Advanced Spatiomotor Rehabilitation in Blindness & Visual Impairment

描述(由申请人提供)：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。对于那些失明的人来说，日常活动中通常可用于操纵物体的眼手协调功能是不可用的，必须由其他感官的信息来取代。为了发展对空间和物体的稳健的非视觉心理表征，激活跨模式大脑可塑性机制以对视觉损失进行功能补偿变得至关重要。这种非可视化的‘地图’被用来指导空间运动器的协调、推理和决策。我们对这一问题的多学科方法独特地位于失明评估、空间运动康复和大脑功能领域的交叉点，每个领域都有一个特定的目标。这种新颖的方法克服了传统康复训练的缺点，因为传统的康复训练永远不能涵盖一个人在生活中面临的所有任务(而且可能既繁琐又昂贵)。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，通过使用一个完整的任务(绘图)来弥补与广谱失明康复的差距，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训练是一种强大的多种技能的启动者，例如生成精确的记忆表征(心理地图)，增强空间认知和改善空间运动协调。在目标1中，我们将通过一套相辅相成的客观绩效评估形式，全面描述生活史因素的不同影响。在目标2中，我们将进行由触觉记忆引导的精确(非视觉)空间运动协调的C-K康复训练。培训结束后，我们将重新运行目标1中的所有评估，以量化空间运动康复的有效性，将其转移到 盲人能力的标准化测量，以及目标1中的独立生活史变量对康复效果的影响。Aim 3将比较C-K训练前后的全脑功能磁共振成像(FMRI)，以确定非视觉空间记忆/手协调如何取代视觉的眼-手协调。了解视力丧失康复背后的行为和神经适应机制将满足NEI的战略目标，即为未来的康复提供一种知情的科学方法。计划中的全面研究将产生一个大规模的并行测量生命因素、空间运动性能和大脑活动测量的数据集，将向基础和临床科学家公开。

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.