ASSESSMENT OF NEURO-OPTOMETRIC REHABILITATION USING THE DEVELOPMENTAL EYE MOVEMENT (DEM) TEST IN ADULTS WITH ACQUIRED BRAIN INJURY

Neera Kapoora,c,⁎ and Kenneth Joseph Ciuffredab

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 (9.6 h 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.

Keywords: Traumatic brain injury (TBI), Cerebral vascular accident (CVA)/stroke, Developmental Eye Movement (DEM) test, Eye movements, Neuro-optometric rehabilitation

RELATIONSHIP BETWEEN VISUAL-MOTOR INTEGRATION AND HANDWRITING SKILLS OF CHILDREN IN KINDERGARTEN: A Modified Replication Study

Christopher J. Daly; Gail T. Kelley; Andrea Krauss

Abstract

OBJECTIVE. The purpose of this study was to examine the relationship of performance on the Developmental Test of Visual-Motor Integration (VMI; Beery, 1997) to handwriting legibility in children attending kindergarten. The relationship of using lined versus unlined paper on letter legibility, based on a modified version of the Scale of Children’s Readiness in PrinTing (Modified SCRIPT; Weil & Cunningham Amundson, 1994) was also investigated.

METHOD. Fifty-four typically developing kindergarten students were administered the VMI; 30 students completed the Modified SCRIPT with unlined paper, 24 students completed the Modified SCRIPT with lined paper. Students were assessed in the first quarter of the kindergarten school year and scores were analyzed using correlational and nonparametric statistical measures.

RESULTS. Strong positive relationships were found between VMI assessment scores and student’s ability to legibly copy letterforms. Students who could copy the first nine forms on the VMI performed significantly better than students who could not correctly copy the first nine VMI forms on both versions of the Modified SCRIPT.

CONCLUSION. Visual-motor integration skills were shown to be related to the ability to copy letters legibly. These findings support the research of Weil and Cunningham Amundson. Findings from this study also support the conclusion that there is no significant difference in letter writing legibility between students who use paper with or without lines.

THE EFFICACY OF OPTOMETRIC VISION THERAPY

The 1986/87 Future of Visual Development/Performance Task Force.

Abstract

Vision is not simply the ability to read a certain size letter at a distance of 20 feet. Vision is a complex and adaptable information gathering and processing system which collects, groups, analyzes, accumulates, equates, and remembers information. In this review, some of the essential components of the visual system and their disorders which can be physiologically and clinically identified, i.e., the oculomotor, the accommodative, and the fusional vergence systems have been discussed. Any dysfunctions in these systems, can lessen the quality and quantity of the initial input of information into the visual system. Deficiencies in one or more of these visual subsystems have been shown to result in symptoms, such as blurred or uncomfortable vision or headaches, or behavioral signs such as rubbing of the eyes, eyes turning inward or outward, reduced job efficiency or reading performance, or simply the avoidance of near point tasks. In addition, these signs/symptoms may contribute to reducing a person's attention and interest in near tasks. The goal of vision therapy is to eliminate visual problems, thereby reducing the frequency and severity of the patient's signs and symptoms. Vision therapy should only be expected to be of clinical benefit to patients who have detectable visual deficiencies. In response to the question, "How effective is vision therapy in remediating visual deficiencies?," it is evident from the research presented that there is sufficient scientific support for the efficacy of vision therapy in modifying and improving oculomotor, accommodative, and binocular system disorders, as measured by standardized clinical and laboratory testing methods, in the majority of patients of all ages for whom it is properly undertaken and employed. The American Optometric Association reaffirms its long-standing position that vision therapy is an effective therapeutic modality in the treatment of many physiological and information processing dysfunctions of the vision system. It continues to support quality optometric care, education, and research and will cooperate with all professions dedicated to providing the highest quality of life in which vision plays such an important role.

EYE GAZE PATTERNS REVEAL HOW REASONING SKILLS IMPROVE WITH EXPERIENCE

Belén C. Guerra-Carrillo & Silvia A. Bunge 

npj Science of Learning volume 3, Article number: 18 (2018)

ABSTRACT

Reasoning, our ability to solve novel problems, has been shown to improve as a result of learning experiences. However, the underlying mechanisms of change in this high-level cognitive ability are unclear. We hypothesized that possible mechanisms include improvements in the encoding, maintenance, and/or integration of relations among mental representations – i.e., relational thinking. Here, we developed several eye gaze metrics to pinpoint learning mechanisms that underpin improved reasoning performance. We collected behavioral and eyetracking data from young adults who participated in a Law School Admission Test preparation course involving word-based reasoning problems or reading comprehension. The Reasoning group improved more than the Comprehension group on a composite measure of four visuospatial reasoning assessments. Both groups improved similarly on an eyetracking paradigm involving transitive inference problems, exhibiting faster response times while maintaining high accuracy levels; nevertheless, the Reasoning group exhibited a larger change than the Comprehension group on an ocular metric of relational thinking. Across the full sample, individual differences in response time reductions were associated with increased efficiency of relational thinking. Accounting for changes in visual search and a more specific measure of relational integration improved the prediction accuracy of the model, but changes in these two processes alone did not adequately explain behavioral improvements. These findings provide evidence of transfer of learning across different kinds of reasoning problems after completing a brief but intensive course. More broadly, the high temporal precision and rich derivable parameters of eyetracking make it a powerful approach for probing learning mechanisms.

EMOTION-INDUCED TRADE-OFFS IN SPATIOTEMPORAL VISION

Bruno R. Bocanegra and Rene´ Zeelenberg Erasmus University Rotterdam

It is generally assumed that emotion facilitates human vision in order to promote adaptive responses to a potential threat in the environment. Surprisingly, we recently found that emotion in some cases impairs the perception of elementary visual features (Bocanegra & Zeelenberg, 2009b). Here, we demonstrate that emotion improves fast temporal vision at the expense of fine-grained spatial vision. We tested participants’ threshold resolution with Landolt circles containing a small spatial or brief temporal discontinuity. The prior presentation of a fearful face cue, compared with a neutral face cue, impaired spatial resolution but improved temporal resolution. In addition, we show that these benefits and deficits were triggered selectively by the global configural properties of the faces, which were transmitted only through low spatial frequencies. Critically, the common locus of these opposite effects suggests a trade-off between magno- and parvocellular-type visual channels, which contradicts the common assumption that emotion invariably improves vision. We show that, rather than being a general “boost” for all visual features, affective neural circuits sacrifice the slower processing of small details for a coarser but faster visual signal.

Keywords: emotion, vision, fearful faces, spatial resolution, temporal resolution

EMOTION IMPROVES AND IMPAIRS EARLY VISION

Bruno R. Bocanegra and Rene´ Zeelenberg

Erasmus University Rotterdam

ABSTRACT

Recent studies indicate that emotion enhances early vision, but the generality of this finding remains unknown. Do the benefits of emotion extend to all basic aspects of vision, or are they limited in scope? Our results show that the brief presentation of a fearful face, compared with a neutral face, enhances sensitivity for the orientation of subsequently presented low-spatial-frequency stimuli, but diminishes orientation sensitivity for high-spatial-frequency stimuli. This is the first demonstration that emotion not only improves but also impairs low-level vision. The selective low-spatial-frequency benefits are consistent with the idea that emotion enhances magnocellular processing. Additionally, we suggest that the high-spatial-frequency deficits are due to inhibitory interactions between magnocellular and parvocellular pathways. Our results suggest an emotion-induced tradeoff in visual processing, rather than a general improvement. This trade-off may benefit perceptual dimensions that are relevant for survival at the expense of those that are less relevant.

THE OCULOMOTOR SYSTEM'S ABILITY TO ADAPT TO STRUCTURAL CHANGES CAUSED BY THE PROCESS OF SENESCENCE: A REVIEW

Jan Richard Bruenech, Inga-Britt Kjellevold Haugen, Ulla Bak, Marianne Maagaard, Frans Vander Werf

Abstract

Age-related binocular vision anomalies are frequently encountered during clinical examination of mature patients. Observations of both concomitant and incomitant restrictions in eye motility indicate that all oculomotor system levels are implicated, from cortical neurons down to extraocular muscles. The system can make adaptations in response to changes induced by growth and ageing, which it does by monitoring and adjusting its own performance. This adaptive mechanism, which is important for maintaining motility, spatial orientation, and perceptual stability, seems to rely on extra-retinal information about eye position in relation to the head and trunk. Receptors in the extraocular muscles and the vestibular system, assumed to contribute to this type of information, also undergo age-related changes. This may compromise their ability to assist in the adaptive process and in potential calibrations of other neural systems. Furthermore, recent observations of a dual, common, final pathway and double insertions of distal extraocular muscles suggest that muscle and tendon receptors may facilitate other, still unresolved, functions in the visual system. Consequently, age-related changes in certain mechanoreceptors may have more severe implications for ocular motility and visual functions than previously assumed. This review aims to detail some of the most frequent neurogenic and myogenic age-related changes that take place in the human oculomotor system and relevant pre-motor structures. It will also address clinical implications of these changes and the potential adaptive mechanism they initiate.

Keywords

Adaptation; ageing; extraocular muscles; muscle pulley; neural integrator





IMPROVEMENT OF VERGENCE MOVEMENTS BY VISION THERAPY DECREASES K-ARS SCORES OF SYMPTOMATIC ADHD CHILDREN

Abstract

[Purpose] To determine whether the improvement of vergence movements by vision therapy can decrease the K-ARS scores of symptomatic ADHD children. [Methods] Eighty-one out of 1,123 children surveyed using the K-ARS, a parents’-reported questionnaire, led to 16 of these 81 children being showed scores of ≥19, and measurement of binocular function diagnosed as having convergence insufficiency. The 16 children were divided equally into a control group and a vision therapy group. [Results] After vision therapy for 12 weeks, near point convergence (4.38±0.69 cm) significantly neared compared to the near point convergence before vision therapy (11.50±2.28 cm), and both the break point (32.38±2.53 Δ) and recovery point (19.75±2.11 Δ) of near positive fusional vergence significantly improved compared to their values before vision therapy (15.88±2.64 Δ, 6.38±6.70 Δ, respectively). Near exophoria after vision therapy (7.81±2.00 Δ BI) significantly decreased compared to its value before vision therapy (12.00±1.16 Δ BI). The K-ARS scores referring to symptomatic ADHD significantly decreased after vision therapy (17.13±2.84) compared to before vision therapy (23.25±1.49). [Conclusions] Convergence insufficiency symptoms are closely related to symptoms screened for ADHD, and vision therapy to improve vergence movements is an effective method of decreasing the K-ARS scores. Key words: Convergence insufficiency, Vision therapy, ADHD

(This article was submitted Jul. 24, 2013, and was accepted Sep. 1, 2013)

NEURAL BASES OF GAZE AND EMOTION PROCESSING IN CHILDREN WITH AUTISM SPECTRUM DISORDERS

Mari S Davies,1 Mirella Dapretto,2,3,4 Marian Sigman,1,3 Leigh Sepeta,1 and Susan Y Bookheimer1,3

Abstract

Abnormal eye contact is a core symptom of autism spectrum disorders (ASD), though little is understood of the neural bases of gaze processing in ASD. Competing hypotheses suggest that individuals with ASD avoid eye contact due to the anxiety-provoking nature of direct eye gaze or that eye-gaze cues hold less interest or significance to children with ASD. The current study examined the effects of gaze direction on neural processing of emotional faces in typically developing (TD) children and those with ASD. While undergoing functional magnetic resonance imaging (fMRI), 16 high-functioning children and adolescents with ASD and 16 TD controls viewed a series of faces depicting emotional expressions with either direct or averted gaze. Children in both groups showed significant activity in visual-processing regions for both direct and averted gaze trials. However, there was a significant group by gaze interaction such that only TD children showed reliably greater activity in ventrolateral prefrontal cortex for direct versus averted gaze. The ASD group showed no difference between direct and averted gaze in response to faces conveying negative emotions. These results highlight the key role of eye gaze in signaling communicative intent and suggest altered processing of the emotional significance of direct gaze in children with ASD.

Keywords: Autism, facial expression, functional magnetic resonance imaging, gaze, developmental neuroimaging

BEHAVIORAL AND EMOTIONAL PROBLEMS ASSOCIATED WITH CONVERGENCE INSUFFICIENCY IN CHILDREN: AN OPEN TRIAL

J Atten Disord. 2013 Nov 22. [Epub ahead of print]

Borsting E, Mitchell GL, Arnold LE, Sheiman M, Chase C, Kulp M, Cotter S, Group 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).

OCULOMOTOR NEUROREHABILITATION FOR READING IN MILD TRAUMATIC BRAIN INJURY (MTBI): AN INTEGRATIVE APPROACH

NeuroRehabilitation. 2013 Nov 27. [Epub ahead of print]

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