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Covert Tracking to Visual Stimuli in Comatose Patients With Traumatic Brain Injury
Ayham Alkhachroum1, Gabriela Aklepi2, Amin Sarafraz2
1From the Department of Neurology (A.A., G.A., B.M.M., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.), University of Miami; Jackson Memorial Hospital (A.A., G.A., C.F.B., E.S., D.H.B., P.G., D.S., N.M., M.K., A.M., S.D., T.R., K.O.P.); University of Miami Center for Computational Science (A.S.); Neuroscience Graduate Program (L.E.R.), The Miami Project to Cure Paralysis (L.E.R., W.D.D.), Department of Kinesiology and Sport Sciences (B.A.), and Department of Neurosurgery (J.R.J., W.D.D.), University of Miami, FL; Department of Neurology (J.C.), Columbia University, New York, NY; and Department of Neurology (M.F.W.), Case Western Reserve University, Louis Stokes Cleveland VA Medical Center, OH. axa2610@med.miami.edu.
Objectives:
This study investigated video eye tracking (VET) in comatose patients with traumatic brain injury (TBI).
Methods:
We recruited healthy participants and unresponsive patients with TBI. We surveyed the patients' clinicians on whether the patient was tracking and performed the Coma Recovery Scale-Revised (CRS-R). We recorded eye movements in response to motion of a finger, a face, a mirror, and an optokinetic stimulus using VET glasses. Patients were classified as covert tracking (tracking on VET alone) and overt tracking (VET and clinical examination). The ability to obey commands was evaluated at 6-month follow-up.
Results:
We recruited 20 healthy participants and 10 patients with TBI. The use of VET was feasible in all participants and patients. Two patients demonstrated covert tracking (CRS-R of 6 and 8), 2 demonstrated overt tracking (CRS-R of 22 and 11), and 6 patients had no tracking (CRS-R of 8, 6, 5, 7, 6, and 7). Five of 56 (9%) tracking assessments were missed on clinical examination. All patients with tracking recovered consciousness at follow-up, whereas only 2 of 6 patients without tracking recovered at follow-up.
Discussion:
VET is a feasible method to measure covert tracking. Future studies are needed to confirm the prognostic value of covert tracking.
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