Skip to main content

Advertisement

SpringerLink
Log in

Objective assessment of visual pursuit in patients with disorders of consciousness: an exploratory study

  • Original Communication
  • Published:
Journal of Neurology Aims and scope Submit manuscript

Abstract

Visual pursuit is a key marker of residual consciousness in patients with disorders of consciousness (DOC). Currently, its assessment relies on subjective clinical decisions. In this study, we explore the variability of such clinical assessments, and present an easy-to-use device composed of cameras and video processing algorithms that could help the clinician to improve the detection of visual pursuit in a clinical context. Visual pursuit was assessed by an experienced research neuropsychologist on 31 patients with DOC and on 23 healthy subjects, while the device was used to simultaneously record videos of both one eye and the mirror. These videos were then scored by three researchers: the experienced research neuropsychologist who did the clinical assessment, another experienced research neuropsychologist, and a neurologist. For each video, a consensus was decided between the three persons, and used as the gold standard of the presence or absence of visual pursuit. Almost 10% of the patients were misclassified at the bedside according to their consensus. An automatic classifier analyzed eye and mirror trajectories, and was able to identify patients and healthy subjects with visual pursuit, in total agreement with the consensus on video. In conclusion, our device can be used easily in patients with DOC while respecting the current guidelines of visual pursuit assessment. Our results suggest that our material and our classification method can identify patients with visual pursuit, as well as the three researchers based on video recordings can.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Laureys S, Celesia G, Cohadon F et al (2010) Unresponsive wakefulness syndrome: a new name for the vegetative state or apallic syndrome. BMC Med 8:68

    Article  PubMed  PubMed Central  Google Scholar 

  2. Giacino JT, Ashwal S, Childs N et al (2002) The minimally conscious state: definition and diagnostic criteria. Neurology 58(3):349–353

    Article  PubMed  Google Scholar 

  3. Bruno M-A, Majerus S, Boly M et al (2012) Functional neuroanatomy underlying the clinical subcategorization of minimally conscious state patients. J Neurol 259:1087–1098

    Article  PubMed  Google Scholar 

  4. Boly M, Faymonville M-E, Peigneux P et al (2005) Cerebral processing of auditory and noxious stimuli in severely brain injured patients: differences between VS and MCS. Neuropsychol Rehabil 15(3–4):283–289

    Article  PubMed  Google Scholar 

  5. Giacino JT, Kalmar K, Whyte J (2004) The JFK coma recovery scale-revised: measurement characteristics and diagnostic utility. Arch Phys Med Rehabil 85:2020–2029

    Article  PubMed  Google Scholar 

  6. Seel RT, Sherer M, Whyte J et al (2010) Assessment scales for disorders of consciousness: evidence-based recommendations for clinical practice and research. Arch Phys Med Rehabil 91(12):1795–1813

    Article  PubMed  Google Scholar 

  7. Schnakers C, Vanhaudenhuyse A, Giacino J et al (2009) Diagnostic accuracy of the vegetative and minimally conscious state: clinical consensus versus standardized neurobehavioral assessment. BMC Neurol 9(1):35

    Article  PubMed  PubMed Central  Google Scholar 

  8. Bagnato S, Boccagni C, Sant’Angelo A, Fingelkurts AAA, Fingelkurts AAA, Galardi G (2016) Longitudinal assessment of clinical signs of recovery in patients with unresponsive wakefulness syndrome after traumatic or nontraumatic brain injury. J Neurotrauma 33:1–5

    Article  Google Scholar 

  9. Estraneo A, Moretta P, Cardinale V et al (2014) A multicentre study of intentional behavioural responses measured using the coma recovery scale-revised in patients with minimally conscious state. Clin Rehabil 29(8):803–808. doi:10.1177/0269215514556002

    Article  PubMed  Google Scholar 

  10. Thonnard M, Wannez S, Keen S et al (2014) Detection of visual pursuit in patients in minimally conscious state: a matter of stimuli and visual plane? Brain Inj 28(9):1164–1170

    Article  PubMed  Google Scholar 

  11. Vanhaudenhuyse A, Schnakers C, Brédart S, Laureys S (2008) Assessment of visual pursuit in post-comatose states: use a mirror. J Neurol Neurosurg Psychiatry 79(2):223

    Article  CAS  PubMed  Google Scholar 

  12. Cruse D, Fattizzo M, Owen AM, Fernández-Espejo D (2017) Why use a mirror to assess visual pursuit in prolonged disorders of consciousness? Evidence from healthy control participants. BMC Neurol 17(1):14. doi:10.1186/s12883-017-0798-1

    Article  PubMed  PubMed Central  Google Scholar 

  13. Monti MM, Vanhaudenhuyse A, Coleman MR et al (2010) Willful modulation of brain activity in disorders of consciousness. N Engl J Med 362(7):579–589

    Article  CAS  PubMed  Google Scholar 

  14. Cruse D, Chennu S, Chatelle C et al (2012) Relationship between etiology and covert cognition in the minimally conscious state. Neurology 78:816–822. doi:10.1212/WNL.0b013e318249f6f0

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Bekinschtein T, Coleman MR, Niklison J, Pickard JD, Manes FF (2008) Can electromyography objectively detect voluntary movement in disorders of consciousness? J Neurol Neurosurg Psychiatry 79:826–828

    Article  CAS  PubMed  Google Scholar 

  16. Stender J, Gosseries O, Bruno M-A et al (2014) Diagnostic precision of PET imaging and functional MRI in disorders of consciousness: a clinical validation study. Lancet 384(9942):514–522

    Article  PubMed  Google Scholar 

  17. Stender J, Kupers R, Rodell A et al (2014) Quantitative rates of brain glucose metabolism distinguish minimally conscious from vegetative state patients. J Cereb Blood Flow Metab 35:1–8. doi:10.1038/jcbfm.2014.169

    Google Scholar 

  18. Gosseries O, Thibaut A, Boly M, Rosanova M, Massimini M, Laureys S (2014) Assessing consciousness in coma and related states using transcranial magnetic stimulation combined with electroencephalography. Ann Fr Anesth Reanim. doi:10.1016/j.annfar.2013.11.002

    PubMed  Google Scholar 

  19. Trojano L, Moretta P, Loreto V, Cozzolino A, Santoro L, Estraneo A (2012) Quantitative assessment of visual behavior in disorders of consciousness. J Neurol 259(9):1888–1895

    Article  CAS  PubMed  Google Scholar 

  20. Trojano L, Moretta P, Loreto V, Santoro L, Estraneo A (2013) Affective saliency modifies visual tracking behavior in disorders of consciousness: a quantitative analysis. J Neurol 260(1):306–308. doi:10.1007/s00415-012-6717-x

    Article  CAS  PubMed  Google Scholar 

  21. Hoyoux T, Wannez S, Langohr T, Wertz J, Laureys S, Verly J (2016) A new computer vision-based system to help clinicians objectively assess visual pursuit with the moving mirror stimulus for the diagnosis of minimally conscious state. In: IEEE Winter Conference on Applications of Computer Vision (WACV 2016)

  22. Collobert R, Kavukcuoglu K, Farabet C (2011) Torch7: A matlab-like environment for machine learning. NIPS Work, BigLearn, pp 1–6

    Google Scholar 

  23. Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174

    Article  CAS  PubMed  Google Scholar 

  24. Demertzi A, Ledoux D, Bruno M-A et al (2011) Attitudes towards end-of-life issues in disorders of consciousness: a European survey. J Neurol 258:1058–1065

    Article  CAS  PubMed  Google Scholar 

  25. Demertzi A, Schnakers C, Ledoux D et al (2009) Different beliefs about pain perception in the vegetative and minimally conscious states: a European survey of medical and paramedical professionals. Prog Brain Res 177:329–338

  26. Bruno M-A, Ledoux D, Vanhaudenhuyse A, Gosseries O, Thibaut A, Laureys S (2011) Pronostic des patients récupérant du coma. In: Schnakers C, Laureys S (eds) Coma et États de Conscience Altérée. Springer, Paris, pp 17–30

    Chapter  Google Scholar 

Download references

Acknowledgements

The University and University Hospital of Liège, the French Speaking Community Concerted Research Action (ARC 12/17/01), the Belgian National Funds for Scientific Research (FRS-FNRS), Human Brain Project (EU-H2020-fetflagship-hbp-sga1-ga720270), and Luminous project (EU-H2020-fetopen-ga686764), the Wallonie-Bruxelles International, the James McDonnell Foundation, Mind Science Foundation, IAP research network P7/06 of the Belgian Government (Belgian Science Policy), the European Commission, the Public Utility Foundation ‘Université Européenne du Travail’, “Fondazione Europea di Ricerca Biomedica”, the Bial Foundation. OB and CM are research fellows, CC is post-doctoral fellow, and SL is research director at FRS-FNRS.

Author information

Author notes

  1. Sarah Wannez and Thomas Hoyoux contributed equally.

Authors and Affiliations

  1. Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium

    Sarah Wannez, Olivier Bodart, Charlotte Martial, Camille Chatelle & Steven Laureys

  2. Neurology Department, University Hospital of Liège, Liège, Belgium

    Sarah Wannez, Olivier Bodart, Charlotte Martial, Camille Chatelle & Steven Laureys

  3. Laboratory for Signal and Image Exploitation, Department of Electrical Engineering and Computer Science, University of Liège, Liège, Belgium

    Thomas Hoyoux, Thomas Langohr & Jacques G. Verly

  4. Phasya S.A., Liège, Belgium

    Jérôme Wertz

  5. Laboratory for NeuroImaging of Coma and Consciousness, Massachusetts General Hospital, Boston, MA, USA

    Camille Chatelle

  6. Acute Neurorehabilitation Unit, Department of Clinical Neurosciences, University Hospital of Lausanne, Lausanne, Switzerland

    Camille Chatelle

Authors
  1. Sarah Wannez
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Thomas Hoyoux
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Thomas Langohr
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Olivier Bodart
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Charlotte Martial
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jérôme Wertz
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Camille Chatelle
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Jacques G. Verly
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Steven Laureys
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sarah Wannez.

Ethics declarations

Conflicts of interest

Phasya S.A. provided the device without any financial compensation.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study, or by patient surrogate-decision makers.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wannez, S., Hoyoux, T., Langohr, T. et al. Objective assessment of visual pursuit in patients with disorders of consciousness: an exploratory study. J Neurol 264, 928–937 (2017). https://doi.org/10.1007/s00415-017-8469-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00415-017-8469-0

Keywords

Search

Navigation