Smooth Pursuit Research Articles

IVOMS: Instrumented Vestibular / Ocular motor screen in healthy controls and mild traumatic brain injury

Objective Vestibular/ocular deficits occur with mild traumatic brain injury (mTBI). The vestibular/ocular motor screening (VOMS) tool is used to assess individuals post-mTBI, which primarily relies upon subjective self-reported symptoms. Instrumenting the VOMS (iVOMS) with technology may allow for more objective assessment post-mTBI, which reflects actual task performance. This study aimed to validate the iVOMS analytically and clinically in mTBI and controls.Methods Seventy-nine people with sub-acute mTBI (<12 weeks post-injury) and forty-four healthy control participants performed the VOMS whilst wearing a mobile eye-tracking on a one-off visit. People with mTBI were included if they were within 12 weeks of a physician diagnosis. Participants were excluded if they had any musculoskeletal, neurological or sensory deficits which could explain dysfunction. A series of custom-made eye tracking algorithms were used to assess recorded eye-movements.Results The iVOMS was analytically valid compared to the reference (ICC2,1 0.85–0.99) in mTBI and controls. The iVOMS outcomes were clinically valid as there were significant differences between groups for convergence, vertical saccades, smooth pursuit, vestibular ocular reflex and visual motion sensitivity outcomes. However, there was no significant relationship between iVOMS outcomes and self-reported symptoms.Conclusion The iVOMS is analytically and clinically valid in mTBI and controls, but further work is required to examine the sensitivity of iVOMS outcomes across the mTBI spectrum. Findings also highlighted that symptom and physiological issue resolution post-mTBI may not coincide and relationships need further examination.

Acute Eye-Tracking Changes Correlated With Vestibular Symptom Provocation Following Mild Traumatic Brain Injury.

To quantify norms and changes in eye-tracking proficiency, and determine vestibular symptom correlations in varsity college athletes following acute mild traumatic brain injury (mTBI). We hypothesized that mTBI impacts central coordination between the vestibular and oculomotor systems with resultant changes in eye-tracking proficiency that are correlated with vestibular symptom provocation. Retrospective cohort study. Sports medicine care at a single institution. One hundred and nineteen college athletes diagnosed with mTBI by a physician between 2013 and 2019. N/A. Standard deviation of tangential error, standard deviation of radian error, mean phase error, and horizontal gain from virtual reality-based, circular eye-tracking goggles used at baseline and within 72 hours post-mTBI. Headache, dizziness, nausea, and fogginess provocation after the Vestibular Ocular Motor Screening (VOMS) smooth pursuits subtest compared with pretest baseline, assessed within 72 hours post-mTBI. One hundred and nineteen college athletes (N = 56 women and 63 men) aged 18 to 24 years sustained a total of 177 mTBI. Forty-four percent of athletes displayed abnormal eye-tracking on at least 1 eye-tracking measure following acute mTBI compared with their baseline. From the VOMS, horizontal gain showed medium-sized to large-sized positive correlations with headache ( r = 0.34) and dizziness ( r = 0.54), respectively. Mean phase error showed a medium-sized negative correlation with nausea ( r = -0.32) on the VOMS. Eye-tracking proficiency was impaired and correlated with vestibular symptom provocation following acute mTBI in college athletes. Future research should examine eye-tracking proficiency testing in other acute care settings to support mTBI diagnosis.

Assessment of Oculomotor Functions as a Biomarker in Mild Traumatic Brain Injury.

Mild traumatic brain injury (mTBI), or concussion, is a major public health problem, and ambiguity still exists regarding its diagnosis. While functional magnetic resonance imaging (fMRI) has been identified as a helpful screening tool for concussion, its limited accessibility in clinical or field settings necessitates a more efficient alternative. Oculomotor function deficit is an often-reported pathology in mTBI. Due to the neuroanatomical overlap between eye-movement circuitry and mTBI pathophysiology, visual deficits are expected. In this study, we investigate the possibility of using an oculomotor assessment tool for finding biomarkers in concussion. We used fMRI with tasks evaluating oculomotor functions: smooth pursuit (SP), saccades, anti-saccades, and optokinetic nystagmus (OKN). Before the scanning, the testing with a system of virtual reality goggles with integrated eye- and head-tracking was used where subjects performed the same tasks as those used in fMRI. Twenty-nine concussed symptomatic adults (CSA) within 1-month postconcussion and 29 age- and sex-matched healthy controls (HCS) were tested to examine blood oxygen level-dependent (BOLD) fMRI alterations associated with performances in oculomotor function after mTBI and evaluate the efficacy of the oculomotor assessment in detecting oculomotor and gaze deficits following mTBI. Comparing CSA with HCS, significant differences were observed in anti-saccades and OKN performance. CSA group exhibited elevated %BOLD signal change on each task compared with HCS: in the superior frontal gyrus during the smooth pursuit, inferior frontal gyrus during the saccades, putamen and dorsolateral prefrontal cortex (DLPFC) during the anti-saccades, and lingual gyrus and IFG during the OKN. Key findings include the following: (1) oculomotor deficits in concussed subjects compared with controls, (2) abnormal activation patterns in areas related to the regulation and control of oculomotor movements, suggesting concussion-induced disruptions, and (3) the potential of oculomotor assessment as a promising approach for mTBI biomarkers, with anti-saccades and OKN identified as the most sensitive tasks.

Clinical value of video oculomotor evaluation in the differential diagnosis of multiple system atrophy and Parkinson's disease.

Multiple system atrophy (MSA) is a neurodegenerative disease that progresses rapidly and has a poor prognosis. This study aimed to assess the value of video oculomotor evaluation (VOE) in the differential diagnosis of MSA and Parkinson's disease (PD). In total, 28 patients with MSA, 31 patients with PD, and 30 age- and sex-matched healthy controls (HC) were screened and included in this study. The evaluation consisted of a gaze-holding test, smooth pursuit eye movement (SPEM), random saccade, and optokinetic nystagmus (OKN). The MSA and PD groups had more abnormalities and decreased SPEM gain than the HC group (64.29%, 35.48%, 10%, p<.001). The SPEM gain in the MSA group was significantly lower than that in the PD group at specific frequencies. Patients with MSA and PD showed prolonged latencies in all saccade directions compared with those with HC. However, the two diseases had no significant differences in the saccade parameters. The OKN gain gradually decreased from the HC to the PD and the MSA groups (p<.05). Compared with the PD group, the gain in the MSA group was further decreased in the OKN test at 30°/s (Left, p=.010; Right p=.016). Receiver operating characteristic curves showed that the combination of oculomotor parameters with age and course of disease could aid in the differential diagnosis of patients with MSA and PD, with a sensitivity of 89.29% and a specificity of 70.97%. The combination of oculomotor parameters and clinical data may aid in the differential diagnosis of MSA and PD. Furthermore, VOE is vital in the identification of neurodegenerative diseases.

Schizophrenia and Orthoptic Conditions: A Literature Review.

A narrative review of the literature reporting ocular abnormalities in patients with schizophrenia was undertaken to determine the types and prevalence of orthoptic conditions in this patient cohort. A systematic search of multiple databases yielded 1,974 studies published between January 1992 and January 2022. All were screened for relevance based on their title and abstract. Seventeen studies were included in the final review. Ocular abnormalities reported in schizophrenia included a high incidence of strabismus, reduced visual acuity and reduced stereopsis compared to controls. Additionally, eye movement abnormalities (including reduced smooth pursuit gain and increased prosaccade latency) were frequently reported. Reduced visual acuity was associated with negative symptoms and reduced quality of life in schizophrenia. Orthoptists and eye care professionals should be aware that a higher incidence of strabismus, reduced visual acuity, reduced stereoacuity, and eye movement abnormalities are reported in patients with schizophrenia. Further research is required to determine whether, or to what extent, ocular abnormalities and visual disturbances influence or exacerbate the symptoms of schizophrenia, and whether there is an effect of schizophrenia medication on these orthoptic conditions.

Smooth pursuit inhibition reveals audiovisual enhancement of fast movement control.

The sudden onset of a visual object or event elicits an inhibition of eye movements at latencies approaching the minimum delay of visuomotor conductance in the brain. Typically, information presented via multiple sensory modalities, such as sound and vision, evokes stronger and more robust responses than unisensory information. Whether and how multisensory information affects ultra-short latency oculomotor inhibition is unknown. In two experiments, we investigate smooth pursuit and saccadic inhibition in response to multisensory distractors. Observers tracked a horizontallymoving dot and were interrupted by an unpredictable visual, auditory, or audiovisual distractor. Distractors elicited a transient inhibition of pursuit eye velocity and catch-up saccade rate within ∼100 ms of their onset. Audiovisual distractors evoked stronger oculomotor inhibition than visual- or auditory-only distractors, indicating multisensory response enhancement. Multisensory response enhancement magnitudes were equal to the linear sum of responses to component stimuli. These results demonstrate that multisensory information affects eye movements even at ultra-short latencies, establishing a lower time boundary for multisensory-guided behavior. We conclude that oculomotor circuits must have privileged access to sensory information from multiple modalities, presumably via a fast, subcortical pathway.

Detecting Abnormal Eye Movements in Patients with Neurodegenerative Diseases - Current Insights.

This review delineates the ocular motor disturbances across a spectrum of neurodegenerative disorders, including Alzheimer's Disease (AD) and related disorders (ADRD), Parkinson's Disease (PD), atypical parkinsonism, and others, leveraging advancements in eye-tracking technology for enhanced diagnostic precision. We delve into the different classes of eye movements, their clinical assessment, and specific abnormalities manifesting in these diseases, highlighting the nuanced differences and shared patterns. For instance, AD and ADRD are characterized by increased saccadic latencies and instability in fixation, while PD features saccadic hypometria and mild smooth pursuit impairments. Atypical parkinsonism, notably Progressive Supranuclear Palsy (PSP) and Corticobasal Syndrome (CBS), presents with distinct ocular motor signatures such as vertical supranuclear gaze palsy and saccadic apraxia, respectively. Our review underscores the diagnostic value of eye movement analysis in differentiating between these disorders and also posits the existence of underlying common pathological mechanisms. We discuss how eye movements have potential as biomarkers for neurodegenerative diseases but also some of the existing limitations.

Pathways from the superior colliculus and the nucleus of the optic tract to the posterior parietal cortex in macaque monkeys: Functional frameworks for representation updating and online movement guidance.

The posterior parietal cortex (PPC) integrates multisensory and motor-related information for generating and updating body representations and movement plans. We used retrograde transneuronal transfer of rabies virus combined with a conventional tracer in macaque monkeys to identify direct and disynaptic pathways to the arm-related rostral medial intraparietal area (MIP), the ventral lateral intraparietal area (LIPv), belonging to the parietal eye field, and the pursuit-related lateral subdivision of the medial superior temporal area (MSTl). We found that these areas receive major disynaptic pathways via the thalamus from the nucleus of the optic tract (NOT) and the superior colliculus (SC), mainly ipsilaterally. NOT pathways, targeting MSTl most prominently, serve to process the sensory consequences of slow eye movements for which the NOT is the key sensorimotor interface. They potentially contribute to the directional asymmetry of the pursuit and optokinetic systems. MSTl and LIPv receive feedforward inputs from SC visual layers, which are potential correlates for fast detection of motion, perceptual saccadic suppression and visual spatial attention. MSTl is the target of efference copy pathways from saccade- and head-related compartments of SC motor layers and head-related reticulospinal neurons. They are potential sources of extraretinal signals related to eye and head movement in MSTl visual-tracking neurons. LIPv and rostral MIP receive efference copy pathways from all SC motor layers, providing online estimates of eye, head and arm movements. Our findings have important implications for understanding the role of the PPC in representation updating, internal models for online movement guidance, eye-hand coordination and optic ataxia.

The role of eye movement signals in non-invasive brain-computer interface typing system.

Brain-Computer Interfaces (BCIs) have shown great potential in providing communication and control for individuals with severe motor disabilities. However, traditional BCIs that rely on electroencephalography (EEG) signals suffer from low information transfer rates and high variability across users. Recently, eye movement signals have emerged as a promising alternative due to their high accuracy and robustness. Eye movement signals are the electrical or mechanical signals generated by the movements and behaviors of the eyes, serving to denote the diverse forms of eye movements, such as fixations, smooth pursuit, and other oculomotor activities like blinking. This article presents a review of recent studies on the development of BCI typing systems that incorporate eye movement signals. We first discuss the basic principles of BCI and the recent advancements in text entry. Then, we provide a comprehensive summary of the latest advancements in BCI typing systems that leverage eye movement signals. This includes an in-depth analysis of hybrid BCIs that are built upon the integration of electrooculography (EOG) and eye tracking technology, aiming to enhance the performance and functionality of the system. Moreover, we highlight the advantages and limitations of different approaches, as well as potential future directions. Overall, eye movement signals hold great potential for enhancing the usability and accessibility of BCI typing systems, and further research in this area could lead to more effective communication and control for individuals with motor disabilities.

Collegiate Adapted Athlete Baseline Performance on the Vestibular/Ocular Motor Screening.

Concussion assessment in adapted and para-sport athletes has continued to evolve with growing considerations in para-sports, but little is known about vestibular/ocular performance assessment in this sample. To examine baseline performance on the Vestibular/Ocular Motor Screening (VOMS) in collegiate adapted athletes. A secondary objective was to investigate the role of sex, history of concussion, and functional classification on baseline measures. Cross-sectional study. University adapted athletics facility. 54 collegiate adapted athletes (age=21.19±2.6 years) from multiple institution's adapted athletics programs across the United States. Adapted athletes completed a baseline VOMS assessment while at the host university for in-season competition and tournaments. Independent variables were sex, history of concussion and functional classification (1.0-4.5 at 0.5 intervals). VOMS performance consisted of pre-test symptoms (headache, dizziness, nausea, and fogginess) and post-item (e.g., smooth pursuits, saccades) symptom provocation/change from pre-test scores. 50.9% reported 0 symptom provocation on the VOMS, with 72% having no pre-test symptoms. No sex differences were noted on the VOMS (p>0.05); However, adapted athletes with a history of concussion reported greater VOMS provocation on horizontal saccades (p=0.008) than those with no history. Higher functional classifications (2.0-4.5) reported greater provocation on horizontal saccades (p=0.010), horizontal and vertical saccades (p=0.043 and 0.048) vestibular ocular reflex (VOR), and VOR cancellation (p=0.036) than 1.0-1.5 athletes. Our findings provide context for baseline VOMS performance in collegiate adapted athletes and identifying modifiers at baseline. Special consideration is warranted on vestibular and oculomotor assessment in adapted and para-sport athletes with a history of concussion and higher functional classifications.

Recovery Process for Sports-Related Concussion Assessed with Precise Ocular Motility.

Ocular motility has been linked to Sports Concussion Assessment Tool 5 scores. However, the link between ocular motility changes and assessment result changes remains unclear. Hence, we investigated that potential link in patients with sports-related concussions. We retrospectively included participants aged≥18 years who were diagnosed with a sports-related concussion. They underwent smooth pursuit eye movement assessment for allocation to the good improvement (rate of fundamental frequency≥15%) or minor improvement (<15%) groups. Sports Concussion Assessment Tool 5 scores were determined at baseline and two weeks later, and score changes were compared between the groups. Thirteen men (mean±standard deviation age: 20.6±5.0 years) were included: eight (19.0±4.5 years) in the good improvement group and five (20.6±5.7 years) in the minor improvement group. Symptom number (median=2.0 vs. 0.0), symptom severity (median=22.0 vs. 3.0), single-leg stance (median=4.0 vs. 0.5), tandem stance (median=1.0 vs. 0.0), and total errors (median=5.0 vs. 0.5) were worse (all p<0.05) in the minor improvement group. Smooth pursuit eye movement improvements measured using eye-tracking technology was linked to symptom recovery in patients with sports-related concussions. Therefore, ocular motility may be an objective indicator of sports-related concussions. Future studies with more patients are needed to confirm these findings.

Stochastic optimal investment strategy for net‐zero energy houses

AbstractIn this research, Net‐Zero Energy Houses (ZEHs) is investigated that harness regionally produced electricity from photovoltaic (PV) panels and fuel cells, integrating them into a local power system in pursuit of achieving carbon neutrality. This article examines the impact of electricity sharing among users who are working towards attaining ZEH status through the integration of PV panels and battery storage devices. Two potential scenarios are proposed: the first assumes that all users individually invest in storage devices, hence minimizing their costs on a local level without energy sharing; the second envisions cost minimization through the collective use of a shared storage device, managed by a central manager. These two scenarios are formulated as a stochastic convex optimization and a cooperative game, respectively. To tackle the stochastic challenges posed by multiple random variables, the Monte Carlo sample average approximation (SAA) is applied to obtain solvable deterministic convex problems. Last, to demonstrate the practical applicability of these models, the proposed scenarios are implemented in the Jono neighborhood in Kitakyushu, Japan.

Exploring Gaze Dynamics in Virtual Reality through Multiscale Entropy Analysis.

This study employs Multiscale Entropy (MSE) to analyze 5020 binocular eye movement recordings from 407 college-aged participants, as part of the GazeBaseVR dataset, across various virtual reality (VR) tasks to understand the complexity of user interactions. By evaluating the vertical and horizontal components of eye movements across tasks such as vergence, smooth pursuit, video viewing, reading, and random saccade, collected at 250 Hz using an ET-enabled VR headset, this research provides insights into the predictability and complexity of gaze patterns. Participants were recorded up to six times over a 26-month period, offering a longitudinal perspective on eye movement behavior in VR. MSE's application in this context aims to offer a deeper understanding of user behavior in VR, highlighting potential avenues for interface optimization and user experience enhancement. The results suggest that MSE can be a valuable tool in creating more intuitive and immersive VR environments by adapting to users' gaze behaviors. This paper discusses the implications of these findings for the future of VR technology development, emphasizing the need for intuitive design and the potential for MSE to contribute to more personalized and comfortable VR experiences.

In-Season Test-Retest Reliability of Visual Smooth-Pursuit (EyeGuide Focus) Baseline Assessment in Female and Male Field-Sport Athletes.

Sport-related concussions (SRCs) are a mild traumatic brain injury (mTBI) that induces transient symptoms in athletes. These symptoms provide avenues for developing emerging technologies to diagnose SRCs, in particular ocular and vestibular dysfunction. The following study aims to assess the reliability of visual smooth-pursuit technology (EyeGuide Focus) in amateur field-sport athletes. A convenience sample of 30 mixed-gender athletes (mean age = 24.89 ± 6.81 years) completed two testing sessions separated by 2-7 days. Participants were tested at rest, free from distraction, and completed a 10 s smooth pursuit while seated. Participants completed 2-4 practice trials before completing three tests at each session. Appropriate difference, reliability, and repeatability tests were performed in Statistical Packages for the Social Sciences. No significant difference existed between the time points (p > 0.05). The reliability between sessions was poor (ICC = 0.24; 95% CI = 0.03-0.42), and the mean coefficients of variation were 20% and 21% for each session, indicating poor repeatability. However, the implementation of practice trials did prevent the familiarization effects that are evident in the previous literature (p > 0.05). The within-session reliability of EyeGuide Focus has varied from poor (ICC ≤ 0.50) to good (ICC = 0.75-0.90) in the previous literature, indicating the fact that greater research is required before this tool can be implemented in applied settings.

Human estimates of descending objects' motion are more accurate than those of ascending objects regardless of gravity information.

Humans can accurately estimate and track object motion, even if it accelerates. Research shows that humans exhibit superior estimation and tracking performance for descending (falling) than ascending (rising) objects. Previous studies presented ascending and descending targets along the gravitational and body axes in an upright posture. Thus, it is unclear whether humans rely on congruent information between the direction of the target motion and gravity or the direction of the target motion and longitudinal body axes. Two experiments were conducted to explore these possibilities. In Experiment 1, participants estimated the arrival time at a goal for both upward and downward motion of targets along the longitudinal body axis in the upright (both axes of target motion and gravity congruent) and supine (both axes incongruent) postures. In Experiment 2, smooth pursuit eye movements were assessed while tracking both targets in the same postures. Arrival time estimation and smooth pursuit eye movement performance were consistently more accurate for downward target motion than for upward motion, irrespective of posture. These findings suggest that the visual experience of seeing an object moving along an observer's leg side in everyday life may influence the ability to accurately estimate and track the descending object's motion.

SARS-CoV-2 Infection Impairs Oculomotor Functions: A Longitudinal Eye-tracking Study.

Although Severe Acute Respiratory Syndrome Coronavirus 2 infection (SARS-CoV-2) is primarily recognized as a respiratory disease, mounting evidence suggests that it may lead to neurological and cognitive impairments. The current study used three eye-tracking tasks (free-viewing, fixation, and smooth pursuit) to assess the oculomotor functions of mild infected cases over six months with symptomatic SARS-CoV-2 infected volunteers. Fifty symptomatic SARS-CoV-2 infected, and 24 self-reported healthy controls completed the eye-tracking tasks in an initial assessment. Then, 45, and 40 symptomatic SARS-CoV-2 infected completed the tasks at 2- and 6-months post-infection, respectively. In the initial assessment, symptomatic SARS-CoV-2 infected exhibited impairments in diverse eye movement metrics. Over the six months following infection, the infected reported overall improvement in health condition, except for self-perceived mental health. The eye movement patterns in the free-viewing task shifted toward a more focal processing mode and there was no significant improvement in fixation stability among the infected. A linear discriminant analysis shows that eye movement metrics could differentiate the infected from healthy controls with an accuracy of approximately 62%, even 6 months post-infection. These findings suggest that symptomatic SARSCoV- 2 infection may result in persistent impairments in oculomotor functions, and the employment of eye-tracking technology can offer valuable insights into both the immediate and long-term effects of SARS-CoV-2 infections. Future studies should employ a more balanced research design and leverage advanced machine-learning methods to comprehensively investigate the impact of SARSCoV- 2 infection on oculomotor functions.

Eye-hand coordination all the way: from discrete to continuous hand movements.

The differentiation between continuous and discrete actions is key for behavioral neuroscience. Although many studies have characterized eye-hand coordination during discrete (e.g., reaching) and continuous (e.g., pursuit tracking) actions, all these studies were conducted separately, using different setups and participants. In addition, how eye-hand coordination might operate at the frontier between discrete and continuous movements remains unexplored. Here we filled these gaps by means of a task that could elicit different movement dynamics. Twenty-eight participants were asked to simultaneously track with their eyes and a joystick a visual target that followed an unpredictable trajectory and whose position was updated at different rates (from 1.5 to 240 Hz). This procedure allowed us to examine actions ranging from discrete point-to-point movements (low refresh rate) to continuous pursuit (high refresh rate). For comparison, we also tested a manual tracking condition with the eyes fixed and a pure eye tracking condition (hand fixed). The results showed an abrupt transition between discrete and continuous hand movements around 3 Hz contrasting with a smooth trade-off between fixations and smooth pursuit. Nevertheless, hand and eye tracking accuracy remained strongly correlated, with each of these depending on whether the other effector was recruited. Moreover, gaze-cursor distance and lag were smaller when eye and hand performed the task conjointly than separately. Altogether, despite some dissimilarities in eye and hand dynamics when transitioning between discrete and continuous movements, our results emphasize that eye-hand coordination continues to smoothly operate and support the notion of synergies across eye movement types.NEW & NOTEWORTHY The differentiation between continuous and discrete actions is key for behavioral neuroscience. By using a visuomotor task in which we manipulate the target refresh rate to trigger different movement dynamics, we explored eye-hand coordination all the way from discrete to continuous actions. Despite abrupt changes in hand dynamics, eye-hand coordination continues to operate via a gradual trade-off between fixations and smooth pursuit, an observation confirming the notion of synergies across eye movement types.

Enhancing Fixation and Pursuit: Optimizing Field of View and Number of Targets for Selection Performance in Virtual Reality

Gaze interaction in virtual reality (VR) offers promising advantages in speed and hands-free operation. However, selecting a suitable selection mechanism in VR interfaces with different visual encodings remains a challenge. This research compares two visual input techniques and explores specific visual elements, including field of view (FOV), design style, and number of targets, with the goal of alleviating these problems. The pilot study identifies two search stages, and it also demonstrates a significant effect of FOV on search time. In the formal experiment, a gaze-based trigger experiment is employed to examine the selection performance of fixation and smooth pursuit. The results reveal that optimizing FOV and number of targets improves the triggering efficiency. Furthermore, fixation outperforms pursuit in terms of triggering time and accuracy under the same conditions, while cognitive load during triggering process remains relatively similar. These findings are expected to propose design recommendations to enhance fixation and pursuit within VR interfaces.

An Exploratory Analysis of Physical Examination Subtypes in Pediatric Athletes With Concussion.

Pediatric athletes with concussion present with a variety of impairments on clinical assessment and require individualized treatment. The Buffalo Concussion Physical Examination is a brief, pertinent clinical assessment for individuals with concussion. The purpose of this study was to identify physical examination subtypes in pediatric athletes with concussion within 2 weeks of injury that are relevant to diagnosis and treatment. Secondary analysis of a published cohort study and clinician consensus. Three university-affiliated sports medicine centers. Two hundred seventy children (14.9 ± 1.9 years). Orthostatic intolerance, horizontal and vertical saccades, smooth pursuits, vestibulo-ocular reflex, near-point convergence, complex tandem gait, neck range of motion, neck tenderness, and neck spasm. Correlations between independent variables were calculated, and network graphs were made. k -means and hierarchical clustering were used to identify clusters of impairments. Optimal number of clusters was assessed. Results were reviewed by experienced clinicians and consensus was reached on proposed subtypes. Physical examination clusters overlapped with each other, and no optimal number of clusters was identified. Clinician consensus suggested 3 possible subtypes: (1) visio-vestibular (horizontal and vertical saccades, smooth pursuits, and vestibulo-ocular reflex), (2) cervicogenic (neck range of motion and spasm), and (3) autonomic/balance (orthostatic intolerance and complex tandem gait). Although we identified 3 physical examination subtypes, it seemed that physical examination findings alone are not enough to define subtypes that are both statistically supported and clinically relevant, likely because they do not include symptoms, assessment of mood or cognitive problems, or graded exertion testing.

Inclusive learning communities: An English learner framework for all educators

AbstractEducators in many countries must meet the educational needs of students who are not fluent in the language of instruction. Professional learning focused on incremental or individual teacher change has failed to improve student learning trajectories (Cuban, 2013; Gorski &amp; Zenkov, 2014). This article explores Brookfield's (2012) critical articulation of Mezirow's (2012) adult learning theory to support the complex and radical transformation needed from all educators—not just language specialists—to improve classroom learning and schooling. We present the inclusive learning communities framework, with conceptual and pedagogical growth targets, guiding a seven‐course English as a New Language Certification program for PreK‐12 preservice and in‐service teachers working with English learners (ELs) in general education and EL specialist classrooms. The conceptual and pedagogical elements leverage critical transformative learning theory to reframe educators' individual beliefs and practices while developing their collective capacity to challenge oppressive ideologies and systems in pursuit of equity. We conclude that radical improvement in EL outcomes requires all EL teacher educators to plan and evaluate university coursework programmatically in ways that demonstrate real‐world change.