Development of translational visual quality of life outcomes and non-invasive rehabilitation of visual loss

创伤性脑损伤（TBI）是退伍军人受伤的主要原因;估计20%的退伍军人 经历过某种形式的TBI。退伍军人也可以获得非服务相关的TBI，超过200万 美国人接受了某种形式的TBI。最近的许多伤害是由于暴露在爆炸中， 简易爆炸装置爆炸影响了所有美国军队的服务人员 即使没有明显或广泛的爆炸暴露。暴露于TBI的个人可能会经历 头痛和学习障碍等疾病，并可能增加患长期疾病的风险， 爆炸介导的TBI还导致视觉功能障碍， 受影响的个人。TBI引起的视觉功能障碍包括光敏感性、眼球运动功能和视功能的改变， 功能障碍、视神经病变和视网膜病变以及皮质损伤导致的原位视野丧失。甚至 对于轻度TBI，患者经常报告视力困难和视觉生活质量下降， 通过常规眼科检查发现。这些症状可能代表眼睛和大脑的亚临床疾病， 这是低估，并可能发展为更严重的视觉缺陷。虽然视觉和认知 虽然在爆炸暴露后出现缺陷，但视网膜和大脑损伤之间的关系尚未得到证实。 目前还不确定爆炸伤后的视觉损伤是否是直接视网膜损伤、视神经损伤、视网膜损伤和视网膜损伤的结果。 神经损伤或由于大脑视觉处理中心的神经元损失而导致的逆行变性。 建立这种关系对于开发康复疗法以直接针对患者至关重要。 受影响的神经元此外，对人类视觉的复杂性进行建模和测试一直存在困难 和视觉认知的关系在实验室模型爆炸暴露后。 该提案解决了两个阻碍改善退伍军人生活质量的需求， 康复活动.首先是缺乏临床前啮齿动物模型的视觉和视觉认知测试结果 能准确反映人类视觉处理过程。这种动物模型的结果也可以作为 翻译指标，疾病状态降低生活质量或治疗可以提高生活质量， 生活我们的建议旨在提供这样的临床前啮齿动物模型。二是缺乏无创性， 视觉功能的非药物康复。我们的建议将通过确定以下方面来解决这一差距： 经颅直流电刺激（tDCS）可以利用内源性神经元的可塑性来恢复视觉功能， 功能 我们的中心假设是，首先，胚细胞介导的TBI导致突触失调， 神经元有效运作的能力。其次，我们假设tDCS应用于视觉康复过程中， 治疗将导致改善的视觉结果，从而改善视觉认知关系和质量， 生活我们将使用视觉和视觉认知关系的新结果分析这些TBI后， 反映退伍军人的困难和生活质量的方式-除了了解如何康复 这种功能障碍。

Traumatic brain injury (TBI) is a leading cause of injury among Veterans; an estimated 20% of recent Veterans have experienced some form of TBI. Veterans can also acquire non-service related TBIs, with over 2 million Americans having received some form of TBI. Many recent injuries have come via exposures to blast from improvised explosive devices. Blast explosions have affected service members from all American military engagements, even without overt or extensive blast exposure. Individuals exposed to TBI may experience ailments such as headache and learning deficits and may be at increased risk for long-term maladies such as neurodegenerative or psychiatric diseases Blast-mediated TBI has also caused visual dysfunction among affected individuals. Visual dysfunction produced by TBI includes changes in light sensitivity, ocular motility dysfunction, optic neuropathy and retinopathy, and homonymous visual field loss from cortical damage. Even with mild TBI, patients frequently report visual difficulties and a decreased visual quality of life that is not detected by routine eye exams. These symptoms likely represent subclinical disease in the eye and brain, which is underreported, and may progress to more severe visual deficits. While both visual and cognitive deficits manifest after blast exposure, the relationship between damage in the retina and the brain has not been described, and it is uncertain if visual damage after blast injury is a result of direct retinal injury, optic nerve injury, or retrograde degeneration due to neuron loss in visual processing centers of the brain. Establishing this relationship is critical to developing rehabilitative therapies in order to directly target the affected neurons. Furthermore, there has been difficulty modeling and testing the complexity of human vision and visual-cognitive relationships in laboratory models after blast exposure. This proposal addresses two needs that are impediments to improving Veterans’ quality of life through rehabilitation. The first is the lack of visual and visual-cognitive testing outcomes in pre-clinical rodent models that accurately reflect human visual processing. The outcomes of such animal models can also serve as translational indicators that disease states diminish the quality of life or that treatments can improve quality of life. Our proposal seeks to provide just such a pre-clinical rodent model. The second is lack of noninvasive, non-pharmacologic rehabilitation of visual function. Our proposal will address this gap by determining if transcranial direct current stimulation (tDCS) can leverage endogenous neuronal plasticity to rehabilitate visual function. Our central hypotheses are first that blast-mediated TBI results in synaptic dysregulation which can impair the ability of neurons to function efficiently. Second, we hypothesize that tDCS applied during visual rehabilitation therapy will lead to improved visual outcomes and thus improved visual-cognitive relationships and quality of life. We will analyze these using novel outcomes of vision and visual-cognitive relationships following TBI in a manner that reflects Veterans’ difficulties and quality of life – in addition to understanding how to rehabilitate this dysfunction.