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Towards consensus on visual pursuit and visual fixation in patients with disorders of consciousness. A Delphi study

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  • Berno U H Overbeek
  • Jan C M Lavrijsen
  • Simon van Gaal
  • Daniel Kondziella
  • Henk J Eilander
  • Raymond T C M Koopmans
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BACKGROUND: The aim of this Delphi study was to reach consensus about definition, operationalization and assessment of visual pursuit (VP) and visual fixation (VF).

METHODS: In a three-round international Delphi study, clinical and research experts on disorders of consciousness indicated their level of agreement on 87 statements using a 5-point Likert scale. Consensus for agreement was defined by a median of 5, an interquartile range (IQR) ≤ 1, and ≥ 80% indicating moderate or strong agreement.

RESULTS: Forty-three experts from three continents participated, 32 completed all three rounds. For VP, the consensus statements with the highest levels of agreement were on the term 'pursuit of a visual stimulus', the description 'ability to follow visually in horizontal and/or vertical plane', a duration > 2 s, tracking in horizontal and vertical planes, and a frequency of more than 2 times per assessment. For VF, consensus statements with the highest levels of agreement were on the term 'sustained VF', the description 'sustained fixation in response to a salient stimulus', a duration of > 2 s and a frequency of 2 or more times per assessment. The assessment factors with the highest levels of agreement were personalized stimuli, the use of eye tracking technology, a patient dependent time of assessment, sufficient environmental light, upright posture, and the necessity to exclude ocular/oculomotor problems.

CONCLUSION: This first international Delphi study on VP and VF in patients with disorders of consciousness provides provisional operational definitions and an overview of the most relevant assessment factors.

Original languageEnglish
JournalJournal of Neurology
Volume269
Issue number6
Pages (from-to)3204-3215
Number of pages12
ISSN0340-5354
DOIs
Publication statusPublished - Jun 2022

Bibliographical note

© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.

    Research areas

  • Consciousness, Consensus, Delphi Technique, Eye Movements, Fixation, Ocular, Humans, Visual pursuit, Visual fixation, Disorders of consciousness, Delphi study

ID: 79816972