Grading visual impairment in children with brain injury

脑损伤儿童视力障碍分级

• 批准号: 10382300
• 负责人: Glen Thomas Prusky
• 金额: $ 60.35万
• 依托单位: WINIFRED MASTERSON BURKE MED RES INST
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-06-01 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10382300
• 关键词: Admission activity; Affect; Algorithms; Attention; Blindness; Brain Injuries; Caregivers; Child; Childhood; Childhood Injury; Clinical; Clinical Research; Clinical assessments; Cognitive; Color; Communication; Computers; Contrast Sensitivity; Cross-Sectional Studies; Data; Devices; Diagnosis; Diagnostic; Disease; Etiology; Evaluation; Eye; Eye Movements; Frequencies; Functional disorder; Future; Goals; Image; Impairment; Injury; Inpatients; Instinct; Intervention Trial; Knowledge; Left; Measures; Methodology; Methods; Mission; Monitor; Motor; Movement; Natural History; Neurons; Ocular Physiology; Ophthalmology; Participant; Pattern; Pediatric Brain Injury; Plant Roots; Population; Positioning Attribute; Prevalence; Procedures; Prognosis; Property; Public Health; Publishing; Reaction; Recovery; Rehabilitation therapy; Reporting; Research; Research Design; Research Project Grants; Risk; Running; Severities; Stimulus; System; Techniques; Testing; Therapeutic Intervention; Time; United States National Institutes of Health; Variant; Vision; Visual; Visual impairment; Visual system structure; Visuospatial; auditory feedback; base; brain dysfunction; clinical practice; cognitive function; cognitive skill; comorbidity; cortical visual impairment; diagnostic tool; efficacy evaluation; evidence base; expectation; experience; gaze; improved; insight; kinematics; luminance; motor recovery; novel; novel strategies; prognostic tool; remediation; research clinical testing; therapy design; tool; visual dysfunction; visual feedback; visual stimulus; visual threshold; visual tracking

PROJECT SUMMARY/ABSTRACT Visual impairment in children due to brain injury -Cerebral Visual Impairment (CV)- is difficult to objectively assess because children at risk for CVI often lack the requisite verbal and cognitive skills to participate in standard visual assessment procedures. As a result, CVI is commonly diagnosed through subjective evaluations of a child’s gaze-derived reactions to different forms, colors and movements, which has limited insight into its pathophysiology and potential for remediation. Thus, there is a critical need to objectively quantify visual function after brain injury in children, and to characterize how visual impairment changes over time. This research project will evaluate the utility of novel tools we have developed to rapidly and objectively quantify visual function and diagnose CVI from eye movements in brain-injured children, independent of their ability to pay attention and communicate. The system uses a computer to display visual stimuli, and an eye tracking device to measure where a subject is looking. For spatial visual measures (i.e. acuity and contrast sensitivity) we smoothly move a visually interesting band-limited circular image on a computer screen, and an adaptive algorithm evaluates the extent to which the eyes move in concert with the image. When a child smoothly follows the image with their eyes for a few frames -which provides objective evidence that they can see it- stimulus features are changed in real-time to a higher spatial frequency (for acuity) or lower contrast (for contrast sensitivity) until they can no longer follow, which quantifies the limit of their ability in seconds. A variant of the methodology is also able to rapidly quantify gaze diagnostics, such as the velocity, latency and spatial precision of eye movements. Together, these methodologies are able to objectively classify and grade CVI based on visual measures that are rooted in the known physiology of the visual system, and are widely used to evaluate other visual diseases. Our goal in this study is to validate the feasibility of our new approach as a differential diagnostic and prognostic tool for CVI. For this we will evaluate our new gaze-based measures against widely used clinical assessments, to identify and grade visual impairment in children hospitalized for brain injury, and repeat the measures longitudinally. We expect that our approach will be able to identify and grade CVI in many brain-injured children better than current clinical procedures, and better predict the probable course of visual recovery. This evidence-based approach is expected to set the stage for future clinical studies aimed at objectively evaluating the efficacy of therapeutic interventions for CVI.

项目总结/摘要 由于脑损伤导致的儿童视力障碍-脑视力障碍（CV）-很难客观地评估 评估，因为有CVI风险的儿童往往缺乏必要的语言和认知技能， 标准视觉评估程序。因此，CVI通常通过主观诊断， 评估儿童对不同形式，颜色和运动的凝视反应，这限制了 深入了解其病理生理学和补救潜力。因此，迫切需要客观地 量化儿童脑损伤后的视觉功能，并描述视觉障碍如何随着时间的推移而变化。 时间这项研究项目将评估我们开发的新工具的效用，以快速和客观地 量化视觉功能并从脑损伤儿童的眼球运动中诊断CVI， 注意力和沟通的能力。该系统使用计算机来显示视觉刺激， 跟踪设备来测量受试者在看什么。对于空间视觉测量（即敏锐度和对比度 灵敏度），我们在计算机屏幕上平滑地移动视觉上有趣的有限带宽圆形图像， 自适应算法评估眼睛与图像一致移动的程度。当一个孩子 他们的眼睛会平滑地跟随图像几帧-这提供了客观的证据，证明他们可以 看到它-刺激特征实时改变为更高的空间频率（对于敏锐度）或更低的对比度（对于 对比敏感度），直到它们不能再跟随，这以秒为单位量化了它们能力的极限。变体 该方法还能够快速量化凝视诊断，例如速度，延迟和空间 精确的眼球运动。总之，这些方法能够客观地对CVI进行分类和分级 基于植根于视觉系统的已知生理学的视觉测量，并且广泛用于 检查其他视力疾病。我们在这项研究中的目标是验证我们的新方法的可行性， CVI的鉴别诊断和预后工具。为此，我们将评估我们新的基于凝视的措施， 对照广泛使用的临床评估，对因以下原因住院的儿童的视力损害进行识别和分级 脑损伤，并纵向重复测量。我们希望我们的方法能够识别和 在许多脑损伤儿童中，CVI级比目前的临床程序更好，并且更好地预测可能的 视力恢复的过程这种循证方法有望为未来的临床研究奠定基础 目的是客观评价CVI治疗干预的有效性。