Oculomotor, Vestibular, and Reaction Time Tests in Mild Traumatic Brain Injury

Abstract

Objective: Mild traumatic brain injury is a major public health issue and is a particular concern in sports. One of the most difficult issues with respect to mild traumatic brain injury involves the diagnosis of the disorder. Typically, diagnosis is made by a constellation of physical exam findings. However, in order to best manage mild traumatic brain injury, it is critically important to develop objective tests that substantiate the diagnosis. With objective tests the disorder can be better characterized, more accurately diagnosed, and studied more effectively. In addition, prevention and treatments can be applied where necessary.

Methods: Two cohorts each of fifty subjects with mild traumatic brain injury and one hundred controls were evaluated with a battery of oculomotor, vestibular and reaction time related tests applied to a population of individuals with mild traumatic brain injury as compared to controls.

Results: We demonstrated pattern differences between the two groups and showed how three of these tests yield an 89% sensitivity and 95% specificity for confirming a current diagnosis of mild traumatic brain injury.

Interpretation: These results help better characterize the oculomotor, vestibular, and reaction time differences between those the mild traumatic brain injury and non-affected individuals. This characterization will allow for the development of more effective point of care neurologic diagnostic techniques and allow for more targeted treatment which may allow for quicker return to normal activity.

Conflict of interest statement

Alex Kiderman is an employee of Neuro Kinetics, Inc. The remainders of the authors have no conflict of interest to declare. This work was supported by Head Health Challenge II grant (National Football League, Underarmor, General Electric). The views expressed herein do not necessarily reflect the official policy or position of the Department of the Navy, the Department of the Army, Department of Defense or the U.S. Government. Dr. Kiderman’s role was confined to device design and technical aspects of manuscript preparation and thus his employment by Neuro Kinetics, Inc. has no influence on the analysis, discussions, or conclusions of this manuscript. None of the funding sources or sponsors alters our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1. ROC curve for Individual Cohorts and Combined Group.

ROC curves for the first cohort of subjects with mTBI (red), second cohort of subjects with mTBI (green), and the combination of both groups (black).

Fig 2. Cumulative distribution functions are shown for the four metrics in the logistic regression model, 89% sensitivity and 97.5% specificity.

Concussion (red) plotted with controls (black). The vertical line in each graph demarcates the location of the upper or lower 5% cutoff for control subjects.