脑震荡后儿童和青少年的眼动和前庭眼动功能改变。
Altered Oculomotor and Vestibulo-ocular Function in Children and Adolescents Postconcussion.
机构信息
Author Affiliations: Integrated Program in Neuroscience, Faculty of Medicine and Health Sciences, McGill University, Montreal, Québec, Canada (Ms Treleaven); School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, Québec, Canada (Dr Lamontagne); Jewish Rehabilitation Hospital-CISSS Laval site, Centre de Recherche Interdisciplinaire en Réadaptation du Montréal Métropolitain (CRIR), Montréal, Québec, Canada (Dr Lamontagne); Montreal Children's Hospital, McGill University Health Centre, Montreal, Québec, Canada (Mss Grilli and Friedman); and School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, Trauma Center, Montreal Children's Hospital, McGill University Health Center, Montreal, Québec, Canada (Dr Gagnon).
出版信息
J Head Trauma Rehabil. 2024;39(4):E237-E246. doi: 10.1097/HTR.0000000000000898. Epub 2023 Oct 20.
OBJECTIVE
To document (1) oculomotor (OM) and vestibulo-ocular (VO) function in children with concussion who were symptomatic at the time of assessment and to compare it with that in children with concussion who were clinically recovered (asymptomatic) and in children with no concussive injury, and (2) the extent to which OM and VO function relates to postconcussion symptom severity in injured children.
SETTING
Participants were recruited from a concussion clinic or the community.
PARTICIPANTS
A total of 108 youth with concussion (72 symptomatic; 36 recovered) and 79 healthy youth (aged 9-18 years). Youth with concussion were included if aged 9 to 18 years, had no previous concussion within the last 12 months, less than 90 days since injury, and no known existing visual disorders or learning disabilities.
STUDY DESIGN
A prospective cross-sectional study.
MAIN MEASURES
All participants were tested for OM and VO function with a commercial virtual reality (VR) eye-tracking system (Neuroflex ® , Montreal,Québec, Canada). Participants in the concussion group who completed the postconcussion symptoms were scored with the Post-Concussion Symptom Inventory.
RESULTS
There was a significant group effect for vergence during smooth pursuit ( F2,176 = 10.90; P < .05), mean latency during saccades ( F2,171 = 5.99; P = .003), and mean response delay during antisaccades ( F2,177 = 9.07; P < .05), where children with symptomatic concussion showed poorer performance than clinically recovered and healthy children. Similar results were found in VO for average vestibular ocular reflex gain in the horizontal leftward ( F2,168 = 7; P = .001) and rightward directions ( F2,163 = 13.08; P < .05) and vertical upward ( F2,147 = 7.60; P = .001) and downward directions ( F2,144 = 13.70; P < .05). Mean saccade error was positively correlated to total Post-Concussion Symptom Inventory scores in younger clinically recovered children.
CONCLUSION
VR eye tracking may be an effective tool for identifying OM and VO deficits in the subacute phase (<90 days) postconcussion.
目的
记录（1）有症状的脑震荡患儿的眼动（OM）和前庭眼动（VO）功能，并与临床康复（无症状）的脑震荡患儿和无脑震荡损伤的患儿进行比较；（2）OM 和 VO 功能与受伤患儿的脑震荡后症状严重程度的关系程度。
设置
参与者从脑震荡诊所或社区招募。
参与者
共 108 名患有脑震荡的青少年（72 名有症状；36 名康复）和 79 名健康青少年（年龄 9-18 岁）。有症状的脑震荡患儿符合以下标准：年龄 9 至 18 岁，过去 12 个月内无脑震荡史，受伤后不到 90 天，无已知的现有视觉障碍或学习障碍。
研究设计
前瞻性横断面研究。
主要测量指标
所有参与者均使用商业虚拟现实（VR）眼动追踪系统（Neuroflex ® ，加拿大魁北克省蒙特利尔）进行 OM 和 VO 功能测试。完成脑震荡后症状评估的脑震荡组参与者采用脑震荡后症状量表（Post-Concussion Symptom Inventory）进行评分。
结果
在平滑追踪时的聚散（ F2,176 = 10.90；P <.05）、扫视时的平均潜伏期（ F2,171 = 5.99；P =.003）和反向扫视时的平均反应延迟（ F2,177 = 9.07；P <.05）方面，存在显著的组间效应，有症状的脑震荡患儿的表现明显差于临床康复和健康儿童。在 VO 中，水平左向（ F2,168 = 7；P =.001）和右向（ F2,163 = 13.08；P <.05）以及垂直向上（ F2,147 = 7.60；P =.001）和向下（ F2,144 = 13.70；P <.05）方向的平均前庭眼反射增益也存在类似的结果。平均扫视误差与年轻临床康复儿童的总脑震荡后症状量表评分呈正相关。
结论
VR 眼动追踪可能是一种在脑震荡后亚急性期（<90 天）识别 OM 和 VO 缺陷的有效工具。
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