Oculometric Assessment of Sensorimotor Impairment Associated with TBI

PURPOSE: Diffuse tissue damage from impact or blast traumatic brain injury (TBI) degrades information processing throughout the brain, often resulting in impairments in sensorimotor function. We have developed an eye-movement assessment test, consisting of a simple, appropriately randomized, radial tracking task together with a broad set of oculometric measures that can be combined to yield a sensitive overall indicator of sensorimotor functional status. We show here that this multidimensional method can be used to detect and characterize sensorimotor deficits associated with TBI. METHODS: To compare dynamic visuomotor processing of TBI subjects (n = 34) with a separate control population (n = 41), we used the Comprehensive Oculometric Behavioral Response Assessment (COBRA) method (Liston & Stone, J Vision. 14:12, 2014) to quantify 10 performance metrics for each subject. Each TBI subject's set of oculometrics was then combined to compute a single TBI impairment vector whose magnitude we refer to as the impairment index. RESULTS: In our TBI population, several individual oculometrics were significantly degraded, including pursuit latency, initial pursuit acceleration, pursuit gain, catch-up saccade amplitude, proportion smooth tracking, and speed responsiveness. Furthermore, the TBI impairment index discriminated TBI subjects from controls with an 81% probability that increased with self-reported TBI severity; although the 9 subjects self-reporting “little-to-no” residual impairment were statistically indistinguishable from controls (58% probability), the remaining 25 subjects were easily detectable (91% probability). Given the demonstrated link between higher-order visual perception/cognition and eye movements, we interpret the observed TBI-related impairments as degradations in the speed, accuracy, and precision of information processing within cortical circuits supporting higher-order visual processing and sensorimotor control, not just low-level brainstem motor deficits. CONCLUSIONS: We conclude that multidimensional oculometric testing could be used as a sensitive screen for subtle neurological signs of subclinical neurological insults, to quantify functional impairment, to monitor deterioration or recovery, and to evaluate treatment efficacy.