The Quantification of Visual Function and Postural Stability Under Single- and Dual-Task Conditions Using Mobile Technology
Abstract
Service members in the battlefield are required to react quickly and accurately in threatening situations, especially those conditions that require multitasking. Even subtle impairments in processing time or visual acuity coupled with balance or cognitive declines endanger Soldiers and their fellow Service members. Traditional methods of mild traumatic brain injury (mTBI) assessment may assess reaction time or cognitive function in an isolated manner, but none evaluate balance while performing a single or let alone a dual task. Undertaking a dual-task activity that requires divided attention typically results in "dual-task costs," in which a decline in performance is experienced in one or both tasks compared to performance if each task is completed separately. Dual-task activities in which cognitive and motor tasks occur simultaneously are more representative of real-world tasks performed by military Service members. In a military population, the inability to measure and therefore detect balance dysfunction under single or dual-task conditions hampers detection or may result in the premature or inappropriate clearance for full, unrestricted return to duty. Similarly, changes in dynamic visual acuity and other aspects of visual function have been shown to be sensitive measures for the detection of mTBI and excellent predictors of recovery from mTBI. Again, to date no effective tests of visual function, conducive to be used by corpsman-level personnel, have been developed. The proposed project will address fundamental diagnostic and treatment gaps related to balance and visual function. Specifically, our existing validated mobile device technology will be leveraged to develop "mobile devices to test balance that can be administered by corpsman-level medical personnel" and provide "diagnostic methods" for the mitigation and treatment of visual dysfunction associated with TBI. We will build upon our existing mobile technology, the Cleveland Clinic Concussion (C3) App (http://www.apple.com/your-verse/concussion-game-plan/) and create military-specific tests of balance (single and dual task) and visual assessments (static and dynamic visual acuity, low contrast visual acuity and contrast sensitivity function). Our recent work demonstrates that our Balance Module provides a reliable and valid assessment of postural stability comparable to biomechanical gold standards. The clear advantage of our approach is that we are utilizing a platform that has embedded hardware that provides reliable and accurate data that we can use in the quantification of postural stability and visual function. Utilizing this platform will speed the development of more sophisticated, military-specific assessment modules, that are scalable, portable, affordable and can be integrated in the practice patterns of the multiple providers involved in the care of mTBI patients. The overall hypothesis, based on our previous work, is that the developed visual and balance modules will be similar in their ability to quantify postural stability and visual function compared to biomechanical measures and results of a comprehensive neuro-ophthalmologic exam. The initial phase of development will include testing and validating the new balance and visual modules in a group (n=50) of civilian healthy young controls (18-24 years). Phase II of this project will be to refine each module based on Phase I results and validate these modules in a larger group of civilian controls (18-40 years) and military personnel (18-40 years); N=200 for each group. The approval (05-18-13) by the Department of Defense to allow government-issued Apple products such as the iPad or iPhone to connect to military networks indicates that these commercial-off-the shelf (COTS) devices are ideally suited to be used by corpsman-level medical personnel. A number of military hardened COTS cases exist for the iPad and iPhone as well. Rather than spend resources (time and money) on the
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Mar 29, 2016
- Source ID
- W81XWH1610052
Entities
People
- Jay L Alberts
Organizations
- Cleveland Clinic
- United States Army