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The MICK (Mobile integrated cognitive kit) app: Digital rapid automatized naming for visual assessment across the spectrum of neurological disorders

Park, George; Balcer, Marc J; Hasanaj, Lisena; Joseph, Binu; Kenney, Rachel; Hudson, Todd; Rizzo, John-Ross; Rucker, Janet C; Galetta, Steven L; Balcer, Laura J; Grossman, Scott N
OBJECTIVE:Rapid automatized naming (RAN) tasks have been utilized for decades to evaluate neurological conditions. Time scores for the Mobile Universal Lexicon Evaluation System (MULES, rapid picture naming) and Staggered Uneven Number (SUN, rapid number naming) are prolonged (worse) with concussion, mild cognitive impairment, multiple sclerosis and Parkinson's disease. The purpose of this investigation was to compare paper/pencil versions of MULES and SUN with a new digitized format, the MICK app. METHODS:Participants (healthy office-based volunteers, professional women's hockey players), completed two trials of the MULES and SUN tests on both platforms (tablet, paper/pencil). The order of presentation of the testing platforms was randomized. Between-platform variability was calculated using the two-way random-effects intraclass correlation coefficient (ICC). RESULTS:Among 59 participants (median age 32, range 22-83), no significant differences were observed for comparisons of mean best scores for the paper/pencil versus MICK app platforms, counterbalanced for order of administration (P = 0.45 for MULES, P = 0.50 for SUN, linear regression). ICCs for agreement between the MICK and paper/pencil tests were 0.92 (95% CI 0.86, 0.95) for MULES and 0.94 (95% CI 0.89, 0.96) for SUN, representing excellent levels of agreement. Inter-platform differences did not vary systematically across the range of average best time score for either test. CONCLUSION/CONCLUSIONS:The MICK app for digital administration of MULES and SUN demonstrates excellent agreement of time scores with paper/pencil testing. The computerized app allows for greater accessibility and scalability in neurological diseases, inclusive of remote monitoring. Sideline testing for sports-related concussion may also benefit from this technology.
PMID: 35038658
ISSN: 1878-5883
CID: 5131412

Network-Aware 5G Edge Computing for Object Detection: Augmenting Wearables to “See” More, Farther and Faster

Yuan, Zhongzheng; Azzino, Tommy; Hao, Yu; Lyu, Yixuan; Pei, Haoyang; Boldini, Alain; Mezzavilla, Marco; Beheshti, Mahya; Porfiri, Maurizio; Hudson, Todd; Seiple, William; Fang, Yi; Rangan, Sundeep; Wang, Yao; Rizzo, J. R.
Advanced wearable devices are increasingly incorporating high-resolution multi-camera systems. As state-of-the-art neural networks for processing the resulting image data are computationally demanding, there has been a growing interest in leveraging fifth generation (5G) wireless connectivity and mobile edge computing for offloading this processing closer to end-users. To assess this possibility, this paper presents a detailed simulation and evaluation of 5G wireless offloading for object detection in the case of a powerful, new smart wearable called VIS4ION, for the Blind-and-Visually Impaired (BVI). The current VIS4ION system is an instrumented book-bag with high-resolution cameras, vision processing, and haptic and audio feedback. The paper considers uploading the camera data to a mobile edge server to perform real-time object detection and transmitting the detection results back to the wearable. To determine the video requirements, the paper evaluates the impact of video bit rate and resolution on object detection accuracy and range. A new street scene dataset with labeled objects relevant to BVI navigation is leveraged for analysis. The vision evaluation is combined with a full-stack wireless network simulation to determine the distribution of throughputs and delays with real navigation paths and ray-tracing from new high-resolution 3D models in an urban environment. For comparison, the wireless simulation considers both a standard 4G-Long Term Evolution (LTE) sub-6-GHz carrier and high-rate 5G millimeter-wave (mmWave) carrier. The work thus provides a thorough and detailed assessment of edge computing for object detection with mmWave and sub-6-GHz connectivity in an application with both high bandwidth and low latency requirements.
ISSN: 2169-3536
CID: 5189272

King-Devick Test Performance and Cognitive Dysfunction after Concussion: A Pilot Eye Movement Study

Gold, Doria M; Rizzo, John-Ross; Lee, Yuen Shan Christine; Childs, Amanda; Hudson, Todd E; Martone, John; Matsuzawa, Yuka K; Fraser, Felicia; Ricker, Joseph H; Dai, Weiwei; Selesnick, Ivan; Balcer, Laura J; Galetta, Steven L; Rucker, Janet C
(1) Background: The King-Devick (KD) rapid number naming test is sensitive for concussion diagnosis, with increased test time from baseline as the outcome measure. Eye tracking during KD performance in concussed individuals shows an association between inter-saccadic interval (ISI) (the time between saccades) prolongation and prolonged testing time. This pilot study retrospectively assesses the relation between ISI prolongation during KD testing and cognitive performance in persistently-symptomatic individuals post-concussion. (2) Results: Fourteen participants (median age 34 years; 6 women) with prior neuropsychological assessment and KD testing with eye tracking were included. KD test times (72.6 ± 20.7 s) and median ISI (379.1 ± 199.1 msec) were prolonged compared to published normative values. Greater ISI prolongation was associated with lower scores for processing speed (WAIS-IV Coding, r = 0.72, p = 0.0017), attention/working memory (Trails Making A, r = -0.65, p = 0.006) (Digit Span Forward, r = 0.57, p = -0.017) (Digit Span Backward, r= -0.55, p = 0.021) (Digit Span Total, r = -0.74, p = 0.001), and executive function (Stroop Color Word Interference, r = -0.8, p = 0.0003). (3) Conclusions: This pilot study provides preliminary evidence suggesting that cognitive dysfunction may be associated with prolonged ISI and KD test times in concussion.
PMID: 34942873
ISSN: 2076-3425
CID: 5092962

Dysfunctional mode switching between fixation and saccades: collaborative insights into two unusual clinical disorders

Rucker, Janet C; Rizzo, John-Ross; Hudson, Todd E; Horn, Anja K E; Buettner-Ennever, Jean A; Leigh, R John; Optican, Lance M
Voluntary rapid eye movements (saccades) redirect the fovea toward objects of visual interest. The saccadic system can be considered as a dual-mode system: in one mode the eye is fixating, in the other it is making a saccade. In this review, we consider two examples of dysfunctional saccades, interrupted saccades in late-onset Tay-Sachs disease and gaze-position dependent opsoclonus after concussion, which fail to properly shift between fixation and saccade modes. Insights and benefits gained from bi-directional collaborative exchange between clinical and basic scientists are emphasized. In the case of interrupted saccades, existing mathematical models were sufficiently detailed to provide support for the cause of interrupted saccades. In the case of gaze-position dependent opsoclonus, existing models could not explain the behavior, but further development provided a reasonable hypothesis for the mechanism underlying the behavior. Collaboration between clinical and basic science is a rich source of progress for developing biologically plausible models and understanding neurological disease. Approaching a clinical problem with a specific hypothesis (model) in mind often prompts new experimental tests and provides insights into basic mechanisms.
PMID: 33839988
ISSN: 1573-6873
CID: 4840982

Detection of normal and slow saccades using implicit piecewise polynomial approximation

Dai, Weiwei; Selesnick, Ivan; Rizzo, John-Ross; Rucker, Janet; Hudson, Todd
The quantitative analysis of saccades in eye movement data unveils information associated with intention, cognition, and health status. Abnormally slow saccades are indicative of neurological disorders and often imply a specific pathological disturbance. However, conventional saccade detection algorithms are not designed to detect slow saccades, and are correspondingly unreliable when saccades are unusually slow. In this article, we propose an algorithm that is effective for the detection of both normal and slow saccades. The proposed algorithm is partly based on modeling saccadic waveforms as piecewise-quadratic signals. The algorithm first decreases noise in acquired eye-tracking data using optimization to minimize a prescribed objective function, then uses velocity thresholding to detect saccades. Using both simulated saccades and real saccades generated by healthy subjects and patients, we evaluate the performance of the proposed algorithm and 10 other detection algorithms. We show the proposed algorithm is more accurate in detecting both normal and slow saccades than other algorithms.
PMID: 34125160
ISSN: 1534-7362
CID: 4924622

Art therapy for Parkinson's disease

Cucca, Alberto; Di Rocco, Alessandro; Acosta, Ikuko; Beheshti, Mahya; Berberian, Marygrace; Bertisch, Hilary C; Droby, Amgad; Ettinger, Tom; Hudson, Todd E; Inglese, Matilde; Jung, Yoon J; Mania, Daniella F; Quartarone, Angelo; Rizzo, John-Ross; Sharma, Kush; Feigin, Andrew; Biagioni, Milton C; Ghilardi, M Felice
OBJECTIVE:To explore the potential rehabilitative effect of art therapy and its underlying mechanisms in Parkinson's disease (PD). METHODS:Observational study of eighteen patients with PD, followed in a prospective, open-label, exploratory trial. Before and after twenty sessions of art therapy, PD patients were assessed with the UPDRS, Pegboard Test, Timed Up and Go Test (TUG), Beck Depression Inventory (BDI), Modified Fatigue Impact Scale and PROMIS-Self-Efficacy, Montreal Cognitive Assessment, Rey-Osterrieth Complex Figure Test (RCFT), Benton Visual Recognition Test (BVRT), Navon Test, Visual Search, and Stop Signal Task. Eye movements were recorded during the BVRT. Resting-state functional MRI (rs-fMRI) was also performed to assess functional connectivity (FC) changes within the dorsal attention (DAN), executive control (ECN), fronto-occipital (FOC), salience (SAL), primary and secondary visual (V1, V2) brain networks. We also tested fourteen age-matched healthy controls at baseline. RESULTS:At baseline, PD patients showed abnormal visual-cognitive functions and eye movements. Analyses of rs-fMRI showed increased functional connectivity within DAN and ECN in patients compared to controls. Following art therapy, performance improved on Navon test, eye tracking, and UPDRS scores. Rs-fMRI analysis revealed significantly increased FC levels in brain regions within V1 and V2 networks. INTERPRETATION/CONCLUSIONS:Art therapy improves overall visual-cognitive skills and visual exploration strategies as well as general motor function in patients with PD. The changes in brain connectivity highlight a functional reorganization of visual networks.
PMID: 33526323
ISSN: 1873-5126
CID: 4776032

How sandbag-able are concussion sideline assessments? A close look at eye movements to uncover strategies

Rizzo, John-Ross; Hudson, Todd E; Martone, John; Dai, Weiwei; Ihionu, Oluchi; Chaudhry, Yash; Selesnick, Ivan; Balcer, Laura J; Galetta, Steven L; Rucker, Janet C
Background: Sideline diagnostic tests for concussion are vulnerable to volitional poor performance ("sandbagging") on baseline assessments, motivated by desire to subvert concussion detection and potential removal from play. We investigated eye movements during sandbagging versus best effort on the King-Devick (KD) test, a rapid automatized naming (RAN) task. Methods: Participants performed KD testing during oculography following instructions to sandbag or give best effort. Results: Twenty healthy participants without concussion history were included (mean age 27 ± 8 years). Sandbagging resulted in longer test times (89.6 ± 39.2 s vs 48.2 ± 8.5 s, p < .001), longer inter-saccadic intervals (459.5 ± 125.4 ms vs 311.2 ± 79.1 ms, p < .001) and greater numbers of saccades (171.4 ± 47 vs 138 ± 24.2, p < .001) and reverse saccades (wrong direction for reading) (21.2% vs 11.3%, p < .001). Sandbagging was detectable using a logistic model with KD times as the only predictor, though more robustly detectable using eye movement metrics. Conclusions: KD sandbagging results in eye movement differences that are detectable by eye movement recordings and suggest an invalid test score. Objective eye movement recording during the KD test shows promise for distinguishing between best effort and post-injury performance, as well as for identifying sandbagging red flags.
PMID: 33529094
ISSN: 1362-301x
CID: 4776222

Bayesian data analysis for the behavioral and neural sciences : non-calculus fundamentals

Hudson, Todd Erik
Cambridge UK : Cambridge University Press, 2021
Extent: xiv, 597 p. ; 26cm
ISBN: 9781108835565
CID: 5102762

Looking "Cherry Red Spot Myoclonus" in the Eyes: Clinical Phenotype, Treatment Response, and Eye Movements in Sialidosis Type 1

Riboldi, Giulietta M; Martone, John; Rizzo, John-Ross; Hudson, Todd E; Rucker, Janet C; Frucht, Steven J
Sialidosis type 1 is a rare lysosomal storage disorder caused by mutations of the neuraminidase gene. Specific features suggesting this condition include myoclonus, ataxia and macular cherry-red spots. However, phenotypic variability exists. Here, we present detailed clinical and video description of three patients with this rare condition. We also provide an in-depth characterization of eye movement abnormalities, as an additional tool to investigate pathophysiological mechanisms and to facilitate diagnosis. In our patients, despite phenotypic differences, eye movement deficits largely localized to the cerebellum.
PMID: 34992946
ISSN: 2160-8288
CID: 5107412

The global crisis of visual impairment: an emerging global health priority requiring urgent action [Editorial]

Rizzo, John-Ross; Beheshti, Mahya; Hudson, Todd E; Mongkolwat, Pattanasak; Riewpaiboon, Wachara; Seiple, William; Ogedegbe, Olugbenga G; Vedanthan, Rajesh
PMID: 33332166
ISSN: 1748-3115
CID: 4718052