001). Group differences occurred at all postintervention points; the kicking-control group performed KDT faster at 0 hours (-2.2 [95% CI, -0.8 to -3.5] seconds; P = .001), 2 hours (-2.8 [95% CI, -1.2 to -4.4] seconds; P < .001), and 24 hours after the intervention (-2.0 [95% CI, -0.5 to -3.4] seconds; P = .007) compared with those of the heading group. These data support the hypothesis that neuro-ophthalmologic function is affected, at least in the short term, by subconcussive head impacts that may affect some individuals in some contact sports. Further studies may help determine if these measures can be a useful clinical tool in detecting acute subconcussive injury. ClinicalTrials.gov Identifier: NCT03488381.

Oculomotor functions in focal dystonias: A systematic review.

Focal Dystonia (FD) is a chronic neurological disorder, which causes twisting and repetitive movements and abnormal postures induced by involuntary sustained contractions of agonist and antagonist muscles.Based on the hypothesis that several dystonia-related brain regions, including cerebellum, are implicated in oculomotor disturbances (OCD), a number of studies investigated oculomotor function in patients with dystonia. However, conceptual clarity with respect to the used assessment tools and interpretation of the findings is lacking in the literature. This is the first article to systematically review studies that assessed oculomotor function in patients with FD.In total, 329 publications, published until September 1, 2019, were identified through MEDLINE search. Twenty out of 329 studies, involving 232 subjects in total, met the inclusion criteria. Most of the studies reported oculomotor disturbances in patients with FD. Abnormalities included asymmetry in vestibulo-ocular reflex (VOR), disturbances in saccadic functions, and prolonged latencies of eye motion. Discrepancies in the results could be explained, at least partially, by the long period of time over which the reviewed studies were published, the different methods used for testing the eye movements, and the limited number of patients assessed since the majority of data derived from case reports or small-scale studies. Further prospective studies with larger subject numbers are needed, using advanced tools for the assessment of oculomotor function in focal dystonia.

Involvement of Centrally Projecting Edinger-Westphal Nucleus Neuropeptides in Actions of Addictive Drugs.

The centrally-projecting Edinger–Westphal nucleus (EWcp) is a brain region distinct from the preganglionic Edinger–Westphal nucleus (EWpg). In contrast to the EWpg, the EWcp does not send projections to the ciliary ganglion and appears not to regulate oculomotor function. Instead, evidence is accumulating that the EWcp is extremely sensitive to alcohol and several other drugs of abuse. Studies using surgical, genetic knockout, and shRNA approaches further implicate the EWcp in the regulation of alcohol sensitivity and self-administration. The EWcp is also known as the site of preferential expression of urocortin 1, a peptide of the corticotropin-releasing factor family. However, neuroanatomical data indicate that the EWcp is not a monotypic brain region and consists of several distinct subpopulations of neurons. It is most likely that these subpopulations of the EWcp are differentially involved in the regulation of actions of addictive drugs. This review summarizes and analyzes the current literature of the EWcp’s involvement in actions of drugs of abuse in male and female subjects in light of the accumulating evidence of complexities of this brain region.

Female adolescents demonstrate greater oculomotor and vestibular dysfunction than male adolescents following concussion

ObjectiveTo examine differences between male and female adolescents on measures of balance, vestibular and oculomotor function within 3 weeks of concussion among a group of pediatric patients presenting to a sports medicine clinic. DesignMedical record review. SettingSports medicine clinic. Participants197 female (median age = 15.2 years) and 381 male (median age = 14.6 years) pediatric patients seen for a concussion, evaluated 9.3 ± 5.2 (mean ± SD) days post-concussion. Main outcome measuresPatients completed Balance Error Scoring System (BESS), tandem gait, gaze stability, and near point of convergence (NPC) tests. ResultsA higher proportion of female patients exhibited abnormal NPC (22% vs. 14%; p = 0.017), gaze stability (53% vs. 43%; p = 0.028), and tandem gait tests (20% vs. 13%; p = 0.026) compared to male patients. Multivariable analysis indicated an independent association between female sex and increased odds of abnormal NPC (adjusted odds ratio [aOR] = 1.79, 95% CI = 1.07–3.00), and tandem gait tests (aOR = 1.96, 95% CI = 1.12–3.41) following concussion. ConclusionsOur results indicate that within the first three weeks of a concussion, female pediatric patients demonstrated increased odds of exhibiting abnormal near point of convergence, and tandem gait test performance compared to male patients.

Interventions Addressing Vision, Visual-perceptual Impairments Following Acquired Brain Injury: A Cross-sectional Survey.

The existing literature on the effectiveness of interventions targeting vision, visual-perceptual impairments following acquired brain injury (ABI) is scarce and unlinked to occupational performance. To explore current occupational therapy practice in vision-rehabilitation among adults with ABI in Canada, and to determine the evidence-practice gaps. An online survey was made available through the Canadian Association of Occupational Therapists (CAOT) website, and disseminated to seven public healthcare institutions in Quebec. The survey collected respondent demographic information, and the types and frequency of treatments delivered. Descriptive statistics were conducted to determine interventions' frequency. Participant comments were collected and grouped into recurring themes. Over half (55%) of respondents regularly use evidence-based interventions when addressing visual acuity (VA) and visual field (VF) deficits, but only very few (3%) use it when dealing with oculomotor function and visual stress impairments. Results gave a glimpse of interventions used and suggested the need for further research in vision rehabilitation.

Early physical activity and clinical outcomes following pediatric sport-related concussion

The objective of the study was to evaluate the clinical outcomes among patients who did and did not report engaging in early physical activity (PA) following sport-related concussion. We evaluated pediatric patients seen within 21 days of concussion. The independent variable was early PA engagement (since the injury and before initial clinical evaluation). Dependent variables included demographics, injury details, medical history, Health and Behavior Inventory (HBI) score, and balance, vestibular, and oculomotor function tests. We examined data from 575 pediatric patients: Sixty-nine (12%) reported engaging in early PA (mean age=14.3±2.4 years; 30% female). The no PA group (mean age=14.5±2.4 years; 35% female) had significantly longer symptom resolution times than the early PA group (median= 16 [interquartile range (IQR)=8-24] vs. 10.5 [IQR=4-17] days; p=0.02). When controlling for pre-existing headache history and time from injury-evaluation time, the early PA group demonstrated lower odds of reporting current headache (adjusted odds ratio=0.14; 95% CI=0.07, 0.26), and reported lower symptom frequency ratings than the no PA group (b=-5.58, 95% CI=-8.94, -2.22). Patients who did not engage in early PA had longer symptom duration, greater odds of post-injury headache, and greater symptoms at initial clinical evaluation. We cannot determine if patients engaged in early PA due to the lower symptom burden and higher functioning at the time of assessment, or if early PA positively affected outcomes. However, as early PA was associated with better post-injury outcomes, clinicians may consider supervised and structured early PA programs as a method to improve clinical outcomes following concussion. Children and adolescents who were engaged in PA after concussion presented to a clinic with less severe symptoms and had symptoms that resolved sooner compared to those who did not engage in early PA after concussion.

Yaşlanmanın Okülomotor Fonksiyonlara Etkisi

Yaşlanmanın Okülomotor Fonksiyonlara Etkisi

The scientific rationale for the use of electroneurostimulation of the cervical sympathetic ganglia in patients with computer vision syndrome

Was a scientific justification, an assessment of the effectiveness and safety of the use of electroneurostimulation (ENS) of the cervical sympathetic ganglia in patients with CVS. 120 patients with the syndrome observed on an outpatient basis were examined. Patients were divided into 3 groups using simple randomization method. The 1st group (the main group - MG) included 39 patients who, against the background of gymnastics of the oculomotor muscles and muscles of the shoulder girdle, used ENS on the area of the sympathetic ganglia; in the 2nd group (group of comparison - GoC) included 41 patients who strictly performed the same muscle gymnastics (after every 2 hours of work with the PC); Group 3 (control group - CG) consisted of 40 patients who took an ENS course of exposure in placebo mode. In the dynamics, the stock of relative accommodation, near heterophory, tear production, threshold electrical sensitivity of the retina, electrolability of the optic nerve, contrast sensitivity, reading speed, print speed and accuracy and the level of subjective asthenopia were evaluated. Initially, groups of patients with CVS did not differ among themselves in any of the investigated parameters. After a course of procedures in the MG, in contrast to the other two (GoC and CG), statistically significant positive shifts were revealed in relation to the selected endpoints, reflecting the severity of asthenopia, sensorineural, accommodative and oculomotor functions of the visual analyzer, as well as ophthalmoergonomics. Of the side effects of the procedures were recorded: moderate drowsiness (in 4 patients), a feeling of heaviness of the head (in 1 patient) and an increase in blood pressure (BP) by more than 15% of the initial (in 1 patient). They disappeared on their own and did not require withdrawal of treatment. A patient who noted a single increase in blood pressure subsequently received therapy every other day. Redness of the skin of the neck in the area of application of the electrodes was found with the same frequency in MG and CG. The inclusion of ENS in the rehabilitation treatment of workers professionally using a personal computer significantly increases the effectiveness of therapeutic measures, which proves the appropriateness of applying the proposed technology in CVS. The therapeutic action of complex therapy is realized through the effect of the ENS on an important reflexogenic zone - the cervical sympathetic ganglia, the activation of which ensures the normalization of the central, peripheral and autonomic functioning of the visual analyzer. Analysis of the frequency of registration of side effects in patients of the three groups allows us to conclude that the technique is safe.

Influência da privação crônica do sono no equilíbrio postural

O desempenho humano ideal depende de funções sensório-motoras e cognitivas integradas, ambas conhecidas por serem extremamente sensíveis à perda de sono. O presente estudo tem por objetivo verificar a ocorrência de queixas relacionadas ao sono em uma amostra de sujeitos com tontura e comparar os resultados da vestibulometria entre eles. Trata-se de uma pesquisa transversal, observacional, de abordagem quantitativa, realizada com sujeitos atendidos em um Ambulatório de Equilíbrio de um Hospital Universitário, submetidos a Posturografia Dinâmica Foam Laser (teste de organização sensorial e análise sensorial), Vectoeletronistagmografia computadorizada (provas oculomotoras e vestibulares) e o questionário Dizziness Handicap Inventory (DHI) para verificar a restrição de participação causada pela tontura. Participaram 29 (20,14%) homens e 115 (79,86%) mulheres, com média de idade de 58,36 anos. Do total, 83 (57,64%) apresentaram histórico de sono regular (SR) e 61 (42,36%) de sono irregular (SI). Na posturografia, houve relação entre o SI e menores valores nas posições II, III, IV e V, bem como com o sistema vestibular, na análise sensorial. Na vectoeletronistagmografia os resultados apontam para normalidade da função oculomotora e reflexos vestibulares, com raras indicações de alteração central. Os domínios do DHI foram significativamente menores no SI, indicando maior restrição de participação causada pela tontura. Esses resultados indicam alta frequência de queixas relacionadas ao sono nessa população, afetando principalmente a informação vestibular, porém não relacionada aos reflexos, mas provavelmente ao processamento da informação vestibular superior.

Vestibular and Balance Dysfunction Following Sport-Related Concussion

Purpose Sport-related concussion is a significant public health concern that requires a multidisciplinary team to appropriately manage. Athletes often report dizziness and imbalance following concussion, and these symptoms can predict increased time to recover. Vestibular diagnostic evaluations provide important information regarding the athlete's oculomotor, gaze stability, and balance function in order to identify deficits for rehabilitation. These measures also describe objective function helpful for determining when an athlete is ready to return to play. The purpose of this clinical focus article is to provide background on the current understanding of the effects of concussion on the peripheral and central vestibular system, as well as information on a protocol that can be used for acute concussion assessment. Case studies describing 3 common postconcussion presentations will highlight the usefulness of this protocol. Conclusion Sport-related concussion is a highly visible disorder with many symptoms that may be evaluated in the vestibular clinic. A thoughtful protocol evaluating the typical presentation of these patients may help guide the multidisciplinary team in determining appropriate management and clearance for return to sport.