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