Oculomotor neurorehabilitation for reading in mild traumatic brain injury (mTBI): An integrative approach

Abstract

BACKGROUND: Considering the extensive neural network of the oculomotor subsystems, traumatic brain injury (TBI) could affect oculomotor control and related reading dysfunction. OBJECTIVE: To evaluate comprehensively the effect of oculomotor-based vision rehabilitation (OBVR) in individuals with mTBI. METHODS: Twelve subjects with mTBI participated in a cross-over, interventional study involving oculomotor training (OMT) and sham training (ST). Each training was performed for 6 weeks, 2 sessions a week. During each training session, all three oculomotor subsystems (vergence/accommodation/version) were trained in a randomized order across sessions. All laboratory and clinical parameters were determined before and after OMT and ST. In addition, nearvision-related symptoms using the Convergence Insufficiency Symptom Survey (CISS) scale and subjective visual attention using the Visual Search and Attention Test (VSAT) were assessed. RESULTS: Following the OMT, over 80% of the abnormal parameters significantly improved. Reading rate, along with the amplitudes of vergence and accommodation, improved markedly. Saccadic eye movements demonstrated enhanced rhythmicity and accuracy. The improved reading-related oculomotor behavior was reflected in reduced symptoms and increased visual attention. None of the parameters changed with ST. CONCLUSIONS: OBVR had a strong positive effect on oculomotor control, reading rate, and overall reading ability. This oculomotor learning effect suggests considerable residual neuroplasticity following mTBI.

Effect of retinal defocus on basketball free throw shooting performance

“…Thus, with repetition and practice, motor patterns eventually become stored in long-term memory and effectively become 'reflexive' movements, in much the same way that everyday tasks, such as the sequencing of eye movements during reading, are automatic. 15 The basketball free throw is likely a motor pattern that becomes reflexive and pre-programmed with considerable practice. Indeed, Ripoll, Bard and Paillard 16 described the basketball shot as a preprogrammed movement that proceeds 'in an automatic fashion, without requiring any more visual and head stabilisation during the throwing action itself'.…”

A conceptual model for vision rehabilitation

“…As vision function and functional vision exist on a continuous spectrum, basic visual impairments (e.g., acuity, oculomotor skills) result in poor performance on more complex and advanced visuoperceptual tasks [50]. As noted previously, Warren [32] established a hierarchical model of visual-spatial abilities in which the most basic skills form the foundation for each successive level.…”

“…Furthermore, if we assume that the integration of “vision specialists” into our rehabilitation team is successful, ample evidence suggests that visual deficits can be remediated through vision rehabilitation [50–55]. Padula et al have developed comprehensive courses to address visual impairment and subsequent dysfunction and even proposed changes in legislation to better address these needs [56–58].…”

Visual fatigue effects on vergence dynamics in asymptomatic individuals

“…The PRII has been used in several experiments in our laboratory. [29][30][31] Test procedure Congruent (C) and non-congruent (NC) tasks 25,32 of equal total vergence demand (4.5 MA) were tested on two different sessions on separate days. The tasks were counterbalanced among the subjects.…”

“…This criterion has been used in earlier experiments. [29][30][31] An exponential decay function was fit to the traces, and the response amplitudes and time constants were obtained using Graphpad Prism â software (www. graphpad.com).…”