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Clinical Utility of Oculomotor and Electrophysiological Measures in Identifying Concussion History

Ledwidge, Patrick S. PhD*,†,‡; Patterson, Jessie N. PhD†,§; Molfese, Dennis L. PhD*,†; Honaker, Julie A. PhD†,§,‖

Clinical Journal of Sport Medicine: July 2019 - Volume 29 - Issue 4 - p 292–297
doi: 10.1097/JSM.0000000000000512
Original Research
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Objective: To examine whether oculomotor and electrophysiological measures improve the clinical performance of the typical concussion protocol for classifying collegiate athletes with a history of concussion.

Design: Cross-sectional.

Setting: University Athletic Medicine and Research Facility.

Participants: Forty-five varsity collegiate athletes.

Independent Variables: Collegiate varsity athletes with or without a history of a diagnosed concussion.

Main Outcome Measures: Multivariate receiver operating curve and area under the curve (AUC) analyses tested the clinical performance of the typical concussion protocol (symptoms, postural control, neuropsychological abilities). We examined differences in clinical performance between this protocol and after adding reflexive saccade and event-related potential (ERP) indices. Hypotheses were formed after data collection.

Results: Significant AUCs were demonstrated for the typical concussion protocol (model 1: AUC = 0.75, P = 0.007), after adding reflexive saccade eye excursion gain (model 2: AUC = 0.80, P = 0.001), and ERPs (model 3: AUC = 0.79, P = 0.002). The AUC for reflexive saccades and ERPs was significant (model 4: AUC = 0.70, P = 0.030). Model 2's increased clinical performance compared with model 1 was nonsignificant, χ2(2) = 1.871, P = 0.171.

Conclusions: All 4 models demonstrated adequate sensitivity and specificity for classifying athletes with a previous concussion. Adding reflexive saccades and ERPs did not significantly increase clinical performance of the typical concussion protocol. Future research should determine the clinical utility of saccades and ERPs for acute postconcussion assessments.

*Department of Psychology, University of Nebraska-Lincoln, Lincoln, Nebraska;

Center for Brain, Biology, and Behavior, University of Nebraska-Lincoln, Lincoln, Nebraska;

Department of Psychology, Baldwin Wallace University, Berea, Ohio;

§Department of Special Education and Communication Disorders, University of Nebraska-Lincoln, Lincoln, Nebraska; and

Cleveland Clinic, Head and Neck Institute, Cleveland, Ohio.

Corresponding Author: Patrick S. Ledwidge, PhD, Department of Psychology, Baldwin Wallace University, 275 Eastland Rd, Berea, OH 44017 (pledwidg@bw.edu).

Supported partially by the National Institutes of Health, NIHR01 HD073202, and the Nebraska Tobacco Settlement Biomedical Enhancement funds.

The authors report no conflicts of interest.

Received February 22, 2017

Accepted July 25, 2017

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