Advanced Spatiomotor Rehabilitation in Blindness & Visual Impairment

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DESCRIPTION (provided by applicant): We propose a multidisciplinary approach to effective spatiomotor rehabilitation in blindness and visual impairment. For those who have lost vision, the eye-hand coordination normally available for the manipulation of objects for everyday activities is unavailable and has to be replaced by information from other senses. It becomes crucial to activate cross-modal brain plasticity mechanisms for functional compensation of the visual loss in order to develop robust non-visual mental representations of space and objects. Such non- visual 'maps' are needed to guide spatiomotor coordination, reasoning and decision-making. Our multidisciplinary approach to this problem lies uniquely at the intersection of the fields of blindness assessment, spatiomotor rehabilitation, and brain function, each a focus of one Specific Aim. The novel approach overcomes the shortcomings of traditional rehabilitation training, which can never cover all tasks that a person faces in life (and can be both tedious and expensive). To bridge this gap, we have developed an effective rehabilitation tool, the Cognitive-Kinesthetic (C-K) training protocol to bridge the gap to wide- spectrum blind rehabilitation by employing an integral task (drawing) that can affect 'at one stroke' a wide vocabulary of core abilities that are building blocks for numerous everyday tasks. Our pilot testing shows C-K training to be a powerful instigator of multiple skills, such as generation of precise memory representations (mental maps), enhanced spatial cognition and improved spatiomotor coordination. In Aim 1, we will comprehensively characterize the differential impact of life-history factors through a set of complementary forms of objective assessment of performance. In Aim 2, we will run the C-K rehabilitation training of precise (non-visual) spatiomotor coordination guided by tactile memory. After training, we will re-run all the assessments from Aim 1 to quantify the effectiveness of spatiomotor rehabilitation, its transfer to standardized measures for blind capabilities, and the effect of the independent life-history variables from Aim 1 on the effectiveness of the rehabilitation. Aim 3 will compare whole-brain functional Magnetic Resonance Imaging (fMRI) before and after the C-K training to determine how the visual 'eye-hand' coordination is replaced by nonvisual spatial-memory/hand coordination. Understanding the behavioral and neural adaptation mechanisms underlying the rehabilitation of vision loss will meet the NEI strategic goal of providing for a well-informed scientific approach to future rehabilitation. The comprehensive studies planned will generate a large-scale dataset of parallel measures of life-factors, spatiomotor performance and brain activity measures, which will be made publicly available to basic and clinical scientists.