Neurolign Published Research

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Neurolign Clinical Research

Neurolign, formerly Neuro Kinetics Inc., is the world leader in clinical eye-tracking. Take a look at a few of our published research articles below.

"Normative data for ages 18-45 for ocular motor and vestibular testing using eye-tracking."
Kullmann A, Ashmore RC, Braverman A, Mazur C, Snapp H, Williams E, Szczupak M, Murphy S, Marshall K, Crawford J, Balaban CD, Hoffer M, Kiderman A. Laryngoscope, Investigative Otolaryngology. 2021;1–12, DOI: 10.1002/lio2.632.

Reference values for eye movements in response to different patterns of stimuli were analyzed from 290 to 449 participants. Data were pooled and presented for each test metric as the 95% reference interval (RI) with 90% confidence intervals (CI) on upper and lower limits of the RI. Normative data was approved by FDA. Read More

"Distinctive Convergence Eye Movements in an Acquired Neurosensory Dysfunction."
Balaban CD, Szczupak M, Kiderman A, Levin BE, Hoffer ME. Front Neurol. 2020;11:469. doi: 10.3389/fneur.2020.00469. eCollection 2020. PubMed PMID: 32655474; PubMed Central PMCID: PMC7325881.

From late 2016 to 2017, several individuals who were on diplomatic visits to Havana, Cuba, began to complain of ear pain, dizziness, and tinnitus after the visits.  When these individuals were examined at the University of Miami, they showed both otolithic abnormality and symptoms associated with mild traumatic brain injury (mTBI). This study was based on analysis of Dx100 video-oculography data of vergence test and pupillary light reflex performance. It was determined that pattern difference in eye and pupil behavior may be a useful screen to help objectively distinguish trauma from Havana-type effects and mTBI and guide the affected individuals to appropriate care. Read More

"Peripheral Vestibular and Balance Function in Athletes With and Without Concussion."
Christy JB, Cochrane GD, Almutairi A, Busettini C, Swanson MW, Weise KK. J Neurol Phys Ther. 2019 Jul;43(3):153-159. doi: 10.1097/NPT.0000000000000280. PubMed PMID: 31205229; PubMed Central PMCID: PMC6590702.

When sports-related concussion (SRC) is suspected, the person in question should receive a complete neurological evaluation.  However, there are no base results for some tests that are used to compare a concussed individual to in some cases.  This study first examined a group of healthy athletes to get a base data set for vestibular and balance tests and then compared to those who had suspected SRC. No significant difference was found between the tests of peripheral vestibular function (rotary chair test and cervical vestibular-evoked myogenic potential (c-VEMP) test). Individuals with SRC had worse scores on the Sensory Organization Test and vestibular-ocular testing. Read More

"Oculomotor, Vestibular, and Reaction Time Effects of Sports-Related Concussion: Video-Oculography in Assessing Sports-Related Concussion."
Kelly KM, Kiderman A, Akhavan S, Quigley MR, Snell ED, Happ E, Synowiec AS, Miller ER, Bauer MA, Oakes LP, Eydelman Y, Gallagher CW, Dinehart T, Schroeder JH, Ashmore RC. J Head Trauma Rehabil. 2019 May/Jun;34(3):176-188. doi: 10.1097/ HTR.0000000000000437. PubMed PMID: 30234848; PubMed Central PMCID: PMC6553977.

There is no one test that can diagnose concussion. Video-oculography, in which eye movements are tracked by stimuli, tasks, and reflexive movements, can provide signs of brain injury that might indicate concussion.  This study involved a group of high school athletes with concussion diagnosis and used video-oculography to assess oculomotor, vestibular, and reaction time, and compared them to a control group of athletes who underwent the same tests.  The group who had suffered from concussion performed poorly on  smooth pursuit tracking and optokinetic nystagmus tests, indicating that those tests can be part of the diagnosis of concussion or traumatic brain injury. Read More

"Acute findings in an acquired neurosensory dysfunction."
Hoffer ME, Levin BE, Snapp H, Buskirk J, Balaban C. Laryngoscope Investig Otolaryngol. 2019 Feb;4(1):124-131. doi: 10.1002/lio2.231. eCollection 2019 Feb. PubMed PMID: 30828629; PubMed Central PMCID: PMC6383299.

Another study of those diplomats in Havana who reported various neurological difficulties after visiting the city.  They reported the symptoms began after experiencing a high-pitched noise as well as pressure on the ears.  This study compared those who reported such an instance to those who were in Havana and experienced no such sensation.  Both groups were subjected to various examinations of the neuro-otologic systems. The group who experienced the noise had far greater instance of dizziness, ear pain, tinnitus, and cognitive issues. Those who reported dizziness had a higher instance of abnormal results on various vestibular tests.  No definitive explanation for these symptoms could be found, but they are consistent with certain effects of concussion. Read More

"Neurosensory Disorders in Mild Traumatic Brain Injury."
Balaban C, Yankastas K, Kiderman A. Emerging Diagnostic Modalities. 2019.

This is a chapter in a book about using different diagnostic techniques to diagnose mild traumatic brain injury (mTBI). mTBI is often difficult to diagnose because the lapse of consciousness in the patient is brief and there are no imaging findings that show brain injury.  Any markers that may be found are of little use unless there is some way to objectively document them.  Certain neurocognitive tests, like the Post-Concussion Symptom Scale and the Sport Concussion Assessment Tool, are of assistance in diagnosing mTBI.  Imaging tests can be run but often show nothing abnormal.  EEG activity is sometimes able to show more subtle defects.

"Patterns of Pupillary Activity During Binocular Disparity Resolution."
Balaban CD, Kiderman A, Szczupak M, Ashmore RC, Hoffer ME. Front Neurol. 2018;9:990. doi: 10.3389/fneur.2018.00990. eCollection 2018. PubMed PMID: 30534109; PubMed Central PMCID: PMC6276540.

Binocular disparity is one way that three dimensional objects are located by the eye.  This study used a virtual reality display to test the response of binocular disparity by itself without the other responses of the eye typically found in such tests.  Neurolign’s Dx100 was used to track and record pupil response and eye movement. Divergent and convergent eye movements were the primary means that the eyes of the subjects used to track the objects, with alternating pupillary response to convergent and divergent movements. Convergent movements produced pupilar constriction and divergent movements produced pupilar dilation. Read More

"Examination of Utricular Response Using oVEMP and Unilateral Centrifugation Rotation Testing."
Zalewski CK, Ackley RS, McCaslin DL, Clark MD, Hanks WD, Brewer CC. Ear Hear. 2018 Sep/Oct;39(5):910-921. doi: 10.1097/AUD.0000000000000552. PubMed PMID: 29432406; PubMed Central PMCID: PMC6425474.

The ability to assess vestibular maculae has increased dramatically over the past two decades.  However, both utricular function through ocular vestibular-evoked myogenic potentials (oVEMP) and unilateral centrifugation (UCF) testing have not been studied in relation to each other. This study used Neurolign NOTC system  and compared UCF outcome measures of ocular counter roll, subjective visual vertical, and ocular counter roll-gravitational inertial acceleration slope with  peak to peak oVEMP N1-P1 amplitude.  No relational response was found between the two different stimuli, indicating that both responses may be controlled by different systems.  It also indicates that utricular sensitivity cannot be directly determined by either test. Read More

"Long-term effects of mild traumatic brain injuries to oculomotor tracking performances and reaction times to simple environmental stimuli."
Danna-Dos-Santos A, Mohapatra S, Santos M, Degani AM. Sci Rep. 2018 Mar 15;8(1):4583. doi: 10.1038/s41598-018-22825-5. PubMed PMID: 29784923; PubMed Central PMCID: PMC5962641.

The long-term effects of concussion need to be more widely understood for both treatment and prevention.  This study utilized Neurolign video-oculography system to test oculomotor performance in those who had previously suffered mild traumatic brain injury (mTBI).  The tests included assessment of horizontal smooth pursuit tasks, horizontal saccadic movements, and reaction time. Result revealed the presence of abnormal saccadic eye movements while performing horizontal smooth pursuit, diminished accuracy of primary saccadic horizontal eye movement, and a slower reaction to both visual and auditory stimuli. Read More

"Vestibular Test Patterns in the NICoE Intensive Outpatient Program Patient Population."
King JE, Pape MM, Kodosky PN. Mil Med. 2018 Mar 1;183(suppl_1):237-244. doi: 10.1093/milmed/usx170. PubMed PMID: 29635576.

Traumatic brain injury (TBI) remains one of the most common diagnoses in returning Service Members (SM).  This study assessed various tests of vestibular activity to determined which ones produced the most consistent results in TBI patients. Results of this study indicated that oculomotor tests, particularly pursuit and saccade, were most often abnormal. The vertical subtests of the pursuit and saccade tests were abnormal more frequently than the horizontal subtests, suggesting that the vertical subtests should be utilized when evaluating the TBI population. Overall, oculomotor tests of vertical pursuit and saccades, as well as tests of central vestibular function, appear useful for detecting neurologic changes in active duty SMs with chronic symptoms after TBI. Read More

"The use of oculomotor, vestibular, and reaction time tests to assess mild traumatic brain injury (mTBI) over time."
Hoffer ME, Balaban C, Szczupak M, Buskirk J, Snapp H, Crawford J, Wise S, Murphy S, Marshall K, Pelusso C, Knowles S, Kiderman A. Laryngoscope Investig Otolaryngol. 2017 Aug;2(4):157-165. doi: 10.1002/lio2.74. eCollection 2017 Aug. PubMed PMID: 28894835; PubMed Central PMCID: PMC5562938.

This study aimed to measure oculomotor, vestibular, and reaction time in individuals that had suffered mild traumatic brain injury (mTBI) and compared them with a control group. The individuals with mTBI were recruited from University of Miami, Naval Medical Center San Diego, and Madigan Army Medical Center emergency rooms where they had a documented mTBI.  The tests that showed the maximum differentiation between these  groups were crHIT  predictive saccade, anti-saccade, optokinetic and the horizontal smooth pursuit. Six measures from 5 tests can classify the control and mTBI up to one week after event with a true positive rate (sensitivity) of 84.9% and true negative rate (specificity) of 97.0%. Patterns of abnormalities changed over time in the mTBI group and overall normalized in a subset of individuals after two weeks. Read More

"Oculomotor, Vestibular, and Reaction Time Tests in Mild Traumatic Brain Injury."
Balaban C, Hoffer ME, Szczupak M, Snapp H, Crawford J, Murphy S, Marshall K, Pelusso C, Knowles S, Kiderman A. PLoS One. 2016; 11(9):e0162168. doi: 10.1371/journal.pone.0162168. eCollection 2016. PubMed PMID: 27654131; PubMed Central PMCID: PMC5031310.

Like the previous study, this study also tested oculomotor, vestibular, and reaction times in those with mild traumatic brain injury (mTBI). Two groups of fifty individuals with mTBI along with a control group were subjected to a battery of tests that could be used to diagnose brain injury.  Three different tests showed a very high (89% sensitivity and 95% specificity) indication of distinguishing those with mTBI versus those who did not. Read More

"Neurosensory Symptom Complexes after Acute Mild Traumatic Brain Injury."
Hoffer ME, Szczupak M, Kiderman A, Crawford J, Murphy S, Marshall K, Pelusso C, Balaban C. PLoS One. 2016;11(1):e0146039. doi: 10.1371/journal.pone.0146039. eCollection 2016. PubMed PMID: 26727256; PubMed Central PMCID: PMC4699767.

The majority of diagnoses of mild traumatic brain injury (mTBI) are based on reported symptoms and are thus subjective. This study compared the reported symptoms of individuals with mTBI to a control group to examine how vestibular testing can be used to diagnose mTBI.  Both groups had a detailed medical history, a symptom checklist administered by the investigators, and several tests of vestibular function.  The tests included the Dizziness Handicap Inventory (DHI), Trail Making Tests A and B (TMTA, TMTB), Functional Gait Assessment (FGA), and a rotational chair test battery.  All symptoms from the checklist occurred at a greater rate in the mTBI group than in the control group, with a varying amount of significance.  This indicates that that questionnaire on its own could be sufficient as a diagnostic indicator. Read More

"The horizontal computerized rotational impulse test." Furman JM, Shirey I, Roxberg J, Kiderman A. J Vestib Res. 2016;26(5-6):447-457. doi: 10.3233/VES-160595. PubMed PMID: 28262644.

The head impulse test (HIT) consists of manual head rotations and observation of eye movement and is considered to be a valuable test of unilateral horizontal semicircular canal function.  Another version of this test, the video head impulse test (vHIT), uses video recording to determine head and eye position, and is more precise in recording head rotations and eye movement.  This study aimed to test a modified version of the vHIT, the computerized rotational head impulse test (crHIT).   This study demonstrated that the horizontal crHIT is a new assessment tool that overcome many of the limitations of manual head impulse testing and provided a reliable measure of unilateral horizontal semicircular canal function. Read More

"Rotary chair (Diagnostic Procedure)"
González, JE, Kiderman, A. Encyclopedia of Otolaryngology, Head and Neck Surgery. 2013

Definition of the rotary chair test as a diagnostic procedure was defined  The test is developed to  evaluate human vestibulo-ocular reflex (VOR) is through the motorized angular stimulation of the horizontal semicircular canals.  The test is most widely used for diagnosis of vestibular problems but can also be used for TBI diagnosis.  The test is performed in darkness. Read More

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