NeuroRehabilitation. 2013 Nov 27. [Epub ahead of print]

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

Thiagarajan PCiuffreda KJCapo-Aponte JELudlam DPKapoor N


SUNY State College of Optometry, Department of Biological and Vision Sciences, New York, NY, USA.



Considering the extensive neural network of the oculomotor subsystems, traumatic brain injury (TBI) could affect oculomotor control and related reading dysfunction.


To evaluate comprehensively the effect of oculomotor-based vision rehabilitation (OBVR) in individuals with mTBI.


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.


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.


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.


Traumatic brain injury, eye movements, mTBI, nearvision symptoms, neuroplasticity, oculomotor deficiency, oculomotor learning, oculomotor rehabilitation, reading dysfunction

J Atten Disord. 2013 Nov 22. [Epub ahead of print]

Behavioral and Emotional Problems Associated With Convergence Insufficiency in Children: An Open Trial

Borsting EMitchell GLArnold LESheiman MChase CKulp MCotter SGroup CR.


Objective: This study investigated behavioral and emotional characteristics of children with convergence insufficiency (CI), before and after treatment with office-based vergence accommodative therapy (OBVAT).Method: Parents of 44 children ages 9 to 17 years with symptomatic CI completed the Conners 3 ADHD Index and the Child Behavior Checklist (CBCL) before and after OBVAT. Pre-treatment scores were compared with normative data and post-treatment scores were compared with baseline using the Wilcoxon sign rank test.Results: Following OBVAT, CI children showed a significant mean improvement (p < .0001, effect size of 0.58) on the Conners 3 ADHD Index with the largest changes occurring in the 23 children who scored the highest at baseline. On the CBCL, anxious/depressed, somatic, and internalizing problems improved significantly (p < .001, effect sizes of -0.36, -1.15, and -0.67, respectively).Conclusion: In an open trial, attention and internalizing problems improved significantly following treatment for CI. (J. of Att. Dis. XXXX; XX(X) XX-XX).