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Katherine Weise OD, MBA, FAAO and Claudio Busettini, PhD test a patient with the head accelerometers/oculomotor system.

New Vestibular Ocular Reflex Lab Captures Data for Assessing Concussions

Does “I feel great, doc,” mean a young athlete has recovered from a concussion sufficiently to return to the fray of contact sports? Or could the eagerness to play be greater than the understanding of what can happen if a brain injury isn’t allowed to heal? And with a condition that doesn’t always show up on a standard CT or MRI, how do you monitor patients who are too young to speak for themselves, or who have other difficulties in communicating?

Between an increasing number of traumatic brain injuries and Alabama’s new law requiring that a physician sign off before young athletes with suspected concussions return to play, having to make a judgment call with very little objective evidence is a situation clinicians are facing more often.

“Both diagnosing and monitoring recovery from a traumatic brain injury can be hindered by an absence of reliable biomarkers. Some functional and metabolic neural alterations aren’t well visualized with existing imaging technology,” UAB Vision Sciences researcher Claudio Busettini, PhD said. “However, even if young athletes who want to get back to their team overstate how well they are doing, eye movements from vestibular ocular reflexes are a test that can’t be fudged.”

UAB School of Optometry and the Department of Rehabilitation are joining forces with Children’s Hospital of Alabama to make a powerful new diagnostic tool available that can provide objective, real-time data on what is happening inside the brain. The new Vestibular and Oculomotor Research Laboratory, or VORLab, will assess signs of acute traumatic brain injury and the cumulative effects of head injuries using a new technology that tracks eye movement in response to changes in body position. The VORLab is the first in Alabama and one of only a few in the United States.

Like a steadycam movie camera with built-in gyros that keep the picture level when a cameraman walks alongside an actor, the vestibular-oculo-reflex system keeps vision clear while the body is in motion. Input from sensors in the inner ear interacts through the brain with eye movements to stabilize retinal images as the body moves through three dimensional space. Patterns of eye movement in the normal brain tend to change with brain injuries. Ongoing research is fine tuning the science of tracking, measuring and monitoring these movement patterns to detect acute injuries and progress as the healing process continues.

Co-director and technical manager of the new facility, Busettini said, “Due to their sensitivity and specificity, vestibular and oculomotor testing may offer powerful biomarkers for both initial diagnosis and short and long-term rehabilitation. The initial focus of the lab will be oculomotor research and evaluating children with mild traumatic brain injuries, with broader applications in research and diagnosis as the program develops.”

The centerpiece of the new lab is a chair system by Neuro Kinetics that performs horizontal, vertical and torsional movements with real time digital tracking of binocular eye movements and stimulus feedback without lag time. The chair can accommodate patients up to 400 pounds, and analysis software tracks and correlates eye movement with the movement of the chair to detect patterns that might indicate a problem.

Katherine Weise, OD, MBA, FAAO is a co-director of the project and heads up the UAB Eye Care Pediatric Clinic, which sees 6,000 patients under 18 each year.

“Younger patients account for a large percentage of traumatic brain injury cases. Their neck muscles tend to be less developed, which puts them at greater risk for rotational injuries. This project is a collaborative effort. We’re working with the departments of Ophthalmology, Neurology, Neurosurgery, and Rehabilitation, as well as Sports Medicine and Bioengineering and other specialties.”

Traumatic brain injuries are the most frequently occurring brain disorder, ahead of stroke and dementia. In very young and elderly patients, falls are the most common cause. Traffic accidents, job related injuries and combat injuries in military personnel add to the toll. Recreation and sports-related injuries are common, particularly in older children, teens and young adults. The American Academy of Pediatrics estimates that up to 3.8 million recreation and sports-related concussions occur annually in the United States.

“In addition to evaluating when it is safe for patients to return to play, what makes an accurate assessment of injuries and healing important in young people is that the brain needs time and rest to heal,” Weise said. “Injured brain cells need more glucose, and returning to study or demanding mental work too soon can compete for resources the healing brain needs and interfere with recovery.”

UAB is also involved in outreach programs to help prevent injuries and increase awareness of symptoms so possible concussions are recognized and children receive appropriate care.

“Among some high school athletic teams, especially in the inner city, being able to take a hard hit and just walk it off is considered something of a badge of honor,” Busettini said. “We’re working with the CDC’s Heads Up initiative and the Wise Up initiative sponsored by the Al and Sharyne Wallace Family Foundation. We want athletes and coaches to be aware that concussions are something to take seriously. We also want to help them learn to recognize symptoms so they will know when an athlete may need follow up.”

Busettini hopes to be on the football sidelines soon testing a more portable form of concussion detection that uses a handheld device to measure changes in pupil movement. In the lab, he and the VOR team will continue doing research looking for new biomarkers to detect concussions.

In the future, the VORLab would potentially be useful in the assessment of NASA astronauts, helping veterans with blast injuries and research into a wide range of conditions including Alzheimer’s and cerebral palsy.

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