Effect of oculomotor rehabilitation on vergence responsivity in mild traumatic brain injury

Abstract

Abstract-A range of dynamic and static vergence responses were evaluated in 12 individuals with mild traumatic brain injury (age: 29 +/-3 yr) having near vision symptoms. All measures were performed in a crossover design before and after oculomotor training (OMT) and placebo (P) training. Following OMT, peak velocity for both convergence and divergence increased significantly. Increased peak velocity was significantly correlated with increased clinically based vergence prism flipper rate. Steady-state response variability for convergence reduced significantly following OMT. The maximum amplitude of convergence, relative fusional amplitudes, and near stereoacuity improved significantly. In addition, symptoms reduced significantly, and visual attention improved markedly. None of the measures were found to change significantly following P training. The significant improvement in most aspects of vergence eye movements following OMT demonstrates considerable residual brain plasticity via oculomotor learning. The improved vergence affected positively on nearwork-related symptoms and visual attention.

Active Rehabilitation of Concussion and Post-concussion Syndrome

“…[95][96][97] With respect to the treatment of visual symptoms after concussion in adults, a preliminary placebo controlled trial showed that oculomotor training (OMT) therapy improved rhythmicity, accuracy, and sequencing of saccades following mTBI (as a result of oculomotor learning). 98 There was also a significant reduction in near vision-related symptoms, increased visual attention, and improved reading ability in the OMT but not the placebo arm of the study.…”

Oculomotor-Based Vision Assessment in Mild Traumatic Brain Injury: A Systematic Review

“…44 Furthermore, research regarding ocular rehabilitation for vergence has demonstrated positive results, namely, an improvement in objective optometric findings, reduction of self-reported symptoms (eg, fatigue, headache), and improvement in function (eg, improved reading). 18,53 Given that impairments in vergence are easily assessed by vision specialists and may be relatively easily correctable with glasses or improved with ocular rehabilitation, 54 further study of the utility of vergence in relation to the clinical identification of mTBI may be worthwhile.…”

A review of the current practice in diagnosis and management of visual complaints associated with concussion and postconcussion syndrome

“…Over 70% of patients with a vertical heterophoria reported relief with prismatic correction [11]. Accommodative symptoms may occur as a result of accommodative insufficiency (incidence of 10-33%), accommodative excess (4%), or varying accommodation [50]. Treatment for accommodative complaints may be addressed with spectacle correction for near.…”

“…Treatment for accommodative complaints may be addressed with spectacle correction for near. Oculomotor training may improve accommodative symptoms in patients with concussion [50], but the improvements may not be sustained after treatment termination [51 & ]. Convergence insufficiency treatments include base in prism, near convergence exercises with in-office or home based programs and oculomotor training.…”

“…Convergence insufficiency treatments include base in prism, near convergence exercises with in-office or home based programs and oculomotor training. The only study to date on convergence insufficiency treatment in patients with concussion utilized oculomotor training and reported encouraging results [50]. Convergence insufficiency therapies may be an effective tool in helping patients improve performance at work and in the classroom however, further research into effectiveness of convergence exercises in patients specifically following concussion are needed.…”