Binasal Occlusion (BNO), Visual Motion Sensitivity (VMS), and the Visually-Evoked Potential (VEP) in mild Traumatic Brain Injury and Traumatic Brain Injury (mTBI/TBI)

Kenneth J Ciuffreda, Naveen K Yadav, Diana P Ludlam, Kenneth J Ciuffreda, Naveen K Yadav, Diana P Ludlam

Abstract

The diagnosis and treatment of the possible visual sequelae in those with traumatic brain injury (TBI) represents an important area of health care in this special population. One of their most prevalent yet elusive visual symptoms is visual motion sensitivity (VMS). In this review, we present the basic VMS phenomenon and its related symptoms, clinical studies in the area, clinical research investigations using the visual-evoked potential (VEP) as a cortical probe, and possible mechanisms and related neurophysiology that may underlie VMS. Lastly, therapeutic interventions are briefly described, as well as future directions for clinical research and patient care in those with VMS and TBI.

Keywords: binasal occlusion (BNO); dorsal stream; magnocellular pathway; traumatic brain injury (TBI); visual motion perception; visual motion sensitivity (VMS); visually-evoked potential (VEP); visuomotor.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Strabismus mask for esotropia.
Figure 2
Figure 2
Gibsonian optic flow while walking down a supermarket aisle.
Figure 3
Figure 3
Schematic representation of binasal occluders on a subject [11,12].
Figure 4
Figure 4
Representation of the binocular visual-field with binasal occluders in place, including the checkerboard visual stimulus. Not drawn to scale. f = fovea [12].
Figure 5
Figure 5
Group mean amplitude for the full field without and with binasal occluders in normals and in mTBI [12]. * means statically significant.
Figure 6
Figure 6
Diagnostic group mean amplitude difference for individual subjects (%). Positive and negative percentage values represent an increase or decrease in mean amplitude difference values, respectively [11].
Figure 7
Figure 7
Group mean VEP amplitude for the four test conditions (baseline, prism, BNO, and BNO plus prism). Plotted is the mean +1 SEM. (a) visually-normal; (b) mTBI. Brackets with an asterisk (*) represent significant differences (p < 0.05) [12].
Figure 8
Figure 8
Group mean VEP latency (P100) for the four test conditions (baseline, prism, BNO, and BNO plus prism). Plotted is the mean +1 SEM. (a) visually-normal; (b) mTBI. Brackets with an asterisk (*) represent significant differences (p < 0.05) [12].
Figure 9
Figure 9
Percentage amplitude differences for three test conditions relative to baseline values for each subject. Negative values indicate a decrease in amplitude and positive values indicate an increase in amplitude. (a) Visually-normal; (b) mTBI [12].
Figure 10
Figure 10
Visual motion habituation training: (a) optokinetic drum (OKN); (b) hand motion.

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