Functional Mechanism of Neural Control in Post-Concussion Convergence Insufficiency

脑震荡后收敛不足的神经控制功能机制

• 批准号: 10297371
• 负责人: Tara Lynn Alvarez
• 金额: $ 61.55万
• 依托单位: NEW JERSEY INSTITUTE OF TECHNOLOGY
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-04-01 至 2026-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10297371
• 关键词: 21 year old; Address; Adolescent and Young Adult; Adult; Age; Automobile Driving; Behavior; Binocular Vision Disorder; Brain; Brain Concussion; Caring; Cerebellar vermis structure; Child; Clinical; Clinical Sciences; Communities; Convergence Insufficiency; Craniocerebral Trauma; Data; Diagnostic; Enrollment; Etiology; Eye Movements; Functional Magnetic Resonance Imaging; Health; Hour; Injury; Lead; Link; Measurement; Measures; Ocular Fixation; Outcome; Outcome Measure; Participant; Pathology; Patients; Performance; Population; Positioning Attribute; Post-Concussion Syndrome; Preparation; Prevalence; Procedures; Protocols documentation; Publishing; Ramp; Randomized; Randomized Clinical Trials; Reading; Recording of previous events; Recovery; Reporting; Research; Saccades; Schools; Severities; Smooth Pursuit; Sports; Symptoms; System; Testing; Thalamic structure; Therapeutic; Time; Vision; Visual; Work; base; brain behavior; compare effectiveness; digital; disabling symptom; dosage; effective therapy; effectiveness evaluation; experimental study; frontal eye fields; improved; neuromechanism; neuroregulation; novel therapeutics; oculomotor; point of care; relating to nervous system; response; sample fixation; visual performance; young adult

Project Summary/Abstract: During the past 6 years, our study team investigated the neural mechanism of typically-occurring convergence insufficiency (TYP-CI), the most common binocular vision disorder in children and young adults (3.4% to 12.7%5–11) leading to 20 publications12–31 with 4 more in review and 6 in preparation. We conducted the only randomized clinical trial (RCT) integrating objective eye movement and fMRI outcome measures, achieving 100% planned enrollment and retention of 100 young adults.28 Our results localized the reduction in functional activity for TYP-CI compared to controls within the oculomotor vermis (OVM) and the cuneus. Functional activity in the OVM and cuneus was significantly correlated to convergence peak velocity providing the first mechanistic identification of these deficits that create significant burden to those afflicted. 23 Our longitudinal results discovered that the neural mechanistic change stimulated by office-based vergence /accommodative therapy (OBVAT) is an increase in the frontal eye field (FEF) and thalamus functional activity. Increased functional activity from the FEF and thalamus significantly correlates to convergence peak velocity. 23,32,33 Results are leading to personalized point-of-care therapies remediating the debilitating symptoms for TYP-CI patients. While our research and results of other RCTs show that OBVAT is the most effective treatment for remediating symptoms and improving vision function in both TYP-CI children 34–36 and adults, 37,38 none of these participants had a history of head injury, a pathology that has been linked to CI. Our research team has demonstrated that the prevalence of CI is higher (38% to 49%) in children 39,40 and adults 41,42 with persistent post-concussive symptoms (PPCS-CI), than in the non-concussed population. Currently, there is no validated treatment for PPCS-CI. This difference in prevalence, mode of onset (longstanding versus sudden onset), and severity of the condition has led to a debate about whether the diagnostic and management procedures effective for TYP-CI should be utilized for PPCS-CI, and strongly suggests that new research is needed to optimize PPCS-CI management. We are uniquely positioned to provide answers to these questions by building on our work establishing the neurofunctional mechanism of TYP-CI and OBVAT administered to TYP-CI. Such research is of great importance because PPCS-CI is associated with debilitating visual symptoms impacting the return to school/sports, 43–47 work, 48–51 or driving. 52 We have identified three significant gaps for the treatment of PPCS-CI that must be addressed to determine its most effective management. First, given the obvious differences in etiology, are there significant differences between TYP-CI and PPCS-CI related to objective eye movement measures (peak velocity, final amplitude, and repeatability) due to underlying neural mechanistic differences? Second, what is the underlying neural mechanism of OBVAT for PPCS-CI compared to TYP-CI? Third, how effective is OBVAT for PPCS-CI and is the dosage of administration different than TYP-CI? This renewal addresses these gaps in clinical science.

项目概要/摘要：在过去的6年里，我们的研究团队研究了神经机制 典型发生的会聚不足（TYP-CI），儿童最常见的双眼视觉障碍 青年人（3.4% 至 12.7%5-11）发表了 20 篇出版物12-31，其中 4 篇正在审阅，6 篇正在准备中。 我们进行了唯一一项整合客观眼动和功能磁共振成像结果的随机临床试验 (RCT) 措施，实现了 100 名年轻人的 100% 计划入学率和保留率。28 我们的结果将 与动眼蚓部 (OVM) 内的对照相比，TYP-CI 的功能活动减少 楔肌。 OVM 和楔骨的功能活动与收敛峰值速度显着相关 首次对这些给受影响者造成重大负担的缺陷进行机械识别。 23 我们的纵向结果发现，办公室的聚散刺激了神经机制的变化 /调节疗法 (OBVAT) 是增加额叶视野 (FEF) 和丘脑功能活动。 FEF 和丘脑功能活动的增加与收敛峰值显着相关 速度。 23,32,33 结果导致个性化的护理点疗法可以治愈衰弱的患者 TYP-CI 患者的症状。虽然我们的研究和其他随机对照试验的结果表明 OBVAT 是最有效的 有效治疗 TYP-CI 儿童 34-36 岁和 成人，37,38 这些参与者都没有头部损伤史，这是一种与 CI 相关的病理学。我们的 研究小组证明，儿童中 CI 的患病率较高（38% 至 49%）39,40 与非脑震荡人群相比，患有持续性脑震荡后症状 (PPCS-CI) 的成年人 41,42 更高。 目前，PPCS-CI 尚无经过验证的治疗方法。这种患病率、发病方式的差异 （长期发病与突然发病），以及病情的严重程度引发了一场争论： 对 TYP-CI 有效的诊断和管理程序应适用于 PPCS-CI，并且强烈 表明需要新的研究来优化 PPCS-CI 管理。我们拥有独特的定位 通过建立我们的神经功能机制的工作，为这些问题提供答案 TYP-CI 和 OBVAT 给予 TYP-CI。此类研究非常重要，因为 PPCS-CI 是 与影响重返学校/运动、43-47 岁工作、48-51 岁或驾驶的视力衰弱症状相关。 52 我们已经确定了 PPCS-CI 治疗的三个显着差距，必须解决这些差距以确定其治疗效果 最有效的管理。一、鉴于病因明显差异，是否存在显着差异 TYP-CI 和 PPCS-CI 之间与客观眼动测量（峰值速度、最终幅度、 和可重复性）由于潜在的神经机制差异？二、底层神经是什么 与 TYP-CI 相比，PPCS-CI 的 OBVAT 机制如何？第三，OBVAT 对于 PPCS-CI 的效果如何？ 给药剂量与TYP-CI不同吗？这一更新弥补了临床科学中的这些空白。