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27


The New MULES: A Sideline-Friendly Test of Rapid Picture Naming for Concussion [Meeting Abstract]

Akhand, Omar; Galetta, Matthew; Hasanaj, Lisena; Cobbs, Lucy; Webb, Nikki; Brandt, Julia; Amorapanth, Prin; Rizzo, John-Ross; Serrano, Liliana; Nolan, Rachel; Rucker, Janet; Silverio, Arlene; Jordan, Barry; Galetta, Steven; Balcer, Laura
ISI:000453090801159
ISSN: 0028-3878
CID: 3562002

Mobile Universal Lexicon Evaluation System (MULES) in MS: Evaluation of a New Visual Test of Rapid Picture Naming [Meeting Abstract]

Seay, Meagan; Akhand, Omar; Cobbs, Lucy; Hasanaj, Lisena; Amorapanth, Prin; Rizzo, John-Ross; Nolan, Rachel; Serrano, Liliana; Jordan, Barry; Rucker, Janet; Galetta, Steven; Balcer, Laura J.
ISI:000429034600043
ISSN: 1352-4585
CID: 3039272

Traumatic brain injury results in altered physiologic, but not subjective responses to emotional stimuli

Amorapanth, Prin X; Aluru, Viswanath; Stone, Jennifer; Yousefi, Arash; Tang, Alvin; Cox, Sarah; Bilaloglu, Seda; Lu, Ying; Rath, Joseph; Long, Coralynn; Im, Brian; Raghavan, Preeti
BACKGROUND:While the cognitive sequelae of traumatic brain injury (TBI) are well known, emotional impairments after TBI are suboptimally characterized. Lack of awareness of emotional difficulties can make self-report unreliable. However, individuals with TBI demonstrate involuntary changes in heart rate variability which may enable objective quantification of emotional dysfunction. METHODS:Sixteen subjects with chronic TBI and 10 age-matched controls were tested on an emotional function battery during which they watched a series of film clips normed to elicit specific positively and negatively valenced emotions: amusement, sexual amusement, sadness, fear and disgust. Subjective responses to the emotional stimuli were also obtained. Additionally, surface electrodes measured cardiac and respiratory signals to compute heart rate variability (HRV), from which measures of parasympathetic activity, the respiratory frequency area (RFA) and sympathetic activity, the low frequency area (LFA), of the HRV frequency spectrum were derived. The Neurobehavioral Rating Scale-Revised (NRS-R) and the King-Devick (KD) test were administered to assess neurobehavioral dysfunction. RESULTS:The two groups showed no differences in subjective ratings of emotional intensity. Subjects with TBI showed significantly decreased sympathetic activity when viewing amusing stimuli and significantly increased sympathetic activity when viewing sad stimuli compared to controls. Most of the subjects did not show agitation, anxiety, depression, blunted affect, emotional withdrawal, decreased motivation or mental fatiguability on the NRS-R. However, 13/16 subjects with TBI demonstrated attention difficulty on the NRS-R which was positively correlated with the increased sympathetic activity during sad stimuli. Both attention difficulty and abnormal autonomic responses to sad stimuli were correlated with the timing on the KD test, which reflected difficulty with visual attention shifting. CONCLUSIONS:The HRV spectrum may be useful to identify subclinical emotional dysfunction in individuals with TBI. Attention difficulites, specifically impairment in visual attention shifting, may contribute to abnormal reactivity to sad stimuli that may be detected and potentially treated to improve emotional function.
PMID: 30261156
ISSN: 1362-301x
CID: 3306672

The effect of linguistic background on rapid number naming: implications for native versus non-native English speakers on sideline-focused concussion assessments

Rizzo, John-Ross; Hudson, Todd E; Amorapanth, Prin X; Dai, Weiwei; Birkemeier, Joel; Pasculli, Rosa; Conti, Kyle; Feinberg, Charles; Verstraete, Jan; Dempsey, Katie; Selesnick, Ivan; Balcer, Laura J; Galetta, Steven L; Rucker, Janet C
OBJECTIVE:To determine if native English speakers (NES) perform differently compared to non-native English speakers (NNES) on a sideline-focused rapid number naming task. A secondary aim was to characterize objective differences in eye movement behaviour between cohorts. BACKGROUND:The King-Devick (KD) test is a rapid number-naming task in which numbers are read from left-to-right. This performance measure adds vision-based assessment to sideline concussion testing. Reading strategies differ by language. Concussion may also impact language and attention. Both factors may affect test performance. METHODS:Twenty-seven healthy  NNES and healthy NES performed a computerized KD test under high-resolution video-oculography.  NNES also performed a Bilingual Dominance Scale (BDS) questionnaire to weight linguistic preferences (i.e., reliance on non-English language(s)). RESULTS:Inter-saccadic intervals were significantly longer in  NNES (346.3 ± 78.3 ms vs. 286.1 ± 49.7 ms, p = 0.001), as were KD test times (54.4 ± 15.1 s vs. 43.8 ± 8.6 s, p = 0.002). Higher BDS scores, reflecting higher native language dominance, were associated with longer inter-saccadic intervals in  NNES. CONCLUSION/CONCLUSIONS:These findings have direct implications for the assessment of athlete performance on vision-based and other verbal sideline concussion tests; these results are particularly important given the international scope of sport. Pre-season baseline scores are essential to evaluation in the event of concussion, and performance of sideline tests in the athlete's native language should be considered to optimize both baseline and post-injury test accuracy.
PMID: 30182749
ISSN: 1362-301x
CID: 3271312

Mobile universal lexicon evaluation system (MULES): Pre-season baseline concussion testing for a new measure of rapid picture naming [Meeting Abstract]

Cobbs, L; Hasanaj, L; Webb, N; Brandt, J; Amorapanth, P; Rizzo, J -R; Nolan, R; Serrano, L; Raynowska, J; Rucker, J; Jordan, B; Silverio, A; Galetta, S; Balcer, L
Objective: This study introduces the Mobile Universal Lexicon Evaluation System (MULES), a new vision-based test of rapid picture naming, in a cohort of youth and collegiate athletes at pre-season concussion testing. Background: Vision-based measures of rapid number naming (King-Devick [K-D]) have improved the sensitivity of sports-related concussion screening. K-D requires saccades and vergence, measuring aspects of frontal, parietal and brainstem centers. We developed the MULES to capture a more extensive vision network, integrating saccades, color perception, and object identification. Design/Methods: We administered MULES and K-D to youth and collegiate athletes during pre-season baseline testing. Sports for 2016-17 included ice hockey, football, soccer, volleyball and wrestling. Test administration order was randomized. Results: Among 165 athletes (age 14+/-5 years, range 6-24, 25% female), average K-D times (59.9+/-29.7 seconds) were similar to MULES (57.9+/-20.4 seconds). Higher K-D times predicted greater MULES times, accounting for age (p<0.001, linear regression). Age was itself a predictor of K-D and MULES time scores, with longer times noted for younger participants (p<0.001). Faster times with increasing age were noted primarily among athletes <16 years for K-D and <15 years for MULES. MULES showed greater degrees of improvement between two baseline trials (57.9 vs. 51.2 seconds, p<0.0001, paired t-test), vs. K-D (59.9 vs. 58.3 seconds, p=0.01). Conclusions: A complex task, the MULES test of rapid picture naming involves a more extensive visual network that captures not only rapid saccades but color perception and the characterization of objects. Color recognition is early in object processing and requires area V4 and the inferior temporal projections. In contrast, rapid number naming appears to engage a specific area of the inferior temporal cortex. Both tests use the centers responsible for initiating and sequencing saccadic eye movements, and will be further examined in our youth and collegiate cohorts during this athletic season for their ability to detect concussion
EMBASE:616552046
ISSN: 1526-632x
CID: 2608662

Windows to the brain: Visual systems, rehabilitation and research in concussion [Meeting Abstract]

Amorapanth, Prin; Rizzo, John Ross; Rucker, Janet; Waskiewicz, Meg
ISI:000406734000340
ISSN: 1362-301x
CID: 2675612

Traumatic brain injury alters physiologic, but not subjective, responses to emotional stimuli [Meeting Abstract]

Amorapanth, Prin
ISI:000406734000333
ISSN: 1362-301x
CID: 2675622

Mobile Universal Lexicon Evaluation System (MULES): Pre-Season Baseline Concussion Testing for a New Measure of Rapid Picture Naming [Meeting Abstract]

Cobbs, Lucy; Hasanaj, Lisena; Webb, Nikki; Brandt, Julia; Amorapanth, Prin; Rizzo, John-Ross; Nolan, Rachel; Serrano, Liliana; Raynowska, Jenelle; Rucker, Janet; Jordan, Barry; Silverio, Arlene; Galetta, Steven; Balcer, Laura
ISI:000577381505001
ISSN: 0028-3878
CID: 5524312

Pain in the Geriatric Patient with Advanced Chronic Disease

Phongtankuel, Veerawat; Amorapanth, Prin X; Siegler, Eugenia L
The World Health Organization, one of the leading authorities on pain management, stressed the need for further guidelines to help manage pain in patients with chronic disease. In light of the impact of pain on morbidity and quality of life, this article summarizes current knowledge about pain experienced by older adults in 3 advanced non-cancer-related chronic diseases (ie, congestive heart failure, end-stage renal disease, and stroke) in which pain is common but not typically a primary focus of disease management. This article examines the data on the prevalence of pain, co-occurring symptoms, and challenges in managing pain in these conditions.
PMID: 27741961
ISSN: 1879-8853
CID: 2278572

Relationships among slowed processing speed, emotional reactivity, and postconcussive symptoms in adults with mild traumatic brain injury [Meeting Abstract]

Ellois, V; Long, C; Childs, A; Smith, J; Amorapanth, P X; Bertisch, H; Lui, Y; Rath, J F
Research Objectives: Processing speed (PS) deficits are among the most common neuropsychological (NP) deficits following traumatic brain injury (TBI). These objective deficits may lead to subjective feelings of being flooded and overwhelmed or that things happen too quickly that one can no longer keep up with cognitive demands made by external events. This subjective experience of slowed PS has been proposed to underlie symptoms of emotional reactivity (ER), such as, tension, frustration, and irritability, which in turn may exacerbate cognitive complaints. The aim of this study was to evaluate the role of objective PS deficits in ER and cognitive/somatic postconcussive symptoms (PCS) following mild TBI (mTBI). Design: Correlational/regression analyses examining objective PS measures, ER, and somatic/cognitive PCS. Setting: Large academic medical center. Participants: Adults with mTBI (n = 31), 52% female, primarily White (74%), average age of 35.8, with 16.1 years of education. Interventions: N/A. Main Outcome Measure(s): Standard TBI outcome battery, 6,7 addressing (a) objective NP impairments, (b) psychological status, and (c) PCS. ER was assessed using z-score composite of relevant self-report items. Results: Objective PS measures were significantly related to ER. ER explained a significant 33% of variance in somatic/cognitive PCS, Beta = -.62, t (29) = -3.15, p =.004, over and above variance explained directly by PS, Beta = -.07, t (29) = -.38, ns. Conclusions: ER is directly related to objective PS deficits. In addition, ER is a significant predictor of somatic/cognitive PCS, whereas objective PS measures are not directly related to PCS. Emotional reactions to the experience of objective cognitive slowing warrant further investigation as a predictor of those at risk for prolonged PCS. Further examination of ER as a predictor of PCS may lead to more accurate assessment/prognosis following mTBI
EMBASE:612945297
ISSN: 1532-821x
CID: 2299562