Post Concussion Research Articles

Physical Therapy Evaluation and Treatment After Concussion/Mild Traumatic Brain Injury.

Over the last decade, numerous concussion evidence-based clinical practice guidelines (CPGs), consensus statements, and clinical guidance documents have been published. These documents have typically focused on the diagnosis of concussion and medical management of individuals post concussion, but provide little specific guidance for physical therapy management of concussion and its associated impairments. Further, many of these guidance documents have targeted specific populations in specific care contexts. The primary purpose of this CPG is to provide a set of evidence-based recommendations for physical therapist management of the wide spectrum of patients who have experienced a concussive event. J Orthop Sports Phys Ther 2020;50(4):CPG1-CPG73. doi:10.2519/jospt.2020.0301.

Corticomotor correlates of somatosensory reaction time and variability in individuals with post concussion symptoms

Persistent post concussion symptoms (PPCS) describe the condition when an individual experiences chronic symptoms, particularly fatigue, beyond the expected time of recovery. The aim of this study was to quantify the effect of fatigue and related ongoing symptoms on somatosensory and corticomotor pathways using reaction time (RT) testing, and single-pulse and paired-pulse transcranial magnetic stimulation (TMS). Eighty-three participants (nine female, mean age 37.9 ± 11.5 years) were divided into two groups (persistent symptoms versus asymptomatic) following self-report based upon previously published clinical symptom scores. All participants completed somatosensory and visuomotor RT testing, as well as corticomotor excitability and inhibition measurements via TMS. Participants in the persistent symptom group (n = 38) reported greater number of previous concussions (t = 2.81, p = 0.006) and significantly higher levels of fatigue and related symptoms in the asymptomatic group (n = 45; t = 11.32, p < 0.006). Somatosensory RT showed significant slowing and increased variability in the persistent symptoms group (p < 0.001), however no significant differences were observed between groups for visuomotor RTs. Transcranial magnetic stimulation revealed differences between groups for intracortical inhibition at all stimulus intensities and paired pulse measures. The results indicate that somatosensory and corticomotor systems reflect on-going fatigue. From a practical perspective, objective and simplistic measures such as somatosensory and corticomotor measures can be used in the assessment of PPCS and gauging the efficacy of post concussion rehabilitation programmes.

Visual Evoked Potential and Voltage Changes Associated with Acute Concussion and Frequency Specific Photophobia

ObjectiveIn this paper we present a case series of concussion patients' VEP as well as a single concussion patient with a VEP baseline and post concussion VEP data.BackgroundVisual Evoked Potentials (VEP) are a means of measuring the electrical behavior of the brain following a visual stimuli. The use of VEP for diagnostics following traumatic brain injury (TBI) is emerging with additional data concerning sports related concussion coming.Design/MethodsDuring the 2016 spring football season there was 1 concussion of a subject who had a VEP baseline and a VEP performed during the acute phase of the concussion. Concurrently we have been using VEP for concussion patients who have not had a baseline. Fifteen subjects in the post acute phase; while symptomatic, had VEP performed using White, Red, Blue and Green for the evoked potentials.ResultsThe patient with a VEP baseline had increased voltages with subtle slowing of N75 and P100. N75 increased from 67.5 msec at baseline to 75.1 msec post concussion. Voltages went from 19.3 mVolts to 24.6 mVolts post concussion. Also, the colored flashes associated with the lowest voltages were consistent with mitigation of frequency specific photophobia; 20.9 mVolts for mitigation color compared (red) to 24.6 for white. In the concussion population studied (N = 15) the voltages where the color corresponded to symptom relief were: 10.9 ± 5.7 mVolts compared to symptom evoking voltages 12.7 ± 6.3 (p = 0.0031) mVolts.ConclusionsIn this paper we present evidence of VEP changes in one acute concussion patient as well as a population of concussion patients where voltages are increased post concussion. The increased voltages associated with color VEP may be a useful technique to assess frequency specific photophobia as well as helping manage post concussion photophobia. Futures studies to assess the utility of VEP as a concussion management tool are needed.

The Relationship between Headache Severity and Convergence Insufficiency in a Post-Concussive Population

ObjectiveTo examine the relationship between self-reported post concussion headache severity and convergence insufficiency (CI) a common binocular vision deficit, in a clinical post-concussive population.BackgroundBoth headache and CI are common sequelae of concussion that have been associated with prolonged recovery. Independent of head injury, CI is a known predictor of headache pain [1]. However, the relationship between CI and headache in a post-concussion population is less clear. This is an important relationship to explore since headaches are one of the most common and debilitating post-concussive symptoms.Design/MethodsRetrospective databank analysis was conducted of 174 participants between the ages of 13–84 (M = 37 SD = 19) recruited from an interdisciplinary concussion clinic (M = 295 SD = 609 days post-injury). Near point convergence (NPC) and subjective headache severity were obtained by a neurologist during routine clinical visits. Near point convergence was dichotomized: &gt;5 cm being CI, and &lt;5 “normal.” Current headache severity was measured using a self-report pain severity scale ranging from 0 (none) to 10 (most severe). Spearman rank-order correlation was used in order to elucidate the relationship between headache severity and CI.ResultsResults suggest only a weak relationship between post-concussion headache severity and NPC status that failed to reach statistical significance (r = 0.171, p = 0.098). NPC status explained only 3% of the variance in headache severity.ConclusionsThe results of this study suggest that headache and NPC measurements following concussion are very weakly associated. Given the episodic nature of headaches, it may be that statistically significant correlations are not evident unless there is a certain headache severity at time of NPC measurement. Future studies are needed in order to determine whether and to what extent injury severity or patient demographic characteristics mediate this relationship.

An objective method to assess and recommend exertion and exercise targets for return to play post concussion

ObjectiveThe object of this presentation is to supply the athletic trainer with data concerning a methodology that can be used to aid in designing a cardio conditioning regimen postconcussion as well as an exercise or lifting program postconcussion. This objective measure does not rely on subjective patient reports of symptoms and utilizes a reflex based assessment method.BackgroundSports concussion is a substantial concern for athletic trainers and there is a critical need to objectively and safely allow an athlete to return to play as soon as safely possible. Being able to make cogent recommendations as opposed to empirically trying something that has an intrinsic risk of eliciting symptoms or causing setbacks is urgently needed.Design/MethodsWe present data concerning 65 athletes (mean age 20.8 years) who were assessed. This was done while on an exercise bike going through a progression of exertion levels. The TERC Murmur was listened for every 2 minutes at the traditional carotid artery position.ResultsResults for cardio assessment. 73% of the cardio assessment subjects had a TERC Murmur at a heart rate of 127.2 bpm (± 16 SD). The transient exertion related carotid (TERC) murmur is a murmur that is heard at the carotid arteries during exercise. It normally is heard at around a heart rate of 150, but is heard a lower heart rates in concussion patients.ConclusionsThe clinical advantages of the use of the TERC murmur is that it can be applied by an athletic trainer with the training to listen for a blood pressure. It provides objective information concerning safe heart rates and target heart rate. Being able to safely recommend a means by which an athlete can condition (cardio and or lifting) will accelerate return to play as well as aid in keeping the athlete happy, healthy and engaged.

Can the Neck Contribute to Persistent Symptoms Post Concussion? A Prospective Descriptive Case Series

Persistent symptoms post concussion can arise from a range of sources, including the neck. There is little description of neck assessment findings in people with persistent symptoms post concussion. To assess people with persistent symptoms following a concussion and determine whether the neck has also been injured, and to evaluate the potential of the neck to contribute to their symptoms. A consecutive series of participants (n = 20) referred for neck assessment were prospectively recruited by 2 providers of a multidisciplinary concussion service for people with persistent symptoms. Data were collected at initial assessment and on completion of neck treatment, which included standard questionnaires (Rivermead Post Concussion Symptoms Questionnaire, Neck Disability Index, Dizziness Handicap Inventory); patient-reported measures of headache, dizziness, and neck pain; physical examination findings; and details of comorbidities. Participants were evaluated at a mean of 7.5 weeks post concussion (median, 5 weeks). On neck assessment, 90% were considered by the clinician to have a neck problem contributing to their current symptoms. Multiple findings were consistent with this view, including moderate-to-severe Neck Disability Index scores (mean ± SD, 33.4 ± 9.5 points), frequent neck pain (85%), frequent moderate-to-severe pain on occiput-C4 segmental assessment (85%), a positive flexion-rotation test (45%), and muscle tenderness (50%-55%). Multiple findings were indicative of concurrent neck injury, particularly involving the upper cervical spine. These neck-related findings are important to recognize, as they have the potential to contribute to persistent symptoms post concussion and may respond to neck treatment. This study was prospectively registered with the Australian New Zealand Clinical Trials Registry (ACTRN12616001183471). J Orthop Sports Phys Ther 2019;49(11):845-854. Epub 1 Jun 2019. doi:10.2519/jospt.2019.8547.

Single and dual tandem gait assessment post concussion: What performance time is clinically relevant across adult ages and what can influence results?

AimThe three-metre tandem gait test (TG) is used to assess postural control during locomotion following sports concussion. However, values used to determine a pass/fail result are currently based on young athletic populations. Times for test completion may be influenced by several intrinsic or extrinsic factors. The aim of this study was to collate healthy individual single, dual task as well as dual task cost – motor TG times for a non-elite athlete population, across several age groups, and to investigate several potential influencing factors. MethodsHealthy individuals aged 18–55+, who had never experienced a concussion completed single and dual task TG following the SCAT5 protocol. A separate group (n = 20, age, foot length and body mass index matched) performed the tests with alternate instructions. ResultsMean best TG time for all participants were: single task 21.03 (±5.26s), dual task 29.59 (±9.84s) and DTC-motor 8.57 (±7.5s:41.7%). Age and foot length but not specificity of verbal instructions were related to TG times. Significantly slower single and dual task times were identified for the 55 + age group when compared to the three youngest groups (p < 0.01). No difference was seen for DTC-motor time or % between age groups (p > 0.05). ConclusionHealthy individual data collected exceeded previously reported average times. Faster times were evident in younger participants and those with longer foot length. Results from this study can be used as a reliable guideline to inform clinical decisions around the pass/fail result of TGT across age ranges in non-elite athlete populations post-concussion.

Baseline concussion symptom score differences comparing collision, contact, and noncontact sports and comparison of between sexes

ObjectiveTo determine if baseline concussion symptoms scores in athletes prior to the start of their season vary by sport or sex.BackgroundConcussion is a clinical diagnosis that includes an appropriate clinical scenario, reporting of symptoms through a post concussion symptom score list, and an objective neurologic exam. Symptom reporting is considered when determining if an athlete has recovered from their concussion. Recent studies have shown that athletes at baseline can report symptoms at a rate high enough to meet criteria for post concussion syndrome without any history of concussion. The number of symptoms reported was found to be higher in female athletes than male athletes, but to date there has not been a clear consideration of how these symptoms compare across different sports played.MethodsRetrospective chart review of baseline pre-participation sport exams from 2016. More than 2000 charts were reviewed for age, sex, sport played, number of past concussions. Baseline concussion symptom checklist scores were reviewed for number of symptoms reported and severity of symptoms reported. Comparisons were made between groups comparing age, sex, sport played, and number of previous concussions prior to the start of this season.ResultsFemale athletes in all sports compared reported more baseline symptoms and more severe symptoms compared to their male counterparts. Athletes of the same sex, male or female who participated in collision or contact sports reported less baseline symptoms than athletes who participated in noncontact sports.ConclusionContact and collision sport athletes report at baseline less concussion checklist symptoms than noncontact sport athletes in all age groups compared. This leads to many questions about why certain athlete populations report less symptoms. Symptom reporting could be due to underlying physical traits in different sports, or player psychology differences between sports.

A systematic review of the emotional responses of student athletes post concussion

BackgroundThe estimated incidence of sports related concussion has increased from 300,000 in 2007 to over 1.6 million in 2017, with a large percentage occurring in youth athletes. There are growing concerns about the cognitive and emotional wellbeing of young athletes during concussion recovery.ObjectiveTo review research evaluating how concussion relates to changes in emotion and mood in high school and college athletes.Design/methodsRelevant articles from 1997 to 2017 were searched on PubMed using keywords and official MeSH terms such as: (1) concussion; or brain injuries, traumatic; or TBI and (2) high school; or college; and, (3) depression; or affect; or mood. English language articles were included for analysis if they measured concussed high school or college athletes using a validated instrument for assessing emotion and mood.ResultsTen published studies met the inclusion criteria. Five studies measured changes in emotional response in athletes after concussion. The other studies compared emotional response in athletes after concussion to the emotional response in athletes after non-concussive sports injury, such as musculoskeletal, or orthopedic injury.ConclusionDespite heterogeneity in methods and limitations in the literature, our review suggests growing consensus that concussions result in altered emotions and mood. However, current research shows conflicting results on whether alterations in emotional response are different post-concussion than post non-concussive sports injury.

Central nervous system microbleeds in the acute phase are associated with structural integrity by DTI one year after mild traumatic brain injury: A longitudinal study

IntroductionSeveral imaging modalities are under investigation to unravel the pathophysiological mystery of delayed performance deficits in patients after mild traumatic brain injury (mTBI). Although both imaging and neuropsychological studies have been conducted, only few data on longitudinal correlations of diffusion tensor imaging (DTI), susceptibility weighted imaging (SWI) and extensive neuropsychological testing exist. MethodsMRI with T1- and T2-weighted, SWI and DTI sequences at baseline and 12 months of 30 mTBI patients were compared with 20 healthy controls. Multiparametric assessment included neuropsychological testing of cognitive performance and post-concussion syndrome (PCS) at baseline, 3 and 12 months post-injury. Data analysis encompassed assessment of cerebral microbleeds (Mb) in SWI, tract-based spatial statistics (TBSS) and voxel-based morphometry (VBM) of DTI (VBM-DTI). Imaging markers were correlated with neuropsychological testing to evaluate sensitivity to cognitive performance and post-concussive symptoms. ResultsPatients with Mb in SWI in the acute phase showed worse performance in several cognitive tests at baseline and in the follow-ups during the chronic phase and higher symptom severity in the post concussion symptom scale (PCSS) at twelve months post-injury. In the acute phase there was no statistical difference in structural integrity as measured with DTI between mTBI patients and healthy controls. At twelve months post-injury, loss of structural integrity in mTBI patients was found in nearly all DTI indices compared to healthy controls. ConclusionsPresence of Mb detected by SWI was associated with worse cognitive outcome and persistent PCS in mTBI patients, while DTI did not prove to predict neuropsychological outcome in the acute phase.

Juvenile psammomatoid ossifying fibroma of the ethmoid sinus: A rare case report

Juvenile psammomatoid ossifying fibroma (JPOF) is a rare, aggressive benign bony tumour that has been distinguished from a larger group of ossifying fibromas (OF) based on age of occurrence, most common site of involvement, and its clinical behaviour.We reported a case of asymptomatic 14 year old boy who had incidental finding of left ethmoidal bony mass on his CT brain imaging done for post traumatic cerebral concussion. The diagnosis of juvenile psammomatoid ossifying fibroma (JPOF) was made based on radiological and histological findings.International Journal of Human and Health Sciences Vol. 02 No. 04 October’18. Page : 228-231

Integration of a Complex Balance Task into a Concussion Management Protocol Specific to Dancers

Mechanisms for concussions in dance include drops from lifting, falls from stage sets, and contact with the floor or fellow dancers that happen during class, rehearsal, or performances. Despite the recent awareness of sports-related concussions, there are gaps in knowledge regarding dance-specific concussions and what a “return to dance” protocol should look like for dancers. Although dance is not a high-impact sport like football or rugby, concussions still occur and can be calamitous for a collegiate and professional dancer’s career. Balance tests, standard in concussion management protocols, are useful tools for evaluating the motor domain of balance functioning and are considered reliable and valid assessments of athletes suffering from concussions. PURPOSE: Develop and investigate a complex balance task to integrate into a concussion management protocol specific to dancers. METHODS: 31 participants, pre-professional dancers (n=12) and recreational dancers (n=19), completed an multipart evaluation to assess static and dynamic balance. They were tested using the Balance Error Scoring System (BESS) test which assessed static balance through performing 3 stances on surfaces (ground and Airex Balance Pad). The modified Dance BESS (DBESS) test assessed static and dynamic balance of the participants through performing 10 dance movements on 3 surfaces (ground, Airex Balance Pad and foam balance beam). Participants were monitored and scored for errors on each balance test. RESULTS: Pre- professional dancers and recreational dancers were not significantly different for static balance on the BESS and DBESS (p>0.05). There was significant difference between the pre-professional dancers and recreational dancers (p<0.05) for the dynamic balance conditions in the Dance BESS. CONCLUSIONS: More skilled dancers show greater differences with dynamic balance conditions. Thus, creation of more dynamic balance tasks would be useful for baseline and post concussion testing and aid in the overall tracking during the concussion rehabilitation period for dancers.

A preliminary report of cerebral white matter microstructural changes associated with adolescent sports concussion acutely and subacutely using diffusion tensor imaging.

Diffusion tensor imaging (DTI) has demonstrated its utility in detecting microscopic post-concussion cerebral white matter structural changes, which are not routinely evident on conventional neuroimaging modalities. In this study, we compared 10 adolescents with sports concussion (SC) to 12 orthopedically-injured (OI) individuals within 96h and three months post injury to 12 typically-developing (TD) participants using DTI and volumetric analyses. In terms of volume, no group differences were noted between SC, OI and TD groups at both 96h and three months post concussion. Results did not show significant differences between SC, OI, and TD groups for both fractional anisotropy (FA) and apparent diffusion coefficient (ADC) in all regions of interest within 96h post concussion. However, at three months post-injury, the SC group exhibited significantly lower FA than the TD group in various regions of interest. In terms of ADC, significant group differences between SC and TD groups were found in some regions, with SC group having higher ADC than TD. No group differences for FA and ADC were noted between SC and OI groups at three months post-injury. However, several moderate effect sizes on between-group analyses were noted such that FA was lower and ADC was higher in SC relative to OI. Longitudinally, the SC group demonstrated decreased FA and increased ADC in some areas. The findings highlight the fact that the brain continues to change during the post-injury recovery period, and raises the possibility that adverse changes may result from the neurometabolic cascade that purportedly ensues following SC. DTI may potentially be used to characterize the nature of brain changes that occur following sports-related concussions.

Using neurophysiological measures to assess concussion. a case control study in one player

Objectivecase study presents data using multimodal assessment using impact sensors, oculomotor function and transcranial magnetic stimulation (TMS) to quantify neurophysiological changes in the acute period following concussion.DesignCase control study.ParticipantsOver one season, we evaluated a male rugby union player (age: 29 years; prior concussions: 1; last concussed &gt;120 months) for head impacts using impact sensors (X2 Biosystems, USA) and oculomotor function (King-Devick test).1TMS (MagVenture, Denmark) protocols utilised previously published methods for concussion studies2,3with data compared to our normative database of age-group controls (33 males; mean age: 28.6±3.9 years).InterventionAny impact that resulted in a concussion, confirmed by the team doctor, required post-match testing utilising the King-Devick test and follow up testing for TMS at 5 d and 12 d.Outcome measuresTime and errors completing the King-Devick test. TMS measures included latency (TMS stimulus to evoked potential onset ), evoked potential amplitude, and intracortical inhibition (TMS onset to return of uninterrupted electromyography activity).Main resultsAn impact of 60.7 g/17, 114.1 rads/s2revelead a decreased King-Devick performance of 3.8 s. At 30 d King Devick remained below pre concussion baseline. Compared to controls, TMS revealed increased intracortical inhibition duration of 20.6 ms at 5 d post concussion, and returning to baseline/control levels by 12 d.ConclusionsThis novel case study demonstrates the value of using multimodal measurements in the assessment of concussion and return to play decisions.Competing interestsNone.AJP is supported, in part, by a research grant by the Australian Football League.

(413) Pain as a predictor of persistent post concussion symptoms in adolescents

(413) Pain as a predictor of persistent post concussion symptoms in adolescents

The importance of a neck exam in sport-related concussion: Cervical schwannoma in post concussion syndrome

ObjectiveFew cases of cervical schwannoma have been reported following head trauma. The present case, involves a schwannoma of the C2 spinal nerve mimicking post-concussion symptoms following a sport-related concussion (SRC). DesignCase study. SettingUniversity of Calgary, Sport Medicine Clinic, Calgary, Alberta, Canada. ResultsWe report a 28 year old, athlete who developed headache, dizziness, photophobia, and neck pain following a cycling accident. She presented nine months later to our sports clinic with persistent symptoms. She had a normal neurological examination but complained of painful neck range of motion, and exacerbation of symptoms with neck extension. On palpation, a lump was found in the right suboccipital muscles and MRI showed a T2 hyperintense mass at the C1-2 level. The patient underwent resection and histology revealed a schwannoma of the C2 nerve root. Following resection her symptoms improved, with no recurrence at 2 months follow up. ConclusionOur patient's slow recovery following SRC is consistent with a schwannoma formation, which may have been precipitated by the injury itself or merely unmasked from trauma. This case illustrates the importance of a thorough physical examination and broad differential in patients presenting with worsening of symptoms after initial improvement in SRC.

Neuromuscular changes post sports concussion in elite football players

Neuromuscular changes post sports concussion in elite football players

Concussion beliefs in varsity athletes: Identifying the good, the bad and the ugly

Objective Identify and describe attitudes and intentions towards personal concussion risk and protective behaviours among varsity athletes. Determine subgroups of athletes characterized by problematic intentions towards concussion prevention and management behaviours. Design Cross-sectional survey. Main outcome measures Varsity athletes ( N = 175; 60% male; 55.4% contact athletes; 56.6% history of concussion) completed a survey examining attitudes and intentions towards personal risk and concussion-management behaviours. Cluster and discriminant analyses were used to identify athlete risk response subgroups on intention items. The clusters were examined for differences in attitudes towards concussion prevention behaviours, demographics and concussion exposure. Results A substantially problematic subgroup of athletes (28% of the sample) reported low intent to engage in post concussion management practices or primary prevention behaviours. These individuals reported high concussion-risk acceptance and very low belief in the efficacy of concussion-management behaviours. They were also more likely to have sustained a concussion. Two other clusters demonstrated more acceptable behavioural intentions towards concussion prevention and management, with one holding model attitudes and intentions. Conclusions Varsity athletes exhibit one of three different patterns of intentions and attitudes towards concussion prevention and management behaviours. Athletes in one of these groups are at much greater risk of concussion injury and poorly follow recommended treatments. Intervention programmes need to target and aim to change these problematic intentions and attitudes to improve the effectiveness of concussion prevention and injury management.

Whiplash trauma to the vestibular system: What effect does whiplash have on the ear?

Introduction Dizziness after traumatic acceleration/deceleration injury is well-known and the complaints voiced by these patients are similar to those of many non-trauma patients referred with vestibular sounding complaints. Patients often deny spinning but voice “non-traditional” complaints of imbalance, subtle boat like feelings and nausea. These complaints may arise because of otolithic damage from the trauma. It is traditionally thought that most vestibular pathology is unilateral and our concern is that trauma patients may have suffered bilateral damage due to the mechanism of the injury. We felt the need to document this. Pathology in these patients is important to define, as bilateral pathology is more of a challenge to compensate for. Material and methods We assess patients with computerized dynamic posturography in our tertiary care diagnostic unit, but we also carry out vestibular-evoked myogenic potential (VEMP) assessment which can document and quantify otolithic pathology. Posturography, OVEMP and CVEMP results were compared in 25 whiplash trauma patients with an age and sex matched group of non-trauma patients with spontaneous vestibular disease. Results We examined both groups of patients with respect to CVEMP and OVEMP abnormalities. Posturography results were not different between the two groups but there was a statistically higher OVEMP abnormality rate in the trauma group when compared to the vestibular non-trauma patients. The meaning of this will be discussed. Discussion–conclusion We will be discussing the findings in our two groups of patients. It is important to document the pathology in these patients as being vestibular, as immediate activation with “goal directed” activities in the patient with vestibular pathology is extremely important. Our concern is patients may be diagnosed with “post concussion syndrome”; the treatment for this is complete rest.

P.034 Eye movement assessment and diffusion tensor imaging in patients with post concussion syndrome

Background: Post concussion syndrome (PCS) can affect up to 30% of patients with concussion. Biomarkers of this condition would be beneficial for diagnosis and management. We hypothesized that eye tracking parameters would correlate with microstructural changes of white matter integrity, as measured by diffusion tensor imaging (DTI), in patients with PCS. Methods: Sixty patients with PCS and at least 2 concussions participated in our prospective study. Attention and executive function were tested using Visual Attention Scanning Technology (VAST). In a matching task, the normalized number of visits to master image before making the first selection is used as a surrogate of working memory. We related performance on VAST to white matter integrity using Tract-Based Spatial Statistics of diffusion tensor imaging data. Results: 60 participants (mean age 34.3 years, SD 13.8) had a mean of 4 concussions. There were negative correlations between fractional anisotropy (FA) of the genu, body, and splenium of the corpus callosum and normalized number of visits to master image before first selection (r=-0.432, p=0.001; r=-0.504, p&lt;0.001; and r=-0.388, p=0.002; respectively). A negative correlation was also seen between right cingulum FA and the global processing index (r=-0.349, p=0.006). Conclusions: Impaired performance on eye tracking measures of attention and executive function may reflect alterations in white matter tracts.