John-Ross Rizzo

Objectifying eye movements during rapid number naming: Methodology for assessment of normative data for the King-Devick test

OBJECTIVE Concussion is a major public health problem and considerable efforts are focused on sideline-based diagnostic testing to guide return-to-play decision-making and clinical care. The King-Devick (K-D) test, a sensitive sideline performance measure for concussion detection, reveals slowed reading times in acutely concussed subjects, as compared to healthy controls; however, the normal behavior of eye movements during the task and deficits underlying the slowing have not been defined. METHODS Twelve healthy control subjects underwent quantitative eye tracking during digitized K-D testing. RESULTS The total K-D reading time was 51.24 (±9.7) seconds. A total of 145 saccades (±15) per subject were generated, with average peak velocity 299.5°/s and average amplitude 8.2°. The average inter-saccadic interval was 248.4 ms. Task-specific horizontal and oblique saccades per subject numbered, respectively, 102 (±10) and 17 (±4). Subjects with the fewest saccades tended to blink more, resulting in a larger amount of missing data; whereas, subjects with the most saccades tended to make extra saccades during line transitions. CONCLUSIONS Establishment of normal and objective ocular motor behavior during the K-D test is a critical first step towards defining the range of deficits underlying abnormal testing in concussion. Further, it sets the groundwork for exploration of K-D correlations with cognitive dysfunction and saccadic paradigms that may reflect specific neuroanatomic deficits in the concussed brain.

Rapid number naming in chronic concussion: eye movements in the King–Devick test

The King–Devick (KD) test, which is based on rapid number naming speed, is a performance measure that adds vision and eye movement assessments to sideline concussion testing. We performed a laboratory‐based study to characterize ocular motor behavior during the KD test in a patient cohort with chronic concussion to identify features associated with prolonged KD reading times.

Motor planning poststroke: impairment in vector‐coded reach plans

Healthy individuals appear to use both vector‐coded reach plans that encode movements in terms of their desired direction and extent, and target‐coded reach plans that encode the desired endpoint position of the effector. We examined whether these vector and target reach‐planning codes are differentially affected after stroke. Participants with stroke and healthy controls made blocks of reaches that were grouped by target location (providing target‐specific practice) and by movement vector (providing vector‐specific practice). Reach accuracy was impaired in the more affected arm after stroke, but not distinguishable for target‐ versus vector‐grouped reaches. Reach velocity and acceleration were not only impaired in both the less and more affected arms poststroke, but also not distinguishable for target‐ versus vector‐grouped reaches. As previously reported in controls, target‐grouped reaches yielded isotropic (circular) error distributions and vector‐grouped reaches yielded error distributions elongated in the direction of the reach. In stroke, the pattern of variability was similar. However, the more affected arm showed less elongated error ellipses for vector‐grouped reaches compared to the less affected arm, particularly in individuals with right‐hemispheric stroke. The results suggest greater impairment to the vector‐coded movement‐planning system after stroke, and have implications for the development of personalized approaches to poststroke rehabilitation: Motor learning may be enhanced by practice that uses the preserved code or, conversely, by retraining the more impaired code to restore function.

Sensor fusion for ecologically valid obstacle identification: Building a comprehensive assistive technology platform for the visually impaired

Sensor fusion represents a robust approach to ecologically valid obstacle identification in building a comprehensive electronic travel aid (ETA) for the blind and visually impaired. A stereoscopic camera system and an infrared sensor with 16 independent elements is proposed to be combined with a multi-scale convolutional neural network for this fusion framework. While object detection and identification can be combined with depth information from a stereo camera system, our experiments demonstrate that depth information may be inconsistent given material surfaces of specific potential collision hazards. This inconsistency can be easily remedied by supplementation with a more reliable depth signal from an alternate sensing modality. The sensing redundancy in this multi-modal strategy, as deployed in this platform, may enhance the situational awareness of a visually impaired end user, permitting more efficient and safer obstacle negotiation.

Mobile Universal Lexicon Evaluation System (MULES) test: A new measure of rapid picture naming for concussion

OBJECTIVE This study introduces a rapid picture naming test, the Mobile Universal Lexicon Evaluation System (MULES), as a novel, vision-based performance measure for concussion screening. The MULES is a visual-verbal task that includes 54 original photographs of fruits, objects and animals. We piloted MULES in a cohort of volunteers to determine feasibility, ranges of picture naming responses, and the relation of MULES time scores to those of King-Devick (K-D), a rapid number naming test. METHODS A convenience sample (n=20, age 34±10) underwent MULES and K-D (spiral bound, iPad versions). Administration order was randomized; MULES tests were audio-recorded to provide objective data on temporal variability and ranges of picture naming responses. RESULTS Scores for the best of two trials for all tests were 40-50s; average times required to name each MULES picture (0.72±0.14s) was greater than those needed for each K-D number ((spiral: 0.33±0.05s, iPad: 0.36±0.06s, 120 numbers), p<0.0001, paired t-test). MULES scores showed the greatest degree of improvement between trials (9.4±4.8s, p<0.0001 for trials 1 vs. 2), compared to K-D (spiral 1.5±3.3s, iPad 1.8±3.4s). Shorter MULES times demonstrated moderate and significant correlations with shorter iPad but not spiral K-D times (r=0.49, p=0.03). CONCLUSION The MULES test is a rapid picture naming task that may engage more extensive neural systems than more commonly used rapid number naming tasks. Rapid picture naming may require additional processing devoted to color perception, object identification, and categorization. Both tests rely on initiation and sequencing of saccadic eye movements.

Disrupted Saccade Control in Chronic Cerebral Injury: Upper Motor Neuron-Like Disinhibition in the Ocular Motor System

Saccades rapidly direct the line of sight to targets of interest to make use of the high acuity foveal region of the retina. These fast eye movements are instrumental for scanning visual scenes, foveating targets, and, ultimately, serve to guide manual motor control, including eye–hand coordination. Cerebral injury has long been known to impair ocular motor control. Recently, it has been suggested that alterations in control may be useful as a marker for recovery. We measured eye movement control in a saccade task in subjects with chronic middle cerebral artery stroke with both cortical and substantial basal ganglia involvement and in healthy controls. Saccade latency distributions were bimodal, with an early peak at 60 ms (anticipatory saccades) and a later peak at 250 ms (regular saccades). Although the latencies corresponding to these peaks were the same in the two groups, there were clear differences in the size of the peaks. Classifying saccade latencies relative to the saccade “go signal” into anticipatory (latencies up to 80 ms), “early” (latencies between 80 and 160 ms), and “regular” types (latencies longer than 160 ms), stroke subjects displayed a disproportionate number of anticipatory saccades, whereas control subjects produced the majority of their saccades in the regular range. We suggest that this increase in the number of anticipatory saccade events may result from a disinhibition phenomenon that manifests as an impairment in the endogenous control of ocular motor events (saccades) and interleaved fixations. These preliminary findings may help shed light on the ocular motor deficits of neurodegenerative conditions, results that may be subclinical to an examiner, but clinically significant secondary to their functional implications.

The Intersection between Ocular and Manual Motor Control: Eye–Hand Coordination in Acquired Brain Injury

Acute and chronic disease processes that lead to cerebral injury can often be clinically challenging diagnostically, prognostically, and therapeutically. Neurodegenerative processes are one such elusive diagnostic group, given their often diffuse and indolent nature, creating difficulties in pinpointing specific structural abnormalities that relate to functional limitations. A number of studies in recent years have focused on eye–hand coordination (EHC) in the setting of acquired brain injury (ABI), highlighting the important set of interconnected functions of the eye and hand and their relevance in neurological conditions. These experiments, which have concentrated on focal lesion-based models, have significantly improved our understanding of neurophysiology and underscored the sensitivity of biomarkers in acute and chronic neurological disease processes, especially when such biomarkers are combined synergistically. To better understand EHC and its connection with ABI, there is a need to clarify its definition and to delineate its neuroanatomical and computational underpinnings. Successful EHC relies on the complex feedback- and prediction-mediated relationship between the visual, ocular motor, and manual motor systems and takes advantage of finely orchestrated synergies between these systems in both the spatial and temporal domains. Interactions of this type are representative of functional sensorimotor control, and their disruption constitutes one of the most frequent deficits secondary to brain injury. The present review describes the visually mediated planning and control of eye movements, hand movements, and their coordination, with a particular focus on deficits that occur following neurovascular, neurotraumatic, and neurodegenerative conditions. Following this review, we also discuss potential future research directions, highlighting objective EHC as a sensitive biomarker complement within acute and chronic neurological disease processes.

Effect of blocking tactile information from the fingertips on adaptation and execution of grip forces to friction at the grasping surface

Adaptation of fingertip forces to friction at the grasping surface is necessary to prevent use of inadequate or excessive grip forces. In the current study we investigated the effect of blocking tactile information from the fingertips noninvasively on the adaptation and efficiency of grip forces to surface friction during precision grasp. Ten neurologically intact subjects grasped and lifted an instrumented grip device with 18 different frictional surfaces under three conditions: with bare hands or with a thin layer of plastic (Tegaderm) or an additional layer of foam affixed to the fingertips. The coefficient of friction at the finger-object interface of each surface was obtained for each subject with bare hands and Tegaderm by measuring the slip ratio (grip force/load force) at the moment of slip. We found that the foam layer reduced sensibility for two-point discrimination and pressure sensitivity at the fingertips, but Tegaderm did not. However, Tegaderm reduced static, but not dynamic, tactile discrimination. Adaptation of fingertip grip forces to surface friction measured by the rate of change of peak grip force, and grip force efficiency measured by the grip-load force ratio at lift, showed a proportional relationship with bare hands but were impaired with Tegaderm and foam. Activation of muscles engaged in precision grip also varied with the frictional surface with bare hands but not with Tegaderm and foam. The results suggest that sensitivity for static tactile discrimination is necessary for feedforward and feedback control of grip forces and for adaptive modulation of muscle activity during precision grasp.

Smart Wearable Systems for Enhanced Monitoring and Mobility

The percentage of people over age 65 will shift from 12% to 20% nationwide while the average life expectancy for men and women of all races continues to rise, introducing a national and global concern for health related expenses. In particular, diminished stability leading to an increased risk of falling is on the forefront of medical expense projections. The World Health Organization (WHO) estimates there are 285 million suffering from visual impairment (39 million blind, 246 million low vision) worldwide. When adding the aging population with concomitant increases in life expectancy and the climbing rates of vision pathology, the numbers are even more dramatic. Blindness and low vision result in a host of social, emotional and health problems, often due to antecedent difficulties with mobility. This paper presents two smart wearable systems designed to enhance the mobility and monitoring of elderly and those with impaired vision. By using advances in sensors, actuators, and micro-electronics, these wearable systems acquire large amount of data, and with high speed data processing and pattern recognition, provide feedback signals to those wearing them. These systems are self-contained and operate with an easily accessible battery power. Details of the design and analysis of these smart wearable systems are presented.

Feasibility of a Cost-Effective, Video Analysis Software–Based Mobility Protocol for Objective Spine Kinematics and Gait Metrics: A Proof of Concept Study

The purpose of this study was to investigate the potential of a high‐throughput, easily implemented, cost‐effective, video analysis software–based mobility protocol to quantify spine kinematics. This prospective cohort study of clinical biomechanics implemented 2‐dimensional (2D) image processing at a tertiary‐care academic institution. Ten healthy, able‐bodied volunteers were recruited for 2D videography of gait and functional motion. The reliability of a 2D video analysis software program for gait and range of motion metrics was evaluated over 2 independent experimental sessions, assessing for inter‐trial, inter‐session, and inter‐rater reliability. Healthy volunteers were evaluated for simple forward and side bending, rotation, treadmill stride length, and more complex seated‐to‐standing tasks. Based on established intraclass correlation coefficients, results indicated that reliability was considered good to excellent for simple forward and side bending, rotation, stride length, and more complex sit‐to‐standing tasks. In conclusion, a cost‐effective, 2D, video analysis software–based mobility protocol represents a feasible and clinically useful approach for objective spine kinematics and gait metrics. As the complication rate of operative management in the setting of spinal deformity is weighed against functional performance and quality of life measures, an objective analysis tool in combination with an appropriate protocol will aid in clinical assessments and lead to an increased evidence base for management options and decision algorithms.