EYE TRACKING AS A BIOMARKER FOR CONCUSSION MELISSA HUNFALVAY PHD - PowerPoint PPT Presentation

EYE TRACKING AS A BIOMARKER FOR CONCUSSION MELISSA HUNFALVAY PHD CHIEF SCIENCE OFFICER, RIGHTEYE, LLC. MELISSA@RIGHTEYE.COM Reduce Costs – Improve Processes – Please Participants -

DISCLOSURES Dr Hunfalvay is an owner of the company RightEye, LLC.

LEARNING OUTCOMES At the conclusion of this activity, participants will be able to: 1. Attendees will be able to learn oculomotor behavior specifically reflecting mTBI using eye tracking 2. Attendees will be able to identify oculomotor metrics of importance related to brain mapping mTBI locations 3. Attendees will be able to discuss or translate opportunities into specific oculomotor therapies to improve symptomology

HOW TO CLAIM CE CREDIT If you would like to receive continuing education credit for this activity, please visit: nabis.cds.pesgce.com

The Eyes and the Brain • The eye is not independent of the brain • The retina is part of the brain • The brain is highly involved in vision and visual processing 9/22/2018 RightEye 5

The Process 1. Examine 3. Re- 2. Therapy examine & Training 9/22/2018 RightEye 6

Fixation A stopping point of the eye 9/22/2018 RightEye 7

Fixation Stability – Control 9/22/2018 RightEye 8

Fixation Stability – Severe TBI RED level 9/22/2018 RightEye 9

Fixation Stability – Dysfunctional: Brain Location Neural Integrator/Brain Stem Neural Integrator/Brain Stem 9/22/2018 RightEye 10

Fixation Stability – mTBI: ORANGE level 9/22/2018 RightEye 11

Primary Role of Brain Areas Identified • Brain Stem: • Specific areas of the brain stem involved in fixations are: • Reticular formation in basal ganglia • Superior Colliculus • Fixation is an active process and includes microsaccades, microdrifts and microtremors. • Neural Integrator: integrate eye velocity and eye position information to allow image stabilization. • Brain areas for fixation also include eye fields, dorsolateral prefrontal cortex and areas of the thalamus (V5 & 5A). 9/22/2018 RightEye 12

Fixation Stability – Dysfunctional: Lifestyle • Eyes are not working optimally when having to focus on a moving object. • The brain area that may be affected is the brain stem. • Typical symptoms: gaze stability, motion sensitivity, disorientation, confusion, fatigue, low energy, sleep disturbances, nervousness, anxiousness. • Typical risks: falling, clumsiness, inaccurate reach, impaired hand-eye coordination. 9/22/2018 RightEye 13

Vertical Pursuits Horizontal Pursuits Circular Pursuits Pursuits Eye movements that follow a target 9/22/2018 RightEye 14

Circular Smooth Pursuit – Control 9/22/2018 RightEye 15

Circular Smooth Pursuit – Severe TBI: RED level 9/22/2018 RightEye 16

Pursuit – Dysfunctional: Brain Location Cerebellum and/or parietal lobe Cerebellum and/or parietal lobe 9/22/2018 RightEye 17

Circular Smooth Pursuit – mTBI: ORANGE level 9/22/2018 RightEye 18

Primary Role of Brain Areas Identified • Parietal Lobe: This dorsal stream has been called both the "where" stream (as in spatial vision) and the "how" stream (as in vision for action). The posterior parietal cortex (PPC) receives somatosensory and/or visual input, which then, through motor signals, controls movement of the arm, hand, as well as eye movements. • Cerebellum: • Receives and regulates eye movements • guarantees the precision of ocular movements to optimize visual performance and occupies a central role in all classes of eye movements both in real-time control and in long-term calibration and learning (i.e., adaptation). 9/22/2018 RightEye 19

Pursuit – Dysfunctional: Lifestyle • Eyes are not working optimally when having to track an object. • The brain area that may be affected are the cerebellum and/or parietal lobe. • Typical symptoms: impaired tracking abilities, sensory disturbances. • Typical risks: misjudging speed of moving objects (e.g. cars when driving), catching a ball, left and right field of view differences. 9/22/2018 RightEye 20

Saccades Fast eye movements designed to reorient focal gaze 9/22/2018 RightEye 21

Horizontal Saccades – Control 9/22/2018 RightEye 22

Horizontal Saccades: Severe TBI: RED level 9/22/2018 RightEye 23

Horizontal Saccades – Dysfunctional: Brain Location Cerebellum and/or frontal lobe Cerebellum and/or frontal lobe 9/22/2018 RightEye 24

Horizontal Saccades: mild TBI: ORANGE level 9/22/2018 RightEye 25

Primary Role of Brain Areas Identified • Frontal Lobe: The cortical area called frontal eye field (FEF) plays an important role in the control of visual attention and eye movements. Electrical stimulation in the FEF elicits saccadic eye movements. The FEF have a topographic structure and represents saccade targets in retinotopic coordinates. • Cerebellum: • Receives and regulates eye movements • guarantees the precision of ocular movements to optimize visual performance and occupies a central role in all classes of eye movements both in real-time control and in long-term calibration and learning (i.e., adaptation). 9/22/2018 RightEye 26

Horizontal Saccades– Dysfunctional: Lifestyle • Eyes are not working optimally when they need to move quickly and may affect accuracy when targeting objects (hypometria or hypermetria). • The brain areas that may be affected are the cerebellum, brain stem and frontal lobe. • Typical symptoms: fatigue, slow to react, slower information processing, impaired executive function, multi-tasking issues, lack of mental clarity, brain “fog”, emotional lability. • Typical risks: reading difficulties, slower to complete tasks (e.g. student may need extra time for exams), quicker to anger, more impulsive. 9/22/2018 RightEye 27