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Biscardi M, Grossinger Z, Colantonio A, Bayley M, Mollayeva T. Efficacy of restitutive interventions for oculomotor deficits in adults with mild traumatic brain injury: a systematic review and meta-analysis. Brain Inj 2024; 38:499-513. [PMID: 38433498 DOI: 10.1080/02699052.2024.2320163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 02/13/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Mild traumatic brain injury (mTBI) can cause persistent symptoms suggestive of oculomotor deficits. This research synthesized evidence on restitutive interventions for reducing oculomotor deficits in adults with mTBI to understand if these interventions have clinical utility for improving recovery. METHODS Medline, EMBASE, CINHAL, PsychInfo, and Scopus, databases were searched for experimental studies published in English. We rated risk of bias (RoB) using recommended tools, and the certainty of the evidence according to GRADE guidelines. We conducted meta-analyses for similar outcomes reported in at least two studies. RESULTS Out of 5,328 citations, 12 studies (seven case series and five crossover design), with a combined sample size of 354 participants; (43% males) met the inclusion criteria and were analyzed. The analysis revealed a trend toward improvement of oculomotor deficits and visual tasks in response to restitutive intervention. None of the studies addressed sex or gender effects. All studies had high RoB, suggesting low certainty in the reported results. DISCUSSION Restitutive interventions may be beneficial for adults with oculomotor deficits after mTBI, however overall certainty of the evidence remains low. Future efforts must include enhancing attention to study methodology and reporting, sex and gender analyses, and reaching a consensus on outcome measures. PROSPERO REGISTRATION NUMBER CRD42022352276.
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Affiliation(s)
- Melissa Biscardi
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Zane Grossinger
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Angela Colantonio
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Mark Bayley
- Hull Ellis Concussion and Research Clinic, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Tatyana Mollayeva
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
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Nakamura K, Fuchigami T, Morioka S. Eye movement training and gaze analysis for a patient with binocular diplopia after traumatic brain injury: a case report. J Med Case Rep 2023; 17:551. [PMID: 38110994 PMCID: PMC10726626 DOI: 10.1186/s13256-023-04221-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 10/16/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Patients with traumatic brain injury often develop sequelae such as eye movement disorders, including diplopia. Eye movement training is effective in diplopia management. However, few longitudinal follow-up studies have been conducted from the subacute disease stage, owing to the complexity of methods for quantifying diplopia. CASE PRESENTATION The patient is a 30-year-old Japanese man who presented with diplopia and underwent eye movement training for approximately 4 weeks. The angle of diplopia, distance of abduction of the eye, gaze analysis, and self-assessment of diplopia using Holmes' diplopia questionnaire were evaluated. The degree of diplopia increased from 12° to 40° on the right side. The distance of eye abduction increased from 10.4 to 12.8 mm. The self-assessment score improved from 76 to 12 points. Analysis of gaze transition revealed a reduction in the error between the target and gaze. CONCLUSION Eye movement training was successful in ameliorating the symptoms of diplopia in the patient with binocular diplopia. Furthermore, for patients with diplopia symptoms, it was suggested that the oculomotor approach to eye movement training should not only focus on the direction of the diplopia but also on the direction opposite to the diplopia (the weak side).
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Affiliation(s)
- Kaneharu Nakamura
- Department of Rehabilitation, Eishinkai Kishiwada Rehabilitation Hospital, 2-8-10, Kanmatsucho, Kishiwada, Osaka, 596-0827, Japan
- Stroke Rehabilitation Research Laboratory, Eishinkai Kishiwada Rehabilitation Hospital, Kishiwada, Osaka, Japan
| | - Takeshi Fuchigami
- Department of Rehabilitation, Eishinkai Kishiwada Rehabilitation Hospital, 2-8-10, Kanmatsucho, Kishiwada, Osaka, 596-0827, Japan.
- Stroke Rehabilitation Research Laboratory, Eishinkai Kishiwada Rehabilitation Hospital, Kishiwada, Osaka, Japan.
- Neurorehabilitation Research Center, Kio University, Kitakatsuragi-gun, Nara, Japan.
| | - Shu Morioka
- Stroke Rehabilitation Research Laboratory, Eishinkai Kishiwada Rehabilitation Hospital, Kishiwada, Osaka, Japan
- Neurorehabilitation Research Center, Kio University, Kitakatsuragi-gun, Nara, Japan
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Wheeler S, Acord-Vira A. Occupational Therapy Practice Guidelines for Adults With Traumatic Brain Injury. Am J Occup Ther 2023; 77:7704397010. [PMID: 37624997 DOI: 10.5014/ajot.2023.077401] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2023] Open
Abstract
IMPORTANCE Occupational therapy practitioners are uniquely qualified to address the occupational needs of people with traumatic brain injury (TBI) and their caregivers to maximize participation, health, and well-being. OBJECTIVE These Practice Guidelines are informed by systematic reviews of the effectiveness of interventions that address impairments and skills to improve the occupational performance of people with TBI, as well as interventions for caregivers of people with TBI. The purpose of these guidelines is to summarize the current evidence available to assist clinicians' clinical decision-making in providing interventions for people with TBI and their caregivers. METHOD We reviewed six systematic reviews and synthesized the results into clinical recommendations to be used in occupational therapy clinical practice. RESULTS Sixty-two articles served as the basis for the clinical recommendations. CONCLUSIONS AND RECOMMENDATIONS Strong to moderate evidence supports multimodal sensory stimulation, unimodal auditory stimulation, physical activity, virtual reality, cognitive interventions, vision therapy, goal-focused interventions, individual and group training and education, and caregiver supports. Occupational therapy practitioners should incorporate these interventions into individual and group sessions to maximize recovery and promote occupational participation. Additional interventions are also available, based on emerging evidence and expert opinion, including prevention approaches, complexity of injury, and the use of occupation-based performance assessments. What This Article Adds: These Practice Guidelines provide a summary of evidence in clinical recommendations tables supporting occupational therapy interventions that address impairments resulting from and skills to improve occupational performance after TBI. The guidelines also include case study examples and evidence graphics for practitioners to use to support clinical reasoning when selecting interventions that address the goals of the person with TBI and their caregiver's needs.
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Affiliation(s)
- Steven Wheeler
- Steven Wheeler, PhD, OTR/L, FAOTA, CBIS, is Professor and Chair of Occupational Therapy, Division of Occupational Therapy, West Virginia University, Morgantown;
| | - Amanda Acord-Vira
- Amanda Acord-Vira, EdD, OTR/L, FAOTA, CBIS, is Associate Professor of Occupational Therapy, Division of Occupational Therapy, West Virginia University, Morgantown
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Ross EA, Hines RB, Hoffmann M, Jay K, Antonucci MM. Multi-Modal Neurorehabilitation for Persisting Post-Concussion Symptoms. Neurotrauma Rep 2023; 4:297-306. [PMID: 37187507 PMCID: PMC10181800 DOI: 10.1089/neur.2022.0081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
Treatment of the chronic sequela that persist after a mild traumatic brain injury has been challenging with limited efficacy. The aim of this work was to report outcomes obtained from persons who met the criteria of persisting post-concussive symptoms (PPCS), utilizing a novel combination of modalities in a structured neurorehabilitation program. This work was designed as a retrospective, pre-post chart review of objective and subjective measures collected from 62 outpatients with PPCS a mean of 2.2 years post-injury, before and after a multi-modal 5-day treatment protocol. The subjective outcome measure was the 27-item modified Graded Symptom Checklist (mGSC). Objective outcome measures were motor speed/reaction time, coordination, cognitive processing, visual acuity, and vestibular function. Interventions included non-invasive neuromodulation, neuromuscular re-education exercises, gaze stabilization exercises, orthoptic exercises, cognitive training, therapeutic exercises, and single/multi-axis rotation therapy. Pre-post differences in measures were analyzed using the Wilcoxon signed-rank test, with effect size determined by the rank-biserial correlation coefficient. Pre-post treatment comparisons for the subjective mGSC overall, combined symptom measures, individual components of the mGSC, and cluster scores significantly improved for all items. Moderate strength relationships were observed for the mGSC composite score, number of symptoms, average symptom score, feeling in a "fog," "don't feel right," irritability, and physical, cognitive, and affective cluster scores. Objective symptom assessment significantly improved for trail making, processing speed, reaction time, visual acuity, and Standardized Assessment of Concussion. Patients suffering from PPCS ∼2 years after injury may have significant benefits with some moderate effect sizes from an intensive, multi-modal neurorehabilitation program.
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Affiliation(s)
- Edward A. Ross
- Department of Medicine, University of Central Florida, Orlando, Florida, USA
- Address correspondence to: Edward A. Ross, MD, Department of Medicine, University of Central Florida, 6850 Lake Nona Boulevard, Orlando, FL 32832, USA
| | - Robert B. Hines
- Department of Population Health Sciences, University of Central Florida, Orlando, Florida, USA
| | - Michael Hoffmann
- Department of Medicine, University of Central Florida, Orlando, Florida, USA
- Neurology Section, Orlando VA Medical Center, Orlando, Florida, USA
| | - Kenneth Jay
- Department of Medicine, University of Central Florida, Orlando, Florida, USA
- Department of Neurology, Carrick Institute, Cape Canaveral, Florida, USA
- Department of Research, Cervello, A/S, Roskilde, Denmark
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Mucha A, Pardini JE, Herring SA, Murphy J, Elbin RJ, Bauer RM, Schmidt JD, Resch JE, Broshek DK. Persisting symptoms after concussion: Considerations for active treatment. PM R 2022; 15:663-673. [PMID: 36507616 DOI: 10.1002/pmrj.12931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 11/04/2022] [Accepted: 11/23/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Anne Mucha
- UPMC Centers for Rehab Services, UPMC Sports Medicine Concussion Program, Pittsburgh, Pennsylvania, USA
| | - Jamie E Pardini
- Departments of Internal Medicine and Neurology, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, USA
| | - Stanley A Herring
- Departments of Rehabilitation Medicine, Orthopaedics and Sports Medicine and Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Justin Murphy
- Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - R J Elbin
- Department of Health, Human Performance and Recreation, University of Arkansas, Fayetteville, Arkansas, USA
| | - Russell M Bauer
- Department of Clinical & Health Psychology, University of Florida Department of Clinical & Health Psychology, Gainesville, Florida, USA
| | - Julianne D Schmidt
- UGA Concussion Research Laboratory, Department of Kinesiology, University of Georgia, Athens, Georgia, USA
| | - Jacob E Resch
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia, USA
| | - Donna K Broshek
- Department of Psychiatry & Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, Virginia, USA
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Watabe T, Suzuki H, Sako R, Abe M, Aoki K, Yoda M. Effect of an oculomotor rehabilitation program for subacute brain injury patients with ophthalmoplegia: a case-control study. Disabil Rehabil 2022; 44:6642-6648. [PMID: 34464538 DOI: 10.1080/09638288.2021.1970249] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE Examining the effects of an oculomotor rehabilitation program in subacute brain injury patients presenting with external ophthalmoplegia. METHODS This case-control study included 33 patients with subacute brain injury accompanied by external ophthalmoplegia (15 cases, 18 controls) from a hospital rehabilitation ward. Participants underwent comprehensive rehabilitation for 8 weeks. The patients participated in an oculomotor rehabilitation program, which involved inducing pursuit, fixation, saccade, and vergence for 20 min daily, 6 days a week for 8 weeks. We assessed improvements in the angle of strabismus; visual function index (VFI), which evaluates inconvenience in daily life; and diplopia after 8 weeks in the two groups using statistical methods. RESULTS The program resulted in an immediate strabismus angle improvement (p < 0.001). Strabismus angle change over the 8-week period was significantly higher (p < 0.001) in patients (22.9 ± 12.3°) than in control participants (8.3 ± 7.6°). VFI change was significantly greater (p = 0.003) in patients (7.1 ± 5.1 points) than in control participants (2.7 ± 2.4 points). The patients exhibited significantly higher diplopia improvement rates while looking straight ahead and in the direction of paralysis than did control participants (p = 0.021 and p = 0.037, respectively). CONCLUSION This program improved external ophthalmoplegia without any specialized environmental configurations or personnel, which ensures wide clinical applications.IMPLICATIONS FOR REHABILITATIONOur oculomotor rehabilitation program improved external ophthalmoplegia in subacute brain injury patients.The program promotes pursuit, fixation, saccades, and vergence. The patients lay in the supine position and it places a little burden on them.The program can be completed within 20 min daily, requires no special environmental configurations, and can be performed by anyone.
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Affiliation(s)
- Takayuki Watabe
- Rehabilitation Division, Northern Yokohama Hospital, Showa University, Yokohama, Japan.,Department of Occupational Therapy, School of Nursing and Rehabilitation Sciences, Showa University, Yokohama, Japan
| | - Hisayoshi Suzuki
- Department of Occupational Therapy, School of Nursing and Rehabilitation Sciences, Showa University, Yokohama, Japan
| | - Rikitaro Sako
- Rehabilitation Center, Fujigaoka Rehabilitation Hospital, Showa University, Yokohama, Japan
| | - Marina Abe
- Rehabilitation Center, Fujigaoka Rehabilitation Hospital, Showa University, Yokohama, Japan
| | - Keiichiro Aoki
- Department of Occupational Therapy, School of Nursing and Rehabilitation Sciences, Showa University, Yokohama, Japan
| | - Mitsumasa Yoda
- Rehabilitation Medicine, School of Medicine, Showa University, Shinagawa, Japan
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Kaldenberg J, Newman R, Jimenez C, Walker M. Vision Therapy Interventions to Support Occupational Performance for People With Traumatic Brain Injury With Visual Symptoms (June 2013-October 2020). Am J Occup Ther 2022; 76:23917. [PMID: 36165888 DOI: 10.5014/ajot.2022/76s2006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Systematic Review Briefs provide a summary of the findings from systematic reviews developed in conjunction with the American Occupational Therapy Association's Evidence-Based Practice Program. Each Systematic Review Brief summarizes the evidence on a theme related to a systematic review topic. This Systematic Review Brief presents findings from the systematic review on the effectiveness of interventions that address visual impairments and visual perception to improve occupational performance for adults with traumatic brain injury.
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Affiliation(s)
- Jennifer Kaldenberg
- Jennifer Kaldenberg, DrPH, MSA, OTR/L, SCLV, FAOTA, is Interim OTD Program DirectorClinical Associate Professor, Boston University College of Health & Rehabilitation Sciences: Sargent College
| | - Robin Newman
- Robin Newman, OTD, MA, OTR/L, CLT, FAOTA, is Clinical Assistant Professor, Boston University College of Health & Rehabilitation Sciences: Sargent College
| | - Christine Jimenez
- Christine Jimenez, OTS, is a graduate student at Boston University College of Health & Rehabilitation Sciences: Sargent College
| | - Mary Walker
- Mary Walker, OTS, is a graduate student at Boston University College of Health & Rehabilitation Sciences: Sargent College
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Thiagarajan P, Ciuffreda KJ. Accommodative and pupillary dysfunctions in concussion/mild traumatic brain injury: A Review. NeuroRehabilitation 2022; 50:261-278. [DOI: 10.3233/nre-228011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Visual dysfunctions are common in individuals following concussion/mild traumatic brain injury (C/mTBI). Many deficits have been uncovered in their oculomotor system, such as in the pupil and accommodation. OBJECTIVE: To describe the static and dynamic abnormalities in the pupillary and accommodative systems in those with C/mTBI. This includes both diagnostic and therapeutic aspects, with emphasis on objectively-based test findings, as well as their basic and clinical ramifications. METHODS: PubMed, Google Scholar, and Semantic Scholar databases were searched from 1980–2020, using key words of accommodation, pupil, vision therapy, vision rehabilitation, and objective testing, for peer-reviewed papers, as well as related textbooks in the area, in those with C/mTBI. RESULTS: For both systems, most static and dynamic response parameters were abnormal: they were typically reduced, slowed, delayed, and/or more variable. Most of the abnormal accommodative parameters could be significantly improved with vision therapy. CONCLUSIONS: For both systems, most response parameters were abnormal, which could explain their visual symptoms and related problems. For accommodation, the improvements following vision therapy suggest the presence of considerable visual system plasticity, even in older adults with chronic brain injury.
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Watabe T, Suzuki H, Abe M, Uchibori K, Senga K. Rehabilitation practice for external ophthalmoplegia including voluntary training for patients with medial longitudinal fasciculus syndrome. JAPANESE JOURNAL OF COMPREHENSIVE REHABILITATION SCIENCE 2022; 13:36-40. [PMID: 37859853 PMCID: PMC10545030 DOI: 10.11336/jjcrs.13.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/16/2022] [Indexed: 10/21/2023]
Abstract
Watabe T, Suzuki H, Abe M, Uchibori K, Senga K. Rehabilitation practice for external ophthalmoplegia including voluntary training for patients with medial longitudinal fasciculus syndrome. Jpn J Compr Rehabil Sci 2022; 13: 36-40. Introduction This report presents a case of external ophthalmoplegia caused by medial longitudinal fasciculus (MLF) syndrome. The patient underwent oculomotor rehabilitation by an occupational therapist during hospitalization and voluntary training supervised by the occupational therapist after discharge. Case The patient presented with MLF syndrome due to bridge infarction. The left eye had a pronounced adduction disorder, and diplopia was observed in the median vision, resulting in severe discomfort in daily life. During the hospitalization, the patient underwent eye movement rehabilitation led by an occupational therapist that included pursuit, fixation, saccades, and convergence, and after discharge from the hospital, the patient underwent two sets of voluntary training for 10 min daily to induce pursuit, fixation, and convergence under the guidance of the occupational therapist. As a result, the angle of squint, degree of diplopia, and degree of inconvenience in daily life improved. Discussion Eye movement rehabilitation, including voluntary training, improved external ophthalmoplegia.
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Affiliation(s)
- Takayuki Watabe
- Rehabilitation Division, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, Japan
- Department of Occupational Therapy, Showa University School of Nursing and Rehabilitation Sciences, Yokohama, Kanagawa, Japan
| | - Hisayoshi Suzuki
- Department of Occupational Therapy, Showa University School of Nursing and Rehabilitation Sciences, Yokohama, Kanagawa, Japan
| | - Marina Abe
- Rehabilitation Center, Showa University Fujigaoka Rehabilitation Hospital, Yokohama, Kanagawa, Japan
| | - Kengo Uchibori
- Rehabilitation Center, Showa University Fujigaoka Rehabilitation Hospital, Yokohama, Kanagawa, Japan
| | - Kotaro Senga
- Department of Occupational Therapy, Showa University School of Nursing and Rehabilitation Sciences, Yokohama, Kanagawa, Japan
- Rehabilitation Center, Showa University Fujigaoka Rehabilitation Hospital, Yokohama, Kanagawa, Japan
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Watabe T, Abe M, Sako R, Suzuki H, Yoda M, Kawate N. Association between external ophthalmoplegia with diplopia due to brain injury and FIM motor items: a case-control study. JAPANESE JOURNAL OF COMPREHENSIVE REHABILITATION SCIENCE 2021; 12:58-63. [PMID: 37860212 PMCID: PMC10545038 DOI: 10.11336/jjcrs.12.58] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/04/2021] [Indexed: 10/21/2023]
Abstract
Watabe T, Abe M, Sako R, Suzuki H, Yoda M, Kawate N. Association between external ophthalmoplegia with diplopia due to brain injury and FIM motor items: a case-control study. Jpn J Compr Rehabil Sci 2021; 12: 58-63. Objectives This study aimed to determine the association between the presence of external ophthalmoplegia with diplopia due to brain injury and Functional Independence Measure (FIM) motor items in a case-control study. Methods The subjects were patients with brain injury, admitted to a convalescent rehabilitation ward, who were able to walk under supervision and had preserved intellectual function. The correlation between the strabismus angle of the external ophthalmoplegia group and the total points of FIM motor items were examined. In addition, the total points and sub-items were compared between the external ophthalmoplegia group and control group using statistical processing. Results There were 78 subjects: 34 in the external ophthalmoplegia group and 44 in the control group. Strabismus angle and the total points of FIM motor items of the external ophthalmoplegia group were significantly negatively correlated. Compared with the control group, the external ophthalmoplegia group had significantly lower levels of independence in bathing, dressing (lower body), toileting, transfer to the chair, transfer to the toilet, transfer to the bathroom, and locomotion (walking). Conclusions External ophthalmoplegia with diplopia is associated with FIM motor items.
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Affiliation(s)
- Takayuki Watabe
- Department of Rehabilitation, Showa University Yokohama City Northern Hospital, Yokohama, Kanagawa, Japan
- Department of Occupational Therapy, School of Nursing and Rehabilitation Sciences, Showa University, Yokohama, Kanagawa, Japan
| | - Marina Abe
- Rehabilitation Center, Showa University Fujigaoka Rehabilitation Hospital, Yokohama, Kanagawa, Japan
| | - Rikitaro Sako
- Rehabilitation Center, Showa University Fujigaoka Rehabilitation Hospital, Yokohama, Kanagawa, Japan
| | - Hisayoshi Suzuki
- Department of Occupational Therapy, School of Nursing and Rehabilitation Sciences, Showa University, Yokohama, Kanagawa, Japan
| | - Mitsumasa Yoda
- Department of Rehabilitation Medicine, Showa University School of Medicine, Shinagawa-ku, Tokyo, Japan
| | - Nobuyuki Kawate
- Department of Rehabilitation Medicine, Showa University School of Medicine, Shinagawa-ku, Tokyo, Japan
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Objectively-based vergence and accommodative dynamics in mild traumatic brain injury (mTBI): A mini review. Vision Res 2021; 191:107967. [PMID: 34808548 DOI: 10.1016/j.visres.2021.107967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 10/12/2021] [Accepted: 10/25/2021] [Indexed: 11/23/2022]
Abstract
Vergence and accommodation have been critical areas of investigation in those with mild traumatic brain injury (mTBI). In this mini-review, the major laboratory studies in the area using objective assessment of vergence and accommodative dynamics in this population are discussed. These include the basic findings, their diagnostic and therapeutic implications, potential study limitations, and suggested future research directions. All studies provided important new information, and insights, into the area. There were two key outcomes of the reviewed studies common to both the vergence and accommodative systems in those with mTBI. First, most dynamic parameter's responsivity at baseline was abnormal: it was slowed, delayed, and/or inaccurate as compared to the normative control data. Second, most of the abnormal dynamic parameter's responsivity could be remediated, at least in part, following a short period of oculomotor-based vision therapy, thus demonstrating considerable residual neuroplasticity in the damaged, human brain.
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Poltavski D, Biberdorf D, Praus Poltavski C. Which Comes First in Sports Vision Training: The Software or the Hardware Update? Utility of Electrophysiological Measures in Monitoring Specialized Visual Training in Youth Athletes. Front Hum Neurosci 2021; 15:732303. [PMID: 34690722 PMCID: PMC8527177 DOI: 10.3389/fnhum.2021.732303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 09/06/2021] [Indexed: 11/13/2022] Open
Abstract
In the present study we combined popular methods of sports vision training (SVT) with traditional oculomotor protocols of Optometric Vision Therapy (OVT) and electrophysiological indexes of EEG and VEP activity to monitor training progress and changes in performance of youth ice hockey players without the history of concussion. We hypothesized that administration of OVT protocols before SVT training may result in larger performance improvements compared to the reverse order due to the initial strengthening of visual hardware capable of handling greater demands during training of visuomotor integration and information processing skills (visual software). In a cross-over design 53 youth ice hockey players (ages 13-18) were randomly assigned to one of the two training groups. Group one (hardware-software group) completed 5 weeks of oculomotor training first followed by 5 weeks of software training. For group 2 (software-hardware) the order of procedures were reversed. After 10 weeks of training both groups significantly improved their performance on all but one measure of the Nike/Senaptec Sensory station measures. Additionally, the software-hardware training order resulted in significantly lower frontal theta-to-gamma amplitude ratios on the Nike/Senaptec test of Near-Far Quickness as well as in faster P100 latencies. Both training orders also resulted in significant decreases in post-treatment P100 amplitude to transient VEP stimuli as well as decreased theta-gamma ratios for perception span, Go/No-Go and Hand Reaction time. The observed changes in the electrophysiological indexes in the present study are thought to reflect greater efficiency in visual information processing and cognitive resource allocation following 10 weeks of visual training. There is also some evidence of the greater effectiveness of the software-hardware training order possibly due to the improved preparedness of the oculomotor system in the youth athletes for administration of targeted protocols of the Optometric Vision Therapy.
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Affiliation(s)
- Dmitri Poltavski
- Department of Psychology, University of North Dakota, Grand Forks, ND, United States
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Rehabilitation of visual disorders. HANDBOOK OF CLINICAL NEUROLOGY 2021; 178:361-386. [PMID: 33832686 DOI: 10.1016/b978-0-12-821377-3.00015-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
While there is a long history of rehabilitation for motor deficits following cerebral lesions, less is known about our ability to improve visual deficits. Vision therapy, prisms, occluders, and filters have been advocated for patients with mild traumatic brain injury, on the premise that some of their symptoms may reflect abnormal visual or ocular motor function, but the evidence for their efficacy is modest. For hemianopia, attempts to restore vision have had unimpressive results, though it appears possible to generate blindsight through training. Strategic approaches that train more efficient use of visual search in hemianopia have shown consistent benefit in visual function, while prism aids may help some patients. There are many varieties of alexia. Strategic adaptation of saccades can improve hemianopic alexia, but there has been less work and mixed results for pure alexia, neglect dyslexia, attentional dyslexia, and the central dyslexias. A number of approaches have been tried in prosopagnosia, with recent studies of small groups suggesting that face perception of prosopagnosic subjects can be enhanced through perceptual learning.
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14
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Barton JJS, Ranalli PJ. Vision Therapy: Ocular Motor Training in Mild Traumatic Brain Injury. Ann Neurol 2020; 88:453-461. [DOI: 10.1002/ana.25820] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 05/28/2020] [Accepted: 06/07/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Jason J. S. Barton
- Departments of Medicine (Neurology), Ophthalmology and Visual Sciences, and PsychologyUniversity of British Columbia Vancouver British Columbia Canada
| | - Paul J. Ranalli
- Departments of Medicine (Neurology), Ophthalmology and Visual Sciences, and Oto‐LaryngologyUniversity of Toronto Toronto Ontario Canada
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Near Point of Convergence Deficits and Treatment Following Concussion: A Systematic Review. J Sport Rehabil 2020; 29:1179-1193. [PMID: 32131046 DOI: 10.1123/jsr.2019-0428] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 12/28/2019] [Accepted: 01/19/2020] [Indexed: 11/18/2022]
Abstract
CONTEXT Convergence dysfunction following concussion is common. Near point of convergence (NPC) is a quick and easy assessment that may detect oculomotor dysfunction such as convergence insufficiency (CI), but NPC measurements are rarely reported. Convergence dysfunction is treatable in otherwise healthy patients; the effectiveness of oculomotor therapy following concussion is unclear. OBJECTIVES The purpose of this article was to systematically review the literature and answer the following clinical questions: (1) Is performance on NPC negatively affected in patients diagnosed with a concussion compared with pre-injury levels or healthy controls? (2) In patients diagnosed with concussion, what is the effect of oculomotor/vision therapy on NPC break measurements? EVIDENCE ACQUISITION The search was conducted in CINAHL, SPORTDiscus, MEDLINE, and PubMed using terms related to concussion, mild traumatic brain injury, convergence, vision, and rehabilitation. Literature considered for review included original research publications that collected measures of NPC break in concussion patients, with a pretest-posttest comparison or comparison with a healthy control group. A literature review was completed; 242 relevant articles were reviewed, with 18 articles meeting criteria for inclusion in the review. EVIDENCE SYNTHESIS Articles were categorized according to the clinical question they addressed. The patient or participant sample (number, sex, age, and health status), study design, instrumentation, or intervention used, and main results were extracted from each article. CONCLUSIONS The authors' main findings suggest that there is a moderate level of evidence that patients have impaired NPC up to several months postconcussion, and a low level of evidence that impairments can be successfully treated with oculomotor therapy. These findings should be cautiously evaluated; the studies are limited by weak/moderate quality, small sample sizes, varied methodology, and nonrandomized treatment groups. Future research should explore factors affecting convergence postconcussion and include randomized, controlled studies to determine if performing vision therapy improves visual measures and promotes recovery.
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Alvarez TL, Scheiman M, Santos EM, Morales C, Yaramothu C, D’Antonio-Bertagnolli JV, Biswal BB, Gohel S, Li X. The Convergence Insufficiency Neuro-mechanism in Adult Population Study (CINAPS) Randomized Clinical Trial: Design, Methods, and Clinical Data. Ophthalmic Epidemiol 2020; 27:52-72. [PMID: 31640452 PMCID: PMC6944764 DOI: 10.1080/09286586.2019.1679192] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 09/17/2019] [Accepted: 10/07/2019] [Indexed: 01/28/2023]
Abstract
Purpose: To describe the design and methodology of the Convergence Insufficiency Neuro-mechanism in Adult Population Study (CINAPS), the first randomized clinical trial (RCT) studying young adults with symptomatic convergence insufficiency (CI) using a combination of traditional clinical tests, objective eye movement recordings, and functional brain activities as outcome measures.Methods: In this double-masked RCT, binocularly normal controls (BNC) (N = 50) and CI patients (N = 50) are randomized into office-based vergence/accommodative therapy (OBVAT) or office-based placebo therapy (OBPT). Outcome measures included clinical signs and symptoms, phoria adaptation, forced fixation disparity curves, binocular rivalry, vergence and saccadic objective eye movements, and task-induced functional brain activities. This study is registered on ClinicalTrials.gov NCT03593031.Results: No significant baseline differences are observed between the BNC (p > .4) or CI (p > .3) participants assigned to OBVAT or OBPT for age, near point of convergence (NPC), positive fusional vergence (PFV), phoria at distance and near, amplitude of accommodation, or the Convergence Insufficiency Symptom Survey (CISS). Significant differences are observed between the CI and BNC cohorts at baseline measurements for NPC, PFV, difference in phoria from far to near, amplitude of accommodation, and CISS (p < .001). For the CI patients, 26% had a comorbidity of accommodation insufficiency, and 16% self-reported ADHD.Conclusion: Features of the study design include the following: standardized diagnostic and office-based therapeutic intervention, placebo treatment arm, masked clinical outcome examinations, objective eye movement recordings, functional imaging, phoria adaptation, fixation disparity curves and binocular rivalry measurements.
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Affiliation(s)
- Tara L. Alvarez
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, USA
| | - Mitchell Scheiman
- Pennsylvania College of Optometry, Salus University, Elkins Park, USA
| | - Elio M. Santos
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, USA
| | - Cristian Morales
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, USA
| | - Chang Yaramothu
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, USA
| | | | - Bharat B. Biswal
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, USA
| | - Suril Gohel
- Department of Health Informatics, Rutgers University School of Health Professions, Newark, USA
| | - Xiaobo Li
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, USA
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Watabe T, Suzuki H, Abe M, Sasaki S, Nagashima J, Kawate N. Systematic review of visual rehabilitation interventions for oculomotor deficits in patients with brain injury. Brain Inj 2019; 33:1592-1596. [PMID: 31455098 DOI: 10.1080/02699052.2019.1658225] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: Secondary to brain injury, many people develop eye movement disorders (oculomotor deficits). To clarify, optimize, and standardize the development of oculomotor rehabilitation programs, we systematically reviewed the literature on vision rehabilitation interventions for oculomotor deficits in brain injury, focusing on those with broad clinical feasibility.Materials and Methods: We searched MEDLINE (PubMed), CENTRAL, Scopus, and CINAHL databases for key title terms "oculomotor", "rehabilitation", or a related term, and "brain injury" or a related term in the title or abstract. We excluded case reports of a single patient, studies of non-oculomotor visual deficits, and articles in which the intervention and assessment methods were not explicitly identified.Results: Nine articles were included, six of which utilized computer-based training programs to elicit characteristic fixation, saccades, pursuit, vergence, and accommodative movements. Within the entire sample, interventions ranged from 3 to 10 weeks, and involved 2 to 5 training sessions per week.Conclusions: Oculomotor rehabilitation interventions showed some efficacy in treating patients with brain injury; however, there were very few studies overall. Several eye movement types - fixation, saccades, pursuit, vergence, and accommodation - can be elicited manually by therapists. We eagerly await the development and implementation of new intervention programs for broad-based clinical practice.
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Affiliation(s)
- Takayuki Watabe
- Rehabilitation Center, Showa University Fujigaoka Rehabilitation Hospital, Kanagawa, Japan.,Department of Occupational Therapy, School of Nursing and Rehabilitation Sciences, Showa University, Kanagawa, Japan
| | - Hisayoshi Suzuki
- Department of Occupational Therapy, School of Nursing and Rehabilitation Sciences, Showa University, Kanagawa, Japan
| | - Marina Abe
- Rehabilitation Center, Showa University Fujigaoka Rehabilitation Hospital, Kanagawa, Japan
| | - Shuichi Sasaki
- Department of Rehabilitation, Kitasato University Hospital, Kanagawa, Japan
| | - Jun Nagashima
- Rehabilitation Center, Showa University Fujigaoka Rehabilitation Hospital, Kanagawa, Japan.,Department of Occupational Therapy, School of Nursing and Rehabilitation Sciences, Showa University, Kanagawa, Japan
| | - Nobuyuki Kawate
- Rehabilitation Medicine, Showa University School of Medicine, Kanagawa, Japan
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Abstract
Concussions are a common injury for which patients often present first to primary care physicians. They can affect the day-to-day function of patients in school and work, as well as in sports and recreational activities. Recognizing common physical signs and symptoms after injury facilitates timely diagnosis and treatment, permitting initiation of an active management approach to recovery while preventing secondary injury. For persons with persistent symptoms, active rehabilitation may be utilized, with the goal of returning patients to full function.
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Affiliation(s)
- Christina L Master
- From the Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. (C.L.M., M.F.G.)
| | - Andrew R Mayer
- From the Mind Research Network, Albuquerque, New Mexico. (A.R.M.)
| | - Davin Quinn
- From the University of New Mexico, Albuquerque, New Mexico. (D.Q.)
| | - Matthew F Grady
- From the Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. (C.L.M., M.F.G.)
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Simpson-Jones ME, Hunt AW. Vision rehabilitation interventions following mild traumatic brain injury: a scoping review. Disabil Rehabil 2018; 41:2206-2222. [DOI: 10.1080/09638288.2018.1460407] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Mary E. Simpson-Jones
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Canada
| | - Anne W. Hunt
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Canada
- Clinical Study Investigator Bloorview Research Institute, Toronto, Canada
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20
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Kapoor N, Ciuffreda KJ. Assessment of neuro-optometric rehabilitation using the Developmental Eye Movement (DEM) test in adults with acquired brain injury. JOURNAL OF OPTOMETRY 2018; 11:103-112. [PMID: 28676352 PMCID: PMC5904826 DOI: 10.1016/j.optom.2017.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 01/16/2017] [Accepted: 01/20/2017] [Indexed: 05/14/2023]
Abstract
PURPOSE This pilot study sought to determine the efficacy of using the Developmental Eye Movement (DEM) test in the adult, acquired brain injury (ABI) population to quantify clinically the effects of controlled, laboratory-performed, oculomotor-based vision therapy/vision rehabilitation. METHODS Nine adult subjects with mild traumatic brain injury (mTBI) and five with stroke were assessed before and after an eight-week, computer-based, versional oculomotor (fixation, saccades, pursuit, and simulated reading) training program (9.6h total). The protocol incorporated a cross-over, interventional design with and without the addition of auditory feedback regarding two-dimensional eye position. The clinical outcome measure was the Developmental Eye Movement (DEM) test score (ratio, errors) taken before, midway, and immediately following training. RESULTS For the DEM ratio parameter, improvements were found in 80-89% of the subjects. For the DEM error parameter, improvements were found in 100% of the subjects. Incorporation of the auditory feedback component revealed a trend toward enhanced performance. The findings were similar for both DEM parameters, as well as for incorporation of the auditory feedback, in both diagnostic groups. DISCUSSION The results of the present study demonstrated considerable improvements in the DEM test scores following the oculomotor-based training, thus reflecting more time-optimal and accurate saccadic tracking after the training. The DEM test should be considered as another clinical test of global saccadic tracking performance in the ABI population.
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Affiliation(s)
- Neera Kapoor
- New York University's School of Medicine's Department of Rehabilitation Medicine, New York University's Langone Medical Center's RUSK Rehabilitation, 240 East 38th Street, Room 15-32, New York, NY 10016, United States.
| | - Kenneth Joseph Ciuffreda
- State University of New York, State College of Optometry, 33 West 42nd Street, New York, NY 10036, United States
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21
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Ciuffreda KJ, Yadav NK, Thiagarajan P, Ludlam DP. A Novel Computer Oculomotor Rehabilitation (COR) Program for Mild Traumatic Brain Injury (mTBI). Brain Sci 2017; 7:brainsci7080099. [PMID: 28792451 PMCID: PMC5575619 DOI: 10.3390/brainsci7080099] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 07/25/2017] [Accepted: 08/04/2017] [Indexed: 11/16/2022] Open
Abstract
Individuals with traumatic brain injury (TBI) manifest a wide range of visual dysfunctions. One of the most prevalent involves the oculomotor system, which includes version, vergence, and accommodation. However, until recently, there has been no comprehensive, computer-based program for remediation of these oculomotor deficits. We present such an oculomotor rehabilitation program that has been tested in a clinical trial in patients having TBI with a high degree of success based on before-and-after objective system recordings, performance measures, and related visual symptomotology. The basic program components include a versatile stimulus package incorporating the attentional paradigm of rapid serial visual presentation (RSVP), the ability to add a visual and/or auditory distractor to the training to increase difficulty level ("task loading"), automated assessment of RSVP errors, and automated assessment of visual performance over the training period. Program limitations and future directions are also considered.
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Affiliation(s)
- Kenneth J Ciuffreda
- Department of Biological and Vision Sciences, State University of New York, College of Optometry, New York, NY 10016, USA.
| | - Naveen K Yadav
- Chicago College of Optometry, Midwestern University, Downers Grove, IL 60515, USA.
| | - Preethi Thiagarajan
- Department of Biological and Vision Sciences, State University of New York, College of Optometry, New York, NY 10016, USA.
| | - Diana P Ludlam
- Department of Biological and Vision Sciences, State University of New York, College of Optometry, New York, NY 10016, USA.
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22
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A review of the current practice in diagnosis and management of visual complaints associated with concussion and postconcussion syndrome. Curr Opin Ophthalmol 2016; 27:407-12. [PMID: 27213924 DOI: 10.1097/icu.0000000000000296] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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