Gait control – visuo-motor interactions and plasticity in glaucoma

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Unsteady gait is a cause of increased incidences of falls and reduced mobility in the elderly, and is thus a source of a significant reduction in quality of life. A critical factor of gait control constitutes, apart from the motor-skills themselves, the interplay of the motoric system with both sensory and cognitive processes. This renders elderly with sensory impairment particularly prone to falls. Important examples are persons with glaucoma, a prevalent disease causing substantial visual impairment. An understanding of the role of visual, cognitive and visuo-cognitive functionality and their interactions during gait control is expected to pave the way for efficient interventional instruments to improve gait control in glaucoma and beyond. This prompts the question, whether multimodal movement-related interventions, i.e., those addressing motor-, sensory, and cognitive functions in a combined manner, are superior to unimodal movement-related interventions in their effect on gait control.Our project aims to understand the interplay of motor-, visual, cognitive and visuo-cognitive function during gait control and its impact on the development of interventional instruments. It addresses glaucoma as an important and relevant model for risk groups with sensory impairment. In a multidisciplinary approach the project combines expertise in physical-activity and movement sciences, ophthalmology and neurosciences to address the following steps: (i) Development of research tools to identify interactions of visual function, cognition, visuo-cognition and gait control for both laboratory settings and, importantly, everyday like conditions. (ii) Application of these tools in ≥50 participants with glaucoma and matched controls to uncover and understand the relative importance of visual function, cognition, and visuo-cognition for gait control. (iii) Comparison of two interventional concepts, a unimodal and a multimodal movement-related intervention, in a longitudinal design in two glaucoma intervention groups, comprising a total of ≥50 participants. Behavioural readouts of the intervention effects will be combined with physiological correlates from resting state fMRI, to uncover mechanisms of neuro-plasticity and their correlation with behavioural measures. This will target changes in functional connectivity between brain regions representing motor skills, vision and cognition.We expect this investigation of the interaction of cognition, vision, and visuo-cognition in gait control in glaucoma and matched controls to considerably increase our understanding of gait control and to guide the identification of efficient interventional concepts for prevention and rehabilitation in general.