Cervicocephalic kinesthetic sensibility, active range of cervical motion, and oculomotor function in patients with whiplash injury

OBJECTIVE: To investigate cervicocephalic kinesthetic sensibility, active range of cervical motion, and oculomotor function in patients with whiplash injury. DESIGN: A 2-year review of consecutive patients admitted to the emergency unit after whiplash injury. SETTING: An otorhinolaryngology department. PATIENTS AND SUBJECTS: Twenty-seven consecutive patients with diagnosed whiplash injury (14 men and 13 women, mean age, 33.8yrs [range, 18 to 66yrs]). The controls were healthy subjects without a history of whiplash injury. MAIN OUTCOME MEASURES: Oculomotor function was tested at 2 months and at 2 years after whiplash injury. The ability to appreciate both movement and head position was studied. Active range of cervical motion was measured. Subjective intensity of neck pain and major medical symptoms were recorded. RESULTS: Active head repositioning was significantly less precise in the whiplash subjects than in the control group. Failures in oculomotor functions were observed in 62% of subjects. Significant correlations occurred between smooth pursuit tests and active cervical range of motion. Correlations also were established between the oculomotor test and the kinesthetic sensibility test. CONCLUSION: The results suggest that restricted cervical movements and changes in the quality of proprioceptive information from the cervical spine region affect voluntary eye movements. A flexion/extension injury to the neck may result in dysfunction of the proprioceptive system. Oculomotor dysfunction after neck trauma might be related to cervical afferent input disturbances.     

Changes in dorsal neck muscle activity related to imposed eye movement in the decerebrate pigeon

Movements of the head and eyes are known to be intimately related. Eye position has also been shown to be closely related to the electromyographic activity of dorsal neck muscles; however, extraocular muscle proprioception has not generally been considered to play a part in the control of such movements. We have previously shown that, in the pigeon, imposed movements of one eye modify the vestibular responses of several dorsal neck muscles in ways that are dependent on stimulus parameters such as the amplitude and velocity of imposed eye movement. The present study examines more closely the interactions between imposed eye movements and different muscle pairs. The three neck muscle pairs studied each responded to afferent signals from the extraocular muscles in discrete and specific ways which appeared to be correlated with their different actions. Complementary effects of imposed eye movements in the horizontal plane were seen for both the complexus and splenius muscle pairs, with imposed eye movements in one direction producing the largest inhibition of the ipsilateral muscle's vestibular response and imposed eye movements in the opposite direction the largest inhibition of the contralateral muscle's vestibular response. During roll tilt oscillation (ear-up/ear-down) in the frontal plane, similar complementary effects of imposed eye movement were seen in the complexus muscle pair, but the splenius muscle pair showed little tuning, with similar inhibition for imposed eye movement directed either upwards or downwards. In contrast to these complementary effects, the biventer cervicis muscle pair showed no vestibular modulation during vestibular stimulation in the horizontal plane and their spontaneous activity was not altered by imposed eye movement. During roll-tilt oscillation (ear-up/ear-down) in the frontal plane imposed eye movement directed vertically upwards increased both muscles' vestibular responses and imposed eye movement directed vertically downwards inhibited both muscles' vestibular responses. Section of the ophthalmic branch of the trigeminal nerve (deafferenting the eye muscles) abolished the effects of imposed eye movement on the neck muscle pairs. In conjunction with further control experiments these results provide compelling evidence that proprioceptive signals from the extraocular muscles reach the neck muscles and provide them with a functionally significant signal. We have previously shown that signals from the extraocular muscles appear to be involved in the control of the vestibulo-ocular reflex. It follows from the experiments reported here that proprioceptive signals from the extraocular muscles are also likely to be involved in the control of gaze.     

Reduced cognitive functions in a group of whiplash patients with demonstrated disturbances in the posture control system

Past studies examining whether or not cognitive changes actually have occurred as a result of a whiplash (WL) accident have produced varying results. The aim of this study was to identify possible cognitive dysfunctions in a group with persistent problems after whiplash due to injuries to the posture control system and related structures. The whiplash subjects (n = 23) were selected on the basis of their reduced gain in the Smooth Pursuit Neck Torsion test (SPNT). The WL group differed significantly from a closely matched control group on tests of learning and memory, and prolonged divided attention and concentration. After attempting to rule out other ways of interpreting these differences (such as pain, depression, medication, and premorbid health problems), these data were interpreted as lending support to the notion of a causal connection between the disturbed posture control system and some cognitive malfunctions.     

MRI of cerebrum and cervical columna within two days after whiplash neck sprain injury

The present study was undertaken to evaluate if MRI within 2 days of a motor vehicle accident could reveal pathology of importance for understanding long-term disability after whiplash neck-sprain injuries. As part of a prospective study cervical and cerebral MRI was performed on 40 neck sprain patients with whiplash injury after car accidents. The imaging was done within 2 days of the injury to make sure that any neck muscle bleeding, oedema or other soft tissue injuries could be detected. The MRI findings from the patients were both correlated to reported symptoms 6 months after the accident and compared to a control group of 20 volunteers. The MRI of both brain and neck revealed no significant differences between the patients and the control group. When the patients were grouped according to the main MRI findings at intake and compared according to the development of subjective symptoms reported by the patients, the only significant difference was more headaches at 6 months in the groups with disk pathology or spondylosis when compared to the group with no pathology. In conclusion, MRI within 2 days of the whiplash neck-sprain injury could not detect pathology connected to the injury nor predict symptom development and outcome.     

Eye movement efficiency in normal and reading disabled elementary school children: effects of varying luminance and wavelength

BACKGROUND: This investigation examines the question of whether decreasing wavelength of light and/or reducing luminance benefits oculomotor efficiency in normal and reading disabled (RD) children. METHODS: Two groups of children were identified as normal or disabled readers using standardized reading tests. After suitable practice, eye movements were objectively measured with the Visagraph II as each of the subjects silently read a series of three different selections at their independent reading level with clear (control), gray, and blue filters. Four variables were measured for each subject. Data were analyzed using a repeated measure ANOVA and post hoc tests. RESULTS: The standardized reading tests significantly differentiated average from poor readers using grade scores and percentiles. Initially, with clear filters, eye movement scores of normal readers were superior to disabled readers for fixations regressions, and rate of reading. Among the RDs--but not the normals--the three variables improved with the blue filter when compared with the clear filter, number of fixations and regressions were significantly lower, and rate was significantly higher. Gray filters yielded no significant changes. Improvement with the blue filters normalized the three variables in that there were no significant differences between normal and disabled readers. CONCLUSION: This investigation confirms a link between wavelength of light and eye movement efficiency in reading. Blue filters resulted in a significant improvement in the number of fixations and regressions and rate of reading in RD children. The outcome broadens the concept of transient system deficit established in previous research to include the effect on oculomotor efficiency. The educational implications of this study are of special interest to optometrists.     

Eye movements in reading and information processing.

Reviews studies of eye movements in reading and other information-processing tasks such as picture viewing, visual search, and problem solving. The major emphasis of the review is on reading as a specific example of the more general phenomenon of cognitive processing. Basic topics discussed are the perceptual span, eye guidance, integration across saccades, control of fixation durations, individual differences, and eye movements as they relate to dyslexia and speed reading. In addition, eye movements and the use of peripheral vision and scan paths in picture perception, visual search, and pattern recognition are discussed, as is the role of eye movements in visual illusion. The basic theme of the review is that eye movement data reflect the cognitive processes occurring in a particular task. Theoretical and practical considerations concerning the use of eye movement data are also presented. (7? p ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Eye movements in reading and information processing: 20 years of research

Recent studies of eye movements in reading and other information processing tasks, such as music reading, typing, visual search, and scene perception, are reviewed. The major emphasis of the review is on reading as a specific example of cognitive processing. Basic topics discussed with respect to reading are (a) the characteristics of eye movements, (b) the perceptual span, (c) integration of information across saccades, (d) eye movement control, and (e) individual differences (including dyslexia). Similar topics are discussed with respect to the other tasks examined. The basic theme of the review is that eye movement data reflect moment-to-moment cognitive processes in the various tasks examined. Theoretical and practical considerations concerning the use of eye movement data are also discussed.     

Quantifying serum antiplague antibody with a fiber-optic biosensor

Several studies of patients with chronic cervical pain and chronic whiplash syndrome report a high frequency of oculomotor function derangements pointing towards brainstem involvement and/or default sensory input from neck afferents. In light of these reports, it seems important to investigate other patient groups with similar upper cervical spine disorders. In this study, voluntary eye motor performance was evaluated in 11 rheumatoid patients (RA) with upper cervical dislocation and a clearly noticed joint affection of the cervical spine. The results were compared with 6 RA patients without cervical engagement and normal individuals. Nine of the 11 patients with atlanto-axial dislocation showed pronounced oculomotor disturbances of smooth pursuits compared with only minor changes in the control group. The pattern of oculomotor dysfunction in patients with rheumatoid cervical dislocation indicates brainstem involvement, which may be an early sign of brainstem affection/myelopathy.     

The relationship between visual attention and eye movements.

Experimental psychologists have recently amassed a great deal of evidence supporting the hypothesis that the visual system can select a particular location over other locations in the visual field for further analysis without overtly orienting the eyes to the selected location. At the same time, we know that during reading and scene perception, the eyes are overtly directed to new regions of the visual field every 200 to 300 msec on average. How are covert shifts of attention and overt movements of the eyes related during complex visual-cognitive tasks? The available evidence from studies of the perceptual span in reading suggests that attention is allocated asymmetrically around the fixation point, with more information acquired in the direction that the eyes are moving. Based on this evidence and evidence from explorations of eye movement control in reading, the author presents a tentative model of the relationship between attention and eye movements, called the Sequential Attention Model. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predictive eye movements do not discriminate between dyslexic and control children

Pavlidis has suggested that predictive saccadic tracking eye movements distinguish between reading disabled and normal children. We have examined saccadic eye movement tracking in 34 dyslexic and 33 control subjects, between 10 and 12 yr old. The subjects were equivalent in performance IQ (WISC-R), with differences between verbal and performance IQ of less than 30 points. Children with neurological, visual or auditory deficits or histories of emotional problems and hyperactivity were excluded. There were no differences between the groups on the eye movement tracking task when scored objectively by computerized analysis of the eye movement records, or by ranking of the records by an experienced observer. Our results (and those of other recent studies) fail to support Pavlidis' contention that eye movements hold the key to dyslexia.     

Eye movements, prematurity and developmental co-ordination disorder

Horizontal pursuit eye movements were investigated in two separate groups of children: One group exhibited developmental co-ordination disorder (n = 8) whilst another group of children were born prematurely (n = 8). Both studies found a reduced gain in pursuit eye movements when the respective populations were compared with control groups (n = 32). A difference was also found in the ability of some children to temporally synchronize their tracking response to the stimulus, which was indicative of poor predictive control rather than lags in the control system. We suggest that horizontal eye movements may be a sensitive indicator of more general motor deficits during childhood development.     

Colocalisation of taurine- with transmitter-immunoreactivities in the nervous system of the migratory locust

The validity of whiplash syndrome has been a source of debate in the medical literature for many years. Some authors have published articles suggesting that whiplash injuries are impossible at certain collision speeds; others have stated that the problem is psychological, or is feigned as a means to obtain secondary financial gain. These articles contradict the majority of the literature, which shows that whiplash injuries and their sequelae are a highly prevalent problem that affects a significant proportion of the population. The authors of the current literature critique reviewed the biomedical and engineering literature relating to whiplash syndrome, searching for articles that refuted the validity of whiplash injuries. Twenty articles containing nine distinct statements refuting the validity of whiplash syndrome were found that fit the inclusion criteria. The methodology described in these articles was evaluated critically to determine if the authors' observations regarding the validity of whiplash syndrome were scientifically sound. The authors of the current critique found that all of the articles contained significant methodologic flaws with regard to their respective authors' statements refuting the validity of whiplash syndrome. The most frequently found flaws were inadequate study size, nonrepresentative study sample, nonrepresentative crash conditions (for crash tests), and inappropriate study design. As a result of the current literature review, it was determined that there is no epidemiologic or scientific basis in the literature for the following statements: whiplash injuries do not lead to chronic pain, rear impact collisions that do not result in vehicle damage are unlikely to cause injury, and whiplash trauma is biomechanically comparable with common movements of daily living.     

Torticollis due to disinhibition of the vestibulo-collic reflex in a patient with Steele-Richardson-Olszewski syndrome

A patient with the clinical picture of Steele-Richardson-Olszewski syndrome and an unusual intermittent neck twisting is reported. He had virtually no voluntary ocular movements and only very slow, low-amplitude voluntary head movements. However, in response to optokinetic or vestibular stimulation, he developed full eye deviations in the direction of the slow phase of the expected nystagmus. No quick phases were observed, and the deviation outlasted the duration of the vestibular stimuli because of defective saccades. The head also turned fully during these stimuli, quicker than on attempted voluntary movements, and remained deviated similarly to the eyes. This suggests that the neck deviations in this patient were due to a disinhibited vestibulo-collic reflex and a disturbed head position resetting mechanism. Neck electromyographic responses in response to whole-body rotation indicated that the vestibulocollic reflex responsible for the torticollis in this patient had a short latency of approximately 30 ms.     

Eye movements evoked by proprioceptive stimulation along the body axis in humans

Proprioceptive input arising from torsional body movements elicits small reflexive eye movements. The functional relevance of these eye movements is still unknown so far. We evaluated their slow components as a function of stimulus frequency and velocity. The horizontal eye movements of seven adult subjects were recorded using an infrared device, while horizontal rotations were applied at three segmental levels of the body [i.e., between head and shoulders (neck stimulus), shoulders and pelvis (trunk stimulus), and pelvis and feet (leg stimulus)]. The following results were obtained: (1) Sinusoidal leg stimulation evoked an eye response with the slow component in the direction of the movement of the feet, while the response to trunk and neck stimulation was oriented in the opposite direction (i.e., in that of the head). (2) In contrast, the gain behavior of all three responses was similar, with very low gain at mid- to high frequencies (tested up to 0.4 Hz) but increasing gain at low frequencies (down to 0.0125 Hz). We show that this gain behavior is mainly due to a gain nonlinearity for low angular velocities. (3) The responses were compatible with linear summation when an interaction series was tested in which the leg stimulus was combined with a vestibular stimulus. (4) There was good correspondence of the median gain curves when eye responses were compared with psychophysical responses (perceived body rotation in space; additionally recorded in the interaction series). However, correlation of gain values on a single-trial basis was poor. (5) During transient neck stimulation (smoothed position ramp), the neck response noticeably consisted of two components -- an initial head-directed eye shift (phasic component) followed by a shift in the opposite direction (compensatory tonic component). Both leg and neck responses can be described by one simple, dynamic model. In the model the proprioceptive input is fed into the gaze network via two pathways which differ in their dynamics and directional sign. The model simulates either leg or neck responses by selecting an appropriate weight for the gain of one of the pathways (phasic component). The interaction results can also be simulated when a vestibular path is added. This model has similarities to one we recently proposed for human self-motion perception and postural control. A major difference, though, is that the proprioceptive input to the gaze-stabilizing network is weak (restricted to low velocities), unlike that used for perception and postural control. We hold that the former undergoes involution during ontogenesis, as subjects depend on the functionally more appropriate vestibulo-ocular reflex. Yet, the weak proprioceptive eye responses that remain may have some functional relevance. Their tonic component tends to stabilize the eyes by slowly shifting them toward the primary head position relative to the body support. This applies solely to the earth-horizontal plane in which the vestibular signal has no static sensitivity.     

Dizziness from whiplash and head injury: differences between whiplash and head injury

OBJECTIVE: Large discrepancies exist in the literature regarding incidence and types of symptomatology in whiplash. This is because of the evolution of whiplash injury over the years with the advent of head rests and seat belts. Previous authors have regarded symptoms of dizziness as a result of brainstem or cerebellar injury or both. It has been difficult in those studies to ascribe a mechanism of injury, as patients with whiplash injury only have been grouped with those who have incurred mild traumatic brain injury as a result of a significant blow to the head. The authors saw the need to delineate patients who had suffered whiplash injury from those who also had suffered mild head injury, as defined in the rehabilitation-neurosurgical literature, to attempt to define differences in symptoms, abnormalities, and mechanisms of recovery in these two groups. STUDY DESIGN: The study design was a retrospective case review. SETTING: The study was conducted at a tertiary-quaternary referral clinic. PATIENTS: The records of 36 patients were reviewed. Nineteen of these patients suffered a whiplash-associated disorder and 17 suffered a mild head injury as well. These patients were referred for assessment of symptoms persisting for at least 2 years after their injury. Patients were excluded if they had not completed clinical assessment, including electronystagmography (ENG) and computerized dynamic posturography (CDP). INTERVENTIONS: A full history, otolaryngologic examination, including assessment of eye movements, corneal reflexes and gait, as well as an investigation, including ENG and CDP, and history taking and detailed recording of related complaints immediately before diagnostic work-up were performed. MAIN OUTCOME MEASURES: Symptoms reported by patients who had received either whiplash alone or whiplash plus mild head trauma as defined in the literature were measured. Patients were classified according to type of accident, type of injury suffered, and degree and nature of posturographic abnormalities. RESULTS: Patients often have similar complaints regardless of whether or not they had suffered a head injury. Although CDP showed abnormalities in both groups, standard ENG assessment, including caloric testing, showed abnormalities only in the head-injured group. The posturographic abnormalities also were analyzed in both groups, and it was found that there was a correlation between the type of posturographic abnormality and the type of injury suffered. Although ENG testing is done routinely, posturography is shown to be more sensitive in picking up abnormalities. In addition, the authors have shown that posturography can delineate the type of injury suffered by exhibiting the compensation strategy used as well as the efficacy of that compensation strategy. CONCLUSIONS: Because ENG abnormalities are limited to patients who have suffered a head injury, the inference is that these two groups of patients have suffered damage at different sites along the balance system pathways, but both of these lesions can lead to similar symptoms. Although the mechanisms of whiplash injury and how they affect the vestibular system are poorly understood, posturography testing is essential in inferring how a patient is recovering by measuring how and how well the patient is overcoming his or her deficit. This has important medical legal implications regarding legitimizing a patient's problem, prognostic factors, as well as rehabilitation plans, measures, and outcomes.     

Recent studies of eye movements in reading.

Grouping the studies under the general topic headings of techniques of measurement, analysis of the reading process, training to improve eye movements, typography and eye movements, and eye movements and fatigue the author reviews the relevant research literature which has appeared since January, 1945. In general there has been a dimunition of interest in this area. However, there has appeared a large amount of work on visual fixation, speed of eye movements, reaction time of the eye, oculomotor efficiency, and vision during eye movements. There is a need for more basic research. 72-item bibliography. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Motion analysis in whiplash injuries

Motion analysis of the cervical spine is a sensitive tool in the fields of preventive and clinical biomechanics of whiplash. In the field of preventive biomechanics motion analysis contributes to validation and optimisation of dummy based crash test experiments and simulations. In the clinical field motion analysis up to now is of restricted value. Data exist about restrictions and pathologies of movement and motion of the cervical spine, coordinative disturbances, postural control, TMJ-function and oculomotor disturbances after whiplash. The standardisation of technical and clinical set-ups is necessary to establish a well proven biomechanical model of whiplash and whiplash related biomechanical dysfunction. Without this model the value of motion analysis for clinical use will be restricted due to lack of comparable data on sensitivity and specificity although motion analysis of the cervical spine is neither cost- nor time consuming and free of adverse effects. Within a prospective series of 28 patients (14 m/14 f) with a follow-up to six weeks we were lucky to describe numerically two different types of reaction to low energy (delta v < 20 km/h) rear end collision: Type I with disturbances in complex movements only, Type II with overall restriction of movement. Control of angular velocity during cyclic movements of the head was disturbed by oscillations of higher frequency in all patients. Recovery from whiplash within 6 weeks could be monitored.     

Toward a model of eye movement control in reading

The authors present several versions of a general model, titled the E-Z Reader model, of eye movement control in reading. The major goal of the modeling is to relate cognitive processing (specifically aspects of lexical access) to eye movements in reading. The earliest and simplest versions of the model (E-Z Readers 1 and 2) merely attempt to explain the total time spent on a word before moving forward (the gaze duration) and the probability of fixating a word; later versions (E-Z Readers 3-5) also attempt to explain the durations of individual fixations on individual words and the number of fixations on individual words. The final version (E-Z Reader 5) appears to be psychologically plausible and gives a good account of many phenomena in reading. It is also a good tool for analyzing eye movement data in reading. Limitations of the model and directions for future research are also discussed.     

Signal-dependent noise determines motor planning

When we make saccadic eye movements or goal-directed arm movements, there is an infinite number of possible trajectories that the eye or arm could take to reach the target. However, humans show highly stereotyped trajectories in which velocity profiles of both the eye and hand are smooth and symmetric for brief movements. Here we present a unifying theory of eye and arm movements based on the single physiological assumption that the neural control signals are corrupted by noise whose variance increases with the size of the control signal. We propose that in the presence of such signal-dependent noise, the shape of a trajectory is selected to minimize the variance of the final eye or arm position. This minimum-variance theory accurately predicts the trajectories of both saccades and arm movements and the speed-accuracy trade-off described by Fitt's law. These profiles are robust to changes in the dynamics of the eye or arm, as found empirically. Moreover, the relation between path curvature and hand velocity during drawing movements reproduces the empirical 'two-thirds power law. This theory provides a simple and powerful unifying perspective for both eye and arm movement control.     

The role of eye and head movements in detecting information about fly balls.

The authors attempted to identify perceptual mechanisms that pick up information for initiating a run to catch fly balls and for judging their landing locations. Fly balls have been shown to be tracked with the eyes and head (R. R. D. Oudejans, C. F. Michaels, F. C. Bakker, & K. Davids, 1999). This raised the question of whether constraining eye and head movements of experienced baseball players by having them wear eye-movement-preventing goggles (eye movements would lead to losing sight of the ball) or a head-movement-preventing neck brace, or both, would limit their capacity (a) to start running in the correct direction and (b) to make correct judgments about the balls' landing locations. Restrictions had minimal effects on response accuracy, but response latency was affected. The goggles increased latency of both running and judging. Moreover, the neck brace decreased judgment time, particularly for difficult balls, suggesting that head stability is important for making judgments. High performance levels suggested that the perceptual system was flexible; that is, different parts of the system can perform the same function. The implications of these findings for perceptual mechanisms are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)