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J Am Acad Audiol
DOI: 10.1055/s-0044-1791207
Research Article

Normative Ranges for Oculomotor and Reaction Time Tests in U.S. Military Service Members and Veterans

Daniel S. Talian
1   Audiology and Speech Pathology Center, Walter Reed National Military Medical Center, Bethesda, Maryland
2   Department of Hearing, Speech and Language Sciences, Gallaudet University, Washington, District of Columbia
3   Department of Otorhinolaryngology, University of Pennsylvania Health System, Philadelphia, Pennsylvania
,
Megan M. Eitel
1   Audiology and Speech Pathology Center, Walter Reed National Military Medical Center, Bethesda, Maryland
4   Traumatic Brain Injury Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland
5   Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
,
Danielle J. Zion
1   Audiology and Speech Pathology Center, Walter Reed National Military Medical Center, Bethesda, Maryland
5   Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
,
Stefanie E. Kuchinsky
1   Audiology and Speech Pathology Center, Walter Reed National Military Medical Center, Bethesda, Maryland
,
Louis M. French
4   Traumatic Brain Injury Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland
6   National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland
7   School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
,
Tracey A. Brickell
4   Traumatic Brain Injury Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland
6   National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland
7   School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
9   General Dynamics Information Technology, Silver Spring, Maryland
,
Sara M. Lippa
6   National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland
,
Rael T. Lange
4   Traumatic Brain Injury Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland
6   National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland
7   School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
8   Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
9   General Dynamics Information Technology, Silver Spring, Maryland
,
Douglas S. Brungart
1   Audiology and Speech Pathology Center, Walter Reed National Military Medical Center, Bethesda, Maryland
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Abstract

Background Oculomotor and reaction time tests are frequently used assessments of vestibular symptoms, traumatic brain injury (TBI), or other neurological disorders in both clinical and research contexts. When interpreting these tests it is important to have a reference interval (RI) as a comparison for what constitutes a typical/expected response; however, the current body of research has only limited information regarding normative ranges calculated according to established standards or for a military-specific sample.

Purpose The purpose of the present study was to describe RIs for oculomotor and reaction time tests in a cohort of service members and veterans (SMVs) for use as comparators by clinicians and scientists.

Research Design Descriptive.

Study Sample Participants were prospectively enrolled in the Defense and Veterans Brain Injury Center-Traumatic Brain Injury Center of Excellence 15-year Longitudinal Traumatic Brain Injury Study. Only SMVs without a history of TBI or blast exposure were included in the RI calculations.

Data Collection and Analysis The test paradigms included in this analysis were: smooth pursuit, prosaccades, antisaccades, saccades and reaction time, predictive saccades, optokinetic nystagmus, auditory reaction time, and visual reaction time. Nonparametric methods, based on the U.S. Food and Drug Administration's recognized consensus standards, were used to calculate 95% RIs. A comparison between the calculated RIs and those available from previously published research is provided.

Results Summary statistics and RIs were calculated for 47 outcome parameters from 13 oculomotor and reaction time tests. Sample sizes and age ranges varied across outcome parameters depending on the availability of reference values for RI calculations. The sample sizes used to calculate RIs ranged from 51 to 69. The age of SMVs included in each RI ranged from 19 to 61 years with mean ages ranging from 37 to 39 years. Similarities/differences between the RIs in the present study and those in previously published research are highly dependent on the outcome parameter; however, in general, the RIs in the present study tended to be somewhat wider.

Conclusions The RIs provided in this paper can serve as comparisons for clinicians and scientists who are utilizing these oculomotor and reaction time testing paradigms in similar cohorts of patients or research participants.

Keywords

traumatic brain injury - reference values - eye movements - military personnel - reaction time

Data Availability Statement

The datasets presented in this article are not readily available because Department of Defense (DoD) policy prohibits sharing of sensitive data for this DoD-funded research. Requests to access the datasets should be directed to D.S.T., daniel.s.talian.ctr@health.mil.




Publication History

Received: 14 August 2023

Accepted: 22 November 2023

Article published online:
12 December 2024

© 2024. American Academy of Audiology. This article is published by Thieme.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Fife TD, Desmond AL, Kerber KA. Coding and reimbursement for vestibular tests by the U.S. Centers for Medicare and Medicaid Services (CMS). Otol Neurotol 2021; 42 (10) e1544-e1547
    CrossrefPubMedSearch in Google Scholar
  • 2 Cochrane GD, Christy JB, Almutairi A, Busettini C, Swanson MW, Weise KK. Visuo-oculomotor function and reaction times in athletes with and without concussion. Optom Vis Sci 2019; 96 (04) 256-265
    CrossrefPubMedSearch in Google Scholar
  • 3 Stuart S, Parrington L, Martini D, Peterka R, Chesnutt J, King L. The measurement of eye movements in mild traumatic brain injury: a structured review of an emerging area. Front Sports Act Living 2020; 2: 5
    CrossrefPubMedSearch in Google Scholar
  • 4 Nij Bijvank JA, van Rijn LJ, Balk LJ, Tan HS, Uitdehaag BMJ, Petzold A. Diagnosing and quantifying a common deficit in multiple sclerosis: internuclear ophthalmoplegia. Neurology 2019; 92 (20) e2299-e2308
    CrossrefPubMedSearch in Google Scholar
  • 5 Wu CC, Cao B, Dali V. et al. Eye movement control during visual pursuit in Parkinson's disease. PeerJ 2018; 6: e5442
    CrossrefPubMedSearch in Google Scholar
  • 6 Balaban C, Hoffer ME, Szczupak M. et al. Oculomotor, vestibular, and reaction time tests in mild traumatic brain injury. PLoS One 2016; 11 (09) e0162168
    CrossrefPubMedSearch in Google Scholar
  • 7 Hopf S, Liesenfeld M, Schmidtmann I, Ashayer S, Pitz S. Age dependent normative data of vertical and horizontal reflexive saccades. PLoS One 2018; 13 (09) e0204008
    CrossrefPubMedSearch in Google Scholar
  • 8 Mossman B, Mossman S, Purdie G, Schneider E. Age dependent normal horizontal VOR gain of head impulse test as measured with video-oculography. J Otolaryngol Head Neck Surg 2015; 44 (01) 29
    CrossrefPubMedSearch in Google Scholar
  • 9 Narayana Swamy S, Yuvaraj P, Pruthi N, Thennarasu K, Rajasekaran AK. Comprehensive normative data for objective vestibular tests. Cureus 2023; 15 (06) e40080
    PubMedSearch in Google Scholar
  • 10 Sinno S, Najem F, Abouchacra KS, Perrin P, Dumas G. Normative values of saccades and smooth pursuit in children aged 5 to 17 years. J Am Acad Audiol 2020; 31 (06) 384-392
    Thieme ConnectPubMedSearch in Google Scholar
  • 11 Solberg HE. Approved recommendation (1987) on the theory of reference values. Part 5. Statistical treatment of collected reference values. Determination of reference limits. Clin Chim Acta 1987; 170 (2–3): S13-S32
    CrossrefSearch in Google Scholar
  • 12 FDA. Federal Register. [Docket No. FDA–2004–N–0451] US Department Health and Human Services Food Drug Administration. 2014; 79 (20) 4913-4935
    Search in Google Scholar
  • 13 CLSI. Defining, establishing, and verifying reference intervals in the clinical laboratory–third edition (EP28–A3c). Wayne, PA: Clinical and Laboratory Standards Institute; 2010. Report No.: CLSI document EP28–A3c.
    Search in Google Scholar
  • 14 Kullmann A, Ashmore RC, Braverman A. et al. Portable eye-tracking as a reliable assessment of oculomotor, cognitive and reaction time function: normative data for 18–45 year old. PLoS One 2021; 16 (11) e0260351
    CrossrefPubMedSearch in Google Scholar
  • 15 Talian DS, Eitel MM, Zion DJ. et al. Normative ranges for, and interrater reliability of, rotational vestibular and balance tests in U.S. Military Service Members and Veterans. Am J Audiol 2023; 32 (3S): 694-705
    CrossrefPubMedSearch in Google Scholar
  • 16 Lange RT, Lippa SM, French LM. et al. Long-term neurobehavioural symptom reporting following mild, moderate, severe, and penetrating traumatic brain injury in U.S. military service members. Neuropsychol Rehabil 2020; 30 (09) 1762-1785
    CrossrefPubMedSearch in Google Scholar
  • 17 Hunfalvay M, Murray NP, Creel WT, Carrick FR. Long-term effects of low-level blast exposure and high-caliber weapons use in military special operators. Brain Sci 2022; 12 (05) 679
    CrossrefPubMedSearch in Google Scholar
  • 18 Dixon WJ. Processing data for outliers. Biometrics 1953; 9 (01) 74-89
    CrossrefSearch in Google Scholar
  • 19 Reed AH, Henry RJ, Mason WB. Influence of statistical method used on the resulting estimate of normal range. Clin Chem 1971; 17 (04) 275-284
    CrossrefPubMedSearch in Google Scholar
  • 20 Benjamini Y, Hochberg Y. Controlling the false discovery rate: a practical and powerful approach to multiple testing. J R Stat Soc 1995; 57 (01) 289-300
    CrossrefSearch in Google Scholar
  • 21 Kullmann A, Ashmore RC, Braverman A. et al. Normative data for ages 18-45 for ocular motor and vestibular testing using eye tracking. Laryngoscope Investig Otolaryngol 2021; 6 (05) 1116-1127
    CrossrefPubMedSearch in Google Scholar
  • 22 R Core Team. R: A language and environment for statistical computing [Internet]. Vienna, Austria: R Foundation for Statistical Computing; 2023. Accessed at: https://www.R-project.org/
    Search in Google Scholar
  • 23 Wickham H, Averick M, Bryan J. et al. Welcome to the tidyverse. J Open Source Softw 2019; 4 (43) 1686
    CrossrefSearch in Google Scholar
  • 24 Moschner C, Baloh RW. Age-related changes in visual tracking. J Gerontol 1994; 49 (05) M235-M238
    CrossrefPubMedSearch in Google Scholar
  • 25 Ceyte H, Lion A, Caudron S, Perrin P, Gauchard GC. Visuo-oculomotor skills related to the visual demands of sporting environments. Exp Brain Res 2017; 235 (01) 269-277
    CrossrefPubMedSearch in Google Scholar
  • 26 Paige GD. Senescence of human visual-vestibular interactions: smooth pursuit, optokinetic, and vestibular control of eye movements with aging. Exp Brain Res 1994; 98 (02) 355-372
    CrossrefPubMedSearch in Google Scholar
  • 27 Arbogast KB, Ghosh RP, Corwin DJ. et al. Trajectories of visual and vestibular markers of youth concussion. J Neurotrauma 2022; 39 (19–20): 1382-1390
    CrossrefPubMedSearch in Google Scholar
  • 28 Mucha A, Collins MW, Elbin RJ. et al. A brief vestibular/ocular motor screening (VOMS) assessment to evaluate concussions: preliminary findings. Am J Sports Med 2014; 42 (10) 2479-2486
    CrossrefPubMedSearch in Google Scholar
  • 29 Hoffer ME, Balaban C, Szczupak M. et al. The use of oculomotor, vestibular, and reaction time tests to assess mild traumatic brain injury (mTBI) over time. Laryngoscope Investig Otolaryngol 2017; 2 (04) 157-165
    CrossrefPubMedSearch in Google Scholar
  • 30 TBICoE. DOD TBI Worldwide Numbers [Internet]. Health.mil. 2021. Accessed August 12, 2021 at: https://health.mil/Military-Health-Topics/Centers-of-Excellence/Traumatic-Brain-Injury-Center-of-Excellence/DOD-TBI-Worldwide-Numbers