Research

 

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

Source

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

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.

KEYWORDS:

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.

Abstract

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).