Advanced Spatiomotor Rehabilitation in Blindness & Visual Impairment

描述（申请人提供）：我们提出了一种多学科的方法来有效地治疗失明和视力障碍的空间运动康复。对于那些失去视力的人来说，通常用于日常活动中操纵物体的手眼协调能力是不可用的，必须由其他感官的信息来代替。激活跨模态脑可塑性机制对视觉损失进行功能补偿，以发展对空间和物体的健全的非视觉心理表征变得至关重要。这种非视觉的“地图”是指导空间运动协调、推理和决策所必需的。我们对这个问题的多学科方法独特地存在于失明评估，空间运动康复和脑功能领域的交叉点，每个领域都是一个特定目标的焦点。这种新颖的方法克服了传统康复训练的缺点，传统康复训练不可能涵盖一个人在生活中面临的所有任务（而且可能既乏味又昂贵）。为了弥补这一差距，我们开发了一种有效的康复工具，认知-动觉（C-K）训练方案，通过采用一项整体任务（绘画）来弥补广谱盲人康复的差距，该任务可以“一举”影响广泛的核心能力词汇，这些核心能力是许多日常任务的基石。我们的试点测试表明，C-K训练是多种技能的有力促进者，如产生精确的记忆表征（心理地图），增强空间认知和改善空间运动协调。在目标1中，我们将通过一组互补形式的客观绩效评估来全面描述生活史因素的不同影响。在Aim 2中，我们将进行触觉记忆引导下的精确（非视觉）空间运动协调的C-K康复训练。训练结束后，我们将重新进行Aim 1的所有评估，以量化空间运动康复的有效性，将其转移到

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.