March 2012
Volume 53, Issue 14
Free
ARVO Annual Meeting Abstract  |   March 2012
Effect Of Oculomotor Rehabilitation On Accommodative Dynamics In Individuals With Mild Traumatic Brain Injury (mtbi)
Author Affiliations & Notes
  • Preethi Thiagarajan
    Vision Sciences,
    SUNY College of Optometry, New York, New York
  • Kenneth J. Ciuffreda
    Vision Sciences,
    SUNY College of Optometry, New York, New York
  • Diana P. Ludlam
    Vision Sciences,
    SUNY College of Optometry, New York, New York
  • Neera Kapoor
    Clinical Sciences,
    SUNY College of Optometry, New York, New York
  • Jose E. Capo-Aponte
    Sensory Research Division, US Army Aeromedical Rsrch Lab, Enterprise, Alabama
  • Footnotes
    Commercial Relationships  Preethi Thiagarajan, None; Kenneth J. Ciuffreda, None; Diana P. Ludlam, None; Neera Kapoor, None; Jose E. Capo-Aponte, None
  • Footnotes
    Support  US Army, TATRC # W81XWH-10-1-1041
Investigative Ophthalmology & Visual Science March 2012, Vol.53, 1356. doi:
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      Preethi Thiagarajan, Kenneth J. Ciuffreda, Diana P. Ludlam, Neera Kapoor, Jose E. Capo-Aponte; Effect Of Oculomotor Rehabilitation On Accommodative Dynamics In Individuals With Mild Traumatic Brain Injury (mtbi). Invest. Ophthalmol. Vis. Sci. 2012;53(14):1356.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose: : To evaluate objectively accommodative dynamics immediately before and after accommodative oculomotor-based vision rehabilitation in individuals with mTBI.

Methods: : Monocular accommodative dynamics for a 2D step (2.5↔4.5D) stimulus were assessed objectively (WAM 5500 open-field autorefractor; 5Hz sampling rate) before and after 6 weeks (2 sessions/week; 20 minutes/session) of accommodative step training (total training time of 4 hours) in 5 visually-symptomatic, adult, non-presbyopic (mean age: 28 years) individuals with mTBI. Accommodative training was part of a comprehensive oculomotor rehabilitation protocol that included version (20 minutes/session) and vergence (20 minutes/session) components. First-order dynamics for increasing and decreasing accommodative responses were derived from 4 artifact-free dynamic trajectories that were statistically analyzed before and after the oculomotor rehabilitation.

Results: : Mean peak velocity increased significantly following the rehabilitation for both increasing (2.9 to 4 D/sec) and decreasing (2 to 3.3 D/sec) accommodation. Concomitantly, mean time constant reduced significantly for both increasing (637 to 455 msec) and decreasing (951 to 677 msec) accommodation. Clinically, this increase in the response speed was consistent with a significant increase in mean clinical accommodative facility testing (4.75 to 7 cycles/min). However, there were no significant differences in the mean response amplitude, steady-state (SS) response variability, and SS response level before and after vision rehabilitation for both increasing and decreasing accommodation. In addition, following the rehabilitation, individuals reported reduced (~65%) symptoms of intermittent blur and defocus for near tasks measured using convergence insufficiency symptom survey (CISS) scale. This subjective response was consistent with an improvement in the accommodative amplitude (push-up technique) assessed clinically.

Conclusions: : Improved dynamics of the accommodative system in individuals with mTBI are attributed to oculomotor learning effects. This reflects underlying neuroplasticity in the compromised brain following its injury. Reduced near-vision symptoms were consistent with the improved objective findings.

Keywords: accommodation • learning • plasticity 
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