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

Issue title: The Practice of Cognitive Rehabilitation Therapy

Guest editors: Rick Parente

Article type: Research Article

Authors: Thiagarajan, Preethi^{a; *} | Ciuffreda, Kenneth J.^a | Capo-Aponte, Jose E.^b | Ludlam, Diana P.^a | Kapoor, Neera^c

Affiliations: [a] Department of Biological and Vision Sciences, SUNY State College of Optometry, New York, NY, USA | [b] Optometry Service, Womack Army Medical Center, Fort Bragg, NC, USA | [c] Department of Clinical Sciences, SUNY State College of Optometry, New York, NY, USA

Correspondence: [*] Address for correspondence: Preethi Thiagarajan, Retina Foundation of the Southwest, 9600 N Central Expy, Suite 200, Dallas, TX 75231, USA. Tel.: +1 214 363 3911; Fax: +1 214 363 4538; E-mail: [email protected]

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

DOI: 10.3233/NRE-131025

Journal: NeuroRehabilitation, vol. 34, no. 1, pp. 129-146, 2014