Automated Tracking of Eye Movements an Objective Biomarker of Pediatric Concussion
Researchers at the Children's Hospital of Philadelphia's (CHOP) Center for Injury Research and Prevention (CIRP) have evaluated use of eye-tracking measurements and visiovestibular evaluation (VVE) to assess mild traumatic brain injury (mTBI), also known as concussion, in children. The VVE assesses the patient’s ability to integrate sensory input of balance, vision, and movement by measuring how eyes track movement, change focus, perceive depth.
Of 432 randomly selected children ages 5 to 18 years who presented to a specialty concussion clinic, 88% had visiovestibular deficits. Inability to track and focus on an object, double vision, and balance deficits all predicted prolonged concussion recovery. Children with a history of motion sickness had a higher level of vestibular dysfunction, and those who were younger, had public insurance, and had headache were more likely to wait longer after injury to come to the clinic for care. Symptoms measured with the vestibular-ocular reflex, smooth movement of the eye from one objected to another, and abnormal balance were predictors of prolonged recovery from mTBI. (Clin J Sport Med. 2018;28(2):139-145.)
Chart review from 400 children ages 6 to 18 who presented to the emergency department with head injury and concern for mTBI over a 12-month period showed VVE was done for 64% of the children. In children who were diagnosed with concussion, 73% were evaluated with VVE. Despite having 1 or no clinical signs of concussion, 9% of those patients had findings on the VVE suggesting VVE can assist in diagnosis of mTBI. (Am J Emerg Med. 2018:September 4)
"This study showed us that, with training and clinical support tools, pediatricians, emergency medicine clinicians and advanced practice practitioners are able to conduct the VVE in a high-volume acute care setting," says Daniel Corwin, MD, MSCE, lead author and pediatric emergency medicine physician at CHOP.
Other studies in collaboration with Children's Hospital of Colorado, Boston Children's Hospital, and University of Minnesota showed that automated eye-tracking assessment, a rapid, objective, non-invasive test that does preinjury baseline data to accurately diagnose mTBI. The patient stabilizes their head on a chin strap to reduce head movements and watches a 220 second video as software analyzes whether or not the patients’ eyes are moving together. (J Child Neurol. 2018 Oct;33(12):794-800,Clin J Sport Med. 2018:August 8)
"Based on our findings, the automated eye-tracking assessment could ultimately advance clinical practice such that healthcare providers and athletic trainers could systematically, objectively and quickly identify a child or youth with a concussion by assessing eye movements," says Master. "However, we still see this as one tool in a clinician's diagnostic toolbox. There still isn't one definitive test for concussion."