Neuroplasticity: A Paradigm Sea Change Latest Updated File

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Neuroplasticity-A Paradigm Sea Change Dominick M. Maino, OD, MEd, FAAO, FCOVD-A Disclosure Statement: Nothing to disclose Please silence all mobile devices. Unauthorized recording of this session is prohibited. 1

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Page 1: Neuroplasticity: A Paradigm Sea Change Latest Updated File

Neuroplasticity-A Paradigm Sea Change

Dominick M Maino OD MEd FAAO FCOVD-A

Disclosure Statement Nothing to disclose

Please silence all mobile devices

Unauthorized recording of this session is prohibited

1

Sea Change OriginFrom Shakespeares The Tempest 1610

ARIEL [sings]

Full fathom five thy father lies Of his bones are coral made

Those are pearls that were his eyes Nothing of him that doth fade

But doth suffer a sea-change Into something rich and strange

2

PresenterTitle Contact info

Neuroplasticity-A Paradigm Sea Change

Dominick M Maino OD MEd FAAO FCOVD-A

Professor PediatricsBinocular VisionIllinois Eye InstituteIllinois College of Optometry

dmainoicoeduhttpwwwMainosMemosblogspotcom

Sea Change OriginFrom Shakespeares The Tempest 1610

ARIEL [sings]

Full fathom five thy father lies Of his bones are coral made

Those are pearls that were his eyes Nothing of him that doth fade

But doth suffer a sea-change Into something rich and strange

4

I Sea Change (Meaning)

A radical and apparently mystical change

It is change of such magnitude that it alters the way we think and what we do

in a sweeping far ranging mind expanding mega-behavior

transformative fashion

5

Neuroplasticity

Up until recentlyhellipapparently unknown to many within the professions of optometry and ophthalmologyhellip

6

7

The BrainA hellip is not just a static soft round mass bathed in a fluid and surrounded by a hard caseB hellip can change its form and resultant function through neuroplasticity

The BrainA hellip is not just a static soft round mass bathed in a fluid and surrounded by a hard caseB hellip can change its form and resultant function through neuroplasticity

The BrainA hellip is not just a static soft round mass bathed in a fluid and surrounded by a hard caseB hellip can change its form and resultant function through neuroplasticity

The BrainA hellip is not just a static soft round mass bathed in a fluid and surrounded by a hard caseB hellip can change its form and resultant function through neuroplasticity

II The Brain

hellip is not just a static soft round mass bathed in a fluid and surrounded by a hard case

hellip can change its form and resultant function through neuroplasticity

8

III CriticalSensitive Periods

A A critical period occurs when the individual is sensitive to environmental influences and stimulation

1 The Precritical period The initial formation of neuronal circuits that is not dependent on visual experience

9

CriticalSensitive Periods

2 The Critical period A distinct onset of robust plasticity in response to the visual experience when the initially formed circuit can be modified by experience

3 Closure of the critical period After the end of the critical period the same visual experience no longer elicits the same degree of plasticity

10

CriticalSensitive Periods

B The concept of a critical period does not imply that neuroplasticity ends after a certain age

C Sensitive period begins and ends gradually (not abruptly like the critical period) and provides for maximum sensitivity

to stimuli

11

VI Neuroplasticity and the Brain

A Can adult brain neurons actually exhibit neuroplasticity The short answer is yes

B Resultant changes are noted in not only functional outcomes but also in brain anatomy and structure

12

IV Neuroplasticity and Rehabilitation

Kleim amp Jones note that

A The Key Principles of Experience-Dependent Neural Plasticity

1 Use it or lose it

2 Use it and improve it

3 Specificity

13

4 Repetition matters

5 Intensity matters

6 Time matters

7 Salience matters

14

8 Age matters

9 Transference

10 Interference

15

Use it or lose it If you do not drive specific brain functions

functional loss will occur

Use it and improve it Therapy that drives cortical function

enhances that particular function

Specificity The therapy you choose determines the resultant

plasticity and function

Repetition matters Plasticity that results in functional change

requires repetition

16

Intensity matters Induction of plasticity requires the appropriate

amount of intensity

Time matters Different forms of plasticity take place at different

times during therapy

Salience matters It has to be important to the individual

Age matters Plasticity is easier in a younger brain but is also

possible in an adult brain

17

Transference Neuroplasticity and the change in function that

results from one therapy can augment the attainment of similar

behaviors

Interference Plasticity in response to one experience can interfere

with the acquisition of other behaviors

18

B Examples of Changes in Function and Structure

1) Jugglers

2) Typists

19

B Examples of Changes in Function and Structure

1) Jugglers

One study suggested that adults taught how to juggle demonstrated a

significant transient bilateral expansion of gray matter in the mid-

temporal area and the left posterior intraparietal sulcus between baseline brain scan and

follow-up The findings were specific to training stimulus individuals who were

not instructed how to juggle demonstrated no change in gray

matter over the same period These findings oppose the conventional

understanding that the anatomical structure of the adult brain does not change

over time

20

B Examples of Changes in Function and Structure

2) Typists

helliplong-term bimanual training also increases

gray matter volume in experienced adult typists

These results suggest that learning not

only affects function but also structure in

adult brains

21

V Neuroplasticity and Optometry

A Evolutionary neuroplasticity

B Reactive plasticity

C Adaptational plasticity

D Reparation plasticity

22

V Neuroplasticity and Optometry

A Evolutionary neuroplasticity

hellip is ideally suited for the developmental OD who

specializes in vision function as it changes over time

either with or without intervention

23

V Neuroplasticity and Optometry

B Reactive plasticity

hellip can be thought of as the immediate effect that

initial optometric treatment may have on a system This can

be reflected in an immediate but often transient change in

the individuallsquos accommodative systemmdashie when an

uncorrected myope initially puts on his or her new

spectacles

24

V Neuroplasticity and Optometry

C Adaptational plasticity

hellip could describe the long-term effects of in-office optometric

vision therapy on disorders of the binocular vision system

25

V Neuroplasticity and Optometry

D Reparation plasticity

hellipin contrast to adaptational

plasticity reparation plasticity may

occur during treatment by a low

Vision specialist or an OD

Working with those who have

Experienced a traumatic brain

injury (TBI)

26

V Neuroplasticity and Optometry

The effects of plasticity can lead to either

positive or negative changes during

development (evolutionary plasticity) after

short-term exposure (reactive plasticity)

after long-term or continuous stimuli

(adaptational plasticity) and during

functional or structural recovery of damaged

neuronal circuits (reparation plasticity)

httpwwwciteulikeorguserjasonepriorarticle2856526

27

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

A Refractive error development

B Amblyopia

C Strabismus

28

D Non-strabismus non-amblyopic binocular vision disorders

E Learning related vision anomalies

F Vision developmentperception disorders

29

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

A Refractive error development

Several recent studies have noted that neuroplasticity may play a

role in refractive error development

retinal defocus use of progressive addition lenses

drug studies (M1-antagonist2 pirenzepine ) slow myopia

progression demonstrated nearly a 50 reduction in myopia

progression over a two-year period

30

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged

7 to 17 years Arch Ophthalmol 2005 Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three

to less than 10 years of age Am J Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction

Am J Ophthalmol 2007 Jun143(6)1060-3

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine

vs patching for treatment of moderate amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-

57

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for

strabismic and anisometropic amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Treatment of severe amblyopia with weekend atropine results from 2 randomized clinical trials

Levodopacarbidopa in the treatment of amblyopia

31

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

J Pediatr Ophthalmol Strabismus 2009 Mar-Apr46(2)87-90 quiz 91-2 Levodopacarbidopa in the

treatment of amblyopia Dadeya S Vats P Malik KP

PURPOSE To evaluate the role of levodopacarbidopa in the treatment of amblyopia METHODS

Thirty patients with strabismic amblyopia between the ages of 3 and 12 years were part of this double-

blind randomized study Patients were divided into two groups Group A received 050 mg + 125 mg of

levodopacarbidopa per kilogram body weight three times daily after meals with a protein rich drink

whereas Group B received placebo Both groups received full-time conventional occlusion until a visual

acuity of 66 was achieved or for a maximum of 3 months RESULTS The authors observed more than

two lines improvement in visual acuity that was greater in the levodopa group (15 of 15) than in the

placebo group (9 of 15) (P lt 005) Furthermore improvement in visual acuity of more than two lines

was greater in patients younger than 8 years (100) than in patients older than 8 years of age (60) (P =

0026) There was also no significant reversal of the improved visual acuity in up to 6 months of follow-

up CONCLUSION Levodopacarbidopa improves visual acuity in patients with

amblyopia and maintains improved visual acuity especially in patients

younger than 8 years

32

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

J Pediatr Ophthalmol Strabismus 2008 May-Jun45(3)174-6 The use of levodopa in the treatment of

bilateral amblyopia secondary to uncorrected high hypermetropia Abrams MS

The standard treatment of bilateral amblyopia secondary to uncorrected high bilateral hypermetropia has

been spectacles and time The patient described here failed to show adequate improvement in visual

acuity after 18 months of standard treatment Visual acuity improved dramatically when the

patient began taking levodopa dropped precipitously when the medication was

discontinued and returned quickly to post-treatment levels when levodopa was

restarted Visual acuity remained stable when the medication was slowly tapered

and discontinued This report suggests that dopamine may play a role in the pathophysiology of

bilateral amblyopia secondary to uncorrected high bilateral hypermetropia

33

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

Bottom Line

Amblyopia can be treated at any age

May be able to use neuro-enhancing drugs

as a part of basic amblyopia therapy

34

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

C Strabismus and non-strabismic non-amblyopic binocular

vision disorders

Clinical Trial of Treatments for Symptomatic Convergence Insufficiency in Children has

clearly demonstrated the superiority of in-office optometric vision therapy (in conjunction

with home therapy) vs out-of-office therapy alone The study concluded that optometric

vision therapyorthoptics was more effective than pencil push-ups or placebo vision

therapyorthoptics in reducing symptoms and improving clinical signs of convergence

insufficiency

Long-term effectiveness of treatments for symptomatic convergence insufficiency

in children (Optom Vis Sci 2009 Sep86(9)1096-103)

CITT patients improvements lasted a year

35

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

Strabismus 1999 Sep7(3)169-74 Convergence insufficiency in

idiopathic Parkinsons disease responsive to levodopa Racette BA

Gokden MS Tychsen LS Perlmutter JS

We report a patient with pathologically proven idiopathic Parkinsons

disease (IPD) who developed diplopia secondary to convergence

insufficiency during his motor off periods Diplopia resolved with

onset of motor benefit from levodopa Neuro-ophthalmologic

examination demonstrated convergence insufficiency during motor

off periods that was alleviated after onset of motor benefit from

levodopa This is the first reported case of convergence insufficiency

in IPD responsive to levodopa

36

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

Bottom Line

Optometric Vision Therapy is the most efficacious treatment available for binocular vision disorders and the

treatment effects are long lasting Neuro-enhancing drugs

may assist us as well

37

EF Learning related vision anomalies Vision

developmentperception disorders

hellipresearch includes an examination of the role vision plays in

reading the effect of oculomotor vergence and

accommodativecoherent motion therapy on reading eye movements

and reading speed the diagnosis and treatment of perceptual

disorders and the effect of therapy on various learning anomalies

38

EF Learning related vision anomalies Vision developmentperception disorders

magnocellular (MC) deficit in dyslexia

LM speed-matching ratio predicts reading in childrenChase C Dougherty RF Ray N

Fowler S Stein JOptom Vis Sci 2007 Mar84(3)229-36

Effect of attention therapy on reading comprehension Solan HA Shelley-Tremblay J

Ficarra A Silverman M Larson S J Learn Disabil 2003 Nov-Dec36(6)556-63

Is there a common linkage among reading comprehension visual attention and

magnocellular processing Solan HA Shelley-Tremblay JF Hansen PC Larson S

J Learn Disabil 2007 May-Jun40(3)270-8

Lawton T Filtered Text and Direction Discrimination Training Improved Reading

Fluency for Both Dyslexic and Normal Readers Optom Vis Dev 200839 (3)114

Fischer B Hartnegg K Saccade control in dyslexia Development deficits training

and transfer to reading Optom Vis Dev 200839(4)181-190

39

EF Learning related vision anomalies Vision developmentperception disorders

J Learn Disabil 2003 Nov-Dec36(6)556-63 Effect of attention therapy on reading

comprehension Solan HA Shelley-Tremblay J Ficarra A Silverman M Larson S

hellip At the completion of attention therapy the mean

standard attention and reading comprehension scores of

the experimental group had improved significantly The

control group however showed no significant

improvement in reading comprehension scores after 12

weeks Although uncertainties still exist this investigation

supports the notion that visual attention is malleable and

that attention therapy has a significant effect on reading

comprehension in this often neglected population

40

VII Vision dysfunction association with acquired brain injury

A Exotropia (or high exophoriaCI)

B Accommodative dysfunction

C Convergence insufficiency

41

D Decreased blink rate

E Spatial disorientation

F Pursuitsaccade dysfunction

G Unstable ambient vision (Magnocellular pathway)

42

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Stelmack JA Frith T Van Koevering D Rinne S Stelmack TR Visual function in patients

followed at a Veterans Affairs polytrauma network site an electronic medical record review

Optometry 2009 Aug80(8)419-24

RESULTS Visual symptoms were self-reported by 76 of patients

with polytrauma and 75 of the patients with TBI Problems with reading

(polytrauma 60 and TBI 50) and accommodation (polytrauma 30 and

TBI 47) were frequently found on eye examinations Spectacles were the

treatment most frequently prescribed (polytrauma 62 and TBI 78)

CONCLUSIONS It is important for optometrists to be aware of the high

rates of self-reported symptoms and visual problems in military personnel

returning from deployment to the wars in Iraq and Afghanistan Post-

traumatic stress disorder and depression may complicate optometric

evaluation and management

43

VII Vision dysfunction association with acquired brain injury

Avoidance of near tasks

Oculomotor-based reading difficulties

Eye tracking problems

Eye focusing problems

Eyestrain Diplopia

Dizziness Vertigo

Vision-derived nausea

44

VII Vision dysfunction association with acquired brain injury

Increased sensitivity to visual motion

Visual inattention and distractibility

Short-term visual memory loss

Difficulty judging distances (relative and absolute

Difficulty with global scanning

Difficulty with personal grooming especially involving the face

Inability to interactcope visually in a complex social situation

(eg minimal eye contact)

Inability to tolerate complex visual environments (eg grocery store

aisles and highly-patterned floors)

45

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Ciuffreda KJ Ludlam DP Kapoor N Clinical oculomotor training in traumatic brain injury Optom Vis

Dev 200940(1)16-23

Individuals with traumatic brain injury present with a constellation of

oculomotor dysfunctions and correlated symptoms Simple and

effective clinical oculomotor-based training procedures will be

presented with respect to the versional vergence and

accommodative systems and their interactions These therapeutic

procedures can also be applied as needed to individuals with either

low vision neurological dysfunctions or general visual skills cases

manifesting similar oculomotor deficits

46

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Leslie S Myopia and accommodative insufficiency associated with

moderate head trauma Opt Vis Dev 200940(1)25-31

The majority of subjects reviewed had developed a stable degree of

myopia between 100 and 200 diopters as well as an abnormally

high lag of accommodation When their distance and near spatial area

of focus was compared the majority were focused at an intermediate

area in space suggesting a loss of control of accommodation in

space

47

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

B Drugs

C Exercise

D Learning new and challenging things

48

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements

prevent cognitive decline A systematic review of randomized controlled trials J Hum

Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among

preterm infants attributable to early supplementation of human milk with

docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings

and structural-functional synergies with cell membrane phospholipids Altern Med Rev

2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function

Neuroscience 20089(7)568-78

49

VIII Improving Brain Function and Neuroplasticity

B Drugs Maya Vetencourt JF Sale A Viegi A et al The antidepressant

fluoxetine (PROZAC) restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the

antidepressant tianeptine CNS Drugs 200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances

hippocampal long-term potentiation and memory BMC Biol 2008 Sep

9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine

improves neuropsychological disorders in a child with creatine

transporter defect Neurocase 200814(2) 151-61

50

VIII Improving Brain Function and Neuroplasticity

C Exercise

Hunsberger JG et al Antidepressant actions of the exercise-

regulated gene VGF Nat Med 2007 Dec 2 131476

VGF may be a common pathway by which exercise induces

neuroplasticity and growth-factor genes at least one of these might act

similarly to antidepressants in promoting an adaptive response to stress

However the tests used here may be modeling stress-induced

helplessness not depression hellipexercise seems to induce multiple

interacting genes that enhance neuronal resilience

51

VIII Improving Brain Function and Neuroplasticity

D Learning new and challenging things

What have we (optometry amp ophthalmology)

been thinking all these years

Where did we miss the news about neuroplasticity

52

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Huang JC Neuroplasticity as a proposed mechanism for the efficacy of optometric vision therapy and rehabilitation J Bev Optom 200920(4)96-100

Homologous area adaptationCompensatory masqueradeCross-modal reassignment

Map expansion

EquipotentialityVicariation

53

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Homologous area adaptation a transfer of function from a damaged brain area to a non-damaged brain area May be limited to early stages of human development and may crowd a new brain area resulting in reduced functionality of that brain area (Competition between spatial amp verbal functioning)

54

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Compensatory masquerade reorganizing of existing neuro-pathways to us alternative cognitive strategies to perform a task

55

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Cross-modal reassignment using new sensory input in a brain structure deprived of its main input source (changing processing from visual to tactile stimuli in the blind)

56

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Map expansion increase in brain mass due to repeated behavior or exposure to stimuli

57

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Equipotentiality anatomical areas of the brain can perform disparate functions

Vicariation redundant neural systems can operate under abnormal conditions

This may explain why recovery is noted for many neurological conditions (degenerative psychiatric developmental vascular traumatic)

58

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Constraint therapy Use it and improve it

Patching penalization ldquonear activitiesrdquo during amblyopia therapy

59

IX Improving Brain Function and Neuroplasticity Optometric Clinical ApplicationsOptometric Vision Therapy

Kleim amp Jones

Use it or lose it If you do not drive specific brain functions

functional loss will occur

If you want to improve oculomotor brain neuroplastic function amp

structure therapy should be specific for that brain function

Use it and improve it Therapy that drives cortical function enhances

that particular function

If you use therapy to improve oculomotor dysfunction it should

improve

Specificity The therapy you choose determines the resultant

plasticity and function

You must choose therapy that is appropriate

60

IX Improving Brain Function and Neuroplasticity Optometric Clinical Applications

Kleim amp Jones

Repetition matters Plasticity that results in functional change

requires repetition

Do the therapy Do it again Do it yet again No quick fix

Intensity matters Induction of plasticity requires the appropriate

amount of intensity

Intensity means strength force concentration power and passion

Without these plasticity may not occur Function may not improve

Time matters Different forms of plasticity take place at different

times during therapy

Do the basics than the more advanced therapeutic procedures

61

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Salience matters It has to be important to the individual

Make the therapy matter to the patient

Age matters Plasticity is easier in a younger brain but is also

possible in an adult brain

Do not let age determine what therapy options you offer your

patients Think of Susan Barry PhD (StereoSue) and her success

Offer your patients options Let them choose Be realistic about

outcomeshelliphave outcome measures built into therapy program

62

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Transference Neuroplasticity and the change in function

that results from one therapy can augment the attainment

of similar behaviors

What you do during oculomotor therapy may affected

vergence therapy outcomes

Interference Plasticity in response to one experience can

interfere with the acquisition of other behaviors

Monitor Evaluate progress Discuss function in other areas

of your patientslsquo life

63

Why pay attention to binocular vision dysfunctions

and neuroplasticity

December 2009 issue of the Review of Optometry

The Binocular Vision Dysfunction Pandemic

In 2010 almost 170 million individuals will be wearing glasses In

2010 there will also be up to 93 million amblyopes and 12 and a half

million strabismics For children under 18 years of age that means

there will be more than 22 and a half million amblyopes and millions

of children with strabismus A clinical trial to determine the

prevalence of binocular vision dysfunction within the general

population suggested the possibility of up to 56 or 173 million men

women and children with symptoms associated with a binocular

vision dysfunction 189 million (61) with accommodative problems

and 118 million (38) demonstrating various vergence

anomalies

64

65

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Brain plasticity life long changes in the structure of the brain

Sensory substitution replacement of one sensory input by another

Measurement techniques

Voxel based morphometryhellipmeasures difference in brain volume

Fluorodeoxyglucose glucose analog PET scan tells you

distribution and metabolism of brain

Cortical thickness measures

Visual cortex of the blind turns somatic ―The eye of the tongue

Transcranial magnetic stmiulation non-invasive technique to

stimulate cortex

66

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Blind Braille readers report tingling in fingers when pressure

phosphenes are applied Blind feel tingling in tongue

Bind use tongue to perform orientation task motion perception

sensory perception Visual cortex recruited in a variety of sensory

and cognitive tasks (DM Can we use tongue as a VT tool)

Dilks Reorganizations of human adult visual system

When a region of sensory cortex is deprived of its bottom up

input the deprived region begins to respond to stimuli that

normally activate adjacent cortex

67

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Retinotopic map changes for stroke pts Cortical reorganization in

adults occurs Perceived objectshellipelongation in stroke amp AMD

What happens to deprived cortex in AMD

fMRI shows cortical reorganization in adults

Proposed mechanisms

hellipGrowth of new connections

hellipUnmasking of pre-existing connections this is true

happens within seconds

Bavelier

Action video games

68

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Bavelier

Action video games Looked at attention Gamers can track more

activities

Attention over space (me peripheral awarenress) Useful field

of view shrinks with age

Performance not VA relatedhellipis related to attention

Action game playing changes spatial resolutionhellipovercoming

crowding in VA assessment (me amblyopia therapy)

Temporal resolution of vision Backward masking

changehellipbrain changes

Visual sensitivity (contrast sensitivity) Post action game training

improves CSF

69

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Action video games correcting optics of the cortex (me this is

actualy OVT)

Games factor

Variable entry leanringhellipadapt task to skill level

Incremental learning tune task to subjectlsquos leanring steps

Motivationarousal

Rewards

Self masterself confidence

Action games factors

Pacingrate of exposure to infohellipincreasing processing speed

Dynamic display

Rich environment

Rich motor involvement

70

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Surgeons may be made to play action games

Pilot training

Amblyopia tx Dennis Levi research

PresenterTitle Contact info

Neuroplasticity-A Paradigm Sea Change

This presentation is available at

httpwwwslidesharenetDMAINOneuroplasticity-a-paradigm-sea-change-2459693

httpwwwmainosmemosblogspotcom

My FaceBook Page

and

Twitter

PresenterTitle Contact info

Questions About

Neuroplasticity-A Paradigm Sea Change

Dominick M Maino OD MEd FAAO FCOVD-A

Professor PediatricsBinocular VisionIllinois Eye InstituteIllinois College of Optometry

dmainoicoeduhttpwwwMainosMemosblogspotcom

Thanks to

httpwwwcovdorgHomeOVDJournalOVD401tabid263D

efaultaspx

httpbipolarblastfileswordpresscom200908neurojpg

httpwwwspecialcheerscomimagesanimated_braingif

httpblogmarsdencartoonscomwp-

contentuploads200810frankenstein-myspace-lightbeergif

httpwwwshangralafamilyfuncomgala-ecalvindreamgif

httppsychiatryjwatchorgcgicontentfull20082251

73

Chakraborty R Chatterjee A Choudhart S Chakraborty PK Neuroplasticitymdasha paradigm shift in neurosciences J Indian Med Assoc

2007105(9)513-4516-8520-1

Sacks O A neurologistlsquos notebook Stereo Sue Why two eyes are better than one The New Yorker 2006 Jun 1964-73

Krulwich R National Public Radio Going Binocular Susanlsquos First Snowfall Available at

wwwnprorgtemplatesstorystoryphpstoryId=5507789 (Accessed December 8 2008)

Press LJ The story behind Stereo Suelsquo and a world-famous neurologistlsquos discovery of vision therapy Optom Vis Dev 200637(2) 55-7

Levin HS Neuroplasticity and brain imaging research implications for rehabilitation Arch Phys Med Rehabil 2006 Dec87(12 Suppl

2)S1

Wiesel TN Hubel DH Single-cell responses in striate cortex of kittens deprived of vision in one eye J Neurophysiol 1963

Nov261003-17

Hook BM Chen C Critical periods in the visual system Changing views for a model of experience-dependent plasticity Neuron 2007

Oct56(2)312-26

Ramey CT Ramey SL Prevention of intellectual disabilities early interventions to improve cognitive development Prev Med 1998

Mar-Apr27(2)224-32

Heuninckx S Wenderoth N Swinnen SP Systems neuroplasticity in the aging brain recruiting additional neural resources for

successful motor performance in elderly persons J Neurosci 2008 Jan 228(1)91-9

Ge S Yang CH Hsu KS et al A critical period for enhanced synaptic plasticity in newly generated neurons of the adult brain Neuron

2007 May54(4)559-66

74

Draganski B Gaser C Busch V et al Neuroplasticity changes in grey matter induced by training Nature 2004 Jan 22427(6972)

311-2

Cannonieri GC Bonilha L Fernandes PT et al Practice and perfect length of training and structural brain changes in experienced

typists Neuroreport 2007 Jul 218(10)1063-6

Kleim JA Jones TA Principles of experience-dependent neural plasticity implications for rehabilitation after brain damage J

Speech Lang Hear Res 2008 Feb51(1)S225-39

Trojan S Porkorny J Theoretical aspects of neuroplasticity Physiol Res 199948(2)87-97

Ramamirtham R Kee CS Hung LF et al Wave aberrations in rhesus monkeys with vision-induced ametropias Vision Res 2007

Sep47(21)2751-66

Smith EL 3rd Ramamirtham R Qiao-Grider Y et al Effects of foveal ablation on emmetropization and form-deprivation myopia

Invest Ophthalmol Vis Sci 2007 Sep48(9)3914-22

Smith EL 3rd Kee CS Ramamirtham R et al Peripheral vision can influence eye growth and refractive development in infant

monkeys Invest Ophthalmol Vis Sci 2005 Nov46(11)3965-72

Ciuffreda KJ Vasudevan B Nearwork-induced transient myopia (NITM) and permanent myopiandashndashis there a link Ophthalmic

Physiol Opt 2008 Mar28(2)103-14

Hung GK Ciuffreda KJ Incremental retinal-defocus theory of myopia development--schematic analysis and computer simulation

Comput Biol Med 2007 Jul37(7)930-46

Hung GK Ciuffreda KJ A unifying theory of refractive error development Bull Math Biol 2000 Nov62(6)1087-108

75

Pang Y Maino D Zhang G Lu F Myopia Can its progress be controlled Optom Vis Dev 200637(2)75-9

Leung JT Brown B Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lenses Optom Vis Sci

1999 Jun76(6)346-54

Hasebe S Ohtsuki H Nonaka T et al Effect of progressive addition lenses on myopia progression in Japanese children a prospective

randomized double-masked crossover trial Invest Ophthalmol Vis Sci 2008 Jul49(7)2781-9

Gwiazda J Hyman L Hussein M et al A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression

of myopia in children Invest Ophthalmol Vis Sci 2003 Apr44(4)1492-500

Siatkowski RM Cotter SA Crockett RS et al Two-year multi-center randomized double-masked placebo-controlled parallel safety and

efficacy study of 2 pirenzepine ophthalmic gel in children with myopia J AAPOS 2008 Aug12(4)332-9

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged 7 to 17 years Arch Ophthalmol 2005

Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three to less than 10 years of age Am J

Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction Am J Ophthalmol 2007

Jun143(6)1060-3

Holmes JM Edwards AR Beck RW et al A randomized pilot study of near activities versus non-near activities during patching therapy for

amblyopia J AAPOS 2005 Apr9(2)129-36

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate

amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-57

76

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic

amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Convergence Insufficiency Treatment Trial Study Group Randomized clinical trial of treatments for symptomatic convergence insufficiency

in children Arch Ophthalmol 2008 Oct126(10)1336-49

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

Solan HA Shelley-Tremblay J Hansen PC et al M-cell deficit and reading disability a preliminary study of the effects of temporal vision-

processing therapy Optometry 2004 Oct75(10)640-50

Solan HA Larson S Shelley-Tremblay J et al Role of visual attention in cognitive control of oculomotor readiness in students with reading

disabilities J Learn Disabil 2001 Mar-Apr34(2)107-18

Gallaway M Boas MB The impact of vergence and accommodative therapy on reading eye movements and reading speed Optom Vis Dev

200738(3)115-20

Goss DA Downing DB Lowther AH et al The effect of HTS vision therapy conducted in a school setting on reading skills in third and

fourth grade students Optom Vis Dev 200738(1)27-32

Crutch SJ Warrington EK Foveal crowding in posterior cortical atrophy a specific early-visual-processing deficit affecting word reading

Cogn Neuropsychol 2007 Dec24(8)843-66

Helms D Sawtelle SM A study of the effectiveness of cognitive therapy delivered in a video game format Optom Vis Dev 200738 (1)19-

26

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

77

Lawton T Training direction-discrimination sensitivity remediates a wide spectrum of reading skills OptomVis Dev 200738(1) 33-47

Goldstand S Koslowe KC Parush S Vision visual-information processing and academic performance among seventh-grade schoolchildren a

more significant relationship than we thought Am J Occup Ther 2005 Jul-Aug59(4)377-89

Fischer B Koumlngeter A Hartnegg K Effects of daily practice on subitizing visual counting and basic arithmetic skills Optom Vis Dev

200839(1)30-4

Sands W Taub M Maino D Limited research and education on special populations in optometry and ophthalomology Optom Vis Dev

200839(2)60-1

Wesson M Maino D Oculo-visual findings in Down syndrome cerebral palsy and mental retardation with non-specific etiology In Maino D

(ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 199517-54 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

Cui Y Stapleton F Suttle C Developing an instrument to assess vision-related and subjective quality of life in children with intellectual

disability data collection and preliminary analysis in a Chinese population Ophthal Physiolog Optics 2008 May28(3) 238-46

Maino D Steele G Tahir S Sajja R Attitudes of optometry students toward individuals with disabilities Optom Ed 200227(2)45-50

Maino D Special populations in the optometric curriculum Optom Ed 200227(2)38-9

Maino D Overview of special populations In Scheiman M Rouse M (eds) Optometric Management of Learning-Related Vision Problems

St Louis Mosby Inc 200685-106

Maino D (ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 1995 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

78

McCarthy P Maino D Alport syndrome a review Clin Eye Vis Care 2000 Dec12(3-4)139-50

Block SS Brusca-Vega R Pizzi WJ et al Cognitive and visual processing skills and their relationship to mutation size in full and

permutation female fragile X carriers Optom Vis Sci 2000 Nov77 (11)592-9

Maino D The young child with developmental disabilities An introduction to mental retardation and genetic syndromes In Moore BD

(ed) Eye Care for Infants and Young Children Butter-worth--Heinemann Newton MA1997285-300

Amin V Maino D The Fragile X female Visual visual perceptual and ocular health anomalies J Am Optom Assoc 1995 May66

(5)290-95

Maino DM Maino JH Cibis GW Hecht F Ocular health anomalies in patients with developmental disabilities In Maino D (ed)

Diagnosis and Management of Special Populations Mosby-Year-book Inc St Louis MO 1995189-206 Reprinted Optometric

Education Program Foundation Santa Anna Calif 2001

Maino D Wesson M Schlange D Cibis G Maino J Optometric findings in the fragile X syndrome Optom Vis Sci 199168634-40

Scheiman MMOptometric findings in children with cerebral palsy Am J Optom Physiol Opt 1984 May61(5)321-3

Maino D Maino J Maino S Mental retardation syndromes with associated ocular defects J Am Optom Assoc 199061707-16

Stewart RE Woodhouse JM Cregg M Pakeman VH Association between accommodative accuracy hypermetropia and strabismus in

children with Downs syndrome Optom Vis Sci 2007 Feb84(2)149-55

Cregg M Woodhouse JM Pakeman VH et al Accommodation and refractive error in children with Down syndrome cross-sectional

and longitudinal studies Invest Ophthalmol Vis Sci 2001 Jan42 (1)55-63

79

McClelland JF Parkes J Hill N et al Accommodative dysfunction in children with cerebral palsy a population-

based study Invest Ophthalmol Vis Sci 2006 May47(5)1824-30

Duckman RH Vision therapy for the child with cerebral palsy J Am Optom Assoc 198758(1)28-35

Duckman R Accommodation in cerebral palsy function and remediation J Am Optom Assoc 198455(4)281-3

Scheiman M Understanding and managing vision deficits a guide for occupational therapists 2nd ed Slack

Thorofare NJ 2002

Maino D Binasal occlusion for the child with Cerebral Palsy J Ill Optom Assoc 198644(1)1218

Battaglia F Quartarone A Rizzo V et al Early impairment of synaptic plasticity in patients with Downs syndrome

Neurobiol Aging 2008 Aug29(8)1272-5

Bonnier C Evaluation of early stimulation programs for enhancing brain development Acta Paediatr 2008

Jul97(7)853-8

Morice E Andreae LC Cooke SF et al Preservation of long-term memory and synaptic plasticity despite short-term

impairments in the Tc1 mouse model of Down syndrome Learn Mem 2008 Jul 1415(7)492-500

Gordon AM Schneider JA Chinnan A Charles JR Efficacy of a hand-arm bimanual intensive therapy (HABIT) in

children with hemiplegic cerebral palsy a randomized control trial Dev Med Child Neurol 2007 Nov49(11)830-8

Kapoor N Ciuffreda KJ Vision disturbances following traumatic brain injury Curr Treat Options Neurol 2002

Jul4(4)271-80

80

Ciuffreda KJ Rutner D Kapoor N et al Vision therapy for oculomotor dysfunctions in acquired brain injury a

retrospective analysis Optometry 2008 Jan79(1)18-22

Ciuffreda KJ Han Y Kapoor N Ficarra AP Oculomotor rehabilitation for reading in acquired brain injury

NeuroRehabilitation 200621(1)9-21

Zost M Diagnosis and management of visual dysfunction in cerebral injury In Maino D (ed) Diagnosis and

Management of Special Populations Mosby-Yearbook Inc St Louis 199579 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001 [Figure used with permission of the editor]

DeGutis JM Bentin S Robertson LC DEsposito M Functional plasticity in ventral temporal cortex following

cognitive rehabilitation of a congenital prosopagnosic J Cogn Neurosci 2007 Nov19 (11)1790-802

Welbourne SR Ralph MA Exploring the impact of plasticity-related recovery after brain damage in a connectionist

model of single-word reading Cogn Affect Behav Neurosci 2005 Mar5(1)77-92

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements prevent cognitive decline A

systematic review of randomized controlled trials J Hum Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among preterm infants attributable to early

supplementation of human milk with docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings and structural-functional

synergies with cell membrane phospholipids Altern Med Rev 2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function Neuroscience 20089(7)568-78

81

Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

BMC Biol 2008 Sep 9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine improves neuropsychological disorders in a child with

creatine transporter defect Neurocase 200814(2) 151-61

Forrester LW Wheaton LA Luft AR Exercise-mediated locomotor recovery and lower-limb neuroplasticity after

stroke J Rehabil Res Dev 200845(2)205-20

82

Page 2: Neuroplasticity: A Paradigm Sea Change Latest Updated File

Sea Change OriginFrom Shakespeares The Tempest 1610

ARIEL [sings]

Full fathom five thy father lies Of his bones are coral made

Those are pearls that were his eyes Nothing of him that doth fade

But doth suffer a sea-change Into something rich and strange

2

PresenterTitle Contact info

Neuroplasticity-A Paradigm Sea Change

Dominick M Maino OD MEd FAAO FCOVD-A

Professor PediatricsBinocular VisionIllinois Eye InstituteIllinois College of Optometry

dmainoicoeduhttpwwwMainosMemosblogspotcom

Sea Change OriginFrom Shakespeares The Tempest 1610

ARIEL [sings]

Full fathom five thy father lies Of his bones are coral made

Those are pearls that were his eyes Nothing of him that doth fade

But doth suffer a sea-change Into something rich and strange

4

I Sea Change (Meaning)

A radical and apparently mystical change

It is change of such magnitude that it alters the way we think and what we do

in a sweeping far ranging mind expanding mega-behavior

transformative fashion

5

Neuroplasticity

Up until recentlyhellipapparently unknown to many within the professions of optometry and ophthalmologyhellip

6

7

The BrainA hellip is not just a static soft round mass bathed in a fluid and surrounded by a hard caseB hellip can change its form and resultant function through neuroplasticity

The BrainA hellip is not just a static soft round mass bathed in a fluid and surrounded by a hard caseB hellip can change its form and resultant function through neuroplasticity

The BrainA hellip is not just a static soft round mass bathed in a fluid and surrounded by a hard caseB hellip can change its form and resultant function through neuroplasticity

The BrainA hellip is not just a static soft round mass bathed in a fluid and surrounded by a hard caseB hellip can change its form and resultant function through neuroplasticity

II The Brain

hellip is not just a static soft round mass bathed in a fluid and surrounded by a hard case

hellip can change its form and resultant function through neuroplasticity

8

III CriticalSensitive Periods

A A critical period occurs when the individual is sensitive to environmental influences and stimulation

1 The Precritical period The initial formation of neuronal circuits that is not dependent on visual experience

9

CriticalSensitive Periods

2 The Critical period A distinct onset of robust plasticity in response to the visual experience when the initially formed circuit can be modified by experience

3 Closure of the critical period After the end of the critical period the same visual experience no longer elicits the same degree of plasticity

10

CriticalSensitive Periods

B The concept of a critical period does not imply that neuroplasticity ends after a certain age

C Sensitive period begins and ends gradually (not abruptly like the critical period) and provides for maximum sensitivity

to stimuli

11

VI Neuroplasticity and the Brain

A Can adult brain neurons actually exhibit neuroplasticity The short answer is yes

B Resultant changes are noted in not only functional outcomes but also in brain anatomy and structure

12

IV Neuroplasticity and Rehabilitation

Kleim amp Jones note that

A The Key Principles of Experience-Dependent Neural Plasticity

1 Use it or lose it

2 Use it and improve it

3 Specificity

13

4 Repetition matters

5 Intensity matters

6 Time matters

7 Salience matters

14

8 Age matters

9 Transference

10 Interference

15

Use it or lose it If you do not drive specific brain functions

functional loss will occur

Use it and improve it Therapy that drives cortical function

enhances that particular function

Specificity The therapy you choose determines the resultant

plasticity and function

Repetition matters Plasticity that results in functional change

requires repetition

16

Intensity matters Induction of plasticity requires the appropriate

amount of intensity

Time matters Different forms of plasticity take place at different

times during therapy

Salience matters It has to be important to the individual

Age matters Plasticity is easier in a younger brain but is also

possible in an adult brain

17

Transference Neuroplasticity and the change in function that

results from one therapy can augment the attainment of similar

behaviors

Interference Plasticity in response to one experience can interfere

with the acquisition of other behaviors

18

B Examples of Changes in Function and Structure

1) Jugglers

2) Typists

19

B Examples of Changes in Function and Structure

1) Jugglers

One study suggested that adults taught how to juggle demonstrated a

significant transient bilateral expansion of gray matter in the mid-

temporal area and the left posterior intraparietal sulcus between baseline brain scan and

follow-up The findings were specific to training stimulus individuals who were

not instructed how to juggle demonstrated no change in gray

matter over the same period These findings oppose the conventional

understanding that the anatomical structure of the adult brain does not change

over time

20

B Examples of Changes in Function and Structure

2) Typists

helliplong-term bimanual training also increases

gray matter volume in experienced adult typists

These results suggest that learning not

only affects function but also structure in

adult brains

21

V Neuroplasticity and Optometry

A Evolutionary neuroplasticity

B Reactive plasticity

C Adaptational plasticity

D Reparation plasticity

22

V Neuroplasticity and Optometry

A Evolutionary neuroplasticity

hellip is ideally suited for the developmental OD who

specializes in vision function as it changes over time

either with or without intervention

23

V Neuroplasticity and Optometry

B Reactive plasticity

hellip can be thought of as the immediate effect that

initial optometric treatment may have on a system This can

be reflected in an immediate but often transient change in

the individuallsquos accommodative systemmdashie when an

uncorrected myope initially puts on his or her new

spectacles

24

V Neuroplasticity and Optometry

C Adaptational plasticity

hellip could describe the long-term effects of in-office optometric

vision therapy on disorders of the binocular vision system

25

V Neuroplasticity and Optometry

D Reparation plasticity

hellipin contrast to adaptational

plasticity reparation plasticity may

occur during treatment by a low

Vision specialist or an OD

Working with those who have

Experienced a traumatic brain

injury (TBI)

26

V Neuroplasticity and Optometry

The effects of plasticity can lead to either

positive or negative changes during

development (evolutionary plasticity) after

short-term exposure (reactive plasticity)

after long-term or continuous stimuli

(adaptational plasticity) and during

functional or structural recovery of damaged

neuronal circuits (reparation plasticity)

httpwwwciteulikeorguserjasonepriorarticle2856526

27

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

A Refractive error development

B Amblyopia

C Strabismus

28

D Non-strabismus non-amblyopic binocular vision disorders

E Learning related vision anomalies

F Vision developmentperception disorders

29

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

A Refractive error development

Several recent studies have noted that neuroplasticity may play a

role in refractive error development

retinal defocus use of progressive addition lenses

drug studies (M1-antagonist2 pirenzepine ) slow myopia

progression demonstrated nearly a 50 reduction in myopia

progression over a two-year period

30

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged

7 to 17 years Arch Ophthalmol 2005 Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three

to less than 10 years of age Am J Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction

Am J Ophthalmol 2007 Jun143(6)1060-3

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine

vs patching for treatment of moderate amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-

57

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for

strabismic and anisometropic amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Treatment of severe amblyopia with weekend atropine results from 2 randomized clinical trials

Levodopacarbidopa in the treatment of amblyopia

31

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

J Pediatr Ophthalmol Strabismus 2009 Mar-Apr46(2)87-90 quiz 91-2 Levodopacarbidopa in the

treatment of amblyopia Dadeya S Vats P Malik KP

PURPOSE To evaluate the role of levodopacarbidopa in the treatment of amblyopia METHODS

Thirty patients with strabismic amblyopia between the ages of 3 and 12 years were part of this double-

blind randomized study Patients were divided into two groups Group A received 050 mg + 125 mg of

levodopacarbidopa per kilogram body weight three times daily after meals with a protein rich drink

whereas Group B received placebo Both groups received full-time conventional occlusion until a visual

acuity of 66 was achieved or for a maximum of 3 months RESULTS The authors observed more than

two lines improvement in visual acuity that was greater in the levodopa group (15 of 15) than in the

placebo group (9 of 15) (P lt 005) Furthermore improvement in visual acuity of more than two lines

was greater in patients younger than 8 years (100) than in patients older than 8 years of age (60) (P =

0026) There was also no significant reversal of the improved visual acuity in up to 6 months of follow-

up CONCLUSION Levodopacarbidopa improves visual acuity in patients with

amblyopia and maintains improved visual acuity especially in patients

younger than 8 years

32

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

J Pediatr Ophthalmol Strabismus 2008 May-Jun45(3)174-6 The use of levodopa in the treatment of

bilateral amblyopia secondary to uncorrected high hypermetropia Abrams MS

The standard treatment of bilateral amblyopia secondary to uncorrected high bilateral hypermetropia has

been spectacles and time The patient described here failed to show adequate improvement in visual

acuity after 18 months of standard treatment Visual acuity improved dramatically when the

patient began taking levodopa dropped precipitously when the medication was

discontinued and returned quickly to post-treatment levels when levodopa was

restarted Visual acuity remained stable when the medication was slowly tapered

and discontinued This report suggests that dopamine may play a role in the pathophysiology of

bilateral amblyopia secondary to uncorrected high bilateral hypermetropia

33

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

Bottom Line

Amblyopia can be treated at any age

May be able to use neuro-enhancing drugs

as a part of basic amblyopia therapy

34

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

C Strabismus and non-strabismic non-amblyopic binocular

vision disorders

Clinical Trial of Treatments for Symptomatic Convergence Insufficiency in Children has

clearly demonstrated the superiority of in-office optometric vision therapy (in conjunction

with home therapy) vs out-of-office therapy alone The study concluded that optometric

vision therapyorthoptics was more effective than pencil push-ups or placebo vision

therapyorthoptics in reducing symptoms and improving clinical signs of convergence

insufficiency

Long-term effectiveness of treatments for symptomatic convergence insufficiency

in children (Optom Vis Sci 2009 Sep86(9)1096-103)

CITT patients improvements lasted a year

35

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

Strabismus 1999 Sep7(3)169-74 Convergence insufficiency in

idiopathic Parkinsons disease responsive to levodopa Racette BA

Gokden MS Tychsen LS Perlmutter JS

We report a patient with pathologically proven idiopathic Parkinsons

disease (IPD) who developed diplopia secondary to convergence

insufficiency during his motor off periods Diplopia resolved with

onset of motor benefit from levodopa Neuro-ophthalmologic

examination demonstrated convergence insufficiency during motor

off periods that was alleviated after onset of motor benefit from

levodopa This is the first reported case of convergence insufficiency

in IPD responsive to levodopa

36

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

Bottom Line

Optometric Vision Therapy is the most efficacious treatment available for binocular vision disorders and the

treatment effects are long lasting Neuro-enhancing drugs

may assist us as well

37

EF Learning related vision anomalies Vision

developmentperception disorders

hellipresearch includes an examination of the role vision plays in

reading the effect of oculomotor vergence and

accommodativecoherent motion therapy on reading eye movements

and reading speed the diagnosis and treatment of perceptual

disorders and the effect of therapy on various learning anomalies

38

EF Learning related vision anomalies Vision developmentperception disorders

magnocellular (MC) deficit in dyslexia

LM speed-matching ratio predicts reading in childrenChase C Dougherty RF Ray N

Fowler S Stein JOptom Vis Sci 2007 Mar84(3)229-36

Effect of attention therapy on reading comprehension Solan HA Shelley-Tremblay J

Ficarra A Silverman M Larson S J Learn Disabil 2003 Nov-Dec36(6)556-63

Is there a common linkage among reading comprehension visual attention and

magnocellular processing Solan HA Shelley-Tremblay JF Hansen PC Larson S

J Learn Disabil 2007 May-Jun40(3)270-8

Lawton T Filtered Text and Direction Discrimination Training Improved Reading

Fluency for Both Dyslexic and Normal Readers Optom Vis Dev 200839 (3)114

Fischer B Hartnegg K Saccade control in dyslexia Development deficits training

and transfer to reading Optom Vis Dev 200839(4)181-190

39

EF Learning related vision anomalies Vision developmentperception disorders

J Learn Disabil 2003 Nov-Dec36(6)556-63 Effect of attention therapy on reading

comprehension Solan HA Shelley-Tremblay J Ficarra A Silverman M Larson S

hellip At the completion of attention therapy the mean

standard attention and reading comprehension scores of

the experimental group had improved significantly The

control group however showed no significant

improvement in reading comprehension scores after 12

weeks Although uncertainties still exist this investigation

supports the notion that visual attention is malleable and

that attention therapy has a significant effect on reading

comprehension in this often neglected population

40

VII Vision dysfunction association with acquired brain injury

A Exotropia (or high exophoriaCI)

B Accommodative dysfunction

C Convergence insufficiency

41

D Decreased blink rate

E Spatial disorientation

F Pursuitsaccade dysfunction

G Unstable ambient vision (Magnocellular pathway)

42

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Stelmack JA Frith T Van Koevering D Rinne S Stelmack TR Visual function in patients

followed at a Veterans Affairs polytrauma network site an electronic medical record review

Optometry 2009 Aug80(8)419-24

RESULTS Visual symptoms were self-reported by 76 of patients

with polytrauma and 75 of the patients with TBI Problems with reading

(polytrauma 60 and TBI 50) and accommodation (polytrauma 30 and

TBI 47) were frequently found on eye examinations Spectacles were the

treatment most frequently prescribed (polytrauma 62 and TBI 78)

CONCLUSIONS It is important for optometrists to be aware of the high

rates of self-reported symptoms and visual problems in military personnel

returning from deployment to the wars in Iraq and Afghanistan Post-

traumatic stress disorder and depression may complicate optometric

evaluation and management

43

VII Vision dysfunction association with acquired brain injury

Avoidance of near tasks

Oculomotor-based reading difficulties

Eye tracking problems

Eye focusing problems

Eyestrain Diplopia

Dizziness Vertigo

Vision-derived nausea

44

VII Vision dysfunction association with acquired brain injury

Increased sensitivity to visual motion

Visual inattention and distractibility

Short-term visual memory loss

Difficulty judging distances (relative and absolute

Difficulty with global scanning

Difficulty with personal grooming especially involving the face

Inability to interactcope visually in a complex social situation

(eg minimal eye contact)

Inability to tolerate complex visual environments (eg grocery store

aisles and highly-patterned floors)

45

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Ciuffreda KJ Ludlam DP Kapoor N Clinical oculomotor training in traumatic brain injury Optom Vis

Dev 200940(1)16-23

Individuals with traumatic brain injury present with a constellation of

oculomotor dysfunctions and correlated symptoms Simple and

effective clinical oculomotor-based training procedures will be

presented with respect to the versional vergence and

accommodative systems and their interactions These therapeutic

procedures can also be applied as needed to individuals with either

low vision neurological dysfunctions or general visual skills cases

manifesting similar oculomotor deficits

46

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Leslie S Myopia and accommodative insufficiency associated with

moderate head trauma Opt Vis Dev 200940(1)25-31

The majority of subjects reviewed had developed a stable degree of

myopia between 100 and 200 diopters as well as an abnormally

high lag of accommodation When their distance and near spatial area

of focus was compared the majority were focused at an intermediate

area in space suggesting a loss of control of accommodation in

space

47

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

B Drugs

C Exercise

D Learning new and challenging things

48

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements

prevent cognitive decline A systematic review of randomized controlled trials J Hum

Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among

preterm infants attributable to early supplementation of human milk with

docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings

and structural-functional synergies with cell membrane phospholipids Altern Med Rev

2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function

Neuroscience 20089(7)568-78

49

VIII Improving Brain Function and Neuroplasticity

B Drugs Maya Vetencourt JF Sale A Viegi A et al The antidepressant

fluoxetine (PROZAC) restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the

antidepressant tianeptine CNS Drugs 200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances

hippocampal long-term potentiation and memory BMC Biol 2008 Sep

9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine

improves neuropsychological disorders in a child with creatine

transporter defect Neurocase 200814(2) 151-61

50

VIII Improving Brain Function and Neuroplasticity

C Exercise

Hunsberger JG et al Antidepressant actions of the exercise-

regulated gene VGF Nat Med 2007 Dec 2 131476

VGF may be a common pathway by which exercise induces

neuroplasticity and growth-factor genes at least one of these might act

similarly to antidepressants in promoting an adaptive response to stress

However the tests used here may be modeling stress-induced

helplessness not depression hellipexercise seems to induce multiple

interacting genes that enhance neuronal resilience

51

VIII Improving Brain Function and Neuroplasticity

D Learning new and challenging things

What have we (optometry amp ophthalmology)

been thinking all these years

Where did we miss the news about neuroplasticity

52

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Huang JC Neuroplasticity as a proposed mechanism for the efficacy of optometric vision therapy and rehabilitation J Bev Optom 200920(4)96-100

Homologous area adaptationCompensatory masqueradeCross-modal reassignment

Map expansion

EquipotentialityVicariation

53

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Homologous area adaptation a transfer of function from a damaged brain area to a non-damaged brain area May be limited to early stages of human development and may crowd a new brain area resulting in reduced functionality of that brain area (Competition between spatial amp verbal functioning)

54

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Compensatory masquerade reorganizing of existing neuro-pathways to us alternative cognitive strategies to perform a task

55

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Cross-modal reassignment using new sensory input in a brain structure deprived of its main input source (changing processing from visual to tactile stimuli in the blind)

56

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Map expansion increase in brain mass due to repeated behavior or exposure to stimuli

57

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Equipotentiality anatomical areas of the brain can perform disparate functions

Vicariation redundant neural systems can operate under abnormal conditions

This may explain why recovery is noted for many neurological conditions (degenerative psychiatric developmental vascular traumatic)

58

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Constraint therapy Use it and improve it

Patching penalization ldquonear activitiesrdquo during amblyopia therapy

59

IX Improving Brain Function and Neuroplasticity Optometric Clinical ApplicationsOptometric Vision Therapy

Kleim amp Jones

Use it or lose it If you do not drive specific brain functions

functional loss will occur

If you want to improve oculomotor brain neuroplastic function amp

structure therapy should be specific for that brain function

Use it and improve it Therapy that drives cortical function enhances

that particular function

If you use therapy to improve oculomotor dysfunction it should

improve

Specificity The therapy you choose determines the resultant

plasticity and function

You must choose therapy that is appropriate

60

IX Improving Brain Function and Neuroplasticity Optometric Clinical Applications

Kleim amp Jones

Repetition matters Plasticity that results in functional change

requires repetition

Do the therapy Do it again Do it yet again No quick fix

Intensity matters Induction of plasticity requires the appropriate

amount of intensity

Intensity means strength force concentration power and passion

Without these plasticity may not occur Function may not improve

Time matters Different forms of plasticity take place at different

times during therapy

Do the basics than the more advanced therapeutic procedures

61

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Salience matters It has to be important to the individual

Make the therapy matter to the patient

Age matters Plasticity is easier in a younger brain but is also

possible in an adult brain

Do not let age determine what therapy options you offer your

patients Think of Susan Barry PhD (StereoSue) and her success

Offer your patients options Let them choose Be realistic about

outcomeshelliphave outcome measures built into therapy program

62

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Transference Neuroplasticity and the change in function

that results from one therapy can augment the attainment

of similar behaviors

What you do during oculomotor therapy may affected

vergence therapy outcomes

Interference Plasticity in response to one experience can

interfere with the acquisition of other behaviors

Monitor Evaluate progress Discuss function in other areas

of your patientslsquo life

63

Why pay attention to binocular vision dysfunctions

and neuroplasticity

December 2009 issue of the Review of Optometry

The Binocular Vision Dysfunction Pandemic

In 2010 almost 170 million individuals will be wearing glasses In

2010 there will also be up to 93 million amblyopes and 12 and a half

million strabismics For children under 18 years of age that means

there will be more than 22 and a half million amblyopes and millions

of children with strabismus A clinical trial to determine the

prevalence of binocular vision dysfunction within the general

population suggested the possibility of up to 56 or 173 million men

women and children with symptoms associated with a binocular

vision dysfunction 189 million (61) with accommodative problems

and 118 million (38) demonstrating various vergence

anomalies

64

65

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Brain plasticity life long changes in the structure of the brain

Sensory substitution replacement of one sensory input by another

Measurement techniques

Voxel based morphometryhellipmeasures difference in brain volume

Fluorodeoxyglucose glucose analog PET scan tells you

distribution and metabolism of brain

Cortical thickness measures

Visual cortex of the blind turns somatic ―The eye of the tongue

Transcranial magnetic stmiulation non-invasive technique to

stimulate cortex

66

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Blind Braille readers report tingling in fingers when pressure

phosphenes are applied Blind feel tingling in tongue

Bind use tongue to perform orientation task motion perception

sensory perception Visual cortex recruited in a variety of sensory

and cognitive tasks (DM Can we use tongue as a VT tool)

Dilks Reorganizations of human adult visual system

When a region of sensory cortex is deprived of its bottom up

input the deprived region begins to respond to stimuli that

normally activate adjacent cortex

67

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Retinotopic map changes for stroke pts Cortical reorganization in

adults occurs Perceived objectshellipelongation in stroke amp AMD

What happens to deprived cortex in AMD

fMRI shows cortical reorganization in adults

Proposed mechanisms

hellipGrowth of new connections

hellipUnmasking of pre-existing connections this is true

happens within seconds

Bavelier

Action video games

68

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Bavelier

Action video games Looked at attention Gamers can track more

activities

Attention over space (me peripheral awarenress) Useful field

of view shrinks with age

Performance not VA relatedhellipis related to attention

Action game playing changes spatial resolutionhellipovercoming

crowding in VA assessment (me amblyopia therapy)

Temporal resolution of vision Backward masking

changehellipbrain changes

Visual sensitivity (contrast sensitivity) Post action game training

improves CSF

69

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Action video games correcting optics of the cortex (me this is

actualy OVT)

Games factor

Variable entry leanringhellipadapt task to skill level

Incremental learning tune task to subjectlsquos leanring steps

Motivationarousal

Rewards

Self masterself confidence

Action games factors

Pacingrate of exposure to infohellipincreasing processing speed

Dynamic display

Rich environment

Rich motor involvement

70

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Surgeons may be made to play action games

Pilot training

Amblyopia tx Dennis Levi research

PresenterTitle Contact info

Neuroplasticity-A Paradigm Sea Change

This presentation is available at

httpwwwslidesharenetDMAINOneuroplasticity-a-paradigm-sea-change-2459693

httpwwwmainosmemosblogspotcom

My FaceBook Page

and

Twitter

PresenterTitle Contact info

Questions About

Neuroplasticity-A Paradigm Sea Change

Dominick M Maino OD MEd FAAO FCOVD-A

Professor PediatricsBinocular VisionIllinois Eye InstituteIllinois College of Optometry

dmainoicoeduhttpwwwMainosMemosblogspotcom

Thanks to

httpwwwcovdorgHomeOVDJournalOVD401tabid263D

efaultaspx

httpbipolarblastfileswordpresscom200908neurojpg

httpwwwspecialcheerscomimagesanimated_braingif

httpblogmarsdencartoonscomwp-

contentuploads200810frankenstein-myspace-lightbeergif

httpwwwshangralafamilyfuncomgala-ecalvindreamgif

httppsychiatryjwatchorgcgicontentfull20082251

73

Chakraborty R Chatterjee A Choudhart S Chakraborty PK Neuroplasticitymdasha paradigm shift in neurosciences J Indian Med Assoc

2007105(9)513-4516-8520-1

Sacks O A neurologistlsquos notebook Stereo Sue Why two eyes are better than one The New Yorker 2006 Jun 1964-73

Krulwich R National Public Radio Going Binocular Susanlsquos First Snowfall Available at

wwwnprorgtemplatesstorystoryphpstoryId=5507789 (Accessed December 8 2008)

Press LJ The story behind Stereo Suelsquo and a world-famous neurologistlsquos discovery of vision therapy Optom Vis Dev 200637(2) 55-7

Levin HS Neuroplasticity and brain imaging research implications for rehabilitation Arch Phys Med Rehabil 2006 Dec87(12 Suppl

2)S1

Wiesel TN Hubel DH Single-cell responses in striate cortex of kittens deprived of vision in one eye J Neurophysiol 1963

Nov261003-17

Hook BM Chen C Critical periods in the visual system Changing views for a model of experience-dependent plasticity Neuron 2007

Oct56(2)312-26

Ramey CT Ramey SL Prevention of intellectual disabilities early interventions to improve cognitive development Prev Med 1998

Mar-Apr27(2)224-32

Heuninckx S Wenderoth N Swinnen SP Systems neuroplasticity in the aging brain recruiting additional neural resources for

successful motor performance in elderly persons J Neurosci 2008 Jan 228(1)91-9

Ge S Yang CH Hsu KS et al A critical period for enhanced synaptic plasticity in newly generated neurons of the adult brain Neuron

2007 May54(4)559-66

74

Draganski B Gaser C Busch V et al Neuroplasticity changes in grey matter induced by training Nature 2004 Jan 22427(6972)

311-2

Cannonieri GC Bonilha L Fernandes PT et al Practice and perfect length of training and structural brain changes in experienced

typists Neuroreport 2007 Jul 218(10)1063-6

Kleim JA Jones TA Principles of experience-dependent neural plasticity implications for rehabilitation after brain damage J

Speech Lang Hear Res 2008 Feb51(1)S225-39

Trojan S Porkorny J Theoretical aspects of neuroplasticity Physiol Res 199948(2)87-97

Ramamirtham R Kee CS Hung LF et al Wave aberrations in rhesus monkeys with vision-induced ametropias Vision Res 2007

Sep47(21)2751-66

Smith EL 3rd Ramamirtham R Qiao-Grider Y et al Effects of foveal ablation on emmetropization and form-deprivation myopia

Invest Ophthalmol Vis Sci 2007 Sep48(9)3914-22

Smith EL 3rd Kee CS Ramamirtham R et al Peripheral vision can influence eye growth and refractive development in infant

monkeys Invest Ophthalmol Vis Sci 2005 Nov46(11)3965-72

Ciuffreda KJ Vasudevan B Nearwork-induced transient myopia (NITM) and permanent myopiandashndashis there a link Ophthalmic

Physiol Opt 2008 Mar28(2)103-14

Hung GK Ciuffreda KJ Incremental retinal-defocus theory of myopia development--schematic analysis and computer simulation

Comput Biol Med 2007 Jul37(7)930-46

Hung GK Ciuffreda KJ A unifying theory of refractive error development Bull Math Biol 2000 Nov62(6)1087-108

75

Pang Y Maino D Zhang G Lu F Myopia Can its progress be controlled Optom Vis Dev 200637(2)75-9

Leung JT Brown B Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lenses Optom Vis Sci

1999 Jun76(6)346-54

Hasebe S Ohtsuki H Nonaka T et al Effect of progressive addition lenses on myopia progression in Japanese children a prospective

randomized double-masked crossover trial Invest Ophthalmol Vis Sci 2008 Jul49(7)2781-9

Gwiazda J Hyman L Hussein M et al A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression

of myopia in children Invest Ophthalmol Vis Sci 2003 Apr44(4)1492-500

Siatkowski RM Cotter SA Crockett RS et al Two-year multi-center randomized double-masked placebo-controlled parallel safety and

efficacy study of 2 pirenzepine ophthalmic gel in children with myopia J AAPOS 2008 Aug12(4)332-9

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged 7 to 17 years Arch Ophthalmol 2005

Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three to less than 10 years of age Am J

Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction Am J Ophthalmol 2007

Jun143(6)1060-3

Holmes JM Edwards AR Beck RW et al A randomized pilot study of near activities versus non-near activities during patching therapy for

amblyopia J AAPOS 2005 Apr9(2)129-36

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate

amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-57

76

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic

amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Convergence Insufficiency Treatment Trial Study Group Randomized clinical trial of treatments for symptomatic convergence insufficiency

in children Arch Ophthalmol 2008 Oct126(10)1336-49

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

Solan HA Shelley-Tremblay J Hansen PC et al M-cell deficit and reading disability a preliminary study of the effects of temporal vision-

processing therapy Optometry 2004 Oct75(10)640-50

Solan HA Larson S Shelley-Tremblay J et al Role of visual attention in cognitive control of oculomotor readiness in students with reading

disabilities J Learn Disabil 2001 Mar-Apr34(2)107-18

Gallaway M Boas MB The impact of vergence and accommodative therapy on reading eye movements and reading speed Optom Vis Dev

200738(3)115-20

Goss DA Downing DB Lowther AH et al The effect of HTS vision therapy conducted in a school setting on reading skills in third and

fourth grade students Optom Vis Dev 200738(1)27-32

Crutch SJ Warrington EK Foveal crowding in posterior cortical atrophy a specific early-visual-processing deficit affecting word reading

Cogn Neuropsychol 2007 Dec24(8)843-66

Helms D Sawtelle SM A study of the effectiveness of cognitive therapy delivered in a video game format Optom Vis Dev 200738 (1)19-

26

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

77

Lawton T Training direction-discrimination sensitivity remediates a wide spectrum of reading skills OptomVis Dev 200738(1) 33-47

Goldstand S Koslowe KC Parush S Vision visual-information processing and academic performance among seventh-grade schoolchildren a

more significant relationship than we thought Am J Occup Ther 2005 Jul-Aug59(4)377-89

Fischer B Koumlngeter A Hartnegg K Effects of daily practice on subitizing visual counting and basic arithmetic skills Optom Vis Dev

200839(1)30-4

Sands W Taub M Maino D Limited research and education on special populations in optometry and ophthalomology Optom Vis Dev

200839(2)60-1

Wesson M Maino D Oculo-visual findings in Down syndrome cerebral palsy and mental retardation with non-specific etiology In Maino D

(ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 199517-54 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

Cui Y Stapleton F Suttle C Developing an instrument to assess vision-related and subjective quality of life in children with intellectual

disability data collection and preliminary analysis in a Chinese population Ophthal Physiolog Optics 2008 May28(3) 238-46

Maino D Steele G Tahir S Sajja R Attitudes of optometry students toward individuals with disabilities Optom Ed 200227(2)45-50

Maino D Special populations in the optometric curriculum Optom Ed 200227(2)38-9

Maino D Overview of special populations In Scheiman M Rouse M (eds) Optometric Management of Learning-Related Vision Problems

St Louis Mosby Inc 200685-106

Maino D (ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 1995 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

78

McCarthy P Maino D Alport syndrome a review Clin Eye Vis Care 2000 Dec12(3-4)139-50

Block SS Brusca-Vega R Pizzi WJ et al Cognitive and visual processing skills and their relationship to mutation size in full and

permutation female fragile X carriers Optom Vis Sci 2000 Nov77 (11)592-9

Maino D The young child with developmental disabilities An introduction to mental retardation and genetic syndromes In Moore BD

(ed) Eye Care for Infants and Young Children Butter-worth--Heinemann Newton MA1997285-300

Amin V Maino D The Fragile X female Visual visual perceptual and ocular health anomalies J Am Optom Assoc 1995 May66

(5)290-95

Maino DM Maino JH Cibis GW Hecht F Ocular health anomalies in patients with developmental disabilities In Maino D (ed)

Diagnosis and Management of Special Populations Mosby-Year-book Inc St Louis MO 1995189-206 Reprinted Optometric

Education Program Foundation Santa Anna Calif 2001

Maino D Wesson M Schlange D Cibis G Maino J Optometric findings in the fragile X syndrome Optom Vis Sci 199168634-40

Scheiman MMOptometric findings in children with cerebral palsy Am J Optom Physiol Opt 1984 May61(5)321-3

Maino D Maino J Maino S Mental retardation syndromes with associated ocular defects J Am Optom Assoc 199061707-16

Stewart RE Woodhouse JM Cregg M Pakeman VH Association between accommodative accuracy hypermetropia and strabismus in

children with Downs syndrome Optom Vis Sci 2007 Feb84(2)149-55

Cregg M Woodhouse JM Pakeman VH et al Accommodation and refractive error in children with Down syndrome cross-sectional

and longitudinal studies Invest Ophthalmol Vis Sci 2001 Jan42 (1)55-63

79

McClelland JF Parkes J Hill N et al Accommodative dysfunction in children with cerebral palsy a population-

based study Invest Ophthalmol Vis Sci 2006 May47(5)1824-30

Duckman RH Vision therapy for the child with cerebral palsy J Am Optom Assoc 198758(1)28-35

Duckman R Accommodation in cerebral palsy function and remediation J Am Optom Assoc 198455(4)281-3

Scheiman M Understanding and managing vision deficits a guide for occupational therapists 2nd ed Slack

Thorofare NJ 2002

Maino D Binasal occlusion for the child with Cerebral Palsy J Ill Optom Assoc 198644(1)1218

Battaglia F Quartarone A Rizzo V et al Early impairment of synaptic plasticity in patients with Downs syndrome

Neurobiol Aging 2008 Aug29(8)1272-5

Bonnier C Evaluation of early stimulation programs for enhancing brain development Acta Paediatr 2008

Jul97(7)853-8

Morice E Andreae LC Cooke SF et al Preservation of long-term memory and synaptic plasticity despite short-term

impairments in the Tc1 mouse model of Down syndrome Learn Mem 2008 Jul 1415(7)492-500

Gordon AM Schneider JA Chinnan A Charles JR Efficacy of a hand-arm bimanual intensive therapy (HABIT) in

children with hemiplegic cerebral palsy a randomized control trial Dev Med Child Neurol 2007 Nov49(11)830-8

Kapoor N Ciuffreda KJ Vision disturbances following traumatic brain injury Curr Treat Options Neurol 2002

Jul4(4)271-80

80

Ciuffreda KJ Rutner D Kapoor N et al Vision therapy for oculomotor dysfunctions in acquired brain injury a

retrospective analysis Optometry 2008 Jan79(1)18-22

Ciuffreda KJ Han Y Kapoor N Ficarra AP Oculomotor rehabilitation for reading in acquired brain injury

NeuroRehabilitation 200621(1)9-21

Zost M Diagnosis and management of visual dysfunction in cerebral injury In Maino D (ed) Diagnosis and

Management of Special Populations Mosby-Yearbook Inc St Louis 199579 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001 [Figure used with permission of the editor]

DeGutis JM Bentin S Robertson LC DEsposito M Functional plasticity in ventral temporal cortex following

cognitive rehabilitation of a congenital prosopagnosic J Cogn Neurosci 2007 Nov19 (11)1790-802

Welbourne SR Ralph MA Exploring the impact of plasticity-related recovery after brain damage in a connectionist

model of single-word reading Cogn Affect Behav Neurosci 2005 Mar5(1)77-92

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements prevent cognitive decline A

systematic review of randomized controlled trials J Hum Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among preterm infants attributable to early

supplementation of human milk with docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings and structural-functional

synergies with cell membrane phospholipids Altern Med Rev 2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function Neuroscience 20089(7)568-78

81

Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

BMC Biol 2008 Sep 9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine improves neuropsychological disorders in a child with

creatine transporter defect Neurocase 200814(2) 151-61

Forrester LW Wheaton LA Luft AR Exercise-mediated locomotor recovery and lower-limb neuroplasticity after

stroke J Rehabil Res Dev 200845(2)205-20

82

Page 3: Neuroplasticity: A Paradigm Sea Change Latest Updated File

PresenterTitle Contact info

Neuroplasticity-A Paradigm Sea Change

Dominick M Maino OD MEd FAAO FCOVD-A

Professor PediatricsBinocular VisionIllinois Eye InstituteIllinois College of Optometry

dmainoicoeduhttpwwwMainosMemosblogspotcom

Sea Change OriginFrom Shakespeares The Tempest 1610

ARIEL [sings]

Full fathom five thy father lies Of his bones are coral made

Those are pearls that were his eyes Nothing of him that doth fade

But doth suffer a sea-change Into something rich and strange

4

I Sea Change (Meaning)

A radical and apparently mystical change

It is change of such magnitude that it alters the way we think and what we do

in a sweeping far ranging mind expanding mega-behavior

transformative fashion

5

Neuroplasticity

Up until recentlyhellipapparently unknown to many within the professions of optometry and ophthalmologyhellip

6

7

The BrainA hellip is not just a static soft round mass bathed in a fluid and surrounded by a hard caseB hellip can change its form and resultant function through neuroplasticity

The BrainA hellip is not just a static soft round mass bathed in a fluid and surrounded by a hard caseB hellip can change its form and resultant function through neuroplasticity

The BrainA hellip is not just a static soft round mass bathed in a fluid and surrounded by a hard caseB hellip can change its form and resultant function through neuroplasticity

The BrainA hellip is not just a static soft round mass bathed in a fluid and surrounded by a hard caseB hellip can change its form and resultant function through neuroplasticity

II The Brain

hellip is not just a static soft round mass bathed in a fluid and surrounded by a hard case

hellip can change its form and resultant function through neuroplasticity

8

III CriticalSensitive Periods

A A critical period occurs when the individual is sensitive to environmental influences and stimulation

1 The Precritical period The initial formation of neuronal circuits that is not dependent on visual experience

9

CriticalSensitive Periods

2 The Critical period A distinct onset of robust plasticity in response to the visual experience when the initially formed circuit can be modified by experience

3 Closure of the critical period After the end of the critical period the same visual experience no longer elicits the same degree of plasticity

10

CriticalSensitive Periods

B The concept of a critical period does not imply that neuroplasticity ends after a certain age

C Sensitive period begins and ends gradually (not abruptly like the critical period) and provides for maximum sensitivity

to stimuli

11

VI Neuroplasticity and the Brain

A Can adult brain neurons actually exhibit neuroplasticity The short answer is yes

B Resultant changes are noted in not only functional outcomes but also in brain anatomy and structure

12

IV Neuroplasticity and Rehabilitation

Kleim amp Jones note that

A The Key Principles of Experience-Dependent Neural Plasticity

1 Use it or lose it

2 Use it and improve it

3 Specificity

13

4 Repetition matters

5 Intensity matters

6 Time matters

7 Salience matters

14

8 Age matters

9 Transference

10 Interference

15

Use it or lose it If you do not drive specific brain functions

functional loss will occur

Use it and improve it Therapy that drives cortical function

enhances that particular function

Specificity The therapy you choose determines the resultant

plasticity and function

Repetition matters Plasticity that results in functional change

requires repetition

16

Intensity matters Induction of plasticity requires the appropriate

amount of intensity

Time matters Different forms of plasticity take place at different

times during therapy

Salience matters It has to be important to the individual

Age matters Plasticity is easier in a younger brain but is also

possible in an adult brain

17

Transference Neuroplasticity and the change in function that

results from one therapy can augment the attainment of similar

behaviors

Interference Plasticity in response to one experience can interfere

with the acquisition of other behaviors

18

B Examples of Changes in Function and Structure

1) Jugglers

2) Typists

19

B Examples of Changes in Function and Structure

1) Jugglers

One study suggested that adults taught how to juggle demonstrated a

significant transient bilateral expansion of gray matter in the mid-

temporal area and the left posterior intraparietal sulcus between baseline brain scan and

follow-up The findings were specific to training stimulus individuals who were

not instructed how to juggle demonstrated no change in gray

matter over the same period These findings oppose the conventional

understanding that the anatomical structure of the adult brain does not change

over time

20

B Examples of Changes in Function and Structure

2) Typists

helliplong-term bimanual training also increases

gray matter volume in experienced adult typists

These results suggest that learning not

only affects function but also structure in

adult brains

21

V Neuroplasticity and Optometry

A Evolutionary neuroplasticity

B Reactive plasticity

C Adaptational plasticity

D Reparation plasticity

22

V Neuroplasticity and Optometry

A Evolutionary neuroplasticity

hellip is ideally suited for the developmental OD who

specializes in vision function as it changes over time

either with or without intervention

23

V Neuroplasticity and Optometry

B Reactive plasticity

hellip can be thought of as the immediate effect that

initial optometric treatment may have on a system This can

be reflected in an immediate but often transient change in

the individuallsquos accommodative systemmdashie when an

uncorrected myope initially puts on his or her new

spectacles

24

V Neuroplasticity and Optometry

C Adaptational plasticity

hellip could describe the long-term effects of in-office optometric

vision therapy on disorders of the binocular vision system

25

V Neuroplasticity and Optometry

D Reparation plasticity

hellipin contrast to adaptational

plasticity reparation plasticity may

occur during treatment by a low

Vision specialist or an OD

Working with those who have

Experienced a traumatic brain

injury (TBI)

26

V Neuroplasticity and Optometry

The effects of plasticity can lead to either

positive or negative changes during

development (evolutionary plasticity) after

short-term exposure (reactive plasticity)

after long-term or continuous stimuli

(adaptational plasticity) and during

functional or structural recovery of damaged

neuronal circuits (reparation plasticity)

httpwwwciteulikeorguserjasonepriorarticle2856526

27

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

A Refractive error development

B Amblyopia

C Strabismus

28

D Non-strabismus non-amblyopic binocular vision disorders

E Learning related vision anomalies

F Vision developmentperception disorders

29

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

A Refractive error development

Several recent studies have noted that neuroplasticity may play a

role in refractive error development

retinal defocus use of progressive addition lenses

drug studies (M1-antagonist2 pirenzepine ) slow myopia

progression demonstrated nearly a 50 reduction in myopia

progression over a two-year period

30

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged

7 to 17 years Arch Ophthalmol 2005 Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three

to less than 10 years of age Am J Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction

Am J Ophthalmol 2007 Jun143(6)1060-3

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine

vs patching for treatment of moderate amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-

57

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for

strabismic and anisometropic amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Treatment of severe amblyopia with weekend atropine results from 2 randomized clinical trials

Levodopacarbidopa in the treatment of amblyopia

31

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

J Pediatr Ophthalmol Strabismus 2009 Mar-Apr46(2)87-90 quiz 91-2 Levodopacarbidopa in the

treatment of amblyopia Dadeya S Vats P Malik KP

PURPOSE To evaluate the role of levodopacarbidopa in the treatment of amblyopia METHODS

Thirty patients with strabismic amblyopia between the ages of 3 and 12 years were part of this double-

blind randomized study Patients were divided into two groups Group A received 050 mg + 125 mg of

levodopacarbidopa per kilogram body weight three times daily after meals with a protein rich drink

whereas Group B received placebo Both groups received full-time conventional occlusion until a visual

acuity of 66 was achieved or for a maximum of 3 months RESULTS The authors observed more than

two lines improvement in visual acuity that was greater in the levodopa group (15 of 15) than in the

placebo group (9 of 15) (P lt 005) Furthermore improvement in visual acuity of more than two lines

was greater in patients younger than 8 years (100) than in patients older than 8 years of age (60) (P =

0026) There was also no significant reversal of the improved visual acuity in up to 6 months of follow-

up CONCLUSION Levodopacarbidopa improves visual acuity in patients with

amblyopia and maintains improved visual acuity especially in patients

younger than 8 years

32

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

J Pediatr Ophthalmol Strabismus 2008 May-Jun45(3)174-6 The use of levodopa in the treatment of

bilateral amblyopia secondary to uncorrected high hypermetropia Abrams MS

The standard treatment of bilateral amblyopia secondary to uncorrected high bilateral hypermetropia has

been spectacles and time The patient described here failed to show adequate improvement in visual

acuity after 18 months of standard treatment Visual acuity improved dramatically when the

patient began taking levodopa dropped precipitously when the medication was

discontinued and returned quickly to post-treatment levels when levodopa was

restarted Visual acuity remained stable when the medication was slowly tapered

and discontinued This report suggests that dopamine may play a role in the pathophysiology of

bilateral amblyopia secondary to uncorrected high bilateral hypermetropia

33

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

Bottom Line

Amblyopia can be treated at any age

May be able to use neuro-enhancing drugs

as a part of basic amblyopia therapy

34

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

C Strabismus and non-strabismic non-amblyopic binocular

vision disorders

Clinical Trial of Treatments for Symptomatic Convergence Insufficiency in Children has

clearly demonstrated the superiority of in-office optometric vision therapy (in conjunction

with home therapy) vs out-of-office therapy alone The study concluded that optometric

vision therapyorthoptics was more effective than pencil push-ups or placebo vision

therapyorthoptics in reducing symptoms and improving clinical signs of convergence

insufficiency

Long-term effectiveness of treatments for symptomatic convergence insufficiency

in children (Optom Vis Sci 2009 Sep86(9)1096-103)

CITT patients improvements lasted a year

35

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

Strabismus 1999 Sep7(3)169-74 Convergence insufficiency in

idiopathic Parkinsons disease responsive to levodopa Racette BA

Gokden MS Tychsen LS Perlmutter JS

We report a patient with pathologically proven idiopathic Parkinsons

disease (IPD) who developed diplopia secondary to convergence

insufficiency during his motor off periods Diplopia resolved with

onset of motor benefit from levodopa Neuro-ophthalmologic

examination demonstrated convergence insufficiency during motor

off periods that was alleviated after onset of motor benefit from

levodopa This is the first reported case of convergence insufficiency

in IPD responsive to levodopa

36

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

Bottom Line

Optometric Vision Therapy is the most efficacious treatment available for binocular vision disorders and the

treatment effects are long lasting Neuro-enhancing drugs

may assist us as well

37

EF Learning related vision anomalies Vision

developmentperception disorders

hellipresearch includes an examination of the role vision plays in

reading the effect of oculomotor vergence and

accommodativecoherent motion therapy on reading eye movements

and reading speed the diagnosis and treatment of perceptual

disorders and the effect of therapy on various learning anomalies

38

EF Learning related vision anomalies Vision developmentperception disorders

magnocellular (MC) deficit in dyslexia

LM speed-matching ratio predicts reading in childrenChase C Dougherty RF Ray N

Fowler S Stein JOptom Vis Sci 2007 Mar84(3)229-36

Effect of attention therapy on reading comprehension Solan HA Shelley-Tremblay J

Ficarra A Silverman M Larson S J Learn Disabil 2003 Nov-Dec36(6)556-63

Is there a common linkage among reading comprehension visual attention and

magnocellular processing Solan HA Shelley-Tremblay JF Hansen PC Larson S

J Learn Disabil 2007 May-Jun40(3)270-8

Lawton T Filtered Text and Direction Discrimination Training Improved Reading

Fluency for Both Dyslexic and Normal Readers Optom Vis Dev 200839 (3)114

Fischer B Hartnegg K Saccade control in dyslexia Development deficits training

and transfer to reading Optom Vis Dev 200839(4)181-190

39

EF Learning related vision anomalies Vision developmentperception disorders

J Learn Disabil 2003 Nov-Dec36(6)556-63 Effect of attention therapy on reading

comprehension Solan HA Shelley-Tremblay J Ficarra A Silverman M Larson S

hellip At the completion of attention therapy the mean

standard attention and reading comprehension scores of

the experimental group had improved significantly The

control group however showed no significant

improvement in reading comprehension scores after 12

weeks Although uncertainties still exist this investigation

supports the notion that visual attention is malleable and

that attention therapy has a significant effect on reading

comprehension in this often neglected population

40

VII Vision dysfunction association with acquired brain injury

A Exotropia (or high exophoriaCI)

B Accommodative dysfunction

C Convergence insufficiency

41

D Decreased blink rate

E Spatial disorientation

F Pursuitsaccade dysfunction

G Unstable ambient vision (Magnocellular pathway)

42

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Stelmack JA Frith T Van Koevering D Rinne S Stelmack TR Visual function in patients

followed at a Veterans Affairs polytrauma network site an electronic medical record review

Optometry 2009 Aug80(8)419-24

RESULTS Visual symptoms were self-reported by 76 of patients

with polytrauma and 75 of the patients with TBI Problems with reading

(polytrauma 60 and TBI 50) and accommodation (polytrauma 30 and

TBI 47) were frequently found on eye examinations Spectacles were the

treatment most frequently prescribed (polytrauma 62 and TBI 78)

CONCLUSIONS It is important for optometrists to be aware of the high

rates of self-reported symptoms and visual problems in military personnel

returning from deployment to the wars in Iraq and Afghanistan Post-

traumatic stress disorder and depression may complicate optometric

evaluation and management

43

VII Vision dysfunction association with acquired brain injury

Avoidance of near tasks

Oculomotor-based reading difficulties

Eye tracking problems

Eye focusing problems

Eyestrain Diplopia

Dizziness Vertigo

Vision-derived nausea

44

VII Vision dysfunction association with acquired brain injury

Increased sensitivity to visual motion

Visual inattention and distractibility

Short-term visual memory loss

Difficulty judging distances (relative and absolute

Difficulty with global scanning

Difficulty with personal grooming especially involving the face

Inability to interactcope visually in a complex social situation

(eg minimal eye contact)

Inability to tolerate complex visual environments (eg grocery store

aisles and highly-patterned floors)

45

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Ciuffreda KJ Ludlam DP Kapoor N Clinical oculomotor training in traumatic brain injury Optom Vis

Dev 200940(1)16-23

Individuals with traumatic brain injury present with a constellation of

oculomotor dysfunctions and correlated symptoms Simple and

effective clinical oculomotor-based training procedures will be

presented with respect to the versional vergence and

accommodative systems and their interactions These therapeutic

procedures can also be applied as needed to individuals with either

low vision neurological dysfunctions or general visual skills cases

manifesting similar oculomotor deficits

46

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Leslie S Myopia and accommodative insufficiency associated with

moderate head trauma Opt Vis Dev 200940(1)25-31

The majority of subjects reviewed had developed a stable degree of

myopia between 100 and 200 diopters as well as an abnormally

high lag of accommodation When their distance and near spatial area

of focus was compared the majority were focused at an intermediate

area in space suggesting a loss of control of accommodation in

space

47

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

B Drugs

C Exercise

D Learning new and challenging things

48

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements

prevent cognitive decline A systematic review of randomized controlled trials J Hum

Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among

preterm infants attributable to early supplementation of human milk with

docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings

and structural-functional synergies with cell membrane phospholipids Altern Med Rev

2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function

Neuroscience 20089(7)568-78

49

VIII Improving Brain Function and Neuroplasticity

B Drugs Maya Vetencourt JF Sale A Viegi A et al The antidepressant

fluoxetine (PROZAC) restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the

antidepressant tianeptine CNS Drugs 200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances

hippocampal long-term potentiation and memory BMC Biol 2008 Sep

9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine

improves neuropsychological disorders in a child with creatine

transporter defect Neurocase 200814(2) 151-61

50

VIII Improving Brain Function and Neuroplasticity

C Exercise

Hunsberger JG et al Antidepressant actions of the exercise-

regulated gene VGF Nat Med 2007 Dec 2 131476

VGF may be a common pathway by which exercise induces

neuroplasticity and growth-factor genes at least one of these might act

similarly to antidepressants in promoting an adaptive response to stress

However the tests used here may be modeling stress-induced

helplessness not depression hellipexercise seems to induce multiple

interacting genes that enhance neuronal resilience

51

VIII Improving Brain Function and Neuroplasticity

D Learning new and challenging things

What have we (optometry amp ophthalmology)

been thinking all these years

Where did we miss the news about neuroplasticity

52

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Huang JC Neuroplasticity as a proposed mechanism for the efficacy of optometric vision therapy and rehabilitation J Bev Optom 200920(4)96-100

Homologous area adaptationCompensatory masqueradeCross-modal reassignment

Map expansion

EquipotentialityVicariation

53

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Homologous area adaptation a transfer of function from a damaged brain area to a non-damaged brain area May be limited to early stages of human development and may crowd a new brain area resulting in reduced functionality of that brain area (Competition between spatial amp verbal functioning)

54

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Compensatory masquerade reorganizing of existing neuro-pathways to us alternative cognitive strategies to perform a task

55

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Cross-modal reassignment using new sensory input in a brain structure deprived of its main input source (changing processing from visual to tactile stimuli in the blind)

56

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Map expansion increase in brain mass due to repeated behavior or exposure to stimuli

57

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Equipotentiality anatomical areas of the brain can perform disparate functions

Vicariation redundant neural systems can operate under abnormal conditions

This may explain why recovery is noted for many neurological conditions (degenerative psychiatric developmental vascular traumatic)

58

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Constraint therapy Use it and improve it

Patching penalization ldquonear activitiesrdquo during amblyopia therapy

59

IX Improving Brain Function and Neuroplasticity Optometric Clinical ApplicationsOptometric Vision Therapy

Kleim amp Jones

Use it or lose it If you do not drive specific brain functions

functional loss will occur

If you want to improve oculomotor brain neuroplastic function amp

structure therapy should be specific for that brain function

Use it and improve it Therapy that drives cortical function enhances

that particular function

If you use therapy to improve oculomotor dysfunction it should

improve

Specificity The therapy you choose determines the resultant

plasticity and function

You must choose therapy that is appropriate

60

IX Improving Brain Function and Neuroplasticity Optometric Clinical Applications

Kleim amp Jones

Repetition matters Plasticity that results in functional change

requires repetition

Do the therapy Do it again Do it yet again No quick fix

Intensity matters Induction of plasticity requires the appropriate

amount of intensity

Intensity means strength force concentration power and passion

Without these plasticity may not occur Function may not improve

Time matters Different forms of plasticity take place at different

times during therapy

Do the basics than the more advanced therapeutic procedures

61

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Salience matters It has to be important to the individual

Make the therapy matter to the patient

Age matters Plasticity is easier in a younger brain but is also

possible in an adult brain

Do not let age determine what therapy options you offer your

patients Think of Susan Barry PhD (StereoSue) and her success

Offer your patients options Let them choose Be realistic about

outcomeshelliphave outcome measures built into therapy program

62

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Transference Neuroplasticity and the change in function

that results from one therapy can augment the attainment

of similar behaviors

What you do during oculomotor therapy may affected

vergence therapy outcomes

Interference Plasticity in response to one experience can

interfere with the acquisition of other behaviors

Monitor Evaluate progress Discuss function in other areas

of your patientslsquo life

63

Why pay attention to binocular vision dysfunctions

and neuroplasticity

December 2009 issue of the Review of Optometry

The Binocular Vision Dysfunction Pandemic

In 2010 almost 170 million individuals will be wearing glasses In

2010 there will also be up to 93 million amblyopes and 12 and a half

million strabismics For children under 18 years of age that means

there will be more than 22 and a half million amblyopes and millions

of children with strabismus A clinical trial to determine the

prevalence of binocular vision dysfunction within the general

population suggested the possibility of up to 56 or 173 million men

women and children with symptoms associated with a binocular

vision dysfunction 189 million (61) with accommodative problems

and 118 million (38) demonstrating various vergence

anomalies

64

65

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Brain plasticity life long changes in the structure of the brain

Sensory substitution replacement of one sensory input by another

Measurement techniques

Voxel based morphometryhellipmeasures difference in brain volume

Fluorodeoxyglucose glucose analog PET scan tells you

distribution and metabolism of brain

Cortical thickness measures

Visual cortex of the blind turns somatic ―The eye of the tongue

Transcranial magnetic stmiulation non-invasive technique to

stimulate cortex

66

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Blind Braille readers report tingling in fingers when pressure

phosphenes are applied Blind feel tingling in tongue

Bind use tongue to perform orientation task motion perception

sensory perception Visual cortex recruited in a variety of sensory

and cognitive tasks (DM Can we use tongue as a VT tool)

Dilks Reorganizations of human adult visual system

When a region of sensory cortex is deprived of its bottom up

input the deprived region begins to respond to stimuli that

normally activate adjacent cortex

67

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Retinotopic map changes for stroke pts Cortical reorganization in

adults occurs Perceived objectshellipelongation in stroke amp AMD

What happens to deprived cortex in AMD

fMRI shows cortical reorganization in adults

Proposed mechanisms

hellipGrowth of new connections

hellipUnmasking of pre-existing connections this is true

happens within seconds

Bavelier

Action video games

68

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Bavelier

Action video games Looked at attention Gamers can track more

activities

Attention over space (me peripheral awarenress) Useful field

of view shrinks with age

Performance not VA relatedhellipis related to attention

Action game playing changes spatial resolutionhellipovercoming

crowding in VA assessment (me amblyopia therapy)

Temporal resolution of vision Backward masking

changehellipbrain changes

Visual sensitivity (contrast sensitivity) Post action game training

improves CSF

69

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Action video games correcting optics of the cortex (me this is

actualy OVT)

Games factor

Variable entry leanringhellipadapt task to skill level

Incremental learning tune task to subjectlsquos leanring steps

Motivationarousal

Rewards

Self masterself confidence

Action games factors

Pacingrate of exposure to infohellipincreasing processing speed

Dynamic display

Rich environment

Rich motor involvement

70

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Surgeons may be made to play action games

Pilot training

Amblyopia tx Dennis Levi research

PresenterTitle Contact info

Neuroplasticity-A Paradigm Sea Change

This presentation is available at

httpwwwslidesharenetDMAINOneuroplasticity-a-paradigm-sea-change-2459693

httpwwwmainosmemosblogspotcom

My FaceBook Page

and

Twitter

PresenterTitle Contact info

Questions About

Neuroplasticity-A Paradigm Sea Change

Dominick M Maino OD MEd FAAO FCOVD-A

Professor PediatricsBinocular VisionIllinois Eye InstituteIllinois College of Optometry

dmainoicoeduhttpwwwMainosMemosblogspotcom

Thanks to

httpwwwcovdorgHomeOVDJournalOVD401tabid263D

efaultaspx

httpbipolarblastfileswordpresscom200908neurojpg

httpwwwspecialcheerscomimagesanimated_braingif

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contentuploads200810frankenstein-myspace-lightbeergif

httpwwwshangralafamilyfuncomgala-ecalvindreamgif

httppsychiatryjwatchorgcgicontentfull20082251

73

Chakraborty R Chatterjee A Choudhart S Chakraborty PK Neuroplasticitymdasha paradigm shift in neurosciences J Indian Med Assoc

2007105(9)513-4516-8520-1

Sacks O A neurologistlsquos notebook Stereo Sue Why two eyes are better than one The New Yorker 2006 Jun 1964-73

Krulwich R National Public Radio Going Binocular Susanlsquos First Snowfall Available at

wwwnprorgtemplatesstorystoryphpstoryId=5507789 (Accessed December 8 2008)

Press LJ The story behind Stereo Suelsquo and a world-famous neurologistlsquos discovery of vision therapy Optom Vis Dev 200637(2) 55-7

Levin HS Neuroplasticity and brain imaging research implications for rehabilitation Arch Phys Med Rehabil 2006 Dec87(12 Suppl

2)S1

Wiesel TN Hubel DH Single-cell responses in striate cortex of kittens deprived of vision in one eye J Neurophysiol 1963

Nov261003-17

Hook BM Chen C Critical periods in the visual system Changing views for a model of experience-dependent plasticity Neuron 2007

Oct56(2)312-26

Ramey CT Ramey SL Prevention of intellectual disabilities early interventions to improve cognitive development Prev Med 1998

Mar-Apr27(2)224-32

Heuninckx S Wenderoth N Swinnen SP Systems neuroplasticity in the aging brain recruiting additional neural resources for

successful motor performance in elderly persons J Neurosci 2008 Jan 228(1)91-9

Ge S Yang CH Hsu KS et al A critical period for enhanced synaptic plasticity in newly generated neurons of the adult brain Neuron

2007 May54(4)559-66

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Draganski B Gaser C Busch V et al Neuroplasticity changes in grey matter induced by training Nature 2004 Jan 22427(6972)

311-2

Cannonieri GC Bonilha L Fernandes PT et al Practice and perfect length of training and structural brain changes in experienced

typists Neuroreport 2007 Jul 218(10)1063-6

Kleim JA Jones TA Principles of experience-dependent neural plasticity implications for rehabilitation after brain damage J

Speech Lang Hear Res 2008 Feb51(1)S225-39

Trojan S Porkorny J Theoretical aspects of neuroplasticity Physiol Res 199948(2)87-97

Ramamirtham R Kee CS Hung LF et al Wave aberrations in rhesus monkeys with vision-induced ametropias Vision Res 2007

Sep47(21)2751-66

Smith EL 3rd Ramamirtham R Qiao-Grider Y et al Effects of foveal ablation on emmetropization and form-deprivation myopia

Invest Ophthalmol Vis Sci 2007 Sep48(9)3914-22

Smith EL 3rd Kee CS Ramamirtham R et al Peripheral vision can influence eye growth and refractive development in infant

monkeys Invest Ophthalmol Vis Sci 2005 Nov46(11)3965-72

Ciuffreda KJ Vasudevan B Nearwork-induced transient myopia (NITM) and permanent myopiandashndashis there a link Ophthalmic

Physiol Opt 2008 Mar28(2)103-14

Hung GK Ciuffreda KJ Incremental retinal-defocus theory of myopia development--schematic analysis and computer simulation

Comput Biol Med 2007 Jul37(7)930-46

Hung GK Ciuffreda KJ A unifying theory of refractive error development Bull Math Biol 2000 Nov62(6)1087-108

75

Pang Y Maino D Zhang G Lu F Myopia Can its progress be controlled Optom Vis Dev 200637(2)75-9

Leung JT Brown B Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lenses Optom Vis Sci

1999 Jun76(6)346-54

Hasebe S Ohtsuki H Nonaka T et al Effect of progressive addition lenses on myopia progression in Japanese children a prospective

randomized double-masked crossover trial Invest Ophthalmol Vis Sci 2008 Jul49(7)2781-9

Gwiazda J Hyman L Hussein M et al A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression

of myopia in children Invest Ophthalmol Vis Sci 2003 Apr44(4)1492-500

Siatkowski RM Cotter SA Crockett RS et al Two-year multi-center randomized double-masked placebo-controlled parallel safety and

efficacy study of 2 pirenzepine ophthalmic gel in children with myopia J AAPOS 2008 Aug12(4)332-9

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged 7 to 17 years Arch Ophthalmol 2005

Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three to less than 10 years of age Am J

Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction Am J Ophthalmol 2007

Jun143(6)1060-3

Holmes JM Edwards AR Beck RW et al A randomized pilot study of near activities versus non-near activities during patching therapy for

amblyopia J AAPOS 2005 Apr9(2)129-36

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate

amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-57

76

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic

amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Convergence Insufficiency Treatment Trial Study Group Randomized clinical trial of treatments for symptomatic convergence insufficiency

in children Arch Ophthalmol 2008 Oct126(10)1336-49

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

Solan HA Shelley-Tremblay J Hansen PC et al M-cell deficit and reading disability a preliminary study of the effects of temporal vision-

processing therapy Optometry 2004 Oct75(10)640-50

Solan HA Larson S Shelley-Tremblay J et al Role of visual attention in cognitive control of oculomotor readiness in students with reading

disabilities J Learn Disabil 2001 Mar-Apr34(2)107-18

Gallaway M Boas MB The impact of vergence and accommodative therapy on reading eye movements and reading speed Optom Vis Dev

200738(3)115-20

Goss DA Downing DB Lowther AH et al The effect of HTS vision therapy conducted in a school setting on reading skills in third and

fourth grade students Optom Vis Dev 200738(1)27-32

Crutch SJ Warrington EK Foveal crowding in posterior cortical atrophy a specific early-visual-processing deficit affecting word reading

Cogn Neuropsychol 2007 Dec24(8)843-66

Helms D Sawtelle SM A study of the effectiveness of cognitive therapy delivered in a video game format Optom Vis Dev 200738 (1)19-

26

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

77

Lawton T Training direction-discrimination sensitivity remediates a wide spectrum of reading skills OptomVis Dev 200738(1) 33-47

Goldstand S Koslowe KC Parush S Vision visual-information processing and academic performance among seventh-grade schoolchildren a

more significant relationship than we thought Am J Occup Ther 2005 Jul-Aug59(4)377-89

Fischer B Koumlngeter A Hartnegg K Effects of daily practice on subitizing visual counting and basic arithmetic skills Optom Vis Dev

200839(1)30-4

Sands W Taub M Maino D Limited research and education on special populations in optometry and ophthalomology Optom Vis Dev

200839(2)60-1

Wesson M Maino D Oculo-visual findings in Down syndrome cerebral palsy and mental retardation with non-specific etiology In Maino D

(ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 199517-54 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

Cui Y Stapleton F Suttle C Developing an instrument to assess vision-related and subjective quality of life in children with intellectual

disability data collection and preliminary analysis in a Chinese population Ophthal Physiolog Optics 2008 May28(3) 238-46

Maino D Steele G Tahir S Sajja R Attitudes of optometry students toward individuals with disabilities Optom Ed 200227(2)45-50

Maino D Special populations in the optometric curriculum Optom Ed 200227(2)38-9

Maino D Overview of special populations In Scheiman M Rouse M (eds) Optometric Management of Learning-Related Vision Problems

St Louis Mosby Inc 200685-106

Maino D (ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 1995 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

78

McCarthy P Maino D Alport syndrome a review Clin Eye Vis Care 2000 Dec12(3-4)139-50

Block SS Brusca-Vega R Pizzi WJ et al Cognitive and visual processing skills and their relationship to mutation size in full and

permutation female fragile X carriers Optom Vis Sci 2000 Nov77 (11)592-9

Maino D The young child with developmental disabilities An introduction to mental retardation and genetic syndromes In Moore BD

(ed) Eye Care for Infants and Young Children Butter-worth--Heinemann Newton MA1997285-300

Amin V Maino D The Fragile X female Visual visual perceptual and ocular health anomalies J Am Optom Assoc 1995 May66

(5)290-95

Maino DM Maino JH Cibis GW Hecht F Ocular health anomalies in patients with developmental disabilities In Maino D (ed)

Diagnosis and Management of Special Populations Mosby-Year-book Inc St Louis MO 1995189-206 Reprinted Optometric

Education Program Foundation Santa Anna Calif 2001

Maino D Wesson M Schlange D Cibis G Maino J Optometric findings in the fragile X syndrome Optom Vis Sci 199168634-40

Scheiman MMOptometric findings in children with cerebral palsy Am J Optom Physiol Opt 1984 May61(5)321-3

Maino D Maino J Maino S Mental retardation syndromes with associated ocular defects J Am Optom Assoc 199061707-16

Stewart RE Woodhouse JM Cregg M Pakeman VH Association between accommodative accuracy hypermetropia and strabismus in

children with Downs syndrome Optom Vis Sci 2007 Feb84(2)149-55

Cregg M Woodhouse JM Pakeman VH et al Accommodation and refractive error in children with Down syndrome cross-sectional

and longitudinal studies Invest Ophthalmol Vis Sci 2001 Jan42 (1)55-63

79

McClelland JF Parkes J Hill N et al Accommodative dysfunction in children with cerebral palsy a population-

based study Invest Ophthalmol Vis Sci 2006 May47(5)1824-30

Duckman RH Vision therapy for the child with cerebral palsy J Am Optom Assoc 198758(1)28-35

Duckman R Accommodation in cerebral palsy function and remediation J Am Optom Assoc 198455(4)281-3

Scheiman M Understanding and managing vision deficits a guide for occupational therapists 2nd ed Slack

Thorofare NJ 2002

Maino D Binasal occlusion for the child with Cerebral Palsy J Ill Optom Assoc 198644(1)1218

Battaglia F Quartarone A Rizzo V et al Early impairment of synaptic plasticity in patients with Downs syndrome

Neurobiol Aging 2008 Aug29(8)1272-5

Bonnier C Evaluation of early stimulation programs for enhancing brain development Acta Paediatr 2008

Jul97(7)853-8

Morice E Andreae LC Cooke SF et al Preservation of long-term memory and synaptic plasticity despite short-term

impairments in the Tc1 mouse model of Down syndrome Learn Mem 2008 Jul 1415(7)492-500

Gordon AM Schneider JA Chinnan A Charles JR Efficacy of a hand-arm bimanual intensive therapy (HABIT) in

children with hemiplegic cerebral palsy a randomized control trial Dev Med Child Neurol 2007 Nov49(11)830-8

Kapoor N Ciuffreda KJ Vision disturbances following traumatic brain injury Curr Treat Options Neurol 2002

Jul4(4)271-80

80

Ciuffreda KJ Rutner D Kapoor N et al Vision therapy for oculomotor dysfunctions in acquired brain injury a

retrospective analysis Optometry 2008 Jan79(1)18-22

Ciuffreda KJ Han Y Kapoor N Ficarra AP Oculomotor rehabilitation for reading in acquired brain injury

NeuroRehabilitation 200621(1)9-21

Zost M Diagnosis and management of visual dysfunction in cerebral injury In Maino D (ed) Diagnosis and

Management of Special Populations Mosby-Yearbook Inc St Louis 199579 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001 [Figure used with permission of the editor]

DeGutis JM Bentin S Robertson LC DEsposito M Functional plasticity in ventral temporal cortex following

cognitive rehabilitation of a congenital prosopagnosic J Cogn Neurosci 2007 Nov19 (11)1790-802

Welbourne SR Ralph MA Exploring the impact of plasticity-related recovery after brain damage in a connectionist

model of single-word reading Cogn Affect Behav Neurosci 2005 Mar5(1)77-92

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements prevent cognitive decline A

systematic review of randomized controlled trials J Hum Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among preterm infants attributable to early

supplementation of human milk with docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings and structural-functional

synergies with cell membrane phospholipids Altern Med Rev 2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function Neuroscience 20089(7)568-78

81

Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

BMC Biol 2008 Sep 9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine improves neuropsychological disorders in a child with

creatine transporter defect Neurocase 200814(2) 151-61

Forrester LW Wheaton LA Luft AR Exercise-mediated locomotor recovery and lower-limb neuroplasticity after

stroke J Rehabil Res Dev 200845(2)205-20

82

Page 4: Neuroplasticity: A Paradigm Sea Change Latest Updated File

Sea Change OriginFrom Shakespeares The Tempest 1610

ARIEL [sings]

Full fathom five thy father lies Of his bones are coral made

Those are pearls that were his eyes Nothing of him that doth fade

But doth suffer a sea-change Into something rich and strange

4

I Sea Change (Meaning)

A radical and apparently mystical change

It is change of such magnitude that it alters the way we think and what we do

in a sweeping far ranging mind expanding mega-behavior

transformative fashion

5

Neuroplasticity

Up until recentlyhellipapparently unknown to many within the professions of optometry and ophthalmologyhellip

6

7

The BrainA hellip is not just a static soft round mass bathed in a fluid and surrounded by a hard caseB hellip can change its form and resultant function through neuroplasticity

The BrainA hellip is not just a static soft round mass bathed in a fluid and surrounded by a hard caseB hellip can change its form and resultant function through neuroplasticity

The BrainA hellip is not just a static soft round mass bathed in a fluid and surrounded by a hard caseB hellip can change its form and resultant function through neuroplasticity

The BrainA hellip is not just a static soft round mass bathed in a fluid and surrounded by a hard caseB hellip can change its form and resultant function through neuroplasticity

II The Brain

hellip is not just a static soft round mass bathed in a fluid and surrounded by a hard case

hellip can change its form and resultant function through neuroplasticity

8

III CriticalSensitive Periods

A A critical period occurs when the individual is sensitive to environmental influences and stimulation

1 The Precritical period The initial formation of neuronal circuits that is not dependent on visual experience

9

CriticalSensitive Periods

2 The Critical period A distinct onset of robust plasticity in response to the visual experience when the initially formed circuit can be modified by experience

3 Closure of the critical period After the end of the critical period the same visual experience no longer elicits the same degree of plasticity

10

CriticalSensitive Periods

B The concept of a critical period does not imply that neuroplasticity ends after a certain age

C Sensitive period begins and ends gradually (not abruptly like the critical period) and provides for maximum sensitivity

to stimuli

11

VI Neuroplasticity and the Brain

A Can adult brain neurons actually exhibit neuroplasticity The short answer is yes

B Resultant changes are noted in not only functional outcomes but also in brain anatomy and structure

12

IV Neuroplasticity and Rehabilitation

Kleim amp Jones note that

A The Key Principles of Experience-Dependent Neural Plasticity

1 Use it or lose it

2 Use it and improve it

3 Specificity

13

4 Repetition matters

5 Intensity matters

6 Time matters

7 Salience matters

14

8 Age matters

9 Transference

10 Interference

15

Use it or lose it If you do not drive specific brain functions

functional loss will occur

Use it and improve it Therapy that drives cortical function

enhances that particular function

Specificity The therapy you choose determines the resultant

plasticity and function

Repetition matters Plasticity that results in functional change

requires repetition

16

Intensity matters Induction of plasticity requires the appropriate

amount of intensity

Time matters Different forms of plasticity take place at different

times during therapy

Salience matters It has to be important to the individual

Age matters Plasticity is easier in a younger brain but is also

possible in an adult brain

17

Transference Neuroplasticity and the change in function that

results from one therapy can augment the attainment of similar

behaviors

Interference Plasticity in response to one experience can interfere

with the acquisition of other behaviors

18

B Examples of Changes in Function and Structure

1) Jugglers

2) Typists

19

B Examples of Changes in Function and Structure

1) Jugglers

One study suggested that adults taught how to juggle demonstrated a

significant transient bilateral expansion of gray matter in the mid-

temporal area and the left posterior intraparietal sulcus between baseline brain scan and

follow-up The findings were specific to training stimulus individuals who were

not instructed how to juggle demonstrated no change in gray

matter over the same period These findings oppose the conventional

understanding that the anatomical structure of the adult brain does not change

over time

20

B Examples of Changes in Function and Structure

2) Typists

helliplong-term bimanual training also increases

gray matter volume in experienced adult typists

These results suggest that learning not

only affects function but also structure in

adult brains

21

V Neuroplasticity and Optometry

A Evolutionary neuroplasticity

B Reactive plasticity

C Adaptational plasticity

D Reparation plasticity

22

V Neuroplasticity and Optometry

A Evolutionary neuroplasticity

hellip is ideally suited for the developmental OD who

specializes in vision function as it changes over time

either with or without intervention

23

V Neuroplasticity and Optometry

B Reactive plasticity

hellip can be thought of as the immediate effect that

initial optometric treatment may have on a system This can

be reflected in an immediate but often transient change in

the individuallsquos accommodative systemmdashie when an

uncorrected myope initially puts on his or her new

spectacles

24

V Neuroplasticity and Optometry

C Adaptational plasticity

hellip could describe the long-term effects of in-office optometric

vision therapy on disorders of the binocular vision system

25

V Neuroplasticity and Optometry

D Reparation plasticity

hellipin contrast to adaptational

plasticity reparation plasticity may

occur during treatment by a low

Vision specialist or an OD

Working with those who have

Experienced a traumatic brain

injury (TBI)

26

V Neuroplasticity and Optometry

The effects of plasticity can lead to either

positive or negative changes during

development (evolutionary plasticity) after

short-term exposure (reactive plasticity)

after long-term or continuous stimuli

(adaptational plasticity) and during

functional or structural recovery of damaged

neuronal circuits (reparation plasticity)

httpwwwciteulikeorguserjasonepriorarticle2856526

27

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

A Refractive error development

B Amblyopia

C Strabismus

28

D Non-strabismus non-amblyopic binocular vision disorders

E Learning related vision anomalies

F Vision developmentperception disorders

29

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

A Refractive error development

Several recent studies have noted that neuroplasticity may play a

role in refractive error development

retinal defocus use of progressive addition lenses

drug studies (M1-antagonist2 pirenzepine ) slow myopia

progression demonstrated nearly a 50 reduction in myopia

progression over a two-year period

30

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged

7 to 17 years Arch Ophthalmol 2005 Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three

to less than 10 years of age Am J Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction

Am J Ophthalmol 2007 Jun143(6)1060-3

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine

vs patching for treatment of moderate amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-

57

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for

strabismic and anisometropic amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Treatment of severe amblyopia with weekend atropine results from 2 randomized clinical trials

Levodopacarbidopa in the treatment of amblyopia

31

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

J Pediatr Ophthalmol Strabismus 2009 Mar-Apr46(2)87-90 quiz 91-2 Levodopacarbidopa in the

treatment of amblyopia Dadeya S Vats P Malik KP

PURPOSE To evaluate the role of levodopacarbidopa in the treatment of amblyopia METHODS

Thirty patients with strabismic amblyopia between the ages of 3 and 12 years were part of this double-

blind randomized study Patients were divided into two groups Group A received 050 mg + 125 mg of

levodopacarbidopa per kilogram body weight three times daily after meals with a protein rich drink

whereas Group B received placebo Both groups received full-time conventional occlusion until a visual

acuity of 66 was achieved or for a maximum of 3 months RESULTS The authors observed more than

two lines improvement in visual acuity that was greater in the levodopa group (15 of 15) than in the

placebo group (9 of 15) (P lt 005) Furthermore improvement in visual acuity of more than two lines

was greater in patients younger than 8 years (100) than in patients older than 8 years of age (60) (P =

0026) There was also no significant reversal of the improved visual acuity in up to 6 months of follow-

up CONCLUSION Levodopacarbidopa improves visual acuity in patients with

amblyopia and maintains improved visual acuity especially in patients

younger than 8 years

32

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

J Pediatr Ophthalmol Strabismus 2008 May-Jun45(3)174-6 The use of levodopa in the treatment of

bilateral amblyopia secondary to uncorrected high hypermetropia Abrams MS

The standard treatment of bilateral amblyopia secondary to uncorrected high bilateral hypermetropia has

been spectacles and time The patient described here failed to show adequate improvement in visual

acuity after 18 months of standard treatment Visual acuity improved dramatically when the

patient began taking levodopa dropped precipitously when the medication was

discontinued and returned quickly to post-treatment levels when levodopa was

restarted Visual acuity remained stable when the medication was slowly tapered

and discontinued This report suggests that dopamine may play a role in the pathophysiology of

bilateral amblyopia secondary to uncorrected high bilateral hypermetropia

33

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

Bottom Line

Amblyopia can be treated at any age

May be able to use neuro-enhancing drugs

as a part of basic amblyopia therapy

34

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

C Strabismus and non-strabismic non-amblyopic binocular

vision disorders

Clinical Trial of Treatments for Symptomatic Convergence Insufficiency in Children has

clearly demonstrated the superiority of in-office optometric vision therapy (in conjunction

with home therapy) vs out-of-office therapy alone The study concluded that optometric

vision therapyorthoptics was more effective than pencil push-ups or placebo vision

therapyorthoptics in reducing symptoms and improving clinical signs of convergence

insufficiency

Long-term effectiveness of treatments for symptomatic convergence insufficiency

in children (Optom Vis Sci 2009 Sep86(9)1096-103)

CITT patients improvements lasted a year

35

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

Strabismus 1999 Sep7(3)169-74 Convergence insufficiency in

idiopathic Parkinsons disease responsive to levodopa Racette BA

Gokden MS Tychsen LS Perlmutter JS

We report a patient with pathologically proven idiopathic Parkinsons

disease (IPD) who developed diplopia secondary to convergence

insufficiency during his motor off periods Diplopia resolved with

onset of motor benefit from levodopa Neuro-ophthalmologic

examination demonstrated convergence insufficiency during motor

off periods that was alleviated after onset of motor benefit from

levodopa This is the first reported case of convergence insufficiency

in IPD responsive to levodopa

36

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

Bottom Line

Optometric Vision Therapy is the most efficacious treatment available for binocular vision disorders and the

treatment effects are long lasting Neuro-enhancing drugs

may assist us as well

37

EF Learning related vision anomalies Vision

developmentperception disorders

hellipresearch includes an examination of the role vision plays in

reading the effect of oculomotor vergence and

accommodativecoherent motion therapy on reading eye movements

and reading speed the diagnosis and treatment of perceptual

disorders and the effect of therapy on various learning anomalies

38

EF Learning related vision anomalies Vision developmentperception disorders

magnocellular (MC) deficit in dyslexia

LM speed-matching ratio predicts reading in childrenChase C Dougherty RF Ray N

Fowler S Stein JOptom Vis Sci 2007 Mar84(3)229-36

Effect of attention therapy on reading comprehension Solan HA Shelley-Tremblay J

Ficarra A Silverman M Larson S J Learn Disabil 2003 Nov-Dec36(6)556-63

Is there a common linkage among reading comprehension visual attention and

magnocellular processing Solan HA Shelley-Tremblay JF Hansen PC Larson S

J Learn Disabil 2007 May-Jun40(3)270-8

Lawton T Filtered Text and Direction Discrimination Training Improved Reading

Fluency for Both Dyslexic and Normal Readers Optom Vis Dev 200839 (3)114

Fischer B Hartnegg K Saccade control in dyslexia Development deficits training

and transfer to reading Optom Vis Dev 200839(4)181-190

39

EF Learning related vision anomalies Vision developmentperception disorders

J Learn Disabil 2003 Nov-Dec36(6)556-63 Effect of attention therapy on reading

comprehension Solan HA Shelley-Tremblay J Ficarra A Silverman M Larson S

hellip At the completion of attention therapy the mean

standard attention and reading comprehension scores of

the experimental group had improved significantly The

control group however showed no significant

improvement in reading comprehension scores after 12

weeks Although uncertainties still exist this investigation

supports the notion that visual attention is malleable and

that attention therapy has a significant effect on reading

comprehension in this often neglected population

40

VII Vision dysfunction association with acquired brain injury

A Exotropia (or high exophoriaCI)

B Accommodative dysfunction

C Convergence insufficiency

41

D Decreased blink rate

E Spatial disorientation

F Pursuitsaccade dysfunction

G Unstable ambient vision (Magnocellular pathway)

42

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Stelmack JA Frith T Van Koevering D Rinne S Stelmack TR Visual function in patients

followed at a Veterans Affairs polytrauma network site an electronic medical record review

Optometry 2009 Aug80(8)419-24

RESULTS Visual symptoms were self-reported by 76 of patients

with polytrauma and 75 of the patients with TBI Problems with reading

(polytrauma 60 and TBI 50) and accommodation (polytrauma 30 and

TBI 47) were frequently found on eye examinations Spectacles were the

treatment most frequently prescribed (polytrauma 62 and TBI 78)

CONCLUSIONS It is important for optometrists to be aware of the high

rates of self-reported symptoms and visual problems in military personnel

returning from deployment to the wars in Iraq and Afghanistan Post-

traumatic stress disorder and depression may complicate optometric

evaluation and management

43

VII Vision dysfunction association with acquired brain injury

Avoidance of near tasks

Oculomotor-based reading difficulties

Eye tracking problems

Eye focusing problems

Eyestrain Diplopia

Dizziness Vertigo

Vision-derived nausea

44

VII Vision dysfunction association with acquired brain injury

Increased sensitivity to visual motion

Visual inattention and distractibility

Short-term visual memory loss

Difficulty judging distances (relative and absolute

Difficulty with global scanning

Difficulty with personal grooming especially involving the face

Inability to interactcope visually in a complex social situation

(eg minimal eye contact)

Inability to tolerate complex visual environments (eg grocery store

aisles and highly-patterned floors)

45

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Ciuffreda KJ Ludlam DP Kapoor N Clinical oculomotor training in traumatic brain injury Optom Vis

Dev 200940(1)16-23

Individuals with traumatic brain injury present with a constellation of

oculomotor dysfunctions and correlated symptoms Simple and

effective clinical oculomotor-based training procedures will be

presented with respect to the versional vergence and

accommodative systems and their interactions These therapeutic

procedures can also be applied as needed to individuals with either

low vision neurological dysfunctions or general visual skills cases

manifesting similar oculomotor deficits

46

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Leslie S Myopia and accommodative insufficiency associated with

moderate head trauma Opt Vis Dev 200940(1)25-31

The majority of subjects reviewed had developed a stable degree of

myopia between 100 and 200 diopters as well as an abnormally

high lag of accommodation When their distance and near spatial area

of focus was compared the majority were focused at an intermediate

area in space suggesting a loss of control of accommodation in

space

47

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

B Drugs

C Exercise

D Learning new and challenging things

48

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements

prevent cognitive decline A systematic review of randomized controlled trials J Hum

Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among

preterm infants attributable to early supplementation of human milk with

docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings

and structural-functional synergies with cell membrane phospholipids Altern Med Rev

2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function

Neuroscience 20089(7)568-78

49

VIII Improving Brain Function and Neuroplasticity

B Drugs Maya Vetencourt JF Sale A Viegi A et al The antidepressant

fluoxetine (PROZAC) restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the

antidepressant tianeptine CNS Drugs 200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances

hippocampal long-term potentiation and memory BMC Biol 2008 Sep

9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine

improves neuropsychological disorders in a child with creatine

transporter defect Neurocase 200814(2) 151-61

50

VIII Improving Brain Function and Neuroplasticity

C Exercise

Hunsberger JG et al Antidepressant actions of the exercise-

regulated gene VGF Nat Med 2007 Dec 2 131476

VGF may be a common pathway by which exercise induces

neuroplasticity and growth-factor genes at least one of these might act

similarly to antidepressants in promoting an adaptive response to stress

However the tests used here may be modeling stress-induced

helplessness not depression hellipexercise seems to induce multiple

interacting genes that enhance neuronal resilience

51

VIII Improving Brain Function and Neuroplasticity

D Learning new and challenging things

What have we (optometry amp ophthalmology)

been thinking all these years

Where did we miss the news about neuroplasticity

52

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Huang JC Neuroplasticity as a proposed mechanism for the efficacy of optometric vision therapy and rehabilitation J Bev Optom 200920(4)96-100

Homologous area adaptationCompensatory masqueradeCross-modal reassignment

Map expansion

EquipotentialityVicariation

53

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Homologous area adaptation a transfer of function from a damaged brain area to a non-damaged brain area May be limited to early stages of human development and may crowd a new brain area resulting in reduced functionality of that brain area (Competition between spatial amp verbal functioning)

54

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Compensatory masquerade reorganizing of existing neuro-pathways to us alternative cognitive strategies to perform a task

55

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Cross-modal reassignment using new sensory input in a brain structure deprived of its main input source (changing processing from visual to tactile stimuli in the blind)

56

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Map expansion increase in brain mass due to repeated behavior or exposure to stimuli

57

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Equipotentiality anatomical areas of the brain can perform disparate functions

Vicariation redundant neural systems can operate under abnormal conditions

This may explain why recovery is noted for many neurological conditions (degenerative psychiatric developmental vascular traumatic)

58

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Constraint therapy Use it and improve it

Patching penalization ldquonear activitiesrdquo during amblyopia therapy

59

IX Improving Brain Function and Neuroplasticity Optometric Clinical ApplicationsOptometric Vision Therapy

Kleim amp Jones

Use it or lose it If you do not drive specific brain functions

functional loss will occur

If you want to improve oculomotor brain neuroplastic function amp

structure therapy should be specific for that brain function

Use it and improve it Therapy that drives cortical function enhances

that particular function

If you use therapy to improve oculomotor dysfunction it should

improve

Specificity The therapy you choose determines the resultant

plasticity and function

You must choose therapy that is appropriate

60

IX Improving Brain Function and Neuroplasticity Optometric Clinical Applications

Kleim amp Jones

Repetition matters Plasticity that results in functional change

requires repetition

Do the therapy Do it again Do it yet again No quick fix

Intensity matters Induction of plasticity requires the appropriate

amount of intensity

Intensity means strength force concentration power and passion

Without these plasticity may not occur Function may not improve

Time matters Different forms of plasticity take place at different

times during therapy

Do the basics than the more advanced therapeutic procedures

61

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Salience matters It has to be important to the individual

Make the therapy matter to the patient

Age matters Plasticity is easier in a younger brain but is also

possible in an adult brain

Do not let age determine what therapy options you offer your

patients Think of Susan Barry PhD (StereoSue) and her success

Offer your patients options Let them choose Be realistic about

outcomeshelliphave outcome measures built into therapy program

62

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Transference Neuroplasticity and the change in function

that results from one therapy can augment the attainment

of similar behaviors

What you do during oculomotor therapy may affected

vergence therapy outcomes

Interference Plasticity in response to one experience can

interfere with the acquisition of other behaviors

Monitor Evaluate progress Discuss function in other areas

of your patientslsquo life

63

Why pay attention to binocular vision dysfunctions

and neuroplasticity

December 2009 issue of the Review of Optometry

The Binocular Vision Dysfunction Pandemic

In 2010 almost 170 million individuals will be wearing glasses In

2010 there will also be up to 93 million amblyopes and 12 and a half

million strabismics For children under 18 years of age that means

there will be more than 22 and a half million amblyopes and millions

of children with strabismus A clinical trial to determine the

prevalence of binocular vision dysfunction within the general

population suggested the possibility of up to 56 or 173 million men

women and children with symptoms associated with a binocular

vision dysfunction 189 million (61) with accommodative problems

and 118 million (38) demonstrating various vergence

anomalies

64

65

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Brain plasticity life long changes in the structure of the brain

Sensory substitution replacement of one sensory input by another

Measurement techniques

Voxel based morphometryhellipmeasures difference in brain volume

Fluorodeoxyglucose glucose analog PET scan tells you

distribution and metabolism of brain

Cortical thickness measures

Visual cortex of the blind turns somatic ―The eye of the tongue

Transcranial magnetic stmiulation non-invasive technique to

stimulate cortex

66

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Blind Braille readers report tingling in fingers when pressure

phosphenes are applied Blind feel tingling in tongue

Bind use tongue to perform orientation task motion perception

sensory perception Visual cortex recruited in a variety of sensory

and cognitive tasks (DM Can we use tongue as a VT tool)

Dilks Reorganizations of human adult visual system

When a region of sensory cortex is deprived of its bottom up

input the deprived region begins to respond to stimuli that

normally activate adjacent cortex

67

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Retinotopic map changes for stroke pts Cortical reorganization in

adults occurs Perceived objectshellipelongation in stroke amp AMD

What happens to deprived cortex in AMD

fMRI shows cortical reorganization in adults

Proposed mechanisms

hellipGrowth of new connections

hellipUnmasking of pre-existing connections this is true

happens within seconds

Bavelier

Action video games

68

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Bavelier

Action video games Looked at attention Gamers can track more

activities

Attention over space (me peripheral awarenress) Useful field

of view shrinks with age

Performance not VA relatedhellipis related to attention

Action game playing changes spatial resolutionhellipovercoming

crowding in VA assessment (me amblyopia therapy)

Temporal resolution of vision Backward masking

changehellipbrain changes

Visual sensitivity (contrast sensitivity) Post action game training

improves CSF

69

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Action video games correcting optics of the cortex (me this is

actualy OVT)

Games factor

Variable entry leanringhellipadapt task to skill level

Incremental learning tune task to subjectlsquos leanring steps

Motivationarousal

Rewards

Self masterself confidence

Action games factors

Pacingrate of exposure to infohellipincreasing processing speed

Dynamic display

Rich environment

Rich motor involvement

70

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Surgeons may be made to play action games

Pilot training

Amblyopia tx Dennis Levi research

PresenterTitle Contact info

Neuroplasticity-A Paradigm Sea Change

This presentation is available at

httpwwwslidesharenetDMAINOneuroplasticity-a-paradigm-sea-change-2459693

httpwwwmainosmemosblogspotcom

My FaceBook Page

and

Twitter

PresenterTitle Contact info

Questions About

Neuroplasticity-A Paradigm Sea Change

Dominick M Maino OD MEd FAAO FCOVD-A

Professor PediatricsBinocular VisionIllinois Eye InstituteIllinois College of Optometry

dmainoicoeduhttpwwwMainosMemosblogspotcom

Thanks to

httpwwwcovdorgHomeOVDJournalOVD401tabid263D

efaultaspx

httpbipolarblastfileswordpresscom200908neurojpg

httpwwwspecialcheerscomimagesanimated_braingif

httpblogmarsdencartoonscomwp-

contentuploads200810frankenstein-myspace-lightbeergif

httpwwwshangralafamilyfuncomgala-ecalvindreamgif

httppsychiatryjwatchorgcgicontentfull20082251

73

Chakraborty R Chatterjee A Choudhart S Chakraborty PK Neuroplasticitymdasha paradigm shift in neurosciences J Indian Med Assoc

2007105(9)513-4516-8520-1

Sacks O A neurologistlsquos notebook Stereo Sue Why two eyes are better than one The New Yorker 2006 Jun 1964-73

Krulwich R National Public Radio Going Binocular Susanlsquos First Snowfall Available at

wwwnprorgtemplatesstorystoryphpstoryId=5507789 (Accessed December 8 2008)

Press LJ The story behind Stereo Suelsquo and a world-famous neurologistlsquos discovery of vision therapy Optom Vis Dev 200637(2) 55-7

Levin HS Neuroplasticity and brain imaging research implications for rehabilitation Arch Phys Med Rehabil 2006 Dec87(12 Suppl

2)S1

Wiesel TN Hubel DH Single-cell responses in striate cortex of kittens deprived of vision in one eye J Neurophysiol 1963

Nov261003-17

Hook BM Chen C Critical periods in the visual system Changing views for a model of experience-dependent plasticity Neuron 2007

Oct56(2)312-26

Ramey CT Ramey SL Prevention of intellectual disabilities early interventions to improve cognitive development Prev Med 1998

Mar-Apr27(2)224-32

Heuninckx S Wenderoth N Swinnen SP Systems neuroplasticity in the aging brain recruiting additional neural resources for

successful motor performance in elderly persons J Neurosci 2008 Jan 228(1)91-9

Ge S Yang CH Hsu KS et al A critical period for enhanced synaptic plasticity in newly generated neurons of the adult brain Neuron

2007 May54(4)559-66

74

Draganski B Gaser C Busch V et al Neuroplasticity changes in grey matter induced by training Nature 2004 Jan 22427(6972)

311-2

Cannonieri GC Bonilha L Fernandes PT et al Practice and perfect length of training and structural brain changes in experienced

typists Neuroreport 2007 Jul 218(10)1063-6

Kleim JA Jones TA Principles of experience-dependent neural plasticity implications for rehabilitation after brain damage J

Speech Lang Hear Res 2008 Feb51(1)S225-39

Trojan S Porkorny J Theoretical aspects of neuroplasticity Physiol Res 199948(2)87-97

Ramamirtham R Kee CS Hung LF et al Wave aberrations in rhesus monkeys with vision-induced ametropias Vision Res 2007

Sep47(21)2751-66

Smith EL 3rd Ramamirtham R Qiao-Grider Y et al Effects of foveal ablation on emmetropization and form-deprivation myopia

Invest Ophthalmol Vis Sci 2007 Sep48(9)3914-22

Smith EL 3rd Kee CS Ramamirtham R et al Peripheral vision can influence eye growth and refractive development in infant

monkeys Invest Ophthalmol Vis Sci 2005 Nov46(11)3965-72

Ciuffreda KJ Vasudevan B Nearwork-induced transient myopia (NITM) and permanent myopiandashndashis there a link Ophthalmic

Physiol Opt 2008 Mar28(2)103-14

Hung GK Ciuffreda KJ Incremental retinal-defocus theory of myopia development--schematic analysis and computer simulation

Comput Biol Med 2007 Jul37(7)930-46

Hung GK Ciuffreda KJ A unifying theory of refractive error development Bull Math Biol 2000 Nov62(6)1087-108

75

Pang Y Maino D Zhang G Lu F Myopia Can its progress be controlled Optom Vis Dev 200637(2)75-9

Leung JT Brown B Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lenses Optom Vis Sci

1999 Jun76(6)346-54

Hasebe S Ohtsuki H Nonaka T et al Effect of progressive addition lenses on myopia progression in Japanese children a prospective

randomized double-masked crossover trial Invest Ophthalmol Vis Sci 2008 Jul49(7)2781-9

Gwiazda J Hyman L Hussein M et al A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression

of myopia in children Invest Ophthalmol Vis Sci 2003 Apr44(4)1492-500

Siatkowski RM Cotter SA Crockett RS et al Two-year multi-center randomized double-masked placebo-controlled parallel safety and

efficacy study of 2 pirenzepine ophthalmic gel in children with myopia J AAPOS 2008 Aug12(4)332-9

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged 7 to 17 years Arch Ophthalmol 2005

Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three to less than 10 years of age Am J

Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction Am J Ophthalmol 2007

Jun143(6)1060-3

Holmes JM Edwards AR Beck RW et al A randomized pilot study of near activities versus non-near activities during patching therapy for

amblyopia J AAPOS 2005 Apr9(2)129-36

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate

amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-57

76

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic

amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Convergence Insufficiency Treatment Trial Study Group Randomized clinical trial of treatments for symptomatic convergence insufficiency

in children Arch Ophthalmol 2008 Oct126(10)1336-49

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

Solan HA Shelley-Tremblay J Hansen PC et al M-cell deficit and reading disability a preliminary study of the effects of temporal vision-

processing therapy Optometry 2004 Oct75(10)640-50

Solan HA Larson S Shelley-Tremblay J et al Role of visual attention in cognitive control of oculomotor readiness in students with reading

disabilities J Learn Disabil 2001 Mar-Apr34(2)107-18

Gallaway M Boas MB The impact of vergence and accommodative therapy on reading eye movements and reading speed Optom Vis Dev

200738(3)115-20

Goss DA Downing DB Lowther AH et al The effect of HTS vision therapy conducted in a school setting on reading skills in third and

fourth grade students Optom Vis Dev 200738(1)27-32

Crutch SJ Warrington EK Foveal crowding in posterior cortical atrophy a specific early-visual-processing deficit affecting word reading

Cogn Neuropsychol 2007 Dec24(8)843-66

Helms D Sawtelle SM A study of the effectiveness of cognitive therapy delivered in a video game format Optom Vis Dev 200738 (1)19-

26

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

77

Lawton T Training direction-discrimination sensitivity remediates a wide spectrum of reading skills OptomVis Dev 200738(1) 33-47

Goldstand S Koslowe KC Parush S Vision visual-information processing and academic performance among seventh-grade schoolchildren a

more significant relationship than we thought Am J Occup Ther 2005 Jul-Aug59(4)377-89

Fischer B Koumlngeter A Hartnegg K Effects of daily practice on subitizing visual counting and basic arithmetic skills Optom Vis Dev

200839(1)30-4

Sands W Taub M Maino D Limited research and education on special populations in optometry and ophthalomology Optom Vis Dev

200839(2)60-1

Wesson M Maino D Oculo-visual findings in Down syndrome cerebral palsy and mental retardation with non-specific etiology In Maino D

(ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 199517-54 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

Cui Y Stapleton F Suttle C Developing an instrument to assess vision-related and subjective quality of life in children with intellectual

disability data collection and preliminary analysis in a Chinese population Ophthal Physiolog Optics 2008 May28(3) 238-46

Maino D Steele G Tahir S Sajja R Attitudes of optometry students toward individuals with disabilities Optom Ed 200227(2)45-50

Maino D Special populations in the optometric curriculum Optom Ed 200227(2)38-9

Maino D Overview of special populations In Scheiman M Rouse M (eds) Optometric Management of Learning-Related Vision Problems

St Louis Mosby Inc 200685-106

Maino D (ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 1995 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

78

McCarthy P Maino D Alport syndrome a review Clin Eye Vis Care 2000 Dec12(3-4)139-50

Block SS Brusca-Vega R Pizzi WJ et al Cognitive and visual processing skills and their relationship to mutation size in full and

permutation female fragile X carriers Optom Vis Sci 2000 Nov77 (11)592-9

Maino D The young child with developmental disabilities An introduction to mental retardation and genetic syndromes In Moore BD

(ed) Eye Care for Infants and Young Children Butter-worth--Heinemann Newton MA1997285-300

Amin V Maino D The Fragile X female Visual visual perceptual and ocular health anomalies J Am Optom Assoc 1995 May66

(5)290-95

Maino DM Maino JH Cibis GW Hecht F Ocular health anomalies in patients with developmental disabilities In Maino D (ed)

Diagnosis and Management of Special Populations Mosby-Year-book Inc St Louis MO 1995189-206 Reprinted Optometric

Education Program Foundation Santa Anna Calif 2001

Maino D Wesson M Schlange D Cibis G Maino J Optometric findings in the fragile X syndrome Optom Vis Sci 199168634-40

Scheiman MMOptometric findings in children with cerebral palsy Am J Optom Physiol Opt 1984 May61(5)321-3

Maino D Maino J Maino S Mental retardation syndromes with associated ocular defects J Am Optom Assoc 199061707-16

Stewart RE Woodhouse JM Cregg M Pakeman VH Association between accommodative accuracy hypermetropia and strabismus in

children with Downs syndrome Optom Vis Sci 2007 Feb84(2)149-55

Cregg M Woodhouse JM Pakeman VH et al Accommodation and refractive error in children with Down syndrome cross-sectional

and longitudinal studies Invest Ophthalmol Vis Sci 2001 Jan42 (1)55-63

79

McClelland JF Parkes J Hill N et al Accommodative dysfunction in children with cerebral palsy a population-

based study Invest Ophthalmol Vis Sci 2006 May47(5)1824-30

Duckman RH Vision therapy for the child with cerebral palsy J Am Optom Assoc 198758(1)28-35

Duckman R Accommodation in cerebral palsy function and remediation J Am Optom Assoc 198455(4)281-3

Scheiman M Understanding and managing vision deficits a guide for occupational therapists 2nd ed Slack

Thorofare NJ 2002

Maino D Binasal occlusion for the child with Cerebral Palsy J Ill Optom Assoc 198644(1)1218

Battaglia F Quartarone A Rizzo V et al Early impairment of synaptic plasticity in patients with Downs syndrome

Neurobiol Aging 2008 Aug29(8)1272-5

Bonnier C Evaluation of early stimulation programs for enhancing brain development Acta Paediatr 2008

Jul97(7)853-8

Morice E Andreae LC Cooke SF et al Preservation of long-term memory and synaptic plasticity despite short-term

impairments in the Tc1 mouse model of Down syndrome Learn Mem 2008 Jul 1415(7)492-500

Gordon AM Schneider JA Chinnan A Charles JR Efficacy of a hand-arm bimanual intensive therapy (HABIT) in

children with hemiplegic cerebral palsy a randomized control trial Dev Med Child Neurol 2007 Nov49(11)830-8

Kapoor N Ciuffreda KJ Vision disturbances following traumatic brain injury Curr Treat Options Neurol 2002

Jul4(4)271-80

80

Ciuffreda KJ Rutner D Kapoor N et al Vision therapy for oculomotor dysfunctions in acquired brain injury a

retrospective analysis Optometry 2008 Jan79(1)18-22

Ciuffreda KJ Han Y Kapoor N Ficarra AP Oculomotor rehabilitation for reading in acquired brain injury

NeuroRehabilitation 200621(1)9-21

Zost M Diagnosis and management of visual dysfunction in cerebral injury In Maino D (ed) Diagnosis and

Management of Special Populations Mosby-Yearbook Inc St Louis 199579 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001 [Figure used with permission of the editor]

DeGutis JM Bentin S Robertson LC DEsposito M Functional plasticity in ventral temporal cortex following

cognitive rehabilitation of a congenital prosopagnosic J Cogn Neurosci 2007 Nov19 (11)1790-802

Welbourne SR Ralph MA Exploring the impact of plasticity-related recovery after brain damage in a connectionist

model of single-word reading Cogn Affect Behav Neurosci 2005 Mar5(1)77-92

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements prevent cognitive decline A

systematic review of randomized controlled trials J Hum Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among preterm infants attributable to early

supplementation of human milk with docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings and structural-functional

synergies with cell membrane phospholipids Altern Med Rev 2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function Neuroscience 20089(7)568-78

81

Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

BMC Biol 2008 Sep 9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine improves neuropsychological disorders in a child with

creatine transporter defect Neurocase 200814(2) 151-61

Forrester LW Wheaton LA Luft AR Exercise-mediated locomotor recovery and lower-limb neuroplasticity after

stroke J Rehabil Res Dev 200845(2)205-20

82

Page 5: Neuroplasticity: A Paradigm Sea Change Latest Updated File

I Sea Change (Meaning)

A radical and apparently mystical change

It is change of such magnitude that it alters the way we think and what we do

in a sweeping far ranging mind expanding mega-behavior

transformative fashion

5

Neuroplasticity

Up until recentlyhellipapparently unknown to many within the professions of optometry and ophthalmologyhellip

6

7

The BrainA hellip is not just a static soft round mass bathed in a fluid and surrounded by a hard caseB hellip can change its form and resultant function through neuroplasticity

The BrainA hellip is not just a static soft round mass bathed in a fluid and surrounded by a hard caseB hellip can change its form and resultant function through neuroplasticity

The BrainA hellip is not just a static soft round mass bathed in a fluid and surrounded by a hard caseB hellip can change its form and resultant function through neuroplasticity

The BrainA hellip is not just a static soft round mass bathed in a fluid and surrounded by a hard caseB hellip can change its form and resultant function through neuroplasticity

II The Brain

hellip is not just a static soft round mass bathed in a fluid and surrounded by a hard case

hellip can change its form and resultant function through neuroplasticity

8

III CriticalSensitive Periods

A A critical period occurs when the individual is sensitive to environmental influences and stimulation

1 The Precritical period The initial formation of neuronal circuits that is not dependent on visual experience

9

CriticalSensitive Periods

2 The Critical period A distinct onset of robust plasticity in response to the visual experience when the initially formed circuit can be modified by experience

3 Closure of the critical period After the end of the critical period the same visual experience no longer elicits the same degree of plasticity

10

CriticalSensitive Periods

B The concept of a critical period does not imply that neuroplasticity ends after a certain age

C Sensitive period begins and ends gradually (not abruptly like the critical period) and provides for maximum sensitivity

to stimuli

11

VI Neuroplasticity and the Brain

A Can adult brain neurons actually exhibit neuroplasticity The short answer is yes

B Resultant changes are noted in not only functional outcomes but also in brain anatomy and structure

12

IV Neuroplasticity and Rehabilitation

Kleim amp Jones note that

A The Key Principles of Experience-Dependent Neural Plasticity

1 Use it or lose it

2 Use it and improve it

3 Specificity

13

4 Repetition matters

5 Intensity matters

6 Time matters

7 Salience matters

14

8 Age matters

9 Transference

10 Interference

15

Use it or lose it If you do not drive specific brain functions

functional loss will occur

Use it and improve it Therapy that drives cortical function

enhances that particular function

Specificity The therapy you choose determines the resultant

plasticity and function

Repetition matters Plasticity that results in functional change

requires repetition

16

Intensity matters Induction of plasticity requires the appropriate

amount of intensity

Time matters Different forms of plasticity take place at different

times during therapy

Salience matters It has to be important to the individual

Age matters Plasticity is easier in a younger brain but is also

possible in an adult brain

17

Transference Neuroplasticity and the change in function that

results from one therapy can augment the attainment of similar

behaviors

Interference Plasticity in response to one experience can interfere

with the acquisition of other behaviors

18

B Examples of Changes in Function and Structure

1) Jugglers

2) Typists

19

B Examples of Changes in Function and Structure

1) Jugglers

One study suggested that adults taught how to juggle demonstrated a

significant transient bilateral expansion of gray matter in the mid-

temporal area and the left posterior intraparietal sulcus between baseline brain scan and

follow-up The findings were specific to training stimulus individuals who were

not instructed how to juggle demonstrated no change in gray

matter over the same period These findings oppose the conventional

understanding that the anatomical structure of the adult brain does not change

over time

20

B Examples of Changes in Function and Structure

2) Typists

helliplong-term bimanual training also increases

gray matter volume in experienced adult typists

These results suggest that learning not

only affects function but also structure in

adult brains

21

V Neuroplasticity and Optometry

A Evolutionary neuroplasticity

B Reactive plasticity

C Adaptational plasticity

D Reparation plasticity

22

V Neuroplasticity and Optometry

A Evolutionary neuroplasticity

hellip is ideally suited for the developmental OD who

specializes in vision function as it changes over time

either with or without intervention

23

V Neuroplasticity and Optometry

B Reactive plasticity

hellip can be thought of as the immediate effect that

initial optometric treatment may have on a system This can

be reflected in an immediate but often transient change in

the individuallsquos accommodative systemmdashie when an

uncorrected myope initially puts on his or her new

spectacles

24

V Neuroplasticity and Optometry

C Adaptational plasticity

hellip could describe the long-term effects of in-office optometric

vision therapy on disorders of the binocular vision system

25

V Neuroplasticity and Optometry

D Reparation plasticity

hellipin contrast to adaptational

plasticity reparation plasticity may

occur during treatment by a low

Vision specialist or an OD

Working with those who have

Experienced a traumatic brain

injury (TBI)

26

V Neuroplasticity and Optometry

The effects of plasticity can lead to either

positive or negative changes during

development (evolutionary plasticity) after

short-term exposure (reactive plasticity)

after long-term or continuous stimuli

(adaptational plasticity) and during

functional or structural recovery of damaged

neuronal circuits (reparation plasticity)

httpwwwciteulikeorguserjasonepriorarticle2856526

27

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

A Refractive error development

B Amblyopia

C Strabismus

28

D Non-strabismus non-amblyopic binocular vision disorders

E Learning related vision anomalies

F Vision developmentperception disorders

29

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

A Refractive error development

Several recent studies have noted that neuroplasticity may play a

role in refractive error development

retinal defocus use of progressive addition lenses

drug studies (M1-antagonist2 pirenzepine ) slow myopia

progression demonstrated nearly a 50 reduction in myopia

progression over a two-year period

30

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged

7 to 17 years Arch Ophthalmol 2005 Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three

to less than 10 years of age Am J Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction

Am J Ophthalmol 2007 Jun143(6)1060-3

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine

vs patching for treatment of moderate amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-

57

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for

strabismic and anisometropic amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Treatment of severe amblyopia with weekend atropine results from 2 randomized clinical trials

Levodopacarbidopa in the treatment of amblyopia

31

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

J Pediatr Ophthalmol Strabismus 2009 Mar-Apr46(2)87-90 quiz 91-2 Levodopacarbidopa in the

treatment of amblyopia Dadeya S Vats P Malik KP

PURPOSE To evaluate the role of levodopacarbidopa in the treatment of amblyopia METHODS

Thirty patients with strabismic amblyopia between the ages of 3 and 12 years were part of this double-

blind randomized study Patients were divided into two groups Group A received 050 mg + 125 mg of

levodopacarbidopa per kilogram body weight three times daily after meals with a protein rich drink

whereas Group B received placebo Both groups received full-time conventional occlusion until a visual

acuity of 66 was achieved or for a maximum of 3 months RESULTS The authors observed more than

two lines improvement in visual acuity that was greater in the levodopa group (15 of 15) than in the

placebo group (9 of 15) (P lt 005) Furthermore improvement in visual acuity of more than two lines

was greater in patients younger than 8 years (100) than in patients older than 8 years of age (60) (P =

0026) There was also no significant reversal of the improved visual acuity in up to 6 months of follow-

up CONCLUSION Levodopacarbidopa improves visual acuity in patients with

amblyopia and maintains improved visual acuity especially in patients

younger than 8 years

32

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

J Pediatr Ophthalmol Strabismus 2008 May-Jun45(3)174-6 The use of levodopa in the treatment of

bilateral amblyopia secondary to uncorrected high hypermetropia Abrams MS

The standard treatment of bilateral amblyopia secondary to uncorrected high bilateral hypermetropia has

been spectacles and time The patient described here failed to show adequate improvement in visual

acuity after 18 months of standard treatment Visual acuity improved dramatically when the

patient began taking levodopa dropped precipitously when the medication was

discontinued and returned quickly to post-treatment levels when levodopa was

restarted Visual acuity remained stable when the medication was slowly tapered

and discontinued This report suggests that dopamine may play a role in the pathophysiology of

bilateral amblyopia secondary to uncorrected high bilateral hypermetropia

33

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

Bottom Line

Amblyopia can be treated at any age

May be able to use neuro-enhancing drugs

as a part of basic amblyopia therapy

34

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

C Strabismus and non-strabismic non-amblyopic binocular

vision disorders

Clinical Trial of Treatments for Symptomatic Convergence Insufficiency in Children has

clearly demonstrated the superiority of in-office optometric vision therapy (in conjunction

with home therapy) vs out-of-office therapy alone The study concluded that optometric

vision therapyorthoptics was more effective than pencil push-ups or placebo vision

therapyorthoptics in reducing symptoms and improving clinical signs of convergence

insufficiency

Long-term effectiveness of treatments for symptomatic convergence insufficiency

in children (Optom Vis Sci 2009 Sep86(9)1096-103)

CITT patients improvements lasted a year

35

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

Strabismus 1999 Sep7(3)169-74 Convergence insufficiency in

idiopathic Parkinsons disease responsive to levodopa Racette BA

Gokden MS Tychsen LS Perlmutter JS

We report a patient with pathologically proven idiopathic Parkinsons

disease (IPD) who developed diplopia secondary to convergence

insufficiency during his motor off periods Diplopia resolved with

onset of motor benefit from levodopa Neuro-ophthalmologic

examination demonstrated convergence insufficiency during motor

off periods that was alleviated after onset of motor benefit from

levodopa This is the first reported case of convergence insufficiency

in IPD responsive to levodopa

36

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

Bottom Line

Optometric Vision Therapy is the most efficacious treatment available for binocular vision disorders and the

treatment effects are long lasting Neuro-enhancing drugs

may assist us as well

37

EF Learning related vision anomalies Vision

developmentperception disorders

hellipresearch includes an examination of the role vision plays in

reading the effect of oculomotor vergence and

accommodativecoherent motion therapy on reading eye movements

and reading speed the diagnosis and treatment of perceptual

disorders and the effect of therapy on various learning anomalies

38

EF Learning related vision anomalies Vision developmentperception disorders

magnocellular (MC) deficit in dyslexia

LM speed-matching ratio predicts reading in childrenChase C Dougherty RF Ray N

Fowler S Stein JOptom Vis Sci 2007 Mar84(3)229-36

Effect of attention therapy on reading comprehension Solan HA Shelley-Tremblay J

Ficarra A Silverman M Larson S J Learn Disabil 2003 Nov-Dec36(6)556-63

Is there a common linkage among reading comprehension visual attention and

magnocellular processing Solan HA Shelley-Tremblay JF Hansen PC Larson S

J Learn Disabil 2007 May-Jun40(3)270-8

Lawton T Filtered Text and Direction Discrimination Training Improved Reading

Fluency for Both Dyslexic and Normal Readers Optom Vis Dev 200839 (3)114

Fischer B Hartnegg K Saccade control in dyslexia Development deficits training

and transfer to reading Optom Vis Dev 200839(4)181-190

39

EF Learning related vision anomalies Vision developmentperception disorders

J Learn Disabil 2003 Nov-Dec36(6)556-63 Effect of attention therapy on reading

comprehension Solan HA Shelley-Tremblay J Ficarra A Silverman M Larson S

hellip At the completion of attention therapy the mean

standard attention and reading comprehension scores of

the experimental group had improved significantly The

control group however showed no significant

improvement in reading comprehension scores after 12

weeks Although uncertainties still exist this investigation

supports the notion that visual attention is malleable and

that attention therapy has a significant effect on reading

comprehension in this often neglected population

40

VII Vision dysfunction association with acquired brain injury

A Exotropia (or high exophoriaCI)

B Accommodative dysfunction

C Convergence insufficiency

41

D Decreased blink rate

E Spatial disorientation

F Pursuitsaccade dysfunction

G Unstable ambient vision (Magnocellular pathway)

42

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Stelmack JA Frith T Van Koevering D Rinne S Stelmack TR Visual function in patients

followed at a Veterans Affairs polytrauma network site an electronic medical record review

Optometry 2009 Aug80(8)419-24

RESULTS Visual symptoms were self-reported by 76 of patients

with polytrauma and 75 of the patients with TBI Problems with reading

(polytrauma 60 and TBI 50) and accommodation (polytrauma 30 and

TBI 47) were frequently found on eye examinations Spectacles were the

treatment most frequently prescribed (polytrauma 62 and TBI 78)

CONCLUSIONS It is important for optometrists to be aware of the high

rates of self-reported symptoms and visual problems in military personnel

returning from deployment to the wars in Iraq and Afghanistan Post-

traumatic stress disorder and depression may complicate optometric

evaluation and management

43

VII Vision dysfunction association with acquired brain injury

Avoidance of near tasks

Oculomotor-based reading difficulties

Eye tracking problems

Eye focusing problems

Eyestrain Diplopia

Dizziness Vertigo

Vision-derived nausea

44

VII Vision dysfunction association with acquired brain injury

Increased sensitivity to visual motion

Visual inattention and distractibility

Short-term visual memory loss

Difficulty judging distances (relative and absolute

Difficulty with global scanning

Difficulty with personal grooming especially involving the face

Inability to interactcope visually in a complex social situation

(eg minimal eye contact)

Inability to tolerate complex visual environments (eg grocery store

aisles and highly-patterned floors)

45

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Ciuffreda KJ Ludlam DP Kapoor N Clinical oculomotor training in traumatic brain injury Optom Vis

Dev 200940(1)16-23

Individuals with traumatic brain injury present with a constellation of

oculomotor dysfunctions and correlated symptoms Simple and

effective clinical oculomotor-based training procedures will be

presented with respect to the versional vergence and

accommodative systems and their interactions These therapeutic

procedures can also be applied as needed to individuals with either

low vision neurological dysfunctions or general visual skills cases

manifesting similar oculomotor deficits

46

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Leslie S Myopia and accommodative insufficiency associated with

moderate head trauma Opt Vis Dev 200940(1)25-31

The majority of subjects reviewed had developed a stable degree of

myopia between 100 and 200 diopters as well as an abnormally

high lag of accommodation When their distance and near spatial area

of focus was compared the majority were focused at an intermediate

area in space suggesting a loss of control of accommodation in

space

47

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

B Drugs

C Exercise

D Learning new and challenging things

48

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements

prevent cognitive decline A systematic review of randomized controlled trials J Hum

Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among

preterm infants attributable to early supplementation of human milk with

docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings

and structural-functional synergies with cell membrane phospholipids Altern Med Rev

2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function

Neuroscience 20089(7)568-78

49

VIII Improving Brain Function and Neuroplasticity

B Drugs Maya Vetencourt JF Sale A Viegi A et al The antidepressant

fluoxetine (PROZAC) restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the

antidepressant tianeptine CNS Drugs 200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances

hippocampal long-term potentiation and memory BMC Biol 2008 Sep

9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine

improves neuropsychological disorders in a child with creatine

transporter defect Neurocase 200814(2) 151-61

50

VIII Improving Brain Function and Neuroplasticity

C Exercise

Hunsberger JG et al Antidepressant actions of the exercise-

regulated gene VGF Nat Med 2007 Dec 2 131476

VGF may be a common pathway by which exercise induces

neuroplasticity and growth-factor genes at least one of these might act

similarly to antidepressants in promoting an adaptive response to stress

However the tests used here may be modeling stress-induced

helplessness not depression hellipexercise seems to induce multiple

interacting genes that enhance neuronal resilience

51

VIII Improving Brain Function and Neuroplasticity

D Learning new and challenging things

What have we (optometry amp ophthalmology)

been thinking all these years

Where did we miss the news about neuroplasticity

52

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Huang JC Neuroplasticity as a proposed mechanism for the efficacy of optometric vision therapy and rehabilitation J Bev Optom 200920(4)96-100

Homologous area adaptationCompensatory masqueradeCross-modal reassignment

Map expansion

EquipotentialityVicariation

53

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Homologous area adaptation a transfer of function from a damaged brain area to a non-damaged brain area May be limited to early stages of human development and may crowd a new brain area resulting in reduced functionality of that brain area (Competition between spatial amp verbal functioning)

54

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Compensatory masquerade reorganizing of existing neuro-pathways to us alternative cognitive strategies to perform a task

55

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Cross-modal reassignment using new sensory input in a brain structure deprived of its main input source (changing processing from visual to tactile stimuli in the blind)

56

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Map expansion increase in brain mass due to repeated behavior or exposure to stimuli

57

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Equipotentiality anatomical areas of the brain can perform disparate functions

Vicariation redundant neural systems can operate under abnormal conditions

This may explain why recovery is noted for many neurological conditions (degenerative psychiatric developmental vascular traumatic)

58

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Constraint therapy Use it and improve it

Patching penalization ldquonear activitiesrdquo during amblyopia therapy

59

IX Improving Brain Function and Neuroplasticity Optometric Clinical ApplicationsOptometric Vision Therapy

Kleim amp Jones

Use it or lose it If you do not drive specific brain functions

functional loss will occur

If you want to improve oculomotor brain neuroplastic function amp

structure therapy should be specific for that brain function

Use it and improve it Therapy that drives cortical function enhances

that particular function

If you use therapy to improve oculomotor dysfunction it should

improve

Specificity The therapy you choose determines the resultant

plasticity and function

You must choose therapy that is appropriate

60

IX Improving Brain Function and Neuroplasticity Optometric Clinical Applications

Kleim amp Jones

Repetition matters Plasticity that results in functional change

requires repetition

Do the therapy Do it again Do it yet again No quick fix

Intensity matters Induction of plasticity requires the appropriate

amount of intensity

Intensity means strength force concentration power and passion

Without these plasticity may not occur Function may not improve

Time matters Different forms of plasticity take place at different

times during therapy

Do the basics than the more advanced therapeutic procedures

61

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Salience matters It has to be important to the individual

Make the therapy matter to the patient

Age matters Plasticity is easier in a younger brain but is also

possible in an adult brain

Do not let age determine what therapy options you offer your

patients Think of Susan Barry PhD (StereoSue) and her success

Offer your patients options Let them choose Be realistic about

outcomeshelliphave outcome measures built into therapy program

62

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Transference Neuroplasticity and the change in function

that results from one therapy can augment the attainment

of similar behaviors

What you do during oculomotor therapy may affected

vergence therapy outcomes

Interference Plasticity in response to one experience can

interfere with the acquisition of other behaviors

Monitor Evaluate progress Discuss function in other areas

of your patientslsquo life

63

Why pay attention to binocular vision dysfunctions

and neuroplasticity

December 2009 issue of the Review of Optometry

The Binocular Vision Dysfunction Pandemic

In 2010 almost 170 million individuals will be wearing glasses In

2010 there will also be up to 93 million amblyopes and 12 and a half

million strabismics For children under 18 years of age that means

there will be more than 22 and a half million amblyopes and millions

of children with strabismus A clinical trial to determine the

prevalence of binocular vision dysfunction within the general

population suggested the possibility of up to 56 or 173 million men

women and children with symptoms associated with a binocular

vision dysfunction 189 million (61) with accommodative problems

and 118 million (38) demonstrating various vergence

anomalies

64

65

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Brain plasticity life long changes in the structure of the brain

Sensory substitution replacement of one sensory input by another

Measurement techniques

Voxel based morphometryhellipmeasures difference in brain volume

Fluorodeoxyglucose glucose analog PET scan tells you

distribution and metabolism of brain

Cortical thickness measures

Visual cortex of the blind turns somatic ―The eye of the tongue

Transcranial magnetic stmiulation non-invasive technique to

stimulate cortex

66

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Blind Braille readers report tingling in fingers when pressure

phosphenes are applied Blind feel tingling in tongue

Bind use tongue to perform orientation task motion perception

sensory perception Visual cortex recruited in a variety of sensory

and cognitive tasks (DM Can we use tongue as a VT tool)

Dilks Reorganizations of human adult visual system

When a region of sensory cortex is deprived of its bottom up

input the deprived region begins to respond to stimuli that

normally activate adjacent cortex

67

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Retinotopic map changes for stroke pts Cortical reorganization in

adults occurs Perceived objectshellipelongation in stroke amp AMD

What happens to deprived cortex in AMD

fMRI shows cortical reorganization in adults

Proposed mechanisms

hellipGrowth of new connections

hellipUnmasking of pre-existing connections this is true

happens within seconds

Bavelier

Action video games

68

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Bavelier

Action video games Looked at attention Gamers can track more

activities

Attention over space (me peripheral awarenress) Useful field

of view shrinks with age

Performance not VA relatedhellipis related to attention

Action game playing changes spatial resolutionhellipovercoming

crowding in VA assessment (me amblyopia therapy)

Temporal resolution of vision Backward masking

changehellipbrain changes

Visual sensitivity (contrast sensitivity) Post action game training

improves CSF

69

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Action video games correcting optics of the cortex (me this is

actualy OVT)

Games factor

Variable entry leanringhellipadapt task to skill level

Incremental learning tune task to subjectlsquos leanring steps

Motivationarousal

Rewards

Self masterself confidence

Action games factors

Pacingrate of exposure to infohellipincreasing processing speed

Dynamic display

Rich environment

Rich motor involvement

70

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Surgeons may be made to play action games

Pilot training

Amblyopia tx Dennis Levi research

PresenterTitle Contact info

Neuroplasticity-A Paradigm Sea Change

This presentation is available at

httpwwwslidesharenetDMAINOneuroplasticity-a-paradigm-sea-change-2459693

httpwwwmainosmemosblogspotcom

My FaceBook Page

and

Twitter

PresenterTitle Contact info

Questions About

Neuroplasticity-A Paradigm Sea Change

Dominick M Maino OD MEd FAAO FCOVD-A

Professor PediatricsBinocular VisionIllinois Eye InstituteIllinois College of Optometry

dmainoicoeduhttpwwwMainosMemosblogspotcom

Thanks to

httpwwwcovdorgHomeOVDJournalOVD401tabid263D

efaultaspx

httpbipolarblastfileswordpresscom200908neurojpg

httpwwwspecialcheerscomimagesanimated_braingif

httpblogmarsdencartoonscomwp-

contentuploads200810frankenstein-myspace-lightbeergif

httpwwwshangralafamilyfuncomgala-ecalvindreamgif

httppsychiatryjwatchorgcgicontentfull20082251

73

Chakraborty R Chatterjee A Choudhart S Chakraborty PK Neuroplasticitymdasha paradigm shift in neurosciences J Indian Med Assoc

2007105(9)513-4516-8520-1

Sacks O A neurologistlsquos notebook Stereo Sue Why two eyes are better than one The New Yorker 2006 Jun 1964-73

Krulwich R National Public Radio Going Binocular Susanlsquos First Snowfall Available at

wwwnprorgtemplatesstorystoryphpstoryId=5507789 (Accessed December 8 2008)

Press LJ The story behind Stereo Suelsquo and a world-famous neurologistlsquos discovery of vision therapy Optom Vis Dev 200637(2) 55-7

Levin HS Neuroplasticity and brain imaging research implications for rehabilitation Arch Phys Med Rehabil 2006 Dec87(12 Suppl

2)S1

Wiesel TN Hubel DH Single-cell responses in striate cortex of kittens deprived of vision in one eye J Neurophysiol 1963

Nov261003-17

Hook BM Chen C Critical periods in the visual system Changing views for a model of experience-dependent plasticity Neuron 2007

Oct56(2)312-26

Ramey CT Ramey SL Prevention of intellectual disabilities early interventions to improve cognitive development Prev Med 1998

Mar-Apr27(2)224-32

Heuninckx S Wenderoth N Swinnen SP Systems neuroplasticity in the aging brain recruiting additional neural resources for

successful motor performance in elderly persons J Neurosci 2008 Jan 228(1)91-9

Ge S Yang CH Hsu KS et al A critical period for enhanced synaptic plasticity in newly generated neurons of the adult brain Neuron

2007 May54(4)559-66

74

Draganski B Gaser C Busch V et al Neuroplasticity changes in grey matter induced by training Nature 2004 Jan 22427(6972)

311-2

Cannonieri GC Bonilha L Fernandes PT et al Practice and perfect length of training and structural brain changes in experienced

typists Neuroreport 2007 Jul 218(10)1063-6

Kleim JA Jones TA Principles of experience-dependent neural plasticity implications for rehabilitation after brain damage J

Speech Lang Hear Res 2008 Feb51(1)S225-39

Trojan S Porkorny J Theoretical aspects of neuroplasticity Physiol Res 199948(2)87-97

Ramamirtham R Kee CS Hung LF et al Wave aberrations in rhesus monkeys with vision-induced ametropias Vision Res 2007

Sep47(21)2751-66

Smith EL 3rd Ramamirtham R Qiao-Grider Y et al Effects of foveal ablation on emmetropization and form-deprivation myopia

Invest Ophthalmol Vis Sci 2007 Sep48(9)3914-22

Smith EL 3rd Kee CS Ramamirtham R et al Peripheral vision can influence eye growth and refractive development in infant

monkeys Invest Ophthalmol Vis Sci 2005 Nov46(11)3965-72

Ciuffreda KJ Vasudevan B Nearwork-induced transient myopia (NITM) and permanent myopiandashndashis there a link Ophthalmic

Physiol Opt 2008 Mar28(2)103-14

Hung GK Ciuffreda KJ Incremental retinal-defocus theory of myopia development--schematic analysis and computer simulation

Comput Biol Med 2007 Jul37(7)930-46

Hung GK Ciuffreda KJ A unifying theory of refractive error development Bull Math Biol 2000 Nov62(6)1087-108

75

Pang Y Maino D Zhang G Lu F Myopia Can its progress be controlled Optom Vis Dev 200637(2)75-9

Leung JT Brown B Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lenses Optom Vis Sci

1999 Jun76(6)346-54

Hasebe S Ohtsuki H Nonaka T et al Effect of progressive addition lenses on myopia progression in Japanese children a prospective

randomized double-masked crossover trial Invest Ophthalmol Vis Sci 2008 Jul49(7)2781-9

Gwiazda J Hyman L Hussein M et al A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression

of myopia in children Invest Ophthalmol Vis Sci 2003 Apr44(4)1492-500

Siatkowski RM Cotter SA Crockett RS et al Two-year multi-center randomized double-masked placebo-controlled parallel safety and

efficacy study of 2 pirenzepine ophthalmic gel in children with myopia J AAPOS 2008 Aug12(4)332-9

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged 7 to 17 years Arch Ophthalmol 2005

Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three to less than 10 years of age Am J

Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction Am J Ophthalmol 2007

Jun143(6)1060-3

Holmes JM Edwards AR Beck RW et al A randomized pilot study of near activities versus non-near activities during patching therapy for

amblyopia J AAPOS 2005 Apr9(2)129-36

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate

amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-57

76

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic

amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Convergence Insufficiency Treatment Trial Study Group Randomized clinical trial of treatments for symptomatic convergence insufficiency

in children Arch Ophthalmol 2008 Oct126(10)1336-49

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

Solan HA Shelley-Tremblay J Hansen PC et al M-cell deficit and reading disability a preliminary study of the effects of temporal vision-

processing therapy Optometry 2004 Oct75(10)640-50

Solan HA Larson S Shelley-Tremblay J et al Role of visual attention in cognitive control of oculomotor readiness in students with reading

disabilities J Learn Disabil 2001 Mar-Apr34(2)107-18

Gallaway M Boas MB The impact of vergence and accommodative therapy on reading eye movements and reading speed Optom Vis Dev

200738(3)115-20

Goss DA Downing DB Lowther AH et al The effect of HTS vision therapy conducted in a school setting on reading skills in third and

fourth grade students Optom Vis Dev 200738(1)27-32

Crutch SJ Warrington EK Foveal crowding in posterior cortical atrophy a specific early-visual-processing deficit affecting word reading

Cogn Neuropsychol 2007 Dec24(8)843-66

Helms D Sawtelle SM A study of the effectiveness of cognitive therapy delivered in a video game format Optom Vis Dev 200738 (1)19-

26

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

77

Lawton T Training direction-discrimination sensitivity remediates a wide spectrum of reading skills OptomVis Dev 200738(1) 33-47

Goldstand S Koslowe KC Parush S Vision visual-information processing and academic performance among seventh-grade schoolchildren a

more significant relationship than we thought Am J Occup Ther 2005 Jul-Aug59(4)377-89

Fischer B Koumlngeter A Hartnegg K Effects of daily practice on subitizing visual counting and basic arithmetic skills Optom Vis Dev

200839(1)30-4

Sands W Taub M Maino D Limited research and education on special populations in optometry and ophthalomology Optom Vis Dev

200839(2)60-1

Wesson M Maino D Oculo-visual findings in Down syndrome cerebral palsy and mental retardation with non-specific etiology In Maino D

(ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 199517-54 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

Cui Y Stapleton F Suttle C Developing an instrument to assess vision-related and subjective quality of life in children with intellectual

disability data collection and preliminary analysis in a Chinese population Ophthal Physiolog Optics 2008 May28(3) 238-46

Maino D Steele G Tahir S Sajja R Attitudes of optometry students toward individuals with disabilities Optom Ed 200227(2)45-50

Maino D Special populations in the optometric curriculum Optom Ed 200227(2)38-9

Maino D Overview of special populations In Scheiman M Rouse M (eds) Optometric Management of Learning-Related Vision Problems

St Louis Mosby Inc 200685-106

Maino D (ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 1995 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

78

McCarthy P Maino D Alport syndrome a review Clin Eye Vis Care 2000 Dec12(3-4)139-50

Block SS Brusca-Vega R Pizzi WJ et al Cognitive and visual processing skills and their relationship to mutation size in full and

permutation female fragile X carriers Optom Vis Sci 2000 Nov77 (11)592-9

Maino D The young child with developmental disabilities An introduction to mental retardation and genetic syndromes In Moore BD

(ed) Eye Care for Infants and Young Children Butter-worth--Heinemann Newton MA1997285-300

Amin V Maino D The Fragile X female Visual visual perceptual and ocular health anomalies J Am Optom Assoc 1995 May66

(5)290-95

Maino DM Maino JH Cibis GW Hecht F Ocular health anomalies in patients with developmental disabilities In Maino D (ed)

Diagnosis and Management of Special Populations Mosby-Year-book Inc St Louis MO 1995189-206 Reprinted Optometric

Education Program Foundation Santa Anna Calif 2001

Maino D Wesson M Schlange D Cibis G Maino J Optometric findings in the fragile X syndrome Optom Vis Sci 199168634-40

Scheiman MMOptometric findings in children with cerebral palsy Am J Optom Physiol Opt 1984 May61(5)321-3

Maino D Maino J Maino S Mental retardation syndromes with associated ocular defects J Am Optom Assoc 199061707-16

Stewart RE Woodhouse JM Cregg M Pakeman VH Association between accommodative accuracy hypermetropia and strabismus in

children with Downs syndrome Optom Vis Sci 2007 Feb84(2)149-55

Cregg M Woodhouse JM Pakeman VH et al Accommodation and refractive error in children with Down syndrome cross-sectional

and longitudinal studies Invest Ophthalmol Vis Sci 2001 Jan42 (1)55-63

79

McClelland JF Parkes J Hill N et al Accommodative dysfunction in children with cerebral palsy a population-

based study Invest Ophthalmol Vis Sci 2006 May47(5)1824-30

Duckman RH Vision therapy for the child with cerebral palsy J Am Optom Assoc 198758(1)28-35

Duckman R Accommodation in cerebral palsy function and remediation J Am Optom Assoc 198455(4)281-3

Scheiman M Understanding and managing vision deficits a guide for occupational therapists 2nd ed Slack

Thorofare NJ 2002

Maino D Binasal occlusion for the child with Cerebral Palsy J Ill Optom Assoc 198644(1)1218

Battaglia F Quartarone A Rizzo V et al Early impairment of synaptic plasticity in patients with Downs syndrome

Neurobiol Aging 2008 Aug29(8)1272-5

Bonnier C Evaluation of early stimulation programs for enhancing brain development Acta Paediatr 2008

Jul97(7)853-8

Morice E Andreae LC Cooke SF et al Preservation of long-term memory and synaptic plasticity despite short-term

impairments in the Tc1 mouse model of Down syndrome Learn Mem 2008 Jul 1415(7)492-500

Gordon AM Schneider JA Chinnan A Charles JR Efficacy of a hand-arm bimanual intensive therapy (HABIT) in

children with hemiplegic cerebral palsy a randomized control trial Dev Med Child Neurol 2007 Nov49(11)830-8

Kapoor N Ciuffreda KJ Vision disturbances following traumatic brain injury Curr Treat Options Neurol 2002

Jul4(4)271-80

80

Ciuffreda KJ Rutner D Kapoor N et al Vision therapy for oculomotor dysfunctions in acquired brain injury a

retrospective analysis Optometry 2008 Jan79(1)18-22

Ciuffreda KJ Han Y Kapoor N Ficarra AP Oculomotor rehabilitation for reading in acquired brain injury

NeuroRehabilitation 200621(1)9-21

Zost M Diagnosis and management of visual dysfunction in cerebral injury In Maino D (ed) Diagnosis and

Management of Special Populations Mosby-Yearbook Inc St Louis 199579 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001 [Figure used with permission of the editor]

DeGutis JM Bentin S Robertson LC DEsposito M Functional plasticity in ventral temporal cortex following

cognitive rehabilitation of a congenital prosopagnosic J Cogn Neurosci 2007 Nov19 (11)1790-802

Welbourne SR Ralph MA Exploring the impact of plasticity-related recovery after brain damage in a connectionist

model of single-word reading Cogn Affect Behav Neurosci 2005 Mar5(1)77-92

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements prevent cognitive decline A

systematic review of randomized controlled trials J Hum Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among preterm infants attributable to early

supplementation of human milk with docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings and structural-functional

synergies with cell membrane phospholipids Altern Med Rev 2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function Neuroscience 20089(7)568-78

81

Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

BMC Biol 2008 Sep 9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine improves neuropsychological disorders in a child with

creatine transporter defect Neurocase 200814(2) 151-61

Forrester LW Wheaton LA Luft AR Exercise-mediated locomotor recovery and lower-limb neuroplasticity after

stroke J Rehabil Res Dev 200845(2)205-20

82

Page 6: Neuroplasticity: A Paradigm Sea Change Latest Updated File

Neuroplasticity

Up until recentlyhellipapparently unknown to many within the professions of optometry and ophthalmologyhellip

6

7

The BrainA hellip is not just a static soft round mass bathed in a fluid and surrounded by a hard caseB hellip can change its form and resultant function through neuroplasticity

The BrainA hellip is not just a static soft round mass bathed in a fluid and surrounded by a hard caseB hellip can change its form and resultant function through neuroplasticity

The BrainA hellip is not just a static soft round mass bathed in a fluid and surrounded by a hard caseB hellip can change its form and resultant function through neuroplasticity

The BrainA hellip is not just a static soft round mass bathed in a fluid and surrounded by a hard caseB hellip can change its form and resultant function through neuroplasticity

II The Brain

hellip is not just a static soft round mass bathed in a fluid and surrounded by a hard case

hellip can change its form and resultant function through neuroplasticity

8

III CriticalSensitive Periods

A A critical period occurs when the individual is sensitive to environmental influences and stimulation

1 The Precritical period The initial formation of neuronal circuits that is not dependent on visual experience

9

CriticalSensitive Periods

2 The Critical period A distinct onset of robust plasticity in response to the visual experience when the initially formed circuit can be modified by experience

3 Closure of the critical period After the end of the critical period the same visual experience no longer elicits the same degree of plasticity

10

CriticalSensitive Periods

B The concept of a critical period does not imply that neuroplasticity ends after a certain age

C Sensitive period begins and ends gradually (not abruptly like the critical period) and provides for maximum sensitivity

to stimuli

11

VI Neuroplasticity and the Brain

A Can adult brain neurons actually exhibit neuroplasticity The short answer is yes

B Resultant changes are noted in not only functional outcomes but also in brain anatomy and structure

12

IV Neuroplasticity and Rehabilitation

Kleim amp Jones note that

A The Key Principles of Experience-Dependent Neural Plasticity

1 Use it or lose it

2 Use it and improve it

3 Specificity

13

4 Repetition matters

5 Intensity matters

6 Time matters

7 Salience matters

14

8 Age matters

9 Transference

10 Interference

15

Use it or lose it If you do not drive specific brain functions

functional loss will occur

Use it and improve it Therapy that drives cortical function

enhances that particular function

Specificity The therapy you choose determines the resultant

plasticity and function

Repetition matters Plasticity that results in functional change

requires repetition

16

Intensity matters Induction of plasticity requires the appropriate

amount of intensity

Time matters Different forms of plasticity take place at different

times during therapy

Salience matters It has to be important to the individual

Age matters Plasticity is easier in a younger brain but is also

possible in an adult brain

17

Transference Neuroplasticity and the change in function that

results from one therapy can augment the attainment of similar

behaviors

Interference Plasticity in response to one experience can interfere

with the acquisition of other behaviors

18

B Examples of Changes in Function and Structure

1) Jugglers

2) Typists

19

B Examples of Changes in Function and Structure

1) Jugglers

One study suggested that adults taught how to juggle demonstrated a

significant transient bilateral expansion of gray matter in the mid-

temporal area and the left posterior intraparietal sulcus between baseline brain scan and

follow-up The findings were specific to training stimulus individuals who were

not instructed how to juggle demonstrated no change in gray

matter over the same period These findings oppose the conventional

understanding that the anatomical structure of the adult brain does not change

over time

20

B Examples of Changes in Function and Structure

2) Typists

helliplong-term bimanual training also increases

gray matter volume in experienced adult typists

These results suggest that learning not

only affects function but also structure in

adult brains

21

V Neuroplasticity and Optometry

A Evolutionary neuroplasticity

B Reactive plasticity

C Adaptational plasticity

D Reparation plasticity

22

V Neuroplasticity and Optometry

A Evolutionary neuroplasticity

hellip is ideally suited for the developmental OD who

specializes in vision function as it changes over time

either with or without intervention

23

V Neuroplasticity and Optometry

B Reactive plasticity

hellip can be thought of as the immediate effect that

initial optometric treatment may have on a system This can

be reflected in an immediate but often transient change in

the individuallsquos accommodative systemmdashie when an

uncorrected myope initially puts on his or her new

spectacles

24

V Neuroplasticity and Optometry

C Adaptational plasticity

hellip could describe the long-term effects of in-office optometric

vision therapy on disorders of the binocular vision system

25

V Neuroplasticity and Optometry

D Reparation plasticity

hellipin contrast to adaptational

plasticity reparation plasticity may

occur during treatment by a low

Vision specialist or an OD

Working with those who have

Experienced a traumatic brain

injury (TBI)

26

V Neuroplasticity and Optometry

The effects of plasticity can lead to either

positive or negative changes during

development (evolutionary plasticity) after

short-term exposure (reactive plasticity)

after long-term or continuous stimuli

(adaptational plasticity) and during

functional or structural recovery of damaged

neuronal circuits (reparation plasticity)

httpwwwciteulikeorguserjasonepriorarticle2856526

27

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

A Refractive error development

B Amblyopia

C Strabismus

28

D Non-strabismus non-amblyopic binocular vision disorders

E Learning related vision anomalies

F Vision developmentperception disorders

29

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

A Refractive error development

Several recent studies have noted that neuroplasticity may play a

role in refractive error development

retinal defocus use of progressive addition lenses

drug studies (M1-antagonist2 pirenzepine ) slow myopia

progression demonstrated nearly a 50 reduction in myopia

progression over a two-year period

30

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged

7 to 17 years Arch Ophthalmol 2005 Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three

to less than 10 years of age Am J Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction

Am J Ophthalmol 2007 Jun143(6)1060-3

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine

vs patching for treatment of moderate amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-

57

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for

strabismic and anisometropic amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Treatment of severe amblyopia with weekend atropine results from 2 randomized clinical trials

Levodopacarbidopa in the treatment of amblyopia

31

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

J Pediatr Ophthalmol Strabismus 2009 Mar-Apr46(2)87-90 quiz 91-2 Levodopacarbidopa in the

treatment of amblyopia Dadeya S Vats P Malik KP

PURPOSE To evaluate the role of levodopacarbidopa in the treatment of amblyopia METHODS

Thirty patients with strabismic amblyopia between the ages of 3 and 12 years were part of this double-

blind randomized study Patients were divided into two groups Group A received 050 mg + 125 mg of

levodopacarbidopa per kilogram body weight three times daily after meals with a protein rich drink

whereas Group B received placebo Both groups received full-time conventional occlusion until a visual

acuity of 66 was achieved or for a maximum of 3 months RESULTS The authors observed more than

two lines improvement in visual acuity that was greater in the levodopa group (15 of 15) than in the

placebo group (9 of 15) (P lt 005) Furthermore improvement in visual acuity of more than two lines

was greater in patients younger than 8 years (100) than in patients older than 8 years of age (60) (P =

0026) There was also no significant reversal of the improved visual acuity in up to 6 months of follow-

up CONCLUSION Levodopacarbidopa improves visual acuity in patients with

amblyopia and maintains improved visual acuity especially in patients

younger than 8 years

32

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

J Pediatr Ophthalmol Strabismus 2008 May-Jun45(3)174-6 The use of levodopa in the treatment of

bilateral amblyopia secondary to uncorrected high hypermetropia Abrams MS

The standard treatment of bilateral amblyopia secondary to uncorrected high bilateral hypermetropia has

been spectacles and time The patient described here failed to show adequate improvement in visual

acuity after 18 months of standard treatment Visual acuity improved dramatically when the

patient began taking levodopa dropped precipitously when the medication was

discontinued and returned quickly to post-treatment levels when levodopa was

restarted Visual acuity remained stable when the medication was slowly tapered

and discontinued This report suggests that dopamine may play a role in the pathophysiology of

bilateral amblyopia secondary to uncorrected high bilateral hypermetropia

33

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

Bottom Line

Amblyopia can be treated at any age

May be able to use neuro-enhancing drugs

as a part of basic amblyopia therapy

34

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

C Strabismus and non-strabismic non-amblyopic binocular

vision disorders

Clinical Trial of Treatments for Symptomatic Convergence Insufficiency in Children has

clearly demonstrated the superiority of in-office optometric vision therapy (in conjunction

with home therapy) vs out-of-office therapy alone The study concluded that optometric

vision therapyorthoptics was more effective than pencil push-ups or placebo vision

therapyorthoptics in reducing symptoms and improving clinical signs of convergence

insufficiency

Long-term effectiveness of treatments for symptomatic convergence insufficiency

in children (Optom Vis Sci 2009 Sep86(9)1096-103)

CITT patients improvements lasted a year

35

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

Strabismus 1999 Sep7(3)169-74 Convergence insufficiency in

idiopathic Parkinsons disease responsive to levodopa Racette BA

Gokden MS Tychsen LS Perlmutter JS

We report a patient with pathologically proven idiopathic Parkinsons

disease (IPD) who developed diplopia secondary to convergence

insufficiency during his motor off periods Diplopia resolved with

onset of motor benefit from levodopa Neuro-ophthalmologic

examination demonstrated convergence insufficiency during motor

off periods that was alleviated after onset of motor benefit from

levodopa This is the first reported case of convergence insufficiency

in IPD responsive to levodopa

36

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

Bottom Line

Optometric Vision Therapy is the most efficacious treatment available for binocular vision disorders and the

treatment effects are long lasting Neuro-enhancing drugs

may assist us as well

37

EF Learning related vision anomalies Vision

developmentperception disorders

hellipresearch includes an examination of the role vision plays in

reading the effect of oculomotor vergence and

accommodativecoherent motion therapy on reading eye movements

and reading speed the diagnosis and treatment of perceptual

disorders and the effect of therapy on various learning anomalies

38

EF Learning related vision anomalies Vision developmentperception disorders

magnocellular (MC) deficit in dyslexia

LM speed-matching ratio predicts reading in childrenChase C Dougherty RF Ray N

Fowler S Stein JOptom Vis Sci 2007 Mar84(3)229-36

Effect of attention therapy on reading comprehension Solan HA Shelley-Tremblay J

Ficarra A Silverman M Larson S J Learn Disabil 2003 Nov-Dec36(6)556-63

Is there a common linkage among reading comprehension visual attention and

magnocellular processing Solan HA Shelley-Tremblay JF Hansen PC Larson S

J Learn Disabil 2007 May-Jun40(3)270-8

Lawton T Filtered Text and Direction Discrimination Training Improved Reading

Fluency for Both Dyslexic and Normal Readers Optom Vis Dev 200839 (3)114

Fischer B Hartnegg K Saccade control in dyslexia Development deficits training

and transfer to reading Optom Vis Dev 200839(4)181-190

39

EF Learning related vision anomalies Vision developmentperception disorders

J Learn Disabil 2003 Nov-Dec36(6)556-63 Effect of attention therapy on reading

comprehension Solan HA Shelley-Tremblay J Ficarra A Silverman M Larson S

hellip At the completion of attention therapy the mean

standard attention and reading comprehension scores of

the experimental group had improved significantly The

control group however showed no significant

improvement in reading comprehension scores after 12

weeks Although uncertainties still exist this investigation

supports the notion that visual attention is malleable and

that attention therapy has a significant effect on reading

comprehension in this often neglected population

40

VII Vision dysfunction association with acquired brain injury

A Exotropia (or high exophoriaCI)

B Accommodative dysfunction

C Convergence insufficiency

41

D Decreased blink rate

E Spatial disorientation

F Pursuitsaccade dysfunction

G Unstable ambient vision (Magnocellular pathway)

42

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Stelmack JA Frith T Van Koevering D Rinne S Stelmack TR Visual function in patients

followed at a Veterans Affairs polytrauma network site an electronic medical record review

Optometry 2009 Aug80(8)419-24

RESULTS Visual symptoms were self-reported by 76 of patients

with polytrauma and 75 of the patients with TBI Problems with reading

(polytrauma 60 and TBI 50) and accommodation (polytrauma 30 and

TBI 47) were frequently found on eye examinations Spectacles were the

treatment most frequently prescribed (polytrauma 62 and TBI 78)

CONCLUSIONS It is important for optometrists to be aware of the high

rates of self-reported symptoms and visual problems in military personnel

returning from deployment to the wars in Iraq and Afghanistan Post-

traumatic stress disorder and depression may complicate optometric

evaluation and management

43

VII Vision dysfunction association with acquired brain injury

Avoidance of near tasks

Oculomotor-based reading difficulties

Eye tracking problems

Eye focusing problems

Eyestrain Diplopia

Dizziness Vertigo

Vision-derived nausea

44

VII Vision dysfunction association with acquired brain injury

Increased sensitivity to visual motion

Visual inattention and distractibility

Short-term visual memory loss

Difficulty judging distances (relative and absolute

Difficulty with global scanning

Difficulty with personal grooming especially involving the face

Inability to interactcope visually in a complex social situation

(eg minimal eye contact)

Inability to tolerate complex visual environments (eg grocery store

aisles and highly-patterned floors)

45

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Ciuffreda KJ Ludlam DP Kapoor N Clinical oculomotor training in traumatic brain injury Optom Vis

Dev 200940(1)16-23

Individuals with traumatic brain injury present with a constellation of

oculomotor dysfunctions and correlated symptoms Simple and

effective clinical oculomotor-based training procedures will be

presented with respect to the versional vergence and

accommodative systems and their interactions These therapeutic

procedures can also be applied as needed to individuals with either

low vision neurological dysfunctions or general visual skills cases

manifesting similar oculomotor deficits

46

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Leslie S Myopia and accommodative insufficiency associated with

moderate head trauma Opt Vis Dev 200940(1)25-31

The majority of subjects reviewed had developed a stable degree of

myopia between 100 and 200 diopters as well as an abnormally

high lag of accommodation When their distance and near spatial area

of focus was compared the majority were focused at an intermediate

area in space suggesting a loss of control of accommodation in

space

47

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

B Drugs

C Exercise

D Learning new and challenging things

48

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements

prevent cognitive decline A systematic review of randomized controlled trials J Hum

Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among

preterm infants attributable to early supplementation of human milk with

docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings

and structural-functional synergies with cell membrane phospholipids Altern Med Rev

2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function

Neuroscience 20089(7)568-78

49

VIII Improving Brain Function and Neuroplasticity

B Drugs Maya Vetencourt JF Sale A Viegi A et al The antidepressant

fluoxetine (PROZAC) restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the

antidepressant tianeptine CNS Drugs 200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances

hippocampal long-term potentiation and memory BMC Biol 2008 Sep

9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine

improves neuropsychological disorders in a child with creatine

transporter defect Neurocase 200814(2) 151-61

50

VIII Improving Brain Function and Neuroplasticity

C Exercise

Hunsberger JG et al Antidepressant actions of the exercise-

regulated gene VGF Nat Med 2007 Dec 2 131476

VGF may be a common pathway by which exercise induces

neuroplasticity and growth-factor genes at least one of these might act

similarly to antidepressants in promoting an adaptive response to stress

However the tests used here may be modeling stress-induced

helplessness not depression hellipexercise seems to induce multiple

interacting genes that enhance neuronal resilience

51

VIII Improving Brain Function and Neuroplasticity

D Learning new and challenging things

What have we (optometry amp ophthalmology)

been thinking all these years

Where did we miss the news about neuroplasticity

52

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Huang JC Neuroplasticity as a proposed mechanism for the efficacy of optometric vision therapy and rehabilitation J Bev Optom 200920(4)96-100

Homologous area adaptationCompensatory masqueradeCross-modal reassignment

Map expansion

EquipotentialityVicariation

53

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Homologous area adaptation a transfer of function from a damaged brain area to a non-damaged brain area May be limited to early stages of human development and may crowd a new brain area resulting in reduced functionality of that brain area (Competition between spatial amp verbal functioning)

54

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Compensatory masquerade reorganizing of existing neuro-pathways to us alternative cognitive strategies to perform a task

55

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Cross-modal reassignment using new sensory input in a brain structure deprived of its main input source (changing processing from visual to tactile stimuli in the blind)

56

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Map expansion increase in brain mass due to repeated behavior or exposure to stimuli

57

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Equipotentiality anatomical areas of the brain can perform disparate functions

Vicariation redundant neural systems can operate under abnormal conditions

This may explain why recovery is noted for many neurological conditions (degenerative psychiatric developmental vascular traumatic)

58

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Constraint therapy Use it and improve it

Patching penalization ldquonear activitiesrdquo during amblyopia therapy

59

IX Improving Brain Function and Neuroplasticity Optometric Clinical ApplicationsOptometric Vision Therapy

Kleim amp Jones

Use it or lose it If you do not drive specific brain functions

functional loss will occur

If you want to improve oculomotor brain neuroplastic function amp

structure therapy should be specific for that brain function

Use it and improve it Therapy that drives cortical function enhances

that particular function

If you use therapy to improve oculomotor dysfunction it should

improve

Specificity The therapy you choose determines the resultant

plasticity and function

You must choose therapy that is appropriate

60

IX Improving Brain Function and Neuroplasticity Optometric Clinical Applications

Kleim amp Jones

Repetition matters Plasticity that results in functional change

requires repetition

Do the therapy Do it again Do it yet again No quick fix

Intensity matters Induction of plasticity requires the appropriate

amount of intensity

Intensity means strength force concentration power and passion

Without these plasticity may not occur Function may not improve

Time matters Different forms of plasticity take place at different

times during therapy

Do the basics than the more advanced therapeutic procedures

61

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Salience matters It has to be important to the individual

Make the therapy matter to the patient

Age matters Plasticity is easier in a younger brain but is also

possible in an adult brain

Do not let age determine what therapy options you offer your

patients Think of Susan Barry PhD (StereoSue) and her success

Offer your patients options Let them choose Be realistic about

outcomeshelliphave outcome measures built into therapy program

62

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Transference Neuroplasticity and the change in function

that results from one therapy can augment the attainment

of similar behaviors

What you do during oculomotor therapy may affected

vergence therapy outcomes

Interference Plasticity in response to one experience can

interfere with the acquisition of other behaviors

Monitor Evaluate progress Discuss function in other areas

of your patientslsquo life

63

Why pay attention to binocular vision dysfunctions

and neuroplasticity

December 2009 issue of the Review of Optometry

The Binocular Vision Dysfunction Pandemic

In 2010 almost 170 million individuals will be wearing glasses In

2010 there will also be up to 93 million amblyopes and 12 and a half

million strabismics For children under 18 years of age that means

there will be more than 22 and a half million amblyopes and millions

of children with strabismus A clinical trial to determine the

prevalence of binocular vision dysfunction within the general

population suggested the possibility of up to 56 or 173 million men

women and children with symptoms associated with a binocular

vision dysfunction 189 million (61) with accommodative problems

and 118 million (38) demonstrating various vergence

anomalies

64

65

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Brain plasticity life long changes in the structure of the brain

Sensory substitution replacement of one sensory input by another

Measurement techniques

Voxel based morphometryhellipmeasures difference in brain volume

Fluorodeoxyglucose glucose analog PET scan tells you

distribution and metabolism of brain

Cortical thickness measures

Visual cortex of the blind turns somatic ―The eye of the tongue

Transcranial magnetic stmiulation non-invasive technique to

stimulate cortex

66

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Blind Braille readers report tingling in fingers when pressure

phosphenes are applied Blind feel tingling in tongue

Bind use tongue to perform orientation task motion perception

sensory perception Visual cortex recruited in a variety of sensory

and cognitive tasks (DM Can we use tongue as a VT tool)

Dilks Reorganizations of human adult visual system

When a region of sensory cortex is deprived of its bottom up

input the deprived region begins to respond to stimuli that

normally activate adjacent cortex

67

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Retinotopic map changes for stroke pts Cortical reorganization in

adults occurs Perceived objectshellipelongation in stroke amp AMD

What happens to deprived cortex in AMD

fMRI shows cortical reorganization in adults

Proposed mechanisms

hellipGrowth of new connections

hellipUnmasking of pre-existing connections this is true

happens within seconds

Bavelier

Action video games

68

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Bavelier

Action video games Looked at attention Gamers can track more

activities

Attention over space (me peripheral awarenress) Useful field

of view shrinks with age

Performance not VA relatedhellipis related to attention

Action game playing changes spatial resolutionhellipovercoming

crowding in VA assessment (me amblyopia therapy)

Temporal resolution of vision Backward masking

changehellipbrain changes

Visual sensitivity (contrast sensitivity) Post action game training

improves CSF

69

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Action video games correcting optics of the cortex (me this is

actualy OVT)

Games factor

Variable entry leanringhellipadapt task to skill level

Incremental learning tune task to subjectlsquos leanring steps

Motivationarousal

Rewards

Self masterself confidence

Action games factors

Pacingrate of exposure to infohellipincreasing processing speed

Dynamic display

Rich environment

Rich motor involvement

70

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Surgeons may be made to play action games

Pilot training

Amblyopia tx Dennis Levi research

PresenterTitle Contact info

Neuroplasticity-A Paradigm Sea Change

This presentation is available at

httpwwwslidesharenetDMAINOneuroplasticity-a-paradigm-sea-change-2459693

httpwwwmainosmemosblogspotcom

My FaceBook Page

and

Twitter

PresenterTitle Contact info

Questions About

Neuroplasticity-A Paradigm Sea Change

Dominick M Maino OD MEd FAAO FCOVD-A

Professor PediatricsBinocular VisionIllinois Eye InstituteIllinois College of Optometry

dmainoicoeduhttpwwwMainosMemosblogspotcom

Thanks to

httpwwwcovdorgHomeOVDJournalOVD401tabid263D

efaultaspx

httpbipolarblastfileswordpresscom200908neurojpg

httpwwwspecialcheerscomimagesanimated_braingif

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contentuploads200810frankenstein-myspace-lightbeergif

httpwwwshangralafamilyfuncomgala-ecalvindreamgif

httppsychiatryjwatchorgcgicontentfull20082251

73

Chakraborty R Chatterjee A Choudhart S Chakraborty PK Neuroplasticitymdasha paradigm shift in neurosciences J Indian Med Assoc

2007105(9)513-4516-8520-1

Sacks O A neurologistlsquos notebook Stereo Sue Why two eyes are better than one The New Yorker 2006 Jun 1964-73

Krulwich R National Public Radio Going Binocular Susanlsquos First Snowfall Available at

wwwnprorgtemplatesstorystoryphpstoryId=5507789 (Accessed December 8 2008)

Press LJ The story behind Stereo Suelsquo and a world-famous neurologistlsquos discovery of vision therapy Optom Vis Dev 200637(2) 55-7

Levin HS Neuroplasticity and brain imaging research implications for rehabilitation Arch Phys Med Rehabil 2006 Dec87(12 Suppl

2)S1

Wiesel TN Hubel DH Single-cell responses in striate cortex of kittens deprived of vision in one eye J Neurophysiol 1963

Nov261003-17

Hook BM Chen C Critical periods in the visual system Changing views for a model of experience-dependent plasticity Neuron 2007

Oct56(2)312-26

Ramey CT Ramey SL Prevention of intellectual disabilities early interventions to improve cognitive development Prev Med 1998

Mar-Apr27(2)224-32

Heuninckx S Wenderoth N Swinnen SP Systems neuroplasticity in the aging brain recruiting additional neural resources for

successful motor performance in elderly persons J Neurosci 2008 Jan 228(1)91-9

Ge S Yang CH Hsu KS et al A critical period for enhanced synaptic plasticity in newly generated neurons of the adult brain Neuron

2007 May54(4)559-66

74

Draganski B Gaser C Busch V et al Neuroplasticity changes in grey matter induced by training Nature 2004 Jan 22427(6972)

311-2

Cannonieri GC Bonilha L Fernandes PT et al Practice and perfect length of training and structural brain changes in experienced

typists Neuroreport 2007 Jul 218(10)1063-6

Kleim JA Jones TA Principles of experience-dependent neural plasticity implications for rehabilitation after brain damage J

Speech Lang Hear Res 2008 Feb51(1)S225-39

Trojan S Porkorny J Theoretical aspects of neuroplasticity Physiol Res 199948(2)87-97

Ramamirtham R Kee CS Hung LF et al Wave aberrations in rhesus monkeys with vision-induced ametropias Vision Res 2007

Sep47(21)2751-66

Smith EL 3rd Ramamirtham R Qiao-Grider Y et al Effects of foveal ablation on emmetropization and form-deprivation myopia

Invest Ophthalmol Vis Sci 2007 Sep48(9)3914-22

Smith EL 3rd Kee CS Ramamirtham R et al Peripheral vision can influence eye growth and refractive development in infant

monkeys Invest Ophthalmol Vis Sci 2005 Nov46(11)3965-72

Ciuffreda KJ Vasudevan B Nearwork-induced transient myopia (NITM) and permanent myopiandashndashis there a link Ophthalmic

Physiol Opt 2008 Mar28(2)103-14

Hung GK Ciuffreda KJ Incremental retinal-defocus theory of myopia development--schematic analysis and computer simulation

Comput Biol Med 2007 Jul37(7)930-46

Hung GK Ciuffreda KJ A unifying theory of refractive error development Bull Math Biol 2000 Nov62(6)1087-108

75

Pang Y Maino D Zhang G Lu F Myopia Can its progress be controlled Optom Vis Dev 200637(2)75-9

Leung JT Brown B Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lenses Optom Vis Sci

1999 Jun76(6)346-54

Hasebe S Ohtsuki H Nonaka T et al Effect of progressive addition lenses on myopia progression in Japanese children a prospective

randomized double-masked crossover trial Invest Ophthalmol Vis Sci 2008 Jul49(7)2781-9

Gwiazda J Hyman L Hussein M et al A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression

of myopia in children Invest Ophthalmol Vis Sci 2003 Apr44(4)1492-500

Siatkowski RM Cotter SA Crockett RS et al Two-year multi-center randomized double-masked placebo-controlled parallel safety and

efficacy study of 2 pirenzepine ophthalmic gel in children with myopia J AAPOS 2008 Aug12(4)332-9

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged 7 to 17 years Arch Ophthalmol 2005

Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three to less than 10 years of age Am J

Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction Am J Ophthalmol 2007

Jun143(6)1060-3

Holmes JM Edwards AR Beck RW et al A randomized pilot study of near activities versus non-near activities during patching therapy for

amblyopia J AAPOS 2005 Apr9(2)129-36

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate

amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-57

76

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic

amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Convergence Insufficiency Treatment Trial Study Group Randomized clinical trial of treatments for symptomatic convergence insufficiency

in children Arch Ophthalmol 2008 Oct126(10)1336-49

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

Solan HA Shelley-Tremblay J Hansen PC et al M-cell deficit and reading disability a preliminary study of the effects of temporal vision-

processing therapy Optometry 2004 Oct75(10)640-50

Solan HA Larson S Shelley-Tremblay J et al Role of visual attention in cognitive control of oculomotor readiness in students with reading

disabilities J Learn Disabil 2001 Mar-Apr34(2)107-18

Gallaway M Boas MB The impact of vergence and accommodative therapy on reading eye movements and reading speed Optom Vis Dev

200738(3)115-20

Goss DA Downing DB Lowther AH et al The effect of HTS vision therapy conducted in a school setting on reading skills in third and

fourth grade students Optom Vis Dev 200738(1)27-32

Crutch SJ Warrington EK Foveal crowding in posterior cortical atrophy a specific early-visual-processing deficit affecting word reading

Cogn Neuropsychol 2007 Dec24(8)843-66

Helms D Sawtelle SM A study of the effectiveness of cognitive therapy delivered in a video game format Optom Vis Dev 200738 (1)19-

26

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

77

Lawton T Training direction-discrimination sensitivity remediates a wide spectrum of reading skills OptomVis Dev 200738(1) 33-47

Goldstand S Koslowe KC Parush S Vision visual-information processing and academic performance among seventh-grade schoolchildren a

more significant relationship than we thought Am J Occup Ther 2005 Jul-Aug59(4)377-89

Fischer B Koumlngeter A Hartnegg K Effects of daily practice on subitizing visual counting and basic arithmetic skills Optom Vis Dev

200839(1)30-4

Sands W Taub M Maino D Limited research and education on special populations in optometry and ophthalomology Optom Vis Dev

200839(2)60-1

Wesson M Maino D Oculo-visual findings in Down syndrome cerebral palsy and mental retardation with non-specific etiology In Maino D

(ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 199517-54 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

Cui Y Stapleton F Suttle C Developing an instrument to assess vision-related and subjective quality of life in children with intellectual

disability data collection and preliminary analysis in a Chinese population Ophthal Physiolog Optics 2008 May28(3) 238-46

Maino D Steele G Tahir S Sajja R Attitudes of optometry students toward individuals with disabilities Optom Ed 200227(2)45-50

Maino D Special populations in the optometric curriculum Optom Ed 200227(2)38-9

Maino D Overview of special populations In Scheiman M Rouse M (eds) Optometric Management of Learning-Related Vision Problems

St Louis Mosby Inc 200685-106

Maino D (ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 1995 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

78

McCarthy P Maino D Alport syndrome a review Clin Eye Vis Care 2000 Dec12(3-4)139-50

Block SS Brusca-Vega R Pizzi WJ et al Cognitive and visual processing skills and their relationship to mutation size in full and

permutation female fragile X carriers Optom Vis Sci 2000 Nov77 (11)592-9

Maino D The young child with developmental disabilities An introduction to mental retardation and genetic syndromes In Moore BD

(ed) Eye Care for Infants and Young Children Butter-worth--Heinemann Newton MA1997285-300

Amin V Maino D The Fragile X female Visual visual perceptual and ocular health anomalies J Am Optom Assoc 1995 May66

(5)290-95

Maino DM Maino JH Cibis GW Hecht F Ocular health anomalies in patients with developmental disabilities In Maino D (ed)

Diagnosis and Management of Special Populations Mosby-Year-book Inc St Louis MO 1995189-206 Reprinted Optometric

Education Program Foundation Santa Anna Calif 2001

Maino D Wesson M Schlange D Cibis G Maino J Optometric findings in the fragile X syndrome Optom Vis Sci 199168634-40

Scheiman MMOptometric findings in children with cerebral palsy Am J Optom Physiol Opt 1984 May61(5)321-3

Maino D Maino J Maino S Mental retardation syndromes with associated ocular defects J Am Optom Assoc 199061707-16

Stewart RE Woodhouse JM Cregg M Pakeman VH Association between accommodative accuracy hypermetropia and strabismus in

children with Downs syndrome Optom Vis Sci 2007 Feb84(2)149-55

Cregg M Woodhouse JM Pakeman VH et al Accommodation and refractive error in children with Down syndrome cross-sectional

and longitudinal studies Invest Ophthalmol Vis Sci 2001 Jan42 (1)55-63

79

McClelland JF Parkes J Hill N et al Accommodative dysfunction in children with cerebral palsy a population-

based study Invest Ophthalmol Vis Sci 2006 May47(5)1824-30

Duckman RH Vision therapy for the child with cerebral palsy J Am Optom Assoc 198758(1)28-35

Duckman R Accommodation in cerebral palsy function and remediation J Am Optom Assoc 198455(4)281-3

Scheiman M Understanding and managing vision deficits a guide for occupational therapists 2nd ed Slack

Thorofare NJ 2002

Maino D Binasal occlusion for the child with Cerebral Palsy J Ill Optom Assoc 198644(1)1218

Battaglia F Quartarone A Rizzo V et al Early impairment of synaptic plasticity in patients with Downs syndrome

Neurobiol Aging 2008 Aug29(8)1272-5

Bonnier C Evaluation of early stimulation programs for enhancing brain development Acta Paediatr 2008

Jul97(7)853-8

Morice E Andreae LC Cooke SF et al Preservation of long-term memory and synaptic plasticity despite short-term

impairments in the Tc1 mouse model of Down syndrome Learn Mem 2008 Jul 1415(7)492-500

Gordon AM Schneider JA Chinnan A Charles JR Efficacy of a hand-arm bimanual intensive therapy (HABIT) in

children with hemiplegic cerebral palsy a randomized control trial Dev Med Child Neurol 2007 Nov49(11)830-8

Kapoor N Ciuffreda KJ Vision disturbances following traumatic brain injury Curr Treat Options Neurol 2002

Jul4(4)271-80

80

Ciuffreda KJ Rutner D Kapoor N et al Vision therapy for oculomotor dysfunctions in acquired brain injury a

retrospective analysis Optometry 2008 Jan79(1)18-22

Ciuffreda KJ Han Y Kapoor N Ficarra AP Oculomotor rehabilitation for reading in acquired brain injury

NeuroRehabilitation 200621(1)9-21

Zost M Diagnosis and management of visual dysfunction in cerebral injury In Maino D (ed) Diagnosis and

Management of Special Populations Mosby-Yearbook Inc St Louis 199579 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001 [Figure used with permission of the editor]

DeGutis JM Bentin S Robertson LC DEsposito M Functional plasticity in ventral temporal cortex following

cognitive rehabilitation of a congenital prosopagnosic J Cogn Neurosci 2007 Nov19 (11)1790-802

Welbourne SR Ralph MA Exploring the impact of plasticity-related recovery after brain damage in a connectionist

model of single-word reading Cogn Affect Behav Neurosci 2005 Mar5(1)77-92

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements prevent cognitive decline A

systematic review of randomized controlled trials J Hum Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among preterm infants attributable to early

supplementation of human milk with docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings and structural-functional

synergies with cell membrane phospholipids Altern Med Rev 2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function Neuroscience 20089(7)568-78

81

Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

BMC Biol 2008 Sep 9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine improves neuropsychological disorders in a child with

creatine transporter defect Neurocase 200814(2) 151-61

Forrester LW Wheaton LA Luft AR Exercise-mediated locomotor recovery and lower-limb neuroplasticity after

stroke J Rehabil Res Dev 200845(2)205-20

82

Page 7: Neuroplasticity: A Paradigm Sea Change Latest Updated File

7

The BrainA hellip is not just a static soft round mass bathed in a fluid and surrounded by a hard caseB hellip can change its form and resultant function through neuroplasticity

The BrainA hellip is not just a static soft round mass bathed in a fluid and surrounded by a hard caseB hellip can change its form and resultant function through neuroplasticity

The BrainA hellip is not just a static soft round mass bathed in a fluid and surrounded by a hard caseB hellip can change its form and resultant function through neuroplasticity

The BrainA hellip is not just a static soft round mass bathed in a fluid and surrounded by a hard caseB hellip can change its form and resultant function through neuroplasticity

II The Brain

hellip is not just a static soft round mass bathed in a fluid and surrounded by a hard case

hellip can change its form and resultant function through neuroplasticity

8

III CriticalSensitive Periods

A A critical period occurs when the individual is sensitive to environmental influences and stimulation

1 The Precritical period The initial formation of neuronal circuits that is not dependent on visual experience

9

CriticalSensitive Periods

2 The Critical period A distinct onset of robust plasticity in response to the visual experience when the initially formed circuit can be modified by experience

3 Closure of the critical period After the end of the critical period the same visual experience no longer elicits the same degree of plasticity

10

CriticalSensitive Periods

B The concept of a critical period does not imply that neuroplasticity ends after a certain age

C Sensitive period begins and ends gradually (not abruptly like the critical period) and provides for maximum sensitivity

to stimuli

11

VI Neuroplasticity and the Brain

A Can adult brain neurons actually exhibit neuroplasticity The short answer is yes

B Resultant changes are noted in not only functional outcomes but also in brain anatomy and structure

12

IV Neuroplasticity and Rehabilitation

Kleim amp Jones note that

A The Key Principles of Experience-Dependent Neural Plasticity

1 Use it or lose it

2 Use it and improve it

3 Specificity

13

4 Repetition matters

5 Intensity matters

6 Time matters

7 Salience matters

14

8 Age matters

9 Transference

10 Interference

15

Use it or lose it If you do not drive specific brain functions

functional loss will occur

Use it and improve it Therapy that drives cortical function

enhances that particular function

Specificity The therapy you choose determines the resultant

plasticity and function

Repetition matters Plasticity that results in functional change

requires repetition

16

Intensity matters Induction of plasticity requires the appropriate

amount of intensity

Time matters Different forms of plasticity take place at different

times during therapy

Salience matters It has to be important to the individual

Age matters Plasticity is easier in a younger brain but is also

possible in an adult brain

17

Transference Neuroplasticity and the change in function that

results from one therapy can augment the attainment of similar

behaviors

Interference Plasticity in response to one experience can interfere

with the acquisition of other behaviors

18

B Examples of Changes in Function and Structure

1) Jugglers

2) Typists

19

B Examples of Changes in Function and Structure

1) Jugglers

One study suggested that adults taught how to juggle demonstrated a

significant transient bilateral expansion of gray matter in the mid-

temporal area and the left posterior intraparietal sulcus between baseline brain scan and

follow-up The findings were specific to training stimulus individuals who were

not instructed how to juggle demonstrated no change in gray

matter over the same period These findings oppose the conventional

understanding that the anatomical structure of the adult brain does not change

over time

20

B Examples of Changes in Function and Structure

2) Typists

helliplong-term bimanual training also increases

gray matter volume in experienced adult typists

These results suggest that learning not

only affects function but also structure in

adult brains

21

V Neuroplasticity and Optometry

A Evolutionary neuroplasticity

B Reactive plasticity

C Adaptational plasticity

D Reparation plasticity

22

V Neuroplasticity and Optometry

A Evolutionary neuroplasticity

hellip is ideally suited for the developmental OD who

specializes in vision function as it changes over time

either with or without intervention

23

V Neuroplasticity and Optometry

B Reactive plasticity

hellip can be thought of as the immediate effect that

initial optometric treatment may have on a system This can

be reflected in an immediate but often transient change in

the individuallsquos accommodative systemmdashie when an

uncorrected myope initially puts on his or her new

spectacles

24

V Neuroplasticity and Optometry

C Adaptational plasticity

hellip could describe the long-term effects of in-office optometric

vision therapy on disorders of the binocular vision system

25

V Neuroplasticity and Optometry

D Reparation plasticity

hellipin contrast to adaptational

plasticity reparation plasticity may

occur during treatment by a low

Vision specialist or an OD

Working with those who have

Experienced a traumatic brain

injury (TBI)

26

V Neuroplasticity and Optometry

The effects of plasticity can lead to either

positive or negative changes during

development (evolutionary plasticity) after

short-term exposure (reactive plasticity)

after long-term or continuous stimuli

(adaptational plasticity) and during

functional or structural recovery of damaged

neuronal circuits (reparation plasticity)

httpwwwciteulikeorguserjasonepriorarticle2856526

27

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

A Refractive error development

B Amblyopia

C Strabismus

28

D Non-strabismus non-amblyopic binocular vision disorders

E Learning related vision anomalies

F Vision developmentperception disorders

29

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

A Refractive error development

Several recent studies have noted that neuroplasticity may play a

role in refractive error development

retinal defocus use of progressive addition lenses

drug studies (M1-antagonist2 pirenzepine ) slow myopia

progression demonstrated nearly a 50 reduction in myopia

progression over a two-year period

30

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged

7 to 17 years Arch Ophthalmol 2005 Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three

to less than 10 years of age Am J Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction

Am J Ophthalmol 2007 Jun143(6)1060-3

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine

vs patching for treatment of moderate amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-

57

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for

strabismic and anisometropic amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Treatment of severe amblyopia with weekend atropine results from 2 randomized clinical trials

Levodopacarbidopa in the treatment of amblyopia

31

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

J Pediatr Ophthalmol Strabismus 2009 Mar-Apr46(2)87-90 quiz 91-2 Levodopacarbidopa in the

treatment of amblyopia Dadeya S Vats P Malik KP

PURPOSE To evaluate the role of levodopacarbidopa in the treatment of amblyopia METHODS

Thirty patients with strabismic amblyopia between the ages of 3 and 12 years were part of this double-

blind randomized study Patients were divided into two groups Group A received 050 mg + 125 mg of

levodopacarbidopa per kilogram body weight three times daily after meals with a protein rich drink

whereas Group B received placebo Both groups received full-time conventional occlusion until a visual

acuity of 66 was achieved or for a maximum of 3 months RESULTS The authors observed more than

two lines improvement in visual acuity that was greater in the levodopa group (15 of 15) than in the

placebo group (9 of 15) (P lt 005) Furthermore improvement in visual acuity of more than two lines

was greater in patients younger than 8 years (100) than in patients older than 8 years of age (60) (P =

0026) There was also no significant reversal of the improved visual acuity in up to 6 months of follow-

up CONCLUSION Levodopacarbidopa improves visual acuity in patients with

amblyopia and maintains improved visual acuity especially in patients

younger than 8 years

32

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

J Pediatr Ophthalmol Strabismus 2008 May-Jun45(3)174-6 The use of levodopa in the treatment of

bilateral amblyopia secondary to uncorrected high hypermetropia Abrams MS

The standard treatment of bilateral amblyopia secondary to uncorrected high bilateral hypermetropia has

been spectacles and time The patient described here failed to show adequate improvement in visual

acuity after 18 months of standard treatment Visual acuity improved dramatically when the

patient began taking levodopa dropped precipitously when the medication was

discontinued and returned quickly to post-treatment levels when levodopa was

restarted Visual acuity remained stable when the medication was slowly tapered

and discontinued This report suggests that dopamine may play a role in the pathophysiology of

bilateral amblyopia secondary to uncorrected high bilateral hypermetropia

33

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

Bottom Line

Amblyopia can be treated at any age

May be able to use neuro-enhancing drugs

as a part of basic amblyopia therapy

34

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

C Strabismus and non-strabismic non-amblyopic binocular

vision disorders

Clinical Trial of Treatments for Symptomatic Convergence Insufficiency in Children has

clearly demonstrated the superiority of in-office optometric vision therapy (in conjunction

with home therapy) vs out-of-office therapy alone The study concluded that optometric

vision therapyorthoptics was more effective than pencil push-ups or placebo vision

therapyorthoptics in reducing symptoms and improving clinical signs of convergence

insufficiency

Long-term effectiveness of treatments for symptomatic convergence insufficiency

in children (Optom Vis Sci 2009 Sep86(9)1096-103)

CITT patients improvements lasted a year

35

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

Strabismus 1999 Sep7(3)169-74 Convergence insufficiency in

idiopathic Parkinsons disease responsive to levodopa Racette BA

Gokden MS Tychsen LS Perlmutter JS

We report a patient with pathologically proven idiopathic Parkinsons

disease (IPD) who developed diplopia secondary to convergence

insufficiency during his motor off periods Diplopia resolved with

onset of motor benefit from levodopa Neuro-ophthalmologic

examination demonstrated convergence insufficiency during motor

off periods that was alleviated after onset of motor benefit from

levodopa This is the first reported case of convergence insufficiency

in IPD responsive to levodopa

36

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

Bottom Line

Optometric Vision Therapy is the most efficacious treatment available for binocular vision disorders and the

treatment effects are long lasting Neuro-enhancing drugs

may assist us as well

37

EF Learning related vision anomalies Vision

developmentperception disorders

hellipresearch includes an examination of the role vision plays in

reading the effect of oculomotor vergence and

accommodativecoherent motion therapy on reading eye movements

and reading speed the diagnosis and treatment of perceptual

disorders and the effect of therapy on various learning anomalies

38

EF Learning related vision anomalies Vision developmentperception disorders

magnocellular (MC) deficit in dyslexia

LM speed-matching ratio predicts reading in childrenChase C Dougherty RF Ray N

Fowler S Stein JOptom Vis Sci 2007 Mar84(3)229-36

Effect of attention therapy on reading comprehension Solan HA Shelley-Tremblay J

Ficarra A Silverman M Larson S J Learn Disabil 2003 Nov-Dec36(6)556-63

Is there a common linkage among reading comprehension visual attention and

magnocellular processing Solan HA Shelley-Tremblay JF Hansen PC Larson S

J Learn Disabil 2007 May-Jun40(3)270-8

Lawton T Filtered Text and Direction Discrimination Training Improved Reading

Fluency for Both Dyslexic and Normal Readers Optom Vis Dev 200839 (3)114

Fischer B Hartnegg K Saccade control in dyslexia Development deficits training

and transfer to reading Optom Vis Dev 200839(4)181-190

39

EF Learning related vision anomalies Vision developmentperception disorders

J Learn Disabil 2003 Nov-Dec36(6)556-63 Effect of attention therapy on reading

comprehension Solan HA Shelley-Tremblay J Ficarra A Silverman M Larson S

hellip At the completion of attention therapy the mean

standard attention and reading comprehension scores of

the experimental group had improved significantly The

control group however showed no significant

improvement in reading comprehension scores after 12

weeks Although uncertainties still exist this investigation

supports the notion that visual attention is malleable and

that attention therapy has a significant effect on reading

comprehension in this often neglected population

40

VII Vision dysfunction association with acquired brain injury

A Exotropia (or high exophoriaCI)

B Accommodative dysfunction

C Convergence insufficiency

41

D Decreased blink rate

E Spatial disorientation

F Pursuitsaccade dysfunction

G Unstable ambient vision (Magnocellular pathway)

42

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Stelmack JA Frith T Van Koevering D Rinne S Stelmack TR Visual function in patients

followed at a Veterans Affairs polytrauma network site an electronic medical record review

Optometry 2009 Aug80(8)419-24

RESULTS Visual symptoms were self-reported by 76 of patients

with polytrauma and 75 of the patients with TBI Problems with reading

(polytrauma 60 and TBI 50) and accommodation (polytrauma 30 and

TBI 47) were frequently found on eye examinations Spectacles were the

treatment most frequently prescribed (polytrauma 62 and TBI 78)

CONCLUSIONS It is important for optometrists to be aware of the high

rates of self-reported symptoms and visual problems in military personnel

returning from deployment to the wars in Iraq and Afghanistan Post-

traumatic stress disorder and depression may complicate optometric

evaluation and management

43

VII Vision dysfunction association with acquired brain injury

Avoidance of near tasks

Oculomotor-based reading difficulties

Eye tracking problems

Eye focusing problems

Eyestrain Diplopia

Dizziness Vertigo

Vision-derived nausea

44

VII Vision dysfunction association with acquired brain injury

Increased sensitivity to visual motion

Visual inattention and distractibility

Short-term visual memory loss

Difficulty judging distances (relative and absolute

Difficulty with global scanning

Difficulty with personal grooming especially involving the face

Inability to interactcope visually in a complex social situation

(eg minimal eye contact)

Inability to tolerate complex visual environments (eg grocery store

aisles and highly-patterned floors)

45

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Ciuffreda KJ Ludlam DP Kapoor N Clinical oculomotor training in traumatic brain injury Optom Vis

Dev 200940(1)16-23

Individuals with traumatic brain injury present with a constellation of

oculomotor dysfunctions and correlated symptoms Simple and

effective clinical oculomotor-based training procedures will be

presented with respect to the versional vergence and

accommodative systems and their interactions These therapeutic

procedures can also be applied as needed to individuals with either

low vision neurological dysfunctions or general visual skills cases

manifesting similar oculomotor deficits

46

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Leslie S Myopia and accommodative insufficiency associated with

moderate head trauma Opt Vis Dev 200940(1)25-31

The majority of subjects reviewed had developed a stable degree of

myopia between 100 and 200 diopters as well as an abnormally

high lag of accommodation When their distance and near spatial area

of focus was compared the majority were focused at an intermediate

area in space suggesting a loss of control of accommodation in

space

47

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

B Drugs

C Exercise

D Learning new and challenging things

48

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements

prevent cognitive decline A systematic review of randomized controlled trials J Hum

Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among

preterm infants attributable to early supplementation of human milk with

docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings

and structural-functional synergies with cell membrane phospholipids Altern Med Rev

2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function

Neuroscience 20089(7)568-78

49

VIII Improving Brain Function and Neuroplasticity

B Drugs Maya Vetencourt JF Sale A Viegi A et al The antidepressant

fluoxetine (PROZAC) restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the

antidepressant tianeptine CNS Drugs 200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances

hippocampal long-term potentiation and memory BMC Biol 2008 Sep

9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine

improves neuropsychological disorders in a child with creatine

transporter defect Neurocase 200814(2) 151-61

50

VIII Improving Brain Function and Neuroplasticity

C Exercise

Hunsberger JG et al Antidepressant actions of the exercise-

regulated gene VGF Nat Med 2007 Dec 2 131476

VGF may be a common pathway by which exercise induces

neuroplasticity and growth-factor genes at least one of these might act

similarly to antidepressants in promoting an adaptive response to stress

However the tests used here may be modeling stress-induced

helplessness not depression hellipexercise seems to induce multiple

interacting genes that enhance neuronal resilience

51

VIII Improving Brain Function and Neuroplasticity

D Learning new and challenging things

What have we (optometry amp ophthalmology)

been thinking all these years

Where did we miss the news about neuroplasticity

52

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Huang JC Neuroplasticity as a proposed mechanism for the efficacy of optometric vision therapy and rehabilitation J Bev Optom 200920(4)96-100

Homologous area adaptationCompensatory masqueradeCross-modal reassignment

Map expansion

EquipotentialityVicariation

53

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Homologous area adaptation a transfer of function from a damaged brain area to a non-damaged brain area May be limited to early stages of human development and may crowd a new brain area resulting in reduced functionality of that brain area (Competition between spatial amp verbal functioning)

54

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Compensatory masquerade reorganizing of existing neuro-pathways to us alternative cognitive strategies to perform a task

55

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Cross-modal reassignment using new sensory input in a brain structure deprived of its main input source (changing processing from visual to tactile stimuli in the blind)

56

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Map expansion increase in brain mass due to repeated behavior or exposure to stimuli

57

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Equipotentiality anatomical areas of the brain can perform disparate functions

Vicariation redundant neural systems can operate under abnormal conditions

This may explain why recovery is noted for many neurological conditions (degenerative psychiatric developmental vascular traumatic)

58

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Constraint therapy Use it and improve it

Patching penalization ldquonear activitiesrdquo during amblyopia therapy

59

IX Improving Brain Function and Neuroplasticity Optometric Clinical ApplicationsOptometric Vision Therapy

Kleim amp Jones

Use it or lose it If you do not drive specific brain functions

functional loss will occur

If you want to improve oculomotor brain neuroplastic function amp

structure therapy should be specific for that brain function

Use it and improve it Therapy that drives cortical function enhances

that particular function

If you use therapy to improve oculomotor dysfunction it should

improve

Specificity The therapy you choose determines the resultant

plasticity and function

You must choose therapy that is appropriate

60

IX Improving Brain Function and Neuroplasticity Optometric Clinical Applications

Kleim amp Jones

Repetition matters Plasticity that results in functional change

requires repetition

Do the therapy Do it again Do it yet again No quick fix

Intensity matters Induction of plasticity requires the appropriate

amount of intensity

Intensity means strength force concentration power and passion

Without these plasticity may not occur Function may not improve

Time matters Different forms of plasticity take place at different

times during therapy

Do the basics than the more advanced therapeutic procedures

61

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Salience matters It has to be important to the individual

Make the therapy matter to the patient

Age matters Plasticity is easier in a younger brain but is also

possible in an adult brain

Do not let age determine what therapy options you offer your

patients Think of Susan Barry PhD (StereoSue) and her success

Offer your patients options Let them choose Be realistic about

outcomeshelliphave outcome measures built into therapy program

62

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Transference Neuroplasticity and the change in function

that results from one therapy can augment the attainment

of similar behaviors

What you do during oculomotor therapy may affected

vergence therapy outcomes

Interference Plasticity in response to one experience can

interfere with the acquisition of other behaviors

Monitor Evaluate progress Discuss function in other areas

of your patientslsquo life

63

Why pay attention to binocular vision dysfunctions

and neuroplasticity

December 2009 issue of the Review of Optometry

The Binocular Vision Dysfunction Pandemic

In 2010 almost 170 million individuals will be wearing glasses In

2010 there will also be up to 93 million amblyopes and 12 and a half

million strabismics For children under 18 years of age that means

there will be more than 22 and a half million amblyopes and millions

of children with strabismus A clinical trial to determine the

prevalence of binocular vision dysfunction within the general

population suggested the possibility of up to 56 or 173 million men

women and children with symptoms associated with a binocular

vision dysfunction 189 million (61) with accommodative problems

and 118 million (38) demonstrating various vergence

anomalies

64

65

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Brain plasticity life long changes in the structure of the brain

Sensory substitution replacement of one sensory input by another

Measurement techniques

Voxel based morphometryhellipmeasures difference in brain volume

Fluorodeoxyglucose glucose analog PET scan tells you

distribution and metabolism of brain

Cortical thickness measures

Visual cortex of the blind turns somatic ―The eye of the tongue

Transcranial magnetic stmiulation non-invasive technique to

stimulate cortex

66

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Blind Braille readers report tingling in fingers when pressure

phosphenes are applied Blind feel tingling in tongue

Bind use tongue to perform orientation task motion perception

sensory perception Visual cortex recruited in a variety of sensory

and cognitive tasks (DM Can we use tongue as a VT tool)

Dilks Reorganizations of human adult visual system

When a region of sensory cortex is deprived of its bottom up

input the deprived region begins to respond to stimuli that

normally activate adjacent cortex

67

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Retinotopic map changes for stroke pts Cortical reorganization in

adults occurs Perceived objectshellipelongation in stroke amp AMD

What happens to deprived cortex in AMD

fMRI shows cortical reorganization in adults

Proposed mechanisms

hellipGrowth of new connections

hellipUnmasking of pre-existing connections this is true

happens within seconds

Bavelier

Action video games

68

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Bavelier

Action video games Looked at attention Gamers can track more

activities

Attention over space (me peripheral awarenress) Useful field

of view shrinks with age

Performance not VA relatedhellipis related to attention

Action game playing changes spatial resolutionhellipovercoming

crowding in VA assessment (me amblyopia therapy)

Temporal resolution of vision Backward masking

changehellipbrain changes

Visual sensitivity (contrast sensitivity) Post action game training

improves CSF

69

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Action video games correcting optics of the cortex (me this is

actualy OVT)

Games factor

Variable entry leanringhellipadapt task to skill level

Incremental learning tune task to subjectlsquos leanring steps

Motivationarousal

Rewards

Self masterself confidence

Action games factors

Pacingrate of exposure to infohellipincreasing processing speed

Dynamic display

Rich environment

Rich motor involvement

70

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Surgeons may be made to play action games

Pilot training

Amblyopia tx Dennis Levi research

PresenterTitle Contact info

Neuroplasticity-A Paradigm Sea Change

This presentation is available at

httpwwwslidesharenetDMAINOneuroplasticity-a-paradigm-sea-change-2459693

httpwwwmainosmemosblogspotcom

My FaceBook Page

and

Twitter

PresenterTitle Contact info

Questions About

Neuroplasticity-A Paradigm Sea Change

Dominick M Maino OD MEd FAAO FCOVD-A

Professor PediatricsBinocular VisionIllinois Eye InstituteIllinois College of Optometry

dmainoicoeduhttpwwwMainosMemosblogspotcom

Thanks to

httpwwwcovdorgHomeOVDJournalOVD401tabid263D

efaultaspx

httpbipolarblastfileswordpresscom200908neurojpg

httpwwwspecialcheerscomimagesanimated_braingif

httpblogmarsdencartoonscomwp-

contentuploads200810frankenstein-myspace-lightbeergif

httpwwwshangralafamilyfuncomgala-ecalvindreamgif

httppsychiatryjwatchorgcgicontentfull20082251

73

Chakraborty R Chatterjee A Choudhart S Chakraborty PK Neuroplasticitymdasha paradigm shift in neurosciences J Indian Med Assoc

2007105(9)513-4516-8520-1

Sacks O A neurologistlsquos notebook Stereo Sue Why two eyes are better than one The New Yorker 2006 Jun 1964-73

Krulwich R National Public Radio Going Binocular Susanlsquos First Snowfall Available at

wwwnprorgtemplatesstorystoryphpstoryId=5507789 (Accessed December 8 2008)

Press LJ The story behind Stereo Suelsquo and a world-famous neurologistlsquos discovery of vision therapy Optom Vis Dev 200637(2) 55-7

Levin HS Neuroplasticity and brain imaging research implications for rehabilitation Arch Phys Med Rehabil 2006 Dec87(12 Suppl

2)S1

Wiesel TN Hubel DH Single-cell responses in striate cortex of kittens deprived of vision in one eye J Neurophysiol 1963

Nov261003-17

Hook BM Chen C Critical periods in the visual system Changing views for a model of experience-dependent plasticity Neuron 2007

Oct56(2)312-26

Ramey CT Ramey SL Prevention of intellectual disabilities early interventions to improve cognitive development Prev Med 1998

Mar-Apr27(2)224-32

Heuninckx S Wenderoth N Swinnen SP Systems neuroplasticity in the aging brain recruiting additional neural resources for

successful motor performance in elderly persons J Neurosci 2008 Jan 228(1)91-9

Ge S Yang CH Hsu KS et al A critical period for enhanced synaptic plasticity in newly generated neurons of the adult brain Neuron

2007 May54(4)559-66

74

Draganski B Gaser C Busch V et al Neuroplasticity changes in grey matter induced by training Nature 2004 Jan 22427(6972)

311-2

Cannonieri GC Bonilha L Fernandes PT et al Practice and perfect length of training and structural brain changes in experienced

typists Neuroreport 2007 Jul 218(10)1063-6

Kleim JA Jones TA Principles of experience-dependent neural plasticity implications for rehabilitation after brain damage J

Speech Lang Hear Res 2008 Feb51(1)S225-39

Trojan S Porkorny J Theoretical aspects of neuroplasticity Physiol Res 199948(2)87-97

Ramamirtham R Kee CS Hung LF et al Wave aberrations in rhesus monkeys with vision-induced ametropias Vision Res 2007

Sep47(21)2751-66

Smith EL 3rd Ramamirtham R Qiao-Grider Y et al Effects of foveal ablation on emmetropization and form-deprivation myopia

Invest Ophthalmol Vis Sci 2007 Sep48(9)3914-22

Smith EL 3rd Kee CS Ramamirtham R et al Peripheral vision can influence eye growth and refractive development in infant

monkeys Invest Ophthalmol Vis Sci 2005 Nov46(11)3965-72

Ciuffreda KJ Vasudevan B Nearwork-induced transient myopia (NITM) and permanent myopiandashndashis there a link Ophthalmic

Physiol Opt 2008 Mar28(2)103-14

Hung GK Ciuffreda KJ Incremental retinal-defocus theory of myopia development--schematic analysis and computer simulation

Comput Biol Med 2007 Jul37(7)930-46

Hung GK Ciuffreda KJ A unifying theory of refractive error development Bull Math Biol 2000 Nov62(6)1087-108

75

Pang Y Maino D Zhang G Lu F Myopia Can its progress be controlled Optom Vis Dev 200637(2)75-9

Leung JT Brown B Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lenses Optom Vis Sci

1999 Jun76(6)346-54

Hasebe S Ohtsuki H Nonaka T et al Effect of progressive addition lenses on myopia progression in Japanese children a prospective

randomized double-masked crossover trial Invest Ophthalmol Vis Sci 2008 Jul49(7)2781-9

Gwiazda J Hyman L Hussein M et al A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression

of myopia in children Invest Ophthalmol Vis Sci 2003 Apr44(4)1492-500

Siatkowski RM Cotter SA Crockett RS et al Two-year multi-center randomized double-masked placebo-controlled parallel safety and

efficacy study of 2 pirenzepine ophthalmic gel in children with myopia J AAPOS 2008 Aug12(4)332-9

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged 7 to 17 years Arch Ophthalmol 2005

Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three to less than 10 years of age Am J

Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction Am J Ophthalmol 2007

Jun143(6)1060-3

Holmes JM Edwards AR Beck RW et al A randomized pilot study of near activities versus non-near activities during patching therapy for

amblyopia J AAPOS 2005 Apr9(2)129-36

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate

amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-57

76

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic

amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Convergence Insufficiency Treatment Trial Study Group Randomized clinical trial of treatments for symptomatic convergence insufficiency

in children Arch Ophthalmol 2008 Oct126(10)1336-49

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

Solan HA Shelley-Tremblay J Hansen PC et al M-cell deficit and reading disability a preliminary study of the effects of temporal vision-

processing therapy Optometry 2004 Oct75(10)640-50

Solan HA Larson S Shelley-Tremblay J et al Role of visual attention in cognitive control of oculomotor readiness in students with reading

disabilities J Learn Disabil 2001 Mar-Apr34(2)107-18

Gallaway M Boas MB The impact of vergence and accommodative therapy on reading eye movements and reading speed Optom Vis Dev

200738(3)115-20

Goss DA Downing DB Lowther AH et al The effect of HTS vision therapy conducted in a school setting on reading skills in third and

fourth grade students Optom Vis Dev 200738(1)27-32

Crutch SJ Warrington EK Foveal crowding in posterior cortical atrophy a specific early-visual-processing deficit affecting word reading

Cogn Neuropsychol 2007 Dec24(8)843-66

Helms D Sawtelle SM A study of the effectiveness of cognitive therapy delivered in a video game format Optom Vis Dev 200738 (1)19-

26

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

77

Lawton T Training direction-discrimination sensitivity remediates a wide spectrum of reading skills OptomVis Dev 200738(1) 33-47

Goldstand S Koslowe KC Parush S Vision visual-information processing and academic performance among seventh-grade schoolchildren a

more significant relationship than we thought Am J Occup Ther 2005 Jul-Aug59(4)377-89

Fischer B Koumlngeter A Hartnegg K Effects of daily practice on subitizing visual counting and basic arithmetic skills Optom Vis Dev

200839(1)30-4

Sands W Taub M Maino D Limited research and education on special populations in optometry and ophthalomology Optom Vis Dev

200839(2)60-1

Wesson M Maino D Oculo-visual findings in Down syndrome cerebral palsy and mental retardation with non-specific etiology In Maino D

(ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 199517-54 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

Cui Y Stapleton F Suttle C Developing an instrument to assess vision-related and subjective quality of life in children with intellectual

disability data collection and preliminary analysis in a Chinese population Ophthal Physiolog Optics 2008 May28(3) 238-46

Maino D Steele G Tahir S Sajja R Attitudes of optometry students toward individuals with disabilities Optom Ed 200227(2)45-50

Maino D Special populations in the optometric curriculum Optom Ed 200227(2)38-9

Maino D Overview of special populations In Scheiman M Rouse M (eds) Optometric Management of Learning-Related Vision Problems

St Louis Mosby Inc 200685-106

Maino D (ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 1995 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

78

McCarthy P Maino D Alport syndrome a review Clin Eye Vis Care 2000 Dec12(3-4)139-50

Block SS Brusca-Vega R Pizzi WJ et al Cognitive and visual processing skills and their relationship to mutation size in full and

permutation female fragile X carriers Optom Vis Sci 2000 Nov77 (11)592-9

Maino D The young child with developmental disabilities An introduction to mental retardation and genetic syndromes In Moore BD

(ed) Eye Care for Infants and Young Children Butter-worth--Heinemann Newton MA1997285-300

Amin V Maino D The Fragile X female Visual visual perceptual and ocular health anomalies J Am Optom Assoc 1995 May66

(5)290-95

Maino DM Maino JH Cibis GW Hecht F Ocular health anomalies in patients with developmental disabilities In Maino D (ed)

Diagnosis and Management of Special Populations Mosby-Year-book Inc St Louis MO 1995189-206 Reprinted Optometric

Education Program Foundation Santa Anna Calif 2001

Maino D Wesson M Schlange D Cibis G Maino J Optometric findings in the fragile X syndrome Optom Vis Sci 199168634-40

Scheiman MMOptometric findings in children with cerebral palsy Am J Optom Physiol Opt 1984 May61(5)321-3

Maino D Maino J Maino S Mental retardation syndromes with associated ocular defects J Am Optom Assoc 199061707-16

Stewart RE Woodhouse JM Cregg M Pakeman VH Association between accommodative accuracy hypermetropia and strabismus in

children with Downs syndrome Optom Vis Sci 2007 Feb84(2)149-55

Cregg M Woodhouse JM Pakeman VH et al Accommodation and refractive error in children with Down syndrome cross-sectional

and longitudinal studies Invest Ophthalmol Vis Sci 2001 Jan42 (1)55-63

79

McClelland JF Parkes J Hill N et al Accommodative dysfunction in children with cerebral palsy a population-

based study Invest Ophthalmol Vis Sci 2006 May47(5)1824-30

Duckman RH Vision therapy for the child with cerebral palsy J Am Optom Assoc 198758(1)28-35

Duckman R Accommodation in cerebral palsy function and remediation J Am Optom Assoc 198455(4)281-3

Scheiman M Understanding and managing vision deficits a guide for occupational therapists 2nd ed Slack

Thorofare NJ 2002

Maino D Binasal occlusion for the child with Cerebral Palsy J Ill Optom Assoc 198644(1)1218

Battaglia F Quartarone A Rizzo V et al Early impairment of synaptic plasticity in patients with Downs syndrome

Neurobiol Aging 2008 Aug29(8)1272-5

Bonnier C Evaluation of early stimulation programs for enhancing brain development Acta Paediatr 2008

Jul97(7)853-8

Morice E Andreae LC Cooke SF et al Preservation of long-term memory and synaptic plasticity despite short-term

impairments in the Tc1 mouse model of Down syndrome Learn Mem 2008 Jul 1415(7)492-500

Gordon AM Schneider JA Chinnan A Charles JR Efficacy of a hand-arm bimanual intensive therapy (HABIT) in

children with hemiplegic cerebral palsy a randomized control trial Dev Med Child Neurol 2007 Nov49(11)830-8

Kapoor N Ciuffreda KJ Vision disturbances following traumatic brain injury Curr Treat Options Neurol 2002

Jul4(4)271-80

80

Ciuffreda KJ Rutner D Kapoor N et al Vision therapy for oculomotor dysfunctions in acquired brain injury a

retrospective analysis Optometry 2008 Jan79(1)18-22

Ciuffreda KJ Han Y Kapoor N Ficarra AP Oculomotor rehabilitation for reading in acquired brain injury

NeuroRehabilitation 200621(1)9-21

Zost M Diagnosis and management of visual dysfunction in cerebral injury In Maino D (ed) Diagnosis and

Management of Special Populations Mosby-Yearbook Inc St Louis 199579 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001 [Figure used with permission of the editor]

DeGutis JM Bentin S Robertson LC DEsposito M Functional plasticity in ventral temporal cortex following

cognitive rehabilitation of a congenital prosopagnosic J Cogn Neurosci 2007 Nov19 (11)1790-802

Welbourne SR Ralph MA Exploring the impact of plasticity-related recovery after brain damage in a connectionist

model of single-word reading Cogn Affect Behav Neurosci 2005 Mar5(1)77-92

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements prevent cognitive decline A

systematic review of randomized controlled trials J Hum Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among preterm infants attributable to early

supplementation of human milk with docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings and structural-functional

synergies with cell membrane phospholipids Altern Med Rev 2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function Neuroscience 20089(7)568-78

81

Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

BMC Biol 2008 Sep 9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine improves neuropsychological disorders in a child with

creatine transporter defect Neurocase 200814(2) 151-61

Forrester LW Wheaton LA Luft AR Exercise-mediated locomotor recovery and lower-limb neuroplasticity after

stroke J Rehabil Res Dev 200845(2)205-20

82

Page 8: Neuroplasticity: A Paradigm Sea Change Latest Updated File

The BrainA hellip is not just a static soft round mass bathed in a fluid and surrounded by a hard caseB hellip can change its form and resultant function through neuroplasticity

The BrainA hellip is not just a static soft round mass bathed in a fluid and surrounded by a hard caseB hellip can change its form and resultant function through neuroplasticity

The BrainA hellip is not just a static soft round mass bathed in a fluid and surrounded by a hard caseB hellip can change its form and resultant function through neuroplasticity

The BrainA hellip is not just a static soft round mass bathed in a fluid and surrounded by a hard caseB hellip can change its form and resultant function through neuroplasticity

II The Brain

hellip is not just a static soft round mass bathed in a fluid and surrounded by a hard case

hellip can change its form and resultant function through neuroplasticity

8

III CriticalSensitive Periods

A A critical period occurs when the individual is sensitive to environmental influences and stimulation

1 The Precritical period The initial formation of neuronal circuits that is not dependent on visual experience

9

CriticalSensitive Periods

2 The Critical period A distinct onset of robust plasticity in response to the visual experience when the initially formed circuit can be modified by experience

3 Closure of the critical period After the end of the critical period the same visual experience no longer elicits the same degree of plasticity

10

CriticalSensitive Periods

B The concept of a critical period does not imply that neuroplasticity ends after a certain age

C Sensitive period begins and ends gradually (not abruptly like the critical period) and provides for maximum sensitivity

to stimuli

11

VI Neuroplasticity and the Brain

A Can adult brain neurons actually exhibit neuroplasticity The short answer is yes

B Resultant changes are noted in not only functional outcomes but also in brain anatomy and structure

12

IV Neuroplasticity and Rehabilitation

Kleim amp Jones note that

A The Key Principles of Experience-Dependent Neural Plasticity

1 Use it or lose it

2 Use it and improve it

3 Specificity

13

4 Repetition matters

5 Intensity matters

6 Time matters

7 Salience matters

14

8 Age matters

9 Transference

10 Interference

15

Use it or lose it If you do not drive specific brain functions

functional loss will occur

Use it and improve it Therapy that drives cortical function

enhances that particular function

Specificity The therapy you choose determines the resultant

plasticity and function

Repetition matters Plasticity that results in functional change

requires repetition

16

Intensity matters Induction of plasticity requires the appropriate

amount of intensity

Time matters Different forms of plasticity take place at different

times during therapy

Salience matters It has to be important to the individual

Age matters Plasticity is easier in a younger brain but is also

possible in an adult brain

17

Transference Neuroplasticity and the change in function that

results from one therapy can augment the attainment of similar

behaviors

Interference Plasticity in response to one experience can interfere

with the acquisition of other behaviors

18

B Examples of Changes in Function and Structure

1) Jugglers

2) Typists

19

B Examples of Changes in Function and Structure

1) Jugglers

One study suggested that adults taught how to juggle demonstrated a

significant transient bilateral expansion of gray matter in the mid-

temporal area and the left posterior intraparietal sulcus between baseline brain scan and

follow-up The findings were specific to training stimulus individuals who were

not instructed how to juggle demonstrated no change in gray

matter over the same period These findings oppose the conventional

understanding that the anatomical structure of the adult brain does not change

over time

20

B Examples of Changes in Function and Structure

2) Typists

helliplong-term bimanual training also increases

gray matter volume in experienced adult typists

These results suggest that learning not

only affects function but also structure in

adult brains

21

V Neuroplasticity and Optometry

A Evolutionary neuroplasticity

B Reactive plasticity

C Adaptational plasticity

D Reparation plasticity

22

V Neuroplasticity and Optometry

A Evolutionary neuroplasticity

hellip is ideally suited for the developmental OD who

specializes in vision function as it changes over time

either with or without intervention

23

V Neuroplasticity and Optometry

B Reactive plasticity

hellip can be thought of as the immediate effect that

initial optometric treatment may have on a system This can

be reflected in an immediate but often transient change in

the individuallsquos accommodative systemmdashie when an

uncorrected myope initially puts on his or her new

spectacles

24

V Neuroplasticity and Optometry

C Adaptational plasticity

hellip could describe the long-term effects of in-office optometric

vision therapy on disorders of the binocular vision system

25

V Neuroplasticity and Optometry

D Reparation plasticity

hellipin contrast to adaptational

plasticity reparation plasticity may

occur during treatment by a low

Vision specialist or an OD

Working with those who have

Experienced a traumatic brain

injury (TBI)

26

V Neuroplasticity and Optometry

The effects of plasticity can lead to either

positive or negative changes during

development (evolutionary plasticity) after

short-term exposure (reactive plasticity)

after long-term or continuous stimuli

(adaptational plasticity) and during

functional or structural recovery of damaged

neuronal circuits (reparation plasticity)

httpwwwciteulikeorguserjasonepriorarticle2856526

27

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

A Refractive error development

B Amblyopia

C Strabismus

28

D Non-strabismus non-amblyopic binocular vision disorders

E Learning related vision anomalies

F Vision developmentperception disorders

29

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

A Refractive error development

Several recent studies have noted that neuroplasticity may play a

role in refractive error development

retinal defocus use of progressive addition lenses

drug studies (M1-antagonist2 pirenzepine ) slow myopia

progression demonstrated nearly a 50 reduction in myopia

progression over a two-year period

30

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged

7 to 17 years Arch Ophthalmol 2005 Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three

to less than 10 years of age Am J Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction

Am J Ophthalmol 2007 Jun143(6)1060-3

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine

vs patching for treatment of moderate amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-

57

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for

strabismic and anisometropic amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Treatment of severe amblyopia with weekend atropine results from 2 randomized clinical trials

Levodopacarbidopa in the treatment of amblyopia

31

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

J Pediatr Ophthalmol Strabismus 2009 Mar-Apr46(2)87-90 quiz 91-2 Levodopacarbidopa in the

treatment of amblyopia Dadeya S Vats P Malik KP

PURPOSE To evaluate the role of levodopacarbidopa in the treatment of amblyopia METHODS

Thirty patients with strabismic amblyopia between the ages of 3 and 12 years were part of this double-

blind randomized study Patients were divided into two groups Group A received 050 mg + 125 mg of

levodopacarbidopa per kilogram body weight three times daily after meals with a protein rich drink

whereas Group B received placebo Both groups received full-time conventional occlusion until a visual

acuity of 66 was achieved or for a maximum of 3 months RESULTS The authors observed more than

two lines improvement in visual acuity that was greater in the levodopa group (15 of 15) than in the

placebo group (9 of 15) (P lt 005) Furthermore improvement in visual acuity of more than two lines

was greater in patients younger than 8 years (100) than in patients older than 8 years of age (60) (P =

0026) There was also no significant reversal of the improved visual acuity in up to 6 months of follow-

up CONCLUSION Levodopacarbidopa improves visual acuity in patients with

amblyopia and maintains improved visual acuity especially in patients

younger than 8 years

32

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

J Pediatr Ophthalmol Strabismus 2008 May-Jun45(3)174-6 The use of levodopa in the treatment of

bilateral amblyopia secondary to uncorrected high hypermetropia Abrams MS

The standard treatment of bilateral amblyopia secondary to uncorrected high bilateral hypermetropia has

been spectacles and time The patient described here failed to show adequate improvement in visual

acuity after 18 months of standard treatment Visual acuity improved dramatically when the

patient began taking levodopa dropped precipitously when the medication was

discontinued and returned quickly to post-treatment levels when levodopa was

restarted Visual acuity remained stable when the medication was slowly tapered

and discontinued This report suggests that dopamine may play a role in the pathophysiology of

bilateral amblyopia secondary to uncorrected high bilateral hypermetropia

33

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

Bottom Line

Amblyopia can be treated at any age

May be able to use neuro-enhancing drugs

as a part of basic amblyopia therapy

34

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

C Strabismus and non-strabismic non-amblyopic binocular

vision disorders

Clinical Trial of Treatments for Symptomatic Convergence Insufficiency in Children has

clearly demonstrated the superiority of in-office optometric vision therapy (in conjunction

with home therapy) vs out-of-office therapy alone The study concluded that optometric

vision therapyorthoptics was more effective than pencil push-ups or placebo vision

therapyorthoptics in reducing symptoms and improving clinical signs of convergence

insufficiency

Long-term effectiveness of treatments for symptomatic convergence insufficiency

in children (Optom Vis Sci 2009 Sep86(9)1096-103)

CITT patients improvements lasted a year

35

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

Strabismus 1999 Sep7(3)169-74 Convergence insufficiency in

idiopathic Parkinsons disease responsive to levodopa Racette BA

Gokden MS Tychsen LS Perlmutter JS

We report a patient with pathologically proven idiopathic Parkinsons

disease (IPD) who developed diplopia secondary to convergence

insufficiency during his motor off periods Diplopia resolved with

onset of motor benefit from levodopa Neuro-ophthalmologic

examination demonstrated convergence insufficiency during motor

off periods that was alleviated after onset of motor benefit from

levodopa This is the first reported case of convergence insufficiency

in IPD responsive to levodopa

36

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

Bottom Line

Optometric Vision Therapy is the most efficacious treatment available for binocular vision disorders and the

treatment effects are long lasting Neuro-enhancing drugs

may assist us as well

37

EF Learning related vision anomalies Vision

developmentperception disorders

hellipresearch includes an examination of the role vision plays in

reading the effect of oculomotor vergence and

accommodativecoherent motion therapy on reading eye movements

and reading speed the diagnosis and treatment of perceptual

disorders and the effect of therapy on various learning anomalies

38

EF Learning related vision anomalies Vision developmentperception disorders

magnocellular (MC) deficit in dyslexia

LM speed-matching ratio predicts reading in childrenChase C Dougherty RF Ray N

Fowler S Stein JOptom Vis Sci 2007 Mar84(3)229-36

Effect of attention therapy on reading comprehension Solan HA Shelley-Tremblay J

Ficarra A Silverman M Larson S J Learn Disabil 2003 Nov-Dec36(6)556-63

Is there a common linkage among reading comprehension visual attention and

magnocellular processing Solan HA Shelley-Tremblay JF Hansen PC Larson S

J Learn Disabil 2007 May-Jun40(3)270-8

Lawton T Filtered Text and Direction Discrimination Training Improved Reading

Fluency for Both Dyslexic and Normal Readers Optom Vis Dev 200839 (3)114

Fischer B Hartnegg K Saccade control in dyslexia Development deficits training

and transfer to reading Optom Vis Dev 200839(4)181-190

39

EF Learning related vision anomalies Vision developmentperception disorders

J Learn Disabil 2003 Nov-Dec36(6)556-63 Effect of attention therapy on reading

comprehension Solan HA Shelley-Tremblay J Ficarra A Silverman M Larson S

hellip At the completion of attention therapy the mean

standard attention and reading comprehension scores of

the experimental group had improved significantly The

control group however showed no significant

improvement in reading comprehension scores after 12

weeks Although uncertainties still exist this investigation

supports the notion that visual attention is malleable and

that attention therapy has a significant effect on reading

comprehension in this often neglected population

40

VII Vision dysfunction association with acquired brain injury

A Exotropia (or high exophoriaCI)

B Accommodative dysfunction

C Convergence insufficiency

41

D Decreased blink rate

E Spatial disorientation

F Pursuitsaccade dysfunction

G Unstable ambient vision (Magnocellular pathway)

42

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Stelmack JA Frith T Van Koevering D Rinne S Stelmack TR Visual function in patients

followed at a Veterans Affairs polytrauma network site an electronic medical record review

Optometry 2009 Aug80(8)419-24

RESULTS Visual symptoms were self-reported by 76 of patients

with polytrauma and 75 of the patients with TBI Problems with reading

(polytrauma 60 and TBI 50) and accommodation (polytrauma 30 and

TBI 47) were frequently found on eye examinations Spectacles were the

treatment most frequently prescribed (polytrauma 62 and TBI 78)

CONCLUSIONS It is important for optometrists to be aware of the high

rates of self-reported symptoms and visual problems in military personnel

returning from deployment to the wars in Iraq and Afghanistan Post-

traumatic stress disorder and depression may complicate optometric

evaluation and management

43

VII Vision dysfunction association with acquired brain injury

Avoidance of near tasks

Oculomotor-based reading difficulties

Eye tracking problems

Eye focusing problems

Eyestrain Diplopia

Dizziness Vertigo

Vision-derived nausea

44

VII Vision dysfunction association with acquired brain injury

Increased sensitivity to visual motion

Visual inattention and distractibility

Short-term visual memory loss

Difficulty judging distances (relative and absolute

Difficulty with global scanning

Difficulty with personal grooming especially involving the face

Inability to interactcope visually in a complex social situation

(eg minimal eye contact)

Inability to tolerate complex visual environments (eg grocery store

aisles and highly-patterned floors)

45

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Ciuffreda KJ Ludlam DP Kapoor N Clinical oculomotor training in traumatic brain injury Optom Vis

Dev 200940(1)16-23

Individuals with traumatic brain injury present with a constellation of

oculomotor dysfunctions and correlated symptoms Simple and

effective clinical oculomotor-based training procedures will be

presented with respect to the versional vergence and

accommodative systems and their interactions These therapeutic

procedures can also be applied as needed to individuals with either

low vision neurological dysfunctions or general visual skills cases

manifesting similar oculomotor deficits

46

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Leslie S Myopia and accommodative insufficiency associated with

moderate head trauma Opt Vis Dev 200940(1)25-31

The majority of subjects reviewed had developed a stable degree of

myopia between 100 and 200 diopters as well as an abnormally

high lag of accommodation When their distance and near spatial area

of focus was compared the majority were focused at an intermediate

area in space suggesting a loss of control of accommodation in

space

47

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

B Drugs

C Exercise

D Learning new and challenging things

48

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements

prevent cognitive decline A systematic review of randomized controlled trials J Hum

Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among

preterm infants attributable to early supplementation of human milk with

docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings

and structural-functional synergies with cell membrane phospholipids Altern Med Rev

2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function

Neuroscience 20089(7)568-78

49

VIII Improving Brain Function and Neuroplasticity

B Drugs Maya Vetencourt JF Sale A Viegi A et al The antidepressant

fluoxetine (PROZAC) restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the

antidepressant tianeptine CNS Drugs 200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances

hippocampal long-term potentiation and memory BMC Biol 2008 Sep

9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine

improves neuropsychological disorders in a child with creatine

transporter defect Neurocase 200814(2) 151-61

50

VIII Improving Brain Function and Neuroplasticity

C Exercise

Hunsberger JG et al Antidepressant actions of the exercise-

regulated gene VGF Nat Med 2007 Dec 2 131476

VGF may be a common pathway by which exercise induces

neuroplasticity and growth-factor genes at least one of these might act

similarly to antidepressants in promoting an adaptive response to stress

However the tests used here may be modeling stress-induced

helplessness not depression hellipexercise seems to induce multiple

interacting genes that enhance neuronal resilience

51

VIII Improving Brain Function and Neuroplasticity

D Learning new and challenging things

What have we (optometry amp ophthalmology)

been thinking all these years

Where did we miss the news about neuroplasticity

52

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Huang JC Neuroplasticity as a proposed mechanism for the efficacy of optometric vision therapy and rehabilitation J Bev Optom 200920(4)96-100

Homologous area adaptationCompensatory masqueradeCross-modal reassignment

Map expansion

EquipotentialityVicariation

53

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Homologous area adaptation a transfer of function from a damaged brain area to a non-damaged brain area May be limited to early stages of human development and may crowd a new brain area resulting in reduced functionality of that brain area (Competition between spatial amp verbal functioning)

54

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Compensatory masquerade reorganizing of existing neuro-pathways to us alternative cognitive strategies to perform a task

55

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Cross-modal reassignment using new sensory input in a brain structure deprived of its main input source (changing processing from visual to tactile stimuli in the blind)

56

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Map expansion increase in brain mass due to repeated behavior or exposure to stimuli

57

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Equipotentiality anatomical areas of the brain can perform disparate functions

Vicariation redundant neural systems can operate under abnormal conditions

This may explain why recovery is noted for many neurological conditions (degenerative psychiatric developmental vascular traumatic)

58

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Constraint therapy Use it and improve it

Patching penalization ldquonear activitiesrdquo during amblyopia therapy

59

IX Improving Brain Function and Neuroplasticity Optometric Clinical ApplicationsOptometric Vision Therapy

Kleim amp Jones

Use it or lose it If you do not drive specific brain functions

functional loss will occur

If you want to improve oculomotor brain neuroplastic function amp

structure therapy should be specific for that brain function

Use it and improve it Therapy that drives cortical function enhances

that particular function

If you use therapy to improve oculomotor dysfunction it should

improve

Specificity The therapy you choose determines the resultant

plasticity and function

You must choose therapy that is appropriate

60

IX Improving Brain Function and Neuroplasticity Optometric Clinical Applications

Kleim amp Jones

Repetition matters Plasticity that results in functional change

requires repetition

Do the therapy Do it again Do it yet again No quick fix

Intensity matters Induction of plasticity requires the appropriate

amount of intensity

Intensity means strength force concentration power and passion

Without these plasticity may not occur Function may not improve

Time matters Different forms of plasticity take place at different

times during therapy

Do the basics than the more advanced therapeutic procedures

61

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Salience matters It has to be important to the individual

Make the therapy matter to the patient

Age matters Plasticity is easier in a younger brain but is also

possible in an adult brain

Do not let age determine what therapy options you offer your

patients Think of Susan Barry PhD (StereoSue) and her success

Offer your patients options Let them choose Be realistic about

outcomeshelliphave outcome measures built into therapy program

62

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Transference Neuroplasticity and the change in function

that results from one therapy can augment the attainment

of similar behaviors

What you do during oculomotor therapy may affected

vergence therapy outcomes

Interference Plasticity in response to one experience can

interfere with the acquisition of other behaviors

Monitor Evaluate progress Discuss function in other areas

of your patientslsquo life

63

Why pay attention to binocular vision dysfunctions

and neuroplasticity

December 2009 issue of the Review of Optometry

The Binocular Vision Dysfunction Pandemic

In 2010 almost 170 million individuals will be wearing glasses In

2010 there will also be up to 93 million amblyopes and 12 and a half

million strabismics For children under 18 years of age that means

there will be more than 22 and a half million amblyopes and millions

of children with strabismus A clinical trial to determine the

prevalence of binocular vision dysfunction within the general

population suggested the possibility of up to 56 or 173 million men

women and children with symptoms associated with a binocular

vision dysfunction 189 million (61) with accommodative problems

and 118 million (38) demonstrating various vergence

anomalies

64

65

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Brain plasticity life long changes in the structure of the brain

Sensory substitution replacement of one sensory input by another

Measurement techniques

Voxel based morphometryhellipmeasures difference in brain volume

Fluorodeoxyglucose glucose analog PET scan tells you

distribution and metabolism of brain

Cortical thickness measures

Visual cortex of the blind turns somatic ―The eye of the tongue

Transcranial magnetic stmiulation non-invasive technique to

stimulate cortex

66

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Blind Braille readers report tingling in fingers when pressure

phosphenes are applied Blind feel tingling in tongue

Bind use tongue to perform orientation task motion perception

sensory perception Visual cortex recruited in a variety of sensory

and cognitive tasks (DM Can we use tongue as a VT tool)

Dilks Reorganizations of human adult visual system

When a region of sensory cortex is deprived of its bottom up

input the deprived region begins to respond to stimuli that

normally activate adjacent cortex

67

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Retinotopic map changes for stroke pts Cortical reorganization in

adults occurs Perceived objectshellipelongation in stroke amp AMD

What happens to deprived cortex in AMD

fMRI shows cortical reorganization in adults

Proposed mechanisms

hellipGrowth of new connections

hellipUnmasking of pre-existing connections this is true

happens within seconds

Bavelier

Action video games

68

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Bavelier

Action video games Looked at attention Gamers can track more

activities

Attention over space (me peripheral awarenress) Useful field

of view shrinks with age

Performance not VA relatedhellipis related to attention

Action game playing changes spatial resolutionhellipovercoming

crowding in VA assessment (me amblyopia therapy)

Temporal resolution of vision Backward masking

changehellipbrain changes

Visual sensitivity (contrast sensitivity) Post action game training

improves CSF

69

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Action video games correcting optics of the cortex (me this is

actualy OVT)

Games factor

Variable entry leanringhellipadapt task to skill level

Incremental learning tune task to subjectlsquos leanring steps

Motivationarousal

Rewards

Self masterself confidence

Action games factors

Pacingrate of exposure to infohellipincreasing processing speed

Dynamic display

Rich environment

Rich motor involvement

70

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Surgeons may be made to play action games

Pilot training

Amblyopia tx Dennis Levi research

PresenterTitle Contact info

Neuroplasticity-A Paradigm Sea Change

This presentation is available at

httpwwwslidesharenetDMAINOneuroplasticity-a-paradigm-sea-change-2459693

httpwwwmainosmemosblogspotcom

My FaceBook Page

and

Twitter

PresenterTitle Contact info

Questions About

Neuroplasticity-A Paradigm Sea Change

Dominick M Maino OD MEd FAAO FCOVD-A

Professor PediatricsBinocular VisionIllinois Eye InstituteIllinois College of Optometry

dmainoicoeduhttpwwwMainosMemosblogspotcom

Thanks to

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efaultaspx

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httppsychiatryjwatchorgcgicontentfull20082251

73

Chakraborty R Chatterjee A Choudhart S Chakraborty PK Neuroplasticitymdasha paradigm shift in neurosciences J Indian Med Assoc

2007105(9)513-4516-8520-1

Sacks O A neurologistlsquos notebook Stereo Sue Why two eyes are better than one The New Yorker 2006 Jun 1964-73

Krulwich R National Public Radio Going Binocular Susanlsquos First Snowfall Available at

wwwnprorgtemplatesstorystoryphpstoryId=5507789 (Accessed December 8 2008)

Press LJ The story behind Stereo Suelsquo and a world-famous neurologistlsquos discovery of vision therapy Optom Vis Dev 200637(2) 55-7

Levin HS Neuroplasticity and brain imaging research implications for rehabilitation Arch Phys Med Rehabil 2006 Dec87(12 Suppl

2)S1

Wiesel TN Hubel DH Single-cell responses in striate cortex of kittens deprived of vision in one eye J Neurophysiol 1963

Nov261003-17

Hook BM Chen C Critical periods in the visual system Changing views for a model of experience-dependent plasticity Neuron 2007

Oct56(2)312-26

Ramey CT Ramey SL Prevention of intellectual disabilities early interventions to improve cognitive development Prev Med 1998

Mar-Apr27(2)224-32

Heuninckx S Wenderoth N Swinnen SP Systems neuroplasticity in the aging brain recruiting additional neural resources for

successful motor performance in elderly persons J Neurosci 2008 Jan 228(1)91-9

Ge S Yang CH Hsu KS et al A critical period for enhanced synaptic plasticity in newly generated neurons of the adult brain Neuron

2007 May54(4)559-66

74

Draganski B Gaser C Busch V et al Neuroplasticity changes in grey matter induced by training Nature 2004 Jan 22427(6972)

311-2

Cannonieri GC Bonilha L Fernandes PT et al Practice and perfect length of training and structural brain changes in experienced

typists Neuroreport 2007 Jul 218(10)1063-6

Kleim JA Jones TA Principles of experience-dependent neural plasticity implications for rehabilitation after brain damage J

Speech Lang Hear Res 2008 Feb51(1)S225-39

Trojan S Porkorny J Theoretical aspects of neuroplasticity Physiol Res 199948(2)87-97

Ramamirtham R Kee CS Hung LF et al Wave aberrations in rhesus monkeys with vision-induced ametropias Vision Res 2007

Sep47(21)2751-66

Smith EL 3rd Ramamirtham R Qiao-Grider Y et al Effects of foveal ablation on emmetropization and form-deprivation myopia

Invest Ophthalmol Vis Sci 2007 Sep48(9)3914-22

Smith EL 3rd Kee CS Ramamirtham R et al Peripheral vision can influence eye growth and refractive development in infant

monkeys Invest Ophthalmol Vis Sci 2005 Nov46(11)3965-72

Ciuffreda KJ Vasudevan B Nearwork-induced transient myopia (NITM) and permanent myopiandashndashis there a link Ophthalmic

Physiol Opt 2008 Mar28(2)103-14

Hung GK Ciuffreda KJ Incremental retinal-defocus theory of myopia development--schematic analysis and computer simulation

Comput Biol Med 2007 Jul37(7)930-46

Hung GK Ciuffreda KJ A unifying theory of refractive error development Bull Math Biol 2000 Nov62(6)1087-108

75

Pang Y Maino D Zhang G Lu F Myopia Can its progress be controlled Optom Vis Dev 200637(2)75-9

Leung JT Brown B Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lenses Optom Vis Sci

1999 Jun76(6)346-54

Hasebe S Ohtsuki H Nonaka T et al Effect of progressive addition lenses on myopia progression in Japanese children a prospective

randomized double-masked crossover trial Invest Ophthalmol Vis Sci 2008 Jul49(7)2781-9

Gwiazda J Hyman L Hussein M et al A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression

of myopia in children Invest Ophthalmol Vis Sci 2003 Apr44(4)1492-500

Siatkowski RM Cotter SA Crockett RS et al Two-year multi-center randomized double-masked placebo-controlled parallel safety and

efficacy study of 2 pirenzepine ophthalmic gel in children with myopia J AAPOS 2008 Aug12(4)332-9

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged 7 to 17 years Arch Ophthalmol 2005

Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three to less than 10 years of age Am J

Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction Am J Ophthalmol 2007

Jun143(6)1060-3

Holmes JM Edwards AR Beck RW et al A randomized pilot study of near activities versus non-near activities during patching therapy for

amblyopia J AAPOS 2005 Apr9(2)129-36

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate

amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-57

76

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic

amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Convergence Insufficiency Treatment Trial Study Group Randomized clinical trial of treatments for symptomatic convergence insufficiency

in children Arch Ophthalmol 2008 Oct126(10)1336-49

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

Solan HA Shelley-Tremblay J Hansen PC et al M-cell deficit and reading disability a preliminary study of the effects of temporal vision-

processing therapy Optometry 2004 Oct75(10)640-50

Solan HA Larson S Shelley-Tremblay J et al Role of visual attention in cognitive control of oculomotor readiness in students with reading

disabilities J Learn Disabil 2001 Mar-Apr34(2)107-18

Gallaway M Boas MB The impact of vergence and accommodative therapy on reading eye movements and reading speed Optom Vis Dev

200738(3)115-20

Goss DA Downing DB Lowther AH et al The effect of HTS vision therapy conducted in a school setting on reading skills in third and

fourth grade students Optom Vis Dev 200738(1)27-32

Crutch SJ Warrington EK Foveal crowding in posterior cortical atrophy a specific early-visual-processing deficit affecting word reading

Cogn Neuropsychol 2007 Dec24(8)843-66

Helms D Sawtelle SM A study of the effectiveness of cognitive therapy delivered in a video game format Optom Vis Dev 200738 (1)19-

26

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

77

Lawton T Training direction-discrimination sensitivity remediates a wide spectrum of reading skills OptomVis Dev 200738(1) 33-47

Goldstand S Koslowe KC Parush S Vision visual-information processing and academic performance among seventh-grade schoolchildren a

more significant relationship than we thought Am J Occup Ther 2005 Jul-Aug59(4)377-89

Fischer B Koumlngeter A Hartnegg K Effects of daily practice on subitizing visual counting and basic arithmetic skills Optom Vis Dev

200839(1)30-4

Sands W Taub M Maino D Limited research and education on special populations in optometry and ophthalomology Optom Vis Dev

200839(2)60-1

Wesson M Maino D Oculo-visual findings in Down syndrome cerebral palsy and mental retardation with non-specific etiology In Maino D

(ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 199517-54 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

Cui Y Stapleton F Suttle C Developing an instrument to assess vision-related and subjective quality of life in children with intellectual

disability data collection and preliminary analysis in a Chinese population Ophthal Physiolog Optics 2008 May28(3) 238-46

Maino D Steele G Tahir S Sajja R Attitudes of optometry students toward individuals with disabilities Optom Ed 200227(2)45-50

Maino D Special populations in the optometric curriculum Optom Ed 200227(2)38-9

Maino D Overview of special populations In Scheiman M Rouse M (eds) Optometric Management of Learning-Related Vision Problems

St Louis Mosby Inc 200685-106

Maino D (ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 1995 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

78

McCarthy P Maino D Alport syndrome a review Clin Eye Vis Care 2000 Dec12(3-4)139-50

Block SS Brusca-Vega R Pizzi WJ et al Cognitive and visual processing skills and their relationship to mutation size in full and

permutation female fragile X carriers Optom Vis Sci 2000 Nov77 (11)592-9

Maino D The young child with developmental disabilities An introduction to mental retardation and genetic syndromes In Moore BD

(ed) Eye Care for Infants and Young Children Butter-worth--Heinemann Newton MA1997285-300

Amin V Maino D The Fragile X female Visual visual perceptual and ocular health anomalies J Am Optom Assoc 1995 May66

(5)290-95

Maino DM Maino JH Cibis GW Hecht F Ocular health anomalies in patients with developmental disabilities In Maino D (ed)

Diagnosis and Management of Special Populations Mosby-Year-book Inc St Louis MO 1995189-206 Reprinted Optometric

Education Program Foundation Santa Anna Calif 2001

Maino D Wesson M Schlange D Cibis G Maino J Optometric findings in the fragile X syndrome Optom Vis Sci 199168634-40

Scheiman MMOptometric findings in children with cerebral palsy Am J Optom Physiol Opt 1984 May61(5)321-3

Maino D Maino J Maino S Mental retardation syndromes with associated ocular defects J Am Optom Assoc 199061707-16

Stewart RE Woodhouse JM Cregg M Pakeman VH Association between accommodative accuracy hypermetropia and strabismus in

children with Downs syndrome Optom Vis Sci 2007 Feb84(2)149-55

Cregg M Woodhouse JM Pakeman VH et al Accommodation and refractive error in children with Down syndrome cross-sectional

and longitudinal studies Invest Ophthalmol Vis Sci 2001 Jan42 (1)55-63

79

McClelland JF Parkes J Hill N et al Accommodative dysfunction in children with cerebral palsy a population-

based study Invest Ophthalmol Vis Sci 2006 May47(5)1824-30

Duckman RH Vision therapy for the child with cerebral palsy J Am Optom Assoc 198758(1)28-35

Duckman R Accommodation in cerebral palsy function and remediation J Am Optom Assoc 198455(4)281-3

Scheiman M Understanding and managing vision deficits a guide for occupational therapists 2nd ed Slack

Thorofare NJ 2002

Maino D Binasal occlusion for the child with Cerebral Palsy J Ill Optom Assoc 198644(1)1218

Battaglia F Quartarone A Rizzo V et al Early impairment of synaptic plasticity in patients with Downs syndrome

Neurobiol Aging 2008 Aug29(8)1272-5

Bonnier C Evaluation of early stimulation programs for enhancing brain development Acta Paediatr 2008

Jul97(7)853-8

Morice E Andreae LC Cooke SF et al Preservation of long-term memory and synaptic plasticity despite short-term

impairments in the Tc1 mouse model of Down syndrome Learn Mem 2008 Jul 1415(7)492-500

Gordon AM Schneider JA Chinnan A Charles JR Efficacy of a hand-arm bimanual intensive therapy (HABIT) in

children with hemiplegic cerebral palsy a randomized control trial Dev Med Child Neurol 2007 Nov49(11)830-8

Kapoor N Ciuffreda KJ Vision disturbances following traumatic brain injury Curr Treat Options Neurol 2002

Jul4(4)271-80

80

Ciuffreda KJ Rutner D Kapoor N et al Vision therapy for oculomotor dysfunctions in acquired brain injury a

retrospective analysis Optometry 2008 Jan79(1)18-22

Ciuffreda KJ Han Y Kapoor N Ficarra AP Oculomotor rehabilitation for reading in acquired brain injury

NeuroRehabilitation 200621(1)9-21

Zost M Diagnosis and management of visual dysfunction in cerebral injury In Maino D (ed) Diagnosis and

Management of Special Populations Mosby-Yearbook Inc St Louis 199579 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001 [Figure used with permission of the editor]

DeGutis JM Bentin S Robertson LC DEsposito M Functional plasticity in ventral temporal cortex following

cognitive rehabilitation of a congenital prosopagnosic J Cogn Neurosci 2007 Nov19 (11)1790-802

Welbourne SR Ralph MA Exploring the impact of plasticity-related recovery after brain damage in a connectionist

model of single-word reading Cogn Affect Behav Neurosci 2005 Mar5(1)77-92

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements prevent cognitive decline A

systematic review of randomized controlled trials J Hum Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among preterm infants attributable to early

supplementation of human milk with docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings and structural-functional

synergies with cell membrane phospholipids Altern Med Rev 2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function Neuroscience 20089(7)568-78

81

Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

BMC Biol 2008 Sep 9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine improves neuropsychological disorders in a child with

creatine transporter defect Neurocase 200814(2) 151-61

Forrester LW Wheaton LA Luft AR Exercise-mediated locomotor recovery and lower-limb neuroplasticity after

stroke J Rehabil Res Dev 200845(2)205-20

82

Page 9: Neuroplasticity: A Paradigm Sea Change Latest Updated File

III CriticalSensitive Periods

A A critical period occurs when the individual is sensitive to environmental influences and stimulation

1 The Precritical period The initial formation of neuronal circuits that is not dependent on visual experience

9

CriticalSensitive Periods

2 The Critical period A distinct onset of robust plasticity in response to the visual experience when the initially formed circuit can be modified by experience

3 Closure of the critical period After the end of the critical period the same visual experience no longer elicits the same degree of plasticity

10

CriticalSensitive Periods

B The concept of a critical period does not imply that neuroplasticity ends after a certain age

C Sensitive period begins and ends gradually (not abruptly like the critical period) and provides for maximum sensitivity

to stimuli

11

VI Neuroplasticity and the Brain

A Can adult brain neurons actually exhibit neuroplasticity The short answer is yes

B Resultant changes are noted in not only functional outcomes but also in brain anatomy and structure

12

IV Neuroplasticity and Rehabilitation

Kleim amp Jones note that

A The Key Principles of Experience-Dependent Neural Plasticity

1 Use it or lose it

2 Use it and improve it

3 Specificity

13

4 Repetition matters

5 Intensity matters

6 Time matters

7 Salience matters

14

8 Age matters

9 Transference

10 Interference

15

Use it or lose it If you do not drive specific brain functions

functional loss will occur

Use it and improve it Therapy that drives cortical function

enhances that particular function

Specificity The therapy you choose determines the resultant

plasticity and function

Repetition matters Plasticity that results in functional change

requires repetition

16

Intensity matters Induction of plasticity requires the appropriate

amount of intensity

Time matters Different forms of plasticity take place at different

times during therapy

Salience matters It has to be important to the individual

Age matters Plasticity is easier in a younger brain but is also

possible in an adult brain

17

Transference Neuroplasticity and the change in function that

results from one therapy can augment the attainment of similar

behaviors

Interference Plasticity in response to one experience can interfere

with the acquisition of other behaviors

18

B Examples of Changes in Function and Structure

1) Jugglers

2) Typists

19

B Examples of Changes in Function and Structure

1) Jugglers

One study suggested that adults taught how to juggle demonstrated a

significant transient bilateral expansion of gray matter in the mid-

temporal area and the left posterior intraparietal sulcus between baseline brain scan and

follow-up The findings were specific to training stimulus individuals who were

not instructed how to juggle demonstrated no change in gray

matter over the same period These findings oppose the conventional

understanding that the anatomical structure of the adult brain does not change

over time

20

B Examples of Changes in Function and Structure

2) Typists

helliplong-term bimanual training also increases

gray matter volume in experienced adult typists

These results suggest that learning not

only affects function but also structure in

adult brains

21

V Neuroplasticity and Optometry

A Evolutionary neuroplasticity

B Reactive plasticity

C Adaptational plasticity

D Reparation plasticity

22

V Neuroplasticity and Optometry

A Evolutionary neuroplasticity

hellip is ideally suited for the developmental OD who

specializes in vision function as it changes over time

either with or without intervention

23

V Neuroplasticity and Optometry

B Reactive plasticity

hellip can be thought of as the immediate effect that

initial optometric treatment may have on a system This can

be reflected in an immediate but often transient change in

the individuallsquos accommodative systemmdashie when an

uncorrected myope initially puts on his or her new

spectacles

24

V Neuroplasticity and Optometry

C Adaptational plasticity

hellip could describe the long-term effects of in-office optometric

vision therapy on disorders of the binocular vision system

25

V Neuroplasticity and Optometry

D Reparation plasticity

hellipin contrast to adaptational

plasticity reparation plasticity may

occur during treatment by a low

Vision specialist or an OD

Working with those who have

Experienced a traumatic brain

injury (TBI)

26

V Neuroplasticity and Optometry

The effects of plasticity can lead to either

positive or negative changes during

development (evolutionary plasticity) after

short-term exposure (reactive plasticity)

after long-term or continuous stimuli

(adaptational plasticity) and during

functional or structural recovery of damaged

neuronal circuits (reparation plasticity)

httpwwwciteulikeorguserjasonepriorarticle2856526

27

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

A Refractive error development

B Amblyopia

C Strabismus

28

D Non-strabismus non-amblyopic binocular vision disorders

E Learning related vision anomalies

F Vision developmentperception disorders

29

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

A Refractive error development

Several recent studies have noted that neuroplasticity may play a

role in refractive error development

retinal defocus use of progressive addition lenses

drug studies (M1-antagonist2 pirenzepine ) slow myopia

progression demonstrated nearly a 50 reduction in myopia

progression over a two-year period

30

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged

7 to 17 years Arch Ophthalmol 2005 Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three

to less than 10 years of age Am J Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction

Am J Ophthalmol 2007 Jun143(6)1060-3

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine

vs patching for treatment of moderate amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-

57

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for

strabismic and anisometropic amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Treatment of severe amblyopia with weekend atropine results from 2 randomized clinical trials

Levodopacarbidopa in the treatment of amblyopia

31

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

J Pediatr Ophthalmol Strabismus 2009 Mar-Apr46(2)87-90 quiz 91-2 Levodopacarbidopa in the

treatment of amblyopia Dadeya S Vats P Malik KP

PURPOSE To evaluate the role of levodopacarbidopa in the treatment of amblyopia METHODS

Thirty patients with strabismic amblyopia between the ages of 3 and 12 years were part of this double-

blind randomized study Patients were divided into two groups Group A received 050 mg + 125 mg of

levodopacarbidopa per kilogram body weight three times daily after meals with a protein rich drink

whereas Group B received placebo Both groups received full-time conventional occlusion until a visual

acuity of 66 was achieved or for a maximum of 3 months RESULTS The authors observed more than

two lines improvement in visual acuity that was greater in the levodopa group (15 of 15) than in the

placebo group (9 of 15) (P lt 005) Furthermore improvement in visual acuity of more than two lines

was greater in patients younger than 8 years (100) than in patients older than 8 years of age (60) (P =

0026) There was also no significant reversal of the improved visual acuity in up to 6 months of follow-

up CONCLUSION Levodopacarbidopa improves visual acuity in patients with

amblyopia and maintains improved visual acuity especially in patients

younger than 8 years

32

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

J Pediatr Ophthalmol Strabismus 2008 May-Jun45(3)174-6 The use of levodopa in the treatment of

bilateral amblyopia secondary to uncorrected high hypermetropia Abrams MS

The standard treatment of bilateral amblyopia secondary to uncorrected high bilateral hypermetropia has

been spectacles and time The patient described here failed to show adequate improvement in visual

acuity after 18 months of standard treatment Visual acuity improved dramatically when the

patient began taking levodopa dropped precipitously when the medication was

discontinued and returned quickly to post-treatment levels when levodopa was

restarted Visual acuity remained stable when the medication was slowly tapered

and discontinued This report suggests that dopamine may play a role in the pathophysiology of

bilateral amblyopia secondary to uncorrected high bilateral hypermetropia

33

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

Bottom Line

Amblyopia can be treated at any age

May be able to use neuro-enhancing drugs

as a part of basic amblyopia therapy

34

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

C Strabismus and non-strabismic non-amblyopic binocular

vision disorders

Clinical Trial of Treatments for Symptomatic Convergence Insufficiency in Children has

clearly demonstrated the superiority of in-office optometric vision therapy (in conjunction

with home therapy) vs out-of-office therapy alone The study concluded that optometric

vision therapyorthoptics was more effective than pencil push-ups or placebo vision

therapyorthoptics in reducing symptoms and improving clinical signs of convergence

insufficiency

Long-term effectiveness of treatments for symptomatic convergence insufficiency

in children (Optom Vis Sci 2009 Sep86(9)1096-103)

CITT patients improvements lasted a year

35

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

Strabismus 1999 Sep7(3)169-74 Convergence insufficiency in

idiopathic Parkinsons disease responsive to levodopa Racette BA

Gokden MS Tychsen LS Perlmutter JS

We report a patient with pathologically proven idiopathic Parkinsons

disease (IPD) who developed diplopia secondary to convergence

insufficiency during his motor off periods Diplopia resolved with

onset of motor benefit from levodopa Neuro-ophthalmologic

examination demonstrated convergence insufficiency during motor

off periods that was alleviated after onset of motor benefit from

levodopa This is the first reported case of convergence insufficiency

in IPD responsive to levodopa

36

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

Bottom Line

Optometric Vision Therapy is the most efficacious treatment available for binocular vision disorders and the

treatment effects are long lasting Neuro-enhancing drugs

may assist us as well

37

EF Learning related vision anomalies Vision

developmentperception disorders

hellipresearch includes an examination of the role vision plays in

reading the effect of oculomotor vergence and

accommodativecoherent motion therapy on reading eye movements

and reading speed the diagnosis and treatment of perceptual

disorders and the effect of therapy on various learning anomalies

38

EF Learning related vision anomalies Vision developmentperception disorders

magnocellular (MC) deficit in dyslexia

LM speed-matching ratio predicts reading in childrenChase C Dougherty RF Ray N

Fowler S Stein JOptom Vis Sci 2007 Mar84(3)229-36

Effect of attention therapy on reading comprehension Solan HA Shelley-Tremblay J

Ficarra A Silverman M Larson S J Learn Disabil 2003 Nov-Dec36(6)556-63

Is there a common linkage among reading comprehension visual attention and

magnocellular processing Solan HA Shelley-Tremblay JF Hansen PC Larson S

J Learn Disabil 2007 May-Jun40(3)270-8

Lawton T Filtered Text and Direction Discrimination Training Improved Reading

Fluency for Both Dyslexic and Normal Readers Optom Vis Dev 200839 (3)114

Fischer B Hartnegg K Saccade control in dyslexia Development deficits training

and transfer to reading Optom Vis Dev 200839(4)181-190

39

EF Learning related vision anomalies Vision developmentperception disorders

J Learn Disabil 2003 Nov-Dec36(6)556-63 Effect of attention therapy on reading

comprehension Solan HA Shelley-Tremblay J Ficarra A Silverman M Larson S

hellip At the completion of attention therapy the mean

standard attention and reading comprehension scores of

the experimental group had improved significantly The

control group however showed no significant

improvement in reading comprehension scores after 12

weeks Although uncertainties still exist this investigation

supports the notion that visual attention is malleable and

that attention therapy has a significant effect on reading

comprehension in this often neglected population

40

VII Vision dysfunction association with acquired brain injury

A Exotropia (or high exophoriaCI)

B Accommodative dysfunction

C Convergence insufficiency

41

D Decreased blink rate

E Spatial disorientation

F Pursuitsaccade dysfunction

G Unstable ambient vision (Magnocellular pathway)

42

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Stelmack JA Frith T Van Koevering D Rinne S Stelmack TR Visual function in patients

followed at a Veterans Affairs polytrauma network site an electronic medical record review

Optometry 2009 Aug80(8)419-24

RESULTS Visual symptoms were self-reported by 76 of patients

with polytrauma and 75 of the patients with TBI Problems with reading

(polytrauma 60 and TBI 50) and accommodation (polytrauma 30 and

TBI 47) were frequently found on eye examinations Spectacles were the

treatment most frequently prescribed (polytrauma 62 and TBI 78)

CONCLUSIONS It is important for optometrists to be aware of the high

rates of self-reported symptoms and visual problems in military personnel

returning from deployment to the wars in Iraq and Afghanistan Post-

traumatic stress disorder and depression may complicate optometric

evaluation and management

43

VII Vision dysfunction association with acquired brain injury

Avoidance of near tasks

Oculomotor-based reading difficulties

Eye tracking problems

Eye focusing problems

Eyestrain Diplopia

Dizziness Vertigo

Vision-derived nausea

44

VII Vision dysfunction association with acquired brain injury

Increased sensitivity to visual motion

Visual inattention and distractibility

Short-term visual memory loss

Difficulty judging distances (relative and absolute

Difficulty with global scanning

Difficulty with personal grooming especially involving the face

Inability to interactcope visually in a complex social situation

(eg minimal eye contact)

Inability to tolerate complex visual environments (eg grocery store

aisles and highly-patterned floors)

45

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Ciuffreda KJ Ludlam DP Kapoor N Clinical oculomotor training in traumatic brain injury Optom Vis

Dev 200940(1)16-23

Individuals with traumatic brain injury present with a constellation of

oculomotor dysfunctions and correlated symptoms Simple and

effective clinical oculomotor-based training procedures will be

presented with respect to the versional vergence and

accommodative systems and their interactions These therapeutic

procedures can also be applied as needed to individuals with either

low vision neurological dysfunctions or general visual skills cases

manifesting similar oculomotor deficits

46

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Leslie S Myopia and accommodative insufficiency associated with

moderate head trauma Opt Vis Dev 200940(1)25-31

The majority of subjects reviewed had developed a stable degree of

myopia between 100 and 200 diopters as well as an abnormally

high lag of accommodation When their distance and near spatial area

of focus was compared the majority were focused at an intermediate

area in space suggesting a loss of control of accommodation in

space

47

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

B Drugs

C Exercise

D Learning new and challenging things

48

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements

prevent cognitive decline A systematic review of randomized controlled trials J Hum

Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among

preterm infants attributable to early supplementation of human milk with

docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings

and structural-functional synergies with cell membrane phospholipids Altern Med Rev

2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function

Neuroscience 20089(7)568-78

49

VIII Improving Brain Function and Neuroplasticity

B Drugs Maya Vetencourt JF Sale A Viegi A et al The antidepressant

fluoxetine (PROZAC) restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the

antidepressant tianeptine CNS Drugs 200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances

hippocampal long-term potentiation and memory BMC Biol 2008 Sep

9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine

improves neuropsychological disorders in a child with creatine

transporter defect Neurocase 200814(2) 151-61

50

VIII Improving Brain Function and Neuroplasticity

C Exercise

Hunsberger JG et al Antidepressant actions of the exercise-

regulated gene VGF Nat Med 2007 Dec 2 131476

VGF may be a common pathway by which exercise induces

neuroplasticity and growth-factor genes at least one of these might act

similarly to antidepressants in promoting an adaptive response to stress

However the tests used here may be modeling stress-induced

helplessness not depression hellipexercise seems to induce multiple

interacting genes that enhance neuronal resilience

51

VIII Improving Brain Function and Neuroplasticity

D Learning new and challenging things

What have we (optometry amp ophthalmology)

been thinking all these years

Where did we miss the news about neuroplasticity

52

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Huang JC Neuroplasticity as a proposed mechanism for the efficacy of optometric vision therapy and rehabilitation J Bev Optom 200920(4)96-100

Homologous area adaptationCompensatory masqueradeCross-modal reassignment

Map expansion

EquipotentialityVicariation

53

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Homologous area adaptation a transfer of function from a damaged brain area to a non-damaged brain area May be limited to early stages of human development and may crowd a new brain area resulting in reduced functionality of that brain area (Competition between spatial amp verbal functioning)

54

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Compensatory masquerade reorganizing of existing neuro-pathways to us alternative cognitive strategies to perform a task

55

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Cross-modal reassignment using new sensory input in a brain structure deprived of its main input source (changing processing from visual to tactile stimuli in the blind)

56

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Map expansion increase in brain mass due to repeated behavior or exposure to stimuli

57

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Equipotentiality anatomical areas of the brain can perform disparate functions

Vicariation redundant neural systems can operate under abnormal conditions

This may explain why recovery is noted for many neurological conditions (degenerative psychiatric developmental vascular traumatic)

58

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Constraint therapy Use it and improve it

Patching penalization ldquonear activitiesrdquo during amblyopia therapy

59

IX Improving Brain Function and Neuroplasticity Optometric Clinical ApplicationsOptometric Vision Therapy

Kleim amp Jones

Use it or lose it If you do not drive specific brain functions

functional loss will occur

If you want to improve oculomotor brain neuroplastic function amp

structure therapy should be specific for that brain function

Use it and improve it Therapy that drives cortical function enhances

that particular function

If you use therapy to improve oculomotor dysfunction it should

improve

Specificity The therapy you choose determines the resultant

plasticity and function

You must choose therapy that is appropriate

60

IX Improving Brain Function and Neuroplasticity Optometric Clinical Applications

Kleim amp Jones

Repetition matters Plasticity that results in functional change

requires repetition

Do the therapy Do it again Do it yet again No quick fix

Intensity matters Induction of plasticity requires the appropriate

amount of intensity

Intensity means strength force concentration power and passion

Without these plasticity may not occur Function may not improve

Time matters Different forms of plasticity take place at different

times during therapy

Do the basics than the more advanced therapeutic procedures

61

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Salience matters It has to be important to the individual

Make the therapy matter to the patient

Age matters Plasticity is easier in a younger brain but is also

possible in an adult brain

Do not let age determine what therapy options you offer your

patients Think of Susan Barry PhD (StereoSue) and her success

Offer your patients options Let them choose Be realistic about

outcomeshelliphave outcome measures built into therapy program

62

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Transference Neuroplasticity and the change in function

that results from one therapy can augment the attainment

of similar behaviors

What you do during oculomotor therapy may affected

vergence therapy outcomes

Interference Plasticity in response to one experience can

interfere with the acquisition of other behaviors

Monitor Evaluate progress Discuss function in other areas

of your patientslsquo life

63

Why pay attention to binocular vision dysfunctions

and neuroplasticity

December 2009 issue of the Review of Optometry

The Binocular Vision Dysfunction Pandemic

In 2010 almost 170 million individuals will be wearing glasses In

2010 there will also be up to 93 million amblyopes and 12 and a half

million strabismics For children under 18 years of age that means

there will be more than 22 and a half million amblyopes and millions

of children with strabismus A clinical trial to determine the

prevalence of binocular vision dysfunction within the general

population suggested the possibility of up to 56 or 173 million men

women and children with symptoms associated with a binocular

vision dysfunction 189 million (61) with accommodative problems

and 118 million (38) demonstrating various vergence

anomalies

64

65

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Brain plasticity life long changes in the structure of the brain

Sensory substitution replacement of one sensory input by another

Measurement techniques

Voxel based morphometryhellipmeasures difference in brain volume

Fluorodeoxyglucose glucose analog PET scan tells you

distribution and metabolism of brain

Cortical thickness measures

Visual cortex of the blind turns somatic ―The eye of the tongue

Transcranial magnetic stmiulation non-invasive technique to

stimulate cortex

66

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Blind Braille readers report tingling in fingers when pressure

phosphenes are applied Blind feel tingling in tongue

Bind use tongue to perform orientation task motion perception

sensory perception Visual cortex recruited in a variety of sensory

and cognitive tasks (DM Can we use tongue as a VT tool)

Dilks Reorganizations of human adult visual system

When a region of sensory cortex is deprived of its bottom up

input the deprived region begins to respond to stimuli that

normally activate adjacent cortex

67

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Retinotopic map changes for stroke pts Cortical reorganization in

adults occurs Perceived objectshellipelongation in stroke amp AMD

What happens to deprived cortex in AMD

fMRI shows cortical reorganization in adults

Proposed mechanisms

hellipGrowth of new connections

hellipUnmasking of pre-existing connections this is true

happens within seconds

Bavelier

Action video games

68

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Bavelier

Action video games Looked at attention Gamers can track more

activities

Attention over space (me peripheral awarenress) Useful field

of view shrinks with age

Performance not VA relatedhellipis related to attention

Action game playing changes spatial resolutionhellipovercoming

crowding in VA assessment (me amblyopia therapy)

Temporal resolution of vision Backward masking

changehellipbrain changes

Visual sensitivity (contrast sensitivity) Post action game training

improves CSF

69

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Action video games correcting optics of the cortex (me this is

actualy OVT)

Games factor

Variable entry leanringhellipadapt task to skill level

Incremental learning tune task to subjectlsquos leanring steps

Motivationarousal

Rewards

Self masterself confidence

Action games factors

Pacingrate of exposure to infohellipincreasing processing speed

Dynamic display

Rich environment

Rich motor involvement

70

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Surgeons may be made to play action games

Pilot training

Amblyopia tx Dennis Levi research

PresenterTitle Contact info

Neuroplasticity-A Paradigm Sea Change

This presentation is available at

httpwwwslidesharenetDMAINOneuroplasticity-a-paradigm-sea-change-2459693

httpwwwmainosmemosblogspotcom

My FaceBook Page

and

Twitter

PresenterTitle Contact info

Questions About

Neuroplasticity-A Paradigm Sea Change

Dominick M Maino OD MEd FAAO FCOVD-A

Professor PediatricsBinocular VisionIllinois Eye InstituteIllinois College of Optometry

dmainoicoeduhttpwwwMainosMemosblogspotcom

Thanks to

httpwwwcovdorgHomeOVDJournalOVD401tabid263D

efaultaspx

httpbipolarblastfileswordpresscom200908neurojpg

httpwwwspecialcheerscomimagesanimated_braingif

httpblogmarsdencartoonscomwp-

contentuploads200810frankenstein-myspace-lightbeergif

httpwwwshangralafamilyfuncomgala-ecalvindreamgif

httppsychiatryjwatchorgcgicontentfull20082251

73

Chakraborty R Chatterjee A Choudhart S Chakraborty PK Neuroplasticitymdasha paradigm shift in neurosciences J Indian Med Assoc

2007105(9)513-4516-8520-1

Sacks O A neurologistlsquos notebook Stereo Sue Why two eyes are better than one The New Yorker 2006 Jun 1964-73

Krulwich R National Public Radio Going Binocular Susanlsquos First Snowfall Available at

wwwnprorgtemplatesstorystoryphpstoryId=5507789 (Accessed December 8 2008)

Press LJ The story behind Stereo Suelsquo and a world-famous neurologistlsquos discovery of vision therapy Optom Vis Dev 200637(2) 55-7

Levin HS Neuroplasticity and brain imaging research implications for rehabilitation Arch Phys Med Rehabil 2006 Dec87(12 Suppl

2)S1

Wiesel TN Hubel DH Single-cell responses in striate cortex of kittens deprived of vision in one eye J Neurophysiol 1963

Nov261003-17

Hook BM Chen C Critical periods in the visual system Changing views for a model of experience-dependent plasticity Neuron 2007

Oct56(2)312-26

Ramey CT Ramey SL Prevention of intellectual disabilities early interventions to improve cognitive development Prev Med 1998

Mar-Apr27(2)224-32

Heuninckx S Wenderoth N Swinnen SP Systems neuroplasticity in the aging brain recruiting additional neural resources for

successful motor performance in elderly persons J Neurosci 2008 Jan 228(1)91-9

Ge S Yang CH Hsu KS et al A critical period for enhanced synaptic plasticity in newly generated neurons of the adult brain Neuron

2007 May54(4)559-66

74

Draganski B Gaser C Busch V et al Neuroplasticity changes in grey matter induced by training Nature 2004 Jan 22427(6972)

311-2

Cannonieri GC Bonilha L Fernandes PT et al Practice and perfect length of training and structural brain changes in experienced

typists Neuroreport 2007 Jul 218(10)1063-6

Kleim JA Jones TA Principles of experience-dependent neural plasticity implications for rehabilitation after brain damage J

Speech Lang Hear Res 2008 Feb51(1)S225-39

Trojan S Porkorny J Theoretical aspects of neuroplasticity Physiol Res 199948(2)87-97

Ramamirtham R Kee CS Hung LF et al Wave aberrations in rhesus monkeys with vision-induced ametropias Vision Res 2007

Sep47(21)2751-66

Smith EL 3rd Ramamirtham R Qiao-Grider Y et al Effects of foveal ablation on emmetropization and form-deprivation myopia

Invest Ophthalmol Vis Sci 2007 Sep48(9)3914-22

Smith EL 3rd Kee CS Ramamirtham R et al Peripheral vision can influence eye growth and refractive development in infant

monkeys Invest Ophthalmol Vis Sci 2005 Nov46(11)3965-72

Ciuffreda KJ Vasudevan B Nearwork-induced transient myopia (NITM) and permanent myopiandashndashis there a link Ophthalmic

Physiol Opt 2008 Mar28(2)103-14

Hung GK Ciuffreda KJ Incremental retinal-defocus theory of myopia development--schematic analysis and computer simulation

Comput Biol Med 2007 Jul37(7)930-46

Hung GK Ciuffreda KJ A unifying theory of refractive error development Bull Math Biol 2000 Nov62(6)1087-108

75

Pang Y Maino D Zhang G Lu F Myopia Can its progress be controlled Optom Vis Dev 200637(2)75-9

Leung JT Brown B Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lenses Optom Vis Sci

1999 Jun76(6)346-54

Hasebe S Ohtsuki H Nonaka T et al Effect of progressive addition lenses on myopia progression in Japanese children a prospective

randomized double-masked crossover trial Invest Ophthalmol Vis Sci 2008 Jul49(7)2781-9

Gwiazda J Hyman L Hussein M et al A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression

of myopia in children Invest Ophthalmol Vis Sci 2003 Apr44(4)1492-500

Siatkowski RM Cotter SA Crockett RS et al Two-year multi-center randomized double-masked placebo-controlled parallel safety and

efficacy study of 2 pirenzepine ophthalmic gel in children with myopia J AAPOS 2008 Aug12(4)332-9

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged 7 to 17 years Arch Ophthalmol 2005

Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three to less than 10 years of age Am J

Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction Am J Ophthalmol 2007

Jun143(6)1060-3

Holmes JM Edwards AR Beck RW et al A randomized pilot study of near activities versus non-near activities during patching therapy for

amblyopia J AAPOS 2005 Apr9(2)129-36

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate

amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-57

76

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic

amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Convergence Insufficiency Treatment Trial Study Group Randomized clinical trial of treatments for symptomatic convergence insufficiency

in children Arch Ophthalmol 2008 Oct126(10)1336-49

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

Solan HA Shelley-Tremblay J Hansen PC et al M-cell deficit and reading disability a preliminary study of the effects of temporal vision-

processing therapy Optometry 2004 Oct75(10)640-50

Solan HA Larson S Shelley-Tremblay J et al Role of visual attention in cognitive control of oculomotor readiness in students with reading

disabilities J Learn Disabil 2001 Mar-Apr34(2)107-18

Gallaway M Boas MB The impact of vergence and accommodative therapy on reading eye movements and reading speed Optom Vis Dev

200738(3)115-20

Goss DA Downing DB Lowther AH et al The effect of HTS vision therapy conducted in a school setting on reading skills in third and

fourth grade students Optom Vis Dev 200738(1)27-32

Crutch SJ Warrington EK Foveal crowding in posterior cortical atrophy a specific early-visual-processing deficit affecting word reading

Cogn Neuropsychol 2007 Dec24(8)843-66

Helms D Sawtelle SM A study of the effectiveness of cognitive therapy delivered in a video game format Optom Vis Dev 200738 (1)19-

26

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

77

Lawton T Training direction-discrimination sensitivity remediates a wide spectrum of reading skills OptomVis Dev 200738(1) 33-47

Goldstand S Koslowe KC Parush S Vision visual-information processing and academic performance among seventh-grade schoolchildren a

more significant relationship than we thought Am J Occup Ther 2005 Jul-Aug59(4)377-89

Fischer B Koumlngeter A Hartnegg K Effects of daily practice on subitizing visual counting and basic arithmetic skills Optom Vis Dev

200839(1)30-4

Sands W Taub M Maino D Limited research and education on special populations in optometry and ophthalomology Optom Vis Dev

200839(2)60-1

Wesson M Maino D Oculo-visual findings in Down syndrome cerebral palsy and mental retardation with non-specific etiology In Maino D

(ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 199517-54 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

Cui Y Stapleton F Suttle C Developing an instrument to assess vision-related and subjective quality of life in children with intellectual

disability data collection and preliminary analysis in a Chinese population Ophthal Physiolog Optics 2008 May28(3) 238-46

Maino D Steele G Tahir S Sajja R Attitudes of optometry students toward individuals with disabilities Optom Ed 200227(2)45-50

Maino D Special populations in the optometric curriculum Optom Ed 200227(2)38-9

Maino D Overview of special populations In Scheiman M Rouse M (eds) Optometric Management of Learning-Related Vision Problems

St Louis Mosby Inc 200685-106

Maino D (ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 1995 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

78

McCarthy P Maino D Alport syndrome a review Clin Eye Vis Care 2000 Dec12(3-4)139-50

Block SS Brusca-Vega R Pizzi WJ et al Cognitive and visual processing skills and their relationship to mutation size in full and

permutation female fragile X carriers Optom Vis Sci 2000 Nov77 (11)592-9

Maino D The young child with developmental disabilities An introduction to mental retardation and genetic syndromes In Moore BD

(ed) Eye Care for Infants and Young Children Butter-worth--Heinemann Newton MA1997285-300

Amin V Maino D The Fragile X female Visual visual perceptual and ocular health anomalies J Am Optom Assoc 1995 May66

(5)290-95

Maino DM Maino JH Cibis GW Hecht F Ocular health anomalies in patients with developmental disabilities In Maino D (ed)

Diagnosis and Management of Special Populations Mosby-Year-book Inc St Louis MO 1995189-206 Reprinted Optometric

Education Program Foundation Santa Anna Calif 2001

Maino D Wesson M Schlange D Cibis G Maino J Optometric findings in the fragile X syndrome Optom Vis Sci 199168634-40

Scheiman MMOptometric findings in children with cerebral palsy Am J Optom Physiol Opt 1984 May61(5)321-3

Maino D Maino J Maino S Mental retardation syndromes with associated ocular defects J Am Optom Assoc 199061707-16

Stewart RE Woodhouse JM Cregg M Pakeman VH Association between accommodative accuracy hypermetropia and strabismus in

children with Downs syndrome Optom Vis Sci 2007 Feb84(2)149-55

Cregg M Woodhouse JM Pakeman VH et al Accommodation and refractive error in children with Down syndrome cross-sectional

and longitudinal studies Invest Ophthalmol Vis Sci 2001 Jan42 (1)55-63

79

McClelland JF Parkes J Hill N et al Accommodative dysfunction in children with cerebral palsy a population-

based study Invest Ophthalmol Vis Sci 2006 May47(5)1824-30

Duckman RH Vision therapy for the child with cerebral palsy J Am Optom Assoc 198758(1)28-35

Duckman R Accommodation in cerebral palsy function and remediation J Am Optom Assoc 198455(4)281-3

Scheiman M Understanding and managing vision deficits a guide for occupational therapists 2nd ed Slack

Thorofare NJ 2002

Maino D Binasal occlusion for the child with Cerebral Palsy J Ill Optom Assoc 198644(1)1218

Battaglia F Quartarone A Rizzo V et al Early impairment of synaptic plasticity in patients with Downs syndrome

Neurobiol Aging 2008 Aug29(8)1272-5

Bonnier C Evaluation of early stimulation programs for enhancing brain development Acta Paediatr 2008

Jul97(7)853-8

Morice E Andreae LC Cooke SF et al Preservation of long-term memory and synaptic plasticity despite short-term

impairments in the Tc1 mouse model of Down syndrome Learn Mem 2008 Jul 1415(7)492-500

Gordon AM Schneider JA Chinnan A Charles JR Efficacy of a hand-arm bimanual intensive therapy (HABIT) in

children with hemiplegic cerebral palsy a randomized control trial Dev Med Child Neurol 2007 Nov49(11)830-8

Kapoor N Ciuffreda KJ Vision disturbances following traumatic brain injury Curr Treat Options Neurol 2002

Jul4(4)271-80

80

Ciuffreda KJ Rutner D Kapoor N et al Vision therapy for oculomotor dysfunctions in acquired brain injury a

retrospective analysis Optometry 2008 Jan79(1)18-22

Ciuffreda KJ Han Y Kapoor N Ficarra AP Oculomotor rehabilitation for reading in acquired brain injury

NeuroRehabilitation 200621(1)9-21

Zost M Diagnosis and management of visual dysfunction in cerebral injury In Maino D (ed) Diagnosis and

Management of Special Populations Mosby-Yearbook Inc St Louis 199579 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001 [Figure used with permission of the editor]

DeGutis JM Bentin S Robertson LC DEsposito M Functional plasticity in ventral temporal cortex following

cognitive rehabilitation of a congenital prosopagnosic J Cogn Neurosci 2007 Nov19 (11)1790-802

Welbourne SR Ralph MA Exploring the impact of plasticity-related recovery after brain damage in a connectionist

model of single-word reading Cogn Affect Behav Neurosci 2005 Mar5(1)77-92

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements prevent cognitive decline A

systematic review of randomized controlled trials J Hum Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among preterm infants attributable to early

supplementation of human milk with docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings and structural-functional

synergies with cell membrane phospholipids Altern Med Rev 2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function Neuroscience 20089(7)568-78

81

Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

BMC Biol 2008 Sep 9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine improves neuropsychological disorders in a child with

creatine transporter defect Neurocase 200814(2) 151-61

Forrester LW Wheaton LA Luft AR Exercise-mediated locomotor recovery and lower-limb neuroplasticity after

stroke J Rehabil Res Dev 200845(2)205-20

82

Page 10: Neuroplasticity: A Paradigm Sea Change Latest Updated File

CriticalSensitive Periods

2 The Critical period A distinct onset of robust plasticity in response to the visual experience when the initially formed circuit can be modified by experience

3 Closure of the critical period After the end of the critical period the same visual experience no longer elicits the same degree of plasticity

10

CriticalSensitive Periods

B The concept of a critical period does not imply that neuroplasticity ends after a certain age

C Sensitive period begins and ends gradually (not abruptly like the critical period) and provides for maximum sensitivity

to stimuli

11

VI Neuroplasticity and the Brain

A Can adult brain neurons actually exhibit neuroplasticity The short answer is yes

B Resultant changes are noted in not only functional outcomes but also in brain anatomy and structure

12

IV Neuroplasticity and Rehabilitation

Kleim amp Jones note that

A The Key Principles of Experience-Dependent Neural Plasticity

1 Use it or lose it

2 Use it and improve it

3 Specificity

13

4 Repetition matters

5 Intensity matters

6 Time matters

7 Salience matters

14

8 Age matters

9 Transference

10 Interference

15

Use it or lose it If you do not drive specific brain functions

functional loss will occur

Use it and improve it Therapy that drives cortical function

enhances that particular function

Specificity The therapy you choose determines the resultant

plasticity and function

Repetition matters Plasticity that results in functional change

requires repetition

16

Intensity matters Induction of plasticity requires the appropriate

amount of intensity

Time matters Different forms of plasticity take place at different

times during therapy

Salience matters It has to be important to the individual

Age matters Plasticity is easier in a younger brain but is also

possible in an adult brain

17

Transference Neuroplasticity and the change in function that

results from one therapy can augment the attainment of similar

behaviors

Interference Plasticity in response to one experience can interfere

with the acquisition of other behaviors

18

B Examples of Changes in Function and Structure

1) Jugglers

2) Typists

19

B Examples of Changes in Function and Structure

1) Jugglers

One study suggested that adults taught how to juggle demonstrated a

significant transient bilateral expansion of gray matter in the mid-

temporal area and the left posterior intraparietal sulcus between baseline brain scan and

follow-up The findings were specific to training stimulus individuals who were

not instructed how to juggle demonstrated no change in gray

matter over the same period These findings oppose the conventional

understanding that the anatomical structure of the adult brain does not change

over time

20

B Examples of Changes in Function and Structure

2) Typists

helliplong-term bimanual training also increases

gray matter volume in experienced adult typists

These results suggest that learning not

only affects function but also structure in

adult brains

21

V Neuroplasticity and Optometry

A Evolutionary neuroplasticity

B Reactive plasticity

C Adaptational plasticity

D Reparation plasticity

22

V Neuroplasticity and Optometry

A Evolutionary neuroplasticity

hellip is ideally suited for the developmental OD who

specializes in vision function as it changes over time

either with or without intervention

23

V Neuroplasticity and Optometry

B Reactive plasticity

hellip can be thought of as the immediate effect that

initial optometric treatment may have on a system This can

be reflected in an immediate but often transient change in

the individuallsquos accommodative systemmdashie when an

uncorrected myope initially puts on his or her new

spectacles

24

V Neuroplasticity and Optometry

C Adaptational plasticity

hellip could describe the long-term effects of in-office optometric

vision therapy on disorders of the binocular vision system

25

V Neuroplasticity and Optometry

D Reparation plasticity

hellipin contrast to adaptational

plasticity reparation plasticity may

occur during treatment by a low

Vision specialist or an OD

Working with those who have

Experienced a traumatic brain

injury (TBI)

26

V Neuroplasticity and Optometry

The effects of plasticity can lead to either

positive or negative changes during

development (evolutionary plasticity) after

short-term exposure (reactive plasticity)

after long-term or continuous stimuli

(adaptational plasticity) and during

functional or structural recovery of damaged

neuronal circuits (reparation plasticity)

httpwwwciteulikeorguserjasonepriorarticle2856526

27

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

A Refractive error development

B Amblyopia

C Strabismus

28

D Non-strabismus non-amblyopic binocular vision disorders

E Learning related vision anomalies

F Vision developmentperception disorders

29

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

A Refractive error development

Several recent studies have noted that neuroplasticity may play a

role in refractive error development

retinal defocus use of progressive addition lenses

drug studies (M1-antagonist2 pirenzepine ) slow myopia

progression demonstrated nearly a 50 reduction in myopia

progression over a two-year period

30

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged

7 to 17 years Arch Ophthalmol 2005 Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three

to less than 10 years of age Am J Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction

Am J Ophthalmol 2007 Jun143(6)1060-3

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine

vs patching for treatment of moderate amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-

57

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for

strabismic and anisometropic amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Treatment of severe amblyopia with weekend atropine results from 2 randomized clinical trials

Levodopacarbidopa in the treatment of amblyopia

31

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

J Pediatr Ophthalmol Strabismus 2009 Mar-Apr46(2)87-90 quiz 91-2 Levodopacarbidopa in the

treatment of amblyopia Dadeya S Vats P Malik KP

PURPOSE To evaluate the role of levodopacarbidopa in the treatment of amblyopia METHODS

Thirty patients with strabismic amblyopia between the ages of 3 and 12 years were part of this double-

blind randomized study Patients were divided into two groups Group A received 050 mg + 125 mg of

levodopacarbidopa per kilogram body weight three times daily after meals with a protein rich drink

whereas Group B received placebo Both groups received full-time conventional occlusion until a visual

acuity of 66 was achieved or for a maximum of 3 months RESULTS The authors observed more than

two lines improvement in visual acuity that was greater in the levodopa group (15 of 15) than in the

placebo group (9 of 15) (P lt 005) Furthermore improvement in visual acuity of more than two lines

was greater in patients younger than 8 years (100) than in patients older than 8 years of age (60) (P =

0026) There was also no significant reversal of the improved visual acuity in up to 6 months of follow-

up CONCLUSION Levodopacarbidopa improves visual acuity in patients with

amblyopia and maintains improved visual acuity especially in patients

younger than 8 years

32

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

J Pediatr Ophthalmol Strabismus 2008 May-Jun45(3)174-6 The use of levodopa in the treatment of

bilateral amblyopia secondary to uncorrected high hypermetropia Abrams MS

The standard treatment of bilateral amblyopia secondary to uncorrected high bilateral hypermetropia has

been spectacles and time The patient described here failed to show adequate improvement in visual

acuity after 18 months of standard treatment Visual acuity improved dramatically when the

patient began taking levodopa dropped precipitously when the medication was

discontinued and returned quickly to post-treatment levels when levodopa was

restarted Visual acuity remained stable when the medication was slowly tapered

and discontinued This report suggests that dopamine may play a role in the pathophysiology of

bilateral amblyopia secondary to uncorrected high bilateral hypermetropia

33

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

Bottom Line

Amblyopia can be treated at any age

May be able to use neuro-enhancing drugs

as a part of basic amblyopia therapy

34

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

C Strabismus and non-strabismic non-amblyopic binocular

vision disorders

Clinical Trial of Treatments for Symptomatic Convergence Insufficiency in Children has

clearly demonstrated the superiority of in-office optometric vision therapy (in conjunction

with home therapy) vs out-of-office therapy alone The study concluded that optometric

vision therapyorthoptics was more effective than pencil push-ups or placebo vision

therapyorthoptics in reducing symptoms and improving clinical signs of convergence

insufficiency

Long-term effectiveness of treatments for symptomatic convergence insufficiency

in children (Optom Vis Sci 2009 Sep86(9)1096-103)

CITT patients improvements lasted a year

35

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

Strabismus 1999 Sep7(3)169-74 Convergence insufficiency in

idiopathic Parkinsons disease responsive to levodopa Racette BA

Gokden MS Tychsen LS Perlmutter JS

We report a patient with pathologically proven idiopathic Parkinsons

disease (IPD) who developed diplopia secondary to convergence

insufficiency during his motor off periods Diplopia resolved with

onset of motor benefit from levodopa Neuro-ophthalmologic

examination demonstrated convergence insufficiency during motor

off periods that was alleviated after onset of motor benefit from

levodopa This is the first reported case of convergence insufficiency

in IPD responsive to levodopa

36

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

Bottom Line

Optometric Vision Therapy is the most efficacious treatment available for binocular vision disorders and the

treatment effects are long lasting Neuro-enhancing drugs

may assist us as well

37

EF Learning related vision anomalies Vision

developmentperception disorders

hellipresearch includes an examination of the role vision plays in

reading the effect of oculomotor vergence and

accommodativecoherent motion therapy on reading eye movements

and reading speed the diagnosis and treatment of perceptual

disorders and the effect of therapy on various learning anomalies

38

EF Learning related vision anomalies Vision developmentperception disorders

magnocellular (MC) deficit in dyslexia

LM speed-matching ratio predicts reading in childrenChase C Dougherty RF Ray N

Fowler S Stein JOptom Vis Sci 2007 Mar84(3)229-36

Effect of attention therapy on reading comprehension Solan HA Shelley-Tremblay J

Ficarra A Silverman M Larson S J Learn Disabil 2003 Nov-Dec36(6)556-63

Is there a common linkage among reading comprehension visual attention and

magnocellular processing Solan HA Shelley-Tremblay JF Hansen PC Larson S

J Learn Disabil 2007 May-Jun40(3)270-8

Lawton T Filtered Text and Direction Discrimination Training Improved Reading

Fluency for Both Dyslexic and Normal Readers Optom Vis Dev 200839 (3)114

Fischer B Hartnegg K Saccade control in dyslexia Development deficits training

and transfer to reading Optom Vis Dev 200839(4)181-190

39

EF Learning related vision anomalies Vision developmentperception disorders

J Learn Disabil 2003 Nov-Dec36(6)556-63 Effect of attention therapy on reading

comprehension Solan HA Shelley-Tremblay J Ficarra A Silverman M Larson S

hellip At the completion of attention therapy the mean

standard attention and reading comprehension scores of

the experimental group had improved significantly The

control group however showed no significant

improvement in reading comprehension scores after 12

weeks Although uncertainties still exist this investigation

supports the notion that visual attention is malleable and

that attention therapy has a significant effect on reading

comprehension in this often neglected population

40

VII Vision dysfunction association with acquired brain injury

A Exotropia (or high exophoriaCI)

B Accommodative dysfunction

C Convergence insufficiency

41

D Decreased blink rate

E Spatial disorientation

F Pursuitsaccade dysfunction

G Unstable ambient vision (Magnocellular pathway)

42

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Stelmack JA Frith T Van Koevering D Rinne S Stelmack TR Visual function in patients

followed at a Veterans Affairs polytrauma network site an electronic medical record review

Optometry 2009 Aug80(8)419-24

RESULTS Visual symptoms were self-reported by 76 of patients

with polytrauma and 75 of the patients with TBI Problems with reading

(polytrauma 60 and TBI 50) and accommodation (polytrauma 30 and

TBI 47) were frequently found on eye examinations Spectacles were the

treatment most frequently prescribed (polytrauma 62 and TBI 78)

CONCLUSIONS It is important for optometrists to be aware of the high

rates of self-reported symptoms and visual problems in military personnel

returning from deployment to the wars in Iraq and Afghanistan Post-

traumatic stress disorder and depression may complicate optometric

evaluation and management

43

VII Vision dysfunction association with acquired brain injury

Avoidance of near tasks

Oculomotor-based reading difficulties

Eye tracking problems

Eye focusing problems

Eyestrain Diplopia

Dizziness Vertigo

Vision-derived nausea

44

VII Vision dysfunction association with acquired brain injury

Increased sensitivity to visual motion

Visual inattention and distractibility

Short-term visual memory loss

Difficulty judging distances (relative and absolute

Difficulty with global scanning

Difficulty with personal grooming especially involving the face

Inability to interactcope visually in a complex social situation

(eg minimal eye contact)

Inability to tolerate complex visual environments (eg grocery store

aisles and highly-patterned floors)

45

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Ciuffreda KJ Ludlam DP Kapoor N Clinical oculomotor training in traumatic brain injury Optom Vis

Dev 200940(1)16-23

Individuals with traumatic brain injury present with a constellation of

oculomotor dysfunctions and correlated symptoms Simple and

effective clinical oculomotor-based training procedures will be

presented with respect to the versional vergence and

accommodative systems and their interactions These therapeutic

procedures can also be applied as needed to individuals with either

low vision neurological dysfunctions or general visual skills cases

manifesting similar oculomotor deficits

46

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Leslie S Myopia and accommodative insufficiency associated with

moderate head trauma Opt Vis Dev 200940(1)25-31

The majority of subjects reviewed had developed a stable degree of

myopia between 100 and 200 diopters as well as an abnormally

high lag of accommodation When their distance and near spatial area

of focus was compared the majority were focused at an intermediate

area in space suggesting a loss of control of accommodation in

space

47

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

B Drugs

C Exercise

D Learning new and challenging things

48

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements

prevent cognitive decline A systematic review of randomized controlled trials J Hum

Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among

preterm infants attributable to early supplementation of human milk with

docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings

and structural-functional synergies with cell membrane phospholipids Altern Med Rev

2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function

Neuroscience 20089(7)568-78

49

VIII Improving Brain Function and Neuroplasticity

B Drugs Maya Vetencourt JF Sale A Viegi A et al The antidepressant

fluoxetine (PROZAC) restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the

antidepressant tianeptine CNS Drugs 200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances

hippocampal long-term potentiation and memory BMC Biol 2008 Sep

9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine

improves neuropsychological disorders in a child with creatine

transporter defect Neurocase 200814(2) 151-61

50

VIII Improving Brain Function and Neuroplasticity

C Exercise

Hunsberger JG et al Antidepressant actions of the exercise-

regulated gene VGF Nat Med 2007 Dec 2 131476

VGF may be a common pathway by which exercise induces

neuroplasticity and growth-factor genes at least one of these might act

similarly to antidepressants in promoting an adaptive response to stress

However the tests used here may be modeling stress-induced

helplessness not depression hellipexercise seems to induce multiple

interacting genes that enhance neuronal resilience

51

VIII Improving Brain Function and Neuroplasticity

D Learning new and challenging things

What have we (optometry amp ophthalmology)

been thinking all these years

Where did we miss the news about neuroplasticity

52

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Huang JC Neuroplasticity as a proposed mechanism for the efficacy of optometric vision therapy and rehabilitation J Bev Optom 200920(4)96-100

Homologous area adaptationCompensatory masqueradeCross-modal reassignment

Map expansion

EquipotentialityVicariation

53

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Homologous area adaptation a transfer of function from a damaged brain area to a non-damaged brain area May be limited to early stages of human development and may crowd a new brain area resulting in reduced functionality of that brain area (Competition between spatial amp verbal functioning)

54

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Compensatory masquerade reorganizing of existing neuro-pathways to us alternative cognitive strategies to perform a task

55

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Cross-modal reassignment using new sensory input in a brain structure deprived of its main input source (changing processing from visual to tactile stimuli in the blind)

56

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Map expansion increase in brain mass due to repeated behavior or exposure to stimuli

57

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Equipotentiality anatomical areas of the brain can perform disparate functions

Vicariation redundant neural systems can operate under abnormal conditions

This may explain why recovery is noted for many neurological conditions (degenerative psychiatric developmental vascular traumatic)

58

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Constraint therapy Use it and improve it

Patching penalization ldquonear activitiesrdquo during amblyopia therapy

59

IX Improving Brain Function and Neuroplasticity Optometric Clinical ApplicationsOptometric Vision Therapy

Kleim amp Jones

Use it or lose it If you do not drive specific brain functions

functional loss will occur

If you want to improve oculomotor brain neuroplastic function amp

structure therapy should be specific for that brain function

Use it and improve it Therapy that drives cortical function enhances

that particular function

If you use therapy to improve oculomotor dysfunction it should

improve

Specificity The therapy you choose determines the resultant

plasticity and function

You must choose therapy that is appropriate

60

IX Improving Brain Function and Neuroplasticity Optometric Clinical Applications

Kleim amp Jones

Repetition matters Plasticity that results in functional change

requires repetition

Do the therapy Do it again Do it yet again No quick fix

Intensity matters Induction of plasticity requires the appropriate

amount of intensity

Intensity means strength force concentration power and passion

Without these plasticity may not occur Function may not improve

Time matters Different forms of plasticity take place at different

times during therapy

Do the basics than the more advanced therapeutic procedures

61

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Salience matters It has to be important to the individual

Make the therapy matter to the patient

Age matters Plasticity is easier in a younger brain but is also

possible in an adult brain

Do not let age determine what therapy options you offer your

patients Think of Susan Barry PhD (StereoSue) and her success

Offer your patients options Let them choose Be realistic about

outcomeshelliphave outcome measures built into therapy program

62

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Transference Neuroplasticity and the change in function

that results from one therapy can augment the attainment

of similar behaviors

What you do during oculomotor therapy may affected

vergence therapy outcomes

Interference Plasticity in response to one experience can

interfere with the acquisition of other behaviors

Monitor Evaluate progress Discuss function in other areas

of your patientslsquo life

63

Why pay attention to binocular vision dysfunctions

and neuroplasticity

December 2009 issue of the Review of Optometry

The Binocular Vision Dysfunction Pandemic

In 2010 almost 170 million individuals will be wearing glasses In

2010 there will also be up to 93 million amblyopes and 12 and a half

million strabismics For children under 18 years of age that means

there will be more than 22 and a half million amblyopes and millions

of children with strabismus A clinical trial to determine the

prevalence of binocular vision dysfunction within the general

population suggested the possibility of up to 56 or 173 million men

women and children with symptoms associated with a binocular

vision dysfunction 189 million (61) with accommodative problems

and 118 million (38) demonstrating various vergence

anomalies

64

65

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Brain plasticity life long changes in the structure of the brain

Sensory substitution replacement of one sensory input by another

Measurement techniques

Voxel based morphometryhellipmeasures difference in brain volume

Fluorodeoxyglucose glucose analog PET scan tells you

distribution and metabolism of brain

Cortical thickness measures

Visual cortex of the blind turns somatic ―The eye of the tongue

Transcranial magnetic stmiulation non-invasive technique to

stimulate cortex

66

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Blind Braille readers report tingling in fingers when pressure

phosphenes are applied Blind feel tingling in tongue

Bind use tongue to perform orientation task motion perception

sensory perception Visual cortex recruited in a variety of sensory

and cognitive tasks (DM Can we use tongue as a VT tool)

Dilks Reorganizations of human adult visual system

When a region of sensory cortex is deprived of its bottom up

input the deprived region begins to respond to stimuli that

normally activate adjacent cortex

67

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Retinotopic map changes for stroke pts Cortical reorganization in

adults occurs Perceived objectshellipelongation in stroke amp AMD

What happens to deprived cortex in AMD

fMRI shows cortical reorganization in adults

Proposed mechanisms

hellipGrowth of new connections

hellipUnmasking of pre-existing connections this is true

happens within seconds

Bavelier

Action video games

68

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Bavelier

Action video games Looked at attention Gamers can track more

activities

Attention over space (me peripheral awarenress) Useful field

of view shrinks with age

Performance not VA relatedhellipis related to attention

Action game playing changes spatial resolutionhellipovercoming

crowding in VA assessment (me amblyopia therapy)

Temporal resolution of vision Backward masking

changehellipbrain changes

Visual sensitivity (contrast sensitivity) Post action game training

improves CSF

69

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Action video games correcting optics of the cortex (me this is

actualy OVT)

Games factor

Variable entry leanringhellipadapt task to skill level

Incremental learning tune task to subjectlsquos leanring steps

Motivationarousal

Rewards

Self masterself confidence

Action games factors

Pacingrate of exposure to infohellipincreasing processing speed

Dynamic display

Rich environment

Rich motor involvement

70

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Surgeons may be made to play action games

Pilot training

Amblyopia tx Dennis Levi research

PresenterTitle Contact info

Neuroplasticity-A Paradigm Sea Change

This presentation is available at

httpwwwslidesharenetDMAINOneuroplasticity-a-paradigm-sea-change-2459693

httpwwwmainosmemosblogspotcom

My FaceBook Page

and

Twitter

PresenterTitle Contact info

Questions About

Neuroplasticity-A Paradigm Sea Change

Dominick M Maino OD MEd FAAO FCOVD-A

Professor PediatricsBinocular VisionIllinois Eye InstituteIllinois College of Optometry

dmainoicoeduhttpwwwMainosMemosblogspotcom

Thanks to

httpwwwcovdorgHomeOVDJournalOVD401tabid263D

efaultaspx

httpbipolarblastfileswordpresscom200908neurojpg

httpwwwspecialcheerscomimagesanimated_braingif

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contentuploads200810frankenstein-myspace-lightbeergif

httpwwwshangralafamilyfuncomgala-ecalvindreamgif

httppsychiatryjwatchorgcgicontentfull20082251

73

Chakraborty R Chatterjee A Choudhart S Chakraborty PK Neuroplasticitymdasha paradigm shift in neurosciences J Indian Med Assoc

2007105(9)513-4516-8520-1

Sacks O A neurologistlsquos notebook Stereo Sue Why two eyes are better than one The New Yorker 2006 Jun 1964-73

Krulwich R National Public Radio Going Binocular Susanlsquos First Snowfall Available at

wwwnprorgtemplatesstorystoryphpstoryId=5507789 (Accessed December 8 2008)

Press LJ The story behind Stereo Suelsquo and a world-famous neurologistlsquos discovery of vision therapy Optom Vis Dev 200637(2) 55-7

Levin HS Neuroplasticity and brain imaging research implications for rehabilitation Arch Phys Med Rehabil 2006 Dec87(12 Suppl

2)S1

Wiesel TN Hubel DH Single-cell responses in striate cortex of kittens deprived of vision in one eye J Neurophysiol 1963

Nov261003-17

Hook BM Chen C Critical periods in the visual system Changing views for a model of experience-dependent plasticity Neuron 2007

Oct56(2)312-26

Ramey CT Ramey SL Prevention of intellectual disabilities early interventions to improve cognitive development Prev Med 1998

Mar-Apr27(2)224-32

Heuninckx S Wenderoth N Swinnen SP Systems neuroplasticity in the aging brain recruiting additional neural resources for

successful motor performance in elderly persons J Neurosci 2008 Jan 228(1)91-9

Ge S Yang CH Hsu KS et al A critical period for enhanced synaptic plasticity in newly generated neurons of the adult brain Neuron

2007 May54(4)559-66

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Draganski B Gaser C Busch V et al Neuroplasticity changes in grey matter induced by training Nature 2004 Jan 22427(6972)

311-2

Cannonieri GC Bonilha L Fernandes PT et al Practice and perfect length of training and structural brain changes in experienced

typists Neuroreport 2007 Jul 218(10)1063-6

Kleim JA Jones TA Principles of experience-dependent neural plasticity implications for rehabilitation after brain damage J

Speech Lang Hear Res 2008 Feb51(1)S225-39

Trojan S Porkorny J Theoretical aspects of neuroplasticity Physiol Res 199948(2)87-97

Ramamirtham R Kee CS Hung LF et al Wave aberrations in rhesus monkeys with vision-induced ametropias Vision Res 2007

Sep47(21)2751-66

Smith EL 3rd Ramamirtham R Qiao-Grider Y et al Effects of foveal ablation on emmetropization and form-deprivation myopia

Invest Ophthalmol Vis Sci 2007 Sep48(9)3914-22

Smith EL 3rd Kee CS Ramamirtham R et al Peripheral vision can influence eye growth and refractive development in infant

monkeys Invest Ophthalmol Vis Sci 2005 Nov46(11)3965-72

Ciuffreda KJ Vasudevan B Nearwork-induced transient myopia (NITM) and permanent myopiandashndashis there a link Ophthalmic

Physiol Opt 2008 Mar28(2)103-14

Hung GK Ciuffreda KJ Incremental retinal-defocus theory of myopia development--schematic analysis and computer simulation

Comput Biol Med 2007 Jul37(7)930-46

Hung GK Ciuffreda KJ A unifying theory of refractive error development Bull Math Biol 2000 Nov62(6)1087-108

75

Pang Y Maino D Zhang G Lu F Myopia Can its progress be controlled Optom Vis Dev 200637(2)75-9

Leung JT Brown B Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lenses Optom Vis Sci

1999 Jun76(6)346-54

Hasebe S Ohtsuki H Nonaka T et al Effect of progressive addition lenses on myopia progression in Japanese children a prospective

randomized double-masked crossover trial Invest Ophthalmol Vis Sci 2008 Jul49(7)2781-9

Gwiazda J Hyman L Hussein M et al A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression

of myopia in children Invest Ophthalmol Vis Sci 2003 Apr44(4)1492-500

Siatkowski RM Cotter SA Crockett RS et al Two-year multi-center randomized double-masked placebo-controlled parallel safety and

efficacy study of 2 pirenzepine ophthalmic gel in children with myopia J AAPOS 2008 Aug12(4)332-9

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged 7 to 17 years Arch Ophthalmol 2005

Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three to less than 10 years of age Am J

Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction Am J Ophthalmol 2007

Jun143(6)1060-3

Holmes JM Edwards AR Beck RW et al A randomized pilot study of near activities versus non-near activities during patching therapy for

amblyopia J AAPOS 2005 Apr9(2)129-36

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate

amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-57

76

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic

amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Convergence Insufficiency Treatment Trial Study Group Randomized clinical trial of treatments for symptomatic convergence insufficiency

in children Arch Ophthalmol 2008 Oct126(10)1336-49

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

Solan HA Shelley-Tremblay J Hansen PC et al M-cell deficit and reading disability a preliminary study of the effects of temporal vision-

processing therapy Optometry 2004 Oct75(10)640-50

Solan HA Larson S Shelley-Tremblay J et al Role of visual attention in cognitive control of oculomotor readiness in students with reading

disabilities J Learn Disabil 2001 Mar-Apr34(2)107-18

Gallaway M Boas MB The impact of vergence and accommodative therapy on reading eye movements and reading speed Optom Vis Dev

200738(3)115-20

Goss DA Downing DB Lowther AH et al The effect of HTS vision therapy conducted in a school setting on reading skills in third and

fourth grade students Optom Vis Dev 200738(1)27-32

Crutch SJ Warrington EK Foveal crowding in posterior cortical atrophy a specific early-visual-processing deficit affecting word reading

Cogn Neuropsychol 2007 Dec24(8)843-66

Helms D Sawtelle SM A study of the effectiveness of cognitive therapy delivered in a video game format Optom Vis Dev 200738 (1)19-

26

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

77

Lawton T Training direction-discrimination sensitivity remediates a wide spectrum of reading skills OptomVis Dev 200738(1) 33-47

Goldstand S Koslowe KC Parush S Vision visual-information processing and academic performance among seventh-grade schoolchildren a

more significant relationship than we thought Am J Occup Ther 2005 Jul-Aug59(4)377-89

Fischer B Koumlngeter A Hartnegg K Effects of daily practice on subitizing visual counting and basic arithmetic skills Optom Vis Dev

200839(1)30-4

Sands W Taub M Maino D Limited research and education on special populations in optometry and ophthalomology Optom Vis Dev

200839(2)60-1

Wesson M Maino D Oculo-visual findings in Down syndrome cerebral palsy and mental retardation with non-specific etiology In Maino D

(ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 199517-54 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

Cui Y Stapleton F Suttle C Developing an instrument to assess vision-related and subjective quality of life in children with intellectual

disability data collection and preliminary analysis in a Chinese population Ophthal Physiolog Optics 2008 May28(3) 238-46

Maino D Steele G Tahir S Sajja R Attitudes of optometry students toward individuals with disabilities Optom Ed 200227(2)45-50

Maino D Special populations in the optometric curriculum Optom Ed 200227(2)38-9

Maino D Overview of special populations In Scheiman M Rouse M (eds) Optometric Management of Learning-Related Vision Problems

St Louis Mosby Inc 200685-106

Maino D (ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 1995 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

78

McCarthy P Maino D Alport syndrome a review Clin Eye Vis Care 2000 Dec12(3-4)139-50

Block SS Brusca-Vega R Pizzi WJ et al Cognitive and visual processing skills and their relationship to mutation size in full and

permutation female fragile X carriers Optom Vis Sci 2000 Nov77 (11)592-9

Maino D The young child with developmental disabilities An introduction to mental retardation and genetic syndromes In Moore BD

(ed) Eye Care for Infants and Young Children Butter-worth--Heinemann Newton MA1997285-300

Amin V Maino D The Fragile X female Visual visual perceptual and ocular health anomalies J Am Optom Assoc 1995 May66

(5)290-95

Maino DM Maino JH Cibis GW Hecht F Ocular health anomalies in patients with developmental disabilities In Maino D (ed)

Diagnosis and Management of Special Populations Mosby-Year-book Inc St Louis MO 1995189-206 Reprinted Optometric

Education Program Foundation Santa Anna Calif 2001

Maino D Wesson M Schlange D Cibis G Maino J Optometric findings in the fragile X syndrome Optom Vis Sci 199168634-40

Scheiman MMOptometric findings in children with cerebral palsy Am J Optom Physiol Opt 1984 May61(5)321-3

Maino D Maino J Maino S Mental retardation syndromes with associated ocular defects J Am Optom Assoc 199061707-16

Stewart RE Woodhouse JM Cregg M Pakeman VH Association between accommodative accuracy hypermetropia and strabismus in

children with Downs syndrome Optom Vis Sci 2007 Feb84(2)149-55

Cregg M Woodhouse JM Pakeman VH et al Accommodation and refractive error in children with Down syndrome cross-sectional

and longitudinal studies Invest Ophthalmol Vis Sci 2001 Jan42 (1)55-63

79

McClelland JF Parkes J Hill N et al Accommodative dysfunction in children with cerebral palsy a population-

based study Invest Ophthalmol Vis Sci 2006 May47(5)1824-30

Duckman RH Vision therapy for the child with cerebral palsy J Am Optom Assoc 198758(1)28-35

Duckman R Accommodation in cerebral palsy function and remediation J Am Optom Assoc 198455(4)281-3

Scheiman M Understanding and managing vision deficits a guide for occupational therapists 2nd ed Slack

Thorofare NJ 2002

Maino D Binasal occlusion for the child with Cerebral Palsy J Ill Optom Assoc 198644(1)1218

Battaglia F Quartarone A Rizzo V et al Early impairment of synaptic plasticity in patients with Downs syndrome

Neurobiol Aging 2008 Aug29(8)1272-5

Bonnier C Evaluation of early stimulation programs for enhancing brain development Acta Paediatr 2008

Jul97(7)853-8

Morice E Andreae LC Cooke SF et al Preservation of long-term memory and synaptic plasticity despite short-term

impairments in the Tc1 mouse model of Down syndrome Learn Mem 2008 Jul 1415(7)492-500

Gordon AM Schneider JA Chinnan A Charles JR Efficacy of a hand-arm bimanual intensive therapy (HABIT) in

children with hemiplegic cerebral palsy a randomized control trial Dev Med Child Neurol 2007 Nov49(11)830-8

Kapoor N Ciuffreda KJ Vision disturbances following traumatic brain injury Curr Treat Options Neurol 2002

Jul4(4)271-80

80

Ciuffreda KJ Rutner D Kapoor N et al Vision therapy for oculomotor dysfunctions in acquired brain injury a

retrospective analysis Optometry 2008 Jan79(1)18-22

Ciuffreda KJ Han Y Kapoor N Ficarra AP Oculomotor rehabilitation for reading in acquired brain injury

NeuroRehabilitation 200621(1)9-21

Zost M Diagnosis and management of visual dysfunction in cerebral injury In Maino D (ed) Diagnosis and

Management of Special Populations Mosby-Yearbook Inc St Louis 199579 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001 [Figure used with permission of the editor]

DeGutis JM Bentin S Robertson LC DEsposito M Functional plasticity in ventral temporal cortex following

cognitive rehabilitation of a congenital prosopagnosic J Cogn Neurosci 2007 Nov19 (11)1790-802

Welbourne SR Ralph MA Exploring the impact of plasticity-related recovery after brain damage in a connectionist

model of single-word reading Cogn Affect Behav Neurosci 2005 Mar5(1)77-92

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements prevent cognitive decline A

systematic review of randomized controlled trials J Hum Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among preterm infants attributable to early

supplementation of human milk with docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings and structural-functional

synergies with cell membrane phospholipids Altern Med Rev 2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function Neuroscience 20089(7)568-78

81

Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

BMC Biol 2008 Sep 9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine improves neuropsychological disorders in a child with

creatine transporter defect Neurocase 200814(2) 151-61

Forrester LW Wheaton LA Luft AR Exercise-mediated locomotor recovery and lower-limb neuroplasticity after

stroke J Rehabil Res Dev 200845(2)205-20

82

Page 11: Neuroplasticity: A Paradigm Sea Change Latest Updated File

CriticalSensitive Periods

B The concept of a critical period does not imply that neuroplasticity ends after a certain age

C Sensitive period begins and ends gradually (not abruptly like the critical period) and provides for maximum sensitivity

to stimuli

11

VI Neuroplasticity and the Brain

A Can adult brain neurons actually exhibit neuroplasticity The short answer is yes

B Resultant changes are noted in not only functional outcomes but also in brain anatomy and structure

12

IV Neuroplasticity and Rehabilitation

Kleim amp Jones note that

A The Key Principles of Experience-Dependent Neural Plasticity

1 Use it or lose it

2 Use it and improve it

3 Specificity

13

4 Repetition matters

5 Intensity matters

6 Time matters

7 Salience matters

14

8 Age matters

9 Transference

10 Interference

15

Use it or lose it If you do not drive specific brain functions

functional loss will occur

Use it and improve it Therapy that drives cortical function

enhances that particular function

Specificity The therapy you choose determines the resultant

plasticity and function

Repetition matters Plasticity that results in functional change

requires repetition

16

Intensity matters Induction of plasticity requires the appropriate

amount of intensity

Time matters Different forms of plasticity take place at different

times during therapy

Salience matters It has to be important to the individual

Age matters Plasticity is easier in a younger brain but is also

possible in an adult brain

17

Transference Neuroplasticity and the change in function that

results from one therapy can augment the attainment of similar

behaviors

Interference Plasticity in response to one experience can interfere

with the acquisition of other behaviors

18

B Examples of Changes in Function and Structure

1) Jugglers

2) Typists

19

B Examples of Changes in Function and Structure

1) Jugglers

One study suggested that adults taught how to juggle demonstrated a

significant transient bilateral expansion of gray matter in the mid-

temporal area and the left posterior intraparietal sulcus between baseline brain scan and

follow-up The findings were specific to training stimulus individuals who were

not instructed how to juggle demonstrated no change in gray

matter over the same period These findings oppose the conventional

understanding that the anatomical structure of the adult brain does not change

over time

20

B Examples of Changes in Function and Structure

2) Typists

helliplong-term bimanual training also increases

gray matter volume in experienced adult typists

These results suggest that learning not

only affects function but also structure in

adult brains

21

V Neuroplasticity and Optometry

A Evolutionary neuroplasticity

B Reactive plasticity

C Adaptational plasticity

D Reparation plasticity

22

V Neuroplasticity and Optometry

A Evolutionary neuroplasticity

hellip is ideally suited for the developmental OD who

specializes in vision function as it changes over time

either with or without intervention

23

V Neuroplasticity and Optometry

B Reactive plasticity

hellip can be thought of as the immediate effect that

initial optometric treatment may have on a system This can

be reflected in an immediate but often transient change in

the individuallsquos accommodative systemmdashie when an

uncorrected myope initially puts on his or her new

spectacles

24

V Neuroplasticity and Optometry

C Adaptational plasticity

hellip could describe the long-term effects of in-office optometric

vision therapy on disorders of the binocular vision system

25

V Neuroplasticity and Optometry

D Reparation plasticity

hellipin contrast to adaptational

plasticity reparation plasticity may

occur during treatment by a low

Vision specialist or an OD

Working with those who have

Experienced a traumatic brain

injury (TBI)

26

V Neuroplasticity and Optometry

The effects of plasticity can lead to either

positive or negative changes during

development (evolutionary plasticity) after

short-term exposure (reactive plasticity)

after long-term or continuous stimuli

(adaptational plasticity) and during

functional or structural recovery of damaged

neuronal circuits (reparation plasticity)

httpwwwciteulikeorguserjasonepriorarticle2856526

27

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

A Refractive error development

B Amblyopia

C Strabismus

28

D Non-strabismus non-amblyopic binocular vision disorders

E Learning related vision anomalies

F Vision developmentperception disorders

29

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

A Refractive error development

Several recent studies have noted that neuroplasticity may play a

role in refractive error development

retinal defocus use of progressive addition lenses

drug studies (M1-antagonist2 pirenzepine ) slow myopia

progression demonstrated nearly a 50 reduction in myopia

progression over a two-year period

30

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged

7 to 17 years Arch Ophthalmol 2005 Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three

to less than 10 years of age Am J Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction

Am J Ophthalmol 2007 Jun143(6)1060-3

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine

vs patching for treatment of moderate amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-

57

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for

strabismic and anisometropic amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Treatment of severe amblyopia with weekend atropine results from 2 randomized clinical trials

Levodopacarbidopa in the treatment of amblyopia

31

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

J Pediatr Ophthalmol Strabismus 2009 Mar-Apr46(2)87-90 quiz 91-2 Levodopacarbidopa in the

treatment of amblyopia Dadeya S Vats P Malik KP

PURPOSE To evaluate the role of levodopacarbidopa in the treatment of amblyopia METHODS

Thirty patients with strabismic amblyopia between the ages of 3 and 12 years were part of this double-

blind randomized study Patients were divided into two groups Group A received 050 mg + 125 mg of

levodopacarbidopa per kilogram body weight three times daily after meals with a protein rich drink

whereas Group B received placebo Both groups received full-time conventional occlusion until a visual

acuity of 66 was achieved or for a maximum of 3 months RESULTS The authors observed more than

two lines improvement in visual acuity that was greater in the levodopa group (15 of 15) than in the

placebo group (9 of 15) (P lt 005) Furthermore improvement in visual acuity of more than two lines

was greater in patients younger than 8 years (100) than in patients older than 8 years of age (60) (P =

0026) There was also no significant reversal of the improved visual acuity in up to 6 months of follow-

up CONCLUSION Levodopacarbidopa improves visual acuity in patients with

amblyopia and maintains improved visual acuity especially in patients

younger than 8 years

32

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

J Pediatr Ophthalmol Strabismus 2008 May-Jun45(3)174-6 The use of levodopa in the treatment of

bilateral amblyopia secondary to uncorrected high hypermetropia Abrams MS

The standard treatment of bilateral amblyopia secondary to uncorrected high bilateral hypermetropia has

been spectacles and time The patient described here failed to show adequate improvement in visual

acuity after 18 months of standard treatment Visual acuity improved dramatically when the

patient began taking levodopa dropped precipitously when the medication was

discontinued and returned quickly to post-treatment levels when levodopa was

restarted Visual acuity remained stable when the medication was slowly tapered

and discontinued This report suggests that dopamine may play a role in the pathophysiology of

bilateral amblyopia secondary to uncorrected high bilateral hypermetropia

33

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

Bottom Line

Amblyopia can be treated at any age

May be able to use neuro-enhancing drugs

as a part of basic amblyopia therapy

34

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

C Strabismus and non-strabismic non-amblyopic binocular

vision disorders

Clinical Trial of Treatments for Symptomatic Convergence Insufficiency in Children has

clearly demonstrated the superiority of in-office optometric vision therapy (in conjunction

with home therapy) vs out-of-office therapy alone The study concluded that optometric

vision therapyorthoptics was more effective than pencil push-ups or placebo vision

therapyorthoptics in reducing symptoms and improving clinical signs of convergence

insufficiency

Long-term effectiveness of treatments for symptomatic convergence insufficiency

in children (Optom Vis Sci 2009 Sep86(9)1096-103)

CITT patients improvements lasted a year

35

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

Strabismus 1999 Sep7(3)169-74 Convergence insufficiency in

idiopathic Parkinsons disease responsive to levodopa Racette BA

Gokden MS Tychsen LS Perlmutter JS

We report a patient with pathologically proven idiopathic Parkinsons

disease (IPD) who developed diplopia secondary to convergence

insufficiency during his motor off periods Diplopia resolved with

onset of motor benefit from levodopa Neuro-ophthalmologic

examination demonstrated convergence insufficiency during motor

off periods that was alleviated after onset of motor benefit from

levodopa This is the first reported case of convergence insufficiency

in IPD responsive to levodopa

36

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

Bottom Line

Optometric Vision Therapy is the most efficacious treatment available for binocular vision disorders and the

treatment effects are long lasting Neuro-enhancing drugs

may assist us as well

37

EF Learning related vision anomalies Vision

developmentperception disorders

hellipresearch includes an examination of the role vision plays in

reading the effect of oculomotor vergence and

accommodativecoherent motion therapy on reading eye movements

and reading speed the diagnosis and treatment of perceptual

disorders and the effect of therapy on various learning anomalies

38

EF Learning related vision anomalies Vision developmentperception disorders

magnocellular (MC) deficit in dyslexia

LM speed-matching ratio predicts reading in childrenChase C Dougherty RF Ray N

Fowler S Stein JOptom Vis Sci 2007 Mar84(3)229-36

Effect of attention therapy on reading comprehension Solan HA Shelley-Tremblay J

Ficarra A Silverman M Larson S J Learn Disabil 2003 Nov-Dec36(6)556-63

Is there a common linkage among reading comprehension visual attention and

magnocellular processing Solan HA Shelley-Tremblay JF Hansen PC Larson S

J Learn Disabil 2007 May-Jun40(3)270-8

Lawton T Filtered Text and Direction Discrimination Training Improved Reading

Fluency for Both Dyslexic and Normal Readers Optom Vis Dev 200839 (3)114

Fischer B Hartnegg K Saccade control in dyslexia Development deficits training

and transfer to reading Optom Vis Dev 200839(4)181-190

39

EF Learning related vision anomalies Vision developmentperception disorders

J Learn Disabil 2003 Nov-Dec36(6)556-63 Effect of attention therapy on reading

comprehension Solan HA Shelley-Tremblay J Ficarra A Silverman M Larson S

hellip At the completion of attention therapy the mean

standard attention and reading comprehension scores of

the experimental group had improved significantly The

control group however showed no significant

improvement in reading comprehension scores after 12

weeks Although uncertainties still exist this investigation

supports the notion that visual attention is malleable and

that attention therapy has a significant effect on reading

comprehension in this often neglected population

40

VII Vision dysfunction association with acquired brain injury

A Exotropia (or high exophoriaCI)

B Accommodative dysfunction

C Convergence insufficiency

41

D Decreased blink rate

E Spatial disorientation

F Pursuitsaccade dysfunction

G Unstable ambient vision (Magnocellular pathway)

42

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Stelmack JA Frith T Van Koevering D Rinne S Stelmack TR Visual function in patients

followed at a Veterans Affairs polytrauma network site an electronic medical record review

Optometry 2009 Aug80(8)419-24

RESULTS Visual symptoms were self-reported by 76 of patients

with polytrauma and 75 of the patients with TBI Problems with reading

(polytrauma 60 and TBI 50) and accommodation (polytrauma 30 and

TBI 47) were frequently found on eye examinations Spectacles were the

treatment most frequently prescribed (polytrauma 62 and TBI 78)

CONCLUSIONS It is important for optometrists to be aware of the high

rates of self-reported symptoms and visual problems in military personnel

returning from deployment to the wars in Iraq and Afghanistan Post-

traumatic stress disorder and depression may complicate optometric

evaluation and management

43

VII Vision dysfunction association with acquired brain injury

Avoidance of near tasks

Oculomotor-based reading difficulties

Eye tracking problems

Eye focusing problems

Eyestrain Diplopia

Dizziness Vertigo

Vision-derived nausea

44

VII Vision dysfunction association with acquired brain injury

Increased sensitivity to visual motion

Visual inattention and distractibility

Short-term visual memory loss

Difficulty judging distances (relative and absolute

Difficulty with global scanning

Difficulty with personal grooming especially involving the face

Inability to interactcope visually in a complex social situation

(eg minimal eye contact)

Inability to tolerate complex visual environments (eg grocery store

aisles and highly-patterned floors)

45

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Ciuffreda KJ Ludlam DP Kapoor N Clinical oculomotor training in traumatic brain injury Optom Vis

Dev 200940(1)16-23

Individuals with traumatic brain injury present with a constellation of

oculomotor dysfunctions and correlated symptoms Simple and

effective clinical oculomotor-based training procedures will be

presented with respect to the versional vergence and

accommodative systems and their interactions These therapeutic

procedures can also be applied as needed to individuals with either

low vision neurological dysfunctions or general visual skills cases

manifesting similar oculomotor deficits

46

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Leslie S Myopia and accommodative insufficiency associated with

moderate head trauma Opt Vis Dev 200940(1)25-31

The majority of subjects reviewed had developed a stable degree of

myopia between 100 and 200 diopters as well as an abnormally

high lag of accommodation When their distance and near spatial area

of focus was compared the majority were focused at an intermediate

area in space suggesting a loss of control of accommodation in

space

47

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

B Drugs

C Exercise

D Learning new and challenging things

48

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements

prevent cognitive decline A systematic review of randomized controlled trials J Hum

Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among

preterm infants attributable to early supplementation of human milk with

docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings

and structural-functional synergies with cell membrane phospholipids Altern Med Rev

2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function

Neuroscience 20089(7)568-78

49

VIII Improving Brain Function and Neuroplasticity

B Drugs Maya Vetencourt JF Sale A Viegi A et al The antidepressant

fluoxetine (PROZAC) restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the

antidepressant tianeptine CNS Drugs 200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances

hippocampal long-term potentiation and memory BMC Biol 2008 Sep

9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine

improves neuropsychological disorders in a child with creatine

transporter defect Neurocase 200814(2) 151-61

50

VIII Improving Brain Function and Neuroplasticity

C Exercise

Hunsberger JG et al Antidepressant actions of the exercise-

regulated gene VGF Nat Med 2007 Dec 2 131476

VGF may be a common pathway by which exercise induces

neuroplasticity and growth-factor genes at least one of these might act

similarly to antidepressants in promoting an adaptive response to stress

However the tests used here may be modeling stress-induced

helplessness not depression hellipexercise seems to induce multiple

interacting genes that enhance neuronal resilience

51

VIII Improving Brain Function and Neuroplasticity

D Learning new and challenging things

What have we (optometry amp ophthalmology)

been thinking all these years

Where did we miss the news about neuroplasticity

52

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Huang JC Neuroplasticity as a proposed mechanism for the efficacy of optometric vision therapy and rehabilitation J Bev Optom 200920(4)96-100

Homologous area adaptationCompensatory masqueradeCross-modal reassignment

Map expansion

EquipotentialityVicariation

53

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Homologous area adaptation a transfer of function from a damaged brain area to a non-damaged brain area May be limited to early stages of human development and may crowd a new brain area resulting in reduced functionality of that brain area (Competition between spatial amp verbal functioning)

54

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Compensatory masquerade reorganizing of existing neuro-pathways to us alternative cognitive strategies to perform a task

55

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Cross-modal reassignment using new sensory input in a brain structure deprived of its main input source (changing processing from visual to tactile stimuli in the blind)

56

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Map expansion increase in brain mass due to repeated behavior or exposure to stimuli

57

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Equipotentiality anatomical areas of the brain can perform disparate functions

Vicariation redundant neural systems can operate under abnormal conditions

This may explain why recovery is noted for many neurological conditions (degenerative psychiatric developmental vascular traumatic)

58

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Constraint therapy Use it and improve it

Patching penalization ldquonear activitiesrdquo during amblyopia therapy

59

IX Improving Brain Function and Neuroplasticity Optometric Clinical ApplicationsOptometric Vision Therapy

Kleim amp Jones

Use it or lose it If you do not drive specific brain functions

functional loss will occur

If you want to improve oculomotor brain neuroplastic function amp

structure therapy should be specific for that brain function

Use it and improve it Therapy that drives cortical function enhances

that particular function

If you use therapy to improve oculomotor dysfunction it should

improve

Specificity The therapy you choose determines the resultant

plasticity and function

You must choose therapy that is appropriate

60

IX Improving Brain Function and Neuroplasticity Optometric Clinical Applications

Kleim amp Jones

Repetition matters Plasticity that results in functional change

requires repetition

Do the therapy Do it again Do it yet again No quick fix

Intensity matters Induction of plasticity requires the appropriate

amount of intensity

Intensity means strength force concentration power and passion

Without these plasticity may not occur Function may not improve

Time matters Different forms of plasticity take place at different

times during therapy

Do the basics than the more advanced therapeutic procedures

61

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Salience matters It has to be important to the individual

Make the therapy matter to the patient

Age matters Plasticity is easier in a younger brain but is also

possible in an adult brain

Do not let age determine what therapy options you offer your

patients Think of Susan Barry PhD (StereoSue) and her success

Offer your patients options Let them choose Be realistic about

outcomeshelliphave outcome measures built into therapy program

62

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Transference Neuroplasticity and the change in function

that results from one therapy can augment the attainment

of similar behaviors

What you do during oculomotor therapy may affected

vergence therapy outcomes

Interference Plasticity in response to one experience can

interfere with the acquisition of other behaviors

Monitor Evaluate progress Discuss function in other areas

of your patientslsquo life

63

Why pay attention to binocular vision dysfunctions

and neuroplasticity

December 2009 issue of the Review of Optometry

The Binocular Vision Dysfunction Pandemic

In 2010 almost 170 million individuals will be wearing glasses In

2010 there will also be up to 93 million amblyopes and 12 and a half

million strabismics For children under 18 years of age that means

there will be more than 22 and a half million amblyopes and millions

of children with strabismus A clinical trial to determine the

prevalence of binocular vision dysfunction within the general

population suggested the possibility of up to 56 or 173 million men

women and children with symptoms associated with a binocular

vision dysfunction 189 million (61) with accommodative problems

and 118 million (38) demonstrating various vergence

anomalies

64

65

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Brain plasticity life long changes in the structure of the brain

Sensory substitution replacement of one sensory input by another

Measurement techniques

Voxel based morphometryhellipmeasures difference in brain volume

Fluorodeoxyglucose glucose analog PET scan tells you

distribution and metabolism of brain

Cortical thickness measures

Visual cortex of the blind turns somatic ―The eye of the tongue

Transcranial magnetic stmiulation non-invasive technique to

stimulate cortex

66

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Blind Braille readers report tingling in fingers when pressure

phosphenes are applied Blind feel tingling in tongue

Bind use tongue to perform orientation task motion perception

sensory perception Visual cortex recruited in a variety of sensory

and cognitive tasks (DM Can we use tongue as a VT tool)

Dilks Reorganizations of human adult visual system

When a region of sensory cortex is deprived of its bottom up

input the deprived region begins to respond to stimuli that

normally activate adjacent cortex

67

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Retinotopic map changes for stroke pts Cortical reorganization in

adults occurs Perceived objectshellipelongation in stroke amp AMD

What happens to deprived cortex in AMD

fMRI shows cortical reorganization in adults

Proposed mechanisms

hellipGrowth of new connections

hellipUnmasking of pre-existing connections this is true

happens within seconds

Bavelier

Action video games

68

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Bavelier

Action video games Looked at attention Gamers can track more

activities

Attention over space (me peripheral awarenress) Useful field

of view shrinks with age

Performance not VA relatedhellipis related to attention

Action game playing changes spatial resolutionhellipovercoming

crowding in VA assessment (me amblyopia therapy)

Temporal resolution of vision Backward masking

changehellipbrain changes

Visual sensitivity (contrast sensitivity) Post action game training

improves CSF

69

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Action video games correcting optics of the cortex (me this is

actualy OVT)

Games factor

Variable entry leanringhellipadapt task to skill level

Incremental learning tune task to subjectlsquos leanring steps

Motivationarousal

Rewards

Self masterself confidence

Action games factors

Pacingrate of exposure to infohellipincreasing processing speed

Dynamic display

Rich environment

Rich motor involvement

70

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Surgeons may be made to play action games

Pilot training

Amblyopia tx Dennis Levi research

PresenterTitle Contact info

Neuroplasticity-A Paradigm Sea Change

This presentation is available at

httpwwwslidesharenetDMAINOneuroplasticity-a-paradigm-sea-change-2459693

httpwwwmainosmemosblogspotcom

My FaceBook Page

and

Twitter

PresenterTitle Contact info

Questions About

Neuroplasticity-A Paradigm Sea Change

Dominick M Maino OD MEd FAAO FCOVD-A

Professor PediatricsBinocular VisionIllinois Eye InstituteIllinois College of Optometry

dmainoicoeduhttpwwwMainosMemosblogspotcom

Thanks to

httpwwwcovdorgHomeOVDJournalOVD401tabid263D

efaultaspx

httpbipolarblastfileswordpresscom200908neurojpg

httpwwwspecialcheerscomimagesanimated_braingif

httpblogmarsdencartoonscomwp-

contentuploads200810frankenstein-myspace-lightbeergif

httpwwwshangralafamilyfuncomgala-ecalvindreamgif

httppsychiatryjwatchorgcgicontentfull20082251

73

Chakraborty R Chatterjee A Choudhart S Chakraborty PK Neuroplasticitymdasha paradigm shift in neurosciences J Indian Med Assoc

2007105(9)513-4516-8520-1

Sacks O A neurologistlsquos notebook Stereo Sue Why two eyes are better than one The New Yorker 2006 Jun 1964-73

Krulwich R National Public Radio Going Binocular Susanlsquos First Snowfall Available at

wwwnprorgtemplatesstorystoryphpstoryId=5507789 (Accessed December 8 2008)

Press LJ The story behind Stereo Suelsquo and a world-famous neurologistlsquos discovery of vision therapy Optom Vis Dev 200637(2) 55-7

Levin HS Neuroplasticity and brain imaging research implications for rehabilitation Arch Phys Med Rehabil 2006 Dec87(12 Suppl

2)S1

Wiesel TN Hubel DH Single-cell responses in striate cortex of kittens deprived of vision in one eye J Neurophysiol 1963

Nov261003-17

Hook BM Chen C Critical periods in the visual system Changing views for a model of experience-dependent plasticity Neuron 2007

Oct56(2)312-26

Ramey CT Ramey SL Prevention of intellectual disabilities early interventions to improve cognitive development Prev Med 1998

Mar-Apr27(2)224-32

Heuninckx S Wenderoth N Swinnen SP Systems neuroplasticity in the aging brain recruiting additional neural resources for

successful motor performance in elderly persons J Neurosci 2008 Jan 228(1)91-9

Ge S Yang CH Hsu KS et al A critical period for enhanced synaptic plasticity in newly generated neurons of the adult brain Neuron

2007 May54(4)559-66

74

Draganski B Gaser C Busch V et al Neuroplasticity changes in grey matter induced by training Nature 2004 Jan 22427(6972)

311-2

Cannonieri GC Bonilha L Fernandes PT et al Practice and perfect length of training and structural brain changes in experienced

typists Neuroreport 2007 Jul 218(10)1063-6

Kleim JA Jones TA Principles of experience-dependent neural plasticity implications for rehabilitation after brain damage J

Speech Lang Hear Res 2008 Feb51(1)S225-39

Trojan S Porkorny J Theoretical aspects of neuroplasticity Physiol Res 199948(2)87-97

Ramamirtham R Kee CS Hung LF et al Wave aberrations in rhesus monkeys with vision-induced ametropias Vision Res 2007

Sep47(21)2751-66

Smith EL 3rd Ramamirtham R Qiao-Grider Y et al Effects of foveal ablation on emmetropization and form-deprivation myopia

Invest Ophthalmol Vis Sci 2007 Sep48(9)3914-22

Smith EL 3rd Kee CS Ramamirtham R et al Peripheral vision can influence eye growth and refractive development in infant

monkeys Invest Ophthalmol Vis Sci 2005 Nov46(11)3965-72

Ciuffreda KJ Vasudevan B Nearwork-induced transient myopia (NITM) and permanent myopiandashndashis there a link Ophthalmic

Physiol Opt 2008 Mar28(2)103-14

Hung GK Ciuffreda KJ Incremental retinal-defocus theory of myopia development--schematic analysis and computer simulation

Comput Biol Med 2007 Jul37(7)930-46

Hung GK Ciuffreda KJ A unifying theory of refractive error development Bull Math Biol 2000 Nov62(6)1087-108

75

Pang Y Maino D Zhang G Lu F Myopia Can its progress be controlled Optom Vis Dev 200637(2)75-9

Leung JT Brown B Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lenses Optom Vis Sci

1999 Jun76(6)346-54

Hasebe S Ohtsuki H Nonaka T et al Effect of progressive addition lenses on myopia progression in Japanese children a prospective

randomized double-masked crossover trial Invest Ophthalmol Vis Sci 2008 Jul49(7)2781-9

Gwiazda J Hyman L Hussein M et al A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression

of myopia in children Invest Ophthalmol Vis Sci 2003 Apr44(4)1492-500

Siatkowski RM Cotter SA Crockett RS et al Two-year multi-center randomized double-masked placebo-controlled parallel safety and

efficacy study of 2 pirenzepine ophthalmic gel in children with myopia J AAPOS 2008 Aug12(4)332-9

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged 7 to 17 years Arch Ophthalmol 2005

Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three to less than 10 years of age Am J

Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction Am J Ophthalmol 2007

Jun143(6)1060-3

Holmes JM Edwards AR Beck RW et al A randomized pilot study of near activities versus non-near activities during patching therapy for

amblyopia J AAPOS 2005 Apr9(2)129-36

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate

amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-57

76

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic

amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Convergence Insufficiency Treatment Trial Study Group Randomized clinical trial of treatments for symptomatic convergence insufficiency

in children Arch Ophthalmol 2008 Oct126(10)1336-49

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

Solan HA Shelley-Tremblay J Hansen PC et al M-cell deficit and reading disability a preliminary study of the effects of temporal vision-

processing therapy Optometry 2004 Oct75(10)640-50

Solan HA Larson S Shelley-Tremblay J et al Role of visual attention in cognitive control of oculomotor readiness in students with reading

disabilities J Learn Disabil 2001 Mar-Apr34(2)107-18

Gallaway M Boas MB The impact of vergence and accommodative therapy on reading eye movements and reading speed Optom Vis Dev

200738(3)115-20

Goss DA Downing DB Lowther AH et al The effect of HTS vision therapy conducted in a school setting on reading skills in third and

fourth grade students Optom Vis Dev 200738(1)27-32

Crutch SJ Warrington EK Foveal crowding in posterior cortical atrophy a specific early-visual-processing deficit affecting word reading

Cogn Neuropsychol 2007 Dec24(8)843-66

Helms D Sawtelle SM A study of the effectiveness of cognitive therapy delivered in a video game format Optom Vis Dev 200738 (1)19-

26

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

77

Lawton T Training direction-discrimination sensitivity remediates a wide spectrum of reading skills OptomVis Dev 200738(1) 33-47

Goldstand S Koslowe KC Parush S Vision visual-information processing and academic performance among seventh-grade schoolchildren a

more significant relationship than we thought Am J Occup Ther 2005 Jul-Aug59(4)377-89

Fischer B Koumlngeter A Hartnegg K Effects of daily practice on subitizing visual counting and basic arithmetic skills Optom Vis Dev

200839(1)30-4

Sands W Taub M Maino D Limited research and education on special populations in optometry and ophthalomology Optom Vis Dev

200839(2)60-1

Wesson M Maino D Oculo-visual findings in Down syndrome cerebral palsy and mental retardation with non-specific etiology In Maino D

(ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 199517-54 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

Cui Y Stapleton F Suttle C Developing an instrument to assess vision-related and subjective quality of life in children with intellectual

disability data collection and preliminary analysis in a Chinese population Ophthal Physiolog Optics 2008 May28(3) 238-46

Maino D Steele G Tahir S Sajja R Attitudes of optometry students toward individuals with disabilities Optom Ed 200227(2)45-50

Maino D Special populations in the optometric curriculum Optom Ed 200227(2)38-9

Maino D Overview of special populations In Scheiman M Rouse M (eds) Optometric Management of Learning-Related Vision Problems

St Louis Mosby Inc 200685-106

Maino D (ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 1995 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

78

McCarthy P Maino D Alport syndrome a review Clin Eye Vis Care 2000 Dec12(3-4)139-50

Block SS Brusca-Vega R Pizzi WJ et al Cognitive and visual processing skills and their relationship to mutation size in full and

permutation female fragile X carriers Optom Vis Sci 2000 Nov77 (11)592-9

Maino D The young child with developmental disabilities An introduction to mental retardation and genetic syndromes In Moore BD

(ed) Eye Care for Infants and Young Children Butter-worth--Heinemann Newton MA1997285-300

Amin V Maino D The Fragile X female Visual visual perceptual and ocular health anomalies J Am Optom Assoc 1995 May66

(5)290-95

Maino DM Maino JH Cibis GW Hecht F Ocular health anomalies in patients with developmental disabilities In Maino D (ed)

Diagnosis and Management of Special Populations Mosby-Year-book Inc St Louis MO 1995189-206 Reprinted Optometric

Education Program Foundation Santa Anna Calif 2001

Maino D Wesson M Schlange D Cibis G Maino J Optometric findings in the fragile X syndrome Optom Vis Sci 199168634-40

Scheiman MMOptometric findings in children with cerebral palsy Am J Optom Physiol Opt 1984 May61(5)321-3

Maino D Maino J Maino S Mental retardation syndromes with associated ocular defects J Am Optom Assoc 199061707-16

Stewart RE Woodhouse JM Cregg M Pakeman VH Association between accommodative accuracy hypermetropia and strabismus in

children with Downs syndrome Optom Vis Sci 2007 Feb84(2)149-55

Cregg M Woodhouse JM Pakeman VH et al Accommodation and refractive error in children with Down syndrome cross-sectional

and longitudinal studies Invest Ophthalmol Vis Sci 2001 Jan42 (1)55-63

79

McClelland JF Parkes J Hill N et al Accommodative dysfunction in children with cerebral palsy a population-

based study Invest Ophthalmol Vis Sci 2006 May47(5)1824-30

Duckman RH Vision therapy for the child with cerebral palsy J Am Optom Assoc 198758(1)28-35

Duckman R Accommodation in cerebral palsy function and remediation J Am Optom Assoc 198455(4)281-3

Scheiman M Understanding and managing vision deficits a guide for occupational therapists 2nd ed Slack

Thorofare NJ 2002

Maino D Binasal occlusion for the child with Cerebral Palsy J Ill Optom Assoc 198644(1)1218

Battaglia F Quartarone A Rizzo V et al Early impairment of synaptic plasticity in patients with Downs syndrome

Neurobiol Aging 2008 Aug29(8)1272-5

Bonnier C Evaluation of early stimulation programs for enhancing brain development Acta Paediatr 2008

Jul97(7)853-8

Morice E Andreae LC Cooke SF et al Preservation of long-term memory and synaptic plasticity despite short-term

impairments in the Tc1 mouse model of Down syndrome Learn Mem 2008 Jul 1415(7)492-500

Gordon AM Schneider JA Chinnan A Charles JR Efficacy of a hand-arm bimanual intensive therapy (HABIT) in

children with hemiplegic cerebral palsy a randomized control trial Dev Med Child Neurol 2007 Nov49(11)830-8

Kapoor N Ciuffreda KJ Vision disturbances following traumatic brain injury Curr Treat Options Neurol 2002

Jul4(4)271-80

80

Ciuffreda KJ Rutner D Kapoor N et al Vision therapy for oculomotor dysfunctions in acquired brain injury a

retrospective analysis Optometry 2008 Jan79(1)18-22

Ciuffreda KJ Han Y Kapoor N Ficarra AP Oculomotor rehabilitation for reading in acquired brain injury

NeuroRehabilitation 200621(1)9-21

Zost M Diagnosis and management of visual dysfunction in cerebral injury In Maino D (ed) Diagnosis and

Management of Special Populations Mosby-Yearbook Inc St Louis 199579 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001 [Figure used with permission of the editor]

DeGutis JM Bentin S Robertson LC DEsposito M Functional plasticity in ventral temporal cortex following

cognitive rehabilitation of a congenital prosopagnosic J Cogn Neurosci 2007 Nov19 (11)1790-802

Welbourne SR Ralph MA Exploring the impact of plasticity-related recovery after brain damage in a connectionist

model of single-word reading Cogn Affect Behav Neurosci 2005 Mar5(1)77-92

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements prevent cognitive decline A

systematic review of randomized controlled trials J Hum Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among preterm infants attributable to early

supplementation of human milk with docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings and structural-functional

synergies with cell membrane phospholipids Altern Med Rev 2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function Neuroscience 20089(7)568-78

81

Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

BMC Biol 2008 Sep 9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine improves neuropsychological disorders in a child with

creatine transporter defect Neurocase 200814(2) 151-61

Forrester LW Wheaton LA Luft AR Exercise-mediated locomotor recovery and lower-limb neuroplasticity after

stroke J Rehabil Res Dev 200845(2)205-20

82

Page 12: Neuroplasticity: A Paradigm Sea Change Latest Updated File

VI Neuroplasticity and the Brain

A Can adult brain neurons actually exhibit neuroplasticity The short answer is yes

B Resultant changes are noted in not only functional outcomes but also in brain anatomy and structure

12

IV Neuroplasticity and Rehabilitation

Kleim amp Jones note that

A The Key Principles of Experience-Dependent Neural Plasticity

1 Use it or lose it

2 Use it and improve it

3 Specificity

13

4 Repetition matters

5 Intensity matters

6 Time matters

7 Salience matters

14

8 Age matters

9 Transference

10 Interference

15

Use it or lose it If you do not drive specific brain functions

functional loss will occur

Use it and improve it Therapy that drives cortical function

enhances that particular function

Specificity The therapy you choose determines the resultant

plasticity and function

Repetition matters Plasticity that results in functional change

requires repetition

16

Intensity matters Induction of plasticity requires the appropriate

amount of intensity

Time matters Different forms of plasticity take place at different

times during therapy

Salience matters It has to be important to the individual

Age matters Plasticity is easier in a younger brain but is also

possible in an adult brain

17

Transference Neuroplasticity and the change in function that

results from one therapy can augment the attainment of similar

behaviors

Interference Plasticity in response to one experience can interfere

with the acquisition of other behaviors

18

B Examples of Changes in Function and Structure

1) Jugglers

2) Typists

19

B Examples of Changes in Function and Structure

1) Jugglers

One study suggested that adults taught how to juggle demonstrated a

significant transient bilateral expansion of gray matter in the mid-

temporal area and the left posterior intraparietal sulcus between baseline brain scan and

follow-up The findings were specific to training stimulus individuals who were

not instructed how to juggle demonstrated no change in gray

matter over the same period These findings oppose the conventional

understanding that the anatomical structure of the adult brain does not change

over time

20

B Examples of Changes in Function and Structure

2) Typists

helliplong-term bimanual training also increases

gray matter volume in experienced adult typists

These results suggest that learning not

only affects function but also structure in

adult brains

21

V Neuroplasticity and Optometry

A Evolutionary neuroplasticity

B Reactive plasticity

C Adaptational plasticity

D Reparation plasticity

22

V Neuroplasticity and Optometry

A Evolutionary neuroplasticity

hellip is ideally suited for the developmental OD who

specializes in vision function as it changes over time

either with or without intervention

23

V Neuroplasticity and Optometry

B Reactive plasticity

hellip can be thought of as the immediate effect that

initial optometric treatment may have on a system This can

be reflected in an immediate but often transient change in

the individuallsquos accommodative systemmdashie when an

uncorrected myope initially puts on his or her new

spectacles

24

V Neuroplasticity and Optometry

C Adaptational plasticity

hellip could describe the long-term effects of in-office optometric

vision therapy on disorders of the binocular vision system

25

V Neuroplasticity and Optometry

D Reparation plasticity

hellipin contrast to adaptational

plasticity reparation plasticity may

occur during treatment by a low

Vision specialist or an OD

Working with those who have

Experienced a traumatic brain

injury (TBI)

26

V Neuroplasticity and Optometry

The effects of plasticity can lead to either

positive or negative changes during

development (evolutionary plasticity) after

short-term exposure (reactive plasticity)

after long-term or continuous stimuli

(adaptational plasticity) and during

functional or structural recovery of damaged

neuronal circuits (reparation plasticity)

httpwwwciteulikeorguserjasonepriorarticle2856526

27

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

A Refractive error development

B Amblyopia

C Strabismus

28

D Non-strabismus non-amblyopic binocular vision disorders

E Learning related vision anomalies

F Vision developmentperception disorders

29

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

A Refractive error development

Several recent studies have noted that neuroplasticity may play a

role in refractive error development

retinal defocus use of progressive addition lenses

drug studies (M1-antagonist2 pirenzepine ) slow myopia

progression demonstrated nearly a 50 reduction in myopia

progression over a two-year period

30

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged

7 to 17 years Arch Ophthalmol 2005 Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three

to less than 10 years of age Am J Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction

Am J Ophthalmol 2007 Jun143(6)1060-3

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine

vs patching for treatment of moderate amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-

57

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for

strabismic and anisometropic amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Treatment of severe amblyopia with weekend atropine results from 2 randomized clinical trials

Levodopacarbidopa in the treatment of amblyopia

31

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

J Pediatr Ophthalmol Strabismus 2009 Mar-Apr46(2)87-90 quiz 91-2 Levodopacarbidopa in the

treatment of amblyopia Dadeya S Vats P Malik KP

PURPOSE To evaluate the role of levodopacarbidopa in the treatment of amblyopia METHODS

Thirty patients with strabismic amblyopia between the ages of 3 and 12 years were part of this double-

blind randomized study Patients were divided into two groups Group A received 050 mg + 125 mg of

levodopacarbidopa per kilogram body weight three times daily after meals with a protein rich drink

whereas Group B received placebo Both groups received full-time conventional occlusion until a visual

acuity of 66 was achieved or for a maximum of 3 months RESULTS The authors observed more than

two lines improvement in visual acuity that was greater in the levodopa group (15 of 15) than in the

placebo group (9 of 15) (P lt 005) Furthermore improvement in visual acuity of more than two lines

was greater in patients younger than 8 years (100) than in patients older than 8 years of age (60) (P =

0026) There was also no significant reversal of the improved visual acuity in up to 6 months of follow-

up CONCLUSION Levodopacarbidopa improves visual acuity in patients with

amblyopia and maintains improved visual acuity especially in patients

younger than 8 years

32

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

J Pediatr Ophthalmol Strabismus 2008 May-Jun45(3)174-6 The use of levodopa in the treatment of

bilateral amblyopia secondary to uncorrected high hypermetropia Abrams MS

The standard treatment of bilateral amblyopia secondary to uncorrected high bilateral hypermetropia has

been spectacles and time The patient described here failed to show adequate improvement in visual

acuity after 18 months of standard treatment Visual acuity improved dramatically when the

patient began taking levodopa dropped precipitously when the medication was

discontinued and returned quickly to post-treatment levels when levodopa was

restarted Visual acuity remained stable when the medication was slowly tapered

and discontinued This report suggests that dopamine may play a role in the pathophysiology of

bilateral amblyopia secondary to uncorrected high bilateral hypermetropia

33

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

Bottom Line

Amblyopia can be treated at any age

May be able to use neuro-enhancing drugs

as a part of basic amblyopia therapy

34

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

C Strabismus and non-strabismic non-amblyopic binocular

vision disorders

Clinical Trial of Treatments for Symptomatic Convergence Insufficiency in Children has

clearly demonstrated the superiority of in-office optometric vision therapy (in conjunction

with home therapy) vs out-of-office therapy alone The study concluded that optometric

vision therapyorthoptics was more effective than pencil push-ups or placebo vision

therapyorthoptics in reducing symptoms and improving clinical signs of convergence

insufficiency

Long-term effectiveness of treatments for symptomatic convergence insufficiency

in children (Optom Vis Sci 2009 Sep86(9)1096-103)

CITT patients improvements lasted a year

35

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

Strabismus 1999 Sep7(3)169-74 Convergence insufficiency in

idiopathic Parkinsons disease responsive to levodopa Racette BA

Gokden MS Tychsen LS Perlmutter JS

We report a patient with pathologically proven idiopathic Parkinsons

disease (IPD) who developed diplopia secondary to convergence

insufficiency during his motor off periods Diplopia resolved with

onset of motor benefit from levodopa Neuro-ophthalmologic

examination demonstrated convergence insufficiency during motor

off periods that was alleviated after onset of motor benefit from

levodopa This is the first reported case of convergence insufficiency

in IPD responsive to levodopa

36

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

Bottom Line

Optometric Vision Therapy is the most efficacious treatment available for binocular vision disorders and the

treatment effects are long lasting Neuro-enhancing drugs

may assist us as well

37

EF Learning related vision anomalies Vision

developmentperception disorders

hellipresearch includes an examination of the role vision plays in

reading the effect of oculomotor vergence and

accommodativecoherent motion therapy on reading eye movements

and reading speed the diagnosis and treatment of perceptual

disorders and the effect of therapy on various learning anomalies

38

EF Learning related vision anomalies Vision developmentperception disorders

magnocellular (MC) deficit in dyslexia

LM speed-matching ratio predicts reading in childrenChase C Dougherty RF Ray N

Fowler S Stein JOptom Vis Sci 2007 Mar84(3)229-36

Effect of attention therapy on reading comprehension Solan HA Shelley-Tremblay J

Ficarra A Silverman M Larson S J Learn Disabil 2003 Nov-Dec36(6)556-63

Is there a common linkage among reading comprehension visual attention and

magnocellular processing Solan HA Shelley-Tremblay JF Hansen PC Larson S

J Learn Disabil 2007 May-Jun40(3)270-8

Lawton T Filtered Text and Direction Discrimination Training Improved Reading

Fluency for Both Dyslexic and Normal Readers Optom Vis Dev 200839 (3)114

Fischer B Hartnegg K Saccade control in dyslexia Development deficits training

and transfer to reading Optom Vis Dev 200839(4)181-190

39

EF Learning related vision anomalies Vision developmentperception disorders

J Learn Disabil 2003 Nov-Dec36(6)556-63 Effect of attention therapy on reading

comprehension Solan HA Shelley-Tremblay J Ficarra A Silverman M Larson S

hellip At the completion of attention therapy the mean

standard attention and reading comprehension scores of

the experimental group had improved significantly The

control group however showed no significant

improvement in reading comprehension scores after 12

weeks Although uncertainties still exist this investigation

supports the notion that visual attention is malleable and

that attention therapy has a significant effect on reading

comprehension in this often neglected population

40

VII Vision dysfunction association with acquired brain injury

A Exotropia (or high exophoriaCI)

B Accommodative dysfunction

C Convergence insufficiency

41

D Decreased blink rate

E Spatial disorientation

F Pursuitsaccade dysfunction

G Unstable ambient vision (Magnocellular pathway)

42

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Stelmack JA Frith T Van Koevering D Rinne S Stelmack TR Visual function in patients

followed at a Veterans Affairs polytrauma network site an electronic medical record review

Optometry 2009 Aug80(8)419-24

RESULTS Visual symptoms were self-reported by 76 of patients

with polytrauma and 75 of the patients with TBI Problems with reading

(polytrauma 60 and TBI 50) and accommodation (polytrauma 30 and

TBI 47) were frequently found on eye examinations Spectacles were the

treatment most frequently prescribed (polytrauma 62 and TBI 78)

CONCLUSIONS It is important for optometrists to be aware of the high

rates of self-reported symptoms and visual problems in military personnel

returning from deployment to the wars in Iraq and Afghanistan Post-

traumatic stress disorder and depression may complicate optometric

evaluation and management

43

VII Vision dysfunction association with acquired brain injury

Avoidance of near tasks

Oculomotor-based reading difficulties

Eye tracking problems

Eye focusing problems

Eyestrain Diplopia

Dizziness Vertigo

Vision-derived nausea

44

VII Vision dysfunction association with acquired brain injury

Increased sensitivity to visual motion

Visual inattention and distractibility

Short-term visual memory loss

Difficulty judging distances (relative and absolute

Difficulty with global scanning

Difficulty with personal grooming especially involving the face

Inability to interactcope visually in a complex social situation

(eg minimal eye contact)

Inability to tolerate complex visual environments (eg grocery store

aisles and highly-patterned floors)

45

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Ciuffreda KJ Ludlam DP Kapoor N Clinical oculomotor training in traumatic brain injury Optom Vis

Dev 200940(1)16-23

Individuals with traumatic brain injury present with a constellation of

oculomotor dysfunctions and correlated symptoms Simple and

effective clinical oculomotor-based training procedures will be

presented with respect to the versional vergence and

accommodative systems and their interactions These therapeutic

procedures can also be applied as needed to individuals with either

low vision neurological dysfunctions or general visual skills cases

manifesting similar oculomotor deficits

46

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Leslie S Myopia and accommodative insufficiency associated with

moderate head trauma Opt Vis Dev 200940(1)25-31

The majority of subjects reviewed had developed a stable degree of

myopia between 100 and 200 diopters as well as an abnormally

high lag of accommodation When their distance and near spatial area

of focus was compared the majority were focused at an intermediate

area in space suggesting a loss of control of accommodation in

space

47

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

B Drugs

C Exercise

D Learning new and challenging things

48

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements

prevent cognitive decline A systematic review of randomized controlled trials J Hum

Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among

preterm infants attributable to early supplementation of human milk with

docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings

and structural-functional synergies with cell membrane phospholipids Altern Med Rev

2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function

Neuroscience 20089(7)568-78

49

VIII Improving Brain Function and Neuroplasticity

B Drugs Maya Vetencourt JF Sale A Viegi A et al The antidepressant

fluoxetine (PROZAC) restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the

antidepressant tianeptine CNS Drugs 200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances

hippocampal long-term potentiation and memory BMC Biol 2008 Sep

9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine

improves neuropsychological disorders in a child with creatine

transporter defect Neurocase 200814(2) 151-61

50

VIII Improving Brain Function and Neuroplasticity

C Exercise

Hunsberger JG et al Antidepressant actions of the exercise-

regulated gene VGF Nat Med 2007 Dec 2 131476

VGF may be a common pathway by which exercise induces

neuroplasticity and growth-factor genes at least one of these might act

similarly to antidepressants in promoting an adaptive response to stress

However the tests used here may be modeling stress-induced

helplessness not depression hellipexercise seems to induce multiple

interacting genes that enhance neuronal resilience

51

VIII Improving Brain Function and Neuroplasticity

D Learning new and challenging things

What have we (optometry amp ophthalmology)

been thinking all these years

Where did we miss the news about neuroplasticity

52

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Huang JC Neuroplasticity as a proposed mechanism for the efficacy of optometric vision therapy and rehabilitation J Bev Optom 200920(4)96-100

Homologous area adaptationCompensatory masqueradeCross-modal reassignment

Map expansion

EquipotentialityVicariation

53

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Homologous area adaptation a transfer of function from a damaged brain area to a non-damaged brain area May be limited to early stages of human development and may crowd a new brain area resulting in reduced functionality of that brain area (Competition between spatial amp verbal functioning)

54

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Compensatory masquerade reorganizing of existing neuro-pathways to us alternative cognitive strategies to perform a task

55

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Cross-modal reassignment using new sensory input in a brain structure deprived of its main input source (changing processing from visual to tactile stimuli in the blind)

56

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Map expansion increase in brain mass due to repeated behavior or exposure to stimuli

57

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Equipotentiality anatomical areas of the brain can perform disparate functions

Vicariation redundant neural systems can operate under abnormal conditions

This may explain why recovery is noted for many neurological conditions (degenerative psychiatric developmental vascular traumatic)

58

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Constraint therapy Use it and improve it

Patching penalization ldquonear activitiesrdquo during amblyopia therapy

59

IX Improving Brain Function and Neuroplasticity Optometric Clinical ApplicationsOptometric Vision Therapy

Kleim amp Jones

Use it or lose it If you do not drive specific brain functions

functional loss will occur

If you want to improve oculomotor brain neuroplastic function amp

structure therapy should be specific for that brain function

Use it and improve it Therapy that drives cortical function enhances

that particular function

If you use therapy to improve oculomotor dysfunction it should

improve

Specificity The therapy you choose determines the resultant

plasticity and function

You must choose therapy that is appropriate

60

IX Improving Brain Function and Neuroplasticity Optometric Clinical Applications

Kleim amp Jones

Repetition matters Plasticity that results in functional change

requires repetition

Do the therapy Do it again Do it yet again No quick fix

Intensity matters Induction of plasticity requires the appropriate

amount of intensity

Intensity means strength force concentration power and passion

Without these plasticity may not occur Function may not improve

Time matters Different forms of plasticity take place at different

times during therapy

Do the basics than the more advanced therapeutic procedures

61

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Salience matters It has to be important to the individual

Make the therapy matter to the patient

Age matters Plasticity is easier in a younger brain but is also

possible in an adult brain

Do not let age determine what therapy options you offer your

patients Think of Susan Barry PhD (StereoSue) and her success

Offer your patients options Let them choose Be realistic about

outcomeshelliphave outcome measures built into therapy program

62

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Transference Neuroplasticity and the change in function

that results from one therapy can augment the attainment

of similar behaviors

What you do during oculomotor therapy may affected

vergence therapy outcomes

Interference Plasticity in response to one experience can

interfere with the acquisition of other behaviors

Monitor Evaluate progress Discuss function in other areas

of your patientslsquo life

63

Why pay attention to binocular vision dysfunctions

and neuroplasticity

December 2009 issue of the Review of Optometry

The Binocular Vision Dysfunction Pandemic

In 2010 almost 170 million individuals will be wearing glasses In

2010 there will also be up to 93 million amblyopes and 12 and a half

million strabismics For children under 18 years of age that means

there will be more than 22 and a half million amblyopes and millions

of children with strabismus A clinical trial to determine the

prevalence of binocular vision dysfunction within the general

population suggested the possibility of up to 56 or 173 million men

women and children with symptoms associated with a binocular

vision dysfunction 189 million (61) with accommodative problems

and 118 million (38) demonstrating various vergence

anomalies

64

65

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Brain plasticity life long changes in the structure of the brain

Sensory substitution replacement of one sensory input by another

Measurement techniques

Voxel based morphometryhellipmeasures difference in brain volume

Fluorodeoxyglucose glucose analog PET scan tells you

distribution and metabolism of brain

Cortical thickness measures

Visual cortex of the blind turns somatic ―The eye of the tongue

Transcranial magnetic stmiulation non-invasive technique to

stimulate cortex

66

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Blind Braille readers report tingling in fingers when pressure

phosphenes are applied Blind feel tingling in tongue

Bind use tongue to perform orientation task motion perception

sensory perception Visual cortex recruited in a variety of sensory

and cognitive tasks (DM Can we use tongue as a VT tool)

Dilks Reorganizations of human adult visual system

When a region of sensory cortex is deprived of its bottom up

input the deprived region begins to respond to stimuli that

normally activate adjacent cortex

67

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Retinotopic map changes for stroke pts Cortical reorganization in

adults occurs Perceived objectshellipelongation in stroke amp AMD

What happens to deprived cortex in AMD

fMRI shows cortical reorganization in adults

Proposed mechanisms

hellipGrowth of new connections

hellipUnmasking of pre-existing connections this is true

happens within seconds

Bavelier

Action video games

68

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Bavelier

Action video games Looked at attention Gamers can track more

activities

Attention over space (me peripheral awarenress) Useful field

of view shrinks with age

Performance not VA relatedhellipis related to attention

Action game playing changes spatial resolutionhellipovercoming

crowding in VA assessment (me amblyopia therapy)

Temporal resolution of vision Backward masking

changehellipbrain changes

Visual sensitivity (contrast sensitivity) Post action game training

improves CSF

69

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Action video games correcting optics of the cortex (me this is

actualy OVT)

Games factor

Variable entry leanringhellipadapt task to skill level

Incremental learning tune task to subjectlsquos leanring steps

Motivationarousal

Rewards

Self masterself confidence

Action games factors

Pacingrate of exposure to infohellipincreasing processing speed

Dynamic display

Rich environment

Rich motor involvement

70

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Surgeons may be made to play action games

Pilot training

Amblyopia tx Dennis Levi research

PresenterTitle Contact info

Neuroplasticity-A Paradigm Sea Change

This presentation is available at

httpwwwslidesharenetDMAINOneuroplasticity-a-paradigm-sea-change-2459693

httpwwwmainosmemosblogspotcom

My FaceBook Page

and

Twitter

PresenterTitle Contact info

Questions About

Neuroplasticity-A Paradigm Sea Change

Dominick M Maino OD MEd FAAO FCOVD-A

Professor PediatricsBinocular VisionIllinois Eye InstituteIllinois College of Optometry

dmainoicoeduhttpwwwMainosMemosblogspotcom

Thanks to

httpwwwcovdorgHomeOVDJournalOVD401tabid263D

efaultaspx

httpbipolarblastfileswordpresscom200908neurojpg

httpwwwspecialcheerscomimagesanimated_braingif

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contentuploads200810frankenstein-myspace-lightbeergif

httpwwwshangralafamilyfuncomgala-ecalvindreamgif

httppsychiatryjwatchorgcgicontentfull20082251

73

Chakraborty R Chatterjee A Choudhart S Chakraborty PK Neuroplasticitymdasha paradigm shift in neurosciences J Indian Med Assoc

2007105(9)513-4516-8520-1

Sacks O A neurologistlsquos notebook Stereo Sue Why two eyes are better than one The New Yorker 2006 Jun 1964-73

Krulwich R National Public Radio Going Binocular Susanlsquos First Snowfall Available at

wwwnprorgtemplatesstorystoryphpstoryId=5507789 (Accessed December 8 2008)

Press LJ The story behind Stereo Suelsquo and a world-famous neurologistlsquos discovery of vision therapy Optom Vis Dev 200637(2) 55-7

Levin HS Neuroplasticity and brain imaging research implications for rehabilitation Arch Phys Med Rehabil 2006 Dec87(12 Suppl

2)S1

Wiesel TN Hubel DH Single-cell responses in striate cortex of kittens deprived of vision in one eye J Neurophysiol 1963

Nov261003-17

Hook BM Chen C Critical periods in the visual system Changing views for a model of experience-dependent plasticity Neuron 2007

Oct56(2)312-26

Ramey CT Ramey SL Prevention of intellectual disabilities early interventions to improve cognitive development Prev Med 1998

Mar-Apr27(2)224-32

Heuninckx S Wenderoth N Swinnen SP Systems neuroplasticity in the aging brain recruiting additional neural resources for

successful motor performance in elderly persons J Neurosci 2008 Jan 228(1)91-9

Ge S Yang CH Hsu KS et al A critical period for enhanced synaptic plasticity in newly generated neurons of the adult brain Neuron

2007 May54(4)559-66

74

Draganski B Gaser C Busch V et al Neuroplasticity changes in grey matter induced by training Nature 2004 Jan 22427(6972)

311-2

Cannonieri GC Bonilha L Fernandes PT et al Practice and perfect length of training and structural brain changes in experienced

typists Neuroreport 2007 Jul 218(10)1063-6

Kleim JA Jones TA Principles of experience-dependent neural plasticity implications for rehabilitation after brain damage J

Speech Lang Hear Res 2008 Feb51(1)S225-39

Trojan S Porkorny J Theoretical aspects of neuroplasticity Physiol Res 199948(2)87-97

Ramamirtham R Kee CS Hung LF et al Wave aberrations in rhesus monkeys with vision-induced ametropias Vision Res 2007

Sep47(21)2751-66

Smith EL 3rd Ramamirtham R Qiao-Grider Y et al Effects of foveal ablation on emmetropization and form-deprivation myopia

Invest Ophthalmol Vis Sci 2007 Sep48(9)3914-22

Smith EL 3rd Kee CS Ramamirtham R et al Peripheral vision can influence eye growth and refractive development in infant

monkeys Invest Ophthalmol Vis Sci 2005 Nov46(11)3965-72

Ciuffreda KJ Vasudevan B Nearwork-induced transient myopia (NITM) and permanent myopiandashndashis there a link Ophthalmic

Physiol Opt 2008 Mar28(2)103-14

Hung GK Ciuffreda KJ Incremental retinal-defocus theory of myopia development--schematic analysis and computer simulation

Comput Biol Med 2007 Jul37(7)930-46

Hung GK Ciuffreda KJ A unifying theory of refractive error development Bull Math Biol 2000 Nov62(6)1087-108

75

Pang Y Maino D Zhang G Lu F Myopia Can its progress be controlled Optom Vis Dev 200637(2)75-9

Leung JT Brown B Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lenses Optom Vis Sci

1999 Jun76(6)346-54

Hasebe S Ohtsuki H Nonaka T et al Effect of progressive addition lenses on myopia progression in Japanese children a prospective

randomized double-masked crossover trial Invest Ophthalmol Vis Sci 2008 Jul49(7)2781-9

Gwiazda J Hyman L Hussein M et al A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression

of myopia in children Invest Ophthalmol Vis Sci 2003 Apr44(4)1492-500

Siatkowski RM Cotter SA Crockett RS et al Two-year multi-center randomized double-masked placebo-controlled parallel safety and

efficacy study of 2 pirenzepine ophthalmic gel in children with myopia J AAPOS 2008 Aug12(4)332-9

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged 7 to 17 years Arch Ophthalmol 2005

Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three to less than 10 years of age Am J

Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction Am J Ophthalmol 2007

Jun143(6)1060-3

Holmes JM Edwards AR Beck RW et al A randomized pilot study of near activities versus non-near activities during patching therapy for

amblyopia J AAPOS 2005 Apr9(2)129-36

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate

amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-57

76

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic

amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Convergence Insufficiency Treatment Trial Study Group Randomized clinical trial of treatments for symptomatic convergence insufficiency

in children Arch Ophthalmol 2008 Oct126(10)1336-49

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

Solan HA Shelley-Tremblay J Hansen PC et al M-cell deficit and reading disability a preliminary study of the effects of temporal vision-

processing therapy Optometry 2004 Oct75(10)640-50

Solan HA Larson S Shelley-Tremblay J et al Role of visual attention in cognitive control of oculomotor readiness in students with reading

disabilities J Learn Disabil 2001 Mar-Apr34(2)107-18

Gallaway M Boas MB The impact of vergence and accommodative therapy on reading eye movements and reading speed Optom Vis Dev

200738(3)115-20

Goss DA Downing DB Lowther AH et al The effect of HTS vision therapy conducted in a school setting on reading skills in third and

fourth grade students Optom Vis Dev 200738(1)27-32

Crutch SJ Warrington EK Foveal crowding in posterior cortical atrophy a specific early-visual-processing deficit affecting word reading

Cogn Neuropsychol 2007 Dec24(8)843-66

Helms D Sawtelle SM A study of the effectiveness of cognitive therapy delivered in a video game format Optom Vis Dev 200738 (1)19-

26

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

77

Lawton T Training direction-discrimination sensitivity remediates a wide spectrum of reading skills OptomVis Dev 200738(1) 33-47

Goldstand S Koslowe KC Parush S Vision visual-information processing and academic performance among seventh-grade schoolchildren a

more significant relationship than we thought Am J Occup Ther 2005 Jul-Aug59(4)377-89

Fischer B Koumlngeter A Hartnegg K Effects of daily practice on subitizing visual counting and basic arithmetic skills Optom Vis Dev

200839(1)30-4

Sands W Taub M Maino D Limited research and education on special populations in optometry and ophthalomology Optom Vis Dev

200839(2)60-1

Wesson M Maino D Oculo-visual findings in Down syndrome cerebral palsy and mental retardation with non-specific etiology In Maino D

(ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 199517-54 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

Cui Y Stapleton F Suttle C Developing an instrument to assess vision-related and subjective quality of life in children with intellectual

disability data collection and preliminary analysis in a Chinese population Ophthal Physiolog Optics 2008 May28(3) 238-46

Maino D Steele G Tahir S Sajja R Attitudes of optometry students toward individuals with disabilities Optom Ed 200227(2)45-50

Maino D Special populations in the optometric curriculum Optom Ed 200227(2)38-9

Maino D Overview of special populations In Scheiman M Rouse M (eds) Optometric Management of Learning-Related Vision Problems

St Louis Mosby Inc 200685-106

Maino D (ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 1995 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

78

McCarthy P Maino D Alport syndrome a review Clin Eye Vis Care 2000 Dec12(3-4)139-50

Block SS Brusca-Vega R Pizzi WJ et al Cognitive and visual processing skills and their relationship to mutation size in full and

permutation female fragile X carriers Optom Vis Sci 2000 Nov77 (11)592-9

Maino D The young child with developmental disabilities An introduction to mental retardation and genetic syndromes In Moore BD

(ed) Eye Care for Infants and Young Children Butter-worth--Heinemann Newton MA1997285-300

Amin V Maino D The Fragile X female Visual visual perceptual and ocular health anomalies J Am Optom Assoc 1995 May66

(5)290-95

Maino DM Maino JH Cibis GW Hecht F Ocular health anomalies in patients with developmental disabilities In Maino D (ed)

Diagnosis and Management of Special Populations Mosby-Year-book Inc St Louis MO 1995189-206 Reprinted Optometric

Education Program Foundation Santa Anna Calif 2001

Maino D Wesson M Schlange D Cibis G Maino J Optometric findings in the fragile X syndrome Optom Vis Sci 199168634-40

Scheiman MMOptometric findings in children with cerebral palsy Am J Optom Physiol Opt 1984 May61(5)321-3

Maino D Maino J Maino S Mental retardation syndromes with associated ocular defects J Am Optom Assoc 199061707-16

Stewart RE Woodhouse JM Cregg M Pakeman VH Association between accommodative accuracy hypermetropia and strabismus in

children with Downs syndrome Optom Vis Sci 2007 Feb84(2)149-55

Cregg M Woodhouse JM Pakeman VH et al Accommodation and refractive error in children with Down syndrome cross-sectional

and longitudinal studies Invest Ophthalmol Vis Sci 2001 Jan42 (1)55-63

79

McClelland JF Parkes J Hill N et al Accommodative dysfunction in children with cerebral palsy a population-

based study Invest Ophthalmol Vis Sci 2006 May47(5)1824-30

Duckman RH Vision therapy for the child with cerebral palsy J Am Optom Assoc 198758(1)28-35

Duckman R Accommodation in cerebral palsy function and remediation J Am Optom Assoc 198455(4)281-3

Scheiman M Understanding and managing vision deficits a guide for occupational therapists 2nd ed Slack

Thorofare NJ 2002

Maino D Binasal occlusion for the child with Cerebral Palsy J Ill Optom Assoc 198644(1)1218

Battaglia F Quartarone A Rizzo V et al Early impairment of synaptic plasticity in patients with Downs syndrome

Neurobiol Aging 2008 Aug29(8)1272-5

Bonnier C Evaluation of early stimulation programs for enhancing brain development Acta Paediatr 2008

Jul97(7)853-8

Morice E Andreae LC Cooke SF et al Preservation of long-term memory and synaptic plasticity despite short-term

impairments in the Tc1 mouse model of Down syndrome Learn Mem 2008 Jul 1415(7)492-500

Gordon AM Schneider JA Chinnan A Charles JR Efficacy of a hand-arm bimanual intensive therapy (HABIT) in

children with hemiplegic cerebral palsy a randomized control trial Dev Med Child Neurol 2007 Nov49(11)830-8

Kapoor N Ciuffreda KJ Vision disturbances following traumatic brain injury Curr Treat Options Neurol 2002

Jul4(4)271-80

80

Ciuffreda KJ Rutner D Kapoor N et al Vision therapy for oculomotor dysfunctions in acquired brain injury a

retrospective analysis Optometry 2008 Jan79(1)18-22

Ciuffreda KJ Han Y Kapoor N Ficarra AP Oculomotor rehabilitation for reading in acquired brain injury

NeuroRehabilitation 200621(1)9-21

Zost M Diagnosis and management of visual dysfunction in cerebral injury In Maino D (ed) Diagnosis and

Management of Special Populations Mosby-Yearbook Inc St Louis 199579 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001 [Figure used with permission of the editor]

DeGutis JM Bentin S Robertson LC DEsposito M Functional plasticity in ventral temporal cortex following

cognitive rehabilitation of a congenital prosopagnosic J Cogn Neurosci 2007 Nov19 (11)1790-802

Welbourne SR Ralph MA Exploring the impact of plasticity-related recovery after brain damage in a connectionist

model of single-word reading Cogn Affect Behav Neurosci 2005 Mar5(1)77-92

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements prevent cognitive decline A

systematic review of randomized controlled trials J Hum Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among preterm infants attributable to early

supplementation of human milk with docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings and structural-functional

synergies with cell membrane phospholipids Altern Med Rev 2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function Neuroscience 20089(7)568-78

81

Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

BMC Biol 2008 Sep 9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine improves neuropsychological disorders in a child with

creatine transporter defect Neurocase 200814(2) 151-61

Forrester LW Wheaton LA Luft AR Exercise-mediated locomotor recovery and lower-limb neuroplasticity after

stroke J Rehabil Res Dev 200845(2)205-20

82

Page 13: Neuroplasticity: A Paradigm Sea Change Latest Updated File

IV Neuroplasticity and Rehabilitation

Kleim amp Jones note that

A The Key Principles of Experience-Dependent Neural Plasticity

1 Use it or lose it

2 Use it and improve it

3 Specificity

13

4 Repetition matters

5 Intensity matters

6 Time matters

7 Salience matters

14

8 Age matters

9 Transference

10 Interference

15

Use it or lose it If you do not drive specific brain functions

functional loss will occur

Use it and improve it Therapy that drives cortical function

enhances that particular function

Specificity The therapy you choose determines the resultant

plasticity and function

Repetition matters Plasticity that results in functional change

requires repetition

16

Intensity matters Induction of plasticity requires the appropriate

amount of intensity

Time matters Different forms of plasticity take place at different

times during therapy

Salience matters It has to be important to the individual

Age matters Plasticity is easier in a younger brain but is also

possible in an adult brain

17

Transference Neuroplasticity and the change in function that

results from one therapy can augment the attainment of similar

behaviors

Interference Plasticity in response to one experience can interfere

with the acquisition of other behaviors

18

B Examples of Changes in Function and Structure

1) Jugglers

2) Typists

19

B Examples of Changes in Function and Structure

1) Jugglers

One study suggested that adults taught how to juggle demonstrated a

significant transient bilateral expansion of gray matter in the mid-

temporal area and the left posterior intraparietal sulcus between baseline brain scan and

follow-up The findings were specific to training stimulus individuals who were

not instructed how to juggle demonstrated no change in gray

matter over the same period These findings oppose the conventional

understanding that the anatomical structure of the adult brain does not change

over time

20

B Examples of Changes in Function and Structure

2) Typists

helliplong-term bimanual training also increases

gray matter volume in experienced adult typists

These results suggest that learning not

only affects function but also structure in

adult brains

21

V Neuroplasticity and Optometry

A Evolutionary neuroplasticity

B Reactive plasticity

C Adaptational plasticity

D Reparation plasticity

22

V Neuroplasticity and Optometry

A Evolutionary neuroplasticity

hellip is ideally suited for the developmental OD who

specializes in vision function as it changes over time

either with or without intervention

23

V Neuroplasticity and Optometry

B Reactive plasticity

hellip can be thought of as the immediate effect that

initial optometric treatment may have on a system This can

be reflected in an immediate but often transient change in

the individuallsquos accommodative systemmdashie when an

uncorrected myope initially puts on his or her new

spectacles

24

V Neuroplasticity and Optometry

C Adaptational plasticity

hellip could describe the long-term effects of in-office optometric

vision therapy on disorders of the binocular vision system

25

V Neuroplasticity and Optometry

D Reparation plasticity

hellipin contrast to adaptational

plasticity reparation plasticity may

occur during treatment by a low

Vision specialist or an OD

Working with those who have

Experienced a traumatic brain

injury (TBI)

26

V Neuroplasticity and Optometry

The effects of plasticity can lead to either

positive or negative changes during

development (evolutionary plasticity) after

short-term exposure (reactive plasticity)

after long-term or continuous stimuli

(adaptational plasticity) and during

functional or structural recovery of damaged

neuronal circuits (reparation plasticity)

httpwwwciteulikeorguserjasonepriorarticle2856526

27

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

A Refractive error development

B Amblyopia

C Strabismus

28

D Non-strabismus non-amblyopic binocular vision disorders

E Learning related vision anomalies

F Vision developmentperception disorders

29

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

A Refractive error development

Several recent studies have noted that neuroplasticity may play a

role in refractive error development

retinal defocus use of progressive addition lenses

drug studies (M1-antagonist2 pirenzepine ) slow myopia

progression demonstrated nearly a 50 reduction in myopia

progression over a two-year period

30

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged

7 to 17 years Arch Ophthalmol 2005 Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three

to less than 10 years of age Am J Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction

Am J Ophthalmol 2007 Jun143(6)1060-3

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine

vs patching for treatment of moderate amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-

57

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for

strabismic and anisometropic amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Treatment of severe amblyopia with weekend atropine results from 2 randomized clinical trials

Levodopacarbidopa in the treatment of amblyopia

31

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

J Pediatr Ophthalmol Strabismus 2009 Mar-Apr46(2)87-90 quiz 91-2 Levodopacarbidopa in the

treatment of amblyopia Dadeya S Vats P Malik KP

PURPOSE To evaluate the role of levodopacarbidopa in the treatment of amblyopia METHODS

Thirty patients with strabismic amblyopia between the ages of 3 and 12 years were part of this double-

blind randomized study Patients were divided into two groups Group A received 050 mg + 125 mg of

levodopacarbidopa per kilogram body weight three times daily after meals with a protein rich drink

whereas Group B received placebo Both groups received full-time conventional occlusion until a visual

acuity of 66 was achieved or for a maximum of 3 months RESULTS The authors observed more than

two lines improvement in visual acuity that was greater in the levodopa group (15 of 15) than in the

placebo group (9 of 15) (P lt 005) Furthermore improvement in visual acuity of more than two lines

was greater in patients younger than 8 years (100) than in patients older than 8 years of age (60) (P =

0026) There was also no significant reversal of the improved visual acuity in up to 6 months of follow-

up CONCLUSION Levodopacarbidopa improves visual acuity in patients with

amblyopia and maintains improved visual acuity especially in patients

younger than 8 years

32

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

J Pediatr Ophthalmol Strabismus 2008 May-Jun45(3)174-6 The use of levodopa in the treatment of

bilateral amblyopia secondary to uncorrected high hypermetropia Abrams MS

The standard treatment of bilateral amblyopia secondary to uncorrected high bilateral hypermetropia has

been spectacles and time The patient described here failed to show adequate improvement in visual

acuity after 18 months of standard treatment Visual acuity improved dramatically when the

patient began taking levodopa dropped precipitously when the medication was

discontinued and returned quickly to post-treatment levels when levodopa was

restarted Visual acuity remained stable when the medication was slowly tapered

and discontinued This report suggests that dopamine may play a role in the pathophysiology of

bilateral amblyopia secondary to uncorrected high bilateral hypermetropia

33

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

Bottom Line

Amblyopia can be treated at any age

May be able to use neuro-enhancing drugs

as a part of basic amblyopia therapy

34

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

C Strabismus and non-strabismic non-amblyopic binocular

vision disorders

Clinical Trial of Treatments for Symptomatic Convergence Insufficiency in Children has

clearly demonstrated the superiority of in-office optometric vision therapy (in conjunction

with home therapy) vs out-of-office therapy alone The study concluded that optometric

vision therapyorthoptics was more effective than pencil push-ups or placebo vision

therapyorthoptics in reducing symptoms and improving clinical signs of convergence

insufficiency

Long-term effectiveness of treatments for symptomatic convergence insufficiency

in children (Optom Vis Sci 2009 Sep86(9)1096-103)

CITT patients improvements lasted a year

35

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

Strabismus 1999 Sep7(3)169-74 Convergence insufficiency in

idiopathic Parkinsons disease responsive to levodopa Racette BA

Gokden MS Tychsen LS Perlmutter JS

We report a patient with pathologically proven idiopathic Parkinsons

disease (IPD) who developed diplopia secondary to convergence

insufficiency during his motor off periods Diplopia resolved with

onset of motor benefit from levodopa Neuro-ophthalmologic

examination demonstrated convergence insufficiency during motor

off periods that was alleviated after onset of motor benefit from

levodopa This is the first reported case of convergence insufficiency

in IPD responsive to levodopa

36

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

Bottom Line

Optometric Vision Therapy is the most efficacious treatment available for binocular vision disorders and the

treatment effects are long lasting Neuro-enhancing drugs

may assist us as well

37

EF Learning related vision anomalies Vision

developmentperception disorders

hellipresearch includes an examination of the role vision plays in

reading the effect of oculomotor vergence and

accommodativecoherent motion therapy on reading eye movements

and reading speed the diagnosis and treatment of perceptual

disorders and the effect of therapy on various learning anomalies

38

EF Learning related vision anomalies Vision developmentperception disorders

magnocellular (MC) deficit in dyslexia

LM speed-matching ratio predicts reading in childrenChase C Dougherty RF Ray N

Fowler S Stein JOptom Vis Sci 2007 Mar84(3)229-36

Effect of attention therapy on reading comprehension Solan HA Shelley-Tremblay J

Ficarra A Silverman M Larson S J Learn Disabil 2003 Nov-Dec36(6)556-63

Is there a common linkage among reading comprehension visual attention and

magnocellular processing Solan HA Shelley-Tremblay JF Hansen PC Larson S

J Learn Disabil 2007 May-Jun40(3)270-8

Lawton T Filtered Text and Direction Discrimination Training Improved Reading

Fluency for Both Dyslexic and Normal Readers Optom Vis Dev 200839 (3)114

Fischer B Hartnegg K Saccade control in dyslexia Development deficits training

and transfer to reading Optom Vis Dev 200839(4)181-190

39

EF Learning related vision anomalies Vision developmentperception disorders

J Learn Disabil 2003 Nov-Dec36(6)556-63 Effect of attention therapy on reading

comprehension Solan HA Shelley-Tremblay J Ficarra A Silverman M Larson S

hellip At the completion of attention therapy the mean

standard attention and reading comprehension scores of

the experimental group had improved significantly The

control group however showed no significant

improvement in reading comprehension scores after 12

weeks Although uncertainties still exist this investigation

supports the notion that visual attention is malleable and

that attention therapy has a significant effect on reading

comprehension in this often neglected population

40

VII Vision dysfunction association with acquired brain injury

A Exotropia (or high exophoriaCI)

B Accommodative dysfunction

C Convergence insufficiency

41

D Decreased blink rate

E Spatial disorientation

F Pursuitsaccade dysfunction

G Unstable ambient vision (Magnocellular pathway)

42

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Stelmack JA Frith T Van Koevering D Rinne S Stelmack TR Visual function in patients

followed at a Veterans Affairs polytrauma network site an electronic medical record review

Optometry 2009 Aug80(8)419-24

RESULTS Visual symptoms were self-reported by 76 of patients

with polytrauma and 75 of the patients with TBI Problems with reading

(polytrauma 60 and TBI 50) and accommodation (polytrauma 30 and

TBI 47) were frequently found on eye examinations Spectacles were the

treatment most frequently prescribed (polytrauma 62 and TBI 78)

CONCLUSIONS It is important for optometrists to be aware of the high

rates of self-reported symptoms and visual problems in military personnel

returning from deployment to the wars in Iraq and Afghanistan Post-

traumatic stress disorder and depression may complicate optometric

evaluation and management

43

VII Vision dysfunction association with acquired brain injury

Avoidance of near tasks

Oculomotor-based reading difficulties

Eye tracking problems

Eye focusing problems

Eyestrain Diplopia

Dizziness Vertigo

Vision-derived nausea

44

VII Vision dysfunction association with acquired brain injury

Increased sensitivity to visual motion

Visual inattention and distractibility

Short-term visual memory loss

Difficulty judging distances (relative and absolute

Difficulty with global scanning

Difficulty with personal grooming especially involving the face

Inability to interactcope visually in a complex social situation

(eg minimal eye contact)

Inability to tolerate complex visual environments (eg grocery store

aisles and highly-patterned floors)

45

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Ciuffreda KJ Ludlam DP Kapoor N Clinical oculomotor training in traumatic brain injury Optom Vis

Dev 200940(1)16-23

Individuals with traumatic brain injury present with a constellation of

oculomotor dysfunctions and correlated symptoms Simple and

effective clinical oculomotor-based training procedures will be

presented with respect to the versional vergence and

accommodative systems and their interactions These therapeutic

procedures can also be applied as needed to individuals with either

low vision neurological dysfunctions or general visual skills cases

manifesting similar oculomotor deficits

46

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Leslie S Myopia and accommodative insufficiency associated with

moderate head trauma Opt Vis Dev 200940(1)25-31

The majority of subjects reviewed had developed a stable degree of

myopia between 100 and 200 diopters as well as an abnormally

high lag of accommodation When their distance and near spatial area

of focus was compared the majority were focused at an intermediate

area in space suggesting a loss of control of accommodation in

space

47

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

B Drugs

C Exercise

D Learning new and challenging things

48

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements

prevent cognitive decline A systematic review of randomized controlled trials J Hum

Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among

preterm infants attributable to early supplementation of human milk with

docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings

and structural-functional synergies with cell membrane phospholipids Altern Med Rev

2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function

Neuroscience 20089(7)568-78

49

VIII Improving Brain Function and Neuroplasticity

B Drugs Maya Vetencourt JF Sale A Viegi A et al The antidepressant

fluoxetine (PROZAC) restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the

antidepressant tianeptine CNS Drugs 200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances

hippocampal long-term potentiation and memory BMC Biol 2008 Sep

9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine

improves neuropsychological disorders in a child with creatine

transporter defect Neurocase 200814(2) 151-61

50

VIII Improving Brain Function and Neuroplasticity

C Exercise

Hunsberger JG et al Antidepressant actions of the exercise-

regulated gene VGF Nat Med 2007 Dec 2 131476

VGF may be a common pathway by which exercise induces

neuroplasticity and growth-factor genes at least one of these might act

similarly to antidepressants in promoting an adaptive response to stress

However the tests used here may be modeling stress-induced

helplessness not depression hellipexercise seems to induce multiple

interacting genes that enhance neuronal resilience

51

VIII Improving Brain Function and Neuroplasticity

D Learning new and challenging things

What have we (optometry amp ophthalmology)

been thinking all these years

Where did we miss the news about neuroplasticity

52

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Huang JC Neuroplasticity as a proposed mechanism for the efficacy of optometric vision therapy and rehabilitation J Bev Optom 200920(4)96-100

Homologous area adaptationCompensatory masqueradeCross-modal reassignment

Map expansion

EquipotentialityVicariation

53

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Homologous area adaptation a transfer of function from a damaged brain area to a non-damaged brain area May be limited to early stages of human development and may crowd a new brain area resulting in reduced functionality of that brain area (Competition between spatial amp verbal functioning)

54

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Compensatory masquerade reorganizing of existing neuro-pathways to us alternative cognitive strategies to perform a task

55

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Cross-modal reassignment using new sensory input in a brain structure deprived of its main input source (changing processing from visual to tactile stimuli in the blind)

56

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Map expansion increase in brain mass due to repeated behavior or exposure to stimuli

57

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Equipotentiality anatomical areas of the brain can perform disparate functions

Vicariation redundant neural systems can operate under abnormal conditions

This may explain why recovery is noted for many neurological conditions (degenerative psychiatric developmental vascular traumatic)

58

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Constraint therapy Use it and improve it

Patching penalization ldquonear activitiesrdquo during amblyopia therapy

59

IX Improving Brain Function and Neuroplasticity Optometric Clinical ApplicationsOptometric Vision Therapy

Kleim amp Jones

Use it or lose it If you do not drive specific brain functions

functional loss will occur

If you want to improve oculomotor brain neuroplastic function amp

structure therapy should be specific for that brain function

Use it and improve it Therapy that drives cortical function enhances

that particular function

If you use therapy to improve oculomotor dysfunction it should

improve

Specificity The therapy you choose determines the resultant

plasticity and function

You must choose therapy that is appropriate

60

IX Improving Brain Function and Neuroplasticity Optometric Clinical Applications

Kleim amp Jones

Repetition matters Plasticity that results in functional change

requires repetition

Do the therapy Do it again Do it yet again No quick fix

Intensity matters Induction of plasticity requires the appropriate

amount of intensity

Intensity means strength force concentration power and passion

Without these plasticity may not occur Function may not improve

Time matters Different forms of plasticity take place at different

times during therapy

Do the basics than the more advanced therapeutic procedures

61

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Salience matters It has to be important to the individual

Make the therapy matter to the patient

Age matters Plasticity is easier in a younger brain but is also

possible in an adult brain

Do not let age determine what therapy options you offer your

patients Think of Susan Barry PhD (StereoSue) and her success

Offer your patients options Let them choose Be realistic about

outcomeshelliphave outcome measures built into therapy program

62

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Transference Neuroplasticity and the change in function

that results from one therapy can augment the attainment

of similar behaviors

What you do during oculomotor therapy may affected

vergence therapy outcomes

Interference Plasticity in response to one experience can

interfere with the acquisition of other behaviors

Monitor Evaluate progress Discuss function in other areas

of your patientslsquo life

63

Why pay attention to binocular vision dysfunctions

and neuroplasticity

December 2009 issue of the Review of Optometry

The Binocular Vision Dysfunction Pandemic

In 2010 almost 170 million individuals will be wearing glasses In

2010 there will also be up to 93 million amblyopes and 12 and a half

million strabismics For children under 18 years of age that means

there will be more than 22 and a half million amblyopes and millions

of children with strabismus A clinical trial to determine the

prevalence of binocular vision dysfunction within the general

population suggested the possibility of up to 56 or 173 million men

women and children with symptoms associated with a binocular

vision dysfunction 189 million (61) with accommodative problems

and 118 million (38) demonstrating various vergence

anomalies

64

65

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Brain plasticity life long changes in the structure of the brain

Sensory substitution replacement of one sensory input by another

Measurement techniques

Voxel based morphometryhellipmeasures difference in brain volume

Fluorodeoxyglucose glucose analog PET scan tells you

distribution and metabolism of brain

Cortical thickness measures

Visual cortex of the blind turns somatic ―The eye of the tongue

Transcranial magnetic stmiulation non-invasive technique to

stimulate cortex

66

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Blind Braille readers report tingling in fingers when pressure

phosphenes are applied Blind feel tingling in tongue

Bind use tongue to perform orientation task motion perception

sensory perception Visual cortex recruited in a variety of sensory

and cognitive tasks (DM Can we use tongue as a VT tool)

Dilks Reorganizations of human adult visual system

When a region of sensory cortex is deprived of its bottom up

input the deprived region begins to respond to stimuli that

normally activate adjacent cortex

67

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Retinotopic map changes for stroke pts Cortical reorganization in

adults occurs Perceived objectshellipelongation in stroke amp AMD

What happens to deprived cortex in AMD

fMRI shows cortical reorganization in adults

Proposed mechanisms

hellipGrowth of new connections

hellipUnmasking of pre-existing connections this is true

happens within seconds

Bavelier

Action video games

68

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Bavelier

Action video games Looked at attention Gamers can track more

activities

Attention over space (me peripheral awarenress) Useful field

of view shrinks with age

Performance not VA relatedhellipis related to attention

Action game playing changes spatial resolutionhellipovercoming

crowding in VA assessment (me amblyopia therapy)

Temporal resolution of vision Backward masking

changehellipbrain changes

Visual sensitivity (contrast sensitivity) Post action game training

improves CSF

69

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Action video games correcting optics of the cortex (me this is

actualy OVT)

Games factor

Variable entry leanringhellipadapt task to skill level

Incremental learning tune task to subjectlsquos leanring steps

Motivationarousal

Rewards

Self masterself confidence

Action games factors

Pacingrate of exposure to infohellipincreasing processing speed

Dynamic display

Rich environment

Rich motor involvement

70

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Surgeons may be made to play action games

Pilot training

Amblyopia tx Dennis Levi research

PresenterTitle Contact info

Neuroplasticity-A Paradigm Sea Change

This presentation is available at

httpwwwslidesharenetDMAINOneuroplasticity-a-paradigm-sea-change-2459693

httpwwwmainosmemosblogspotcom

My FaceBook Page

and

Twitter

PresenterTitle Contact info

Questions About

Neuroplasticity-A Paradigm Sea Change

Dominick M Maino OD MEd FAAO FCOVD-A

Professor PediatricsBinocular VisionIllinois Eye InstituteIllinois College of Optometry

dmainoicoeduhttpwwwMainosMemosblogspotcom

Thanks to

httpwwwcovdorgHomeOVDJournalOVD401tabid263D

efaultaspx

httpbipolarblastfileswordpresscom200908neurojpg

httpwwwspecialcheerscomimagesanimated_braingif

httpblogmarsdencartoonscomwp-

contentuploads200810frankenstein-myspace-lightbeergif

httpwwwshangralafamilyfuncomgala-ecalvindreamgif

httppsychiatryjwatchorgcgicontentfull20082251

73

Chakraborty R Chatterjee A Choudhart S Chakraborty PK Neuroplasticitymdasha paradigm shift in neurosciences J Indian Med Assoc

2007105(9)513-4516-8520-1

Sacks O A neurologistlsquos notebook Stereo Sue Why two eyes are better than one The New Yorker 2006 Jun 1964-73

Krulwich R National Public Radio Going Binocular Susanlsquos First Snowfall Available at

wwwnprorgtemplatesstorystoryphpstoryId=5507789 (Accessed December 8 2008)

Press LJ The story behind Stereo Suelsquo and a world-famous neurologistlsquos discovery of vision therapy Optom Vis Dev 200637(2) 55-7

Levin HS Neuroplasticity and brain imaging research implications for rehabilitation Arch Phys Med Rehabil 2006 Dec87(12 Suppl

2)S1

Wiesel TN Hubel DH Single-cell responses in striate cortex of kittens deprived of vision in one eye J Neurophysiol 1963

Nov261003-17

Hook BM Chen C Critical periods in the visual system Changing views for a model of experience-dependent plasticity Neuron 2007

Oct56(2)312-26

Ramey CT Ramey SL Prevention of intellectual disabilities early interventions to improve cognitive development Prev Med 1998

Mar-Apr27(2)224-32

Heuninckx S Wenderoth N Swinnen SP Systems neuroplasticity in the aging brain recruiting additional neural resources for

successful motor performance in elderly persons J Neurosci 2008 Jan 228(1)91-9

Ge S Yang CH Hsu KS et al A critical period for enhanced synaptic plasticity in newly generated neurons of the adult brain Neuron

2007 May54(4)559-66

74

Draganski B Gaser C Busch V et al Neuroplasticity changes in grey matter induced by training Nature 2004 Jan 22427(6972)

311-2

Cannonieri GC Bonilha L Fernandes PT et al Practice and perfect length of training and structural brain changes in experienced

typists Neuroreport 2007 Jul 218(10)1063-6

Kleim JA Jones TA Principles of experience-dependent neural plasticity implications for rehabilitation after brain damage J

Speech Lang Hear Res 2008 Feb51(1)S225-39

Trojan S Porkorny J Theoretical aspects of neuroplasticity Physiol Res 199948(2)87-97

Ramamirtham R Kee CS Hung LF et al Wave aberrations in rhesus monkeys with vision-induced ametropias Vision Res 2007

Sep47(21)2751-66

Smith EL 3rd Ramamirtham R Qiao-Grider Y et al Effects of foveal ablation on emmetropization and form-deprivation myopia

Invest Ophthalmol Vis Sci 2007 Sep48(9)3914-22

Smith EL 3rd Kee CS Ramamirtham R et al Peripheral vision can influence eye growth and refractive development in infant

monkeys Invest Ophthalmol Vis Sci 2005 Nov46(11)3965-72

Ciuffreda KJ Vasudevan B Nearwork-induced transient myopia (NITM) and permanent myopiandashndashis there a link Ophthalmic

Physiol Opt 2008 Mar28(2)103-14

Hung GK Ciuffreda KJ Incremental retinal-defocus theory of myopia development--schematic analysis and computer simulation

Comput Biol Med 2007 Jul37(7)930-46

Hung GK Ciuffreda KJ A unifying theory of refractive error development Bull Math Biol 2000 Nov62(6)1087-108

75

Pang Y Maino D Zhang G Lu F Myopia Can its progress be controlled Optom Vis Dev 200637(2)75-9

Leung JT Brown B Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lenses Optom Vis Sci

1999 Jun76(6)346-54

Hasebe S Ohtsuki H Nonaka T et al Effect of progressive addition lenses on myopia progression in Japanese children a prospective

randomized double-masked crossover trial Invest Ophthalmol Vis Sci 2008 Jul49(7)2781-9

Gwiazda J Hyman L Hussein M et al A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression

of myopia in children Invest Ophthalmol Vis Sci 2003 Apr44(4)1492-500

Siatkowski RM Cotter SA Crockett RS et al Two-year multi-center randomized double-masked placebo-controlled parallel safety and

efficacy study of 2 pirenzepine ophthalmic gel in children with myopia J AAPOS 2008 Aug12(4)332-9

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged 7 to 17 years Arch Ophthalmol 2005

Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three to less than 10 years of age Am J

Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction Am J Ophthalmol 2007

Jun143(6)1060-3

Holmes JM Edwards AR Beck RW et al A randomized pilot study of near activities versus non-near activities during patching therapy for

amblyopia J AAPOS 2005 Apr9(2)129-36

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate

amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-57

76

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic

amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Convergence Insufficiency Treatment Trial Study Group Randomized clinical trial of treatments for symptomatic convergence insufficiency

in children Arch Ophthalmol 2008 Oct126(10)1336-49

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

Solan HA Shelley-Tremblay J Hansen PC et al M-cell deficit and reading disability a preliminary study of the effects of temporal vision-

processing therapy Optometry 2004 Oct75(10)640-50

Solan HA Larson S Shelley-Tremblay J et al Role of visual attention in cognitive control of oculomotor readiness in students with reading

disabilities J Learn Disabil 2001 Mar-Apr34(2)107-18

Gallaway M Boas MB The impact of vergence and accommodative therapy on reading eye movements and reading speed Optom Vis Dev

200738(3)115-20

Goss DA Downing DB Lowther AH et al The effect of HTS vision therapy conducted in a school setting on reading skills in third and

fourth grade students Optom Vis Dev 200738(1)27-32

Crutch SJ Warrington EK Foveal crowding in posterior cortical atrophy a specific early-visual-processing deficit affecting word reading

Cogn Neuropsychol 2007 Dec24(8)843-66

Helms D Sawtelle SM A study of the effectiveness of cognitive therapy delivered in a video game format Optom Vis Dev 200738 (1)19-

26

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

77

Lawton T Training direction-discrimination sensitivity remediates a wide spectrum of reading skills OptomVis Dev 200738(1) 33-47

Goldstand S Koslowe KC Parush S Vision visual-information processing and academic performance among seventh-grade schoolchildren a

more significant relationship than we thought Am J Occup Ther 2005 Jul-Aug59(4)377-89

Fischer B Koumlngeter A Hartnegg K Effects of daily practice on subitizing visual counting and basic arithmetic skills Optom Vis Dev

200839(1)30-4

Sands W Taub M Maino D Limited research and education on special populations in optometry and ophthalomology Optom Vis Dev

200839(2)60-1

Wesson M Maino D Oculo-visual findings in Down syndrome cerebral palsy and mental retardation with non-specific etiology In Maino D

(ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 199517-54 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

Cui Y Stapleton F Suttle C Developing an instrument to assess vision-related and subjective quality of life in children with intellectual

disability data collection and preliminary analysis in a Chinese population Ophthal Physiolog Optics 2008 May28(3) 238-46

Maino D Steele G Tahir S Sajja R Attitudes of optometry students toward individuals with disabilities Optom Ed 200227(2)45-50

Maino D Special populations in the optometric curriculum Optom Ed 200227(2)38-9

Maino D Overview of special populations In Scheiman M Rouse M (eds) Optometric Management of Learning-Related Vision Problems

St Louis Mosby Inc 200685-106

Maino D (ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 1995 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

78

McCarthy P Maino D Alport syndrome a review Clin Eye Vis Care 2000 Dec12(3-4)139-50

Block SS Brusca-Vega R Pizzi WJ et al Cognitive and visual processing skills and their relationship to mutation size in full and

permutation female fragile X carriers Optom Vis Sci 2000 Nov77 (11)592-9

Maino D The young child with developmental disabilities An introduction to mental retardation and genetic syndromes In Moore BD

(ed) Eye Care for Infants and Young Children Butter-worth--Heinemann Newton MA1997285-300

Amin V Maino D The Fragile X female Visual visual perceptual and ocular health anomalies J Am Optom Assoc 1995 May66

(5)290-95

Maino DM Maino JH Cibis GW Hecht F Ocular health anomalies in patients with developmental disabilities In Maino D (ed)

Diagnosis and Management of Special Populations Mosby-Year-book Inc St Louis MO 1995189-206 Reprinted Optometric

Education Program Foundation Santa Anna Calif 2001

Maino D Wesson M Schlange D Cibis G Maino J Optometric findings in the fragile X syndrome Optom Vis Sci 199168634-40

Scheiman MMOptometric findings in children with cerebral palsy Am J Optom Physiol Opt 1984 May61(5)321-3

Maino D Maino J Maino S Mental retardation syndromes with associated ocular defects J Am Optom Assoc 199061707-16

Stewart RE Woodhouse JM Cregg M Pakeman VH Association between accommodative accuracy hypermetropia and strabismus in

children with Downs syndrome Optom Vis Sci 2007 Feb84(2)149-55

Cregg M Woodhouse JM Pakeman VH et al Accommodation and refractive error in children with Down syndrome cross-sectional

and longitudinal studies Invest Ophthalmol Vis Sci 2001 Jan42 (1)55-63

79

McClelland JF Parkes J Hill N et al Accommodative dysfunction in children with cerebral palsy a population-

based study Invest Ophthalmol Vis Sci 2006 May47(5)1824-30

Duckman RH Vision therapy for the child with cerebral palsy J Am Optom Assoc 198758(1)28-35

Duckman R Accommodation in cerebral palsy function and remediation J Am Optom Assoc 198455(4)281-3

Scheiman M Understanding and managing vision deficits a guide for occupational therapists 2nd ed Slack

Thorofare NJ 2002

Maino D Binasal occlusion for the child with Cerebral Palsy J Ill Optom Assoc 198644(1)1218

Battaglia F Quartarone A Rizzo V et al Early impairment of synaptic plasticity in patients with Downs syndrome

Neurobiol Aging 2008 Aug29(8)1272-5

Bonnier C Evaluation of early stimulation programs for enhancing brain development Acta Paediatr 2008

Jul97(7)853-8

Morice E Andreae LC Cooke SF et al Preservation of long-term memory and synaptic plasticity despite short-term

impairments in the Tc1 mouse model of Down syndrome Learn Mem 2008 Jul 1415(7)492-500

Gordon AM Schneider JA Chinnan A Charles JR Efficacy of a hand-arm bimanual intensive therapy (HABIT) in

children with hemiplegic cerebral palsy a randomized control trial Dev Med Child Neurol 2007 Nov49(11)830-8

Kapoor N Ciuffreda KJ Vision disturbances following traumatic brain injury Curr Treat Options Neurol 2002

Jul4(4)271-80

80

Ciuffreda KJ Rutner D Kapoor N et al Vision therapy for oculomotor dysfunctions in acquired brain injury a

retrospective analysis Optometry 2008 Jan79(1)18-22

Ciuffreda KJ Han Y Kapoor N Ficarra AP Oculomotor rehabilitation for reading in acquired brain injury

NeuroRehabilitation 200621(1)9-21

Zost M Diagnosis and management of visual dysfunction in cerebral injury In Maino D (ed) Diagnosis and

Management of Special Populations Mosby-Yearbook Inc St Louis 199579 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001 [Figure used with permission of the editor]

DeGutis JM Bentin S Robertson LC DEsposito M Functional plasticity in ventral temporal cortex following

cognitive rehabilitation of a congenital prosopagnosic J Cogn Neurosci 2007 Nov19 (11)1790-802

Welbourne SR Ralph MA Exploring the impact of plasticity-related recovery after brain damage in a connectionist

model of single-word reading Cogn Affect Behav Neurosci 2005 Mar5(1)77-92

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements prevent cognitive decline A

systematic review of randomized controlled trials J Hum Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among preterm infants attributable to early

supplementation of human milk with docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings and structural-functional

synergies with cell membrane phospholipids Altern Med Rev 2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function Neuroscience 20089(7)568-78

81

Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

BMC Biol 2008 Sep 9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine improves neuropsychological disorders in a child with

creatine transporter defect Neurocase 200814(2) 151-61

Forrester LW Wheaton LA Luft AR Exercise-mediated locomotor recovery and lower-limb neuroplasticity after

stroke J Rehabil Res Dev 200845(2)205-20

82

Page 14: Neuroplasticity: A Paradigm Sea Change Latest Updated File

4 Repetition matters

5 Intensity matters

6 Time matters

7 Salience matters

14

8 Age matters

9 Transference

10 Interference

15

Use it or lose it If you do not drive specific brain functions

functional loss will occur

Use it and improve it Therapy that drives cortical function

enhances that particular function

Specificity The therapy you choose determines the resultant

plasticity and function

Repetition matters Plasticity that results in functional change

requires repetition

16

Intensity matters Induction of plasticity requires the appropriate

amount of intensity

Time matters Different forms of plasticity take place at different

times during therapy

Salience matters It has to be important to the individual

Age matters Plasticity is easier in a younger brain but is also

possible in an adult brain

17

Transference Neuroplasticity and the change in function that

results from one therapy can augment the attainment of similar

behaviors

Interference Plasticity in response to one experience can interfere

with the acquisition of other behaviors

18

B Examples of Changes in Function and Structure

1) Jugglers

2) Typists

19

B Examples of Changes in Function and Structure

1) Jugglers

One study suggested that adults taught how to juggle demonstrated a

significant transient bilateral expansion of gray matter in the mid-

temporal area and the left posterior intraparietal sulcus between baseline brain scan and

follow-up The findings were specific to training stimulus individuals who were

not instructed how to juggle demonstrated no change in gray

matter over the same period These findings oppose the conventional

understanding that the anatomical structure of the adult brain does not change

over time

20

B Examples of Changes in Function and Structure

2) Typists

helliplong-term bimanual training also increases

gray matter volume in experienced adult typists

These results suggest that learning not

only affects function but also structure in

adult brains

21

V Neuroplasticity and Optometry

A Evolutionary neuroplasticity

B Reactive plasticity

C Adaptational plasticity

D Reparation plasticity

22

V Neuroplasticity and Optometry

A Evolutionary neuroplasticity

hellip is ideally suited for the developmental OD who

specializes in vision function as it changes over time

either with or without intervention

23

V Neuroplasticity and Optometry

B Reactive plasticity

hellip can be thought of as the immediate effect that

initial optometric treatment may have on a system This can

be reflected in an immediate but often transient change in

the individuallsquos accommodative systemmdashie when an

uncorrected myope initially puts on his or her new

spectacles

24

V Neuroplasticity and Optometry

C Adaptational plasticity

hellip could describe the long-term effects of in-office optometric

vision therapy on disorders of the binocular vision system

25

V Neuroplasticity and Optometry

D Reparation plasticity

hellipin contrast to adaptational

plasticity reparation plasticity may

occur during treatment by a low

Vision specialist or an OD

Working with those who have

Experienced a traumatic brain

injury (TBI)

26

V Neuroplasticity and Optometry

The effects of plasticity can lead to either

positive or negative changes during

development (evolutionary plasticity) after

short-term exposure (reactive plasticity)

after long-term or continuous stimuli

(adaptational plasticity) and during

functional or structural recovery of damaged

neuronal circuits (reparation plasticity)

httpwwwciteulikeorguserjasonepriorarticle2856526

27

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

A Refractive error development

B Amblyopia

C Strabismus

28

D Non-strabismus non-amblyopic binocular vision disorders

E Learning related vision anomalies

F Vision developmentperception disorders

29

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

A Refractive error development

Several recent studies have noted that neuroplasticity may play a

role in refractive error development

retinal defocus use of progressive addition lenses

drug studies (M1-antagonist2 pirenzepine ) slow myopia

progression demonstrated nearly a 50 reduction in myopia

progression over a two-year period

30

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged

7 to 17 years Arch Ophthalmol 2005 Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three

to less than 10 years of age Am J Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction

Am J Ophthalmol 2007 Jun143(6)1060-3

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine

vs patching for treatment of moderate amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-

57

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for

strabismic and anisometropic amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Treatment of severe amblyopia with weekend atropine results from 2 randomized clinical trials

Levodopacarbidopa in the treatment of amblyopia

31

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

J Pediatr Ophthalmol Strabismus 2009 Mar-Apr46(2)87-90 quiz 91-2 Levodopacarbidopa in the

treatment of amblyopia Dadeya S Vats P Malik KP

PURPOSE To evaluate the role of levodopacarbidopa in the treatment of amblyopia METHODS

Thirty patients with strabismic amblyopia between the ages of 3 and 12 years were part of this double-

blind randomized study Patients were divided into two groups Group A received 050 mg + 125 mg of

levodopacarbidopa per kilogram body weight three times daily after meals with a protein rich drink

whereas Group B received placebo Both groups received full-time conventional occlusion until a visual

acuity of 66 was achieved or for a maximum of 3 months RESULTS The authors observed more than

two lines improvement in visual acuity that was greater in the levodopa group (15 of 15) than in the

placebo group (9 of 15) (P lt 005) Furthermore improvement in visual acuity of more than two lines

was greater in patients younger than 8 years (100) than in patients older than 8 years of age (60) (P =

0026) There was also no significant reversal of the improved visual acuity in up to 6 months of follow-

up CONCLUSION Levodopacarbidopa improves visual acuity in patients with

amblyopia and maintains improved visual acuity especially in patients

younger than 8 years

32

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

J Pediatr Ophthalmol Strabismus 2008 May-Jun45(3)174-6 The use of levodopa in the treatment of

bilateral amblyopia secondary to uncorrected high hypermetropia Abrams MS

The standard treatment of bilateral amblyopia secondary to uncorrected high bilateral hypermetropia has

been spectacles and time The patient described here failed to show adequate improvement in visual

acuity after 18 months of standard treatment Visual acuity improved dramatically when the

patient began taking levodopa dropped precipitously when the medication was

discontinued and returned quickly to post-treatment levels when levodopa was

restarted Visual acuity remained stable when the medication was slowly tapered

and discontinued This report suggests that dopamine may play a role in the pathophysiology of

bilateral amblyopia secondary to uncorrected high bilateral hypermetropia

33

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

Bottom Line

Amblyopia can be treated at any age

May be able to use neuro-enhancing drugs

as a part of basic amblyopia therapy

34

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

C Strabismus and non-strabismic non-amblyopic binocular

vision disorders

Clinical Trial of Treatments for Symptomatic Convergence Insufficiency in Children has

clearly demonstrated the superiority of in-office optometric vision therapy (in conjunction

with home therapy) vs out-of-office therapy alone The study concluded that optometric

vision therapyorthoptics was more effective than pencil push-ups or placebo vision

therapyorthoptics in reducing symptoms and improving clinical signs of convergence

insufficiency

Long-term effectiveness of treatments for symptomatic convergence insufficiency

in children (Optom Vis Sci 2009 Sep86(9)1096-103)

CITT patients improvements lasted a year

35

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

Strabismus 1999 Sep7(3)169-74 Convergence insufficiency in

idiopathic Parkinsons disease responsive to levodopa Racette BA

Gokden MS Tychsen LS Perlmutter JS

We report a patient with pathologically proven idiopathic Parkinsons

disease (IPD) who developed diplopia secondary to convergence

insufficiency during his motor off periods Diplopia resolved with

onset of motor benefit from levodopa Neuro-ophthalmologic

examination demonstrated convergence insufficiency during motor

off periods that was alleviated after onset of motor benefit from

levodopa This is the first reported case of convergence insufficiency

in IPD responsive to levodopa

36

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

Bottom Line

Optometric Vision Therapy is the most efficacious treatment available for binocular vision disorders and the

treatment effects are long lasting Neuro-enhancing drugs

may assist us as well

37

EF Learning related vision anomalies Vision

developmentperception disorders

hellipresearch includes an examination of the role vision plays in

reading the effect of oculomotor vergence and

accommodativecoherent motion therapy on reading eye movements

and reading speed the diagnosis and treatment of perceptual

disorders and the effect of therapy on various learning anomalies

38

EF Learning related vision anomalies Vision developmentperception disorders

magnocellular (MC) deficit in dyslexia

LM speed-matching ratio predicts reading in childrenChase C Dougherty RF Ray N

Fowler S Stein JOptom Vis Sci 2007 Mar84(3)229-36

Effect of attention therapy on reading comprehension Solan HA Shelley-Tremblay J

Ficarra A Silverman M Larson S J Learn Disabil 2003 Nov-Dec36(6)556-63

Is there a common linkage among reading comprehension visual attention and

magnocellular processing Solan HA Shelley-Tremblay JF Hansen PC Larson S

J Learn Disabil 2007 May-Jun40(3)270-8

Lawton T Filtered Text and Direction Discrimination Training Improved Reading

Fluency for Both Dyslexic and Normal Readers Optom Vis Dev 200839 (3)114

Fischer B Hartnegg K Saccade control in dyslexia Development deficits training

and transfer to reading Optom Vis Dev 200839(4)181-190

39

EF Learning related vision anomalies Vision developmentperception disorders

J Learn Disabil 2003 Nov-Dec36(6)556-63 Effect of attention therapy on reading

comprehension Solan HA Shelley-Tremblay J Ficarra A Silverman M Larson S

hellip At the completion of attention therapy the mean

standard attention and reading comprehension scores of

the experimental group had improved significantly The

control group however showed no significant

improvement in reading comprehension scores after 12

weeks Although uncertainties still exist this investigation

supports the notion that visual attention is malleable and

that attention therapy has a significant effect on reading

comprehension in this often neglected population

40

VII Vision dysfunction association with acquired brain injury

A Exotropia (or high exophoriaCI)

B Accommodative dysfunction

C Convergence insufficiency

41

D Decreased blink rate

E Spatial disorientation

F Pursuitsaccade dysfunction

G Unstable ambient vision (Magnocellular pathway)

42

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Stelmack JA Frith T Van Koevering D Rinne S Stelmack TR Visual function in patients

followed at a Veterans Affairs polytrauma network site an electronic medical record review

Optometry 2009 Aug80(8)419-24

RESULTS Visual symptoms were self-reported by 76 of patients

with polytrauma and 75 of the patients with TBI Problems with reading

(polytrauma 60 and TBI 50) and accommodation (polytrauma 30 and

TBI 47) were frequently found on eye examinations Spectacles were the

treatment most frequently prescribed (polytrauma 62 and TBI 78)

CONCLUSIONS It is important for optometrists to be aware of the high

rates of self-reported symptoms and visual problems in military personnel

returning from deployment to the wars in Iraq and Afghanistan Post-

traumatic stress disorder and depression may complicate optometric

evaluation and management

43

VII Vision dysfunction association with acquired brain injury

Avoidance of near tasks

Oculomotor-based reading difficulties

Eye tracking problems

Eye focusing problems

Eyestrain Diplopia

Dizziness Vertigo

Vision-derived nausea

44

VII Vision dysfunction association with acquired brain injury

Increased sensitivity to visual motion

Visual inattention and distractibility

Short-term visual memory loss

Difficulty judging distances (relative and absolute

Difficulty with global scanning

Difficulty with personal grooming especially involving the face

Inability to interactcope visually in a complex social situation

(eg minimal eye contact)

Inability to tolerate complex visual environments (eg grocery store

aisles and highly-patterned floors)

45

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Ciuffreda KJ Ludlam DP Kapoor N Clinical oculomotor training in traumatic brain injury Optom Vis

Dev 200940(1)16-23

Individuals with traumatic brain injury present with a constellation of

oculomotor dysfunctions and correlated symptoms Simple and

effective clinical oculomotor-based training procedures will be

presented with respect to the versional vergence and

accommodative systems and their interactions These therapeutic

procedures can also be applied as needed to individuals with either

low vision neurological dysfunctions or general visual skills cases

manifesting similar oculomotor deficits

46

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Leslie S Myopia and accommodative insufficiency associated with

moderate head trauma Opt Vis Dev 200940(1)25-31

The majority of subjects reviewed had developed a stable degree of

myopia between 100 and 200 diopters as well as an abnormally

high lag of accommodation When their distance and near spatial area

of focus was compared the majority were focused at an intermediate

area in space suggesting a loss of control of accommodation in

space

47

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

B Drugs

C Exercise

D Learning new and challenging things

48

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements

prevent cognitive decline A systematic review of randomized controlled trials J Hum

Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among

preterm infants attributable to early supplementation of human milk with

docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings

and structural-functional synergies with cell membrane phospholipids Altern Med Rev

2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function

Neuroscience 20089(7)568-78

49

VIII Improving Brain Function and Neuroplasticity

B Drugs Maya Vetencourt JF Sale A Viegi A et al The antidepressant

fluoxetine (PROZAC) restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the

antidepressant tianeptine CNS Drugs 200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances

hippocampal long-term potentiation and memory BMC Biol 2008 Sep

9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine

improves neuropsychological disorders in a child with creatine

transporter defect Neurocase 200814(2) 151-61

50

VIII Improving Brain Function and Neuroplasticity

C Exercise

Hunsberger JG et al Antidepressant actions of the exercise-

regulated gene VGF Nat Med 2007 Dec 2 131476

VGF may be a common pathway by which exercise induces

neuroplasticity and growth-factor genes at least one of these might act

similarly to antidepressants in promoting an adaptive response to stress

However the tests used here may be modeling stress-induced

helplessness not depression hellipexercise seems to induce multiple

interacting genes that enhance neuronal resilience

51

VIII Improving Brain Function and Neuroplasticity

D Learning new and challenging things

What have we (optometry amp ophthalmology)

been thinking all these years

Where did we miss the news about neuroplasticity

52

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Huang JC Neuroplasticity as a proposed mechanism for the efficacy of optometric vision therapy and rehabilitation J Bev Optom 200920(4)96-100

Homologous area adaptationCompensatory masqueradeCross-modal reassignment

Map expansion

EquipotentialityVicariation

53

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Homologous area adaptation a transfer of function from a damaged brain area to a non-damaged brain area May be limited to early stages of human development and may crowd a new brain area resulting in reduced functionality of that brain area (Competition between spatial amp verbal functioning)

54

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Compensatory masquerade reorganizing of existing neuro-pathways to us alternative cognitive strategies to perform a task

55

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Cross-modal reassignment using new sensory input in a brain structure deprived of its main input source (changing processing from visual to tactile stimuli in the blind)

56

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Map expansion increase in brain mass due to repeated behavior or exposure to stimuli

57

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Equipotentiality anatomical areas of the brain can perform disparate functions

Vicariation redundant neural systems can operate under abnormal conditions

This may explain why recovery is noted for many neurological conditions (degenerative psychiatric developmental vascular traumatic)

58

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Constraint therapy Use it and improve it

Patching penalization ldquonear activitiesrdquo during amblyopia therapy

59

IX Improving Brain Function and Neuroplasticity Optometric Clinical ApplicationsOptometric Vision Therapy

Kleim amp Jones

Use it or lose it If you do not drive specific brain functions

functional loss will occur

If you want to improve oculomotor brain neuroplastic function amp

structure therapy should be specific for that brain function

Use it and improve it Therapy that drives cortical function enhances

that particular function

If you use therapy to improve oculomotor dysfunction it should

improve

Specificity The therapy you choose determines the resultant

plasticity and function

You must choose therapy that is appropriate

60

IX Improving Brain Function and Neuroplasticity Optometric Clinical Applications

Kleim amp Jones

Repetition matters Plasticity that results in functional change

requires repetition

Do the therapy Do it again Do it yet again No quick fix

Intensity matters Induction of plasticity requires the appropriate

amount of intensity

Intensity means strength force concentration power and passion

Without these plasticity may not occur Function may not improve

Time matters Different forms of plasticity take place at different

times during therapy

Do the basics than the more advanced therapeutic procedures

61

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Salience matters It has to be important to the individual

Make the therapy matter to the patient

Age matters Plasticity is easier in a younger brain but is also

possible in an adult brain

Do not let age determine what therapy options you offer your

patients Think of Susan Barry PhD (StereoSue) and her success

Offer your patients options Let them choose Be realistic about

outcomeshelliphave outcome measures built into therapy program

62

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Transference Neuroplasticity and the change in function

that results from one therapy can augment the attainment

of similar behaviors

What you do during oculomotor therapy may affected

vergence therapy outcomes

Interference Plasticity in response to one experience can

interfere with the acquisition of other behaviors

Monitor Evaluate progress Discuss function in other areas

of your patientslsquo life

63

Why pay attention to binocular vision dysfunctions

and neuroplasticity

December 2009 issue of the Review of Optometry

The Binocular Vision Dysfunction Pandemic

In 2010 almost 170 million individuals will be wearing glasses In

2010 there will also be up to 93 million amblyopes and 12 and a half

million strabismics For children under 18 years of age that means

there will be more than 22 and a half million amblyopes and millions

of children with strabismus A clinical trial to determine the

prevalence of binocular vision dysfunction within the general

population suggested the possibility of up to 56 or 173 million men

women and children with symptoms associated with a binocular

vision dysfunction 189 million (61) with accommodative problems

and 118 million (38) demonstrating various vergence

anomalies

64

65

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Brain plasticity life long changes in the structure of the brain

Sensory substitution replacement of one sensory input by another

Measurement techniques

Voxel based morphometryhellipmeasures difference in brain volume

Fluorodeoxyglucose glucose analog PET scan tells you

distribution and metabolism of brain

Cortical thickness measures

Visual cortex of the blind turns somatic ―The eye of the tongue

Transcranial magnetic stmiulation non-invasive technique to

stimulate cortex

66

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Blind Braille readers report tingling in fingers when pressure

phosphenes are applied Blind feel tingling in tongue

Bind use tongue to perform orientation task motion perception

sensory perception Visual cortex recruited in a variety of sensory

and cognitive tasks (DM Can we use tongue as a VT tool)

Dilks Reorganizations of human adult visual system

When a region of sensory cortex is deprived of its bottom up

input the deprived region begins to respond to stimuli that

normally activate adjacent cortex

67

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Retinotopic map changes for stroke pts Cortical reorganization in

adults occurs Perceived objectshellipelongation in stroke amp AMD

What happens to deprived cortex in AMD

fMRI shows cortical reorganization in adults

Proposed mechanisms

hellipGrowth of new connections

hellipUnmasking of pre-existing connections this is true

happens within seconds

Bavelier

Action video games

68

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Bavelier

Action video games Looked at attention Gamers can track more

activities

Attention over space (me peripheral awarenress) Useful field

of view shrinks with age

Performance not VA relatedhellipis related to attention

Action game playing changes spatial resolutionhellipovercoming

crowding in VA assessment (me amblyopia therapy)

Temporal resolution of vision Backward masking

changehellipbrain changes

Visual sensitivity (contrast sensitivity) Post action game training

improves CSF

69

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Action video games correcting optics of the cortex (me this is

actualy OVT)

Games factor

Variable entry leanringhellipadapt task to skill level

Incremental learning tune task to subjectlsquos leanring steps

Motivationarousal

Rewards

Self masterself confidence

Action games factors

Pacingrate of exposure to infohellipincreasing processing speed

Dynamic display

Rich environment

Rich motor involvement

70

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Surgeons may be made to play action games

Pilot training

Amblyopia tx Dennis Levi research

PresenterTitle Contact info

Neuroplasticity-A Paradigm Sea Change

This presentation is available at

httpwwwslidesharenetDMAINOneuroplasticity-a-paradigm-sea-change-2459693

httpwwwmainosmemosblogspotcom

My FaceBook Page

and

Twitter

PresenterTitle Contact info

Questions About

Neuroplasticity-A Paradigm Sea Change

Dominick M Maino OD MEd FAAO FCOVD-A

Professor PediatricsBinocular VisionIllinois Eye InstituteIllinois College of Optometry

dmainoicoeduhttpwwwMainosMemosblogspotcom

Thanks to

httpwwwcovdorgHomeOVDJournalOVD401tabid263D

efaultaspx

httpbipolarblastfileswordpresscom200908neurojpg

httpwwwspecialcheerscomimagesanimated_braingif

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contentuploads200810frankenstein-myspace-lightbeergif

httpwwwshangralafamilyfuncomgala-ecalvindreamgif

httppsychiatryjwatchorgcgicontentfull20082251

73

Chakraborty R Chatterjee A Choudhart S Chakraborty PK Neuroplasticitymdasha paradigm shift in neurosciences J Indian Med Assoc

2007105(9)513-4516-8520-1

Sacks O A neurologistlsquos notebook Stereo Sue Why two eyes are better than one The New Yorker 2006 Jun 1964-73

Krulwich R National Public Radio Going Binocular Susanlsquos First Snowfall Available at

wwwnprorgtemplatesstorystoryphpstoryId=5507789 (Accessed December 8 2008)

Press LJ The story behind Stereo Suelsquo and a world-famous neurologistlsquos discovery of vision therapy Optom Vis Dev 200637(2) 55-7

Levin HS Neuroplasticity and brain imaging research implications for rehabilitation Arch Phys Med Rehabil 2006 Dec87(12 Suppl

2)S1

Wiesel TN Hubel DH Single-cell responses in striate cortex of kittens deprived of vision in one eye J Neurophysiol 1963

Nov261003-17

Hook BM Chen C Critical periods in the visual system Changing views for a model of experience-dependent plasticity Neuron 2007

Oct56(2)312-26

Ramey CT Ramey SL Prevention of intellectual disabilities early interventions to improve cognitive development Prev Med 1998

Mar-Apr27(2)224-32

Heuninckx S Wenderoth N Swinnen SP Systems neuroplasticity in the aging brain recruiting additional neural resources for

successful motor performance in elderly persons J Neurosci 2008 Jan 228(1)91-9

Ge S Yang CH Hsu KS et al A critical period for enhanced synaptic plasticity in newly generated neurons of the adult brain Neuron

2007 May54(4)559-66

74

Draganski B Gaser C Busch V et al Neuroplasticity changes in grey matter induced by training Nature 2004 Jan 22427(6972)

311-2

Cannonieri GC Bonilha L Fernandes PT et al Practice and perfect length of training and structural brain changes in experienced

typists Neuroreport 2007 Jul 218(10)1063-6

Kleim JA Jones TA Principles of experience-dependent neural plasticity implications for rehabilitation after brain damage J

Speech Lang Hear Res 2008 Feb51(1)S225-39

Trojan S Porkorny J Theoretical aspects of neuroplasticity Physiol Res 199948(2)87-97

Ramamirtham R Kee CS Hung LF et al Wave aberrations in rhesus monkeys with vision-induced ametropias Vision Res 2007

Sep47(21)2751-66

Smith EL 3rd Ramamirtham R Qiao-Grider Y et al Effects of foveal ablation on emmetropization and form-deprivation myopia

Invest Ophthalmol Vis Sci 2007 Sep48(9)3914-22

Smith EL 3rd Kee CS Ramamirtham R et al Peripheral vision can influence eye growth and refractive development in infant

monkeys Invest Ophthalmol Vis Sci 2005 Nov46(11)3965-72

Ciuffreda KJ Vasudevan B Nearwork-induced transient myopia (NITM) and permanent myopiandashndashis there a link Ophthalmic

Physiol Opt 2008 Mar28(2)103-14

Hung GK Ciuffreda KJ Incremental retinal-defocus theory of myopia development--schematic analysis and computer simulation

Comput Biol Med 2007 Jul37(7)930-46

Hung GK Ciuffreda KJ A unifying theory of refractive error development Bull Math Biol 2000 Nov62(6)1087-108

75

Pang Y Maino D Zhang G Lu F Myopia Can its progress be controlled Optom Vis Dev 200637(2)75-9

Leung JT Brown B Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lenses Optom Vis Sci

1999 Jun76(6)346-54

Hasebe S Ohtsuki H Nonaka T et al Effect of progressive addition lenses on myopia progression in Japanese children a prospective

randomized double-masked crossover trial Invest Ophthalmol Vis Sci 2008 Jul49(7)2781-9

Gwiazda J Hyman L Hussein M et al A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression

of myopia in children Invest Ophthalmol Vis Sci 2003 Apr44(4)1492-500

Siatkowski RM Cotter SA Crockett RS et al Two-year multi-center randomized double-masked placebo-controlled parallel safety and

efficacy study of 2 pirenzepine ophthalmic gel in children with myopia J AAPOS 2008 Aug12(4)332-9

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged 7 to 17 years Arch Ophthalmol 2005

Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three to less than 10 years of age Am J

Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction Am J Ophthalmol 2007

Jun143(6)1060-3

Holmes JM Edwards AR Beck RW et al A randomized pilot study of near activities versus non-near activities during patching therapy for

amblyopia J AAPOS 2005 Apr9(2)129-36

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate

amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-57

76

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic

amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Convergence Insufficiency Treatment Trial Study Group Randomized clinical trial of treatments for symptomatic convergence insufficiency

in children Arch Ophthalmol 2008 Oct126(10)1336-49

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

Solan HA Shelley-Tremblay J Hansen PC et al M-cell deficit and reading disability a preliminary study of the effects of temporal vision-

processing therapy Optometry 2004 Oct75(10)640-50

Solan HA Larson S Shelley-Tremblay J et al Role of visual attention in cognitive control of oculomotor readiness in students with reading

disabilities J Learn Disabil 2001 Mar-Apr34(2)107-18

Gallaway M Boas MB The impact of vergence and accommodative therapy on reading eye movements and reading speed Optom Vis Dev

200738(3)115-20

Goss DA Downing DB Lowther AH et al The effect of HTS vision therapy conducted in a school setting on reading skills in third and

fourth grade students Optom Vis Dev 200738(1)27-32

Crutch SJ Warrington EK Foveal crowding in posterior cortical atrophy a specific early-visual-processing deficit affecting word reading

Cogn Neuropsychol 2007 Dec24(8)843-66

Helms D Sawtelle SM A study of the effectiveness of cognitive therapy delivered in a video game format Optom Vis Dev 200738 (1)19-

26

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

77

Lawton T Training direction-discrimination sensitivity remediates a wide spectrum of reading skills OptomVis Dev 200738(1) 33-47

Goldstand S Koslowe KC Parush S Vision visual-information processing and academic performance among seventh-grade schoolchildren a

more significant relationship than we thought Am J Occup Ther 2005 Jul-Aug59(4)377-89

Fischer B Koumlngeter A Hartnegg K Effects of daily practice on subitizing visual counting and basic arithmetic skills Optom Vis Dev

200839(1)30-4

Sands W Taub M Maino D Limited research and education on special populations in optometry and ophthalomology Optom Vis Dev

200839(2)60-1

Wesson M Maino D Oculo-visual findings in Down syndrome cerebral palsy and mental retardation with non-specific etiology In Maino D

(ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 199517-54 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

Cui Y Stapleton F Suttle C Developing an instrument to assess vision-related and subjective quality of life in children with intellectual

disability data collection and preliminary analysis in a Chinese population Ophthal Physiolog Optics 2008 May28(3) 238-46

Maino D Steele G Tahir S Sajja R Attitudes of optometry students toward individuals with disabilities Optom Ed 200227(2)45-50

Maino D Special populations in the optometric curriculum Optom Ed 200227(2)38-9

Maino D Overview of special populations In Scheiman M Rouse M (eds) Optometric Management of Learning-Related Vision Problems

St Louis Mosby Inc 200685-106

Maino D (ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 1995 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

78

McCarthy P Maino D Alport syndrome a review Clin Eye Vis Care 2000 Dec12(3-4)139-50

Block SS Brusca-Vega R Pizzi WJ et al Cognitive and visual processing skills and their relationship to mutation size in full and

permutation female fragile X carriers Optom Vis Sci 2000 Nov77 (11)592-9

Maino D The young child with developmental disabilities An introduction to mental retardation and genetic syndromes In Moore BD

(ed) Eye Care for Infants and Young Children Butter-worth--Heinemann Newton MA1997285-300

Amin V Maino D The Fragile X female Visual visual perceptual and ocular health anomalies J Am Optom Assoc 1995 May66

(5)290-95

Maino DM Maino JH Cibis GW Hecht F Ocular health anomalies in patients with developmental disabilities In Maino D (ed)

Diagnosis and Management of Special Populations Mosby-Year-book Inc St Louis MO 1995189-206 Reprinted Optometric

Education Program Foundation Santa Anna Calif 2001

Maino D Wesson M Schlange D Cibis G Maino J Optometric findings in the fragile X syndrome Optom Vis Sci 199168634-40

Scheiman MMOptometric findings in children with cerebral palsy Am J Optom Physiol Opt 1984 May61(5)321-3

Maino D Maino J Maino S Mental retardation syndromes with associated ocular defects J Am Optom Assoc 199061707-16

Stewart RE Woodhouse JM Cregg M Pakeman VH Association between accommodative accuracy hypermetropia and strabismus in

children with Downs syndrome Optom Vis Sci 2007 Feb84(2)149-55

Cregg M Woodhouse JM Pakeman VH et al Accommodation and refractive error in children with Down syndrome cross-sectional

and longitudinal studies Invest Ophthalmol Vis Sci 2001 Jan42 (1)55-63

79

McClelland JF Parkes J Hill N et al Accommodative dysfunction in children with cerebral palsy a population-

based study Invest Ophthalmol Vis Sci 2006 May47(5)1824-30

Duckman RH Vision therapy for the child with cerebral palsy J Am Optom Assoc 198758(1)28-35

Duckman R Accommodation in cerebral palsy function and remediation J Am Optom Assoc 198455(4)281-3

Scheiman M Understanding and managing vision deficits a guide for occupational therapists 2nd ed Slack

Thorofare NJ 2002

Maino D Binasal occlusion for the child with Cerebral Palsy J Ill Optom Assoc 198644(1)1218

Battaglia F Quartarone A Rizzo V et al Early impairment of synaptic plasticity in patients with Downs syndrome

Neurobiol Aging 2008 Aug29(8)1272-5

Bonnier C Evaluation of early stimulation programs for enhancing brain development Acta Paediatr 2008

Jul97(7)853-8

Morice E Andreae LC Cooke SF et al Preservation of long-term memory and synaptic plasticity despite short-term

impairments in the Tc1 mouse model of Down syndrome Learn Mem 2008 Jul 1415(7)492-500

Gordon AM Schneider JA Chinnan A Charles JR Efficacy of a hand-arm bimanual intensive therapy (HABIT) in

children with hemiplegic cerebral palsy a randomized control trial Dev Med Child Neurol 2007 Nov49(11)830-8

Kapoor N Ciuffreda KJ Vision disturbances following traumatic brain injury Curr Treat Options Neurol 2002

Jul4(4)271-80

80

Ciuffreda KJ Rutner D Kapoor N et al Vision therapy for oculomotor dysfunctions in acquired brain injury a

retrospective analysis Optometry 2008 Jan79(1)18-22

Ciuffreda KJ Han Y Kapoor N Ficarra AP Oculomotor rehabilitation for reading in acquired brain injury

NeuroRehabilitation 200621(1)9-21

Zost M Diagnosis and management of visual dysfunction in cerebral injury In Maino D (ed) Diagnosis and

Management of Special Populations Mosby-Yearbook Inc St Louis 199579 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001 [Figure used with permission of the editor]

DeGutis JM Bentin S Robertson LC DEsposito M Functional plasticity in ventral temporal cortex following

cognitive rehabilitation of a congenital prosopagnosic J Cogn Neurosci 2007 Nov19 (11)1790-802

Welbourne SR Ralph MA Exploring the impact of plasticity-related recovery after brain damage in a connectionist

model of single-word reading Cogn Affect Behav Neurosci 2005 Mar5(1)77-92

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements prevent cognitive decline A

systematic review of randomized controlled trials J Hum Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among preterm infants attributable to early

supplementation of human milk with docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings and structural-functional

synergies with cell membrane phospholipids Altern Med Rev 2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function Neuroscience 20089(7)568-78

81

Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

BMC Biol 2008 Sep 9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine improves neuropsychological disorders in a child with

creatine transporter defect Neurocase 200814(2) 151-61

Forrester LW Wheaton LA Luft AR Exercise-mediated locomotor recovery and lower-limb neuroplasticity after

stroke J Rehabil Res Dev 200845(2)205-20

82

Page 15: Neuroplasticity: A Paradigm Sea Change Latest Updated File

8 Age matters

9 Transference

10 Interference

15

Use it or lose it If you do not drive specific brain functions

functional loss will occur

Use it and improve it Therapy that drives cortical function

enhances that particular function

Specificity The therapy you choose determines the resultant

plasticity and function

Repetition matters Plasticity that results in functional change

requires repetition

16

Intensity matters Induction of plasticity requires the appropriate

amount of intensity

Time matters Different forms of plasticity take place at different

times during therapy

Salience matters It has to be important to the individual

Age matters Plasticity is easier in a younger brain but is also

possible in an adult brain

17

Transference Neuroplasticity and the change in function that

results from one therapy can augment the attainment of similar

behaviors

Interference Plasticity in response to one experience can interfere

with the acquisition of other behaviors

18

B Examples of Changes in Function and Structure

1) Jugglers

2) Typists

19

B Examples of Changes in Function and Structure

1) Jugglers

One study suggested that adults taught how to juggle demonstrated a

significant transient bilateral expansion of gray matter in the mid-

temporal area and the left posterior intraparietal sulcus between baseline brain scan and

follow-up The findings were specific to training stimulus individuals who were

not instructed how to juggle demonstrated no change in gray

matter over the same period These findings oppose the conventional

understanding that the anatomical structure of the adult brain does not change

over time

20

B Examples of Changes in Function and Structure

2) Typists

helliplong-term bimanual training also increases

gray matter volume in experienced adult typists

These results suggest that learning not

only affects function but also structure in

adult brains

21

V Neuroplasticity and Optometry

A Evolutionary neuroplasticity

B Reactive plasticity

C Adaptational plasticity

D Reparation plasticity

22

V Neuroplasticity and Optometry

A Evolutionary neuroplasticity

hellip is ideally suited for the developmental OD who

specializes in vision function as it changes over time

either with or without intervention

23

V Neuroplasticity and Optometry

B Reactive plasticity

hellip can be thought of as the immediate effect that

initial optometric treatment may have on a system This can

be reflected in an immediate but often transient change in

the individuallsquos accommodative systemmdashie when an

uncorrected myope initially puts on his or her new

spectacles

24

V Neuroplasticity and Optometry

C Adaptational plasticity

hellip could describe the long-term effects of in-office optometric

vision therapy on disorders of the binocular vision system

25

V Neuroplasticity and Optometry

D Reparation plasticity

hellipin contrast to adaptational

plasticity reparation plasticity may

occur during treatment by a low

Vision specialist or an OD

Working with those who have

Experienced a traumatic brain

injury (TBI)

26

V Neuroplasticity and Optometry

The effects of plasticity can lead to either

positive or negative changes during

development (evolutionary plasticity) after

short-term exposure (reactive plasticity)

after long-term or continuous stimuli

(adaptational plasticity) and during

functional or structural recovery of damaged

neuronal circuits (reparation plasticity)

httpwwwciteulikeorguserjasonepriorarticle2856526

27

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

A Refractive error development

B Amblyopia

C Strabismus

28

D Non-strabismus non-amblyopic binocular vision disorders

E Learning related vision anomalies

F Vision developmentperception disorders

29

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

A Refractive error development

Several recent studies have noted that neuroplasticity may play a

role in refractive error development

retinal defocus use of progressive addition lenses

drug studies (M1-antagonist2 pirenzepine ) slow myopia

progression demonstrated nearly a 50 reduction in myopia

progression over a two-year period

30

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged

7 to 17 years Arch Ophthalmol 2005 Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three

to less than 10 years of age Am J Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction

Am J Ophthalmol 2007 Jun143(6)1060-3

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine

vs patching for treatment of moderate amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-

57

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for

strabismic and anisometropic amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Treatment of severe amblyopia with weekend atropine results from 2 randomized clinical trials

Levodopacarbidopa in the treatment of amblyopia

31

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

J Pediatr Ophthalmol Strabismus 2009 Mar-Apr46(2)87-90 quiz 91-2 Levodopacarbidopa in the

treatment of amblyopia Dadeya S Vats P Malik KP

PURPOSE To evaluate the role of levodopacarbidopa in the treatment of amblyopia METHODS

Thirty patients with strabismic amblyopia between the ages of 3 and 12 years were part of this double-

blind randomized study Patients were divided into two groups Group A received 050 mg + 125 mg of

levodopacarbidopa per kilogram body weight three times daily after meals with a protein rich drink

whereas Group B received placebo Both groups received full-time conventional occlusion until a visual

acuity of 66 was achieved or for a maximum of 3 months RESULTS The authors observed more than

two lines improvement in visual acuity that was greater in the levodopa group (15 of 15) than in the

placebo group (9 of 15) (P lt 005) Furthermore improvement in visual acuity of more than two lines

was greater in patients younger than 8 years (100) than in patients older than 8 years of age (60) (P =

0026) There was also no significant reversal of the improved visual acuity in up to 6 months of follow-

up CONCLUSION Levodopacarbidopa improves visual acuity in patients with

amblyopia and maintains improved visual acuity especially in patients

younger than 8 years

32

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

J Pediatr Ophthalmol Strabismus 2008 May-Jun45(3)174-6 The use of levodopa in the treatment of

bilateral amblyopia secondary to uncorrected high hypermetropia Abrams MS

The standard treatment of bilateral amblyopia secondary to uncorrected high bilateral hypermetropia has

been spectacles and time The patient described here failed to show adequate improvement in visual

acuity after 18 months of standard treatment Visual acuity improved dramatically when the

patient began taking levodopa dropped precipitously when the medication was

discontinued and returned quickly to post-treatment levels when levodopa was

restarted Visual acuity remained stable when the medication was slowly tapered

and discontinued This report suggests that dopamine may play a role in the pathophysiology of

bilateral amblyopia secondary to uncorrected high bilateral hypermetropia

33

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

Bottom Line

Amblyopia can be treated at any age

May be able to use neuro-enhancing drugs

as a part of basic amblyopia therapy

34

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

C Strabismus and non-strabismic non-amblyopic binocular

vision disorders

Clinical Trial of Treatments for Symptomatic Convergence Insufficiency in Children has

clearly demonstrated the superiority of in-office optometric vision therapy (in conjunction

with home therapy) vs out-of-office therapy alone The study concluded that optometric

vision therapyorthoptics was more effective than pencil push-ups or placebo vision

therapyorthoptics in reducing symptoms and improving clinical signs of convergence

insufficiency

Long-term effectiveness of treatments for symptomatic convergence insufficiency

in children (Optom Vis Sci 2009 Sep86(9)1096-103)

CITT patients improvements lasted a year

35

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

Strabismus 1999 Sep7(3)169-74 Convergence insufficiency in

idiopathic Parkinsons disease responsive to levodopa Racette BA

Gokden MS Tychsen LS Perlmutter JS

We report a patient with pathologically proven idiopathic Parkinsons

disease (IPD) who developed diplopia secondary to convergence

insufficiency during his motor off periods Diplopia resolved with

onset of motor benefit from levodopa Neuro-ophthalmologic

examination demonstrated convergence insufficiency during motor

off periods that was alleviated after onset of motor benefit from

levodopa This is the first reported case of convergence insufficiency

in IPD responsive to levodopa

36

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

Bottom Line

Optometric Vision Therapy is the most efficacious treatment available for binocular vision disorders and the

treatment effects are long lasting Neuro-enhancing drugs

may assist us as well

37

EF Learning related vision anomalies Vision

developmentperception disorders

hellipresearch includes an examination of the role vision plays in

reading the effect of oculomotor vergence and

accommodativecoherent motion therapy on reading eye movements

and reading speed the diagnosis and treatment of perceptual

disorders and the effect of therapy on various learning anomalies

38

EF Learning related vision anomalies Vision developmentperception disorders

magnocellular (MC) deficit in dyslexia

LM speed-matching ratio predicts reading in childrenChase C Dougherty RF Ray N

Fowler S Stein JOptom Vis Sci 2007 Mar84(3)229-36

Effect of attention therapy on reading comprehension Solan HA Shelley-Tremblay J

Ficarra A Silverman M Larson S J Learn Disabil 2003 Nov-Dec36(6)556-63

Is there a common linkage among reading comprehension visual attention and

magnocellular processing Solan HA Shelley-Tremblay JF Hansen PC Larson S

J Learn Disabil 2007 May-Jun40(3)270-8

Lawton T Filtered Text and Direction Discrimination Training Improved Reading

Fluency for Both Dyslexic and Normal Readers Optom Vis Dev 200839 (3)114

Fischer B Hartnegg K Saccade control in dyslexia Development deficits training

and transfer to reading Optom Vis Dev 200839(4)181-190

39

EF Learning related vision anomalies Vision developmentperception disorders

J Learn Disabil 2003 Nov-Dec36(6)556-63 Effect of attention therapy on reading

comprehension Solan HA Shelley-Tremblay J Ficarra A Silverman M Larson S

hellip At the completion of attention therapy the mean

standard attention and reading comprehension scores of

the experimental group had improved significantly The

control group however showed no significant

improvement in reading comprehension scores after 12

weeks Although uncertainties still exist this investigation

supports the notion that visual attention is malleable and

that attention therapy has a significant effect on reading

comprehension in this often neglected population

40

VII Vision dysfunction association with acquired brain injury

A Exotropia (or high exophoriaCI)

B Accommodative dysfunction

C Convergence insufficiency

41

D Decreased blink rate

E Spatial disorientation

F Pursuitsaccade dysfunction

G Unstable ambient vision (Magnocellular pathway)

42

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Stelmack JA Frith T Van Koevering D Rinne S Stelmack TR Visual function in patients

followed at a Veterans Affairs polytrauma network site an electronic medical record review

Optometry 2009 Aug80(8)419-24

RESULTS Visual symptoms were self-reported by 76 of patients

with polytrauma and 75 of the patients with TBI Problems with reading

(polytrauma 60 and TBI 50) and accommodation (polytrauma 30 and

TBI 47) were frequently found on eye examinations Spectacles were the

treatment most frequently prescribed (polytrauma 62 and TBI 78)

CONCLUSIONS It is important for optometrists to be aware of the high

rates of self-reported symptoms and visual problems in military personnel

returning from deployment to the wars in Iraq and Afghanistan Post-

traumatic stress disorder and depression may complicate optometric

evaluation and management

43

VII Vision dysfunction association with acquired brain injury

Avoidance of near tasks

Oculomotor-based reading difficulties

Eye tracking problems

Eye focusing problems

Eyestrain Diplopia

Dizziness Vertigo

Vision-derived nausea

44

VII Vision dysfunction association with acquired brain injury

Increased sensitivity to visual motion

Visual inattention and distractibility

Short-term visual memory loss

Difficulty judging distances (relative and absolute

Difficulty with global scanning

Difficulty with personal grooming especially involving the face

Inability to interactcope visually in a complex social situation

(eg minimal eye contact)

Inability to tolerate complex visual environments (eg grocery store

aisles and highly-patterned floors)

45

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Ciuffreda KJ Ludlam DP Kapoor N Clinical oculomotor training in traumatic brain injury Optom Vis

Dev 200940(1)16-23

Individuals with traumatic brain injury present with a constellation of

oculomotor dysfunctions and correlated symptoms Simple and

effective clinical oculomotor-based training procedures will be

presented with respect to the versional vergence and

accommodative systems and their interactions These therapeutic

procedures can also be applied as needed to individuals with either

low vision neurological dysfunctions or general visual skills cases

manifesting similar oculomotor deficits

46

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Leslie S Myopia and accommodative insufficiency associated with

moderate head trauma Opt Vis Dev 200940(1)25-31

The majority of subjects reviewed had developed a stable degree of

myopia between 100 and 200 diopters as well as an abnormally

high lag of accommodation When their distance and near spatial area

of focus was compared the majority were focused at an intermediate

area in space suggesting a loss of control of accommodation in

space

47

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

B Drugs

C Exercise

D Learning new and challenging things

48

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements

prevent cognitive decline A systematic review of randomized controlled trials J Hum

Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among

preterm infants attributable to early supplementation of human milk with

docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings

and structural-functional synergies with cell membrane phospholipids Altern Med Rev

2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function

Neuroscience 20089(7)568-78

49

VIII Improving Brain Function and Neuroplasticity

B Drugs Maya Vetencourt JF Sale A Viegi A et al The antidepressant

fluoxetine (PROZAC) restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the

antidepressant tianeptine CNS Drugs 200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances

hippocampal long-term potentiation and memory BMC Biol 2008 Sep

9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine

improves neuropsychological disorders in a child with creatine

transporter defect Neurocase 200814(2) 151-61

50

VIII Improving Brain Function and Neuroplasticity

C Exercise

Hunsberger JG et al Antidepressant actions of the exercise-

regulated gene VGF Nat Med 2007 Dec 2 131476

VGF may be a common pathway by which exercise induces

neuroplasticity and growth-factor genes at least one of these might act

similarly to antidepressants in promoting an adaptive response to stress

However the tests used here may be modeling stress-induced

helplessness not depression hellipexercise seems to induce multiple

interacting genes that enhance neuronal resilience

51

VIII Improving Brain Function and Neuroplasticity

D Learning new and challenging things

What have we (optometry amp ophthalmology)

been thinking all these years

Where did we miss the news about neuroplasticity

52

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Huang JC Neuroplasticity as a proposed mechanism for the efficacy of optometric vision therapy and rehabilitation J Bev Optom 200920(4)96-100

Homologous area adaptationCompensatory masqueradeCross-modal reassignment

Map expansion

EquipotentialityVicariation

53

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Homologous area adaptation a transfer of function from a damaged brain area to a non-damaged brain area May be limited to early stages of human development and may crowd a new brain area resulting in reduced functionality of that brain area (Competition between spatial amp verbal functioning)

54

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Compensatory masquerade reorganizing of existing neuro-pathways to us alternative cognitive strategies to perform a task

55

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Cross-modal reassignment using new sensory input in a brain structure deprived of its main input source (changing processing from visual to tactile stimuli in the blind)

56

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Map expansion increase in brain mass due to repeated behavior or exposure to stimuli

57

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Equipotentiality anatomical areas of the brain can perform disparate functions

Vicariation redundant neural systems can operate under abnormal conditions

This may explain why recovery is noted for many neurological conditions (degenerative psychiatric developmental vascular traumatic)

58

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Constraint therapy Use it and improve it

Patching penalization ldquonear activitiesrdquo during amblyopia therapy

59

IX Improving Brain Function and Neuroplasticity Optometric Clinical ApplicationsOptometric Vision Therapy

Kleim amp Jones

Use it or lose it If you do not drive specific brain functions

functional loss will occur

If you want to improve oculomotor brain neuroplastic function amp

structure therapy should be specific for that brain function

Use it and improve it Therapy that drives cortical function enhances

that particular function

If you use therapy to improve oculomotor dysfunction it should

improve

Specificity The therapy you choose determines the resultant

plasticity and function

You must choose therapy that is appropriate

60

IX Improving Brain Function and Neuroplasticity Optometric Clinical Applications

Kleim amp Jones

Repetition matters Plasticity that results in functional change

requires repetition

Do the therapy Do it again Do it yet again No quick fix

Intensity matters Induction of plasticity requires the appropriate

amount of intensity

Intensity means strength force concentration power and passion

Without these plasticity may not occur Function may not improve

Time matters Different forms of plasticity take place at different

times during therapy

Do the basics than the more advanced therapeutic procedures

61

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Salience matters It has to be important to the individual

Make the therapy matter to the patient

Age matters Plasticity is easier in a younger brain but is also

possible in an adult brain

Do not let age determine what therapy options you offer your

patients Think of Susan Barry PhD (StereoSue) and her success

Offer your patients options Let them choose Be realistic about

outcomeshelliphave outcome measures built into therapy program

62

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Transference Neuroplasticity and the change in function

that results from one therapy can augment the attainment

of similar behaviors

What you do during oculomotor therapy may affected

vergence therapy outcomes

Interference Plasticity in response to one experience can

interfere with the acquisition of other behaviors

Monitor Evaluate progress Discuss function in other areas

of your patientslsquo life

63

Why pay attention to binocular vision dysfunctions

and neuroplasticity

December 2009 issue of the Review of Optometry

The Binocular Vision Dysfunction Pandemic

In 2010 almost 170 million individuals will be wearing glasses In

2010 there will also be up to 93 million amblyopes and 12 and a half

million strabismics For children under 18 years of age that means

there will be more than 22 and a half million amblyopes and millions

of children with strabismus A clinical trial to determine the

prevalence of binocular vision dysfunction within the general

population suggested the possibility of up to 56 or 173 million men

women and children with symptoms associated with a binocular

vision dysfunction 189 million (61) with accommodative problems

and 118 million (38) demonstrating various vergence

anomalies

64

65

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Brain plasticity life long changes in the structure of the brain

Sensory substitution replacement of one sensory input by another

Measurement techniques

Voxel based morphometryhellipmeasures difference in brain volume

Fluorodeoxyglucose glucose analog PET scan tells you

distribution and metabolism of brain

Cortical thickness measures

Visual cortex of the blind turns somatic ―The eye of the tongue

Transcranial magnetic stmiulation non-invasive technique to

stimulate cortex

66

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Blind Braille readers report tingling in fingers when pressure

phosphenes are applied Blind feel tingling in tongue

Bind use tongue to perform orientation task motion perception

sensory perception Visual cortex recruited in a variety of sensory

and cognitive tasks (DM Can we use tongue as a VT tool)

Dilks Reorganizations of human adult visual system

When a region of sensory cortex is deprived of its bottom up

input the deprived region begins to respond to stimuli that

normally activate adjacent cortex

67

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Retinotopic map changes for stroke pts Cortical reorganization in

adults occurs Perceived objectshellipelongation in stroke amp AMD

What happens to deprived cortex in AMD

fMRI shows cortical reorganization in adults

Proposed mechanisms

hellipGrowth of new connections

hellipUnmasking of pre-existing connections this is true

happens within seconds

Bavelier

Action video games

68

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Bavelier

Action video games Looked at attention Gamers can track more

activities

Attention over space (me peripheral awarenress) Useful field

of view shrinks with age

Performance not VA relatedhellipis related to attention

Action game playing changes spatial resolutionhellipovercoming

crowding in VA assessment (me amblyopia therapy)

Temporal resolution of vision Backward masking

changehellipbrain changes

Visual sensitivity (contrast sensitivity) Post action game training

improves CSF

69

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Action video games correcting optics of the cortex (me this is

actualy OVT)

Games factor

Variable entry leanringhellipadapt task to skill level

Incremental learning tune task to subjectlsquos leanring steps

Motivationarousal

Rewards

Self masterself confidence

Action games factors

Pacingrate of exposure to infohellipincreasing processing speed

Dynamic display

Rich environment

Rich motor involvement

70

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Surgeons may be made to play action games

Pilot training

Amblyopia tx Dennis Levi research

PresenterTitle Contact info

Neuroplasticity-A Paradigm Sea Change

This presentation is available at

httpwwwslidesharenetDMAINOneuroplasticity-a-paradigm-sea-change-2459693

httpwwwmainosmemosblogspotcom

My FaceBook Page

and

Twitter

PresenterTitle Contact info

Questions About

Neuroplasticity-A Paradigm Sea Change

Dominick M Maino OD MEd FAAO FCOVD-A

Professor PediatricsBinocular VisionIllinois Eye InstituteIllinois College of Optometry

dmainoicoeduhttpwwwMainosMemosblogspotcom

Thanks to

httpwwwcovdorgHomeOVDJournalOVD401tabid263D

efaultaspx

httpbipolarblastfileswordpresscom200908neurojpg

httpwwwspecialcheerscomimagesanimated_braingif

httpblogmarsdencartoonscomwp-

contentuploads200810frankenstein-myspace-lightbeergif

httpwwwshangralafamilyfuncomgala-ecalvindreamgif

httppsychiatryjwatchorgcgicontentfull20082251

73

Chakraborty R Chatterjee A Choudhart S Chakraborty PK Neuroplasticitymdasha paradigm shift in neurosciences J Indian Med Assoc

2007105(9)513-4516-8520-1

Sacks O A neurologistlsquos notebook Stereo Sue Why two eyes are better than one The New Yorker 2006 Jun 1964-73

Krulwich R National Public Radio Going Binocular Susanlsquos First Snowfall Available at

wwwnprorgtemplatesstorystoryphpstoryId=5507789 (Accessed December 8 2008)

Press LJ The story behind Stereo Suelsquo and a world-famous neurologistlsquos discovery of vision therapy Optom Vis Dev 200637(2) 55-7

Levin HS Neuroplasticity and brain imaging research implications for rehabilitation Arch Phys Med Rehabil 2006 Dec87(12 Suppl

2)S1

Wiesel TN Hubel DH Single-cell responses in striate cortex of kittens deprived of vision in one eye J Neurophysiol 1963

Nov261003-17

Hook BM Chen C Critical periods in the visual system Changing views for a model of experience-dependent plasticity Neuron 2007

Oct56(2)312-26

Ramey CT Ramey SL Prevention of intellectual disabilities early interventions to improve cognitive development Prev Med 1998

Mar-Apr27(2)224-32

Heuninckx S Wenderoth N Swinnen SP Systems neuroplasticity in the aging brain recruiting additional neural resources for

successful motor performance in elderly persons J Neurosci 2008 Jan 228(1)91-9

Ge S Yang CH Hsu KS et al A critical period for enhanced synaptic plasticity in newly generated neurons of the adult brain Neuron

2007 May54(4)559-66

74

Draganski B Gaser C Busch V et al Neuroplasticity changes in grey matter induced by training Nature 2004 Jan 22427(6972)

311-2

Cannonieri GC Bonilha L Fernandes PT et al Practice and perfect length of training and structural brain changes in experienced

typists Neuroreport 2007 Jul 218(10)1063-6

Kleim JA Jones TA Principles of experience-dependent neural plasticity implications for rehabilitation after brain damage J

Speech Lang Hear Res 2008 Feb51(1)S225-39

Trojan S Porkorny J Theoretical aspects of neuroplasticity Physiol Res 199948(2)87-97

Ramamirtham R Kee CS Hung LF et al Wave aberrations in rhesus monkeys with vision-induced ametropias Vision Res 2007

Sep47(21)2751-66

Smith EL 3rd Ramamirtham R Qiao-Grider Y et al Effects of foveal ablation on emmetropization and form-deprivation myopia

Invest Ophthalmol Vis Sci 2007 Sep48(9)3914-22

Smith EL 3rd Kee CS Ramamirtham R et al Peripheral vision can influence eye growth and refractive development in infant

monkeys Invest Ophthalmol Vis Sci 2005 Nov46(11)3965-72

Ciuffreda KJ Vasudevan B Nearwork-induced transient myopia (NITM) and permanent myopiandashndashis there a link Ophthalmic

Physiol Opt 2008 Mar28(2)103-14

Hung GK Ciuffreda KJ Incremental retinal-defocus theory of myopia development--schematic analysis and computer simulation

Comput Biol Med 2007 Jul37(7)930-46

Hung GK Ciuffreda KJ A unifying theory of refractive error development Bull Math Biol 2000 Nov62(6)1087-108

75

Pang Y Maino D Zhang G Lu F Myopia Can its progress be controlled Optom Vis Dev 200637(2)75-9

Leung JT Brown B Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lenses Optom Vis Sci

1999 Jun76(6)346-54

Hasebe S Ohtsuki H Nonaka T et al Effect of progressive addition lenses on myopia progression in Japanese children a prospective

randomized double-masked crossover trial Invest Ophthalmol Vis Sci 2008 Jul49(7)2781-9

Gwiazda J Hyman L Hussein M et al A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression

of myopia in children Invest Ophthalmol Vis Sci 2003 Apr44(4)1492-500

Siatkowski RM Cotter SA Crockett RS et al Two-year multi-center randomized double-masked placebo-controlled parallel safety and

efficacy study of 2 pirenzepine ophthalmic gel in children with myopia J AAPOS 2008 Aug12(4)332-9

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged 7 to 17 years Arch Ophthalmol 2005

Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three to less than 10 years of age Am J

Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction Am J Ophthalmol 2007

Jun143(6)1060-3

Holmes JM Edwards AR Beck RW et al A randomized pilot study of near activities versus non-near activities during patching therapy for

amblyopia J AAPOS 2005 Apr9(2)129-36

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate

amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-57

76

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic

amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Convergence Insufficiency Treatment Trial Study Group Randomized clinical trial of treatments for symptomatic convergence insufficiency

in children Arch Ophthalmol 2008 Oct126(10)1336-49

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

Solan HA Shelley-Tremblay J Hansen PC et al M-cell deficit and reading disability a preliminary study of the effects of temporal vision-

processing therapy Optometry 2004 Oct75(10)640-50

Solan HA Larson S Shelley-Tremblay J et al Role of visual attention in cognitive control of oculomotor readiness in students with reading

disabilities J Learn Disabil 2001 Mar-Apr34(2)107-18

Gallaway M Boas MB The impact of vergence and accommodative therapy on reading eye movements and reading speed Optom Vis Dev

200738(3)115-20

Goss DA Downing DB Lowther AH et al The effect of HTS vision therapy conducted in a school setting on reading skills in third and

fourth grade students Optom Vis Dev 200738(1)27-32

Crutch SJ Warrington EK Foveal crowding in posterior cortical atrophy a specific early-visual-processing deficit affecting word reading

Cogn Neuropsychol 2007 Dec24(8)843-66

Helms D Sawtelle SM A study of the effectiveness of cognitive therapy delivered in a video game format Optom Vis Dev 200738 (1)19-

26

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

77

Lawton T Training direction-discrimination sensitivity remediates a wide spectrum of reading skills OptomVis Dev 200738(1) 33-47

Goldstand S Koslowe KC Parush S Vision visual-information processing and academic performance among seventh-grade schoolchildren a

more significant relationship than we thought Am J Occup Ther 2005 Jul-Aug59(4)377-89

Fischer B Koumlngeter A Hartnegg K Effects of daily practice on subitizing visual counting and basic arithmetic skills Optom Vis Dev

200839(1)30-4

Sands W Taub M Maino D Limited research and education on special populations in optometry and ophthalomology Optom Vis Dev

200839(2)60-1

Wesson M Maino D Oculo-visual findings in Down syndrome cerebral palsy and mental retardation with non-specific etiology In Maino D

(ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 199517-54 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

Cui Y Stapleton F Suttle C Developing an instrument to assess vision-related and subjective quality of life in children with intellectual

disability data collection and preliminary analysis in a Chinese population Ophthal Physiolog Optics 2008 May28(3) 238-46

Maino D Steele G Tahir S Sajja R Attitudes of optometry students toward individuals with disabilities Optom Ed 200227(2)45-50

Maino D Special populations in the optometric curriculum Optom Ed 200227(2)38-9

Maino D Overview of special populations In Scheiman M Rouse M (eds) Optometric Management of Learning-Related Vision Problems

St Louis Mosby Inc 200685-106

Maino D (ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 1995 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

78

McCarthy P Maino D Alport syndrome a review Clin Eye Vis Care 2000 Dec12(3-4)139-50

Block SS Brusca-Vega R Pizzi WJ et al Cognitive and visual processing skills and their relationship to mutation size in full and

permutation female fragile X carriers Optom Vis Sci 2000 Nov77 (11)592-9

Maino D The young child with developmental disabilities An introduction to mental retardation and genetic syndromes In Moore BD

(ed) Eye Care for Infants and Young Children Butter-worth--Heinemann Newton MA1997285-300

Amin V Maino D The Fragile X female Visual visual perceptual and ocular health anomalies J Am Optom Assoc 1995 May66

(5)290-95

Maino DM Maino JH Cibis GW Hecht F Ocular health anomalies in patients with developmental disabilities In Maino D (ed)

Diagnosis and Management of Special Populations Mosby-Year-book Inc St Louis MO 1995189-206 Reprinted Optometric

Education Program Foundation Santa Anna Calif 2001

Maino D Wesson M Schlange D Cibis G Maino J Optometric findings in the fragile X syndrome Optom Vis Sci 199168634-40

Scheiman MMOptometric findings in children with cerebral palsy Am J Optom Physiol Opt 1984 May61(5)321-3

Maino D Maino J Maino S Mental retardation syndromes with associated ocular defects J Am Optom Assoc 199061707-16

Stewart RE Woodhouse JM Cregg M Pakeman VH Association between accommodative accuracy hypermetropia and strabismus in

children with Downs syndrome Optom Vis Sci 2007 Feb84(2)149-55

Cregg M Woodhouse JM Pakeman VH et al Accommodation and refractive error in children with Down syndrome cross-sectional

and longitudinal studies Invest Ophthalmol Vis Sci 2001 Jan42 (1)55-63

79

McClelland JF Parkes J Hill N et al Accommodative dysfunction in children with cerebral palsy a population-

based study Invest Ophthalmol Vis Sci 2006 May47(5)1824-30

Duckman RH Vision therapy for the child with cerebral palsy J Am Optom Assoc 198758(1)28-35

Duckman R Accommodation in cerebral palsy function and remediation J Am Optom Assoc 198455(4)281-3

Scheiman M Understanding and managing vision deficits a guide for occupational therapists 2nd ed Slack

Thorofare NJ 2002

Maino D Binasal occlusion for the child with Cerebral Palsy J Ill Optom Assoc 198644(1)1218

Battaglia F Quartarone A Rizzo V et al Early impairment of synaptic plasticity in patients with Downs syndrome

Neurobiol Aging 2008 Aug29(8)1272-5

Bonnier C Evaluation of early stimulation programs for enhancing brain development Acta Paediatr 2008

Jul97(7)853-8

Morice E Andreae LC Cooke SF et al Preservation of long-term memory and synaptic plasticity despite short-term

impairments in the Tc1 mouse model of Down syndrome Learn Mem 2008 Jul 1415(7)492-500

Gordon AM Schneider JA Chinnan A Charles JR Efficacy of a hand-arm bimanual intensive therapy (HABIT) in

children with hemiplegic cerebral palsy a randomized control trial Dev Med Child Neurol 2007 Nov49(11)830-8

Kapoor N Ciuffreda KJ Vision disturbances following traumatic brain injury Curr Treat Options Neurol 2002

Jul4(4)271-80

80

Ciuffreda KJ Rutner D Kapoor N et al Vision therapy for oculomotor dysfunctions in acquired brain injury a

retrospective analysis Optometry 2008 Jan79(1)18-22

Ciuffreda KJ Han Y Kapoor N Ficarra AP Oculomotor rehabilitation for reading in acquired brain injury

NeuroRehabilitation 200621(1)9-21

Zost M Diagnosis and management of visual dysfunction in cerebral injury In Maino D (ed) Diagnosis and

Management of Special Populations Mosby-Yearbook Inc St Louis 199579 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001 [Figure used with permission of the editor]

DeGutis JM Bentin S Robertson LC DEsposito M Functional plasticity in ventral temporal cortex following

cognitive rehabilitation of a congenital prosopagnosic J Cogn Neurosci 2007 Nov19 (11)1790-802

Welbourne SR Ralph MA Exploring the impact of plasticity-related recovery after brain damage in a connectionist

model of single-word reading Cogn Affect Behav Neurosci 2005 Mar5(1)77-92

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements prevent cognitive decline A

systematic review of randomized controlled trials J Hum Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among preterm infants attributable to early

supplementation of human milk with docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings and structural-functional

synergies with cell membrane phospholipids Altern Med Rev 2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function Neuroscience 20089(7)568-78

81

Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

BMC Biol 2008 Sep 9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine improves neuropsychological disorders in a child with

creatine transporter defect Neurocase 200814(2) 151-61

Forrester LW Wheaton LA Luft AR Exercise-mediated locomotor recovery and lower-limb neuroplasticity after

stroke J Rehabil Res Dev 200845(2)205-20

82

Page 16: Neuroplasticity: A Paradigm Sea Change Latest Updated File

Use it or lose it If you do not drive specific brain functions

functional loss will occur

Use it and improve it Therapy that drives cortical function

enhances that particular function

Specificity The therapy you choose determines the resultant

plasticity and function

Repetition matters Plasticity that results in functional change

requires repetition

16

Intensity matters Induction of plasticity requires the appropriate

amount of intensity

Time matters Different forms of plasticity take place at different

times during therapy

Salience matters It has to be important to the individual

Age matters Plasticity is easier in a younger brain but is also

possible in an adult brain

17

Transference Neuroplasticity and the change in function that

results from one therapy can augment the attainment of similar

behaviors

Interference Plasticity in response to one experience can interfere

with the acquisition of other behaviors

18

B Examples of Changes in Function and Structure

1) Jugglers

2) Typists

19

B Examples of Changes in Function and Structure

1) Jugglers

One study suggested that adults taught how to juggle demonstrated a

significant transient bilateral expansion of gray matter in the mid-

temporal area and the left posterior intraparietal sulcus between baseline brain scan and

follow-up The findings were specific to training stimulus individuals who were

not instructed how to juggle demonstrated no change in gray

matter over the same period These findings oppose the conventional

understanding that the anatomical structure of the adult brain does not change

over time

20

B Examples of Changes in Function and Structure

2) Typists

helliplong-term bimanual training also increases

gray matter volume in experienced adult typists

These results suggest that learning not

only affects function but also structure in

adult brains

21

V Neuroplasticity and Optometry

A Evolutionary neuroplasticity

B Reactive plasticity

C Adaptational plasticity

D Reparation plasticity

22

V Neuroplasticity and Optometry

A Evolutionary neuroplasticity

hellip is ideally suited for the developmental OD who

specializes in vision function as it changes over time

either with or without intervention

23

V Neuroplasticity and Optometry

B Reactive plasticity

hellip can be thought of as the immediate effect that

initial optometric treatment may have on a system This can

be reflected in an immediate but often transient change in

the individuallsquos accommodative systemmdashie when an

uncorrected myope initially puts on his or her new

spectacles

24

V Neuroplasticity and Optometry

C Adaptational plasticity

hellip could describe the long-term effects of in-office optometric

vision therapy on disorders of the binocular vision system

25

V Neuroplasticity and Optometry

D Reparation plasticity

hellipin contrast to adaptational

plasticity reparation plasticity may

occur during treatment by a low

Vision specialist or an OD

Working with those who have

Experienced a traumatic brain

injury (TBI)

26

V Neuroplasticity and Optometry

The effects of plasticity can lead to either

positive or negative changes during

development (evolutionary plasticity) after

short-term exposure (reactive plasticity)

after long-term or continuous stimuli

(adaptational plasticity) and during

functional or structural recovery of damaged

neuronal circuits (reparation plasticity)

httpwwwciteulikeorguserjasonepriorarticle2856526

27

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

A Refractive error development

B Amblyopia

C Strabismus

28

D Non-strabismus non-amblyopic binocular vision disorders

E Learning related vision anomalies

F Vision developmentperception disorders

29

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

A Refractive error development

Several recent studies have noted that neuroplasticity may play a

role in refractive error development

retinal defocus use of progressive addition lenses

drug studies (M1-antagonist2 pirenzepine ) slow myopia

progression demonstrated nearly a 50 reduction in myopia

progression over a two-year period

30

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged

7 to 17 years Arch Ophthalmol 2005 Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three

to less than 10 years of age Am J Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction

Am J Ophthalmol 2007 Jun143(6)1060-3

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine

vs patching for treatment of moderate amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-

57

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for

strabismic and anisometropic amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Treatment of severe amblyopia with weekend atropine results from 2 randomized clinical trials

Levodopacarbidopa in the treatment of amblyopia

31

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

J Pediatr Ophthalmol Strabismus 2009 Mar-Apr46(2)87-90 quiz 91-2 Levodopacarbidopa in the

treatment of amblyopia Dadeya S Vats P Malik KP

PURPOSE To evaluate the role of levodopacarbidopa in the treatment of amblyopia METHODS

Thirty patients with strabismic amblyopia between the ages of 3 and 12 years were part of this double-

blind randomized study Patients were divided into two groups Group A received 050 mg + 125 mg of

levodopacarbidopa per kilogram body weight three times daily after meals with a protein rich drink

whereas Group B received placebo Both groups received full-time conventional occlusion until a visual

acuity of 66 was achieved or for a maximum of 3 months RESULTS The authors observed more than

two lines improvement in visual acuity that was greater in the levodopa group (15 of 15) than in the

placebo group (9 of 15) (P lt 005) Furthermore improvement in visual acuity of more than two lines

was greater in patients younger than 8 years (100) than in patients older than 8 years of age (60) (P =

0026) There was also no significant reversal of the improved visual acuity in up to 6 months of follow-

up CONCLUSION Levodopacarbidopa improves visual acuity in patients with

amblyopia and maintains improved visual acuity especially in patients

younger than 8 years

32

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

J Pediatr Ophthalmol Strabismus 2008 May-Jun45(3)174-6 The use of levodopa in the treatment of

bilateral amblyopia secondary to uncorrected high hypermetropia Abrams MS

The standard treatment of bilateral amblyopia secondary to uncorrected high bilateral hypermetropia has

been spectacles and time The patient described here failed to show adequate improvement in visual

acuity after 18 months of standard treatment Visual acuity improved dramatically when the

patient began taking levodopa dropped precipitously when the medication was

discontinued and returned quickly to post-treatment levels when levodopa was

restarted Visual acuity remained stable when the medication was slowly tapered

and discontinued This report suggests that dopamine may play a role in the pathophysiology of

bilateral amblyopia secondary to uncorrected high bilateral hypermetropia

33

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

Bottom Line

Amblyopia can be treated at any age

May be able to use neuro-enhancing drugs

as a part of basic amblyopia therapy

34

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

C Strabismus and non-strabismic non-amblyopic binocular

vision disorders

Clinical Trial of Treatments for Symptomatic Convergence Insufficiency in Children has

clearly demonstrated the superiority of in-office optometric vision therapy (in conjunction

with home therapy) vs out-of-office therapy alone The study concluded that optometric

vision therapyorthoptics was more effective than pencil push-ups or placebo vision

therapyorthoptics in reducing symptoms and improving clinical signs of convergence

insufficiency

Long-term effectiveness of treatments for symptomatic convergence insufficiency

in children (Optom Vis Sci 2009 Sep86(9)1096-103)

CITT patients improvements lasted a year

35

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

Strabismus 1999 Sep7(3)169-74 Convergence insufficiency in

idiopathic Parkinsons disease responsive to levodopa Racette BA

Gokden MS Tychsen LS Perlmutter JS

We report a patient with pathologically proven idiopathic Parkinsons

disease (IPD) who developed diplopia secondary to convergence

insufficiency during his motor off periods Diplopia resolved with

onset of motor benefit from levodopa Neuro-ophthalmologic

examination demonstrated convergence insufficiency during motor

off periods that was alleviated after onset of motor benefit from

levodopa This is the first reported case of convergence insufficiency

in IPD responsive to levodopa

36

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

Bottom Line

Optometric Vision Therapy is the most efficacious treatment available for binocular vision disorders and the

treatment effects are long lasting Neuro-enhancing drugs

may assist us as well

37

EF Learning related vision anomalies Vision

developmentperception disorders

hellipresearch includes an examination of the role vision plays in

reading the effect of oculomotor vergence and

accommodativecoherent motion therapy on reading eye movements

and reading speed the diagnosis and treatment of perceptual

disorders and the effect of therapy on various learning anomalies

38

EF Learning related vision anomalies Vision developmentperception disorders

magnocellular (MC) deficit in dyslexia

LM speed-matching ratio predicts reading in childrenChase C Dougherty RF Ray N

Fowler S Stein JOptom Vis Sci 2007 Mar84(3)229-36

Effect of attention therapy on reading comprehension Solan HA Shelley-Tremblay J

Ficarra A Silverman M Larson S J Learn Disabil 2003 Nov-Dec36(6)556-63

Is there a common linkage among reading comprehension visual attention and

magnocellular processing Solan HA Shelley-Tremblay JF Hansen PC Larson S

J Learn Disabil 2007 May-Jun40(3)270-8

Lawton T Filtered Text and Direction Discrimination Training Improved Reading

Fluency for Both Dyslexic and Normal Readers Optom Vis Dev 200839 (3)114

Fischer B Hartnegg K Saccade control in dyslexia Development deficits training

and transfer to reading Optom Vis Dev 200839(4)181-190

39

EF Learning related vision anomalies Vision developmentperception disorders

J Learn Disabil 2003 Nov-Dec36(6)556-63 Effect of attention therapy on reading

comprehension Solan HA Shelley-Tremblay J Ficarra A Silverman M Larson S

hellip At the completion of attention therapy the mean

standard attention and reading comprehension scores of

the experimental group had improved significantly The

control group however showed no significant

improvement in reading comprehension scores after 12

weeks Although uncertainties still exist this investigation

supports the notion that visual attention is malleable and

that attention therapy has a significant effect on reading

comprehension in this often neglected population

40

VII Vision dysfunction association with acquired brain injury

A Exotropia (or high exophoriaCI)

B Accommodative dysfunction

C Convergence insufficiency

41

D Decreased blink rate

E Spatial disorientation

F Pursuitsaccade dysfunction

G Unstable ambient vision (Magnocellular pathway)

42

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Stelmack JA Frith T Van Koevering D Rinne S Stelmack TR Visual function in patients

followed at a Veterans Affairs polytrauma network site an electronic medical record review

Optometry 2009 Aug80(8)419-24

RESULTS Visual symptoms were self-reported by 76 of patients

with polytrauma and 75 of the patients with TBI Problems with reading

(polytrauma 60 and TBI 50) and accommodation (polytrauma 30 and

TBI 47) were frequently found on eye examinations Spectacles were the

treatment most frequently prescribed (polytrauma 62 and TBI 78)

CONCLUSIONS It is important for optometrists to be aware of the high

rates of self-reported symptoms and visual problems in military personnel

returning from deployment to the wars in Iraq and Afghanistan Post-

traumatic stress disorder and depression may complicate optometric

evaluation and management

43

VII Vision dysfunction association with acquired brain injury

Avoidance of near tasks

Oculomotor-based reading difficulties

Eye tracking problems

Eye focusing problems

Eyestrain Diplopia

Dizziness Vertigo

Vision-derived nausea

44

VII Vision dysfunction association with acquired brain injury

Increased sensitivity to visual motion

Visual inattention and distractibility

Short-term visual memory loss

Difficulty judging distances (relative and absolute

Difficulty with global scanning

Difficulty with personal grooming especially involving the face

Inability to interactcope visually in a complex social situation

(eg minimal eye contact)

Inability to tolerate complex visual environments (eg grocery store

aisles and highly-patterned floors)

45

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Ciuffreda KJ Ludlam DP Kapoor N Clinical oculomotor training in traumatic brain injury Optom Vis

Dev 200940(1)16-23

Individuals with traumatic brain injury present with a constellation of

oculomotor dysfunctions and correlated symptoms Simple and

effective clinical oculomotor-based training procedures will be

presented with respect to the versional vergence and

accommodative systems and their interactions These therapeutic

procedures can also be applied as needed to individuals with either

low vision neurological dysfunctions or general visual skills cases

manifesting similar oculomotor deficits

46

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Leslie S Myopia and accommodative insufficiency associated with

moderate head trauma Opt Vis Dev 200940(1)25-31

The majority of subjects reviewed had developed a stable degree of

myopia between 100 and 200 diopters as well as an abnormally

high lag of accommodation When their distance and near spatial area

of focus was compared the majority were focused at an intermediate

area in space suggesting a loss of control of accommodation in

space

47

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

B Drugs

C Exercise

D Learning new and challenging things

48

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements

prevent cognitive decline A systematic review of randomized controlled trials J Hum

Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among

preterm infants attributable to early supplementation of human milk with

docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings

and structural-functional synergies with cell membrane phospholipids Altern Med Rev

2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function

Neuroscience 20089(7)568-78

49

VIII Improving Brain Function and Neuroplasticity

B Drugs Maya Vetencourt JF Sale A Viegi A et al The antidepressant

fluoxetine (PROZAC) restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the

antidepressant tianeptine CNS Drugs 200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances

hippocampal long-term potentiation and memory BMC Biol 2008 Sep

9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine

improves neuropsychological disorders in a child with creatine

transporter defect Neurocase 200814(2) 151-61

50

VIII Improving Brain Function and Neuroplasticity

C Exercise

Hunsberger JG et al Antidepressant actions of the exercise-

regulated gene VGF Nat Med 2007 Dec 2 131476

VGF may be a common pathway by which exercise induces

neuroplasticity and growth-factor genes at least one of these might act

similarly to antidepressants in promoting an adaptive response to stress

However the tests used here may be modeling stress-induced

helplessness not depression hellipexercise seems to induce multiple

interacting genes that enhance neuronal resilience

51

VIII Improving Brain Function and Neuroplasticity

D Learning new and challenging things

What have we (optometry amp ophthalmology)

been thinking all these years

Where did we miss the news about neuroplasticity

52

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Huang JC Neuroplasticity as a proposed mechanism for the efficacy of optometric vision therapy and rehabilitation J Bev Optom 200920(4)96-100

Homologous area adaptationCompensatory masqueradeCross-modal reassignment

Map expansion

EquipotentialityVicariation

53

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Homologous area adaptation a transfer of function from a damaged brain area to a non-damaged brain area May be limited to early stages of human development and may crowd a new brain area resulting in reduced functionality of that brain area (Competition between spatial amp verbal functioning)

54

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Compensatory masquerade reorganizing of existing neuro-pathways to us alternative cognitive strategies to perform a task

55

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Cross-modal reassignment using new sensory input in a brain structure deprived of its main input source (changing processing from visual to tactile stimuli in the blind)

56

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Map expansion increase in brain mass due to repeated behavior or exposure to stimuli

57

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Equipotentiality anatomical areas of the brain can perform disparate functions

Vicariation redundant neural systems can operate under abnormal conditions

This may explain why recovery is noted for many neurological conditions (degenerative psychiatric developmental vascular traumatic)

58

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Constraint therapy Use it and improve it

Patching penalization ldquonear activitiesrdquo during amblyopia therapy

59

IX Improving Brain Function and Neuroplasticity Optometric Clinical ApplicationsOptometric Vision Therapy

Kleim amp Jones

Use it or lose it If you do not drive specific brain functions

functional loss will occur

If you want to improve oculomotor brain neuroplastic function amp

structure therapy should be specific for that brain function

Use it and improve it Therapy that drives cortical function enhances

that particular function

If you use therapy to improve oculomotor dysfunction it should

improve

Specificity The therapy you choose determines the resultant

plasticity and function

You must choose therapy that is appropriate

60

IX Improving Brain Function and Neuroplasticity Optometric Clinical Applications

Kleim amp Jones

Repetition matters Plasticity that results in functional change

requires repetition

Do the therapy Do it again Do it yet again No quick fix

Intensity matters Induction of plasticity requires the appropriate

amount of intensity

Intensity means strength force concentration power and passion

Without these plasticity may not occur Function may not improve

Time matters Different forms of plasticity take place at different

times during therapy

Do the basics than the more advanced therapeutic procedures

61

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Salience matters It has to be important to the individual

Make the therapy matter to the patient

Age matters Plasticity is easier in a younger brain but is also

possible in an adult brain

Do not let age determine what therapy options you offer your

patients Think of Susan Barry PhD (StereoSue) and her success

Offer your patients options Let them choose Be realistic about

outcomeshelliphave outcome measures built into therapy program

62

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Transference Neuroplasticity and the change in function

that results from one therapy can augment the attainment

of similar behaviors

What you do during oculomotor therapy may affected

vergence therapy outcomes

Interference Plasticity in response to one experience can

interfere with the acquisition of other behaviors

Monitor Evaluate progress Discuss function in other areas

of your patientslsquo life

63

Why pay attention to binocular vision dysfunctions

and neuroplasticity

December 2009 issue of the Review of Optometry

The Binocular Vision Dysfunction Pandemic

In 2010 almost 170 million individuals will be wearing glasses In

2010 there will also be up to 93 million amblyopes and 12 and a half

million strabismics For children under 18 years of age that means

there will be more than 22 and a half million amblyopes and millions

of children with strabismus A clinical trial to determine the

prevalence of binocular vision dysfunction within the general

population suggested the possibility of up to 56 or 173 million men

women and children with symptoms associated with a binocular

vision dysfunction 189 million (61) with accommodative problems

and 118 million (38) demonstrating various vergence

anomalies

64

65

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Brain plasticity life long changes in the structure of the brain

Sensory substitution replacement of one sensory input by another

Measurement techniques

Voxel based morphometryhellipmeasures difference in brain volume

Fluorodeoxyglucose glucose analog PET scan tells you

distribution and metabolism of brain

Cortical thickness measures

Visual cortex of the blind turns somatic ―The eye of the tongue

Transcranial magnetic stmiulation non-invasive technique to

stimulate cortex

66

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Blind Braille readers report tingling in fingers when pressure

phosphenes are applied Blind feel tingling in tongue

Bind use tongue to perform orientation task motion perception

sensory perception Visual cortex recruited in a variety of sensory

and cognitive tasks (DM Can we use tongue as a VT tool)

Dilks Reorganizations of human adult visual system

When a region of sensory cortex is deprived of its bottom up

input the deprived region begins to respond to stimuli that

normally activate adjacent cortex

67

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Retinotopic map changes for stroke pts Cortical reorganization in

adults occurs Perceived objectshellipelongation in stroke amp AMD

What happens to deprived cortex in AMD

fMRI shows cortical reorganization in adults

Proposed mechanisms

hellipGrowth of new connections

hellipUnmasking of pre-existing connections this is true

happens within seconds

Bavelier

Action video games

68

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Bavelier

Action video games Looked at attention Gamers can track more

activities

Attention over space (me peripheral awarenress) Useful field

of view shrinks with age

Performance not VA relatedhellipis related to attention

Action game playing changes spatial resolutionhellipovercoming

crowding in VA assessment (me amblyopia therapy)

Temporal resolution of vision Backward masking

changehellipbrain changes

Visual sensitivity (contrast sensitivity) Post action game training

improves CSF

69

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Action video games correcting optics of the cortex (me this is

actualy OVT)

Games factor

Variable entry leanringhellipadapt task to skill level

Incremental learning tune task to subjectlsquos leanring steps

Motivationarousal

Rewards

Self masterself confidence

Action games factors

Pacingrate of exposure to infohellipincreasing processing speed

Dynamic display

Rich environment

Rich motor involvement

70

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Surgeons may be made to play action games

Pilot training

Amblyopia tx Dennis Levi research

PresenterTitle Contact info

Neuroplasticity-A Paradigm Sea Change

This presentation is available at

httpwwwslidesharenetDMAINOneuroplasticity-a-paradigm-sea-change-2459693

httpwwwmainosmemosblogspotcom

My FaceBook Page

and

Twitter

PresenterTitle Contact info

Questions About

Neuroplasticity-A Paradigm Sea Change

Dominick M Maino OD MEd FAAO FCOVD-A

Professor PediatricsBinocular VisionIllinois Eye InstituteIllinois College of Optometry

dmainoicoeduhttpwwwMainosMemosblogspotcom

Thanks to

httpwwwcovdorgHomeOVDJournalOVD401tabid263D

efaultaspx

httpbipolarblastfileswordpresscom200908neurojpg

httpwwwspecialcheerscomimagesanimated_braingif

httpblogmarsdencartoonscomwp-

contentuploads200810frankenstein-myspace-lightbeergif

httpwwwshangralafamilyfuncomgala-ecalvindreamgif

httppsychiatryjwatchorgcgicontentfull20082251

73

Chakraborty R Chatterjee A Choudhart S Chakraborty PK Neuroplasticitymdasha paradigm shift in neurosciences J Indian Med Assoc

2007105(9)513-4516-8520-1

Sacks O A neurologistlsquos notebook Stereo Sue Why two eyes are better than one The New Yorker 2006 Jun 1964-73

Krulwich R National Public Radio Going Binocular Susanlsquos First Snowfall Available at

wwwnprorgtemplatesstorystoryphpstoryId=5507789 (Accessed December 8 2008)

Press LJ The story behind Stereo Suelsquo and a world-famous neurologistlsquos discovery of vision therapy Optom Vis Dev 200637(2) 55-7

Levin HS Neuroplasticity and brain imaging research implications for rehabilitation Arch Phys Med Rehabil 2006 Dec87(12 Suppl

2)S1

Wiesel TN Hubel DH Single-cell responses in striate cortex of kittens deprived of vision in one eye J Neurophysiol 1963

Nov261003-17

Hook BM Chen C Critical periods in the visual system Changing views for a model of experience-dependent plasticity Neuron 2007

Oct56(2)312-26

Ramey CT Ramey SL Prevention of intellectual disabilities early interventions to improve cognitive development Prev Med 1998

Mar-Apr27(2)224-32

Heuninckx S Wenderoth N Swinnen SP Systems neuroplasticity in the aging brain recruiting additional neural resources for

successful motor performance in elderly persons J Neurosci 2008 Jan 228(1)91-9

Ge S Yang CH Hsu KS et al A critical period for enhanced synaptic plasticity in newly generated neurons of the adult brain Neuron

2007 May54(4)559-66

74

Draganski B Gaser C Busch V et al Neuroplasticity changes in grey matter induced by training Nature 2004 Jan 22427(6972)

311-2

Cannonieri GC Bonilha L Fernandes PT et al Practice and perfect length of training and structural brain changes in experienced

typists Neuroreport 2007 Jul 218(10)1063-6

Kleim JA Jones TA Principles of experience-dependent neural plasticity implications for rehabilitation after brain damage J

Speech Lang Hear Res 2008 Feb51(1)S225-39

Trojan S Porkorny J Theoretical aspects of neuroplasticity Physiol Res 199948(2)87-97

Ramamirtham R Kee CS Hung LF et al Wave aberrations in rhesus monkeys with vision-induced ametropias Vision Res 2007

Sep47(21)2751-66

Smith EL 3rd Ramamirtham R Qiao-Grider Y et al Effects of foveal ablation on emmetropization and form-deprivation myopia

Invest Ophthalmol Vis Sci 2007 Sep48(9)3914-22

Smith EL 3rd Kee CS Ramamirtham R et al Peripheral vision can influence eye growth and refractive development in infant

monkeys Invest Ophthalmol Vis Sci 2005 Nov46(11)3965-72

Ciuffreda KJ Vasudevan B Nearwork-induced transient myopia (NITM) and permanent myopiandashndashis there a link Ophthalmic

Physiol Opt 2008 Mar28(2)103-14

Hung GK Ciuffreda KJ Incremental retinal-defocus theory of myopia development--schematic analysis and computer simulation

Comput Biol Med 2007 Jul37(7)930-46

Hung GK Ciuffreda KJ A unifying theory of refractive error development Bull Math Biol 2000 Nov62(6)1087-108

75

Pang Y Maino D Zhang G Lu F Myopia Can its progress be controlled Optom Vis Dev 200637(2)75-9

Leung JT Brown B Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lenses Optom Vis Sci

1999 Jun76(6)346-54

Hasebe S Ohtsuki H Nonaka T et al Effect of progressive addition lenses on myopia progression in Japanese children a prospective

randomized double-masked crossover trial Invest Ophthalmol Vis Sci 2008 Jul49(7)2781-9

Gwiazda J Hyman L Hussein M et al A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression

of myopia in children Invest Ophthalmol Vis Sci 2003 Apr44(4)1492-500

Siatkowski RM Cotter SA Crockett RS et al Two-year multi-center randomized double-masked placebo-controlled parallel safety and

efficacy study of 2 pirenzepine ophthalmic gel in children with myopia J AAPOS 2008 Aug12(4)332-9

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged 7 to 17 years Arch Ophthalmol 2005

Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three to less than 10 years of age Am J

Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction Am J Ophthalmol 2007

Jun143(6)1060-3

Holmes JM Edwards AR Beck RW et al A randomized pilot study of near activities versus non-near activities during patching therapy for

amblyopia J AAPOS 2005 Apr9(2)129-36

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate

amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-57

76

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic

amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Convergence Insufficiency Treatment Trial Study Group Randomized clinical trial of treatments for symptomatic convergence insufficiency

in children Arch Ophthalmol 2008 Oct126(10)1336-49

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

Solan HA Shelley-Tremblay J Hansen PC et al M-cell deficit and reading disability a preliminary study of the effects of temporal vision-

processing therapy Optometry 2004 Oct75(10)640-50

Solan HA Larson S Shelley-Tremblay J et al Role of visual attention in cognitive control of oculomotor readiness in students with reading

disabilities J Learn Disabil 2001 Mar-Apr34(2)107-18

Gallaway M Boas MB The impact of vergence and accommodative therapy on reading eye movements and reading speed Optom Vis Dev

200738(3)115-20

Goss DA Downing DB Lowther AH et al The effect of HTS vision therapy conducted in a school setting on reading skills in third and

fourth grade students Optom Vis Dev 200738(1)27-32

Crutch SJ Warrington EK Foveal crowding in posterior cortical atrophy a specific early-visual-processing deficit affecting word reading

Cogn Neuropsychol 2007 Dec24(8)843-66

Helms D Sawtelle SM A study of the effectiveness of cognitive therapy delivered in a video game format Optom Vis Dev 200738 (1)19-

26

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

77

Lawton T Training direction-discrimination sensitivity remediates a wide spectrum of reading skills OptomVis Dev 200738(1) 33-47

Goldstand S Koslowe KC Parush S Vision visual-information processing and academic performance among seventh-grade schoolchildren a

more significant relationship than we thought Am J Occup Ther 2005 Jul-Aug59(4)377-89

Fischer B Koumlngeter A Hartnegg K Effects of daily practice on subitizing visual counting and basic arithmetic skills Optom Vis Dev

200839(1)30-4

Sands W Taub M Maino D Limited research and education on special populations in optometry and ophthalomology Optom Vis Dev

200839(2)60-1

Wesson M Maino D Oculo-visual findings in Down syndrome cerebral palsy and mental retardation with non-specific etiology In Maino D

(ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 199517-54 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

Cui Y Stapleton F Suttle C Developing an instrument to assess vision-related and subjective quality of life in children with intellectual

disability data collection and preliminary analysis in a Chinese population Ophthal Physiolog Optics 2008 May28(3) 238-46

Maino D Steele G Tahir S Sajja R Attitudes of optometry students toward individuals with disabilities Optom Ed 200227(2)45-50

Maino D Special populations in the optometric curriculum Optom Ed 200227(2)38-9

Maino D Overview of special populations In Scheiman M Rouse M (eds) Optometric Management of Learning-Related Vision Problems

St Louis Mosby Inc 200685-106

Maino D (ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 1995 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

78

McCarthy P Maino D Alport syndrome a review Clin Eye Vis Care 2000 Dec12(3-4)139-50

Block SS Brusca-Vega R Pizzi WJ et al Cognitive and visual processing skills and their relationship to mutation size in full and

permutation female fragile X carriers Optom Vis Sci 2000 Nov77 (11)592-9

Maino D The young child with developmental disabilities An introduction to mental retardation and genetic syndromes In Moore BD

(ed) Eye Care for Infants and Young Children Butter-worth--Heinemann Newton MA1997285-300

Amin V Maino D The Fragile X female Visual visual perceptual and ocular health anomalies J Am Optom Assoc 1995 May66

(5)290-95

Maino DM Maino JH Cibis GW Hecht F Ocular health anomalies in patients with developmental disabilities In Maino D (ed)

Diagnosis and Management of Special Populations Mosby-Year-book Inc St Louis MO 1995189-206 Reprinted Optometric

Education Program Foundation Santa Anna Calif 2001

Maino D Wesson M Schlange D Cibis G Maino J Optometric findings in the fragile X syndrome Optom Vis Sci 199168634-40

Scheiman MMOptometric findings in children with cerebral palsy Am J Optom Physiol Opt 1984 May61(5)321-3

Maino D Maino J Maino S Mental retardation syndromes with associated ocular defects J Am Optom Assoc 199061707-16

Stewart RE Woodhouse JM Cregg M Pakeman VH Association between accommodative accuracy hypermetropia and strabismus in

children with Downs syndrome Optom Vis Sci 2007 Feb84(2)149-55

Cregg M Woodhouse JM Pakeman VH et al Accommodation and refractive error in children with Down syndrome cross-sectional

and longitudinal studies Invest Ophthalmol Vis Sci 2001 Jan42 (1)55-63

79

McClelland JF Parkes J Hill N et al Accommodative dysfunction in children with cerebral palsy a population-

based study Invest Ophthalmol Vis Sci 2006 May47(5)1824-30

Duckman RH Vision therapy for the child with cerebral palsy J Am Optom Assoc 198758(1)28-35

Duckman R Accommodation in cerebral palsy function and remediation J Am Optom Assoc 198455(4)281-3

Scheiman M Understanding and managing vision deficits a guide for occupational therapists 2nd ed Slack

Thorofare NJ 2002

Maino D Binasal occlusion for the child with Cerebral Palsy J Ill Optom Assoc 198644(1)1218

Battaglia F Quartarone A Rizzo V et al Early impairment of synaptic plasticity in patients with Downs syndrome

Neurobiol Aging 2008 Aug29(8)1272-5

Bonnier C Evaluation of early stimulation programs for enhancing brain development Acta Paediatr 2008

Jul97(7)853-8

Morice E Andreae LC Cooke SF et al Preservation of long-term memory and synaptic plasticity despite short-term

impairments in the Tc1 mouse model of Down syndrome Learn Mem 2008 Jul 1415(7)492-500

Gordon AM Schneider JA Chinnan A Charles JR Efficacy of a hand-arm bimanual intensive therapy (HABIT) in

children with hemiplegic cerebral palsy a randomized control trial Dev Med Child Neurol 2007 Nov49(11)830-8

Kapoor N Ciuffreda KJ Vision disturbances following traumatic brain injury Curr Treat Options Neurol 2002

Jul4(4)271-80

80

Ciuffreda KJ Rutner D Kapoor N et al Vision therapy for oculomotor dysfunctions in acquired brain injury a

retrospective analysis Optometry 2008 Jan79(1)18-22

Ciuffreda KJ Han Y Kapoor N Ficarra AP Oculomotor rehabilitation for reading in acquired brain injury

NeuroRehabilitation 200621(1)9-21

Zost M Diagnosis and management of visual dysfunction in cerebral injury In Maino D (ed) Diagnosis and

Management of Special Populations Mosby-Yearbook Inc St Louis 199579 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001 [Figure used with permission of the editor]

DeGutis JM Bentin S Robertson LC DEsposito M Functional plasticity in ventral temporal cortex following

cognitive rehabilitation of a congenital prosopagnosic J Cogn Neurosci 2007 Nov19 (11)1790-802

Welbourne SR Ralph MA Exploring the impact of plasticity-related recovery after brain damage in a connectionist

model of single-word reading Cogn Affect Behav Neurosci 2005 Mar5(1)77-92

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements prevent cognitive decline A

systematic review of randomized controlled trials J Hum Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among preterm infants attributable to early

supplementation of human milk with docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings and structural-functional

synergies with cell membrane phospholipids Altern Med Rev 2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function Neuroscience 20089(7)568-78

81

Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

BMC Biol 2008 Sep 9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine improves neuropsychological disorders in a child with

creatine transporter defect Neurocase 200814(2) 151-61

Forrester LW Wheaton LA Luft AR Exercise-mediated locomotor recovery and lower-limb neuroplasticity after

stroke J Rehabil Res Dev 200845(2)205-20

82

Page 17: Neuroplasticity: A Paradigm Sea Change Latest Updated File

Intensity matters Induction of plasticity requires the appropriate

amount of intensity

Time matters Different forms of plasticity take place at different

times during therapy

Salience matters It has to be important to the individual

Age matters Plasticity is easier in a younger brain but is also

possible in an adult brain

17

Transference Neuroplasticity and the change in function that

results from one therapy can augment the attainment of similar

behaviors

Interference Plasticity in response to one experience can interfere

with the acquisition of other behaviors

18

B Examples of Changes in Function and Structure

1) Jugglers

2) Typists

19

B Examples of Changes in Function and Structure

1) Jugglers

One study suggested that adults taught how to juggle demonstrated a

significant transient bilateral expansion of gray matter in the mid-

temporal area and the left posterior intraparietal sulcus between baseline brain scan and

follow-up The findings were specific to training stimulus individuals who were

not instructed how to juggle demonstrated no change in gray

matter over the same period These findings oppose the conventional

understanding that the anatomical structure of the adult brain does not change

over time

20

B Examples of Changes in Function and Structure

2) Typists

helliplong-term bimanual training also increases

gray matter volume in experienced adult typists

These results suggest that learning not

only affects function but also structure in

adult brains

21

V Neuroplasticity and Optometry

A Evolutionary neuroplasticity

B Reactive plasticity

C Adaptational plasticity

D Reparation plasticity

22

V Neuroplasticity and Optometry

A Evolutionary neuroplasticity

hellip is ideally suited for the developmental OD who

specializes in vision function as it changes over time

either with or without intervention

23

V Neuroplasticity and Optometry

B Reactive plasticity

hellip can be thought of as the immediate effect that

initial optometric treatment may have on a system This can

be reflected in an immediate but often transient change in

the individuallsquos accommodative systemmdashie when an

uncorrected myope initially puts on his or her new

spectacles

24

V Neuroplasticity and Optometry

C Adaptational plasticity

hellip could describe the long-term effects of in-office optometric

vision therapy on disorders of the binocular vision system

25

V Neuroplasticity and Optometry

D Reparation plasticity

hellipin contrast to adaptational

plasticity reparation plasticity may

occur during treatment by a low

Vision specialist or an OD

Working with those who have

Experienced a traumatic brain

injury (TBI)

26

V Neuroplasticity and Optometry

The effects of plasticity can lead to either

positive or negative changes during

development (evolutionary plasticity) after

short-term exposure (reactive plasticity)

after long-term or continuous stimuli

(adaptational plasticity) and during

functional or structural recovery of damaged

neuronal circuits (reparation plasticity)

httpwwwciteulikeorguserjasonepriorarticle2856526

27

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

A Refractive error development

B Amblyopia

C Strabismus

28

D Non-strabismus non-amblyopic binocular vision disorders

E Learning related vision anomalies

F Vision developmentperception disorders

29

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

A Refractive error development

Several recent studies have noted that neuroplasticity may play a

role in refractive error development

retinal defocus use of progressive addition lenses

drug studies (M1-antagonist2 pirenzepine ) slow myopia

progression demonstrated nearly a 50 reduction in myopia

progression over a two-year period

30

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged

7 to 17 years Arch Ophthalmol 2005 Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three

to less than 10 years of age Am J Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction

Am J Ophthalmol 2007 Jun143(6)1060-3

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine

vs patching for treatment of moderate amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-

57

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for

strabismic and anisometropic amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Treatment of severe amblyopia with weekend atropine results from 2 randomized clinical trials

Levodopacarbidopa in the treatment of amblyopia

31

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

J Pediatr Ophthalmol Strabismus 2009 Mar-Apr46(2)87-90 quiz 91-2 Levodopacarbidopa in the

treatment of amblyopia Dadeya S Vats P Malik KP

PURPOSE To evaluate the role of levodopacarbidopa in the treatment of amblyopia METHODS

Thirty patients with strabismic amblyopia between the ages of 3 and 12 years were part of this double-

blind randomized study Patients were divided into two groups Group A received 050 mg + 125 mg of

levodopacarbidopa per kilogram body weight three times daily after meals with a protein rich drink

whereas Group B received placebo Both groups received full-time conventional occlusion until a visual

acuity of 66 was achieved or for a maximum of 3 months RESULTS The authors observed more than

two lines improvement in visual acuity that was greater in the levodopa group (15 of 15) than in the

placebo group (9 of 15) (P lt 005) Furthermore improvement in visual acuity of more than two lines

was greater in patients younger than 8 years (100) than in patients older than 8 years of age (60) (P =

0026) There was also no significant reversal of the improved visual acuity in up to 6 months of follow-

up CONCLUSION Levodopacarbidopa improves visual acuity in patients with

amblyopia and maintains improved visual acuity especially in patients

younger than 8 years

32

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

J Pediatr Ophthalmol Strabismus 2008 May-Jun45(3)174-6 The use of levodopa in the treatment of

bilateral amblyopia secondary to uncorrected high hypermetropia Abrams MS

The standard treatment of bilateral amblyopia secondary to uncorrected high bilateral hypermetropia has

been spectacles and time The patient described here failed to show adequate improvement in visual

acuity after 18 months of standard treatment Visual acuity improved dramatically when the

patient began taking levodopa dropped precipitously when the medication was

discontinued and returned quickly to post-treatment levels when levodopa was

restarted Visual acuity remained stable when the medication was slowly tapered

and discontinued This report suggests that dopamine may play a role in the pathophysiology of

bilateral amblyopia secondary to uncorrected high bilateral hypermetropia

33

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

Bottom Line

Amblyopia can be treated at any age

May be able to use neuro-enhancing drugs

as a part of basic amblyopia therapy

34

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

C Strabismus and non-strabismic non-amblyopic binocular

vision disorders

Clinical Trial of Treatments for Symptomatic Convergence Insufficiency in Children has

clearly demonstrated the superiority of in-office optometric vision therapy (in conjunction

with home therapy) vs out-of-office therapy alone The study concluded that optometric

vision therapyorthoptics was more effective than pencil push-ups or placebo vision

therapyorthoptics in reducing symptoms and improving clinical signs of convergence

insufficiency

Long-term effectiveness of treatments for symptomatic convergence insufficiency

in children (Optom Vis Sci 2009 Sep86(9)1096-103)

CITT patients improvements lasted a year

35

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

Strabismus 1999 Sep7(3)169-74 Convergence insufficiency in

idiopathic Parkinsons disease responsive to levodopa Racette BA

Gokden MS Tychsen LS Perlmutter JS

We report a patient with pathologically proven idiopathic Parkinsons

disease (IPD) who developed diplopia secondary to convergence

insufficiency during his motor off periods Diplopia resolved with

onset of motor benefit from levodopa Neuro-ophthalmologic

examination demonstrated convergence insufficiency during motor

off periods that was alleviated after onset of motor benefit from

levodopa This is the first reported case of convergence insufficiency

in IPD responsive to levodopa

36

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

Bottom Line

Optometric Vision Therapy is the most efficacious treatment available for binocular vision disorders and the

treatment effects are long lasting Neuro-enhancing drugs

may assist us as well

37

EF Learning related vision anomalies Vision

developmentperception disorders

hellipresearch includes an examination of the role vision plays in

reading the effect of oculomotor vergence and

accommodativecoherent motion therapy on reading eye movements

and reading speed the diagnosis and treatment of perceptual

disorders and the effect of therapy on various learning anomalies

38

EF Learning related vision anomalies Vision developmentperception disorders

magnocellular (MC) deficit in dyslexia

LM speed-matching ratio predicts reading in childrenChase C Dougherty RF Ray N

Fowler S Stein JOptom Vis Sci 2007 Mar84(3)229-36

Effect of attention therapy on reading comprehension Solan HA Shelley-Tremblay J

Ficarra A Silverman M Larson S J Learn Disabil 2003 Nov-Dec36(6)556-63

Is there a common linkage among reading comprehension visual attention and

magnocellular processing Solan HA Shelley-Tremblay JF Hansen PC Larson S

J Learn Disabil 2007 May-Jun40(3)270-8

Lawton T Filtered Text and Direction Discrimination Training Improved Reading

Fluency for Both Dyslexic and Normal Readers Optom Vis Dev 200839 (3)114

Fischer B Hartnegg K Saccade control in dyslexia Development deficits training

and transfer to reading Optom Vis Dev 200839(4)181-190

39

EF Learning related vision anomalies Vision developmentperception disorders

J Learn Disabil 2003 Nov-Dec36(6)556-63 Effect of attention therapy on reading

comprehension Solan HA Shelley-Tremblay J Ficarra A Silverman M Larson S

hellip At the completion of attention therapy the mean

standard attention and reading comprehension scores of

the experimental group had improved significantly The

control group however showed no significant

improvement in reading comprehension scores after 12

weeks Although uncertainties still exist this investigation

supports the notion that visual attention is malleable and

that attention therapy has a significant effect on reading

comprehension in this often neglected population

40

VII Vision dysfunction association with acquired brain injury

A Exotropia (or high exophoriaCI)

B Accommodative dysfunction

C Convergence insufficiency

41

D Decreased blink rate

E Spatial disorientation

F Pursuitsaccade dysfunction

G Unstable ambient vision (Magnocellular pathway)

42

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Stelmack JA Frith T Van Koevering D Rinne S Stelmack TR Visual function in patients

followed at a Veterans Affairs polytrauma network site an electronic medical record review

Optometry 2009 Aug80(8)419-24

RESULTS Visual symptoms were self-reported by 76 of patients

with polytrauma and 75 of the patients with TBI Problems with reading

(polytrauma 60 and TBI 50) and accommodation (polytrauma 30 and

TBI 47) were frequently found on eye examinations Spectacles were the

treatment most frequently prescribed (polytrauma 62 and TBI 78)

CONCLUSIONS It is important for optometrists to be aware of the high

rates of self-reported symptoms and visual problems in military personnel

returning from deployment to the wars in Iraq and Afghanistan Post-

traumatic stress disorder and depression may complicate optometric

evaluation and management

43

VII Vision dysfunction association with acquired brain injury

Avoidance of near tasks

Oculomotor-based reading difficulties

Eye tracking problems

Eye focusing problems

Eyestrain Diplopia

Dizziness Vertigo

Vision-derived nausea

44

VII Vision dysfunction association with acquired brain injury

Increased sensitivity to visual motion

Visual inattention and distractibility

Short-term visual memory loss

Difficulty judging distances (relative and absolute

Difficulty with global scanning

Difficulty with personal grooming especially involving the face

Inability to interactcope visually in a complex social situation

(eg minimal eye contact)

Inability to tolerate complex visual environments (eg grocery store

aisles and highly-patterned floors)

45

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Ciuffreda KJ Ludlam DP Kapoor N Clinical oculomotor training in traumatic brain injury Optom Vis

Dev 200940(1)16-23

Individuals with traumatic brain injury present with a constellation of

oculomotor dysfunctions and correlated symptoms Simple and

effective clinical oculomotor-based training procedures will be

presented with respect to the versional vergence and

accommodative systems and their interactions These therapeutic

procedures can also be applied as needed to individuals with either

low vision neurological dysfunctions or general visual skills cases

manifesting similar oculomotor deficits

46

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Leslie S Myopia and accommodative insufficiency associated with

moderate head trauma Opt Vis Dev 200940(1)25-31

The majority of subjects reviewed had developed a stable degree of

myopia between 100 and 200 diopters as well as an abnormally

high lag of accommodation When their distance and near spatial area

of focus was compared the majority were focused at an intermediate

area in space suggesting a loss of control of accommodation in

space

47

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

B Drugs

C Exercise

D Learning new and challenging things

48

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements

prevent cognitive decline A systematic review of randomized controlled trials J Hum

Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among

preterm infants attributable to early supplementation of human milk with

docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings

and structural-functional synergies with cell membrane phospholipids Altern Med Rev

2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function

Neuroscience 20089(7)568-78

49

VIII Improving Brain Function and Neuroplasticity

B Drugs Maya Vetencourt JF Sale A Viegi A et al The antidepressant

fluoxetine (PROZAC) restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the

antidepressant tianeptine CNS Drugs 200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances

hippocampal long-term potentiation and memory BMC Biol 2008 Sep

9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine

improves neuropsychological disorders in a child with creatine

transporter defect Neurocase 200814(2) 151-61

50

VIII Improving Brain Function and Neuroplasticity

C Exercise

Hunsberger JG et al Antidepressant actions of the exercise-

regulated gene VGF Nat Med 2007 Dec 2 131476

VGF may be a common pathway by which exercise induces

neuroplasticity and growth-factor genes at least one of these might act

similarly to antidepressants in promoting an adaptive response to stress

However the tests used here may be modeling stress-induced

helplessness not depression hellipexercise seems to induce multiple

interacting genes that enhance neuronal resilience

51

VIII Improving Brain Function and Neuroplasticity

D Learning new and challenging things

What have we (optometry amp ophthalmology)

been thinking all these years

Where did we miss the news about neuroplasticity

52

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Huang JC Neuroplasticity as a proposed mechanism for the efficacy of optometric vision therapy and rehabilitation J Bev Optom 200920(4)96-100

Homologous area adaptationCompensatory masqueradeCross-modal reassignment

Map expansion

EquipotentialityVicariation

53

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Homologous area adaptation a transfer of function from a damaged brain area to a non-damaged brain area May be limited to early stages of human development and may crowd a new brain area resulting in reduced functionality of that brain area (Competition between spatial amp verbal functioning)

54

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Compensatory masquerade reorganizing of existing neuro-pathways to us alternative cognitive strategies to perform a task

55

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Cross-modal reassignment using new sensory input in a brain structure deprived of its main input source (changing processing from visual to tactile stimuli in the blind)

56

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Map expansion increase in brain mass due to repeated behavior or exposure to stimuli

57

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Equipotentiality anatomical areas of the brain can perform disparate functions

Vicariation redundant neural systems can operate under abnormal conditions

This may explain why recovery is noted for many neurological conditions (degenerative psychiatric developmental vascular traumatic)

58

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Constraint therapy Use it and improve it

Patching penalization ldquonear activitiesrdquo during amblyopia therapy

59

IX Improving Brain Function and Neuroplasticity Optometric Clinical ApplicationsOptometric Vision Therapy

Kleim amp Jones

Use it or lose it If you do not drive specific brain functions

functional loss will occur

If you want to improve oculomotor brain neuroplastic function amp

structure therapy should be specific for that brain function

Use it and improve it Therapy that drives cortical function enhances

that particular function

If you use therapy to improve oculomotor dysfunction it should

improve

Specificity The therapy you choose determines the resultant

plasticity and function

You must choose therapy that is appropriate

60

IX Improving Brain Function and Neuroplasticity Optometric Clinical Applications

Kleim amp Jones

Repetition matters Plasticity that results in functional change

requires repetition

Do the therapy Do it again Do it yet again No quick fix

Intensity matters Induction of plasticity requires the appropriate

amount of intensity

Intensity means strength force concentration power and passion

Without these plasticity may not occur Function may not improve

Time matters Different forms of plasticity take place at different

times during therapy

Do the basics than the more advanced therapeutic procedures

61

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Salience matters It has to be important to the individual

Make the therapy matter to the patient

Age matters Plasticity is easier in a younger brain but is also

possible in an adult brain

Do not let age determine what therapy options you offer your

patients Think of Susan Barry PhD (StereoSue) and her success

Offer your patients options Let them choose Be realistic about

outcomeshelliphave outcome measures built into therapy program

62

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Transference Neuroplasticity and the change in function

that results from one therapy can augment the attainment

of similar behaviors

What you do during oculomotor therapy may affected

vergence therapy outcomes

Interference Plasticity in response to one experience can

interfere with the acquisition of other behaviors

Monitor Evaluate progress Discuss function in other areas

of your patientslsquo life

63

Why pay attention to binocular vision dysfunctions

and neuroplasticity

December 2009 issue of the Review of Optometry

The Binocular Vision Dysfunction Pandemic

In 2010 almost 170 million individuals will be wearing glasses In

2010 there will also be up to 93 million amblyopes and 12 and a half

million strabismics For children under 18 years of age that means

there will be more than 22 and a half million amblyopes and millions

of children with strabismus A clinical trial to determine the

prevalence of binocular vision dysfunction within the general

population suggested the possibility of up to 56 or 173 million men

women and children with symptoms associated with a binocular

vision dysfunction 189 million (61) with accommodative problems

and 118 million (38) demonstrating various vergence

anomalies

64

65

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Brain plasticity life long changes in the structure of the brain

Sensory substitution replacement of one sensory input by another

Measurement techniques

Voxel based morphometryhellipmeasures difference in brain volume

Fluorodeoxyglucose glucose analog PET scan tells you

distribution and metabolism of brain

Cortical thickness measures

Visual cortex of the blind turns somatic ―The eye of the tongue

Transcranial magnetic stmiulation non-invasive technique to

stimulate cortex

66

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Blind Braille readers report tingling in fingers when pressure

phosphenes are applied Blind feel tingling in tongue

Bind use tongue to perform orientation task motion perception

sensory perception Visual cortex recruited in a variety of sensory

and cognitive tasks (DM Can we use tongue as a VT tool)

Dilks Reorganizations of human adult visual system

When a region of sensory cortex is deprived of its bottom up

input the deprived region begins to respond to stimuli that

normally activate adjacent cortex

67

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Retinotopic map changes for stroke pts Cortical reorganization in

adults occurs Perceived objectshellipelongation in stroke amp AMD

What happens to deprived cortex in AMD

fMRI shows cortical reorganization in adults

Proposed mechanisms

hellipGrowth of new connections

hellipUnmasking of pre-existing connections this is true

happens within seconds

Bavelier

Action video games

68

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Bavelier

Action video games Looked at attention Gamers can track more

activities

Attention over space (me peripheral awarenress) Useful field

of view shrinks with age

Performance not VA relatedhellipis related to attention

Action game playing changes spatial resolutionhellipovercoming

crowding in VA assessment (me amblyopia therapy)

Temporal resolution of vision Backward masking

changehellipbrain changes

Visual sensitivity (contrast sensitivity) Post action game training

improves CSF

69

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Action video games correcting optics of the cortex (me this is

actualy OVT)

Games factor

Variable entry leanringhellipadapt task to skill level

Incremental learning tune task to subjectlsquos leanring steps

Motivationarousal

Rewards

Self masterself confidence

Action games factors

Pacingrate of exposure to infohellipincreasing processing speed

Dynamic display

Rich environment

Rich motor involvement

70

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Surgeons may be made to play action games

Pilot training

Amblyopia tx Dennis Levi research

PresenterTitle Contact info

Neuroplasticity-A Paradigm Sea Change

This presentation is available at

httpwwwslidesharenetDMAINOneuroplasticity-a-paradigm-sea-change-2459693

httpwwwmainosmemosblogspotcom

My FaceBook Page

and

Twitter

PresenterTitle Contact info

Questions About

Neuroplasticity-A Paradigm Sea Change

Dominick M Maino OD MEd FAAO FCOVD-A

Professor PediatricsBinocular VisionIllinois Eye InstituteIllinois College of Optometry

dmainoicoeduhttpwwwMainosMemosblogspotcom

Thanks to

httpwwwcovdorgHomeOVDJournalOVD401tabid263D

efaultaspx

httpbipolarblastfileswordpresscom200908neurojpg

httpwwwspecialcheerscomimagesanimated_braingif

httpblogmarsdencartoonscomwp-

contentuploads200810frankenstein-myspace-lightbeergif

httpwwwshangralafamilyfuncomgala-ecalvindreamgif

httppsychiatryjwatchorgcgicontentfull20082251

73

Chakraborty R Chatterjee A Choudhart S Chakraborty PK Neuroplasticitymdasha paradigm shift in neurosciences J Indian Med Assoc

2007105(9)513-4516-8520-1

Sacks O A neurologistlsquos notebook Stereo Sue Why two eyes are better than one The New Yorker 2006 Jun 1964-73

Krulwich R National Public Radio Going Binocular Susanlsquos First Snowfall Available at

wwwnprorgtemplatesstorystoryphpstoryId=5507789 (Accessed December 8 2008)

Press LJ The story behind Stereo Suelsquo and a world-famous neurologistlsquos discovery of vision therapy Optom Vis Dev 200637(2) 55-7

Levin HS Neuroplasticity and brain imaging research implications for rehabilitation Arch Phys Med Rehabil 2006 Dec87(12 Suppl

2)S1

Wiesel TN Hubel DH Single-cell responses in striate cortex of kittens deprived of vision in one eye J Neurophysiol 1963

Nov261003-17

Hook BM Chen C Critical periods in the visual system Changing views for a model of experience-dependent plasticity Neuron 2007

Oct56(2)312-26

Ramey CT Ramey SL Prevention of intellectual disabilities early interventions to improve cognitive development Prev Med 1998

Mar-Apr27(2)224-32

Heuninckx S Wenderoth N Swinnen SP Systems neuroplasticity in the aging brain recruiting additional neural resources for

successful motor performance in elderly persons J Neurosci 2008 Jan 228(1)91-9

Ge S Yang CH Hsu KS et al A critical period for enhanced synaptic plasticity in newly generated neurons of the adult brain Neuron

2007 May54(4)559-66

74

Draganski B Gaser C Busch V et al Neuroplasticity changes in grey matter induced by training Nature 2004 Jan 22427(6972)

311-2

Cannonieri GC Bonilha L Fernandes PT et al Practice and perfect length of training and structural brain changes in experienced

typists Neuroreport 2007 Jul 218(10)1063-6

Kleim JA Jones TA Principles of experience-dependent neural plasticity implications for rehabilitation after brain damage J

Speech Lang Hear Res 2008 Feb51(1)S225-39

Trojan S Porkorny J Theoretical aspects of neuroplasticity Physiol Res 199948(2)87-97

Ramamirtham R Kee CS Hung LF et al Wave aberrations in rhesus monkeys with vision-induced ametropias Vision Res 2007

Sep47(21)2751-66

Smith EL 3rd Ramamirtham R Qiao-Grider Y et al Effects of foveal ablation on emmetropization and form-deprivation myopia

Invest Ophthalmol Vis Sci 2007 Sep48(9)3914-22

Smith EL 3rd Kee CS Ramamirtham R et al Peripheral vision can influence eye growth and refractive development in infant

monkeys Invest Ophthalmol Vis Sci 2005 Nov46(11)3965-72

Ciuffreda KJ Vasudevan B Nearwork-induced transient myopia (NITM) and permanent myopiandashndashis there a link Ophthalmic

Physiol Opt 2008 Mar28(2)103-14

Hung GK Ciuffreda KJ Incremental retinal-defocus theory of myopia development--schematic analysis and computer simulation

Comput Biol Med 2007 Jul37(7)930-46

Hung GK Ciuffreda KJ A unifying theory of refractive error development Bull Math Biol 2000 Nov62(6)1087-108

75

Pang Y Maino D Zhang G Lu F Myopia Can its progress be controlled Optom Vis Dev 200637(2)75-9

Leung JT Brown B Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lenses Optom Vis Sci

1999 Jun76(6)346-54

Hasebe S Ohtsuki H Nonaka T et al Effect of progressive addition lenses on myopia progression in Japanese children a prospective

randomized double-masked crossover trial Invest Ophthalmol Vis Sci 2008 Jul49(7)2781-9

Gwiazda J Hyman L Hussein M et al A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression

of myopia in children Invest Ophthalmol Vis Sci 2003 Apr44(4)1492-500

Siatkowski RM Cotter SA Crockett RS et al Two-year multi-center randomized double-masked placebo-controlled parallel safety and

efficacy study of 2 pirenzepine ophthalmic gel in children with myopia J AAPOS 2008 Aug12(4)332-9

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged 7 to 17 years Arch Ophthalmol 2005

Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three to less than 10 years of age Am J

Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction Am J Ophthalmol 2007

Jun143(6)1060-3

Holmes JM Edwards AR Beck RW et al A randomized pilot study of near activities versus non-near activities during patching therapy for

amblyopia J AAPOS 2005 Apr9(2)129-36

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate

amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-57

76

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic

amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Convergence Insufficiency Treatment Trial Study Group Randomized clinical trial of treatments for symptomatic convergence insufficiency

in children Arch Ophthalmol 2008 Oct126(10)1336-49

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

Solan HA Shelley-Tremblay J Hansen PC et al M-cell deficit and reading disability a preliminary study of the effects of temporal vision-

processing therapy Optometry 2004 Oct75(10)640-50

Solan HA Larson S Shelley-Tremblay J et al Role of visual attention in cognitive control of oculomotor readiness in students with reading

disabilities J Learn Disabil 2001 Mar-Apr34(2)107-18

Gallaway M Boas MB The impact of vergence and accommodative therapy on reading eye movements and reading speed Optom Vis Dev

200738(3)115-20

Goss DA Downing DB Lowther AH et al The effect of HTS vision therapy conducted in a school setting on reading skills in third and

fourth grade students Optom Vis Dev 200738(1)27-32

Crutch SJ Warrington EK Foveal crowding in posterior cortical atrophy a specific early-visual-processing deficit affecting word reading

Cogn Neuropsychol 2007 Dec24(8)843-66

Helms D Sawtelle SM A study of the effectiveness of cognitive therapy delivered in a video game format Optom Vis Dev 200738 (1)19-

26

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

77

Lawton T Training direction-discrimination sensitivity remediates a wide spectrum of reading skills OptomVis Dev 200738(1) 33-47

Goldstand S Koslowe KC Parush S Vision visual-information processing and academic performance among seventh-grade schoolchildren a

more significant relationship than we thought Am J Occup Ther 2005 Jul-Aug59(4)377-89

Fischer B Koumlngeter A Hartnegg K Effects of daily practice on subitizing visual counting and basic arithmetic skills Optom Vis Dev

200839(1)30-4

Sands W Taub M Maino D Limited research and education on special populations in optometry and ophthalomology Optom Vis Dev

200839(2)60-1

Wesson M Maino D Oculo-visual findings in Down syndrome cerebral palsy and mental retardation with non-specific etiology In Maino D

(ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 199517-54 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

Cui Y Stapleton F Suttle C Developing an instrument to assess vision-related and subjective quality of life in children with intellectual

disability data collection and preliminary analysis in a Chinese population Ophthal Physiolog Optics 2008 May28(3) 238-46

Maino D Steele G Tahir S Sajja R Attitudes of optometry students toward individuals with disabilities Optom Ed 200227(2)45-50

Maino D Special populations in the optometric curriculum Optom Ed 200227(2)38-9

Maino D Overview of special populations In Scheiman M Rouse M (eds) Optometric Management of Learning-Related Vision Problems

St Louis Mosby Inc 200685-106

Maino D (ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 1995 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

78

McCarthy P Maino D Alport syndrome a review Clin Eye Vis Care 2000 Dec12(3-4)139-50

Block SS Brusca-Vega R Pizzi WJ et al Cognitive and visual processing skills and their relationship to mutation size in full and

permutation female fragile X carriers Optom Vis Sci 2000 Nov77 (11)592-9

Maino D The young child with developmental disabilities An introduction to mental retardation and genetic syndromes In Moore BD

(ed) Eye Care for Infants and Young Children Butter-worth--Heinemann Newton MA1997285-300

Amin V Maino D The Fragile X female Visual visual perceptual and ocular health anomalies J Am Optom Assoc 1995 May66

(5)290-95

Maino DM Maino JH Cibis GW Hecht F Ocular health anomalies in patients with developmental disabilities In Maino D (ed)

Diagnosis and Management of Special Populations Mosby-Year-book Inc St Louis MO 1995189-206 Reprinted Optometric

Education Program Foundation Santa Anna Calif 2001

Maino D Wesson M Schlange D Cibis G Maino J Optometric findings in the fragile X syndrome Optom Vis Sci 199168634-40

Scheiman MMOptometric findings in children with cerebral palsy Am J Optom Physiol Opt 1984 May61(5)321-3

Maino D Maino J Maino S Mental retardation syndromes with associated ocular defects J Am Optom Assoc 199061707-16

Stewart RE Woodhouse JM Cregg M Pakeman VH Association between accommodative accuracy hypermetropia and strabismus in

children with Downs syndrome Optom Vis Sci 2007 Feb84(2)149-55

Cregg M Woodhouse JM Pakeman VH et al Accommodation and refractive error in children with Down syndrome cross-sectional

and longitudinal studies Invest Ophthalmol Vis Sci 2001 Jan42 (1)55-63

79

McClelland JF Parkes J Hill N et al Accommodative dysfunction in children with cerebral palsy a population-

based study Invest Ophthalmol Vis Sci 2006 May47(5)1824-30

Duckman RH Vision therapy for the child with cerebral palsy J Am Optom Assoc 198758(1)28-35

Duckman R Accommodation in cerebral palsy function and remediation J Am Optom Assoc 198455(4)281-3

Scheiman M Understanding and managing vision deficits a guide for occupational therapists 2nd ed Slack

Thorofare NJ 2002

Maino D Binasal occlusion for the child with Cerebral Palsy J Ill Optom Assoc 198644(1)1218

Battaglia F Quartarone A Rizzo V et al Early impairment of synaptic plasticity in patients with Downs syndrome

Neurobiol Aging 2008 Aug29(8)1272-5

Bonnier C Evaluation of early stimulation programs for enhancing brain development Acta Paediatr 2008

Jul97(7)853-8

Morice E Andreae LC Cooke SF et al Preservation of long-term memory and synaptic plasticity despite short-term

impairments in the Tc1 mouse model of Down syndrome Learn Mem 2008 Jul 1415(7)492-500

Gordon AM Schneider JA Chinnan A Charles JR Efficacy of a hand-arm bimanual intensive therapy (HABIT) in

children with hemiplegic cerebral palsy a randomized control trial Dev Med Child Neurol 2007 Nov49(11)830-8

Kapoor N Ciuffreda KJ Vision disturbances following traumatic brain injury Curr Treat Options Neurol 2002

Jul4(4)271-80

80

Ciuffreda KJ Rutner D Kapoor N et al Vision therapy for oculomotor dysfunctions in acquired brain injury a

retrospective analysis Optometry 2008 Jan79(1)18-22

Ciuffreda KJ Han Y Kapoor N Ficarra AP Oculomotor rehabilitation for reading in acquired brain injury

NeuroRehabilitation 200621(1)9-21

Zost M Diagnosis and management of visual dysfunction in cerebral injury In Maino D (ed) Diagnosis and

Management of Special Populations Mosby-Yearbook Inc St Louis 199579 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001 [Figure used with permission of the editor]

DeGutis JM Bentin S Robertson LC DEsposito M Functional plasticity in ventral temporal cortex following

cognitive rehabilitation of a congenital prosopagnosic J Cogn Neurosci 2007 Nov19 (11)1790-802

Welbourne SR Ralph MA Exploring the impact of plasticity-related recovery after brain damage in a connectionist

model of single-word reading Cogn Affect Behav Neurosci 2005 Mar5(1)77-92

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements prevent cognitive decline A

systematic review of randomized controlled trials J Hum Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among preterm infants attributable to early

supplementation of human milk with docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings and structural-functional

synergies with cell membrane phospholipids Altern Med Rev 2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function Neuroscience 20089(7)568-78

81

Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

BMC Biol 2008 Sep 9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine improves neuropsychological disorders in a child with

creatine transporter defect Neurocase 200814(2) 151-61

Forrester LW Wheaton LA Luft AR Exercise-mediated locomotor recovery and lower-limb neuroplasticity after

stroke J Rehabil Res Dev 200845(2)205-20

82

Page 18: Neuroplasticity: A Paradigm Sea Change Latest Updated File

Transference Neuroplasticity and the change in function that

results from one therapy can augment the attainment of similar

behaviors

Interference Plasticity in response to one experience can interfere

with the acquisition of other behaviors

18

B Examples of Changes in Function and Structure

1) Jugglers

2) Typists

19

B Examples of Changes in Function and Structure

1) Jugglers

One study suggested that adults taught how to juggle demonstrated a

significant transient bilateral expansion of gray matter in the mid-

temporal area and the left posterior intraparietal sulcus between baseline brain scan and

follow-up The findings were specific to training stimulus individuals who were

not instructed how to juggle demonstrated no change in gray

matter over the same period These findings oppose the conventional

understanding that the anatomical structure of the adult brain does not change

over time

20

B Examples of Changes in Function and Structure

2) Typists

helliplong-term bimanual training also increases

gray matter volume in experienced adult typists

These results suggest that learning not

only affects function but also structure in

adult brains

21

V Neuroplasticity and Optometry

A Evolutionary neuroplasticity

B Reactive plasticity

C Adaptational plasticity

D Reparation plasticity

22

V Neuroplasticity and Optometry

A Evolutionary neuroplasticity

hellip is ideally suited for the developmental OD who

specializes in vision function as it changes over time

either with or without intervention

23

V Neuroplasticity and Optometry

B Reactive plasticity

hellip can be thought of as the immediate effect that

initial optometric treatment may have on a system This can

be reflected in an immediate but often transient change in

the individuallsquos accommodative systemmdashie when an

uncorrected myope initially puts on his or her new

spectacles

24

V Neuroplasticity and Optometry

C Adaptational plasticity

hellip could describe the long-term effects of in-office optometric

vision therapy on disorders of the binocular vision system

25

V Neuroplasticity and Optometry

D Reparation plasticity

hellipin contrast to adaptational

plasticity reparation plasticity may

occur during treatment by a low

Vision specialist or an OD

Working with those who have

Experienced a traumatic brain

injury (TBI)

26

V Neuroplasticity and Optometry

The effects of plasticity can lead to either

positive or negative changes during

development (evolutionary plasticity) after

short-term exposure (reactive plasticity)

after long-term or continuous stimuli

(adaptational plasticity) and during

functional or structural recovery of damaged

neuronal circuits (reparation plasticity)

httpwwwciteulikeorguserjasonepriorarticle2856526

27

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

A Refractive error development

B Amblyopia

C Strabismus

28

D Non-strabismus non-amblyopic binocular vision disorders

E Learning related vision anomalies

F Vision developmentperception disorders

29

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

A Refractive error development

Several recent studies have noted that neuroplasticity may play a

role in refractive error development

retinal defocus use of progressive addition lenses

drug studies (M1-antagonist2 pirenzepine ) slow myopia

progression demonstrated nearly a 50 reduction in myopia

progression over a two-year period

30

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged

7 to 17 years Arch Ophthalmol 2005 Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three

to less than 10 years of age Am J Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction

Am J Ophthalmol 2007 Jun143(6)1060-3

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine

vs patching for treatment of moderate amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-

57

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for

strabismic and anisometropic amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Treatment of severe amblyopia with weekend atropine results from 2 randomized clinical trials

Levodopacarbidopa in the treatment of amblyopia

31

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

J Pediatr Ophthalmol Strabismus 2009 Mar-Apr46(2)87-90 quiz 91-2 Levodopacarbidopa in the

treatment of amblyopia Dadeya S Vats P Malik KP

PURPOSE To evaluate the role of levodopacarbidopa in the treatment of amblyopia METHODS

Thirty patients with strabismic amblyopia between the ages of 3 and 12 years were part of this double-

blind randomized study Patients were divided into two groups Group A received 050 mg + 125 mg of

levodopacarbidopa per kilogram body weight three times daily after meals with a protein rich drink

whereas Group B received placebo Both groups received full-time conventional occlusion until a visual

acuity of 66 was achieved or for a maximum of 3 months RESULTS The authors observed more than

two lines improvement in visual acuity that was greater in the levodopa group (15 of 15) than in the

placebo group (9 of 15) (P lt 005) Furthermore improvement in visual acuity of more than two lines

was greater in patients younger than 8 years (100) than in patients older than 8 years of age (60) (P =

0026) There was also no significant reversal of the improved visual acuity in up to 6 months of follow-

up CONCLUSION Levodopacarbidopa improves visual acuity in patients with

amblyopia and maintains improved visual acuity especially in patients

younger than 8 years

32

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

J Pediatr Ophthalmol Strabismus 2008 May-Jun45(3)174-6 The use of levodopa in the treatment of

bilateral amblyopia secondary to uncorrected high hypermetropia Abrams MS

The standard treatment of bilateral amblyopia secondary to uncorrected high bilateral hypermetropia has

been spectacles and time The patient described here failed to show adequate improvement in visual

acuity after 18 months of standard treatment Visual acuity improved dramatically when the

patient began taking levodopa dropped precipitously when the medication was

discontinued and returned quickly to post-treatment levels when levodopa was

restarted Visual acuity remained stable when the medication was slowly tapered

and discontinued This report suggests that dopamine may play a role in the pathophysiology of

bilateral amblyopia secondary to uncorrected high bilateral hypermetropia

33

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

Bottom Line

Amblyopia can be treated at any age

May be able to use neuro-enhancing drugs

as a part of basic amblyopia therapy

34

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

C Strabismus and non-strabismic non-amblyopic binocular

vision disorders

Clinical Trial of Treatments for Symptomatic Convergence Insufficiency in Children has

clearly demonstrated the superiority of in-office optometric vision therapy (in conjunction

with home therapy) vs out-of-office therapy alone The study concluded that optometric

vision therapyorthoptics was more effective than pencil push-ups or placebo vision

therapyorthoptics in reducing symptoms and improving clinical signs of convergence

insufficiency

Long-term effectiveness of treatments for symptomatic convergence insufficiency

in children (Optom Vis Sci 2009 Sep86(9)1096-103)

CITT patients improvements lasted a year

35

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

Strabismus 1999 Sep7(3)169-74 Convergence insufficiency in

idiopathic Parkinsons disease responsive to levodopa Racette BA

Gokden MS Tychsen LS Perlmutter JS

We report a patient with pathologically proven idiopathic Parkinsons

disease (IPD) who developed diplopia secondary to convergence

insufficiency during his motor off periods Diplopia resolved with

onset of motor benefit from levodopa Neuro-ophthalmologic

examination demonstrated convergence insufficiency during motor

off periods that was alleviated after onset of motor benefit from

levodopa This is the first reported case of convergence insufficiency

in IPD responsive to levodopa

36

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

Bottom Line

Optometric Vision Therapy is the most efficacious treatment available for binocular vision disorders and the

treatment effects are long lasting Neuro-enhancing drugs

may assist us as well

37

EF Learning related vision anomalies Vision

developmentperception disorders

hellipresearch includes an examination of the role vision plays in

reading the effect of oculomotor vergence and

accommodativecoherent motion therapy on reading eye movements

and reading speed the diagnosis and treatment of perceptual

disorders and the effect of therapy on various learning anomalies

38

EF Learning related vision anomalies Vision developmentperception disorders

magnocellular (MC) deficit in dyslexia

LM speed-matching ratio predicts reading in childrenChase C Dougherty RF Ray N

Fowler S Stein JOptom Vis Sci 2007 Mar84(3)229-36

Effect of attention therapy on reading comprehension Solan HA Shelley-Tremblay J

Ficarra A Silverman M Larson S J Learn Disabil 2003 Nov-Dec36(6)556-63

Is there a common linkage among reading comprehension visual attention and

magnocellular processing Solan HA Shelley-Tremblay JF Hansen PC Larson S

J Learn Disabil 2007 May-Jun40(3)270-8

Lawton T Filtered Text and Direction Discrimination Training Improved Reading

Fluency for Both Dyslexic and Normal Readers Optom Vis Dev 200839 (3)114

Fischer B Hartnegg K Saccade control in dyslexia Development deficits training

and transfer to reading Optom Vis Dev 200839(4)181-190

39

EF Learning related vision anomalies Vision developmentperception disorders

J Learn Disabil 2003 Nov-Dec36(6)556-63 Effect of attention therapy on reading

comprehension Solan HA Shelley-Tremblay J Ficarra A Silverman M Larson S

hellip At the completion of attention therapy the mean

standard attention and reading comprehension scores of

the experimental group had improved significantly The

control group however showed no significant

improvement in reading comprehension scores after 12

weeks Although uncertainties still exist this investigation

supports the notion that visual attention is malleable and

that attention therapy has a significant effect on reading

comprehension in this often neglected population

40

VII Vision dysfunction association with acquired brain injury

A Exotropia (or high exophoriaCI)

B Accommodative dysfunction

C Convergence insufficiency

41

D Decreased blink rate

E Spatial disorientation

F Pursuitsaccade dysfunction

G Unstable ambient vision (Magnocellular pathway)

42

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Stelmack JA Frith T Van Koevering D Rinne S Stelmack TR Visual function in patients

followed at a Veterans Affairs polytrauma network site an electronic medical record review

Optometry 2009 Aug80(8)419-24

RESULTS Visual symptoms were self-reported by 76 of patients

with polytrauma and 75 of the patients with TBI Problems with reading

(polytrauma 60 and TBI 50) and accommodation (polytrauma 30 and

TBI 47) were frequently found on eye examinations Spectacles were the

treatment most frequently prescribed (polytrauma 62 and TBI 78)

CONCLUSIONS It is important for optometrists to be aware of the high

rates of self-reported symptoms and visual problems in military personnel

returning from deployment to the wars in Iraq and Afghanistan Post-

traumatic stress disorder and depression may complicate optometric

evaluation and management

43

VII Vision dysfunction association with acquired brain injury

Avoidance of near tasks

Oculomotor-based reading difficulties

Eye tracking problems

Eye focusing problems

Eyestrain Diplopia

Dizziness Vertigo

Vision-derived nausea

44

VII Vision dysfunction association with acquired brain injury

Increased sensitivity to visual motion

Visual inattention and distractibility

Short-term visual memory loss

Difficulty judging distances (relative and absolute

Difficulty with global scanning

Difficulty with personal grooming especially involving the face

Inability to interactcope visually in a complex social situation

(eg minimal eye contact)

Inability to tolerate complex visual environments (eg grocery store

aisles and highly-patterned floors)

45

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Ciuffreda KJ Ludlam DP Kapoor N Clinical oculomotor training in traumatic brain injury Optom Vis

Dev 200940(1)16-23

Individuals with traumatic brain injury present with a constellation of

oculomotor dysfunctions and correlated symptoms Simple and

effective clinical oculomotor-based training procedures will be

presented with respect to the versional vergence and

accommodative systems and their interactions These therapeutic

procedures can also be applied as needed to individuals with either

low vision neurological dysfunctions or general visual skills cases

manifesting similar oculomotor deficits

46

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Leslie S Myopia and accommodative insufficiency associated with

moderate head trauma Opt Vis Dev 200940(1)25-31

The majority of subjects reviewed had developed a stable degree of

myopia between 100 and 200 diopters as well as an abnormally

high lag of accommodation When their distance and near spatial area

of focus was compared the majority were focused at an intermediate

area in space suggesting a loss of control of accommodation in

space

47

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

B Drugs

C Exercise

D Learning new and challenging things

48

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements

prevent cognitive decline A systematic review of randomized controlled trials J Hum

Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among

preterm infants attributable to early supplementation of human milk with

docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings

and structural-functional synergies with cell membrane phospholipids Altern Med Rev

2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function

Neuroscience 20089(7)568-78

49

VIII Improving Brain Function and Neuroplasticity

B Drugs Maya Vetencourt JF Sale A Viegi A et al The antidepressant

fluoxetine (PROZAC) restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the

antidepressant tianeptine CNS Drugs 200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances

hippocampal long-term potentiation and memory BMC Biol 2008 Sep

9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine

improves neuropsychological disorders in a child with creatine

transporter defect Neurocase 200814(2) 151-61

50

VIII Improving Brain Function and Neuroplasticity

C Exercise

Hunsberger JG et al Antidepressant actions of the exercise-

regulated gene VGF Nat Med 2007 Dec 2 131476

VGF may be a common pathway by which exercise induces

neuroplasticity and growth-factor genes at least one of these might act

similarly to antidepressants in promoting an adaptive response to stress

However the tests used here may be modeling stress-induced

helplessness not depression hellipexercise seems to induce multiple

interacting genes that enhance neuronal resilience

51

VIII Improving Brain Function and Neuroplasticity

D Learning new and challenging things

What have we (optometry amp ophthalmology)

been thinking all these years

Where did we miss the news about neuroplasticity

52

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Huang JC Neuroplasticity as a proposed mechanism for the efficacy of optometric vision therapy and rehabilitation J Bev Optom 200920(4)96-100

Homologous area adaptationCompensatory masqueradeCross-modal reassignment

Map expansion

EquipotentialityVicariation

53

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Homologous area adaptation a transfer of function from a damaged brain area to a non-damaged brain area May be limited to early stages of human development and may crowd a new brain area resulting in reduced functionality of that brain area (Competition between spatial amp verbal functioning)

54

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Compensatory masquerade reorganizing of existing neuro-pathways to us alternative cognitive strategies to perform a task

55

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Cross-modal reassignment using new sensory input in a brain structure deprived of its main input source (changing processing from visual to tactile stimuli in the blind)

56

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Map expansion increase in brain mass due to repeated behavior or exposure to stimuli

57

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Equipotentiality anatomical areas of the brain can perform disparate functions

Vicariation redundant neural systems can operate under abnormal conditions

This may explain why recovery is noted for many neurological conditions (degenerative psychiatric developmental vascular traumatic)

58

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Constraint therapy Use it and improve it

Patching penalization ldquonear activitiesrdquo during amblyopia therapy

59

IX Improving Brain Function and Neuroplasticity Optometric Clinical ApplicationsOptometric Vision Therapy

Kleim amp Jones

Use it or lose it If you do not drive specific brain functions

functional loss will occur

If you want to improve oculomotor brain neuroplastic function amp

structure therapy should be specific for that brain function

Use it and improve it Therapy that drives cortical function enhances

that particular function

If you use therapy to improve oculomotor dysfunction it should

improve

Specificity The therapy you choose determines the resultant

plasticity and function

You must choose therapy that is appropriate

60

IX Improving Brain Function and Neuroplasticity Optometric Clinical Applications

Kleim amp Jones

Repetition matters Plasticity that results in functional change

requires repetition

Do the therapy Do it again Do it yet again No quick fix

Intensity matters Induction of plasticity requires the appropriate

amount of intensity

Intensity means strength force concentration power and passion

Without these plasticity may not occur Function may not improve

Time matters Different forms of plasticity take place at different

times during therapy

Do the basics than the more advanced therapeutic procedures

61

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Salience matters It has to be important to the individual

Make the therapy matter to the patient

Age matters Plasticity is easier in a younger brain but is also

possible in an adult brain

Do not let age determine what therapy options you offer your

patients Think of Susan Barry PhD (StereoSue) and her success

Offer your patients options Let them choose Be realistic about

outcomeshelliphave outcome measures built into therapy program

62

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Transference Neuroplasticity and the change in function

that results from one therapy can augment the attainment

of similar behaviors

What you do during oculomotor therapy may affected

vergence therapy outcomes

Interference Plasticity in response to one experience can

interfere with the acquisition of other behaviors

Monitor Evaluate progress Discuss function in other areas

of your patientslsquo life

63

Why pay attention to binocular vision dysfunctions

and neuroplasticity

December 2009 issue of the Review of Optometry

The Binocular Vision Dysfunction Pandemic

In 2010 almost 170 million individuals will be wearing glasses In

2010 there will also be up to 93 million amblyopes and 12 and a half

million strabismics For children under 18 years of age that means

there will be more than 22 and a half million amblyopes and millions

of children with strabismus A clinical trial to determine the

prevalence of binocular vision dysfunction within the general

population suggested the possibility of up to 56 or 173 million men

women and children with symptoms associated with a binocular

vision dysfunction 189 million (61) with accommodative problems

and 118 million (38) demonstrating various vergence

anomalies

64

65

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Brain plasticity life long changes in the structure of the brain

Sensory substitution replacement of one sensory input by another

Measurement techniques

Voxel based morphometryhellipmeasures difference in brain volume

Fluorodeoxyglucose glucose analog PET scan tells you

distribution and metabolism of brain

Cortical thickness measures

Visual cortex of the blind turns somatic ―The eye of the tongue

Transcranial magnetic stmiulation non-invasive technique to

stimulate cortex

66

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Blind Braille readers report tingling in fingers when pressure

phosphenes are applied Blind feel tingling in tongue

Bind use tongue to perform orientation task motion perception

sensory perception Visual cortex recruited in a variety of sensory

and cognitive tasks (DM Can we use tongue as a VT tool)

Dilks Reorganizations of human adult visual system

When a region of sensory cortex is deprived of its bottom up

input the deprived region begins to respond to stimuli that

normally activate adjacent cortex

67

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Retinotopic map changes for stroke pts Cortical reorganization in

adults occurs Perceived objectshellipelongation in stroke amp AMD

What happens to deprived cortex in AMD

fMRI shows cortical reorganization in adults

Proposed mechanisms

hellipGrowth of new connections

hellipUnmasking of pre-existing connections this is true

happens within seconds

Bavelier

Action video games

68

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Bavelier

Action video games Looked at attention Gamers can track more

activities

Attention over space (me peripheral awarenress) Useful field

of view shrinks with age

Performance not VA relatedhellipis related to attention

Action game playing changes spatial resolutionhellipovercoming

crowding in VA assessment (me amblyopia therapy)

Temporal resolution of vision Backward masking

changehellipbrain changes

Visual sensitivity (contrast sensitivity) Post action game training

improves CSF

69

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Action video games correcting optics of the cortex (me this is

actualy OVT)

Games factor

Variable entry leanringhellipadapt task to skill level

Incremental learning tune task to subjectlsquos leanring steps

Motivationarousal

Rewards

Self masterself confidence

Action games factors

Pacingrate of exposure to infohellipincreasing processing speed

Dynamic display

Rich environment

Rich motor involvement

70

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Surgeons may be made to play action games

Pilot training

Amblyopia tx Dennis Levi research

PresenterTitle Contact info

Neuroplasticity-A Paradigm Sea Change

This presentation is available at

httpwwwslidesharenetDMAINOneuroplasticity-a-paradigm-sea-change-2459693

httpwwwmainosmemosblogspotcom

My FaceBook Page

and

Twitter

PresenterTitle Contact info

Questions About

Neuroplasticity-A Paradigm Sea Change

Dominick M Maino OD MEd FAAO FCOVD-A

Professor PediatricsBinocular VisionIllinois Eye InstituteIllinois College of Optometry

dmainoicoeduhttpwwwMainosMemosblogspotcom

Thanks to

httpwwwcovdorgHomeOVDJournalOVD401tabid263D

efaultaspx

httpbipolarblastfileswordpresscom200908neurojpg

httpwwwspecialcheerscomimagesanimated_braingif

httpblogmarsdencartoonscomwp-

contentuploads200810frankenstein-myspace-lightbeergif

httpwwwshangralafamilyfuncomgala-ecalvindreamgif

httppsychiatryjwatchorgcgicontentfull20082251

73

Chakraborty R Chatterjee A Choudhart S Chakraborty PK Neuroplasticitymdasha paradigm shift in neurosciences J Indian Med Assoc

2007105(9)513-4516-8520-1

Sacks O A neurologistlsquos notebook Stereo Sue Why two eyes are better than one The New Yorker 2006 Jun 1964-73

Krulwich R National Public Radio Going Binocular Susanlsquos First Snowfall Available at

wwwnprorgtemplatesstorystoryphpstoryId=5507789 (Accessed December 8 2008)

Press LJ The story behind Stereo Suelsquo and a world-famous neurologistlsquos discovery of vision therapy Optom Vis Dev 200637(2) 55-7

Levin HS Neuroplasticity and brain imaging research implications for rehabilitation Arch Phys Med Rehabil 2006 Dec87(12 Suppl

2)S1

Wiesel TN Hubel DH Single-cell responses in striate cortex of kittens deprived of vision in one eye J Neurophysiol 1963

Nov261003-17

Hook BM Chen C Critical periods in the visual system Changing views for a model of experience-dependent plasticity Neuron 2007

Oct56(2)312-26

Ramey CT Ramey SL Prevention of intellectual disabilities early interventions to improve cognitive development Prev Med 1998

Mar-Apr27(2)224-32

Heuninckx S Wenderoth N Swinnen SP Systems neuroplasticity in the aging brain recruiting additional neural resources for

successful motor performance in elderly persons J Neurosci 2008 Jan 228(1)91-9

Ge S Yang CH Hsu KS et al A critical period for enhanced synaptic plasticity in newly generated neurons of the adult brain Neuron

2007 May54(4)559-66

74

Draganski B Gaser C Busch V et al Neuroplasticity changes in grey matter induced by training Nature 2004 Jan 22427(6972)

311-2

Cannonieri GC Bonilha L Fernandes PT et al Practice and perfect length of training and structural brain changes in experienced

typists Neuroreport 2007 Jul 218(10)1063-6

Kleim JA Jones TA Principles of experience-dependent neural plasticity implications for rehabilitation after brain damage J

Speech Lang Hear Res 2008 Feb51(1)S225-39

Trojan S Porkorny J Theoretical aspects of neuroplasticity Physiol Res 199948(2)87-97

Ramamirtham R Kee CS Hung LF et al Wave aberrations in rhesus monkeys with vision-induced ametropias Vision Res 2007

Sep47(21)2751-66

Smith EL 3rd Ramamirtham R Qiao-Grider Y et al Effects of foveal ablation on emmetropization and form-deprivation myopia

Invest Ophthalmol Vis Sci 2007 Sep48(9)3914-22

Smith EL 3rd Kee CS Ramamirtham R et al Peripheral vision can influence eye growth and refractive development in infant

monkeys Invest Ophthalmol Vis Sci 2005 Nov46(11)3965-72

Ciuffreda KJ Vasudevan B Nearwork-induced transient myopia (NITM) and permanent myopiandashndashis there a link Ophthalmic

Physiol Opt 2008 Mar28(2)103-14

Hung GK Ciuffreda KJ Incremental retinal-defocus theory of myopia development--schematic analysis and computer simulation

Comput Biol Med 2007 Jul37(7)930-46

Hung GK Ciuffreda KJ A unifying theory of refractive error development Bull Math Biol 2000 Nov62(6)1087-108

75

Pang Y Maino D Zhang G Lu F Myopia Can its progress be controlled Optom Vis Dev 200637(2)75-9

Leung JT Brown B Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lenses Optom Vis Sci

1999 Jun76(6)346-54

Hasebe S Ohtsuki H Nonaka T et al Effect of progressive addition lenses on myopia progression in Japanese children a prospective

randomized double-masked crossover trial Invest Ophthalmol Vis Sci 2008 Jul49(7)2781-9

Gwiazda J Hyman L Hussein M et al A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression

of myopia in children Invest Ophthalmol Vis Sci 2003 Apr44(4)1492-500

Siatkowski RM Cotter SA Crockett RS et al Two-year multi-center randomized double-masked placebo-controlled parallel safety and

efficacy study of 2 pirenzepine ophthalmic gel in children with myopia J AAPOS 2008 Aug12(4)332-9

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged 7 to 17 years Arch Ophthalmol 2005

Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three to less than 10 years of age Am J

Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction Am J Ophthalmol 2007

Jun143(6)1060-3

Holmes JM Edwards AR Beck RW et al A randomized pilot study of near activities versus non-near activities during patching therapy for

amblyopia J AAPOS 2005 Apr9(2)129-36

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate

amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-57

76

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic

amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Convergence Insufficiency Treatment Trial Study Group Randomized clinical trial of treatments for symptomatic convergence insufficiency

in children Arch Ophthalmol 2008 Oct126(10)1336-49

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

Solan HA Shelley-Tremblay J Hansen PC et al M-cell deficit and reading disability a preliminary study of the effects of temporal vision-

processing therapy Optometry 2004 Oct75(10)640-50

Solan HA Larson S Shelley-Tremblay J et al Role of visual attention in cognitive control of oculomotor readiness in students with reading

disabilities J Learn Disabil 2001 Mar-Apr34(2)107-18

Gallaway M Boas MB The impact of vergence and accommodative therapy on reading eye movements and reading speed Optom Vis Dev

200738(3)115-20

Goss DA Downing DB Lowther AH et al The effect of HTS vision therapy conducted in a school setting on reading skills in third and

fourth grade students Optom Vis Dev 200738(1)27-32

Crutch SJ Warrington EK Foveal crowding in posterior cortical atrophy a specific early-visual-processing deficit affecting word reading

Cogn Neuropsychol 2007 Dec24(8)843-66

Helms D Sawtelle SM A study of the effectiveness of cognitive therapy delivered in a video game format Optom Vis Dev 200738 (1)19-

26

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

77

Lawton T Training direction-discrimination sensitivity remediates a wide spectrum of reading skills OptomVis Dev 200738(1) 33-47

Goldstand S Koslowe KC Parush S Vision visual-information processing and academic performance among seventh-grade schoolchildren a

more significant relationship than we thought Am J Occup Ther 2005 Jul-Aug59(4)377-89

Fischer B Koumlngeter A Hartnegg K Effects of daily practice on subitizing visual counting and basic arithmetic skills Optom Vis Dev

200839(1)30-4

Sands W Taub M Maino D Limited research and education on special populations in optometry and ophthalomology Optom Vis Dev

200839(2)60-1

Wesson M Maino D Oculo-visual findings in Down syndrome cerebral palsy and mental retardation with non-specific etiology In Maino D

(ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 199517-54 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

Cui Y Stapleton F Suttle C Developing an instrument to assess vision-related and subjective quality of life in children with intellectual

disability data collection and preliminary analysis in a Chinese population Ophthal Physiolog Optics 2008 May28(3) 238-46

Maino D Steele G Tahir S Sajja R Attitudes of optometry students toward individuals with disabilities Optom Ed 200227(2)45-50

Maino D Special populations in the optometric curriculum Optom Ed 200227(2)38-9

Maino D Overview of special populations In Scheiman M Rouse M (eds) Optometric Management of Learning-Related Vision Problems

St Louis Mosby Inc 200685-106

Maino D (ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 1995 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

78

McCarthy P Maino D Alport syndrome a review Clin Eye Vis Care 2000 Dec12(3-4)139-50

Block SS Brusca-Vega R Pizzi WJ et al Cognitive and visual processing skills and their relationship to mutation size in full and

permutation female fragile X carriers Optom Vis Sci 2000 Nov77 (11)592-9

Maino D The young child with developmental disabilities An introduction to mental retardation and genetic syndromes In Moore BD

(ed) Eye Care for Infants and Young Children Butter-worth--Heinemann Newton MA1997285-300

Amin V Maino D The Fragile X female Visual visual perceptual and ocular health anomalies J Am Optom Assoc 1995 May66

(5)290-95

Maino DM Maino JH Cibis GW Hecht F Ocular health anomalies in patients with developmental disabilities In Maino D (ed)

Diagnosis and Management of Special Populations Mosby-Year-book Inc St Louis MO 1995189-206 Reprinted Optometric

Education Program Foundation Santa Anna Calif 2001

Maino D Wesson M Schlange D Cibis G Maino J Optometric findings in the fragile X syndrome Optom Vis Sci 199168634-40

Scheiman MMOptometric findings in children with cerebral palsy Am J Optom Physiol Opt 1984 May61(5)321-3

Maino D Maino J Maino S Mental retardation syndromes with associated ocular defects J Am Optom Assoc 199061707-16

Stewart RE Woodhouse JM Cregg M Pakeman VH Association between accommodative accuracy hypermetropia and strabismus in

children with Downs syndrome Optom Vis Sci 2007 Feb84(2)149-55

Cregg M Woodhouse JM Pakeman VH et al Accommodation and refractive error in children with Down syndrome cross-sectional

and longitudinal studies Invest Ophthalmol Vis Sci 2001 Jan42 (1)55-63

79

McClelland JF Parkes J Hill N et al Accommodative dysfunction in children with cerebral palsy a population-

based study Invest Ophthalmol Vis Sci 2006 May47(5)1824-30

Duckman RH Vision therapy for the child with cerebral palsy J Am Optom Assoc 198758(1)28-35

Duckman R Accommodation in cerebral palsy function and remediation J Am Optom Assoc 198455(4)281-3

Scheiman M Understanding and managing vision deficits a guide for occupational therapists 2nd ed Slack

Thorofare NJ 2002

Maino D Binasal occlusion for the child with Cerebral Palsy J Ill Optom Assoc 198644(1)1218

Battaglia F Quartarone A Rizzo V et al Early impairment of synaptic plasticity in patients with Downs syndrome

Neurobiol Aging 2008 Aug29(8)1272-5

Bonnier C Evaluation of early stimulation programs for enhancing brain development Acta Paediatr 2008

Jul97(7)853-8

Morice E Andreae LC Cooke SF et al Preservation of long-term memory and synaptic plasticity despite short-term

impairments in the Tc1 mouse model of Down syndrome Learn Mem 2008 Jul 1415(7)492-500

Gordon AM Schneider JA Chinnan A Charles JR Efficacy of a hand-arm bimanual intensive therapy (HABIT) in

children with hemiplegic cerebral palsy a randomized control trial Dev Med Child Neurol 2007 Nov49(11)830-8

Kapoor N Ciuffreda KJ Vision disturbances following traumatic brain injury Curr Treat Options Neurol 2002

Jul4(4)271-80

80

Ciuffreda KJ Rutner D Kapoor N et al Vision therapy for oculomotor dysfunctions in acquired brain injury a

retrospective analysis Optometry 2008 Jan79(1)18-22

Ciuffreda KJ Han Y Kapoor N Ficarra AP Oculomotor rehabilitation for reading in acquired brain injury

NeuroRehabilitation 200621(1)9-21

Zost M Diagnosis and management of visual dysfunction in cerebral injury In Maino D (ed) Diagnosis and

Management of Special Populations Mosby-Yearbook Inc St Louis 199579 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001 [Figure used with permission of the editor]

DeGutis JM Bentin S Robertson LC DEsposito M Functional plasticity in ventral temporal cortex following

cognitive rehabilitation of a congenital prosopagnosic J Cogn Neurosci 2007 Nov19 (11)1790-802

Welbourne SR Ralph MA Exploring the impact of plasticity-related recovery after brain damage in a connectionist

model of single-word reading Cogn Affect Behav Neurosci 2005 Mar5(1)77-92

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements prevent cognitive decline A

systematic review of randomized controlled trials J Hum Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among preterm infants attributable to early

supplementation of human milk with docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings and structural-functional

synergies with cell membrane phospholipids Altern Med Rev 2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function Neuroscience 20089(7)568-78

81

Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

BMC Biol 2008 Sep 9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine improves neuropsychological disorders in a child with

creatine transporter defect Neurocase 200814(2) 151-61

Forrester LW Wheaton LA Luft AR Exercise-mediated locomotor recovery and lower-limb neuroplasticity after

stroke J Rehabil Res Dev 200845(2)205-20

82

Page 19: Neuroplasticity: A Paradigm Sea Change Latest Updated File

B Examples of Changes in Function and Structure

1) Jugglers

2) Typists

19

B Examples of Changes in Function and Structure

1) Jugglers

One study suggested that adults taught how to juggle demonstrated a

significant transient bilateral expansion of gray matter in the mid-

temporal area and the left posterior intraparietal sulcus between baseline brain scan and

follow-up The findings were specific to training stimulus individuals who were

not instructed how to juggle demonstrated no change in gray

matter over the same period These findings oppose the conventional

understanding that the anatomical structure of the adult brain does not change

over time

20

B Examples of Changes in Function and Structure

2) Typists

helliplong-term bimanual training also increases

gray matter volume in experienced adult typists

These results suggest that learning not

only affects function but also structure in

adult brains

21

V Neuroplasticity and Optometry

A Evolutionary neuroplasticity

B Reactive plasticity

C Adaptational plasticity

D Reparation plasticity

22

V Neuroplasticity and Optometry

A Evolutionary neuroplasticity

hellip is ideally suited for the developmental OD who

specializes in vision function as it changes over time

either with or without intervention

23

V Neuroplasticity and Optometry

B Reactive plasticity

hellip can be thought of as the immediate effect that

initial optometric treatment may have on a system This can

be reflected in an immediate but often transient change in

the individuallsquos accommodative systemmdashie when an

uncorrected myope initially puts on his or her new

spectacles

24

V Neuroplasticity and Optometry

C Adaptational plasticity

hellip could describe the long-term effects of in-office optometric

vision therapy on disorders of the binocular vision system

25

V Neuroplasticity and Optometry

D Reparation plasticity

hellipin contrast to adaptational

plasticity reparation plasticity may

occur during treatment by a low

Vision specialist or an OD

Working with those who have

Experienced a traumatic brain

injury (TBI)

26

V Neuroplasticity and Optometry

The effects of plasticity can lead to either

positive or negative changes during

development (evolutionary plasticity) after

short-term exposure (reactive plasticity)

after long-term or continuous stimuli

(adaptational plasticity) and during

functional or structural recovery of damaged

neuronal circuits (reparation plasticity)

httpwwwciteulikeorguserjasonepriorarticle2856526

27

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

A Refractive error development

B Amblyopia

C Strabismus

28

D Non-strabismus non-amblyopic binocular vision disorders

E Learning related vision anomalies

F Vision developmentperception disorders

29

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

A Refractive error development

Several recent studies have noted that neuroplasticity may play a

role in refractive error development

retinal defocus use of progressive addition lenses

drug studies (M1-antagonist2 pirenzepine ) slow myopia

progression demonstrated nearly a 50 reduction in myopia

progression over a two-year period

30

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged

7 to 17 years Arch Ophthalmol 2005 Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three

to less than 10 years of age Am J Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction

Am J Ophthalmol 2007 Jun143(6)1060-3

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine

vs patching for treatment of moderate amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-

57

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for

strabismic and anisometropic amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Treatment of severe amblyopia with weekend atropine results from 2 randomized clinical trials

Levodopacarbidopa in the treatment of amblyopia

31

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

J Pediatr Ophthalmol Strabismus 2009 Mar-Apr46(2)87-90 quiz 91-2 Levodopacarbidopa in the

treatment of amblyopia Dadeya S Vats P Malik KP

PURPOSE To evaluate the role of levodopacarbidopa in the treatment of amblyopia METHODS

Thirty patients with strabismic amblyopia between the ages of 3 and 12 years were part of this double-

blind randomized study Patients were divided into two groups Group A received 050 mg + 125 mg of

levodopacarbidopa per kilogram body weight three times daily after meals with a protein rich drink

whereas Group B received placebo Both groups received full-time conventional occlusion until a visual

acuity of 66 was achieved or for a maximum of 3 months RESULTS The authors observed more than

two lines improvement in visual acuity that was greater in the levodopa group (15 of 15) than in the

placebo group (9 of 15) (P lt 005) Furthermore improvement in visual acuity of more than two lines

was greater in patients younger than 8 years (100) than in patients older than 8 years of age (60) (P =

0026) There was also no significant reversal of the improved visual acuity in up to 6 months of follow-

up CONCLUSION Levodopacarbidopa improves visual acuity in patients with

amblyopia and maintains improved visual acuity especially in patients

younger than 8 years

32

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

J Pediatr Ophthalmol Strabismus 2008 May-Jun45(3)174-6 The use of levodopa in the treatment of

bilateral amblyopia secondary to uncorrected high hypermetropia Abrams MS

The standard treatment of bilateral amblyopia secondary to uncorrected high bilateral hypermetropia has

been spectacles and time The patient described here failed to show adequate improvement in visual

acuity after 18 months of standard treatment Visual acuity improved dramatically when the

patient began taking levodopa dropped precipitously when the medication was

discontinued and returned quickly to post-treatment levels when levodopa was

restarted Visual acuity remained stable when the medication was slowly tapered

and discontinued This report suggests that dopamine may play a role in the pathophysiology of

bilateral amblyopia secondary to uncorrected high bilateral hypermetropia

33

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

Bottom Line

Amblyopia can be treated at any age

May be able to use neuro-enhancing drugs

as a part of basic amblyopia therapy

34

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

C Strabismus and non-strabismic non-amblyopic binocular

vision disorders

Clinical Trial of Treatments for Symptomatic Convergence Insufficiency in Children has

clearly demonstrated the superiority of in-office optometric vision therapy (in conjunction

with home therapy) vs out-of-office therapy alone The study concluded that optometric

vision therapyorthoptics was more effective than pencil push-ups or placebo vision

therapyorthoptics in reducing symptoms and improving clinical signs of convergence

insufficiency

Long-term effectiveness of treatments for symptomatic convergence insufficiency

in children (Optom Vis Sci 2009 Sep86(9)1096-103)

CITT patients improvements lasted a year

35

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

Strabismus 1999 Sep7(3)169-74 Convergence insufficiency in

idiopathic Parkinsons disease responsive to levodopa Racette BA

Gokden MS Tychsen LS Perlmutter JS

We report a patient with pathologically proven idiopathic Parkinsons

disease (IPD) who developed diplopia secondary to convergence

insufficiency during his motor off periods Diplopia resolved with

onset of motor benefit from levodopa Neuro-ophthalmologic

examination demonstrated convergence insufficiency during motor

off periods that was alleviated after onset of motor benefit from

levodopa This is the first reported case of convergence insufficiency

in IPD responsive to levodopa

36

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

Bottom Line

Optometric Vision Therapy is the most efficacious treatment available for binocular vision disorders and the

treatment effects are long lasting Neuro-enhancing drugs

may assist us as well

37

EF Learning related vision anomalies Vision

developmentperception disorders

hellipresearch includes an examination of the role vision plays in

reading the effect of oculomotor vergence and

accommodativecoherent motion therapy on reading eye movements

and reading speed the diagnosis and treatment of perceptual

disorders and the effect of therapy on various learning anomalies

38

EF Learning related vision anomalies Vision developmentperception disorders

magnocellular (MC) deficit in dyslexia

LM speed-matching ratio predicts reading in childrenChase C Dougherty RF Ray N

Fowler S Stein JOptom Vis Sci 2007 Mar84(3)229-36

Effect of attention therapy on reading comprehension Solan HA Shelley-Tremblay J

Ficarra A Silverman M Larson S J Learn Disabil 2003 Nov-Dec36(6)556-63

Is there a common linkage among reading comprehension visual attention and

magnocellular processing Solan HA Shelley-Tremblay JF Hansen PC Larson S

J Learn Disabil 2007 May-Jun40(3)270-8

Lawton T Filtered Text and Direction Discrimination Training Improved Reading

Fluency for Both Dyslexic and Normal Readers Optom Vis Dev 200839 (3)114

Fischer B Hartnegg K Saccade control in dyslexia Development deficits training

and transfer to reading Optom Vis Dev 200839(4)181-190

39

EF Learning related vision anomalies Vision developmentperception disorders

J Learn Disabil 2003 Nov-Dec36(6)556-63 Effect of attention therapy on reading

comprehension Solan HA Shelley-Tremblay J Ficarra A Silverman M Larson S

hellip At the completion of attention therapy the mean

standard attention and reading comprehension scores of

the experimental group had improved significantly The

control group however showed no significant

improvement in reading comprehension scores after 12

weeks Although uncertainties still exist this investigation

supports the notion that visual attention is malleable and

that attention therapy has a significant effect on reading

comprehension in this often neglected population

40

VII Vision dysfunction association with acquired brain injury

A Exotropia (or high exophoriaCI)

B Accommodative dysfunction

C Convergence insufficiency

41

D Decreased blink rate

E Spatial disorientation

F Pursuitsaccade dysfunction

G Unstable ambient vision (Magnocellular pathway)

42

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Stelmack JA Frith T Van Koevering D Rinne S Stelmack TR Visual function in patients

followed at a Veterans Affairs polytrauma network site an electronic medical record review

Optometry 2009 Aug80(8)419-24

RESULTS Visual symptoms were self-reported by 76 of patients

with polytrauma and 75 of the patients with TBI Problems with reading

(polytrauma 60 and TBI 50) and accommodation (polytrauma 30 and

TBI 47) were frequently found on eye examinations Spectacles were the

treatment most frequently prescribed (polytrauma 62 and TBI 78)

CONCLUSIONS It is important for optometrists to be aware of the high

rates of self-reported symptoms and visual problems in military personnel

returning from deployment to the wars in Iraq and Afghanistan Post-

traumatic stress disorder and depression may complicate optometric

evaluation and management

43

VII Vision dysfunction association with acquired brain injury

Avoidance of near tasks

Oculomotor-based reading difficulties

Eye tracking problems

Eye focusing problems

Eyestrain Diplopia

Dizziness Vertigo

Vision-derived nausea

44

VII Vision dysfunction association with acquired brain injury

Increased sensitivity to visual motion

Visual inattention and distractibility

Short-term visual memory loss

Difficulty judging distances (relative and absolute

Difficulty with global scanning

Difficulty with personal grooming especially involving the face

Inability to interactcope visually in a complex social situation

(eg minimal eye contact)

Inability to tolerate complex visual environments (eg grocery store

aisles and highly-patterned floors)

45

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Ciuffreda KJ Ludlam DP Kapoor N Clinical oculomotor training in traumatic brain injury Optom Vis

Dev 200940(1)16-23

Individuals with traumatic brain injury present with a constellation of

oculomotor dysfunctions and correlated symptoms Simple and

effective clinical oculomotor-based training procedures will be

presented with respect to the versional vergence and

accommodative systems and their interactions These therapeutic

procedures can also be applied as needed to individuals with either

low vision neurological dysfunctions or general visual skills cases

manifesting similar oculomotor deficits

46

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Leslie S Myopia and accommodative insufficiency associated with

moderate head trauma Opt Vis Dev 200940(1)25-31

The majority of subjects reviewed had developed a stable degree of

myopia between 100 and 200 diopters as well as an abnormally

high lag of accommodation When their distance and near spatial area

of focus was compared the majority were focused at an intermediate

area in space suggesting a loss of control of accommodation in

space

47

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

B Drugs

C Exercise

D Learning new and challenging things

48

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements

prevent cognitive decline A systematic review of randomized controlled trials J Hum

Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among

preterm infants attributable to early supplementation of human milk with

docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings

and structural-functional synergies with cell membrane phospholipids Altern Med Rev

2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function

Neuroscience 20089(7)568-78

49

VIII Improving Brain Function and Neuroplasticity

B Drugs Maya Vetencourt JF Sale A Viegi A et al The antidepressant

fluoxetine (PROZAC) restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the

antidepressant tianeptine CNS Drugs 200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances

hippocampal long-term potentiation and memory BMC Biol 2008 Sep

9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine

improves neuropsychological disorders in a child with creatine

transporter defect Neurocase 200814(2) 151-61

50

VIII Improving Brain Function and Neuroplasticity

C Exercise

Hunsberger JG et al Antidepressant actions of the exercise-

regulated gene VGF Nat Med 2007 Dec 2 131476

VGF may be a common pathway by which exercise induces

neuroplasticity and growth-factor genes at least one of these might act

similarly to antidepressants in promoting an adaptive response to stress

However the tests used here may be modeling stress-induced

helplessness not depression hellipexercise seems to induce multiple

interacting genes that enhance neuronal resilience

51

VIII Improving Brain Function and Neuroplasticity

D Learning new and challenging things

What have we (optometry amp ophthalmology)

been thinking all these years

Where did we miss the news about neuroplasticity

52

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Huang JC Neuroplasticity as a proposed mechanism for the efficacy of optometric vision therapy and rehabilitation J Bev Optom 200920(4)96-100

Homologous area adaptationCompensatory masqueradeCross-modal reassignment

Map expansion

EquipotentialityVicariation

53

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Homologous area adaptation a transfer of function from a damaged brain area to a non-damaged brain area May be limited to early stages of human development and may crowd a new brain area resulting in reduced functionality of that brain area (Competition between spatial amp verbal functioning)

54

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Compensatory masquerade reorganizing of existing neuro-pathways to us alternative cognitive strategies to perform a task

55

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Cross-modal reassignment using new sensory input in a brain structure deprived of its main input source (changing processing from visual to tactile stimuli in the blind)

56

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Map expansion increase in brain mass due to repeated behavior or exposure to stimuli

57

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Equipotentiality anatomical areas of the brain can perform disparate functions

Vicariation redundant neural systems can operate under abnormal conditions

This may explain why recovery is noted for many neurological conditions (degenerative psychiatric developmental vascular traumatic)

58

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Constraint therapy Use it and improve it

Patching penalization ldquonear activitiesrdquo during amblyopia therapy

59

IX Improving Brain Function and Neuroplasticity Optometric Clinical ApplicationsOptometric Vision Therapy

Kleim amp Jones

Use it or lose it If you do not drive specific brain functions

functional loss will occur

If you want to improve oculomotor brain neuroplastic function amp

structure therapy should be specific for that brain function

Use it and improve it Therapy that drives cortical function enhances

that particular function

If you use therapy to improve oculomotor dysfunction it should

improve

Specificity The therapy you choose determines the resultant

plasticity and function

You must choose therapy that is appropriate

60

IX Improving Brain Function and Neuroplasticity Optometric Clinical Applications

Kleim amp Jones

Repetition matters Plasticity that results in functional change

requires repetition

Do the therapy Do it again Do it yet again No quick fix

Intensity matters Induction of plasticity requires the appropriate

amount of intensity

Intensity means strength force concentration power and passion

Without these plasticity may not occur Function may not improve

Time matters Different forms of plasticity take place at different

times during therapy

Do the basics than the more advanced therapeutic procedures

61

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Salience matters It has to be important to the individual

Make the therapy matter to the patient

Age matters Plasticity is easier in a younger brain but is also

possible in an adult brain

Do not let age determine what therapy options you offer your

patients Think of Susan Barry PhD (StereoSue) and her success

Offer your patients options Let them choose Be realistic about

outcomeshelliphave outcome measures built into therapy program

62

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Transference Neuroplasticity and the change in function

that results from one therapy can augment the attainment

of similar behaviors

What you do during oculomotor therapy may affected

vergence therapy outcomes

Interference Plasticity in response to one experience can

interfere with the acquisition of other behaviors

Monitor Evaluate progress Discuss function in other areas

of your patientslsquo life

63

Why pay attention to binocular vision dysfunctions

and neuroplasticity

December 2009 issue of the Review of Optometry

The Binocular Vision Dysfunction Pandemic

In 2010 almost 170 million individuals will be wearing glasses In

2010 there will also be up to 93 million amblyopes and 12 and a half

million strabismics For children under 18 years of age that means

there will be more than 22 and a half million amblyopes and millions

of children with strabismus A clinical trial to determine the

prevalence of binocular vision dysfunction within the general

population suggested the possibility of up to 56 or 173 million men

women and children with symptoms associated with a binocular

vision dysfunction 189 million (61) with accommodative problems

and 118 million (38) demonstrating various vergence

anomalies

64

65

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Brain plasticity life long changes in the structure of the brain

Sensory substitution replacement of one sensory input by another

Measurement techniques

Voxel based morphometryhellipmeasures difference in brain volume

Fluorodeoxyglucose glucose analog PET scan tells you

distribution and metabolism of brain

Cortical thickness measures

Visual cortex of the blind turns somatic ―The eye of the tongue

Transcranial magnetic stmiulation non-invasive technique to

stimulate cortex

66

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Blind Braille readers report tingling in fingers when pressure

phosphenes are applied Blind feel tingling in tongue

Bind use tongue to perform orientation task motion perception

sensory perception Visual cortex recruited in a variety of sensory

and cognitive tasks (DM Can we use tongue as a VT tool)

Dilks Reorganizations of human adult visual system

When a region of sensory cortex is deprived of its bottom up

input the deprived region begins to respond to stimuli that

normally activate adjacent cortex

67

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Retinotopic map changes for stroke pts Cortical reorganization in

adults occurs Perceived objectshellipelongation in stroke amp AMD

What happens to deprived cortex in AMD

fMRI shows cortical reorganization in adults

Proposed mechanisms

hellipGrowth of new connections

hellipUnmasking of pre-existing connections this is true

happens within seconds

Bavelier

Action video games

68

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Bavelier

Action video games Looked at attention Gamers can track more

activities

Attention over space (me peripheral awarenress) Useful field

of view shrinks with age

Performance not VA relatedhellipis related to attention

Action game playing changes spatial resolutionhellipovercoming

crowding in VA assessment (me amblyopia therapy)

Temporal resolution of vision Backward masking

changehellipbrain changes

Visual sensitivity (contrast sensitivity) Post action game training

improves CSF

69

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Action video games correcting optics of the cortex (me this is

actualy OVT)

Games factor

Variable entry leanringhellipadapt task to skill level

Incremental learning tune task to subjectlsquos leanring steps

Motivationarousal

Rewards

Self masterself confidence

Action games factors

Pacingrate of exposure to infohellipincreasing processing speed

Dynamic display

Rich environment

Rich motor involvement

70

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Surgeons may be made to play action games

Pilot training

Amblyopia tx Dennis Levi research

PresenterTitle Contact info

Neuroplasticity-A Paradigm Sea Change

This presentation is available at

httpwwwslidesharenetDMAINOneuroplasticity-a-paradigm-sea-change-2459693

httpwwwmainosmemosblogspotcom

My FaceBook Page

and

Twitter

PresenterTitle Contact info

Questions About

Neuroplasticity-A Paradigm Sea Change

Dominick M Maino OD MEd FAAO FCOVD-A

Professor PediatricsBinocular VisionIllinois Eye InstituteIllinois College of Optometry

dmainoicoeduhttpwwwMainosMemosblogspotcom

Thanks to

httpwwwcovdorgHomeOVDJournalOVD401tabid263D

efaultaspx

httpbipolarblastfileswordpresscom200908neurojpg

httpwwwspecialcheerscomimagesanimated_braingif

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contentuploads200810frankenstein-myspace-lightbeergif

httpwwwshangralafamilyfuncomgala-ecalvindreamgif

httppsychiatryjwatchorgcgicontentfull20082251

73

Chakraborty R Chatterjee A Choudhart S Chakraborty PK Neuroplasticitymdasha paradigm shift in neurosciences J Indian Med Assoc

2007105(9)513-4516-8520-1

Sacks O A neurologistlsquos notebook Stereo Sue Why two eyes are better than one The New Yorker 2006 Jun 1964-73

Krulwich R National Public Radio Going Binocular Susanlsquos First Snowfall Available at

wwwnprorgtemplatesstorystoryphpstoryId=5507789 (Accessed December 8 2008)

Press LJ The story behind Stereo Suelsquo and a world-famous neurologistlsquos discovery of vision therapy Optom Vis Dev 200637(2) 55-7

Levin HS Neuroplasticity and brain imaging research implications for rehabilitation Arch Phys Med Rehabil 2006 Dec87(12 Suppl

2)S1

Wiesel TN Hubel DH Single-cell responses in striate cortex of kittens deprived of vision in one eye J Neurophysiol 1963

Nov261003-17

Hook BM Chen C Critical periods in the visual system Changing views for a model of experience-dependent plasticity Neuron 2007

Oct56(2)312-26

Ramey CT Ramey SL Prevention of intellectual disabilities early interventions to improve cognitive development Prev Med 1998

Mar-Apr27(2)224-32

Heuninckx S Wenderoth N Swinnen SP Systems neuroplasticity in the aging brain recruiting additional neural resources for

successful motor performance in elderly persons J Neurosci 2008 Jan 228(1)91-9

Ge S Yang CH Hsu KS et al A critical period for enhanced synaptic plasticity in newly generated neurons of the adult brain Neuron

2007 May54(4)559-66

74

Draganski B Gaser C Busch V et al Neuroplasticity changes in grey matter induced by training Nature 2004 Jan 22427(6972)

311-2

Cannonieri GC Bonilha L Fernandes PT et al Practice and perfect length of training and structural brain changes in experienced

typists Neuroreport 2007 Jul 218(10)1063-6

Kleim JA Jones TA Principles of experience-dependent neural plasticity implications for rehabilitation after brain damage J

Speech Lang Hear Res 2008 Feb51(1)S225-39

Trojan S Porkorny J Theoretical aspects of neuroplasticity Physiol Res 199948(2)87-97

Ramamirtham R Kee CS Hung LF et al Wave aberrations in rhesus monkeys with vision-induced ametropias Vision Res 2007

Sep47(21)2751-66

Smith EL 3rd Ramamirtham R Qiao-Grider Y et al Effects of foveal ablation on emmetropization and form-deprivation myopia

Invest Ophthalmol Vis Sci 2007 Sep48(9)3914-22

Smith EL 3rd Kee CS Ramamirtham R et al Peripheral vision can influence eye growth and refractive development in infant

monkeys Invest Ophthalmol Vis Sci 2005 Nov46(11)3965-72

Ciuffreda KJ Vasudevan B Nearwork-induced transient myopia (NITM) and permanent myopiandashndashis there a link Ophthalmic

Physiol Opt 2008 Mar28(2)103-14

Hung GK Ciuffreda KJ Incremental retinal-defocus theory of myopia development--schematic analysis and computer simulation

Comput Biol Med 2007 Jul37(7)930-46

Hung GK Ciuffreda KJ A unifying theory of refractive error development Bull Math Biol 2000 Nov62(6)1087-108

75

Pang Y Maino D Zhang G Lu F Myopia Can its progress be controlled Optom Vis Dev 200637(2)75-9

Leung JT Brown B Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lenses Optom Vis Sci

1999 Jun76(6)346-54

Hasebe S Ohtsuki H Nonaka T et al Effect of progressive addition lenses on myopia progression in Japanese children a prospective

randomized double-masked crossover trial Invest Ophthalmol Vis Sci 2008 Jul49(7)2781-9

Gwiazda J Hyman L Hussein M et al A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression

of myopia in children Invest Ophthalmol Vis Sci 2003 Apr44(4)1492-500

Siatkowski RM Cotter SA Crockett RS et al Two-year multi-center randomized double-masked placebo-controlled parallel safety and

efficacy study of 2 pirenzepine ophthalmic gel in children with myopia J AAPOS 2008 Aug12(4)332-9

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged 7 to 17 years Arch Ophthalmol 2005

Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three to less than 10 years of age Am J

Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction Am J Ophthalmol 2007

Jun143(6)1060-3

Holmes JM Edwards AR Beck RW et al A randomized pilot study of near activities versus non-near activities during patching therapy for

amblyopia J AAPOS 2005 Apr9(2)129-36

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate

amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-57

76

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic

amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Convergence Insufficiency Treatment Trial Study Group Randomized clinical trial of treatments for symptomatic convergence insufficiency

in children Arch Ophthalmol 2008 Oct126(10)1336-49

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

Solan HA Shelley-Tremblay J Hansen PC et al M-cell deficit and reading disability a preliminary study of the effects of temporal vision-

processing therapy Optometry 2004 Oct75(10)640-50

Solan HA Larson S Shelley-Tremblay J et al Role of visual attention in cognitive control of oculomotor readiness in students with reading

disabilities J Learn Disabil 2001 Mar-Apr34(2)107-18

Gallaway M Boas MB The impact of vergence and accommodative therapy on reading eye movements and reading speed Optom Vis Dev

200738(3)115-20

Goss DA Downing DB Lowther AH et al The effect of HTS vision therapy conducted in a school setting on reading skills in third and

fourth grade students Optom Vis Dev 200738(1)27-32

Crutch SJ Warrington EK Foveal crowding in posterior cortical atrophy a specific early-visual-processing deficit affecting word reading

Cogn Neuropsychol 2007 Dec24(8)843-66

Helms D Sawtelle SM A study of the effectiveness of cognitive therapy delivered in a video game format Optom Vis Dev 200738 (1)19-

26

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

77

Lawton T Training direction-discrimination sensitivity remediates a wide spectrum of reading skills OptomVis Dev 200738(1) 33-47

Goldstand S Koslowe KC Parush S Vision visual-information processing and academic performance among seventh-grade schoolchildren a

more significant relationship than we thought Am J Occup Ther 2005 Jul-Aug59(4)377-89

Fischer B Koumlngeter A Hartnegg K Effects of daily practice on subitizing visual counting and basic arithmetic skills Optom Vis Dev

200839(1)30-4

Sands W Taub M Maino D Limited research and education on special populations in optometry and ophthalomology Optom Vis Dev

200839(2)60-1

Wesson M Maino D Oculo-visual findings in Down syndrome cerebral palsy and mental retardation with non-specific etiology In Maino D

(ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 199517-54 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

Cui Y Stapleton F Suttle C Developing an instrument to assess vision-related and subjective quality of life in children with intellectual

disability data collection and preliminary analysis in a Chinese population Ophthal Physiolog Optics 2008 May28(3) 238-46

Maino D Steele G Tahir S Sajja R Attitudes of optometry students toward individuals with disabilities Optom Ed 200227(2)45-50

Maino D Special populations in the optometric curriculum Optom Ed 200227(2)38-9

Maino D Overview of special populations In Scheiman M Rouse M (eds) Optometric Management of Learning-Related Vision Problems

St Louis Mosby Inc 200685-106

Maino D (ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 1995 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

78

McCarthy P Maino D Alport syndrome a review Clin Eye Vis Care 2000 Dec12(3-4)139-50

Block SS Brusca-Vega R Pizzi WJ et al Cognitive and visual processing skills and their relationship to mutation size in full and

permutation female fragile X carriers Optom Vis Sci 2000 Nov77 (11)592-9

Maino D The young child with developmental disabilities An introduction to mental retardation and genetic syndromes In Moore BD

(ed) Eye Care for Infants and Young Children Butter-worth--Heinemann Newton MA1997285-300

Amin V Maino D The Fragile X female Visual visual perceptual and ocular health anomalies J Am Optom Assoc 1995 May66

(5)290-95

Maino DM Maino JH Cibis GW Hecht F Ocular health anomalies in patients with developmental disabilities In Maino D (ed)

Diagnosis and Management of Special Populations Mosby-Year-book Inc St Louis MO 1995189-206 Reprinted Optometric

Education Program Foundation Santa Anna Calif 2001

Maino D Wesson M Schlange D Cibis G Maino J Optometric findings in the fragile X syndrome Optom Vis Sci 199168634-40

Scheiman MMOptometric findings in children with cerebral palsy Am J Optom Physiol Opt 1984 May61(5)321-3

Maino D Maino J Maino S Mental retardation syndromes with associated ocular defects J Am Optom Assoc 199061707-16

Stewart RE Woodhouse JM Cregg M Pakeman VH Association between accommodative accuracy hypermetropia and strabismus in

children with Downs syndrome Optom Vis Sci 2007 Feb84(2)149-55

Cregg M Woodhouse JM Pakeman VH et al Accommodation and refractive error in children with Down syndrome cross-sectional

and longitudinal studies Invest Ophthalmol Vis Sci 2001 Jan42 (1)55-63

79

McClelland JF Parkes J Hill N et al Accommodative dysfunction in children with cerebral palsy a population-

based study Invest Ophthalmol Vis Sci 2006 May47(5)1824-30

Duckman RH Vision therapy for the child with cerebral palsy J Am Optom Assoc 198758(1)28-35

Duckman R Accommodation in cerebral palsy function and remediation J Am Optom Assoc 198455(4)281-3

Scheiman M Understanding and managing vision deficits a guide for occupational therapists 2nd ed Slack

Thorofare NJ 2002

Maino D Binasal occlusion for the child with Cerebral Palsy J Ill Optom Assoc 198644(1)1218

Battaglia F Quartarone A Rizzo V et al Early impairment of synaptic plasticity in patients with Downs syndrome

Neurobiol Aging 2008 Aug29(8)1272-5

Bonnier C Evaluation of early stimulation programs for enhancing brain development Acta Paediatr 2008

Jul97(7)853-8

Morice E Andreae LC Cooke SF et al Preservation of long-term memory and synaptic plasticity despite short-term

impairments in the Tc1 mouse model of Down syndrome Learn Mem 2008 Jul 1415(7)492-500

Gordon AM Schneider JA Chinnan A Charles JR Efficacy of a hand-arm bimanual intensive therapy (HABIT) in

children with hemiplegic cerebral palsy a randomized control trial Dev Med Child Neurol 2007 Nov49(11)830-8

Kapoor N Ciuffreda KJ Vision disturbances following traumatic brain injury Curr Treat Options Neurol 2002

Jul4(4)271-80

80

Ciuffreda KJ Rutner D Kapoor N et al Vision therapy for oculomotor dysfunctions in acquired brain injury a

retrospective analysis Optometry 2008 Jan79(1)18-22

Ciuffreda KJ Han Y Kapoor N Ficarra AP Oculomotor rehabilitation for reading in acquired brain injury

NeuroRehabilitation 200621(1)9-21

Zost M Diagnosis and management of visual dysfunction in cerebral injury In Maino D (ed) Diagnosis and

Management of Special Populations Mosby-Yearbook Inc St Louis 199579 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001 [Figure used with permission of the editor]

DeGutis JM Bentin S Robertson LC DEsposito M Functional plasticity in ventral temporal cortex following

cognitive rehabilitation of a congenital prosopagnosic J Cogn Neurosci 2007 Nov19 (11)1790-802

Welbourne SR Ralph MA Exploring the impact of plasticity-related recovery after brain damage in a connectionist

model of single-word reading Cogn Affect Behav Neurosci 2005 Mar5(1)77-92

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements prevent cognitive decline A

systematic review of randomized controlled trials J Hum Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among preterm infants attributable to early

supplementation of human milk with docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings and structural-functional

synergies with cell membrane phospholipids Altern Med Rev 2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function Neuroscience 20089(7)568-78

81

Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

BMC Biol 2008 Sep 9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine improves neuropsychological disorders in a child with

creatine transporter defect Neurocase 200814(2) 151-61

Forrester LW Wheaton LA Luft AR Exercise-mediated locomotor recovery and lower-limb neuroplasticity after

stroke J Rehabil Res Dev 200845(2)205-20

82

Page 20: Neuroplasticity: A Paradigm Sea Change Latest Updated File

B Examples of Changes in Function and Structure

1) Jugglers

One study suggested that adults taught how to juggle demonstrated a

significant transient bilateral expansion of gray matter in the mid-

temporal area and the left posterior intraparietal sulcus between baseline brain scan and

follow-up The findings were specific to training stimulus individuals who were

not instructed how to juggle demonstrated no change in gray

matter over the same period These findings oppose the conventional

understanding that the anatomical structure of the adult brain does not change

over time

20

B Examples of Changes in Function and Structure

2) Typists

helliplong-term bimanual training also increases

gray matter volume in experienced adult typists

These results suggest that learning not

only affects function but also structure in

adult brains

21

V Neuroplasticity and Optometry

A Evolutionary neuroplasticity

B Reactive plasticity

C Adaptational plasticity

D Reparation plasticity

22

V Neuroplasticity and Optometry

A Evolutionary neuroplasticity

hellip is ideally suited for the developmental OD who

specializes in vision function as it changes over time

either with or without intervention

23

V Neuroplasticity and Optometry

B Reactive plasticity

hellip can be thought of as the immediate effect that

initial optometric treatment may have on a system This can

be reflected in an immediate but often transient change in

the individuallsquos accommodative systemmdashie when an

uncorrected myope initially puts on his or her new

spectacles

24

V Neuroplasticity and Optometry

C Adaptational plasticity

hellip could describe the long-term effects of in-office optometric

vision therapy on disorders of the binocular vision system

25

V Neuroplasticity and Optometry

D Reparation plasticity

hellipin contrast to adaptational

plasticity reparation plasticity may

occur during treatment by a low

Vision specialist or an OD

Working with those who have

Experienced a traumatic brain

injury (TBI)

26

V Neuroplasticity and Optometry

The effects of plasticity can lead to either

positive or negative changes during

development (evolutionary plasticity) after

short-term exposure (reactive plasticity)

after long-term or continuous stimuli

(adaptational plasticity) and during

functional or structural recovery of damaged

neuronal circuits (reparation plasticity)

httpwwwciteulikeorguserjasonepriorarticle2856526

27

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

A Refractive error development

B Amblyopia

C Strabismus

28

D Non-strabismus non-amblyopic binocular vision disorders

E Learning related vision anomalies

F Vision developmentperception disorders

29

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

A Refractive error development

Several recent studies have noted that neuroplasticity may play a

role in refractive error development

retinal defocus use of progressive addition lenses

drug studies (M1-antagonist2 pirenzepine ) slow myopia

progression demonstrated nearly a 50 reduction in myopia

progression over a two-year period

30

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged

7 to 17 years Arch Ophthalmol 2005 Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three

to less than 10 years of age Am J Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction

Am J Ophthalmol 2007 Jun143(6)1060-3

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine

vs patching for treatment of moderate amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-

57

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for

strabismic and anisometropic amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Treatment of severe amblyopia with weekend atropine results from 2 randomized clinical trials

Levodopacarbidopa in the treatment of amblyopia

31

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

J Pediatr Ophthalmol Strabismus 2009 Mar-Apr46(2)87-90 quiz 91-2 Levodopacarbidopa in the

treatment of amblyopia Dadeya S Vats P Malik KP

PURPOSE To evaluate the role of levodopacarbidopa in the treatment of amblyopia METHODS

Thirty patients with strabismic amblyopia between the ages of 3 and 12 years were part of this double-

blind randomized study Patients were divided into two groups Group A received 050 mg + 125 mg of

levodopacarbidopa per kilogram body weight three times daily after meals with a protein rich drink

whereas Group B received placebo Both groups received full-time conventional occlusion until a visual

acuity of 66 was achieved or for a maximum of 3 months RESULTS The authors observed more than

two lines improvement in visual acuity that was greater in the levodopa group (15 of 15) than in the

placebo group (9 of 15) (P lt 005) Furthermore improvement in visual acuity of more than two lines

was greater in patients younger than 8 years (100) than in patients older than 8 years of age (60) (P =

0026) There was also no significant reversal of the improved visual acuity in up to 6 months of follow-

up CONCLUSION Levodopacarbidopa improves visual acuity in patients with

amblyopia and maintains improved visual acuity especially in patients

younger than 8 years

32

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

J Pediatr Ophthalmol Strabismus 2008 May-Jun45(3)174-6 The use of levodopa in the treatment of

bilateral amblyopia secondary to uncorrected high hypermetropia Abrams MS

The standard treatment of bilateral amblyopia secondary to uncorrected high bilateral hypermetropia has

been spectacles and time The patient described here failed to show adequate improvement in visual

acuity after 18 months of standard treatment Visual acuity improved dramatically when the

patient began taking levodopa dropped precipitously when the medication was

discontinued and returned quickly to post-treatment levels when levodopa was

restarted Visual acuity remained stable when the medication was slowly tapered

and discontinued This report suggests that dopamine may play a role in the pathophysiology of

bilateral amblyopia secondary to uncorrected high bilateral hypermetropia

33

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

Bottom Line

Amblyopia can be treated at any age

May be able to use neuro-enhancing drugs

as a part of basic amblyopia therapy

34

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

C Strabismus and non-strabismic non-amblyopic binocular

vision disorders

Clinical Trial of Treatments for Symptomatic Convergence Insufficiency in Children has

clearly demonstrated the superiority of in-office optometric vision therapy (in conjunction

with home therapy) vs out-of-office therapy alone The study concluded that optometric

vision therapyorthoptics was more effective than pencil push-ups or placebo vision

therapyorthoptics in reducing symptoms and improving clinical signs of convergence

insufficiency

Long-term effectiveness of treatments for symptomatic convergence insufficiency

in children (Optom Vis Sci 2009 Sep86(9)1096-103)

CITT patients improvements lasted a year

35

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

Strabismus 1999 Sep7(3)169-74 Convergence insufficiency in

idiopathic Parkinsons disease responsive to levodopa Racette BA

Gokden MS Tychsen LS Perlmutter JS

We report a patient with pathologically proven idiopathic Parkinsons

disease (IPD) who developed diplopia secondary to convergence

insufficiency during his motor off periods Diplopia resolved with

onset of motor benefit from levodopa Neuro-ophthalmologic

examination demonstrated convergence insufficiency during motor

off periods that was alleviated after onset of motor benefit from

levodopa This is the first reported case of convergence insufficiency

in IPD responsive to levodopa

36

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

Bottom Line

Optometric Vision Therapy is the most efficacious treatment available for binocular vision disorders and the

treatment effects are long lasting Neuro-enhancing drugs

may assist us as well

37

EF Learning related vision anomalies Vision

developmentperception disorders

hellipresearch includes an examination of the role vision plays in

reading the effect of oculomotor vergence and

accommodativecoherent motion therapy on reading eye movements

and reading speed the diagnosis and treatment of perceptual

disorders and the effect of therapy on various learning anomalies

38

EF Learning related vision anomalies Vision developmentperception disorders

magnocellular (MC) deficit in dyslexia

LM speed-matching ratio predicts reading in childrenChase C Dougherty RF Ray N

Fowler S Stein JOptom Vis Sci 2007 Mar84(3)229-36

Effect of attention therapy on reading comprehension Solan HA Shelley-Tremblay J

Ficarra A Silverman M Larson S J Learn Disabil 2003 Nov-Dec36(6)556-63

Is there a common linkage among reading comprehension visual attention and

magnocellular processing Solan HA Shelley-Tremblay JF Hansen PC Larson S

J Learn Disabil 2007 May-Jun40(3)270-8

Lawton T Filtered Text and Direction Discrimination Training Improved Reading

Fluency for Both Dyslexic and Normal Readers Optom Vis Dev 200839 (3)114

Fischer B Hartnegg K Saccade control in dyslexia Development deficits training

and transfer to reading Optom Vis Dev 200839(4)181-190

39

EF Learning related vision anomalies Vision developmentperception disorders

J Learn Disabil 2003 Nov-Dec36(6)556-63 Effect of attention therapy on reading

comprehension Solan HA Shelley-Tremblay J Ficarra A Silverman M Larson S

hellip At the completion of attention therapy the mean

standard attention and reading comprehension scores of

the experimental group had improved significantly The

control group however showed no significant

improvement in reading comprehension scores after 12

weeks Although uncertainties still exist this investigation

supports the notion that visual attention is malleable and

that attention therapy has a significant effect on reading

comprehension in this often neglected population

40

VII Vision dysfunction association with acquired brain injury

A Exotropia (or high exophoriaCI)

B Accommodative dysfunction

C Convergence insufficiency

41

D Decreased blink rate

E Spatial disorientation

F Pursuitsaccade dysfunction

G Unstable ambient vision (Magnocellular pathway)

42

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Stelmack JA Frith T Van Koevering D Rinne S Stelmack TR Visual function in patients

followed at a Veterans Affairs polytrauma network site an electronic medical record review

Optometry 2009 Aug80(8)419-24

RESULTS Visual symptoms were self-reported by 76 of patients

with polytrauma and 75 of the patients with TBI Problems with reading

(polytrauma 60 and TBI 50) and accommodation (polytrauma 30 and

TBI 47) were frequently found on eye examinations Spectacles were the

treatment most frequently prescribed (polytrauma 62 and TBI 78)

CONCLUSIONS It is important for optometrists to be aware of the high

rates of self-reported symptoms and visual problems in military personnel

returning from deployment to the wars in Iraq and Afghanistan Post-

traumatic stress disorder and depression may complicate optometric

evaluation and management

43

VII Vision dysfunction association with acquired brain injury

Avoidance of near tasks

Oculomotor-based reading difficulties

Eye tracking problems

Eye focusing problems

Eyestrain Diplopia

Dizziness Vertigo

Vision-derived nausea

44

VII Vision dysfunction association with acquired brain injury

Increased sensitivity to visual motion

Visual inattention and distractibility

Short-term visual memory loss

Difficulty judging distances (relative and absolute

Difficulty with global scanning

Difficulty with personal grooming especially involving the face

Inability to interactcope visually in a complex social situation

(eg minimal eye contact)

Inability to tolerate complex visual environments (eg grocery store

aisles and highly-patterned floors)

45

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Ciuffreda KJ Ludlam DP Kapoor N Clinical oculomotor training in traumatic brain injury Optom Vis

Dev 200940(1)16-23

Individuals with traumatic brain injury present with a constellation of

oculomotor dysfunctions and correlated symptoms Simple and

effective clinical oculomotor-based training procedures will be

presented with respect to the versional vergence and

accommodative systems and their interactions These therapeutic

procedures can also be applied as needed to individuals with either

low vision neurological dysfunctions or general visual skills cases

manifesting similar oculomotor deficits

46

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Leslie S Myopia and accommodative insufficiency associated with

moderate head trauma Opt Vis Dev 200940(1)25-31

The majority of subjects reviewed had developed a stable degree of

myopia between 100 and 200 diopters as well as an abnormally

high lag of accommodation When their distance and near spatial area

of focus was compared the majority were focused at an intermediate

area in space suggesting a loss of control of accommodation in

space

47

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

B Drugs

C Exercise

D Learning new and challenging things

48

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements

prevent cognitive decline A systematic review of randomized controlled trials J Hum

Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among

preterm infants attributable to early supplementation of human milk with

docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings

and structural-functional synergies with cell membrane phospholipids Altern Med Rev

2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function

Neuroscience 20089(7)568-78

49

VIII Improving Brain Function and Neuroplasticity

B Drugs Maya Vetencourt JF Sale A Viegi A et al The antidepressant

fluoxetine (PROZAC) restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the

antidepressant tianeptine CNS Drugs 200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances

hippocampal long-term potentiation and memory BMC Biol 2008 Sep

9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine

improves neuropsychological disorders in a child with creatine

transporter defect Neurocase 200814(2) 151-61

50

VIII Improving Brain Function and Neuroplasticity

C Exercise

Hunsberger JG et al Antidepressant actions of the exercise-

regulated gene VGF Nat Med 2007 Dec 2 131476

VGF may be a common pathway by which exercise induces

neuroplasticity and growth-factor genes at least one of these might act

similarly to antidepressants in promoting an adaptive response to stress

However the tests used here may be modeling stress-induced

helplessness not depression hellipexercise seems to induce multiple

interacting genes that enhance neuronal resilience

51

VIII Improving Brain Function and Neuroplasticity

D Learning new and challenging things

What have we (optometry amp ophthalmology)

been thinking all these years

Where did we miss the news about neuroplasticity

52

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Huang JC Neuroplasticity as a proposed mechanism for the efficacy of optometric vision therapy and rehabilitation J Bev Optom 200920(4)96-100

Homologous area adaptationCompensatory masqueradeCross-modal reassignment

Map expansion

EquipotentialityVicariation

53

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Homologous area adaptation a transfer of function from a damaged brain area to a non-damaged brain area May be limited to early stages of human development and may crowd a new brain area resulting in reduced functionality of that brain area (Competition between spatial amp verbal functioning)

54

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Compensatory masquerade reorganizing of existing neuro-pathways to us alternative cognitive strategies to perform a task

55

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Cross-modal reassignment using new sensory input in a brain structure deprived of its main input source (changing processing from visual to tactile stimuli in the blind)

56

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Map expansion increase in brain mass due to repeated behavior or exposure to stimuli

57

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Equipotentiality anatomical areas of the brain can perform disparate functions

Vicariation redundant neural systems can operate under abnormal conditions

This may explain why recovery is noted for many neurological conditions (degenerative psychiatric developmental vascular traumatic)

58

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Constraint therapy Use it and improve it

Patching penalization ldquonear activitiesrdquo during amblyopia therapy

59

IX Improving Brain Function and Neuroplasticity Optometric Clinical ApplicationsOptometric Vision Therapy

Kleim amp Jones

Use it or lose it If you do not drive specific brain functions

functional loss will occur

If you want to improve oculomotor brain neuroplastic function amp

structure therapy should be specific for that brain function

Use it and improve it Therapy that drives cortical function enhances

that particular function

If you use therapy to improve oculomotor dysfunction it should

improve

Specificity The therapy you choose determines the resultant

plasticity and function

You must choose therapy that is appropriate

60

IX Improving Brain Function and Neuroplasticity Optometric Clinical Applications

Kleim amp Jones

Repetition matters Plasticity that results in functional change

requires repetition

Do the therapy Do it again Do it yet again No quick fix

Intensity matters Induction of plasticity requires the appropriate

amount of intensity

Intensity means strength force concentration power and passion

Without these plasticity may not occur Function may not improve

Time matters Different forms of plasticity take place at different

times during therapy

Do the basics than the more advanced therapeutic procedures

61

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Salience matters It has to be important to the individual

Make the therapy matter to the patient

Age matters Plasticity is easier in a younger brain but is also

possible in an adult brain

Do not let age determine what therapy options you offer your

patients Think of Susan Barry PhD (StereoSue) and her success

Offer your patients options Let them choose Be realistic about

outcomeshelliphave outcome measures built into therapy program

62

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Transference Neuroplasticity and the change in function

that results from one therapy can augment the attainment

of similar behaviors

What you do during oculomotor therapy may affected

vergence therapy outcomes

Interference Plasticity in response to one experience can

interfere with the acquisition of other behaviors

Monitor Evaluate progress Discuss function in other areas

of your patientslsquo life

63

Why pay attention to binocular vision dysfunctions

and neuroplasticity

December 2009 issue of the Review of Optometry

The Binocular Vision Dysfunction Pandemic

In 2010 almost 170 million individuals will be wearing glasses In

2010 there will also be up to 93 million amblyopes and 12 and a half

million strabismics For children under 18 years of age that means

there will be more than 22 and a half million amblyopes and millions

of children with strabismus A clinical trial to determine the

prevalence of binocular vision dysfunction within the general

population suggested the possibility of up to 56 or 173 million men

women and children with symptoms associated with a binocular

vision dysfunction 189 million (61) with accommodative problems

and 118 million (38) demonstrating various vergence

anomalies

64

65

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Brain plasticity life long changes in the structure of the brain

Sensory substitution replacement of one sensory input by another

Measurement techniques

Voxel based morphometryhellipmeasures difference in brain volume

Fluorodeoxyglucose glucose analog PET scan tells you

distribution and metabolism of brain

Cortical thickness measures

Visual cortex of the blind turns somatic ―The eye of the tongue

Transcranial magnetic stmiulation non-invasive technique to

stimulate cortex

66

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Blind Braille readers report tingling in fingers when pressure

phosphenes are applied Blind feel tingling in tongue

Bind use tongue to perform orientation task motion perception

sensory perception Visual cortex recruited in a variety of sensory

and cognitive tasks (DM Can we use tongue as a VT tool)

Dilks Reorganizations of human adult visual system

When a region of sensory cortex is deprived of its bottom up

input the deprived region begins to respond to stimuli that

normally activate adjacent cortex

67

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Retinotopic map changes for stroke pts Cortical reorganization in

adults occurs Perceived objectshellipelongation in stroke amp AMD

What happens to deprived cortex in AMD

fMRI shows cortical reorganization in adults

Proposed mechanisms

hellipGrowth of new connections

hellipUnmasking of pre-existing connections this is true

happens within seconds

Bavelier

Action video games

68

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Bavelier

Action video games Looked at attention Gamers can track more

activities

Attention over space (me peripheral awarenress) Useful field

of view shrinks with age

Performance not VA relatedhellipis related to attention

Action game playing changes spatial resolutionhellipovercoming

crowding in VA assessment (me amblyopia therapy)

Temporal resolution of vision Backward masking

changehellipbrain changes

Visual sensitivity (contrast sensitivity) Post action game training

improves CSF

69

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Action video games correcting optics of the cortex (me this is

actualy OVT)

Games factor

Variable entry leanringhellipadapt task to skill level

Incremental learning tune task to subjectlsquos leanring steps

Motivationarousal

Rewards

Self masterself confidence

Action games factors

Pacingrate of exposure to infohellipincreasing processing speed

Dynamic display

Rich environment

Rich motor involvement

70

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Surgeons may be made to play action games

Pilot training

Amblyopia tx Dennis Levi research

PresenterTitle Contact info

Neuroplasticity-A Paradigm Sea Change

This presentation is available at

httpwwwslidesharenetDMAINOneuroplasticity-a-paradigm-sea-change-2459693

httpwwwmainosmemosblogspotcom

My FaceBook Page

and

Twitter

PresenterTitle Contact info

Questions About

Neuroplasticity-A Paradigm Sea Change

Dominick M Maino OD MEd FAAO FCOVD-A

Professor PediatricsBinocular VisionIllinois Eye InstituteIllinois College of Optometry

dmainoicoeduhttpwwwMainosMemosblogspotcom

Thanks to

httpwwwcovdorgHomeOVDJournalOVD401tabid263D

efaultaspx

httpbipolarblastfileswordpresscom200908neurojpg

httpwwwspecialcheerscomimagesanimated_braingif

httpblogmarsdencartoonscomwp-

contentuploads200810frankenstein-myspace-lightbeergif

httpwwwshangralafamilyfuncomgala-ecalvindreamgif

httppsychiatryjwatchorgcgicontentfull20082251

73

Chakraborty R Chatterjee A Choudhart S Chakraborty PK Neuroplasticitymdasha paradigm shift in neurosciences J Indian Med Assoc

2007105(9)513-4516-8520-1

Sacks O A neurologistlsquos notebook Stereo Sue Why two eyes are better than one The New Yorker 2006 Jun 1964-73

Krulwich R National Public Radio Going Binocular Susanlsquos First Snowfall Available at

wwwnprorgtemplatesstorystoryphpstoryId=5507789 (Accessed December 8 2008)

Press LJ The story behind Stereo Suelsquo and a world-famous neurologistlsquos discovery of vision therapy Optom Vis Dev 200637(2) 55-7

Levin HS Neuroplasticity and brain imaging research implications for rehabilitation Arch Phys Med Rehabil 2006 Dec87(12 Suppl

2)S1

Wiesel TN Hubel DH Single-cell responses in striate cortex of kittens deprived of vision in one eye J Neurophysiol 1963

Nov261003-17

Hook BM Chen C Critical periods in the visual system Changing views for a model of experience-dependent plasticity Neuron 2007

Oct56(2)312-26

Ramey CT Ramey SL Prevention of intellectual disabilities early interventions to improve cognitive development Prev Med 1998

Mar-Apr27(2)224-32

Heuninckx S Wenderoth N Swinnen SP Systems neuroplasticity in the aging brain recruiting additional neural resources for

successful motor performance in elderly persons J Neurosci 2008 Jan 228(1)91-9

Ge S Yang CH Hsu KS et al A critical period for enhanced synaptic plasticity in newly generated neurons of the adult brain Neuron

2007 May54(4)559-66

74

Draganski B Gaser C Busch V et al Neuroplasticity changes in grey matter induced by training Nature 2004 Jan 22427(6972)

311-2

Cannonieri GC Bonilha L Fernandes PT et al Practice and perfect length of training and structural brain changes in experienced

typists Neuroreport 2007 Jul 218(10)1063-6

Kleim JA Jones TA Principles of experience-dependent neural plasticity implications for rehabilitation after brain damage J

Speech Lang Hear Res 2008 Feb51(1)S225-39

Trojan S Porkorny J Theoretical aspects of neuroplasticity Physiol Res 199948(2)87-97

Ramamirtham R Kee CS Hung LF et al Wave aberrations in rhesus monkeys with vision-induced ametropias Vision Res 2007

Sep47(21)2751-66

Smith EL 3rd Ramamirtham R Qiao-Grider Y et al Effects of foveal ablation on emmetropization and form-deprivation myopia

Invest Ophthalmol Vis Sci 2007 Sep48(9)3914-22

Smith EL 3rd Kee CS Ramamirtham R et al Peripheral vision can influence eye growth and refractive development in infant

monkeys Invest Ophthalmol Vis Sci 2005 Nov46(11)3965-72

Ciuffreda KJ Vasudevan B Nearwork-induced transient myopia (NITM) and permanent myopiandashndashis there a link Ophthalmic

Physiol Opt 2008 Mar28(2)103-14

Hung GK Ciuffreda KJ Incremental retinal-defocus theory of myopia development--schematic analysis and computer simulation

Comput Biol Med 2007 Jul37(7)930-46

Hung GK Ciuffreda KJ A unifying theory of refractive error development Bull Math Biol 2000 Nov62(6)1087-108

75

Pang Y Maino D Zhang G Lu F Myopia Can its progress be controlled Optom Vis Dev 200637(2)75-9

Leung JT Brown B Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lenses Optom Vis Sci

1999 Jun76(6)346-54

Hasebe S Ohtsuki H Nonaka T et al Effect of progressive addition lenses on myopia progression in Japanese children a prospective

randomized double-masked crossover trial Invest Ophthalmol Vis Sci 2008 Jul49(7)2781-9

Gwiazda J Hyman L Hussein M et al A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression

of myopia in children Invest Ophthalmol Vis Sci 2003 Apr44(4)1492-500

Siatkowski RM Cotter SA Crockett RS et al Two-year multi-center randomized double-masked placebo-controlled parallel safety and

efficacy study of 2 pirenzepine ophthalmic gel in children with myopia J AAPOS 2008 Aug12(4)332-9

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged 7 to 17 years Arch Ophthalmol 2005

Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three to less than 10 years of age Am J

Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction Am J Ophthalmol 2007

Jun143(6)1060-3

Holmes JM Edwards AR Beck RW et al A randomized pilot study of near activities versus non-near activities during patching therapy for

amblyopia J AAPOS 2005 Apr9(2)129-36

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate

amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-57

76

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic

amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Convergence Insufficiency Treatment Trial Study Group Randomized clinical trial of treatments for symptomatic convergence insufficiency

in children Arch Ophthalmol 2008 Oct126(10)1336-49

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

Solan HA Shelley-Tremblay J Hansen PC et al M-cell deficit and reading disability a preliminary study of the effects of temporal vision-

processing therapy Optometry 2004 Oct75(10)640-50

Solan HA Larson S Shelley-Tremblay J et al Role of visual attention in cognitive control of oculomotor readiness in students with reading

disabilities J Learn Disabil 2001 Mar-Apr34(2)107-18

Gallaway M Boas MB The impact of vergence and accommodative therapy on reading eye movements and reading speed Optom Vis Dev

200738(3)115-20

Goss DA Downing DB Lowther AH et al The effect of HTS vision therapy conducted in a school setting on reading skills in third and

fourth grade students Optom Vis Dev 200738(1)27-32

Crutch SJ Warrington EK Foveal crowding in posterior cortical atrophy a specific early-visual-processing deficit affecting word reading

Cogn Neuropsychol 2007 Dec24(8)843-66

Helms D Sawtelle SM A study of the effectiveness of cognitive therapy delivered in a video game format Optom Vis Dev 200738 (1)19-

26

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

77

Lawton T Training direction-discrimination sensitivity remediates a wide spectrum of reading skills OptomVis Dev 200738(1) 33-47

Goldstand S Koslowe KC Parush S Vision visual-information processing and academic performance among seventh-grade schoolchildren a

more significant relationship than we thought Am J Occup Ther 2005 Jul-Aug59(4)377-89

Fischer B Koumlngeter A Hartnegg K Effects of daily practice on subitizing visual counting and basic arithmetic skills Optom Vis Dev

200839(1)30-4

Sands W Taub M Maino D Limited research and education on special populations in optometry and ophthalomology Optom Vis Dev

200839(2)60-1

Wesson M Maino D Oculo-visual findings in Down syndrome cerebral palsy and mental retardation with non-specific etiology In Maino D

(ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 199517-54 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

Cui Y Stapleton F Suttle C Developing an instrument to assess vision-related and subjective quality of life in children with intellectual

disability data collection and preliminary analysis in a Chinese population Ophthal Physiolog Optics 2008 May28(3) 238-46

Maino D Steele G Tahir S Sajja R Attitudes of optometry students toward individuals with disabilities Optom Ed 200227(2)45-50

Maino D Special populations in the optometric curriculum Optom Ed 200227(2)38-9

Maino D Overview of special populations In Scheiman M Rouse M (eds) Optometric Management of Learning-Related Vision Problems

St Louis Mosby Inc 200685-106

Maino D (ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 1995 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

78

McCarthy P Maino D Alport syndrome a review Clin Eye Vis Care 2000 Dec12(3-4)139-50

Block SS Brusca-Vega R Pizzi WJ et al Cognitive and visual processing skills and their relationship to mutation size in full and

permutation female fragile X carriers Optom Vis Sci 2000 Nov77 (11)592-9

Maino D The young child with developmental disabilities An introduction to mental retardation and genetic syndromes In Moore BD

(ed) Eye Care for Infants and Young Children Butter-worth--Heinemann Newton MA1997285-300

Amin V Maino D The Fragile X female Visual visual perceptual and ocular health anomalies J Am Optom Assoc 1995 May66

(5)290-95

Maino DM Maino JH Cibis GW Hecht F Ocular health anomalies in patients with developmental disabilities In Maino D (ed)

Diagnosis and Management of Special Populations Mosby-Year-book Inc St Louis MO 1995189-206 Reprinted Optometric

Education Program Foundation Santa Anna Calif 2001

Maino D Wesson M Schlange D Cibis G Maino J Optometric findings in the fragile X syndrome Optom Vis Sci 199168634-40

Scheiman MMOptometric findings in children with cerebral palsy Am J Optom Physiol Opt 1984 May61(5)321-3

Maino D Maino J Maino S Mental retardation syndromes with associated ocular defects J Am Optom Assoc 199061707-16

Stewart RE Woodhouse JM Cregg M Pakeman VH Association between accommodative accuracy hypermetropia and strabismus in

children with Downs syndrome Optom Vis Sci 2007 Feb84(2)149-55

Cregg M Woodhouse JM Pakeman VH et al Accommodation and refractive error in children with Down syndrome cross-sectional

and longitudinal studies Invest Ophthalmol Vis Sci 2001 Jan42 (1)55-63

79

McClelland JF Parkes J Hill N et al Accommodative dysfunction in children with cerebral palsy a population-

based study Invest Ophthalmol Vis Sci 2006 May47(5)1824-30

Duckman RH Vision therapy for the child with cerebral palsy J Am Optom Assoc 198758(1)28-35

Duckman R Accommodation in cerebral palsy function and remediation J Am Optom Assoc 198455(4)281-3

Scheiman M Understanding and managing vision deficits a guide for occupational therapists 2nd ed Slack

Thorofare NJ 2002

Maino D Binasal occlusion for the child with Cerebral Palsy J Ill Optom Assoc 198644(1)1218

Battaglia F Quartarone A Rizzo V et al Early impairment of synaptic plasticity in patients with Downs syndrome

Neurobiol Aging 2008 Aug29(8)1272-5

Bonnier C Evaluation of early stimulation programs for enhancing brain development Acta Paediatr 2008

Jul97(7)853-8

Morice E Andreae LC Cooke SF et al Preservation of long-term memory and synaptic plasticity despite short-term

impairments in the Tc1 mouse model of Down syndrome Learn Mem 2008 Jul 1415(7)492-500

Gordon AM Schneider JA Chinnan A Charles JR Efficacy of a hand-arm bimanual intensive therapy (HABIT) in

children with hemiplegic cerebral palsy a randomized control trial Dev Med Child Neurol 2007 Nov49(11)830-8

Kapoor N Ciuffreda KJ Vision disturbances following traumatic brain injury Curr Treat Options Neurol 2002

Jul4(4)271-80

80

Ciuffreda KJ Rutner D Kapoor N et al Vision therapy for oculomotor dysfunctions in acquired brain injury a

retrospective analysis Optometry 2008 Jan79(1)18-22

Ciuffreda KJ Han Y Kapoor N Ficarra AP Oculomotor rehabilitation for reading in acquired brain injury

NeuroRehabilitation 200621(1)9-21

Zost M Diagnosis and management of visual dysfunction in cerebral injury In Maino D (ed) Diagnosis and

Management of Special Populations Mosby-Yearbook Inc St Louis 199579 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001 [Figure used with permission of the editor]

DeGutis JM Bentin S Robertson LC DEsposito M Functional plasticity in ventral temporal cortex following

cognitive rehabilitation of a congenital prosopagnosic J Cogn Neurosci 2007 Nov19 (11)1790-802

Welbourne SR Ralph MA Exploring the impact of plasticity-related recovery after brain damage in a connectionist

model of single-word reading Cogn Affect Behav Neurosci 2005 Mar5(1)77-92

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements prevent cognitive decline A

systematic review of randomized controlled trials J Hum Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among preterm infants attributable to early

supplementation of human milk with docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings and structural-functional

synergies with cell membrane phospholipids Altern Med Rev 2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function Neuroscience 20089(7)568-78

81

Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

BMC Biol 2008 Sep 9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine improves neuropsychological disorders in a child with

creatine transporter defect Neurocase 200814(2) 151-61

Forrester LW Wheaton LA Luft AR Exercise-mediated locomotor recovery and lower-limb neuroplasticity after

stroke J Rehabil Res Dev 200845(2)205-20

82

Page 21: Neuroplasticity: A Paradigm Sea Change Latest Updated File

B Examples of Changes in Function and Structure

2) Typists

helliplong-term bimanual training also increases

gray matter volume in experienced adult typists

These results suggest that learning not

only affects function but also structure in

adult brains

21

V Neuroplasticity and Optometry

A Evolutionary neuroplasticity

B Reactive plasticity

C Adaptational plasticity

D Reparation plasticity

22

V Neuroplasticity and Optometry

A Evolutionary neuroplasticity

hellip is ideally suited for the developmental OD who

specializes in vision function as it changes over time

either with or without intervention

23

V Neuroplasticity and Optometry

B Reactive plasticity

hellip can be thought of as the immediate effect that

initial optometric treatment may have on a system This can

be reflected in an immediate but often transient change in

the individuallsquos accommodative systemmdashie when an

uncorrected myope initially puts on his or her new

spectacles

24

V Neuroplasticity and Optometry

C Adaptational plasticity

hellip could describe the long-term effects of in-office optometric

vision therapy on disorders of the binocular vision system

25

V Neuroplasticity and Optometry

D Reparation plasticity

hellipin contrast to adaptational

plasticity reparation plasticity may

occur during treatment by a low

Vision specialist or an OD

Working with those who have

Experienced a traumatic brain

injury (TBI)

26

V Neuroplasticity and Optometry

The effects of plasticity can lead to either

positive or negative changes during

development (evolutionary plasticity) after

short-term exposure (reactive plasticity)

after long-term or continuous stimuli

(adaptational plasticity) and during

functional or structural recovery of damaged

neuronal circuits (reparation plasticity)

httpwwwciteulikeorguserjasonepriorarticle2856526

27

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

A Refractive error development

B Amblyopia

C Strabismus

28

D Non-strabismus non-amblyopic binocular vision disorders

E Learning related vision anomalies

F Vision developmentperception disorders

29

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

A Refractive error development

Several recent studies have noted that neuroplasticity may play a

role in refractive error development

retinal defocus use of progressive addition lenses

drug studies (M1-antagonist2 pirenzepine ) slow myopia

progression demonstrated nearly a 50 reduction in myopia

progression over a two-year period

30

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged

7 to 17 years Arch Ophthalmol 2005 Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three

to less than 10 years of age Am J Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction

Am J Ophthalmol 2007 Jun143(6)1060-3

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine

vs patching for treatment of moderate amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-

57

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for

strabismic and anisometropic amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Treatment of severe amblyopia with weekend atropine results from 2 randomized clinical trials

Levodopacarbidopa in the treatment of amblyopia

31

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

J Pediatr Ophthalmol Strabismus 2009 Mar-Apr46(2)87-90 quiz 91-2 Levodopacarbidopa in the

treatment of amblyopia Dadeya S Vats P Malik KP

PURPOSE To evaluate the role of levodopacarbidopa in the treatment of amblyopia METHODS

Thirty patients with strabismic amblyopia between the ages of 3 and 12 years were part of this double-

blind randomized study Patients were divided into two groups Group A received 050 mg + 125 mg of

levodopacarbidopa per kilogram body weight three times daily after meals with a protein rich drink

whereas Group B received placebo Both groups received full-time conventional occlusion until a visual

acuity of 66 was achieved or for a maximum of 3 months RESULTS The authors observed more than

two lines improvement in visual acuity that was greater in the levodopa group (15 of 15) than in the

placebo group (9 of 15) (P lt 005) Furthermore improvement in visual acuity of more than two lines

was greater in patients younger than 8 years (100) than in patients older than 8 years of age (60) (P =

0026) There was also no significant reversal of the improved visual acuity in up to 6 months of follow-

up CONCLUSION Levodopacarbidopa improves visual acuity in patients with

amblyopia and maintains improved visual acuity especially in patients

younger than 8 years

32

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

J Pediatr Ophthalmol Strabismus 2008 May-Jun45(3)174-6 The use of levodopa in the treatment of

bilateral amblyopia secondary to uncorrected high hypermetropia Abrams MS

The standard treatment of bilateral amblyopia secondary to uncorrected high bilateral hypermetropia has

been spectacles and time The patient described here failed to show adequate improvement in visual

acuity after 18 months of standard treatment Visual acuity improved dramatically when the

patient began taking levodopa dropped precipitously when the medication was

discontinued and returned quickly to post-treatment levels when levodopa was

restarted Visual acuity remained stable when the medication was slowly tapered

and discontinued This report suggests that dopamine may play a role in the pathophysiology of

bilateral amblyopia secondary to uncorrected high bilateral hypermetropia

33

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

Bottom Line

Amblyopia can be treated at any age

May be able to use neuro-enhancing drugs

as a part of basic amblyopia therapy

34

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

C Strabismus and non-strabismic non-amblyopic binocular

vision disorders

Clinical Trial of Treatments for Symptomatic Convergence Insufficiency in Children has

clearly demonstrated the superiority of in-office optometric vision therapy (in conjunction

with home therapy) vs out-of-office therapy alone The study concluded that optometric

vision therapyorthoptics was more effective than pencil push-ups or placebo vision

therapyorthoptics in reducing symptoms and improving clinical signs of convergence

insufficiency

Long-term effectiveness of treatments for symptomatic convergence insufficiency

in children (Optom Vis Sci 2009 Sep86(9)1096-103)

CITT patients improvements lasted a year

35

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

Strabismus 1999 Sep7(3)169-74 Convergence insufficiency in

idiopathic Parkinsons disease responsive to levodopa Racette BA

Gokden MS Tychsen LS Perlmutter JS

We report a patient with pathologically proven idiopathic Parkinsons

disease (IPD) who developed diplopia secondary to convergence

insufficiency during his motor off periods Diplopia resolved with

onset of motor benefit from levodopa Neuro-ophthalmologic

examination demonstrated convergence insufficiency during motor

off periods that was alleviated after onset of motor benefit from

levodopa This is the first reported case of convergence insufficiency

in IPD responsive to levodopa

36

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

Bottom Line

Optometric Vision Therapy is the most efficacious treatment available for binocular vision disorders and the

treatment effects are long lasting Neuro-enhancing drugs

may assist us as well

37

EF Learning related vision anomalies Vision

developmentperception disorders

hellipresearch includes an examination of the role vision plays in

reading the effect of oculomotor vergence and

accommodativecoherent motion therapy on reading eye movements

and reading speed the diagnosis and treatment of perceptual

disorders and the effect of therapy on various learning anomalies

38

EF Learning related vision anomalies Vision developmentperception disorders

magnocellular (MC) deficit in dyslexia

LM speed-matching ratio predicts reading in childrenChase C Dougherty RF Ray N

Fowler S Stein JOptom Vis Sci 2007 Mar84(3)229-36

Effect of attention therapy on reading comprehension Solan HA Shelley-Tremblay J

Ficarra A Silverman M Larson S J Learn Disabil 2003 Nov-Dec36(6)556-63

Is there a common linkage among reading comprehension visual attention and

magnocellular processing Solan HA Shelley-Tremblay JF Hansen PC Larson S

J Learn Disabil 2007 May-Jun40(3)270-8

Lawton T Filtered Text and Direction Discrimination Training Improved Reading

Fluency for Both Dyslexic and Normal Readers Optom Vis Dev 200839 (3)114

Fischer B Hartnegg K Saccade control in dyslexia Development deficits training

and transfer to reading Optom Vis Dev 200839(4)181-190

39

EF Learning related vision anomalies Vision developmentperception disorders

J Learn Disabil 2003 Nov-Dec36(6)556-63 Effect of attention therapy on reading

comprehension Solan HA Shelley-Tremblay J Ficarra A Silverman M Larson S

hellip At the completion of attention therapy the mean

standard attention and reading comprehension scores of

the experimental group had improved significantly The

control group however showed no significant

improvement in reading comprehension scores after 12

weeks Although uncertainties still exist this investigation

supports the notion that visual attention is malleable and

that attention therapy has a significant effect on reading

comprehension in this often neglected population

40

VII Vision dysfunction association with acquired brain injury

A Exotropia (or high exophoriaCI)

B Accommodative dysfunction

C Convergence insufficiency

41

D Decreased blink rate

E Spatial disorientation

F Pursuitsaccade dysfunction

G Unstable ambient vision (Magnocellular pathway)

42

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Stelmack JA Frith T Van Koevering D Rinne S Stelmack TR Visual function in patients

followed at a Veterans Affairs polytrauma network site an electronic medical record review

Optometry 2009 Aug80(8)419-24

RESULTS Visual symptoms were self-reported by 76 of patients

with polytrauma and 75 of the patients with TBI Problems with reading

(polytrauma 60 and TBI 50) and accommodation (polytrauma 30 and

TBI 47) were frequently found on eye examinations Spectacles were the

treatment most frequently prescribed (polytrauma 62 and TBI 78)

CONCLUSIONS It is important for optometrists to be aware of the high

rates of self-reported symptoms and visual problems in military personnel

returning from deployment to the wars in Iraq and Afghanistan Post-

traumatic stress disorder and depression may complicate optometric

evaluation and management

43

VII Vision dysfunction association with acquired brain injury

Avoidance of near tasks

Oculomotor-based reading difficulties

Eye tracking problems

Eye focusing problems

Eyestrain Diplopia

Dizziness Vertigo

Vision-derived nausea

44

VII Vision dysfunction association with acquired brain injury

Increased sensitivity to visual motion

Visual inattention and distractibility

Short-term visual memory loss

Difficulty judging distances (relative and absolute

Difficulty with global scanning

Difficulty with personal grooming especially involving the face

Inability to interactcope visually in a complex social situation

(eg minimal eye contact)

Inability to tolerate complex visual environments (eg grocery store

aisles and highly-patterned floors)

45

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Ciuffreda KJ Ludlam DP Kapoor N Clinical oculomotor training in traumatic brain injury Optom Vis

Dev 200940(1)16-23

Individuals with traumatic brain injury present with a constellation of

oculomotor dysfunctions and correlated symptoms Simple and

effective clinical oculomotor-based training procedures will be

presented with respect to the versional vergence and

accommodative systems and their interactions These therapeutic

procedures can also be applied as needed to individuals with either

low vision neurological dysfunctions or general visual skills cases

manifesting similar oculomotor deficits

46

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Leslie S Myopia and accommodative insufficiency associated with

moderate head trauma Opt Vis Dev 200940(1)25-31

The majority of subjects reviewed had developed a stable degree of

myopia between 100 and 200 diopters as well as an abnormally

high lag of accommodation When their distance and near spatial area

of focus was compared the majority were focused at an intermediate

area in space suggesting a loss of control of accommodation in

space

47

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

B Drugs

C Exercise

D Learning new and challenging things

48

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements

prevent cognitive decline A systematic review of randomized controlled trials J Hum

Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among

preterm infants attributable to early supplementation of human milk with

docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings

and structural-functional synergies with cell membrane phospholipids Altern Med Rev

2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function

Neuroscience 20089(7)568-78

49

VIII Improving Brain Function and Neuroplasticity

B Drugs Maya Vetencourt JF Sale A Viegi A et al The antidepressant

fluoxetine (PROZAC) restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the

antidepressant tianeptine CNS Drugs 200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances

hippocampal long-term potentiation and memory BMC Biol 2008 Sep

9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine

improves neuropsychological disorders in a child with creatine

transporter defect Neurocase 200814(2) 151-61

50

VIII Improving Brain Function and Neuroplasticity

C Exercise

Hunsberger JG et al Antidepressant actions of the exercise-

regulated gene VGF Nat Med 2007 Dec 2 131476

VGF may be a common pathway by which exercise induces

neuroplasticity and growth-factor genes at least one of these might act

similarly to antidepressants in promoting an adaptive response to stress

However the tests used here may be modeling stress-induced

helplessness not depression hellipexercise seems to induce multiple

interacting genes that enhance neuronal resilience

51

VIII Improving Brain Function and Neuroplasticity

D Learning new and challenging things

What have we (optometry amp ophthalmology)

been thinking all these years

Where did we miss the news about neuroplasticity

52

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Huang JC Neuroplasticity as a proposed mechanism for the efficacy of optometric vision therapy and rehabilitation J Bev Optom 200920(4)96-100

Homologous area adaptationCompensatory masqueradeCross-modal reassignment

Map expansion

EquipotentialityVicariation

53

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Homologous area adaptation a transfer of function from a damaged brain area to a non-damaged brain area May be limited to early stages of human development and may crowd a new brain area resulting in reduced functionality of that brain area (Competition between spatial amp verbal functioning)

54

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Compensatory masquerade reorganizing of existing neuro-pathways to us alternative cognitive strategies to perform a task

55

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Cross-modal reassignment using new sensory input in a brain structure deprived of its main input source (changing processing from visual to tactile stimuli in the blind)

56

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Map expansion increase in brain mass due to repeated behavior or exposure to stimuli

57

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Equipotentiality anatomical areas of the brain can perform disparate functions

Vicariation redundant neural systems can operate under abnormal conditions

This may explain why recovery is noted for many neurological conditions (degenerative psychiatric developmental vascular traumatic)

58

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Constraint therapy Use it and improve it

Patching penalization ldquonear activitiesrdquo during amblyopia therapy

59

IX Improving Brain Function and Neuroplasticity Optometric Clinical ApplicationsOptometric Vision Therapy

Kleim amp Jones

Use it or lose it If you do not drive specific brain functions

functional loss will occur

If you want to improve oculomotor brain neuroplastic function amp

structure therapy should be specific for that brain function

Use it and improve it Therapy that drives cortical function enhances

that particular function

If you use therapy to improve oculomotor dysfunction it should

improve

Specificity The therapy you choose determines the resultant

plasticity and function

You must choose therapy that is appropriate

60

IX Improving Brain Function and Neuroplasticity Optometric Clinical Applications

Kleim amp Jones

Repetition matters Plasticity that results in functional change

requires repetition

Do the therapy Do it again Do it yet again No quick fix

Intensity matters Induction of plasticity requires the appropriate

amount of intensity

Intensity means strength force concentration power and passion

Without these plasticity may not occur Function may not improve

Time matters Different forms of plasticity take place at different

times during therapy

Do the basics than the more advanced therapeutic procedures

61

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Salience matters It has to be important to the individual

Make the therapy matter to the patient

Age matters Plasticity is easier in a younger brain but is also

possible in an adult brain

Do not let age determine what therapy options you offer your

patients Think of Susan Barry PhD (StereoSue) and her success

Offer your patients options Let them choose Be realistic about

outcomeshelliphave outcome measures built into therapy program

62

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Transference Neuroplasticity and the change in function

that results from one therapy can augment the attainment

of similar behaviors

What you do during oculomotor therapy may affected

vergence therapy outcomes

Interference Plasticity in response to one experience can

interfere with the acquisition of other behaviors

Monitor Evaluate progress Discuss function in other areas

of your patientslsquo life

63

Why pay attention to binocular vision dysfunctions

and neuroplasticity

December 2009 issue of the Review of Optometry

The Binocular Vision Dysfunction Pandemic

In 2010 almost 170 million individuals will be wearing glasses In

2010 there will also be up to 93 million amblyopes and 12 and a half

million strabismics For children under 18 years of age that means

there will be more than 22 and a half million amblyopes and millions

of children with strabismus A clinical trial to determine the

prevalence of binocular vision dysfunction within the general

population suggested the possibility of up to 56 or 173 million men

women and children with symptoms associated with a binocular

vision dysfunction 189 million (61) with accommodative problems

and 118 million (38) demonstrating various vergence

anomalies

64

65

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Brain plasticity life long changes in the structure of the brain

Sensory substitution replacement of one sensory input by another

Measurement techniques

Voxel based morphometryhellipmeasures difference in brain volume

Fluorodeoxyglucose glucose analog PET scan tells you

distribution and metabolism of brain

Cortical thickness measures

Visual cortex of the blind turns somatic ―The eye of the tongue

Transcranial magnetic stmiulation non-invasive technique to

stimulate cortex

66

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Blind Braille readers report tingling in fingers when pressure

phosphenes are applied Blind feel tingling in tongue

Bind use tongue to perform orientation task motion perception

sensory perception Visual cortex recruited in a variety of sensory

and cognitive tasks (DM Can we use tongue as a VT tool)

Dilks Reorganizations of human adult visual system

When a region of sensory cortex is deprived of its bottom up

input the deprived region begins to respond to stimuli that

normally activate adjacent cortex

67

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Retinotopic map changes for stroke pts Cortical reorganization in

adults occurs Perceived objectshellipelongation in stroke amp AMD

What happens to deprived cortex in AMD

fMRI shows cortical reorganization in adults

Proposed mechanisms

hellipGrowth of new connections

hellipUnmasking of pre-existing connections this is true

happens within seconds

Bavelier

Action video games

68

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Bavelier

Action video games Looked at attention Gamers can track more

activities

Attention over space (me peripheral awarenress) Useful field

of view shrinks with age

Performance not VA relatedhellipis related to attention

Action game playing changes spatial resolutionhellipovercoming

crowding in VA assessment (me amblyopia therapy)

Temporal resolution of vision Backward masking

changehellipbrain changes

Visual sensitivity (contrast sensitivity) Post action game training

improves CSF

69

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Action video games correcting optics of the cortex (me this is

actualy OVT)

Games factor

Variable entry leanringhellipadapt task to skill level

Incremental learning tune task to subjectlsquos leanring steps

Motivationarousal

Rewards

Self masterself confidence

Action games factors

Pacingrate of exposure to infohellipincreasing processing speed

Dynamic display

Rich environment

Rich motor involvement

70

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Surgeons may be made to play action games

Pilot training

Amblyopia tx Dennis Levi research

PresenterTitle Contact info

Neuroplasticity-A Paradigm Sea Change

This presentation is available at

httpwwwslidesharenetDMAINOneuroplasticity-a-paradigm-sea-change-2459693

httpwwwmainosmemosblogspotcom

My FaceBook Page

and

Twitter

PresenterTitle Contact info

Questions About

Neuroplasticity-A Paradigm Sea Change

Dominick M Maino OD MEd FAAO FCOVD-A

Professor PediatricsBinocular VisionIllinois Eye InstituteIllinois College of Optometry

dmainoicoeduhttpwwwMainosMemosblogspotcom

Thanks to

httpwwwcovdorgHomeOVDJournalOVD401tabid263D

efaultaspx

httpbipolarblastfileswordpresscom200908neurojpg

httpwwwspecialcheerscomimagesanimated_braingif

httpblogmarsdencartoonscomwp-

contentuploads200810frankenstein-myspace-lightbeergif

httpwwwshangralafamilyfuncomgala-ecalvindreamgif

httppsychiatryjwatchorgcgicontentfull20082251

73

Chakraborty R Chatterjee A Choudhart S Chakraborty PK Neuroplasticitymdasha paradigm shift in neurosciences J Indian Med Assoc

2007105(9)513-4516-8520-1

Sacks O A neurologistlsquos notebook Stereo Sue Why two eyes are better than one The New Yorker 2006 Jun 1964-73

Krulwich R National Public Radio Going Binocular Susanlsquos First Snowfall Available at

wwwnprorgtemplatesstorystoryphpstoryId=5507789 (Accessed December 8 2008)

Press LJ The story behind Stereo Suelsquo and a world-famous neurologistlsquos discovery of vision therapy Optom Vis Dev 200637(2) 55-7

Levin HS Neuroplasticity and brain imaging research implications for rehabilitation Arch Phys Med Rehabil 2006 Dec87(12 Suppl

2)S1

Wiesel TN Hubel DH Single-cell responses in striate cortex of kittens deprived of vision in one eye J Neurophysiol 1963

Nov261003-17

Hook BM Chen C Critical periods in the visual system Changing views for a model of experience-dependent plasticity Neuron 2007

Oct56(2)312-26

Ramey CT Ramey SL Prevention of intellectual disabilities early interventions to improve cognitive development Prev Med 1998

Mar-Apr27(2)224-32

Heuninckx S Wenderoth N Swinnen SP Systems neuroplasticity in the aging brain recruiting additional neural resources for

successful motor performance in elderly persons J Neurosci 2008 Jan 228(1)91-9

Ge S Yang CH Hsu KS et al A critical period for enhanced synaptic plasticity in newly generated neurons of the adult brain Neuron

2007 May54(4)559-66

74

Draganski B Gaser C Busch V et al Neuroplasticity changes in grey matter induced by training Nature 2004 Jan 22427(6972)

311-2

Cannonieri GC Bonilha L Fernandes PT et al Practice and perfect length of training and structural brain changes in experienced

typists Neuroreport 2007 Jul 218(10)1063-6

Kleim JA Jones TA Principles of experience-dependent neural plasticity implications for rehabilitation after brain damage J

Speech Lang Hear Res 2008 Feb51(1)S225-39

Trojan S Porkorny J Theoretical aspects of neuroplasticity Physiol Res 199948(2)87-97

Ramamirtham R Kee CS Hung LF et al Wave aberrations in rhesus monkeys with vision-induced ametropias Vision Res 2007

Sep47(21)2751-66

Smith EL 3rd Ramamirtham R Qiao-Grider Y et al Effects of foveal ablation on emmetropization and form-deprivation myopia

Invest Ophthalmol Vis Sci 2007 Sep48(9)3914-22

Smith EL 3rd Kee CS Ramamirtham R et al Peripheral vision can influence eye growth and refractive development in infant

monkeys Invest Ophthalmol Vis Sci 2005 Nov46(11)3965-72

Ciuffreda KJ Vasudevan B Nearwork-induced transient myopia (NITM) and permanent myopiandashndashis there a link Ophthalmic

Physiol Opt 2008 Mar28(2)103-14

Hung GK Ciuffreda KJ Incremental retinal-defocus theory of myopia development--schematic analysis and computer simulation

Comput Biol Med 2007 Jul37(7)930-46

Hung GK Ciuffreda KJ A unifying theory of refractive error development Bull Math Biol 2000 Nov62(6)1087-108

75

Pang Y Maino D Zhang G Lu F Myopia Can its progress be controlled Optom Vis Dev 200637(2)75-9

Leung JT Brown B Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lenses Optom Vis Sci

1999 Jun76(6)346-54

Hasebe S Ohtsuki H Nonaka T et al Effect of progressive addition lenses on myopia progression in Japanese children a prospective

randomized double-masked crossover trial Invest Ophthalmol Vis Sci 2008 Jul49(7)2781-9

Gwiazda J Hyman L Hussein M et al A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression

of myopia in children Invest Ophthalmol Vis Sci 2003 Apr44(4)1492-500

Siatkowski RM Cotter SA Crockett RS et al Two-year multi-center randomized double-masked placebo-controlled parallel safety and

efficacy study of 2 pirenzepine ophthalmic gel in children with myopia J AAPOS 2008 Aug12(4)332-9

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged 7 to 17 years Arch Ophthalmol 2005

Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three to less than 10 years of age Am J

Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction Am J Ophthalmol 2007

Jun143(6)1060-3

Holmes JM Edwards AR Beck RW et al A randomized pilot study of near activities versus non-near activities during patching therapy for

amblyopia J AAPOS 2005 Apr9(2)129-36

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate

amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-57

76

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic

amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Convergence Insufficiency Treatment Trial Study Group Randomized clinical trial of treatments for symptomatic convergence insufficiency

in children Arch Ophthalmol 2008 Oct126(10)1336-49

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

Solan HA Shelley-Tremblay J Hansen PC et al M-cell deficit and reading disability a preliminary study of the effects of temporal vision-

processing therapy Optometry 2004 Oct75(10)640-50

Solan HA Larson S Shelley-Tremblay J et al Role of visual attention in cognitive control of oculomotor readiness in students with reading

disabilities J Learn Disabil 2001 Mar-Apr34(2)107-18

Gallaway M Boas MB The impact of vergence and accommodative therapy on reading eye movements and reading speed Optom Vis Dev

200738(3)115-20

Goss DA Downing DB Lowther AH et al The effect of HTS vision therapy conducted in a school setting on reading skills in third and

fourth grade students Optom Vis Dev 200738(1)27-32

Crutch SJ Warrington EK Foveal crowding in posterior cortical atrophy a specific early-visual-processing deficit affecting word reading

Cogn Neuropsychol 2007 Dec24(8)843-66

Helms D Sawtelle SM A study of the effectiveness of cognitive therapy delivered in a video game format Optom Vis Dev 200738 (1)19-

26

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

77

Lawton T Training direction-discrimination sensitivity remediates a wide spectrum of reading skills OptomVis Dev 200738(1) 33-47

Goldstand S Koslowe KC Parush S Vision visual-information processing and academic performance among seventh-grade schoolchildren a

more significant relationship than we thought Am J Occup Ther 2005 Jul-Aug59(4)377-89

Fischer B Koumlngeter A Hartnegg K Effects of daily practice on subitizing visual counting and basic arithmetic skills Optom Vis Dev

200839(1)30-4

Sands W Taub M Maino D Limited research and education on special populations in optometry and ophthalomology Optom Vis Dev

200839(2)60-1

Wesson M Maino D Oculo-visual findings in Down syndrome cerebral palsy and mental retardation with non-specific etiology In Maino D

(ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 199517-54 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

Cui Y Stapleton F Suttle C Developing an instrument to assess vision-related and subjective quality of life in children with intellectual

disability data collection and preliminary analysis in a Chinese population Ophthal Physiolog Optics 2008 May28(3) 238-46

Maino D Steele G Tahir S Sajja R Attitudes of optometry students toward individuals with disabilities Optom Ed 200227(2)45-50

Maino D Special populations in the optometric curriculum Optom Ed 200227(2)38-9

Maino D Overview of special populations In Scheiman M Rouse M (eds) Optometric Management of Learning-Related Vision Problems

St Louis Mosby Inc 200685-106

Maino D (ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 1995 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

78

McCarthy P Maino D Alport syndrome a review Clin Eye Vis Care 2000 Dec12(3-4)139-50

Block SS Brusca-Vega R Pizzi WJ et al Cognitive and visual processing skills and their relationship to mutation size in full and

permutation female fragile X carriers Optom Vis Sci 2000 Nov77 (11)592-9

Maino D The young child with developmental disabilities An introduction to mental retardation and genetic syndromes In Moore BD

(ed) Eye Care for Infants and Young Children Butter-worth--Heinemann Newton MA1997285-300

Amin V Maino D The Fragile X female Visual visual perceptual and ocular health anomalies J Am Optom Assoc 1995 May66

(5)290-95

Maino DM Maino JH Cibis GW Hecht F Ocular health anomalies in patients with developmental disabilities In Maino D (ed)

Diagnosis and Management of Special Populations Mosby-Year-book Inc St Louis MO 1995189-206 Reprinted Optometric

Education Program Foundation Santa Anna Calif 2001

Maino D Wesson M Schlange D Cibis G Maino J Optometric findings in the fragile X syndrome Optom Vis Sci 199168634-40

Scheiman MMOptometric findings in children with cerebral palsy Am J Optom Physiol Opt 1984 May61(5)321-3

Maino D Maino J Maino S Mental retardation syndromes with associated ocular defects J Am Optom Assoc 199061707-16

Stewart RE Woodhouse JM Cregg M Pakeman VH Association between accommodative accuracy hypermetropia and strabismus in

children with Downs syndrome Optom Vis Sci 2007 Feb84(2)149-55

Cregg M Woodhouse JM Pakeman VH et al Accommodation and refractive error in children with Down syndrome cross-sectional

and longitudinal studies Invest Ophthalmol Vis Sci 2001 Jan42 (1)55-63

79

McClelland JF Parkes J Hill N et al Accommodative dysfunction in children with cerebral palsy a population-

based study Invest Ophthalmol Vis Sci 2006 May47(5)1824-30

Duckman RH Vision therapy for the child with cerebral palsy J Am Optom Assoc 198758(1)28-35

Duckman R Accommodation in cerebral palsy function and remediation J Am Optom Assoc 198455(4)281-3

Scheiman M Understanding and managing vision deficits a guide for occupational therapists 2nd ed Slack

Thorofare NJ 2002

Maino D Binasal occlusion for the child with Cerebral Palsy J Ill Optom Assoc 198644(1)1218

Battaglia F Quartarone A Rizzo V et al Early impairment of synaptic plasticity in patients with Downs syndrome

Neurobiol Aging 2008 Aug29(8)1272-5

Bonnier C Evaluation of early stimulation programs for enhancing brain development Acta Paediatr 2008

Jul97(7)853-8

Morice E Andreae LC Cooke SF et al Preservation of long-term memory and synaptic plasticity despite short-term

impairments in the Tc1 mouse model of Down syndrome Learn Mem 2008 Jul 1415(7)492-500

Gordon AM Schneider JA Chinnan A Charles JR Efficacy of a hand-arm bimanual intensive therapy (HABIT) in

children with hemiplegic cerebral palsy a randomized control trial Dev Med Child Neurol 2007 Nov49(11)830-8

Kapoor N Ciuffreda KJ Vision disturbances following traumatic brain injury Curr Treat Options Neurol 2002

Jul4(4)271-80

80

Ciuffreda KJ Rutner D Kapoor N et al Vision therapy for oculomotor dysfunctions in acquired brain injury a

retrospective analysis Optometry 2008 Jan79(1)18-22

Ciuffreda KJ Han Y Kapoor N Ficarra AP Oculomotor rehabilitation for reading in acquired brain injury

NeuroRehabilitation 200621(1)9-21

Zost M Diagnosis and management of visual dysfunction in cerebral injury In Maino D (ed) Diagnosis and

Management of Special Populations Mosby-Yearbook Inc St Louis 199579 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001 [Figure used with permission of the editor]

DeGutis JM Bentin S Robertson LC DEsposito M Functional plasticity in ventral temporal cortex following

cognitive rehabilitation of a congenital prosopagnosic J Cogn Neurosci 2007 Nov19 (11)1790-802

Welbourne SR Ralph MA Exploring the impact of plasticity-related recovery after brain damage in a connectionist

model of single-word reading Cogn Affect Behav Neurosci 2005 Mar5(1)77-92

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements prevent cognitive decline A

systematic review of randomized controlled trials J Hum Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among preterm infants attributable to early

supplementation of human milk with docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings and structural-functional

synergies with cell membrane phospholipids Altern Med Rev 2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function Neuroscience 20089(7)568-78

81

Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

BMC Biol 2008 Sep 9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine improves neuropsychological disorders in a child with

creatine transporter defect Neurocase 200814(2) 151-61

Forrester LW Wheaton LA Luft AR Exercise-mediated locomotor recovery and lower-limb neuroplasticity after

stroke J Rehabil Res Dev 200845(2)205-20

82

Page 22: Neuroplasticity: A Paradigm Sea Change Latest Updated File

V Neuroplasticity and Optometry

A Evolutionary neuroplasticity

B Reactive plasticity

C Adaptational plasticity

D Reparation plasticity

22

V Neuroplasticity and Optometry

A Evolutionary neuroplasticity

hellip is ideally suited for the developmental OD who

specializes in vision function as it changes over time

either with or without intervention

23

V Neuroplasticity and Optometry

B Reactive plasticity

hellip can be thought of as the immediate effect that

initial optometric treatment may have on a system This can

be reflected in an immediate but often transient change in

the individuallsquos accommodative systemmdashie when an

uncorrected myope initially puts on his or her new

spectacles

24

V Neuroplasticity and Optometry

C Adaptational plasticity

hellip could describe the long-term effects of in-office optometric

vision therapy on disorders of the binocular vision system

25

V Neuroplasticity and Optometry

D Reparation plasticity

hellipin contrast to adaptational

plasticity reparation plasticity may

occur during treatment by a low

Vision specialist or an OD

Working with those who have

Experienced a traumatic brain

injury (TBI)

26

V Neuroplasticity and Optometry

The effects of plasticity can lead to either

positive or negative changes during

development (evolutionary plasticity) after

short-term exposure (reactive plasticity)

after long-term or continuous stimuli

(adaptational plasticity) and during

functional or structural recovery of damaged

neuronal circuits (reparation plasticity)

httpwwwciteulikeorguserjasonepriorarticle2856526

27

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

A Refractive error development

B Amblyopia

C Strabismus

28

D Non-strabismus non-amblyopic binocular vision disorders

E Learning related vision anomalies

F Vision developmentperception disorders

29

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

A Refractive error development

Several recent studies have noted that neuroplasticity may play a

role in refractive error development

retinal defocus use of progressive addition lenses

drug studies (M1-antagonist2 pirenzepine ) slow myopia

progression demonstrated nearly a 50 reduction in myopia

progression over a two-year period

30

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged

7 to 17 years Arch Ophthalmol 2005 Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three

to less than 10 years of age Am J Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction

Am J Ophthalmol 2007 Jun143(6)1060-3

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine

vs patching for treatment of moderate amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-

57

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for

strabismic and anisometropic amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Treatment of severe amblyopia with weekend atropine results from 2 randomized clinical trials

Levodopacarbidopa in the treatment of amblyopia

31

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

J Pediatr Ophthalmol Strabismus 2009 Mar-Apr46(2)87-90 quiz 91-2 Levodopacarbidopa in the

treatment of amblyopia Dadeya S Vats P Malik KP

PURPOSE To evaluate the role of levodopacarbidopa in the treatment of amblyopia METHODS

Thirty patients with strabismic amblyopia between the ages of 3 and 12 years were part of this double-

blind randomized study Patients were divided into two groups Group A received 050 mg + 125 mg of

levodopacarbidopa per kilogram body weight three times daily after meals with a protein rich drink

whereas Group B received placebo Both groups received full-time conventional occlusion until a visual

acuity of 66 was achieved or for a maximum of 3 months RESULTS The authors observed more than

two lines improvement in visual acuity that was greater in the levodopa group (15 of 15) than in the

placebo group (9 of 15) (P lt 005) Furthermore improvement in visual acuity of more than two lines

was greater in patients younger than 8 years (100) than in patients older than 8 years of age (60) (P =

0026) There was also no significant reversal of the improved visual acuity in up to 6 months of follow-

up CONCLUSION Levodopacarbidopa improves visual acuity in patients with

amblyopia and maintains improved visual acuity especially in patients

younger than 8 years

32

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

J Pediatr Ophthalmol Strabismus 2008 May-Jun45(3)174-6 The use of levodopa in the treatment of

bilateral amblyopia secondary to uncorrected high hypermetropia Abrams MS

The standard treatment of bilateral amblyopia secondary to uncorrected high bilateral hypermetropia has

been spectacles and time The patient described here failed to show adequate improvement in visual

acuity after 18 months of standard treatment Visual acuity improved dramatically when the

patient began taking levodopa dropped precipitously when the medication was

discontinued and returned quickly to post-treatment levels when levodopa was

restarted Visual acuity remained stable when the medication was slowly tapered

and discontinued This report suggests that dopamine may play a role in the pathophysiology of

bilateral amblyopia secondary to uncorrected high bilateral hypermetropia

33

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

Bottom Line

Amblyopia can be treated at any age

May be able to use neuro-enhancing drugs

as a part of basic amblyopia therapy

34

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

C Strabismus and non-strabismic non-amblyopic binocular

vision disorders

Clinical Trial of Treatments for Symptomatic Convergence Insufficiency in Children has

clearly demonstrated the superiority of in-office optometric vision therapy (in conjunction

with home therapy) vs out-of-office therapy alone The study concluded that optometric

vision therapyorthoptics was more effective than pencil push-ups or placebo vision

therapyorthoptics in reducing symptoms and improving clinical signs of convergence

insufficiency

Long-term effectiveness of treatments for symptomatic convergence insufficiency

in children (Optom Vis Sci 2009 Sep86(9)1096-103)

CITT patients improvements lasted a year

35

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

Strabismus 1999 Sep7(3)169-74 Convergence insufficiency in

idiopathic Parkinsons disease responsive to levodopa Racette BA

Gokden MS Tychsen LS Perlmutter JS

We report a patient with pathologically proven idiopathic Parkinsons

disease (IPD) who developed diplopia secondary to convergence

insufficiency during his motor off periods Diplopia resolved with

onset of motor benefit from levodopa Neuro-ophthalmologic

examination demonstrated convergence insufficiency during motor

off periods that was alleviated after onset of motor benefit from

levodopa This is the first reported case of convergence insufficiency

in IPD responsive to levodopa

36

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

Bottom Line

Optometric Vision Therapy is the most efficacious treatment available for binocular vision disorders and the

treatment effects are long lasting Neuro-enhancing drugs

may assist us as well

37

EF Learning related vision anomalies Vision

developmentperception disorders

hellipresearch includes an examination of the role vision plays in

reading the effect of oculomotor vergence and

accommodativecoherent motion therapy on reading eye movements

and reading speed the diagnosis and treatment of perceptual

disorders and the effect of therapy on various learning anomalies

38

EF Learning related vision anomalies Vision developmentperception disorders

magnocellular (MC) deficit in dyslexia

LM speed-matching ratio predicts reading in childrenChase C Dougherty RF Ray N

Fowler S Stein JOptom Vis Sci 2007 Mar84(3)229-36

Effect of attention therapy on reading comprehension Solan HA Shelley-Tremblay J

Ficarra A Silverman M Larson S J Learn Disabil 2003 Nov-Dec36(6)556-63

Is there a common linkage among reading comprehension visual attention and

magnocellular processing Solan HA Shelley-Tremblay JF Hansen PC Larson S

J Learn Disabil 2007 May-Jun40(3)270-8

Lawton T Filtered Text and Direction Discrimination Training Improved Reading

Fluency for Both Dyslexic and Normal Readers Optom Vis Dev 200839 (3)114

Fischer B Hartnegg K Saccade control in dyslexia Development deficits training

and transfer to reading Optom Vis Dev 200839(4)181-190

39

EF Learning related vision anomalies Vision developmentperception disorders

J Learn Disabil 2003 Nov-Dec36(6)556-63 Effect of attention therapy on reading

comprehension Solan HA Shelley-Tremblay J Ficarra A Silverman M Larson S

hellip At the completion of attention therapy the mean

standard attention and reading comprehension scores of

the experimental group had improved significantly The

control group however showed no significant

improvement in reading comprehension scores after 12

weeks Although uncertainties still exist this investigation

supports the notion that visual attention is malleable and

that attention therapy has a significant effect on reading

comprehension in this often neglected population

40

VII Vision dysfunction association with acquired brain injury

A Exotropia (or high exophoriaCI)

B Accommodative dysfunction

C Convergence insufficiency

41

D Decreased blink rate

E Spatial disorientation

F Pursuitsaccade dysfunction

G Unstable ambient vision (Magnocellular pathway)

42

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Stelmack JA Frith T Van Koevering D Rinne S Stelmack TR Visual function in patients

followed at a Veterans Affairs polytrauma network site an electronic medical record review

Optometry 2009 Aug80(8)419-24

RESULTS Visual symptoms were self-reported by 76 of patients

with polytrauma and 75 of the patients with TBI Problems with reading

(polytrauma 60 and TBI 50) and accommodation (polytrauma 30 and

TBI 47) were frequently found on eye examinations Spectacles were the

treatment most frequently prescribed (polytrauma 62 and TBI 78)

CONCLUSIONS It is important for optometrists to be aware of the high

rates of self-reported symptoms and visual problems in military personnel

returning from deployment to the wars in Iraq and Afghanistan Post-

traumatic stress disorder and depression may complicate optometric

evaluation and management

43

VII Vision dysfunction association with acquired brain injury

Avoidance of near tasks

Oculomotor-based reading difficulties

Eye tracking problems

Eye focusing problems

Eyestrain Diplopia

Dizziness Vertigo

Vision-derived nausea

44

VII Vision dysfunction association with acquired brain injury

Increased sensitivity to visual motion

Visual inattention and distractibility

Short-term visual memory loss

Difficulty judging distances (relative and absolute

Difficulty with global scanning

Difficulty with personal grooming especially involving the face

Inability to interactcope visually in a complex social situation

(eg minimal eye contact)

Inability to tolerate complex visual environments (eg grocery store

aisles and highly-patterned floors)

45

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Ciuffreda KJ Ludlam DP Kapoor N Clinical oculomotor training in traumatic brain injury Optom Vis

Dev 200940(1)16-23

Individuals with traumatic brain injury present with a constellation of

oculomotor dysfunctions and correlated symptoms Simple and

effective clinical oculomotor-based training procedures will be

presented with respect to the versional vergence and

accommodative systems and their interactions These therapeutic

procedures can also be applied as needed to individuals with either

low vision neurological dysfunctions or general visual skills cases

manifesting similar oculomotor deficits

46

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Leslie S Myopia and accommodative insufficiency associated with

moderate head trauma Opt Vis Dev 200940(1)25-31

The majority of subjects reviewed had developed a stable degree of

myopia between 100 and 200 diopters as well as an abnormally

high lag of accommodation When their distance and near spatial area

of focus was compared the majority were focused at an intermediate

area in space suggesting a loss of control of accommodation in

space

47

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

B Drugs

C Exercise

D Learning new and challenging things

48

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements

prevent cognitive decline A systematic review of randomized controlled trials J Hum

Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among

preterm infants attributable to early supplementation of human milk with

docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings

and structural-functional synergies with cell membrane phospholipids Altern Med Rev

2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function

Neuroscience 20089(7)568-78

49

VIII Improving Brain Function and Neuroplasticity

B Drugs Maya Vetencourt JF Sale A Viegi A et al The antidepressant

fluoxetine (PROZAC) restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the

antidepressant tianeptine CNS Drugs 200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances

hippocampal long-term potentiation and memory BMC Biol 2008 Sep

9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine

improves neuropsychological disorders in a child with creatine

transporter defect Neurocase 200814(2) 151-61

50

VIII Improving Brain Function and Neuroplasticity

C Exercise

Hunsberger JG et al Antidepressant actions of the exercise-

regulated gene VGF Nat Med 2007 Dec 2 131476

VGF may be a common pathway by which exercise induces

neuroplasticity and growth-factor genes at least one of these might act

similarly to antidepressants in promoting an adaptive response to stress

However the tests used here may be modeling stress-induced

helplessness not depression hellipexercise seems to induce multiple

interacting genes that enhance neuronal resilience

51

VIII Improving Brain Function and Neuroplasticity

D Learning new and challenging things

What have we (optometry amp ophthalmology)

been thinking all these years

Where did we miss the news about neuroplasticity

52

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Huang JC Neuroplasticity as a proposed mechanism for the efficacy of optometric vision therapy and rehabilitation J Bev Optom 200920(4)96-100

Homologous area adaptationCompensatory masqueradeCross-modal reassignment

Map expansion

EquipotentialityVicariation

53

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Homologous area adaptation a transfer of function from a damaged brain area to a non-damaged brain area May be limited to early stages of human development and may crowd a new brain area resulting in reduced functionality of that brain area (Competition between spatial amp verbal functioning)

54

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Compensatory masquerade reorganizing of existing neuro-pathways to us alternative cognitive strategies to perform a task

55

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Cross-modal reassignment using new sensory input in a brain structure deprived of its main input source (changing processing from visual to tactile stimuli in the blind)

56

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Map expansion increase in brain mass due to repeated behavior or exposure to stimuli

57

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Equipotentiality anatomical areas of the brain can perform disparate functions

Vicariation redundant neural systems can operate under abnormal conditions

This may explain why recovery is noted for many neurological conditions (degenerative psychiatric developmental vascular traumatic)

58

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Constraint therapy Use it and improve it

Patching penalization ldquonear activitiesrdquo during amblyopia therapy

59

IX Improving Brain Function and Neuroplasticity Optometric Clinical ApplicationsOptometric Vision Therapy

Kleim amp Jones

Use it or lose it If you do not drive specific brain functions

functional loss will occur

If you want to improve oculomotor brain neuroplastic function amp

structure therapy should be specific for that brain function

Use it and improve it Therapy that drives cortical function enhances

that particular function

If you use therapy to improve oculomotor dysfunction it should

improve

Specificity The therapy you choose determines the resultant

plasticity and function

You must choose therapy that is appropriate

60

IX Improving Brain Function and Neuroplasticity Optometric Clinical Applications

Kleim amp Jones

Repetition matters Plasticity that results in functional change

requires repetition

Do the therapy Do it again Do it yet again No quick fix

Intensity matters Induction of plasticity requires the appropriate

amount of intensity

Intensity means strength force concentration power and passion

Without these plasticity may not occur Function may not improve

Time matters Different forms of plasticity take place at different

times during therapy

Do the basics than the more advanced therapeutic procedures

61

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Salience matters It has to be important to the individual

Make the therapy matter to the patient

Age matters Plasticity is easier in a younger brain but is also

possible in an adult brain

Do not let age determine what therapy options you offer your

patients Think of Susan Barry PhD (StereoSue) and her success

Offer your patients options Let them choose Be realistic about

outcomeshelliphave outcome measures built into therapy program

62

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Transference Neuroplasticity and the change in function

that results from one therapy can augment the attainment

of similar behaviors

What you do during oculomotor therapy may affected

vergence therapy outcomes

Interference Plasticity in response to one experience can

interfere with the acquisition of other behaviors

Monitor Evaluate progress Discuss function in other areas

of your patientslsquo life

63

Why pay attention to binocular vision dysfunctions

and neuroplasticity

December 2009 issue of the Review of Optometry

The Binocular Vision Dysfunction Pandemic

In 2010 almost 170 million individuals will be wearing glasses In

2010 there will also be up to 93 million amblyopes and 12 and a half

million strabismics For children under 18 years of age that means

there will be more than 22 and a half million amblyopes and millions

of children with strabismus A clinical trial to determine the

prevalence of binocular vision dysfunction within the general

population suggested the possibility of up to 56 or 173 million men

women and children with symptoms associated with a binocular

vision dysfunction 189 million (61) with accommodative problems

and 118 million (38) demonstrating various vergence

anomalies

64

65

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Brain plasticity life long changes in the structure of the brain

Sensory substitution replacement of one sensory input by another

Measurement techniques

Voxel based morphometryhellipmeasures difference in brain volume

Fluorodeoxyglucose glucose analog PET scan tells you

distribution and metabolism of brain

Cortical thickness measures

Visual cortex of the blind turns somatic ―The eye of the tongue

Transcranial magnetic stmiulation non-invasive technique to

stimulate cortex

66

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Blind Braille readers report tingling in fingers when pressure

phosphenes are applied Blind feel tingling in tongue

Bind use tongue to perform orientation task motion perception

sensory perception Visual cortex recruited in a variety of sensory

and cognitive tasks (DM Can we use tongue as a VT tool)

Dilks Reorganizations of human adult visual system

When a region of sensory cortex is deprived of its bottom up

input the deprived region begins to respond to stimuli that

normally activate adjacent cortex

67

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Retinotopic map changes for stroke pts Cortical reorganization in

adults occurs Perceived objectshellipelongation in stroke amp AMD

What happens to deprived cortex in AMD

fMRI shows cortical reorganization in adults

Proposed mechanisms

hellipGrowth of new connections

hellipUnmasking of pre-existing connections this is true

happens within seconds

Bavelier

Action video games

68

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Bavelier

Action video games Looked at attention Gamers can track more

activities

Attention over space (me peripheral awarenress) Useful field

of view shrinks with age

Performance not VA relatedhellipis related to attention

Action game playing changes spatial resolutionhellipovercoming

crowding in VA assessment (me amblyopia therapy)

Temporal resolution of vision Backward masking

changehellipbrain changes

Visual sensitivity (contrast sensitivity) Post action game training

improves CSF

69

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Action video games correcting optics of the cortex (me this is

actualy OVT)

Games factor

Variable entry leanringhellipadapt task to skill level

Incremental learning tune task to subjectlsquos leanring steps

Motivationarousal

Rewards

Self masterself confidence

Action games factors

Pacingrate of exposure to infohellipincreasing processing speed

Dynamic display

Rich environment

Rich motor involvement

70

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Surgeons may be made to play action games

Pilot training

Amblyopia tx Dennis Levi research

PresenterTitle Contact info

Neuroplasticity-A Paradigm Sea Change

This presentation is available at

httpwwwslidesharenetDMAINOneuroplasticity-a-paradigm-sea-change-2459693

httpwwwmainosmemosblogspotcom

My FaceBook Page

and

Twitter

PresenterTitle Contact info

Questions About

Neuroplasticity-A Paradigm Sea Change

Dominick M Maino OD MEd FAAO FCOVD-A

Professor PediatricsBinocular VisionIllinois Eye InstituteIllinois College of Optometry

dmainoicoeduhttpwwwMainosMemosblogspotcom

Thanks to

httpwwwcovdorgHomeOVDJournalOVD401tabid263D

efaultaspx

httpbipolarblastfileswordpresscom200908neurojpg

httpwwwspecialcheerscomimagesanimated_braingif

httpblogmarsdencartoonscomwp-

contentuploads200810frankenstein-myspace-lightbeergif

httpwwwshangralafamilyfuncomgala-ecalvindreamgif

httppsychiatryjwatchorgcgicontentfull20082251

73

Chakraborty R Chatterjee A Choudhart S Chakraborty PK Neuroplasticitymdasha paradigm shift in neurosciences J Indian Med Assoc

2007105(9)513-4516-8520-1

Sacks O A neurologistlsquos notebook Stereo Sue Why two eyes are better than one The New Yorker 2006 Jun 1964-73

Krulwich R National Public Radio Going Binocular Susanlsquos First Snowfall Available at

wwwnprorgtemplatesstorystoryphpstoryId=5507789 (Accessed December 8 2008)

Press LJ The story behind Stereo Suelsquo and a world-famous neurologistlsquos discovery of vision therapy Optom Vis Dev 200637(2) 55-7

Levin HS Neuroplasticity and brain imaging research implications for rehabilitation Arch Phys Med Rehabil 2006 Dec87(12 Suppl

2)S1

Wiesel TN Hubel DH Single-cell responses in striate cortex of kittens deprived of vision in one eye J Neurophysiol 1963

Nov261003-17

Hook BM Chen C Critical periods in the visual system Changing views for a model of experience-dependent plasticity Neuron 2007

Oct56(2)312-26

Ramey CT Ramey SL Prevention of intellectual disabilities early interventions to improve cognitive development Prev Med 1998

Mar-Apr27(2)224-32

Heuninckx S Wenderoth N Swinnen SP Systems neuroplasticity in the aging brain recruiting additional neural resources for

successful motor performance in elderly persons J Neurosci 2008 Jan 228(1)91-9

Ge S Yang CH Hsu KS et al A critical period for enhanced synaptic plasticity in newly generated neurons of the adult brain Neuron

2007 May54(4)559-66

74

Draganski B Gaser C Busch V et al Neuroplasticity changes in grey matter induced by training Nature 2004 Jan 22427(6972)

311-2

Cannonieri GC Bonilha L Fernandes PT et al Practice and perfect length of training and structural brain changes in experienced

typists Neuroreport 2007 Jul 218(10)1063-6

Kleim JA Jones TA Principles of experience-dependent neural plasticity implications for rehabilitation after brain damage J

Speech Lang Hear Res 2008 Feb51(1)S225-39

Trojan S Porkorny J Theoretical aspects of neuroplasticity Physiol Res 199948(2)87-97

Ramamirtham R Kee CS Hung LF et al Wave aberrations in rhesus monkeys with vision-induced ametropias Vision Res 2007

Sep47(21)2751-66

Smith EL 3rd Ramamirtham R Qiao-Grider Y et al Effects of foveal ablation on emmetropization and form-deprivation myopia

Invest Ophthalmol Vis Sci 2007 Sep48(9)3914-22

Smith EL 3rd Kee CS Ramamirtham R et al Peripheral vision can influence eye growth and refractive development in infant

monkeys Invest Ophthalmol Vis Sci 2005 Nov46(11)3965-72

Ciuffreda KJ Vasudevan B Nearwork-induced transient myopia (NITM) and permanent myopiandashndashis there a link Ophthalmic

Physiol Opt 2008 Mar28(2)103-14

Hung GK Ciuffreda KJ Incremental retinal-defocus theory of myopia development--schematic analysis and computer simulation

Comput Biol Med 2007 Jul37(7)930-46

Hung GK Ciuffreda KJ A unifying theory of refractive error development Bull Math Biol 2000 Nov62(6)1087-108

75

Pang Y Maino D Zhang G Lu F Myopia Can its progress be controlled Optom Vis Dev 200637(2)75-9

Leung JT Brown B Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lenses Optom Vis Sci

1999 Jun76(6)346-54

Hasebe S Ohtsuki H Nonaka T et al Effect of progressive addition lenses on myopia progression in Japanese children a prospective

randomized double-masked crossover trial Invest Ophthalmol Vis Sci 2008 Jul49(7)2781-9

Gwiazda J Hyman L Hussein M et al A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression

of myopia in children Invest Ophthalmol Vis Sci 2003 Apr44(4)1492-500

Siatkowski RM Cotter SA Crockett RS et al Two-year multi-center randomized double-masked placebo-controlled parallel safety and

efficacy study of 2 pirenzepine ophthalmic gel in children with myopia J AAPOS 2008 Aug12(4)332-9

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged 7 to 17 years Arch Ophthalmol 2005

Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three to less than 10 years of age Am J

Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction Am J Ophthalmol 2007

Jun143(6)1060-3

Holmes JM Edwards AR Beck RW et al A randomized pilot study of near activities versus non-near activities during patching therapy for

amblyopia J AAPOS 2005 Apr9(2)129-36

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate

amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-57

76

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic

amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Convergence Insufficiency Treatment Trial Study Group Randomized clinical trial of treatments for symptomatic convergence insufficiency

in children Arch Ophthalmol 2008 Oct126(10)1336-49

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

Solan HA Shelley-Tremblay J Hansen PC et al M-cell deficit and reading disability a preliminary study of the effects of temporal vision-

processing therapy Optometry 2004 Oct75(10)640-50

Solan HA Larson S Shelley-Tremblay J et al Role of visual attention in cognitive control of oculomotor readiness in students with reading

disabilities J Learn Disabil 2001 Mar-Apr34(2)107-18

Gallaway M Boas MB The impact of vergence and accommodative therapy on reading eye movements and reading speed Optom Vis Dev

200738(3)115-20

Goss DA Downing DB Lowther AH et al The effect of HTS vision therapy conducted in a school setting on reading skills in third and

fourth grade students Optom Vis Dev 200738(1)27-32

Crutch SJ Warrington EK Foveal crowding in posterior cortical atrophy a specific early-visual-processing deficit affecting word reading

Cogn Neuropsychol 2007 Dec24(8)843-66

Helms D Sawtelle SM A study of the effectiveness of cognitive therapy delivered in a video game format Optom Vis Dev 200738 (1)19-

26

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

77

Lawton T Training direction-discrimination sensitivity remediates a wide spectrum of reading skills OptomVis Dev 200738(1) 33-47

Goldstand S Koslowe KC Parush S Vision visual-information processing and academic performance among seventh-grade schoolchildren a

more significant relationship than we thought Am J Occup Ther 2005 Jul-Aug59(4)377-89

Fischer B Koumlngeter A Hartnegg K Effects of daily practice on subitizing visual counting and basic arithmetic skills Optom Vis Dev

200839(1)30-4

Sands W Taub M Maino D Limited research and education on special populations in optometry and ophthalomology Optom Vis Dev

200839(2)60-1

Wesson M Maino D Oculo-visual findings in Down syndrome cerebral palsy and mental retardation with non-specific etiology In Maino D

(ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 199517-54 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

Cui Y Stapleton F Suttle C Developing an instrument to assess vision-related and subjective quality of life in children with intellectual

disability data collection and preliminary analysis in a Chinese population Ophthal Physiolog Optics 2008 May28(3) 238-46

Maino D Steele G Tahir S Sajja R Attitudes of optometry students toward individuals with disabilities Optom Ed 200227(2)45-50

Maino D Special populations in the optometric curriculum Optom Ed 200227(2)38-9

Maino D Overview of special populations In Scheiman M Rouse M (eds) Optometric Management of Learning-Related Vision Problems

St Louis Mosby Inc 200685-106

Maino D (ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 1995 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

78

McCarthy P Maino D Alport syndrome a review Clin Eye Vis Care 2000 Dec12(3-4)139-50

Block SS Brusca-Vega R Pizzi WJ et al Cognitive and visual processing skills and their relationship to mutation size in full and

permutation female fragile X carriers Optom Vis Sci 2000 Nov77 (11)592-9

Maino D The young child with developmental disabilities An introduction to mental retardation and genetic syndromes In Moore BD

(ed) Eye Care for Infants and Young Children Butter-worth--Heinemann Newton MA1997285-300

Amin V Maino D The Fragile X female Visual visual perceptual and ocular health anomalies J Am Optom Assoc 1995 May66

(5)290-95

Maino DM Maino JH Cibis GW Hecht F Ocular health anomalies in patients with developmental disabilities In Maino D (ed)

Diagnosis and Management of Special Populations Mosby-Year-book Inc St Louis MO 1995189-206 Reprinted Optometric

Education Program Foundation Santa Anna Calif 2001

Maino D Wesson M Schlange D Cibis G Maino J Optometric findings in the fragile X syndrome Optom Vis Sci 199168634-40

Scheiman MMOptometric findings in children with cerebral palsy Am J Optom Physiol Opt 1984 May61(5)321-3

Maino D Maino J Maino S Mental retardation syndromes with associated ocular defects J Am Optom Assoc 199061707-16

Stewart RE Woodhouse JM Cregg M Pakeman VH Association between accommodative accuracy hypermetropia and strabismus in

children with Downs syndrome Optom Vis Sci 2007 Feb84(2)149-55

Cregg M Woodhouse JM Pakeman VH et al Accommodation and refractive error in children with Down syndrome cross-sectional

and longitudinal studies Invest Ophthalmol Vis Sci 2001 Jan42 (1)55-63

79

McClelland JF Parkes J Hill N et al Accommodative dysfunction in children with cerebral palsy a population-

based study Invest Ophthalmol Vis Sci 2006 May47(5)1824-30

Duckman RH Vision therapy for the child with cerebral palsy J Am Optom Assoc 198758(1)28-35

Duckman R Accommodation in cerebral palsy function and remediation J Am Optom Assoc 198455(4)281-3

Scheiman M Understanding and managing vision deficits a guide for occupational therapists 2nd ed Slack

Thorofare NJ 2002

Maino D Binasal occlusion for the child with Cerebral Palsy J Ill Optom Assoc 198644(1)1218

Battaglia F Quartarone A Rizzo V et al Early impairment of synaptic plasticity in patients with Downs syndrome

Neurobiol Aging 2008 Aug29(8)1272-5

Bonnier C Evaluation of early stimulation programs for enhancing brain development Acta Paediatr 2008

Jul97(7)853-8

Morice E Andreae LC Cooke SF et al Preservation of long-term memory and synaptic plasticity despite short-term

impairments in the Tc1 mouse model of Down syndrome Learn Mem 2008 Jul 1415(7)492-500

Gordon AM Schneider JA Chinnan A Charles JR Efficacy of a hand-arm bimanual intensive therapy (HABIT) in

children with hemiplegic cerebral palsy a randomized control trial Dev Med Child Neurol 2007 Nov49(11)830-8

Kapoor N Ciuffreda KJ Vision disturbances following traumatic brain injury Curr Treat Options Neurol 2002

Jul4(4)271-80

80

Ciuffreda KJ Rutner D Kapoor N et al Vision therapy for oculomotor dysfunctions in acquired brain injury a

retrospective analysis Optometry 2008 Jan79(1)18-22

Ciuffreda KJ Han Y Kapoor N Ficarra AP Oculomotor rehabilitation for reading in acquired brain injury

NeuroRehabilitation 200621(1)9-21

Zost M Diagnosis and management of visual dysfunction in cerebral injury In Maino D (ed) Diagnosis and

Management of Special Populations Mosby-Yearbook Inc St Louis 199579 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001 [Figure used with permission of the editor]

DeGutis JM Bentin S Robertson LC DEsposito M Functional plasticity in ventral temporal cortex following

cognitive rehabilitation of a congenital prosopagnosic J Cogn Neurosci 2007 Nov19 (11)1790-802

Welbourne SR Ralph MA Exploring the impact of plasticity-related recovery after brain damage in a connectionist

model of single-word reading Cogn Affect Behav Neurosci 2005 Mar5(1)77-92

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements prevent cognitive decline A

systematic review of randomized controlled trials J Hum Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among preterm infants attributable to early

supplementation of human milk with docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings and structural-functional

synergies with cell membrane phospholipids Altern Med Rev 2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function Neuroscience 20089(7)568-78

81

Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

BMC Biol 2008 Sep 9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine improves neuropsychological disorders in a child with

creatine transporter defect Neurocase 200814(2) 151-61

Forrester LW Wheaton LA Luft AR Exercise-mediated locomotor recovery and lower-limb neuroplasticity after

stroke J Rehabil Res Dev 200845(2)205-20

82

Page 23: Neuroplasticity: A Paradigm Sea Change Latest Updated File

V Neuroplasticity and Optometry

A Evolutionary neuroplasticity

hellip is ideally suited for the developmental OD who

specializes in vision function as it changes over time

either with or without intervention

23

V Neuroplasticity and Optometry

B Reactive plasticity

hellip can be thought of as the immediate effect that

initial optometric treatment may have on a system This can

be reflected in an immediate but often transient change in

the individuallsquos accommodative systemmdashie when an

uncorrected myope initially puts on his or her new

spectacles

24

V Neuroplasticity and Optometry

C Adaptational plasticity

hellip could describe the long-term effects of in-office optometric

vision therapy on disorders of the binocular vision system

25

V Neuroplasticity and Optometry

D Reparation plasticity

hellipin contrast to adaptational

plasticity reparation plasticity may

occur during treatment by a low

Vision specialist or an OD

Working with those who have

Experienced a traumatic brain

injury (TBI)

26

V Neuroplasticity and Optometry

The effects of plasticity can lead to either

positive or negative changes during

development (evolutionary plasticity) after

short-term exposure (reactive plasticity)

after long-term or continuous stimuli

(adaptational plasticity) and during

functional or structural recovery of damaged

neuronal circuits (reparation plasticity)

httpwwwciteulikeorguserjasonepriorarticle2856526

27

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

A Refractive error development

B Amblyopia

C Strabismus

28

D Non-strabismus non-amblyopic binocular vision disorders

E Learning related vision anomalies

F Vision developmentperception disorders

29

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

A Refractive error development

Several recent studies have noted that neuroplasticity may play a

role in refractive error development

retinal defocus use of progressive addition lenses

drug studies (M1-antagonist2 pirenzepine ) slow myopia

progression demonstrated nearly a 50 reduction in myopia

progression over a two-year period

30

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged

7 to 17 years Arch Ophthalmol 2005 Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three

to less than 10 years of age Am J Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction

Am J Ophthalmol 2007 Jun143(6)1060-3

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine

vs patching for treatment of moderate amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-

57

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for

strabismic and anisometropic amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Treatment of severe amblyopia with weekend atropine results from 2 randomized clinical trials

Levodopacarbidopa in the treatment of amblyopia

31

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

J Pediatr Ophthalmol Strabismus 2009 Mar-Apr46(2)87-90 quiz 91-2 Levodopacarbidopa in the

treatment of amblyopia Dadeya S Vats P Malik KP

PURPOSE To evaluate the role of levodopacarbidopa in the treatment of amblyopia METHODS

Thirty patients with strabismic amblyopia between the ages of 3 and 12 years were part of this double-

blind randomized study Patients were divided into two groups Group A received 050 mg + 125 mg of

levodopacarbidopa per kilogram body weight three times daily after meals with a protein rich drink

whereas Group B received placebo Both groups received full-time conventional occlusion until a visual

acuity of 66 was achieved or for a maximum of 3 months RESULTS The authors observed more than

two lines improvement in visual acuity that was greater in the levodopa group (15 of 15) than in the

placebo group (9 of 15) (P lt 005) Furthermore improvement in visual acuity of more than two lines

was greater in patients younger than 8 years (100) than in patients older than 8 years of age (60) (P =

0026) There was also no significant reversal of the improved visual acuity in up to 6 months of follow-

up CONCLUSION Levodopacarbidopa improves visual acuity in patients with

amblyopia and maintains improved visual acuity especially in patients

younger than 8 years

32

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

J Pediatr Ophthalmol Strabismus 2008 May-Jun45(3)174-6 The use of levodopa in the treatment of

bilateral amblyopia secondary to uncorrected high hypermetropia Abrams MS

The standard treatment of bilateral amblyopia secondary to uncorrected high bilateral hypermetropia has

been spectacles and time The patient described here failed to show adequate improvement in visual

acuity after 18 months of standard treatment Visual acuity improved dramatically when the

patient began taking levodopa dropped precipitously when the medication was

discontinued and returned quickly to post-treatment levels when levodopa was

restarted Visual acuity remained stable when the medication was slowly tapered

and discontinued This report suggests that dopamine may play a role in the pathophysiology of

bilateral amblyopia secondary to uncorrected high bilateral hypermetropia

33

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

Bottom Line

Amblyopia can be treated at any age

May be able to use neuro-enhancing drugs

as a part of basic amblyopia therapy

34

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

C Strabismus and non-strabismic non-amblyopic binocular

vision disorders

Clinical Trial of Treatments for Symptomatic Convergence Insufficiency in Children has

clearly demonstrated the superiority of in-office optometric vision therapy (in conjunction

with home therapy) vs out-of-office therapy alone The study concluded that optometric

vision therapyorthoptics was more effective than pencil push-ups or placebo vision

therapyorthoptics in reducing symptoms and improving clinical signs of convergence

insufficiency

Long-term effectiveness of treatments for symptomatic convergence insufficiency

in children (Optom Vis Sci 2009 Sep86(9)1096-103)

CITT patients improvements lasted a year

35

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

Strabismus 1999 Sep7(3)169-74 Convergence insufficiency in

idiopathic Parkinsons disease responsive to levodopa Racette BA

Gokden MS Tychsen LS Perlmutter JS

We report a patient with pathologically proven idiopathic Parkinsons

disease (IPD) who developed diplopia secondary to convergence

insufficiency during his motor off periods Diplopia resolved with

onset of motor benefit from levodopa Neuro-ophthalmologic

examination demonstrated convergence insufficiency during motor

off periods that was alleviated after onset of motor benefit from

levodopa This is the first reported case of convergence insufficiency

in IPD responsive to levodopa

36

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

Bottom Line

Optometric Vision Therapy is the most efficacious treatment available for binocular vision disorders and the

treatment effects are long lasting Neuro-enhancing drugs

may assist us as well

37

EF Learning related vision anomalies Vision

developmentperception disorders

hellipresearch includes an examination of the role vision plays in

reading the effect of oculomotor vergence and

accommodativecoherent motion therapy on reading eye movements

and reading speed the diagnosis and treatment of perceptual

disorders and the effect of therapy on various learning anomalies

38

EF Learning related vision anomalies Vision developmentperception disorders

magnocellular (MC) deficit in dyslexia

LM speed-matching ratio predicts reading in childrenChase C Dougherty RF Ray N

Fowler S Stein JOptom Vis Sci 2007 Mar84(3)229-36

Effect of attention therapy on reading comprehension Solan HA Shelley-Tremblay J

Ficarra A Silverman M Larson S J Learn Disabil 2003 Nov-Dec36(6)556-63

Is there a common linkage among reading comprehension visual attention and

magnocellular processing Solan HA Shelley-Tremblay JF Hansen PC Larson S

J Learn Disabil 2007 May-Jun40(3)270-8

Lawton T Filtered Text and Direction Discrimination Training Improved Reading

Fluency for Both Dyslexic and Normal Readers Optom Vis Dev 200839 (3)114

Fischer B Hartnegg K Saccade control in dyslexia Development deficits training

and transfer to reading Optom Vis Dev 200839(4)181-190

39

EF Learning related vision anomalies Vision developmentperception disorders

J Learn Disabil 2003 Nov-Dec36(6)556-63 Effect of attention therapy on reading

comprehension Solan HA Shelley-Tremblay J Ficarra A Silverman M Larson S

hellip At the completion of attention therapy the mean

standard attention and reading comprehension scores of

the experimental group had improved significantly The

control group however showed no significant

improvement in reading comprehension scores after 12

weeks Although uncertainties still exist this investigation

supports the notion that visual attention is malleable and

that attention therapy has a significant effect on reading

comprehension in this often neglected population

40

VII Vision dysfunction association with acquired brain injury

A Exotropia (or high exophoriaCI)

B Accommodative dysfunction

C Convergence insufficiency

41

D Decreased blink rate

E Spatial disorientation

F Pursuitsaccade dysfunction

G Unstable ambient vision (Magnocellular pathway)

42

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Stelmack JA Frith T Van Koevering D Rinne S Stelmack TR Visual function in patients

followed at a Veterans Affairs polytrauma network site an electronic medical record review

Optometry 2009 Aug80(8)419-24

RESULTS Visual symptoms were self-reported by 76 of patients

with polytrauma and 75 of the patients with TBI Problems with reading

(polytrauma 60 and TBI 50) and accommodation (polytrauma 30 and

TBI 47) were frequently found on eye examinations Spectacles were the

treatment most frequently prescribed (polytrauma 62 and TBI 78)

CONCLUSIONS It is important for optometrists to be aware of the high

rates of self-reported symptoms and visual problems in military personnel

returning from deployment to the wars in Iraq and Afghanistan Post-

traumatic stress disorder and depression may complicate optometric

evaluation and management

43

VII Vision dysfunction association with acquired brain injury

Avoidance of near tasks

Oculomotor-based reading difficulties

Eye tracking problems

Eye focusing problems

Eyestrain Diplopia

Dizziness Vertigo

Vision-derived nausea

44

VII Vision dysfunction association with acquired brain injury

Increased sensitivity to visual motion

Visual inattention and distractibility

Short-term visual memory loss

Difficulty judging distances (relative and absolute

Difficulty with global scanning

Difficulty with personal grooming especially involving the face

Inability to interactcope visually in a complex social situation

(eg minimal eye contact)

Inability to tolerate complex visual environments (eg grocery store

aisles and highly-patterned floors)

45

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Ciuffreda KJ Ludlam DP Kapoor N Clinical oculomotor training in traumatic brain injury Optom Vis

Dev 200940(1)16-23

Individuals with traumatic brain injury present with a constellation of

oculomotor dysfunctions and correlated symptoms Simple and

effective clinical oculomotor-based training procedures will be

presented with respect to the versional vergence and

accommodative systems and their interactions These therapeutic

procedures can also be applied as needed to individuals with either

low vision neurological dysfunctions or general visual skills cases

manifesting similar oculomotor deficits

46

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Leslie S Myopia and accommodative insufficiency associated with

moderate head trauma Opt Vis Dev 200940(1)25-31

The majority of subjects reviewed had developed a stable degree of

myopia between 100 and 200 diopters as well as an abnormally

high lag of accommodation When their distance and near spatial area

of focus was compared the majority were focused at an intermediate

area in space suggesting a loss of control of accommodation in

space

47

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

B Drugs

C Exercise

D Learning new and challenging things

48

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements

prevent cognitive decline A systematic review of randomized controlled trials J Hum

Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among

preterm infants attributable to early supplementation of human milk with

docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings

and structural-functional synergies with cell membrane phospholipids Altern Med Rev

2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function

Neuroscience 20089(7)568-78

49

VIII Improving Brain Function and Neuroplasticity

B Drugs Maya Vetencourt JF Sale A Viegi A et al The antidepressant

fluoxetine (PROZAC) restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the

antidepressant tianeptine CNS Drugs 200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances

hippocampal long-term potentiation and memory BMC Biol 2008 Sep

9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine

improves neuropsychological disorders in a child with creatine

transporter defect Neurocase 200814(2) 151-61

50

VIII Improving Brain Function and Neuroplasticity

C Exercise

Hunsberger JG et al Antidepressant actions of the exercise-

regulated gene VGF Nat Med 2007 Dec 2 131476

VGF may be a common pathway by which exercise induces

neuroplasticity and growth-factor genes at least one of these might act

similarly to antidepressants in promoting an adaptive response to stress

However the tests used here may be modeling stress-induced

helplessness not depression hellipexercise seems to induce multiple

interacting genes that enhance neuronal resilience

51

VIII Improving Brain Function and Neuroplasticity

D Learning new and challenging things

What have we (optometry amp ophthalmology)

been thinking all these years

Where did we miss the news about neuroplasticity

52

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Huang JC Neuroplasticity as a proposed mechanism for the efficacy of optometric vision therapy and rehabilitation J Bev Optom 200920(4)96-100

Homologous area adaptationCompensatory masqueradeCross-modal reassignment

Map expansion

EquipotentialityVicariation

53

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Homologous area adaptation a transfer of function from a damaged brain area to a non-damaged brain area May be limited to early stages of human development and may crowd a new brain area resulting in reduced functionality of that brain area (Competition between spatial amp verbal functioning)

54

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Compensatory masquerade reorganizing of existing neuro-pathways to us alternative cognitive strategies to perform a task

55

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Cross-modal reassignment using new sensory input in a brain structure deprived of its main input source (changing processing from visual to tactile stimuli in the blind)

56

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Map expansion increase in brain mass due to repeated behavior or exposure to stimuli

57

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Equipotentiality anatomical areas of the brain can perform disparate functions

Vicariation redundant neural systems can operate under abnormal conditions

This may explain why recovery is noted for many neurological conditions (degenerative psychiatric developmental vascular traumatic)

58

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Constraint therapy Use it and improve it

Patching penalization ldquonear activitiesrdquo during amblyopia therapy

59

IX Improving Brain Function and Neuroplasticity Optometric Clinical ApplicationsOptometric Vision Therapy

Kleim amp Jones

Use it or lose it If you do not drive specific brain functions

functional loss will occur

If you want to improve oculomotor brain neuroplastic function amp

structure therapy should be specific for that brain function

Use it and improve it Therapy that drives cortical function enhances

that particular function

If you use therapy to improve oculomotor dysfunction it should

improve

Specificity The therapy you choose determines the resultant

plasticity and function

You must choose therapy that is appropriate

60

IX Improving Brain Function and Neuroplasticity Optometric Clinical Applications

Kleim amp Jones

Repetition matters Plasticity that results in functional change

requires repetition

Do the therapy Do it again Do it yet again No quick fix

Intensity matters Induction of plasticity requires the appropriate

amount of intensity

Intensity means strength force concentration power and passion

Without these plasticity may not occur Function may not improve

Time matters Different forms of plasticity take place at different

times during therapy

Do the basics than the more advanced therapeutic procedures

61

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Salience matters It has to be important to the individual

Make the therapy matter to the patient

Age matters Plasticity is easier in a younger brain but is also

possible in an adult brain

Do not let age determine what therapy options you offer your

patients Think of Susan Barry PhD (StereoSue) and her success

Offer your patients options Let them choose Be realistic about

outcomeshelliphave outcome measures built into therapy program

62

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Transference Neuroplasticity and the change in function

that results from one therapy can augment the attainment

of similar behaviors

What you do during oculomotor therapy may affected

vergence therapy outcomes

Interference Plasticity in response to one experience can

interfere with the acquisition of other behaviors

Monitor Evaluate progress Discuss function in other areas

of your patientslsquo life

63

Why pay attention to binocular vision dysfunctions

and neuroplasticity

December 2009 issue of the Review of Optometry

The Binocular Vision Dysfunction Pandemic

In 2010 almost 170 million individuals will be wearing glasses In

2010 there will also be up to 93 million amblyopes and 12 and a half

million strabismics For children under 18 years of age that means

there will be more than 22 and a half million amblyopes and millions

of children with strabismus A clinical trial to determine the

prevalence of binocular vision dysfunction within the general

population suggested the possibility of up to 56 or 173 million men

women and children with symptoms associated with a binocular

vision dysfunction 189 million (61) with accommodative problems

and 118 million (38) demonstrating various vergence

anomalies

64

65

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Brain plasticity life long changes in the structure of the brain

Sensory substitution replacement of one sensory input by another

Measurement techniques

Voxel based morphometryhellipmeasures difference in brain volume

Fluorodeoxyglucose glucose analog PET scan tells you

distribution and metabolism of brain

Cortical thickness measures

Visual cortex of the blind turns somatic ―The eye of the tongue

Transcranial magnetic stmiulation non-invasive technique to

stimulate cortex

66

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Blind Braille readers report tingling in fingers when pressure

phosphenes are applied Blind feel tingling in tongue

Bind use tongue to perform orientation task motion perception

sensory perception Visual cortex recruited in a variety of sensory

and cognitive tasks (DM Can we use tongue as a VT tool)

Dilks Reorganizations of human adult visual system

When a region of sensory cortex is deprived of its bottom up

input the deprived region begins to respond to stimuli that

normally activate adjacent cortex

67

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Retinotopic map changes for stroke pts Cortical reorganization in

adults occurs Perceived objectshellipelongation in stroke amp AMD

What happens to deprived cortex in AMD

fMRI shows cortical reorganization in adults

Proposed mechanisms

hellipGrowth of new connections

hellipUnmasking of pre-existing connections this is true

happens within seconds

Bavelier

Action video games

68

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Bavelier

Action video games Looked at attention Gamers can track more

activities

Attention over space (me peripheral awarenress) Useful field

of view shrinks with age

Performance not VA relatedhellipis related to attention

Action game playing changes spatial resolutionhellipovercoming

crowding in VA assessment (me amblyopia therapy)

Temporal resolution of vision Backward masking

changehellipbrain changes

Visual sensitivity (contrast sensitivity) Post action game training

improves CSF

69

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Action video games correcting optics of the cortex (me this is

actualy OVT)

Games factor

Variable entry leanringhellipadapt task to skill level

Incremental learning tune task to subjectlsquos leanring steps

Motivationarousal

Rewards

Self masterself confidence

Action games factors

Pacingrate of exposure to infohellipincreasing processing speed

Dynamic display

Rich environment

Rich motor involvement

70

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Surgeons may be made to play action games

Pilot training

Amblyopia tx Dennis Levi research

PresenterTitle Contact info

Neuroplasticity-A Paradigm Sea Change

This presentation is available at

httpwwwslidesharenetDMAINOneuroplasticity-a-paradigm-sea-change-2459693

httpwwwmainosmemosblogspotcom

My FaceBook Page

and

Twitter

PresenterTitle Contact info

Questions About

Neuroplasticity-A Paradigm Sea Change

Dominick M Maino OD MEd FAAO FCOVD-A

Professor PediatricsBinocular VisionIllinois Eye InstituteIllinois College of Optometry

dmainoicoeduhttpwwwMainosMemosblogspotcom

Thanks to

httpwwwcovdorgHomeOVDJournalOVD401tabid263D

efaultaspx

httpbipolarblastfileswordpresscom200908neurojpg

httpwwwspecialcheerscomimagesanimated_braingif

httpblogmarsdencartoonscomwp-

contentuploads200810frankenstein-myspace-lightbeergif

httpwwwshangralafamilyfuncomgala-ecalvindreamgif

httppsychiatryjwatchorgcgicontentfull20082251

73

Chakraborty R Chatterjee A Choudhart S Chakraborty PK Neuroplasticitymdasha paradigm shift in neurosciences J Indian Med Assoc

2007105(9)513-4516-8520-1

Sacks O A neurologistlsquos notebook Stereo Sue Why two eyes are better than one The New Yorker 2006 Jun 1964-73

Krulwich R National Public Radio Going Binocular Susanlsquos First Snowfall Available at

wwwnprorgtemplatesstorystoryphpstoryId=5507789 (Accessed December 8 2008)

Press LJ The story behind Stereo Suelsquo and a world-famous neurologistlsquos discovery of vision therapy Optom Vis Dev 200637(2) 55-7

Levin HS Neuroplasticity and brain imaging research implications for rehabilitation Arch Phys Med Rehabil 2006 Dec87(12 Suppl

2)S1

Wiesel TN Hubel DH Single-cell responses in striate cortex of kittens deprived of vision in one eye J Neurophysiol 1963

Nov261003-17

Hook BM Chen C Critical periods in the visual system Changing views for a model of experience-dependent plasticity Neuron 2007

Oct56(2)312-26

Ramey CT Ramey SL Prevention of intellectual disabilities early interventions to improve cognitive development Prev Med 1998

Mar-Apr27(2)224-32

Heuninckx S Wenderoth N Swinnen SP Systems neuroplasticity in the aging brain recruiting additional neural resources for

successful motor performance in elderly persons J Neurosci 2008 Jan 228(1)91-9

Ge S Yang CH Hsu KS et al A critical period for enhanced synaptic plasticity in newly generated neurons of the adult brain Neuron

2007 May54(4)559-66

74

Draganski B Gaser C Busch V et al Neuroplasticity changes in grey matter induced by training Nature 2004 Jan 22427(6972)

311-2

Cannonieri GC Bonilha L Fernandes PT et al Practice and perfect length of training and structural brain changes in experienced

typists Neuroreport 2007 Jul 218(10)1063-6

Kleim JA Jones TA Principles of experience-dependent neural plasticity implications for rehabilitation after brain damage J

Speech Lang Hear Res 2008 Feb51(1)S225-39

Trojan S Porkorny J Theoretical aspects of neuroplasticity Physiol Res 199948(2)87-97

Ramamirtham R Kee CS Hung LF et al Wave aberrations in rhesus monkeys with vision-induced ametropias Vision Res 2007

Sep47(21)2751-66

Smith EL 3rd Ramamirtham R Qiao-Grider Y et al Effects of foveal ablation on emmetropization and form-deprivation myopia

Invest Ophthalmol Vis Sci 2007 Sep48(9)3914-22

Smith EL 3rd Kee CS Ramamirtham R et al Peripheral vision can influence eye growth and refractive development in infant

monkeys Invest Ophthalmol Vis Sci 2005 Nov46(11)3965-72

Ciuffreda KJ Vasudevan B Nearwork-induced transient myopia (NITM) and permanent myopiandashndashis there a link Ophthalmic

Physiol Opt 2008 Mar28(2)103-14

Hung GK Ciuffreda KJ Incremental retinal-defocus theory of myopia development--schematic analysis and computer simulation

Comput Biol Med 2007 Jul37(7)930-46

Hung GK Ciuffreda KJ A unifying theory of refractive error development Bull Math Biol 2000 Nov62(6)1087-108

75

Pang Y Maino D Zhang G Lu F Myopia Can its progress be controlled Optom Vis Dev 200637(2)75-9

Leung JT Brown B Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lenses Optom Vis Sci

1999 Jun76(6)346-54

Hasebe S Ohtsuki H Nonaka T et al Effect of progressive addition lenses on myopia progression in Japanese children a prospective

randomized double-masked crossover trial Invest Ophthalmol Vis Sci 2008 Jul49(7)2781-9

Gwiazda J Hyman L Hussein M et al A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression

of myopia in children Invest Ophthalmol Vis Sci 2003 Apr44(4)1492-500

Siatkowski RM Cotter SA Crockett RS et al Two-year multi-center randomized double-masked placebo-controlled parallel safety and

efficacy study of 2 pirenzepine ophthalmic gel in children with myopia J AAPOS 2008 Aug12(4)332-9

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged 7 to 17 years Arch Ophthalmol 2005

Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three to less than 10 years of age Am J

Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction Am J Ophthalmol 2007

Jun143(6)1060-3

Holmes JM Edwards AR Beck RW et al A randomized pilot study of near activities versus non-near activities during patching therapy for

amblyopia J AAPOS 2005 Apr9(2)129-36

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate

amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-57

76

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic

amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Convergence Insufficiency Treatment Trial Study Group Randomized clinical trial of treatments for symptomatic convergence insufficiency

in children Arch Ophthalmol 2008 Oct126(10)1336-49

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

Solan HA Shelley-Tremblay J Hansen PC et al M-cell deficit and reading disability a preliminary study of the effects of temporal vision-

processing therapy Optometry 2004 Oct75(10)640-50

Solan HA Larson S Shelley-Tremblay J et al Role of visual attention in cognitive control of oculomotor readiness in students with reading

disabilities J Learn Disabil 2001 Mar-Apr34(2)107-18

Gallaway M Boas MB The impact of vergence and accommodative therapy on reading eye movements and reading speed Optom Vis Dev

200738(3)115-20

Goss DA Downing DB Lowther AH et al The effect of HTS vision therapy conducted in a school setting on reading skills in third and

fourth grade students Optom Vis Dev 200738(1)27-32

Crutch SJ Warrington EK Foveal crowding in posterior cortical atrophy a specific early-visual-processing deficit affecting word reading

Cogn Neuropsychol 2007 Dec24(8)843-66

Helms D Sawtelle SM A study of the effectiveness of cognitive therapy delivered in a video game format Optom Vis Dev 200738 (1)19-

26

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

77

Lawton T Training direction-discrimination sensitivity remediates a wide spectrum of reading skills OptomVis Dev 200738(1) 33-47

Goldstand S Koslowe KC Parush S Vision visual-information processing and academic performance among seventh-grade schoolchildren a

more significant relationship than we thought Am J Occup Ther 2005 Jul-Aug59(4)377-89

Fischer B Koumlngeter A Hartnegg K Effects of daily practice on subitizing visual counting and basic arithmetic skills Optom Vis Dev

200839(1)30-4

Sands W Taub M Maino D Limited research and education on special populations in optometry and ophthalomology Optom Vis Dev

200839(2)60-1

Wesson M Maino D Oculo-visual findings in Down syndrome cerebral palsy and mental retardation with non-specific etiology In Maino D

(ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 199517-54 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

Cui Y Stapleton F Suttle C Developing an instrument to assess vision-related and subjective quality of life in children with intellectual

disability data collection and preliminary analysis in a Chinese population Ophthal Physiolog Optics 2008 May28(3) 238-46

Maino D Steele G Tahir S Sajja R Attitudes of optometry students toward individuals with disabilities Optom Ed 200227(2)45-50

Maino D Special populations in the optometric curriculum Optom Ed 200227(2)38-9

Maino D Overview of special populations In Scheiman M Rouse M (eds) Optometric Management of Learning-Related Vision Problems

St Louis Mosby Inc 200685-106

Maino D (ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 1995 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

78

McCarthy P Maino D Alport syndrome a review Clin Eye Vis Care 2000 Dec12(3-4)139-50

Block SS Brusca-Vega R Pizzi WJ et al Cognitive and visual processing skills and their relationship to mutation size in full and

permutation female fragile X carriers Optom Vis Sci 2000 Nov77 (11)592-9

Maino D The young child with developmental disabilities An introduction to mental retardation and genetic syndromes In Moore BD

(ed) Eye Care for Infants and Young Children Butter-worth--Heinemann Newton MA1997285-300

Amin V Maino D The Fragile X female Visual visual perceptual and ocular health anomalies J Am Optom Assoc 1995 May66

(5)290-95

Maino DM Maino JH Cibis GW Hecht F Ocular health anomalies in patients with developmental disabilities In Maino D (ed)

Diagnosis and Management of Special Populations Mosby-Year-book Inc St Louis MO 1995189-206 Reprinted Optometric

Education Program Foundation Santa Anna Calif 2001

Maino D Wesson M Schlange D Cibis G Maino J Optometric findings in the fragile X syndrome Optom Vis Sci 199168634-40

Scheiman MMOptometric findings in children with cerebral palsy Am J Optom Physiol Opt 1984 May61(5)321-3

Maino D Maino J Maino S Mental retardation syndromes with associated ocular defects J Am Optom Assoc 199061707-16

Stewart RE Woodhouse JM Cregg M Pakeman VH Association between accommodative accuracy hypermetropia and strabismus in

children with Downs syndrome Optom Vis Sci 2007 Feb84(2)149-55

Cregg M Woodhouse JM Pakeman VH et al Accommodation and refractive error in children with Down syndrome cross-sectional

and longitudinal studies Invest Ophthalmol Vis Sci 2001 Jan42 (1)55-63

79

McClelland JF Parkes J Hill N et al Accommodative dysfunction in children with cerebral palsy a population-

based study Invest Ophthalmol Vis Sci 2006 May47(5)1824-30

Duckman RH Vision therapy for the child with cerebral palsy J Am Optom Assoc 198758(1)28-35

Duckman R Accommodation in cerebral palsy function and remediation J Am Optom Assoc 198455(4)281-3

Scheiman M Understanding and managing vision deficits a guide for occupational therapists 2nd ed Slack

Thorofare NJ 2002

Maino D Binasal occlusion for the child with Cerebral Palsy J Ill Optom Assoc 198644(1)1218

Battaglia F Quartarone A Rizzo V et al Early impairment of synaptic plasticity in patients with Downs syndrome

Neurobiol Aging 2008 Aug29(8)1272-5

Bonnier C Evaluation of early stimulation programs for enhancing brain development Acta Paediatr 2008

Jul97(7)853-8

Morice E Andreae LC Cooke SF et al Preservation of long-term memory and synaptic plasticity despite short-term

impairments in the Tc1 mouse model of Down syndrome Learn Mem 2008 Jul 1415(7)492-500

Gordon AM Schneider JA Chinnan A Charles JR Efficacy of a hand-arm bimanual intensive therapy (HABIT) in

children with hemiplegic cerebral palsy a randomized control trial Dev Med Child Neurol 2007 Nov49(11)830-8

Kapoor N Ciuffreda KJ Vision disturbances following traumatic brain injury Curr Treat Options Neurol 2002

Jul4(4)271-80

80

Ciuffreda KJ Rutner D Kapoor N et al Vision therapy for oculomotor dysfunctions in acquired brain injury a

retrospective analysis Optometry 2008 Jan79(1)18-22

Ciuffreda KJ Han Y Kapoor N Ficarra AP Oculomotor rehabilitation for reading in acquired brain injury

NeuroRehabilitation 200621(1)9-21

Zost M Diagnosis and management of visual dysfunction in cerebral injury In Maino D (ed) Diagnosis and

Management of Special Populations Mosby-Yearbook Inc St Louis 199579 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001 [Figure used with permission of the editor]

DeGutis JM Bentin S Robertson LC DEsposito M Functional plasticity in ventral temporal cortex following

cognitive rehabilitation of a congenital prosopagnosic J Cogn Neurosci 2007 Nov19 (11)1790-802

Welbourne SR Ralph MA Exploring the impact of plasticity-related recovery after brain damage in a connectionist

model of single-word reading Cogn Affect Behav Neurosci 2005 Mar5(1)77-92

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements prevent cognitive decline A

systematic review of randomized controlled trials J Hum Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among preterm infants attributable to early

supplementation of human milk with docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings and structural-functional

synergies with cell membrane phospholipids Altern Med Rev 2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function Neuroscience 20089(7)568-78

81

Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

BMC Biol 2008 Sep 9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine improves neuropsychological disorders in a child with

creatine transporter defect Neurocase 200814(2) 151-61

Forrester LW Wheaton LA Luft AR Exercise-mediated locomotor recovery and lower-limb neuroplasticity after

stroke J Rehabil Res Dev 200845(2)205-20

82

Page 24: Neuroplasticity: A Paradigm Sea Change Latest Updated File

V Neuroplasticity and Optometry

B Reactive plasticity

hellip can be thought of as the immediate effect that

initial optometric treatment may have on a system This can

be reflected in an immediate but often transient change in

the individuallsquos accommodative systemmdashie when an

uncorrected myope initially puts on his or her new

spectacles

24

V Neuroplasticity and Optometry

C Adaptational plasticity

hellip could describe the long-term effects of in-office optometric

vision therapy on disorders of the binocular vision system

25

V Neuroplasticity and Optometry

D Reparation plasticity

hellipin contrast to adaptational

plasticity reparation plasticity may

occur during treatment by a low

Vision specialist or an OD

Working with those who have

Experienced a traumatic brain

injury (TBI)

26

V Neuroplasticity and Optometry

The effects of plasticity can lead to either

positive or negative changes during

development (evolutionary plasticity) after

short-term exposure (reactive plasticity)

after long-term or continuous stimuli

(adaptational plasticity) and during

functional or structural recovery of damaged

neuronal circuits (reparation plasticity)

httpwwwciteulikeorguserjasonepriorarticle2856526

27

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

A Refractive error development

B Amblyopia

C Strabismus

28

D Non-strabismus non-amblyopic binocular vision disorders

E Learning related vision anomalies

F Vision developmentperception disorders

29

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

A Refractive error development

Several recent studies have noted that neuroplasticity may play a

role in refractive error development

retinal defocus use of progressive addition lenses

drug studies (M1-antagonist2 pirenzepine ) slow myopia

progression demonstrated nearly a 50 reduction in myopia

progression over a two-year period

30

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged

7 to 17 years Arch Ophthalmol 2005 Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three

to less than 10 years of age Am J Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction

Am J Ophthalmol 2007 Jun143(6)1060-3

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine

vs patching for treatment of moderate amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-

57

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for

strabismic and anisometropic amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Treatment of severe amblyopia with weekend atropine results from 2 randomized clinical trials

Levodopacarbidopa in the treatment of amblyopia

31

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

J Pediatr Ophthalmol Strabismus 2009 Mar-Apr46(2)87-90 quiz 91-2 Levodopacarbidopa in the

treatment of amblyopia Dadeya S Vats P Malik KP

PURPOSE To evaluate the role of levodopacarbidopa in the treatment of amblyopia METHODS

Thirty patients with strabismic amblyopia between the ages of 3 and 12 years were part of this double-

blind randomized study Patients were divided into two groups Group A received 050 mg + 125 mg of

levodopacarbidopa per kilogram body weight three times daily after meals with a protein rich drink

whereas Group B received placebo Both groups received full-time conventional occlusion until a visual

acuity of 66 was achieved or for a maximum of 3 months RESULTS The authors observed more than

two lines improvement in visual acuity that was greater in the levodopa group (15 of 15) than in the

placebo group (9 of 15) (P lt 005) Furthermore improvement in visual acuity of more than two lines

was greater in patients younger than 8 years (100) than in patients older than 8 years of age (60) (P =

0026) There was also no significant reversal of the improved visual acuity in up to 6 months of follow-

up CONCLUSION Levodopacarbidopa improves visual acuity in patients with

amblyopia and maintains improved visual acuity especially in patients

younger than 8 years

32

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

J Pediatr Ophthalmol Strabismus 2008 May-Jun45(3)174-6 The use of levodopa in the treatment of

bilateral amblyopia secondary to uncorrected high hypermetropia Abrams MS

The standard treatment of bilateral amblyopia secondary to uncorrected high bilateral hypermetropia has

been spectacles and time The patient described here failed to show adequate improvement in visual

acuity after 18 months of standard treatment Visual acuity improved dramatically when the

patient began taking levodopa dropped precipitously when the medication was

discontinued and returned quickly to post-treatment levels when levodopa was

restarted Visual acuity remained stable when the medication was slowly tapered

and discontinued This report suggests that dopamine may play a role in the pathophysiology of

bilateral amblyopia secondary to uncorrected high bilateral hypermetropia

33

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

Bottom Line

Amblyopia can be treated at any age

May be able to use neuro-enhancing drugs

as a part of basic amblyopia therapy

34

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

C Strabismus and non-strabismic non-amblyopic binocular

vision disorders

Clinical Trial of Treatments for Symptomatic Convergence Insufficiency in Children has

clearly demonstrated the superiority of in-office optometric vision therapy (in conjunction

with home therapy) vs out-of-office therapy alone The study concluded that optometric

vision therapyorthoptics was more effective than pencil push-ups or placebo vision

therapyorthoptics in reducing symptoms and improving clinical signs of convergence

insufficiency

Long-term effectiveness of treatments for symptomatic convergence insufficiency

in children (Optom Vis Sci 2009 Sep86(9)1096-103)

CITT patients improvements lasted a year

35

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

Strabismus 1999 Sep7(3)169-74 Convergence insufficiency in

idiopathic Parkinsons disease responsive to levodopa Racette BA

Gokden MS Tychsen LS Perlmutter JS

We report a patient with pathologically proven idiopathic Parkinsons

disease (IPD) who developed diplopia secondary to convergence

insufficiency during his motor off periods Diplopia resolved with

onset of motor benefit from levodopa Neuro-ophthalmologic

examination demonstrated convergence insufficiency during motor

off periods that was alleviated after onset of motor benefit from

levodopa This is the first reported case of convergence insufficiency

in IPD responsive to levodopa

36

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

Bottom Line

Optometric Vision Therapy is the most efficacious treatment available for binocular vision disorders and the

treatment effects are long lasting Neuro-enhancing drugs

may assist us as well

37

EF Learning related vision anomalies Vision

developmentperception disorders

hellipresearch includes an examination of the role vision plays in

reading the effect of oculomotor vergence and

accommodativecoherent motion therapy on reading eye movements

and reading speed the diagnosis and treatment of perceptual

disorders and the effect of therapy on various learning anomalies

38

EF Learning related vision anomalies Vision developmentperception disorders

magnocellular (MC) deficit in dyslexia

LM speed-matching ratio predicts reading in childrenChase C Dougherty RF Ray N

Fowler S Stein JOptom Vis Sci 2007 Mar84(3)229-36

Effect of attention therapy on reading comprehension Solan HA Shelley-Tremblay J

Ficarra A Silverman M Larson S J Learn Disabil 2003 Nov-Dec36(6)556-63

Is there a common linkage among reading comprehension visual attention and

magnocellular processing Solan HA Shelley-Tremblay JF Hansen PC Larson S

J Learn Disabil 2007 May-Jun40(3)270-8

Lawton T Filtered Text and Direction Discrimination Training Improved Reading

Fluency for Both Dyslexic and Normal Readers Optom Vis Dev 200839 (3)114

Fischer B Hartnegg K Saccade control in dyslexia Development deficits training

and transfer to reading Optom Vis Dev 200839(4)181-190

39

EF Learning related vision anomalies Vision developmentperception disorders

J Learn Disabil 2003 Nov-Dec36(6)556-63 Effect of attention therapy on reading

comprehension Solan HA Shelley-Tremblay J Ficarra A Silverman M Larson S

hellip At the completion of attention therapy the mean

standard attention and reading comprehension scores of

the experimental group had improved significantly The

control group however showed no significant

improvement in reading comprehension scores after 12

weeks Although uncertainties still exist this investigation

supports the notion that visual attention is malleable and

that attention therapy has a significant effect on reading

comprehension in this often neglected population

40

VII Vision dysfunction association with acquired brain injury

A Exotropia (or high exophoriaCI)

B Accommodative dysfunction

C Convergence insufficiency

41

D Decreased blink rate

E Spatial disorientation

F Pursuitsaccade dysfunction

G Unstable ambient vision (Magnocellular pathway)

42

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Stelmack JA Frith T Van Koevering D Rinne S Stelmack TR Visual function in patients

followed at a Veterans Affairs polytrauma network site an electronic medical record review

Optometry 2009 Aug80(8)419-24

RESULTS Visual symptoms were self-reported by 76 of patients

with polytrauma and 75 of the patients with TBI Problems with reading

(polytrauma 60 and TBI 50) and accommodation (polytrauma 30 and

TBI 47) were frequently found on eye examinations Spectacles were the

treatment most frequently prescribed (polytrauma 62 and TBI 78)

CONCLUSIONS It is important for optometrists to be aware of the high

rates of self-reported symptoms and visual problems in military personnel

returning from deployment to the wars in Iraq and Afghanistan Post-

traumatic stress disorder and depression may complicate optometric

evaluation and management

43

VII Vision dysfunction association with acquired brain injury

Avoidance of near tasks

Oculomotor-based reading difficulties

Eye tracking problems

Eye focusing problems

Eyestrain Diplopia

Dizziness Vertigo

Vision-derived nausea

44

VII Vision dysfunction association with acquired brain injury

Increased sensitivity to visual motion

Visual inattention and distractibility

Short-term visual memory loss

Difficulty judging distances (relative and absolute

Difficulty with global scanning

Difficulty with personal grooming especially involving the face

Inability to interactcope visually in a complex social situation

(eg minimal eye contact)

Inability to tolerate complex visual environments (eg grocery store

aisles and highly-patterned floors)

45

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Ciuffreda KJ Ludlam DP Kapoor N Clinical oculomotor training in traumatic brain injury Optom Vis

Dev 200940(1)16-23

Individuals with traumatic brain injury present with a constellation of

oculomotor dysfunctions and correlated symptoms Simple and

effective clinical oculomotor-based training procedures will be

presented with respect to the versional vergence and

accommodative systems and their interactions These therapeutic

procedures can also be applied as needed to individuals with either

low vision neurological dysfunctions or general visual skills cases

manifesting similar oculomotor deficits

46

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Leslie S Myopia and accommodative insufficiency associated with

moderate head trauma Opt Vis Dev 200940(1)25-31

The majority of subjects reviewed had developed a stable degree of

myopia between 100 and 200 diopters as well as an abnormally

high lag of accommodation When their distance and near spatial area

of focus was compared the majority were focused at an intermediate

area in space suggesting a loss of control of accommodation in

space

47

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

B Drugs

C Exercise

D Learning new and challenging things

48

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements

prevent cognitive decline A systematic review of randomized controlled trials J Hum

Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among

preterm infants attributable to early supplementation of human milk with

docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings

and structural-functional synergies with cell membrane phospholipids Altern Med Rev

2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function

Neuroscience 20089(7)568-78

49

VIII Improving Brain Function and Neuroplasticity

B Drugs Maya Vetencourt JF Sale A Viegi A et al The antidepressant

fluoxetine (PROZAC) restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the

antidepressant tianeptine CNS Drugs 200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances

hippocampal long-term potentiation and memory BMC Biol 2008 Sep

9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine

improves neuropsychological disorders in a child with creatine

transporter defect Neurocase 200814(2) 151-61

50

VIII Improving Brain Function and Neuroplasticity

C Exercise

Hunsberger JG et al Antidepressant actions of the exercise-

regulated gene VGF Nat Med 2007 Dec 2 131476

VGF may be a common pathway by which exercise induces

neuroplasticity and growth-factor genes at least one of these might act

similarly to antidepressants in promoting an adaptive response to stress

However the tests used here may be modeling stress-induced

helplessness not depression hellipexercise seems to induce multiple

interacting genes that enhance neuronal resilience

51

VIII Improving Brain Function and Neuroplasticity

D Learning new and challenging things

What have we (optometry amp ophthalmology)

been thinking all these years

Where did we miss the news about neuroplasticity

52

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Huang JC Neuroplasticity as a proposed mechanism for the efficacy of optometric vision therapy and rehabilitation J Bev Optom 200920(4)96-100

Homologous area adaptationCompensatory masqueradeCross-modal reassignment

Map expansion

EquipotentialityVicariation

53

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Homologous area adaptation a transfer of function from a damaged brain area to a non-damaged brain area May be limited to early stages of human development and may crowd a new brain area resulting in reduced functionality of that brain area (Competition between spatial amp verbal functioning)

54

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Compensatory masquerade reorganizing of existing neuro-pathways to us alternative cognitive strategies to perform a task

55

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Cross-modal reassignment using new sensory input in a brain structure deprived of its main input source (changing processing from visual to tactile stimuli in the blind)

56

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Map expansion increase in brain mass due to repeated behavior or exposure to stimuli

57

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Equipotentiality anatomical areas of the brain can perform disparate functions

Vicariation redundant neural systems can operate under abnormal conditions

This may explain why recovery is noted for many neurological conditions (degenerative psychiatric developmental vascular traumatic)

58

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Constraint therapy Use it and improve it

Patching penalization ldquonear activitiesrdquo during amblyopia therapy

59

IX Improving Brain Function and Neuroplasticity Optometric Clinical ApplicationsOptometric Vision Therapy

Kleim amp Jones

Use it or lose it If you do not drive specific brain functions

functional loss will occur

If you want to improve oculomotor brain neuroplastic function amp

structure therapy should be specific for that brain function

Use it and improve it Therapy that drives cortical function enhances

that particular function

If you use therapy to improve oculomotor dysfunction it should

improve

Specificity The therapy you choose determines the resultant

plasticity and function

You must choose therapy that is appropriate

60

IX Improving Brain Function and Neuroplasticity Optometric Clinical Applications

Kleim amp Jones

Repetition matters Plasticity that results in functional change

requires repetition

Do the therapy Do it again Do it yet again No quick fix

Intensity matters Induction of plasticity requires the appropriate

amount of intensity

Intensity means strength force concentration power and passion

Without these plasticity may not occur Function may not improve

Time matters Different forms of plasticity take place at different

times during therapy

Do the basics than the more advanced therapeutic procedures

61

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Salience matters It has to be important to the individual

Make the therapy matter to the patient

Age matters Plasticity is easier in a younger brain but is also

possible in an adult brain

Do not let age determine what therapy options you offer your

patients Think of Susan Barry PhD (StereoSue) and her success

Offer your patients options Let them choose Be realistic about

outcomeshelliphave outcome measures built into therapy program

62

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Transference Neuroplasticity and the change in function

that results from one therapy can augment the attainment

of similar behaviors

What you do during oculomotor therapy may affected

vergence therapy outcomes

Interference Plasticity in response to one experience can

interfere with the acquisition of other behaviors

Monitor Evaluate progress Discuss function in other areas

of your patientslsquo life

63

Why pay attention to binocular vision dysfunctions

and neuroplasticity

December 2009 issue of the Review of Optometry

The Binocular Vision Dysfunction Pandemic

In 2010 almost 170 million individuals will be wearing glasses In

2010 there will also be up to 93 million amblyopes and 12 and a half

million strabismics For children under 18 years of age that means

there will be more than 22 and a half million amblyopes and millions

of children with strabismus A clinical trial to determine the

prevalence of binocular vision dysfunction within the general

population suggested the possibility of up to 56 or 173 million men

women and children with symptoms associated with a binocular

vision dysfunction 189 million (61) with accommodative problems

and 118 million (38) demonstrating various vergence

anomalies

64

65

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Brain plasticity life long changes in the structure of the brain

Sensory substitution replacement of one sensory input by another

Measurement techniques

Voxel based morphometryhellipmeasures difference in brain volume

Fluorodeoxyglucose glucose analog PET scan tells you

distribution and metabolism of brain

Cortical thickness measures

Visual cortex of the blind turns somatic ―The eye of the tongue

Transcranial magnetic stmiulation non-invasive technique to

stimulate cortex

66

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Blind Braille readers report tingling in fingers when pressure

phosphenes are applied Blind feel tingling in tongue

Bind use tongue to perform orientation task motion perception

sensory perception Visual cortex recruited in a variety of sensory

and cognitive tasks (DM Can we use tongue as a VT tool)

Dilks Reorganizations of human adult visual system

When a region of sensory cortex is deprived of its bottom up

input the deprived region begins to respond to stimuli that

normally activate adjacent cortex

67

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Retinotopic map changes for stroke pts Cortical reorganization in

adults occurs Perceived objectshellipelongation in stroke amp AMD

What happens to deprived cortex in AMD

fMRI shows cortical reorganization in adults

Proposed mechanisms

hellipGrowth of new connections

hellipUnmasking of pre-existing connections this is true

happens within seconds

Bavelier

Action video games

68

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Bavelier

Action video games Looked at attention Gamers can track more

activities

Attention over space (me peripheral awarenress) Useful field

of view shrinks with age

Performance not VA relatedhellipis related to attention

Action game playing changes spatial resolutionhellipovercoming

crowding in VA assessment (me amblyopia therapy)

Temporal resolution of vision Backward masking

changehellipbrain changes

Visual sensitivity (contrast sensitivity) Post action game training

improves CSF

69

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Action video games correcting optics of the cortex (me this is

actualy OVT)

Games factor

Variable entry leanringhellipadapt task to skill level

Incremental learning tune task to subjectlsquos leanring steps

Motivationarousal

Rewards

Self masterself confidence

Action games factors

Pacingrate of exposure to infohellipincreasing processing speed

Dynamic display

Rich environment

Rich motor involvement

70

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Surgeons may be made to play action games

Pilot training

Amblyopia tx Dennis Levi research

PresenterTitle Contact info

Neuroplasticity-A Paradigm Sea Change

This presentation is available at

httpwwwslidesharenetDMAINOneuroplasticity-a-paradigm-sea-change-2459693

httpwwwmainosmemosblogspotcom

My FaceBook Page

and

Twitter

PresenterTitle Contact info

Questions About

Neuroplasticity-A Paradigm Sea Change

Dominick M Maino OD MEd FAAO FCOVD-A

Professor PediatricsBinocular VisionIllinois Eye InstituteIllinois College of Optometry

dmainoicoeduhttpwwwMainosMemosblogspotcom

Thanks to

httpwwwcovdorgHomeOVDJournalOVD401tabid263D

efaultaspx

httpbipolarblastfileswordpresscom200908neurojpg

httpwwwspecialcheerscomimagesanimated_braingif

httpblogmarsdencartoonscomwp-

contentuploads200810frankenstein-myspace-lightbeergif

httpwwwshangralafamilyfuncomgala-ecalvindreamgif

httppsychiatryjwatchorgcgicontentfull20082251

73

Chakraborty R Chatterjee A Choudhart S Chakraborty PK Neuroplasticitymdasha paradigm shift in neurosciences J Indian Med Assoc

2007105(9)513-4516-8520-1

Sacks O A neurologistlsquos notebook Stereo Sue Why two eyes are better than one The New Yorker 2006 Jun 1964-73

Krulwich R National Public Radio Going Binocular Susanlsquos First Snowfall Available at

wwwnprorgtemplatesstorystoryphpstoryId=5507789 (Accessed December 8 2008)

Press LJ The story behind Stereo Suelsquo and a world-famous neurologistlsquos discovery of vision therapy Optom Vis Dev 200637(2) 55-7

Levin HS Neuroplasticity and brain imaging research implications for rehabilitation Arch Phys Med Rehabil 2006 Dec87(12 Suppl

2)S1

Wiesel TN Hubel DH Single-cell responses in striate cortex of kittens deprived of vision in one eye J Neurophysiol 1963

Nov261003-17

Hook BM Chen C Critical periods in the visual system Changing views for a model of experience-dependent plasticity Neuron 2007

Oct56(2)312-26

Ramey CT Ramey SL Prevention of intellectual disabilities early interventions to improve cognitive development Prev Med 1998

Mar-Apr27(2)224-32

Heuninckx S Wenderoth N Swinnen SP Systems neuroplasticity in the aging brain recruiting additional neural resources for

successful motor performance in elderly persons J Neurosci 2008 Jan 228(1)91-9

Ge S Yang CH Hsu KS et al A critical period for enhanced synaptic plasticity in newly generated neurons of the adult brain Neuron

2007 May54(4)559-66

74

Draganski B Gaser C Busch V et al Neuroplasticity changes in grey matter induced by training Nature 2004 Jan 22427(6972)

311-2

Cannonieri GC Bonilha L Fernandes PT et al Practice and perfect length of training and structural brain changes in experienced

typists Neuroreport 2007 Jul 218(10)1063-6

Kleim JA Jones TA Principles of experience-dependent neural plasticity implications for rehabilitation after brain damage J

Speech Lang Hear Res 2008 Feb51(1)S225-39

Trojan S Porkorny J Theoretical aspects of neuroplasticity Physiol Res 199948(2)87-97

Ramamirtham R Kee CS Hung LF et al Wave aberrations in rhesus monkeys with vision-induced ametropias Vision Res 2007

Sep47(21)2751-66

Smith EL 3rd Ramamirtham R Qiao-Grider Y et al Effects of foveal ablation on emmetropization and form-deprivation myopia

Invest Ophthalmol Vis Sci 2007 Sep48(9)3914-22

Smith EL 3rd Kee CS Ramamirtham R et al Peripheral vision can influence eye growth and refractive development in infant

monkeys Invest Ophthalmol Vis Sci 2005 Nov46(11)3965-72

Ciuffreda KJ Vasudevan B Nearwork-induced transient myopia (NITM) and permanent myopiandashndashis there a link Ophthalmic

Physiol Opt 2008 Mar28(2)103-14

Hung GK Ciuffreda KJ Incremental retinal-defocus theory of myopia development--schematic analysis and computer simulation

Comput Biol Med 2007 Jul37(7)930-46

Hung GK Ciuffreda KJ A unifying theory of refractive error development Bull Math Biol 2000 Nov62(6)1087-108

75

Pang Y Maino D Zhang G Lu F Myopia Can its progress be controlled Optom Vis Dev 200637(2)75-9

Leung JT Brown B Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lenses Optom Vis Sci

1999 Jun76(6)346-54

Hasebe S Ohtsuki H Nonaka T et al Effect of progressive addition lenses on myopia progression in Japanese children a prospective

randomized double-masked crossover trial Invest Ophthalmol Vis Sci 2008 Jul49(7)2781-9

Gwiazda J Hyman L Hussein M et al A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression

of myopia in children Invest Ophthalmol Vis Sci 2003 Apr44(4)1492-500

Siatkowski RM Cotter SA Crockett RS et al Two-year multi-center randomized double-masked placebo-controlled parallel safety and

efficacy study of 2 pirenzepine ophthalmic gel in children with myopia J AAPOS 2008 Aug12(4)332-9

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged 7 to 17 years Arch Ophthalmol 2005

Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three to less than 10 years of age Am J

Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction Am J Ophthalmol 2007

Jun143(6)1060-3

Holmes JM Edwards AR Beck RW et al A randomized pilot study of near activities versus non-near activities during patching therapy for

amblyopia J AAPOS 2005 Apr9(2)129-36

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate

amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-57

76

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic

amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Convergence Insufficiency Treatment Trial Study Group Randomized clinical trial of treatments for symptomatic convergence insufficiency

in children Arch Ophthalmol 2008 Oct126(10)1336-49

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

Solan HA Shelley-Tremblay J Hansen PC et al M-cell deficit and reading disability a preliminary study of the effects of temporal vision-

processing therapy Optometry 2004 Oct75(10)640-50

Solan HA Larson S Shelley-Tremblay J et al Role of visual attention in cognitive control of oculomotor readiness in students with reading

disabilities J Learn Disabil 2001 Mar-Apr34(2)107-18

Gallaway M Boas MB The impact of vergence and accommodative therapy on reading eye movements and reading speed Optom Vis Dev

200738(3)115-20

Goss DA Downing DB Lowther AH et al The effect of HTS vision therapy conducted in a school setting on reading skills in third and

fourth grade students Optom Vis Dev 200738(1)27-32

Crutch SJ Warrington EK Foveal crowding in posterior cortical atrophy a specific early-visual-processing deficit affecting word reading

Cogn Neuropsychol 2007 Dec24(8)843-66

Helms D Sawtelle SM A study of the effectiveness of cognitive therapy delivered in a video game format Optom Vis Dev 200738 (1)19-

26

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

77

Lawton T Training direction-discrimination sensitivity remediates a wide spectrum of reading skills OptomVis Dev 200738(1) 33-47

Goldstand S Koslowe KC Parush S Vision visual-information processing and academic performance among seventh-grade schoolchildren a

more significant relationship than we thought Am J Occup Ther 2005 Jul-Aug59(4)377-89

Fischer B Koumlngeter A Hartnegg K Effects of daily practice on subitizing visual counting and basic arithmetic skills Optom Vis Dev

200839(1)30-4

Sands W Taub M Maino D Limited research and education on special populations in optometry and ophthalomology Optom Vis Dev

200839(2)60-1

Wesson M Maino D Oculo-visual findings in Down syndrome cerebral palsy and mental retardation with non-specific etiology In Maino D

(ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 199517-54 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

Cui Y Stapleton F Suttle C Developing an instrument to assess vision-related and subjective quality of life in children with intellectual

disability data collection and preliminary analysis in a Chinese population Ophthal Physiolog Optics 2008 May28(3) 238-46

Maino D Steele G Tahir S Sajja R Attitudes of optometry students toward individuals with disabilities Optom Ed 200227(2)45-50

Maino D Special populations in the optometric curriculum Optom Ed 200227(2)38-9

Maino D Overview of special populations In Scheiman M Rouse M (eds) Optometric Management of Learning-Related Vision Problems

St Louis Mosby Inc 200685-106

Maino D (ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 1995 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

78

McCarthy P Maino D Alport syndrome a review Clin Eye Vis Care 2000 Dec12(3-4)139-50

Block SS Brusca-Vega R Pizzi WJ et al Cognitive and visual processing skills and their relationship to mutation size in full and

permutation female fragile X carriers Optom Vis Sci 2000 Nov77 (11)592-9

Maino D The young child with developmental disabilities An introduction to mental retardation and genetic syndromes In Moore BD

(ed) Eye Care for Infants and Young Children Butter-worth--Heinemann Newton MA1997285-300

Amin V Maino D The Fragile X female Visual visual perceptual and ocular health anomalies J Am Optom Assoc 1995 May66

(5)290-95

Maino DM Maino JH Cibis GW Hecht F Ocular health anomalies in patients with developmental disabilities In Maino D (ed)

Diagnosis and Management of Special Populations Mosby-Year-book Inc St Louis MO 1995189-206 Reprinted Optometric

Education Program Foundation Santa Anna Calif 2001

Maino D Wesson M Schlange D Cibis G Maino J Optometric findings in the fragile X syndrome Optom Vis Sci 199168634-40

Scheiman MMOptometric findings in children with cerebral palsy Am J Optom Physiol Opt 1984 May61(5)321-3

Maino D Maino J Maino S Mental retardation syndromes with associated ocular defects J Am Optom Assoc 199061707-16

Stewart RE Woodhouse JM Cregg M Pakeman VH Association between accommodative accuracy hypermetropia and strabismus in

children with Downs syndrome Optom Vis Sci 2007 Feb84(2)149-55

Cregg M Woodhouse JM Pakeman VH et al Accommodation and refractive error in children with Down syndrome cross-sectional

and longitudinal studies Invest Ophthalmol Vis Sci 2001 Jan42 (1)55-63

79

McClelland JF Parkes J Hill N et al Accommodative dysfunction in children with cerebral palsy a population-

based study Invest Ophthalmol Vis Sci 2006 May47(5)1824-30

Duckman RH Vision therapy for the child with cerebral palsy J Am Optom Assoc 198758(1)28-35

Duckman R Accommodation in cerebral palsy function and remediation J Am Optom Assoc 198455(4)281-3

Scheiman M Understanding and managing vision deficits a guide for occupational therapists 2nd ed Slack

Thorofare NJ 2002

Maino D Binasal occlusion for the child with Cerebral Palsy J Ill Optom Assoc 198644(1)1218

Battaglia F Quartarone A Rizzo V et al Early impairment of synaptic plasticity in patients with Downs syndrome

Neurobiol Aging 2008 Aug29(8)1272-5

Bonnier C Evaluation of early stimulation programs for enhancing brain development Acta Paediatr 2008

Jul97(7)853-8

Morice E Andreae LC Cooke SF et al Preservation of long-term memory and synaptic plasticity despite short-term

impairments in the Tc1 mouse model of Down syndrome Learn Mem 2008 Jul 1415(7)492-500

Gordon AM Schneider JA Chinnan A Charles JR Efficacy of a hand-arm bimanual intensive therapy (HABIT) in

children with hemiplegic cerebral palsy a randomized control trial Dev Med Child Neurol 2007 Nov49(11)830-8

Kapoor N Ciuffreda KJ Vision disturbances following traumatic brain injury Curr Treat Options Neurol 2002

Jul4(4)271-80

80

Ciuffreda KJ Rutner D Kapoor N et al Vision therapy for oculomotor dysfunctions in acquired brain injury a

retrospective analysis Optometry 2008 Jan79(1)18-22

Ciuffreda KJ Han Y Kapoor N Ficarra AP Oculomotor rehabilitation for reading in acquired brain injury

NeuroRehabilitation 200621(1)9-21

Zost M Diagnosis and management of visual dysfunction in cerebral injury In Maino D (ed) Diagnosis and

Management of Special Populations Mosby-Yearbook Inc St Louis 199579 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001 [Figure used with permission of the editor]

DeGutis JM Bentin S Robertson LC DEsposito M Functional plasticity in ventral temporal cortex following

cognitive rehabilitation of a congenital prosopagnosic J Cogn Neurosci 2007 Nov19 (11)1790-802

Welbourne SR Ralph MA Exploring the impact of plasticity-related recovery after brain damage in a connectionist

model of single-word reading Cogn Affect Behav Neurosci 2005 Mar5(1)77-92

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements prevent cognitive decline A

systematic review of randomized controlled trials J Hum Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among preterm infants attributable to early

supplementation of human milk with docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings and structural-functional

synergies with cell membrane phospholipids Altern Med Rev 2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function Neuroscience 20089(7)568-78

81

Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

BMC Biol 2008 Sep 9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine improves neuropsychological disorders in a child with

creatine transporter defect Neurocase 200814(2) 151-61

Forrester LW Wheaton LA Luft AR Exercise-mediated locomotor recovery and lower-limb neuroplasticity after

stroke J Rehabil Res Dev 200845(2)205-20

82

Page 25: Neuroplasticity: A Paradigm Sea Change Latest Updated File

V Neuroplasticity and Optometry

C Adaptational plasticity

hellip could describe the long-term effects of in-office optometric

vision therapy on disorders of the binocular vision system

25

V Neuroplasticity and Optometry

D Reparation plasticity

hellipin contrast to adaptational

plasticity reparation plasticity may

occur during treatment by a low

Vision specialist or an OD

Working with those who have

Experienced a traumatic brain

injury (TBI)

26

V Neuroplasticity and Optometry

The effects of plasticity can lead to either

positive or negative changes during

development (evolutionary plasticity) after

short-term exposure (reactive plasticity)

after long-term or continuous stimuli

(adaptational plasticity) and during

functional or structural recovery of damaged

neuronal circuits (reparation plasticity)

httpwwwciteulikeorguserjasonepriorarticle2856526

27

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

A Refractive error development

B Amblyopia

C Strabismus

28

D Non-strabismus non-amblyopic binocular vision disorders

E Learning related vision anomalies

F Vision developmentperception disorders

29

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

A Refractive error development

Several recent studies have noted that neuroplasticity may play a

role in refractive error development

retinal defocus use of progressive addition lenses

drug studies (M1-antagonist2 pirenzepine ) slow myopia

progression demonstrated nearly a 50 reduction in myopia

progression over a two-year period

30

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged

7 to 17 years Arch Ophthalmol 2005 Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three

to less than 10 years of age Am J Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction

Am J Ophthalmol 2007 Jun143(6)1060-3

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine

vs patching for treatment of moderate amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-

57

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for

strabismic and anisometropic amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Treatment of severe amblyopia with weekend atropine results from 2 randomized clinical trials

Levodopacarbidopa in the treatment of amblyopia

31

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

J Pediatr Ophthalmol Strabismus 2009 Mar-Apr46(2)87-90 quiz 91-2 Levodopacarbidopa in the

treatment of amblyopia Dadeya S Vats P Malik KP

PURPOSE To evaluate the role of levodopacarbidopa in the treatment of amblyopia METHODS

Thirty patients with strabismic amblyopia between the ages of 3 and 12 years were part of this double-

blind randomized study Patients were divided into two groups Group A received 050 mg + 125 mg of

levodopacarbidopa per kilogram body weight three times daily after meals with a protein rich drink

whereas Group B received placebo Both groups received full-time conventional occlusion until a visual

acuity of 66 was achieved or for a maximum of 3 months RESULTS The authors observed more than

two lines improvement in visual acuity that was greater in the levodopa group (15 of 15) than in the

placebo group (9 of 15) (P lt 005) Furthermore improvement in visual acuity of more than two lines

was greater in patients younger than 8 years (100) than in patients older than 8 years of age (60) (P =

0026) There was also no significant reversal of the improved visual acuity in up to 6 months of follow-

up CONCLUSION Levodopacarbidopa improves visual acuity in patients with

amblyopia and maintains improved visual acuity especially in patients

younger than 8 years

32

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

J Pediatr Ophthalmol Strabismus 2008 May-Jun45(3)174-6 The use of levodopa in the treatment of

bilateral amblyopia secondary to uncorrected high hypermetropia Abrams MS

The standard treatment of bilateral amblyopia secondary to uncorrected high bilateral hypermetropia has

been spectacles and time The patient described here failed to show adequate improvement in visual

acuity after 18 months of standard treatment Visual acuity improved dramatically when the

patient began taking levodopa dropped precipitously when the medication was

discontinued and returned quickly to post-treatment levels when levodopa was

restarted Visual acuity remained stable when the medication was slowly tapered

and discontinued This report suggests that dopamine may play a role in the pathophysiology of

bilateral amblyopia secondary to uncorrected high bilateral hypermetropia

33

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

Bottom Line

Amblyopia can be treated at any age

May be able to use neuro-enhancing drugs

as a part of basic amblyopia therapy

34

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

C Strabismus and non-strabismic non-amblyopic binocular

vision disorders

Clinical Trial of Treatments for Symptomatic Convergence Insufficiency in Children has

clearly demonstrated the superiority of in-office optometric vision therapy (in conjunction

with home therapy) vs out-of-office therapy alone The study concluded that optometric

vision therapyorthoptics was more effective than pencil push-ups or placebo vision

therapyorthoptics in reducing symptoms and improving clinical signs of convergence

insufficiency

Long-term effectiveness of treatments for symptomatic convergence insufficiency

in children (Optom Vis Sci 2009 Sep86(9)1096-103)

CITT patients improvements lasted a year

35

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

Strabismus 1999 Sep7(3)169-74 Convergence insufficiency in

idiopathic Parkinsons disease responsive to levodopa Racette BA

Gokden MS Tychsen LS Perlmutter JS

We report a patient with pathologically proven idiopathic Parkinsons

disease (IPD) who developed diplopia secondary to convergence

insufficiency during his motor off periods Diplopia resolved with

onset of motor benefit from levodopa Neuro-ophthalmologic

examination demonstrated convergence insufficiency during motor

off periods that was alleviated after onset of motor benefit from

levodopa This is the first reported case of convergence insufficiency

in IPD responsive to levodopa

36

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

Bottom Line

Optometric Vision Therapy is the most efficacious treatment available for binocular vision disorders and the

treatment effects are long lasting Neuro-enhancing drugs

may assist us as well

37

EF Learning related vision anomalies Vision

developmentperception disorders

hellipresearch includes an examination of the role vision plays in

reading the effect of oculomotor vergence and

accommodativecoherent motion therapy on reading eye movements

and reading speed the diagnosis and treatment of perceptual

disorders and the effect of therapy on various learning anomalies

38

EF Learning related vision anomalies Vision developmentperception disorders

magnocellular (MC) deficit in dyslexia

LM speed-matching ratio predicts reading in childrenChase C Dougherty RF Ray N

Fowler S Stein JOptom Vis Sci 2007 Mar84(3)229-36

Effect of attention therapy on reading comprehension Solan HA Shelley-Tremblay J

Ficarra A Silverman M Larson S J Learn Disabil 2003 Nov-Dec36(6)556-63

Is there a common linkage among reading comprehension visual attention and

magnocellular processing Solan HA Shelley-Tremblay JF Hansen PC Larson S

J Learn Disabil 2007 May-Jun40(3)270-8

Lawton T Filtered Text and Direction Discrimination Training Improved Reading

Fluency for Both Dyslexic and Normal Readers Optom Vis Dev 200839 (3)114

Fischer B Hartnegg K Saccade control in dyslexia Development deficits training

and transfer to reading Optom Vis Dev 200839(4)181-190

39

EF Learning related vision anomalies Vision developmentperception disorders

J Learn Disabil 2003 Nov-Dec36(6)556-63 Effect of attention therapy on reading

comprehension Solan HA Shelley-Tremblay J Ficarra A Silverman M Larson S

hellip At the completion of attention therapy the mean

standard attention and reading comprehension scores of

the experimental group had improved significantly The

control group however showed no significant

improvement in reading comprehension scores after 12

weeks Although uncertainties still exist this investigation

supports the notion that visual attention is malleable and

that attention therapy has a significant effect on reading

comprehension in this often neglected population

40

VII Vision dysfunction association with acquired brain injury

A Exotropia (or high exophoriaCI)

B Accommodative dysfunction

C Convergence insufficiency

41

D Decreased blink rate

E Spatial disorientation

F Pursuitsaccade dysfunction

G Unstable ambient vision (Magnocellular pathway)

42

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Stelmack JA Frith T Van Koevering D Rinne S Stelmack TR Visual function in patients

followed at a Veterans Affairs polytrauma network site an electronic medical record review

Optometry 2009 Aug80(8)419-24

RESULTS Visual symptoms were self-reported by 76 of patients

with polytrauma and 75 of the patients with TBI Problems with reading

(polytrauma 60 and TBI 50) and accommodation (polytrauma 30 and

TBI 47) were frequently found on eye examinations Spectacles were the

treatment most frequently prescribed (polytrauma 62 and TBI 78)

CONCLUSIONS It is important for optometrists to be aware of the high

rates of self-reported symptoms and visual problems in military personnel

returning from deployment to the wars in Iraq and Afghanistan Post-

traumatic stress disorder and depression may complicate optometric

evaluation and management

43

VII Vision dysfunction association with acquired brain injury

Avoidance of near tasks

Oculomotor-based reading difficulties

Eye tracking problems

Eye focusing problems

Eyestrain Diplopia

Dizziness Vertigo

Vision-derived nausea

44

VII Vision dysfunction association with acquired brain injury

Increased sensitivity to visual motion

Visual inattention and distractibility

Short-term visual memory loss

Difficulty judging distances (relative and absolute

Difficulty with global scanning

Difficulty with personal grooming especially involving the face

Inability to interactcope visually in a complex social situation

(eg minimal eye contact)

Inability to tolerate complex visual environments (eg grocery store

aisles and highly-patterned floors)

45

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Ciuffreda KJ Ludlam DP Kapoor N Clinical oculomotor training in traumatic brain injury Optom Vis

Dev 200940(1)16-23

Individuals with traumatic brain injury present with a constellation of

oculomotor dysfunctions and correlated symptoms Simple and

effective clinical oculomotor-based training procedures will be

presented with respect to the versional vergence and

accommodative systems and their interactions These therapeutic

procedures can also be applied as needed to individuals with either

low vision neurological dysfunctions or general visual skills cases

manifesting similar oculomotor deficits

46

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Leslie S Myopia and accommodative insufficiency associated with

moderate head trauma Opt Vis Dev 200940(1)25-31

The majority of subjects reviewed had developed a stable degree of

myopia between 100 and 200 diopters as well as an abnormally

high lag of accommodation When their distance and near spatial area

of focus was compared the majority were focused at an intermediate

area in space suggesting a loss of control of accommodation in

space

47

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

B Drugs

C Exercise

D Learning new and challenging things

48

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements

prevent cognitive decline A systematic review of randomized controlled trials J Hum

Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among

preterm infants attributable to early supplementation of human milk with

docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings

and structural-functional synergies with cell membrane phospholipids Altern Med Rev

2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function

Neuroscience 20089(7)568-78

49

VIII Improving Brain Function and Neuroplasticity

B Drugs Maya Vetencourt JF Sale A Viegi A et al The antidepressant

fluoxetine (PROZAC) restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the

antidepressant tianeptine CNS Drugs 200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances

hippocampal long-term potentiation and memory BMC Biol 2008 Sep

9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine

improves neuropsychological disorders in a child with creatine

transporter defect Neurocase 200814(2) 151-61

50

VIII Improving Brain Function and Neuroplasticity

C Exercise

Hunsberger JG et al Antidepressant actions of the exercise-

regulated gene VGF Nat Med 2007 Dec 2 131476

VGF may be a common pathway by which exercise induces

neuroplasticity and growth-factor genes at least one of these might act

similarly to antidepressants in promoting an adaptive response to stress

However the tests used here may be modeling stress-induced

helplessness not depression hellipexercise seems to induce multiple

interacting genes that enhance neuronal resilience

51

VIII Improving Brain Function and Neuroplasticity

D Learning new and challenging things

What have we (optometry amp ophthalmology)

been thinking all these years

Where did we miss the news about neuroplasticity

52

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Huang JC Neuroplasticity as a proposed mechanism for the efficacy of optometric vision therapy and rehabilitation J Bev Optom 200920(4)96-100

Homologous area adaptationCompensatory masqueradeCross-modal reassignment

Map expansion

EquipotentialityVicariation

53

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Homologous area adaptation a transfer of function from a damaged brain area to a non-damaged brain area May be limited to early stages of human development and may crowd a new brain area resulting in reduced functionality of that brain area (Competition between spatial amp verbal functioning)

54

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Compensatory masquerade reorganizing of existing neuro-pathways to us alternative cognitive strategies to perform a task

55

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Cross-modal reassignment using new sensory input in a brain structure deprived of its main input source (changing processing from visual to tactile stimuli in the blind)

56

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Map expansion increase in brain mass due to repeated behavior or exposure to stimuli

57

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Equipotentiality anatomical areas of the brain can perform disparate functions

Vicariation redundant neural systems can operate under abnormal conditions

This may explain why recovery is noted for many neurological conditions (degenerative psychiatric developmental vascular traumatic)

58

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Constraint therapy Use it and improve it

Patching penalization ldquonear activitiesrdquo during amblyopia therapy

59

IX Improving Brain Function and Neuroplasticity Optometric Clinical ApplicationsOptometric Vision Therapy

Kleim amp Jones

Use it or lose it If you do not drive specific brain functions

functional loss will occur

If you want to improve oculomotor brain neuroplastic function amp

structure therapy should be specific for that brain function

Use it and improve it Therapy that drives cortical function enhances

that particular function

If you use therapy to improve oculomotor dysfunction it should

improve

Specificity The therapy you choose determines the resultant

plasticity and function

You must choose therapy that is appropriate

60

IX Improving Brain Function and Neuroplasticity Optometric Clinical Applications

Kleim amp Jones

Repetition matters Plasticity that results in functional change

requires repetition

Do the therapy Do it again Do it yet again No quick fix

Intensity matters Induction of plasticity requires the appropriate

amount of intensity

Intensity means strength force concentration power and passion

Without these plasticity may not occur Function may not improve

Time matters Different forms of plasticity take place at different

times during therapy

Do the basics than the more advanced therapeutic procedures

61

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Salience matters It has to be important to the individual

Make the therapy matter to the patient

Age matters Plasticity is easier in a younger brain but is also

possible in an adult brain

Do not let age determine what therapy options you offer your

patients Think of Susan Barry PhD (StereoSue) and her success

Offer your patients options Let them choose Be realistic about

outcomeshelliphave outcome measures built into therapy program

62

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Transference Neuroplasticity and the change in function

that results from one therapy can augment the attainment

of similar behaviors

What you do during oculomotor therapy may affected

vergence therapy outcomes

Interference Plasticity in response to one experience can

interfere with the acquisition of other behaviors

Monitor Evaluate progress Discuss function in other areas

of your patientslsquo life

63

Why pay attention to binocular vision dysfunctions

and neuroplasticity

December 2009 issue of the Review of Optometry

The Binocular Vision Dysfunction Pandemic

In 2010 almost 170 million individuals will be wearing glasses In

2010 there will also be up to 93 million amblyopes and 12 and a half

million strabismics For children under 18 years of age that means

there will be more than 22 and a half million amblyopes and millions

of children with strabismus A clinical trial to determine the

prevalence of binocular vision dysfunction within the general

population suggested the possibility of up to 56 or 173 million men

women and children with symptoms associated with a binocular

vision dysfunction 189 million (61) with accommodative problems

and 118 million (38) demonstrating various vergence

anomalies

64

65

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Brain plasticity life long changes in the structure of the brain

Sensory substitution replacement of one sensory input by another

Measurement techniques

Voxel based morphometryhellipmeasures difference in brain volume

Fluorodeoxyglucose glucose analog PET scan tells you

distribution and metabolism of brain

Cortical thickness measures

Visual cortex of the blind turns somatic ―The eye of the tongue

Transcranial magnetic stmiulation non-invasive technique to

stimulate cortex

66

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Blind Braille readers report tingling in fingers when pressure

phosphenes are applied Blind feel tingling in tongue

Bind use tongue to perform orientation task motion perception

sensory perception Visual cortex recruited in a variety of sensory

and cognitive tasks (DM Can we use tongue as a VT tool)

Dilks Reorganizations of human adult visual system

When a region of sensory cortex is deprived of its bottom up

input the deprived region begins to respond to stimuli that

normally activate adjacent cortex

67

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Retinotopic map changes for stroke pts Cortical reorganization in

adults occurs Perceived objectshellipelongation in stroke amp AMD

What happens to deprived cortex in AMD

fMRI shows cortical reorganization in adults

Proposed mechanisms

hellipGrowth of new connections

hellipUnmasking of pre-existing connections this is true

happens within seconds

Bavelier

Action video games

68

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Bavelier

Action video games Looked at attention Gamers can track more

activities

Attention over space (me peripheral awarenress) Useful field

of view shrinks with age

Performance not VA relatedhellipis related to attention

Action game playing changes spatial resolutionhellipovercoming

crowding in VA assessment (me amblyopia therapy)

Temporal resolution of vision Backward masking

changehellipbrain changes

Visual sensitivity (contrast sensitivity) Post action game training

improves CSF

69

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Action video games correcting optics of the cortex (me this is

actualy OVT)

Games factor

Variable entry leanringhellipadapt task to skill level

Incremental learning tune task to subjectlsquos leanring steps

Motivationarousal

Rewards

Self masterself confidence

Action games factors

Pacingrate of exposure to infohellipincreasing processing speed

Dynamic display

Rich environment

Rich motor involvement

70

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Surgeons may be made to play action games

Pilot training

Amblyopia tx Dennis Levi research

PresenterTitle Contact info

Neuroplasticity-A Paradigm Sea Change

This presentation is available at

httpwwwslidesharenetDMAINOneuroplasticity-a-paradigm-sea-change-2459693

httpwwwmainosmemosblogspotcom

My FaceBook Page

and

Twitter

PresenterTitle Contact info

Questions About

Neuroplasticity-A Paradigm Sea Change

Dominick M Maino OD MEd FAAO FCOVD-A

Professor PediatricsBinocular VisionIllinois Eye InstituteIllinois College of Optometry

dmainoicoeduhttpwwwMainosMemosblogspotcom

Thanks to

httpwwwcovdorgHomeOVDJournalOVD401tabid263D

efaultaspx

httpbipolarblastfileswordpresscom200908neurojpg

httpwwwspecialcheerscomimagesanimated_braingif

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contentuploads200810frankenstein-myspace-lightbeergif

httpwwwshangralafamilyfuncomgala-ecalvindreamgif

httppsychiatryjwatchorgcgicontentfull20082251

73

Chakraborty R Chatterjee A Choudhart S Chakraborty PK Neuroplasticitymdasha paradigm shift in neurosciences J Indian Med Assoc

2007105(9)513-4516-8520-1

Sacks O A neurologistlsquos notebook Stereo Sue Why two eyes are better than one The New Yorker 2006 Jun 1964-73

Krulwich R National Public Radio Going Binocular Susanlsquos First Snowfall Available at

wwwnprorgtemplatesstorystoryphpstoryId=5507789 (Accessed December 8 2008)

Press LJ The story behind Stereo Suelsquo and a world-famous neurologistlsquos discovery of vision therapy Optom Vis Dev 200637(2) 55-7

Levin HS Neuroplasticity and brain imaging research implications for rehabilitation Arch Phys Med Rehabil 2006 Dec87(12 Suppl

2)S1

Wiesel TN Hubel DH Single-cell responses in striate cortex of kittens deprived of vision in one eye J Neurophysiol 1963

Nov261003-17

Hook BM Chen C Critical periods in the visual system Changing views for a model of experience-dependent plasticity Neuron 2007

Oct56(2)312-26

Ramey CT Ramey SL Prevention of intellectual disabilities early interventions to improve cognitive development Prev Med 1998

Mar-Apr27(2)224-32

Heuninckx S Wenderoth N Swinnen SP Systems neuroplasticity in the aging brain recruiting additional neural resources for

successful motor performance in elderly persons J Neurosci 2008 Jan 228(1)91-9

Ge S Yang CH Hsu KS et al A critical period for enhanced synaptic plasticity in newly generated neurons of the adult brain Neuron

2007 May54(4)559-66

74

Draganski B Gaser C Busch V et al Neuroplasticity changes in grey matter induced by training Nature 2004 Jan 22427(6972)

311-2

Cannonieri GC Bonilha L Fernandes PT et al Practice and perfect length of training and structural brain changes in experienced

typists Neuroreport 2007 Jul 218(10)1063-6

Kleim JA Jones TA Principles of experience-dependent neural plasticity implications for rehabilitation after brain damage J

Speech Lang Hear Res 2008 Feb51(1)S225-39

Trojan S Porkorny J Theoretical aspects of neuroplasticity Physiol Res 199948(2)87-97

Ramamirtham R Kee CS Hung LF et al Wave aberrations in rhesus monkeys with vision-induced ametropias Vision Res 2007

Sep47(21)2751-66

Smith EL 3rd Ramamirtham R Qiao-Grider Y et al Effects of foveal ablation on emmetropization and form-deprivation myopia

Invest Ophthalmol Vis Sci 2007 Sep48(9)3914-22

Smith EL 3rd Kee CS Ramamirtham R et al Peripheral vision can influence eye growth and refractive development in infant

monkeys Invest Ophthalmol Vis Sci 2005 Nov46(11)3965-72

Ciuffreda KJ Vasudevan B Nearwork-induced transient myopia (NITM) and permanent myopiandashndashis there a link Ophthalmic

Physiol Opt 2008 Mar28(2)103-14

Hung GK Ciuffreda KJ Incremental retinal-defocus theory of myopia development--schematic analysis and computer simulation

Comput Biol Med 2007 Jul37(7)930-46

Hung GK Ciuffreda KJ A unifying theory of refractive error development Bull Math Biol 2000 Nov62(6)1087-108

75

Pang Y Maino D Zhang G Lu F Myopia Can its progress be controlled Optom Vis Dev 200637(2)75-9

Leung JT Brown B Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lenses Optom Vis Sci

1999 Jun76(6)346-54

Hasebe S Ohtsuki H Nonaka T et al Effect of progressive addition lenses on myopia progression in Japanese children a prospective

randomized double-masked crossover trial Invest Ophthalmol Vis Sci 2008 Jul49(7)2781-9

Gwiazda J Hyman L Hussein M et al A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression

of myopia in children Invest Ophthalmol Vis Sci 2003 Apr44(4)1492-500

Siatkowski RM Cotter SA Crockett RS et al Two-year multi-center randomized double-masked placebo-controlled parallel safety and

efficacy study of 2 pirenzepine ophthalmic gel in children with myopia J AAPOS 2008 Aug12(4)332-9

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged 7 to 17 years Arch Ophthalmol 2005

Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three to less than 10 years of age Am J

Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction Am J Ophthalmol 2007

Jun143(6)1060-3

Holmes JM Edwards AR Beck RW et al A randomized pilot study of near activities versus non-near activities during patching therapy for

amblyopia J AAPOS 2005 Apr9(2)129-36

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate

amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-57

76

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic

amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Convergence Insufficiency Treatment Trial Study Group Randomized clinical trial of treatments for symptomatic convergence insufficiency

in children Arch Ophthalmol 2008 Oct126(10)1336-49

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

Solan HA Shelley-Tremblay J Hansen PC et al M-cell deficit and reading disability a preliminary study of the effects of temporal vision-

processing therapy Optometry 2004 Oct75(10)640-50

Solan HA Larson S Shelley-Tremblay J et al Role of visual attention in cognitive control of oculomotor readiness in students with reading

disabilities J Learn Disabil 2001 Mar-Apr34(2)107-18

Gallaway M Boas MB The impact of vergence and accommodative therapy on reading eye movements and reading speed Optom Vis Dev

200738(3)115-20

Goss DA Downing DB Lowther AH et al The effect of HTS vision therapy conducted in a school setting on reading skills in third and

fourth grade students Optom Vis Dev 200738(1)27-32

Crutch SJ Warrington EK Foveal crowding in posterior cortical atrophy a specific early-visual-processing deficit affecting word reading

Cogn Neuropsychol 2007 Dec24(8)843-66

Helms D Sawtelle SM A study of the effectiveness of cognitive therapy delivered in a video game format Optom Vis Dev 200738 (1)19-

26

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

77

Lawton T Training direction-discrimination sensitivity remediates a wide spectrum of reading skills OptomVis Dev 200738(1) 33-47

Goldstand S Koslowe KC Parush S Vision visual-information processing and academic performance among seventh-grade schoolchildren a

more significant relationship than we thought Am J Occup Ther 2005 Jul-Aug59(4)377-89

Fischer B Koumlngeter A Hartnegg K Effects of daily practice on subitizing visual counting and basic arithmetic skills Optom Vis Dev

200839(1)30-4

Sands W Taub M Maino D Limited research and education on special populations in optometry and ophthalomology Optom Vis Dev

200839(2)60-1

Wesson M Maino D Oculo-visual findings in Down syndrome cerebral palsy and mental retardation with non-specific etiology In Maino D

(ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 199517-54 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

Cui Y Stapleton F Suttle C Developing an instrument to assess vision-related and subjective quality of life in children with intellectual

disability data collection and preliminary analysis in a Chinese population Ophthal Physiolog Optics 2008 May28(3) 238-46

Maino D Steele G Tahir S Sajja R Attitudes of optometry students toward individuals with disabilities Optom Ed 200227(2)45-50

Maino D Special populations in the optometric curriculum Optom Ed 200227(2)38-9

Maino D Overview of special populations In Scheiman M Rouse M (eds) Optometric Management of Learning-Related Vision Problems

St Louis Mosby Inc 200685-106

Maino D (ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 1995 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

78

McCarthy P Maino D Alport syndrome a review Clin Eye Vis Care 2000 Dec12(3-4)139-50

Block SS Brusca-Vega R Pizzi WJ et al Cognitive and visual processing skills and their relationship to mutation size in full and

permutation female fragile X carriers Optom Vis Sci 2000 Nov77 (11)592-9

Maino D The young child with developmental disabilities An introduction to mental retardation and genetic syndromes In Moore BD

(ed) Eye Care for Infants and Young Children Butter-worth--Heinemann Newton MA1997285-300

Amin V Maino D The Fragile X female Visual visual perceptual and ocular health anomalies J Am Optom Assoc 1995 May66

(5)290-95

Maino DM Maino JH Cibis GW Hecht F Ocular health anomalies in patients with developmental disabilities In Maino D (ed)

Diagnosis and Management of Special Populations Mosby-Year-book Inc St Louis MO 1995189-206 Reprinted Optometric

Education Program Foundation Santa Anna Calif 2001

Maino D Wesson M Schlange D Cibis G Maino J Optometric findings in the fragile X syndrome Optom Vis Sci 199168634-40

Scheiman MMOptometric findings in children with cerebral palsy Am J Optom Physiol Opt 1984 May61(5)321-3

Maino D Maino J Maino S Mental retardation syndromes with associated ocular defects J Am Optom Assoc 199061707-16

Stewart RE Woodhouse JM Cregg M Pakeman VH Association between accommodative accuracy hypermetropia and strabismus in

children with Downs syndrome Optom Vis Sci 2007 Feb84(2)149-55

Cregg M Woodhouse JM Pakeman VH et al Accommodation and refractive error in children with Down syndrome cross-sectional

and longitudinal studies Invest Ophthalmol Vis Sci 2001 Jan42 (1)55-63

79

McClelland JF Parkes J Hill N et al Accommodative dysfunction in children with cerebral palsy a population-

based study Invest Ophthalmol Vis Sci 2006 May47(5)1824-30

Duckman RH Vision therapy for the child with cerebral palsy J Am Optom Assoc 198758(1)28-35

Duckman R Accommodation in cerebral palsy function and remediation J Am Optom Assoc 198455(4)281-3

Scheiman M Understanding and managing vision deficits a guide for occupational therapists 2nd ed Slack

Thorofare NJ 2002

Maino D Binasal occlusion for the child with Cerebral Palsy J Ill Optom Assoc 198644(1)1218

Battaglia F Quartarone A Rizzo V et al Early impairment of synaptic plasticity in patients with Downs syndrome

Neurobiol Aging 2008 Aug29(8)1272-5

Bonnier C Evaluation of early stimulation programs for enhancing brain development Acta Paediatr 2008

Jul97(7)853-8

Morice E Andreae LC Cooke SF et al Preservation of long-term memory and synaptic plasticity despite short-term

impairments in the Tc1 mouse model of Down syndrome Learn Mem 2008 Jul 1415(7)492-500

Gordon AM Schneider JA Chinnan A Charles JR Efficacy of a hand-arm bimanual intensive therapy (HABIT) in

children with hemiplegic cerebral palsy a randomized control trial Dev Med Child Neurol 2007 Nov49(11)830-8

Kapoor N Ciuffreda KJ Vision disturbances following traumatic brain injury Curr Treat Options Neurol 2002

Jul4(4)271-80

80

Ciuffreda KJ Rutner D Kapoor N et al Vision therapy for oculomotor dysfunctions in acquired brain injury a

retrospective analysis Optometry 2008 Jan79(1)18-22

Ciuffreda KJ Han Y Kapoor N Ficarra AP Oculomotor rehabilitation for reading in acquired brain injury

NeuroRehabilitation 200621(1)9-21

Zost M Diagnosis and management of visual dysfunction in cerebral injury In Maino D (ed) Diagnosis and

Management of Special Populations Mosby-Yearbook Inc St Louis 199579 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001 [Figure used with permission of the editor]

DeGutis JM Bentin S Robertson LC DEsposito M Functional plasticity in ventral temporal cortex following

cognitive rehabilitation of a congenital prosopagnosic J Cogn Neurosci 2007 Nov19 (11)1790-802

Welbourne SR Ralph MA Exploring the impact of plasticity-related recovery after brain damage in a connectionist

model of single-word reading Cogn Affect Behav Neurosci 2005 Mar5(1)77-92

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements prevent cognitive decline A

systematic review of randomized controlled trials J Hum Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among preterm infants attributable to early

supplementation of human milk with docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings and structural-functional

synergies with cell membrane phospholipids Altern Med Rev 2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function Neuroscience 20089(7)568-78

81

Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

BMC Biol 2008 Sep 9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine improves neuropsychological disorders in a child with

creatine transporter defect Neurocase 200814(2) 151-61

Forrester LW Wheaton LA Luft AR Exercise-mediated locomotor recovery and lower-limb neuroplasticity after

stroke J Rehabil Res Dev 200845(2)205-20

82

Page 26: Neuroplasticity: A Paradigm Sea Change Latest Updated File

V Neuroplasticity and Optometry

D Reparation plasticity

hellipin contrast to adaptational

plasticity reparation plasticity may

occur during treatment by a low

Vision specialist or an OD

Working with those who have

Experienced a traumatic brain

injury (TBI)

26

V Neuroplasticity and Optometry

The effects of plasticity can lead to either

positive or negative changes during

development (evolutionary plasticity) after

short-term exposure (reactive plasticity)

after long-term or continuous stimuli

(adaptational plasticity) and during

functional or structural recovery of damaged

neuronal circuits (reparation plasticity)

httpwwwciteulikeorguserjasonepriorarticle2856526

27

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

A Refractive error development

B Amblyopia

C Strabismus

28

D Non-strabismus non-amblyopic binocular vision disorders

E Learning related vision anomalies

F Vision developmentperception disorders

29

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

A Refractive error development

Several recent studies have noted that neuroplasticity may play a

role in refractive error development

retinal defocus use of progressive addition lenses

drug studies (M1-antagonist2 pirenzepine ) slow myopia

progression demonstrated nearly a 50 reduction in myopia

progression over a two-year period

30

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged

7 to 17 years Arch Ophthalmol 2005 Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three

to less than 10 years of age Am J Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction

Am J Ophthalmol 2007 Jun143(6)1060-3

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine

vs patching for treatment of moderate amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-

57

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for

strabismic and anisometropic amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Treatment of severe amblyopia with weekend atropine results from 2 randomized clinical trials

Levodopacarbidopa in the treatment of amblyopia

31

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

J Pediatr Ophthalmol Strabismus 2009 Mar-Apr46(2)87-90 quiz 91-2 Levodopacarbidopa in the

treatment of amblyopia Dadeya S Vats P Malik KP

PURPOSE To evaluate the role of levodopacarbidopa in the treatment of amblyopia METHODS

Thirty patients with strabismic amblyopia between the ages of 3 and 12 years were part of this double-

blind randomized study Patients were divided into two groups Group A received 050 mg + 125 mg of

levodopacarbidopa per kilogram body weight three times daily after meals with a protein rich drink

whereas Group B received placebo Both groups received full-time conventional occlusion until a visual

acuity of 66 was achieved or for a maximum of 3 months RESULTS The authors observed more than

two lines improvement in visual acuity that was greater in the levodopa group (15 of 15) than in the

placebo group (9 of 15) (P lt 005) Furthermore improvement in visual acuity of more than two lines

was greater in patients younger than 8 years (100) than in patients older than 8 years of age (60) (P =

0026) There was also no significant reversal of the improved visual acuity in up to 6 months of follow-

up CONCLUSION Levodopacarbidopa improves visual acuity in patients with

amblyopia and maintains improved visual acuity especially in patients

younger than 8 years

32

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

J Pediatr Ophthalmol Strabismus 2008 May-Jun45(3)174-6 The use of levodopa in the treatment of

bilateral amblyopia secondary to uncorrected high hypermetropia Abrams MS

The standard treatment of bilateral amblyopia secondary to uncorrected high bilateral hypermetropia has

been spectacles and time The patient described here failed to show adequate improvement in visual

acuity after 18 months of standard treatment Visual acuity improved dramatically when the

patient began taking levodopa dropped precipitously when the medication was

discontinued and returned quickly to post-treatment levels when levodopa was

restarted Visual acuity remained stable when the medication was slowly tapered

and discontinued This report suggests that dopamine may play a role in the pathophysiology of

bilateral amblyopia secondary to uncorrected high bilateral hypermetropia

33

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

Bottom Line

Amblyopia can be treated at any age

May be able to use neuro-enhancing drugs

as a part of basic amblyopia therapy

34

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

C Strabismus and non-strabismic non-amblyopic binocular

vision disorders

Clinical Trial of Treatments for Symptomatic Convergence Insufficiency in Children has

clearly demonstrated the superiority of in-office optometric vision therapy (in conjunction

with home therapy) vs out-of-office therapy alone The study concluded that optometric

vision therapyorthoptics was more effective than pencil push-ups or placebo vision

therapyorthoptics in reducing symptoms and improving clinical signs of convergence

insufficiency

Long-term effectiveness of treatments for symptomatic convergence insufficiency

in children (Optom Vis Sci 2009 Sep86(9)1096-103)

CITT patients improvements lasted a year

35

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

Strabismus 1999 Sep7(3)169-74 Convergence insufficiency in

idiopathic Parkinsons disease responsive to levodopa Racette BA

Gokden MS Tychsen LS Perlmutter JS

We report a patient with pathologically proven idiopathic Parkinsons

disease (IPD) who developed diplopia secondary to convergence

insufficiency during his motor off periods Diplopia resolved with

onset of motor benefit from levodopa Neuro-ophthalmologic

examination demonstrated convergence insufficiency during motor

off periods that was alleviated after onset of motor benefit from

levodopa This is the first reported case of convergence insufficiency

in IPD responsive to levodopa

36

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

Bottom Line

Optometric Vision Therapy is the most efficacious treatment available for binocular vision disorders and the

treatment effects are long lasting Neuro-enhancing drugs

may assist us as well

37

EF Learning related vision anomalies Vision

developmentperception disorders

hellipresearch includes an examination of the role vision plays in

reading the effect of oculomotor vergence and

accommodativecoherent motion therapy on reading eye movements

and reading speed the diagnosis and treatment of perceptual

disorders and the effect of therapy on various learning anomalies

38

EF Learning related vision anomalies Vision developmentperception disorders

magnocellular (MC) deficit in dyslexia

LM speed-matching ratio predicts reading in childrenChase C Dougherty RF Ray N

Fowler S Stein JOptom Vis Sci 2007 Mar84(3)229-36

Effect of attention therapy on reading comprehension Solan HA Shelley-Tremblay J

Ficarra A Silverman M Larson S J Learn Disabil 2003 Nov-Dec36(6)556-63

Is there a common linkage among reading comprehension visual attention and

magnocellular processing Solan HA Shelley-Tremblay JF Hansen PC Larson S

J Learn Disabil 2007 May-Jun40(3)270-8

Lawton T Filtered Text and Direction Discrimination Training Improved Reading

Fluency for Both Dyslexic and Normal Readers Optom Vis Dev 200839 (3)114

Fischer B Hartnegg K Saccade control in dyslexia Development deficits training

and transfer to reading Optom Vis Dev 200839(4)181-190

39

EF Learning related vision anomalies Vision developmentperception disorders

J Learn Disabil 2003 Nov-Dec36(6)556-63 Effect of attention therapy on reading

comprehension Solan HA Shelley-Tremblay J Ficarra A Silverman M Larson S

hellip At the completion of attention therapy the mean

standard attention and reading comprehension scores of

the experimental group had improved significantly The

control group however showed no significant

improvement in reading comprehension scores after 12

weeks Although uncertainties still exist this investigation

supports the notion that visual attention is malleable and

that attention therapy has a significant effect on reading

comprehension in this often neglected population

40

VII Vision dysfunction association with acquired brain injury

A Exotropia (or high exophoriaCI)

B Accommodative dysfunction

C Convergence insufficiency

41

D Decreased blink rate

E Spatial disorientation

F Pursuitsaccade dysfunction

G Unstable ambient vision (Magnocellular pathway)

42

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Stelmack JA Frith T Van Koevering D Rinne S Stelmack TR Visual function in patients

followed at a Veterans Affairs polytrauma network site an electronic medical record review

Optometry 2009 Aug80(8)419-24

RESULTS Visual symptoms were self-reported by 76 of patients

with polytrauma and 75 of the patients with TBI Problems with reading

(polytrauma 60 and TBI 50) and accommodation (polytrauma 30 and

TBI 47) were frequently found on eye examinations Spectacles were the

treatment most frequently prescribed (polytrauma 62 and TBI 78)

CONCLUSIONS It is important for optometrists to be aware of the high

rates of self-reported symptoms and visual problems in military personnel

returning from deployment to the wars in Iraq and Afghanistan Post-

traumatic stress disorder and depression may complicate optometric

evaluation and management

43

VII Vision dysfunction association with acquired brain injury

Avoidance of near tasks

Oculomotor-based reading difficulties

Eye tracking problems

Eye focusing problems

Eyestrain Diplopia

Dizziness Vertigo

Vision-derived nausea

44

VII Vision dysfunction association with acquired brain injury

Increased sensitivity to visual motion

Visual inattention and distractibility

Short-term visual memory loss

Difficulty judging distances (relative and absolute

Difficulty with global scanning

Difficulty with personal grooming especially involving the face

Inability to interactcope visually in a complex social situation

(eg minimal eye contact)

Inability to tolerate complex visual environments (eg grocery store

aisles and highly-patterned floors)

45

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Ciuffreda KJ Ludlam DP Kapoor N Clinical oculomotor training in traumatic brain injury Optom Vis

Dev 200940(1)16-23

Individuals with traumatic brain injury present with a constellation of

oculomotor dysfunctions and correlated symptoms Simple and

effective clinical oculomotor-based training procedures will be

presented with respect to the versional vergence and

accommodative systems and their interactions These therapeutic

procedures can also be applied as needed to individuals with either

low vision neurological dysfunctions or general visual skills cases

manifesting similar oculomotor deficits

46

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Leslie S Myopia and accommodative insufficiency associated with

moderate head trauma Opt Vis Dev 200940(1)25-31

The majority of subjects reviewed had developed a stable degree of

myopia between 100 and 200 diopters as well as an abnormally

high lag of accommodation When their distance and near spatial area

of focus was compared the majority were focused at an intermediate

area in space suggesting a loss of control of accommodation in

space

47

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

B Drugs

C Exercise

D Learning new and challenging things

48

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements

prevent cognitive decline A systematic review of randomized controlled trials J Hum

Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among

preterm infants attributable to early supplementation of human milk with

docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings

and structural-functional synergies with cell membrane phospholipids Altern Med Rev

2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function

Neuroscience 20089(7)568-78

49

VIII Improving Brain Function and Neuroplasticity

B Drugs Maya Vetencourt JF Sale A Viegi A et al The antidepressant

fluoxetine (PROZAC) restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the

antidepressant tianeptine CNS Drugs 200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances

hippocampal long-term potentiation and memory BMC Biol 2008 Sep

9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine

improves neuropsychological disorders in a child with creatine

transporter defect Neurocase 200814(2) 151-61

50

VIII Improving Brain Function and Neuroplasticity

C Exercise

Hunsberger JG et al Antidepressant actions of the exercise-

regulated gene VGF Nat Med 2007 Dec 2 131476

VGF may be a common pathway by which exercise induces

neuroplasticity and growth-factor genes at least one of these might act

similarly to antidepressants in promoting an adaptive response to stress

However the tests used here may be modeling stress-induced

helplessness not depression hellipexercise seems to induce multiple

interacting genes that enhance neuronal resilience

51

VIII Improving Brain Function and Neuroplasticity

D Learning new and challenging things

What have we (optometry amp ophthalmology)

been thinking all these years

Where did we miss the news about neuroplasticity

52

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Huang JC Neuroplasticity as a proposed mechanism for the efficacy of optometric vision therapy and rehabilitation J Bev Optom 200920(4)96-100

Homologous area adaptationCompensatory masqueradeCross-modal reassignment

Map expansion

EquipotentialityVicariation

53

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Homologous area adaptation a transfer of function from a damaged brain area to a non-damaged brain area May be limited to early stages of human development and may crowd a new brain area resulting in reduced functionality of that brain area (Competition between spatial amp verbal functioning)

54

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Compensatory masquerade reorganizing of existing neuro-pathways to us alternative cognitive strategies to perform a task

55

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Cross-modal reassignment using new sensory input in a brain structure deprived of its main input source (changing processing from visual to tactile stimuli in the blind)

56

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Map expansion increase in brain mass due to repeated behavior or exposure to stimuli

57

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Equipotentiality anatomical areas of the brain can perform disparate functions

Vicariation redundant neural systems can operate under abnormal conditions

This may explain why recovery is noted for many neurological conditions (degenerative psychiatric developmental vascular traumatic)

58

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Constraint therapy Use it and improve it

Patching penalization ldquonear activitiesrdquo during amblyopia therapy

59

IX Improving Brain Function and Neuroplasticity Optometric Clinical ApplicationsOptometric Vision Therapy

Kleim amp Jones

Use it or lose it If you do not drive specific brain functions

functional loss will occur

If you want to improve oculomotor brain neuroplastic function amp

structure therapy should be specific for that brain function

Use it and improve it Therapy that drives cortical function enhances

that particular function

If you use therapy to improve oculomotor dysfunction it should

improve

Specificity The therapy you choose determines the resultant

plasticity and function

You must choose therapy that is appropriate

60

IX Improving Brain Function and Neuroplasticity Optometric Clinical Applications

Kleim amp Jones

Repetition matters Plasticity that results in functional change

requires repetition

Do the therapy Do it again Do it yet again No quick fix

Intensity matters Induction of plasticity requires the appropriate

amount of intensity

Intensity means strength force concentration power and passion

Without these plasticity may not occur Function may not improve

Time matters Different forms of plasticity take place at different

times during therapy

Do the basics than the more advanced therapeutic procedures

61

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Salience matters It has to be important to the individual

Make the therapy matter to the patient

Age matters Plasticity is easier in a younger brain but is also

possible in an adult brain

Do not let age determine what therapy options you offer your

patients Think of Susan Barry PhD (StereoSue) and her success

Offer your patients options Let them choose Be realistic about

outcomeshelliphave outcome measures built into therapy program

62

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Transference Neuroplasticity and the change in function

that results from one therapy can augment the attainment

of similar behaviors

What you do during oculomotor therapy may affected

vergence therapy outcomes

Interference Plasticity in response to one experience can

interfere with the acquisition of other behaviors

Monitor Evaluate progress Discuss function in other areas

of your patientslsquo life

63

Why pay attention to binocular vision dysfunctions

and neuroplasticity

December 2009 issue of the Review of Optometry

The Binocular Vision Dysfunction Pandemic

In 2010 almost 170 million individuals will be wearing glasses In

2010 there will also be up to 93 million amblyopes and 12 and a half

million strabismics For children under 18 years of age that means

there will be more than 22 and a half million amblyopes and millions

of children with strabismus A clinical trial to determine the

prevalence of binocular vision dysfunction within the general

population suggested the possibility of up to 56 or 173 million men

women and children with symptoms associated with a binocular

vision dysfunction 189 million (61) with accommodative problems

and 118 million (38) demonstrating various vergence

anomalies

64

65

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Brain plasticity life long changes in the structure of the brain

Sensory substitution replacement of one sensory input by another

Measurement techniques

Voxel based morphometryhellipmeasures difference in brain volume

Fluorodeoxyglucose glucose analog PET scan tells you

distribution and metabolism of brain

Cortical thickness measures

Visual cortex of the blind turns somatic ―The eye of the tongue

Transcranial magnetic stmiulation non-invasive technique to

stimulate cortex

66

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Blind Braille readers report tingling in fingers when pressure

phosphenes are applied Blind feel tingling in tongue

Bind use tongue to perform orientation task motion perception

sensory perception Visual cortex recruited in a variety of sensory

and cognitive tasks (DM Can we use tongue as a VT tool)

Dilks Reorganizations of human adult visual system

When a region of sensory cortex is deprived of its bottom up

input the deprived region begins to respond to stimuli that

normally activate adjacent cortex

67

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Retinotopic map changes for stroke pts Cortical reorganization in

adults occurs Perceived objectshellipelongation in stroke amp AMD

What happens to deprived cortex in AMD

fMRI shows cortical reorganization in adults

Proposed mechanisms

hellipGrowth of new connections

hellipUnmasking of pre-existing connections this is true

happens within seconds

Bavelier

Action video games

68

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Bavelier

Action video games Looked at attention Gamers can track more

activities

Attention over space (me peripheral awarenress) Useful field

of view shrinks with age

Performance not VA relatedhellipis related to attention

Action game playing changes spatial resolutionhellipovercoming

crowding in VA assessment (me amblyopia therapy)

Temporal resolution of vision Backward masking

changehellipbrain changes

Visual sensitivity (contrast sensitivity) Post action game training

improves CSF

69

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Action video games correcting optics of the cortex (me this is

actualy OVT)

Games factor

Variable entry leanringhellipadapt task to skill level

Incremental learning tune task to subjectlsquos leanring steps

Motivationarousal

Rewards

Self masterself confidence

Action games factors

Pacingrate of exposure to infohellipincreasing processing speed

Dynamic display

Rich environment

Rich motor involvement

70

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Surgeons may be made to play action games

Pilot training

Amblyopia tx Dennis Levi research

PresenterTitle Contact info

Neuroplasticity-A Paradigm Sea Change

This presentation is available at

httpwwwslidesharenetDMAINOneuroplasticity-a-paradigm-sea-change-2459693

httpwwwmainosmemosblogspotcom

My FaceBook Page

and

Twitter

PresenterTitle Contact info

Questions About

Neuroplasticity-A Paradigm Sea Change

Dominick M Maino OD MEd FAAO FCOVD-A

Professor PediatricsBinocular VisionIllinois Eye InstituteIllinois College of Optometry

dmainoicoeduhttpwwwMainosMemosblogspotcom

Thanks to

httpwwwcovdorgHomeOVDJournalOVD401tabid263D

efaultaspx

httpbipolarblastfileswordpresscom200908neurojpg

httpwwwspecialcheerscomimagesanimated_braingif

httpblogmarsdencartoonscomwp-

contentuploads200810frankenstein-myspace-lightbeergif

httpwwwshangralafamilyfuncomgala-ecalvindreamgif

httppsychiatryjwatchorgcgicontentfull20082251

73

Chakraborty R Chatterjee A Choudhart S Chakraborty PK Neuroplasticitymdasha paradigm shift in neurosciences J Indian Med Assoc

2007105(9)513-4516-8520-1

Sacks O A neurologistlsquos notebook Stereo Sue Why two eyes are better than one The New Yorker 2006 Jun 1964-73

Krulwich R National Public Radio Going Binocular Susanlsquos First Snowfall Available at

wwwnprorgtemplatesstorystoryphpstoryId=5507789 (Accessed December 8 2008)

Press LJ The story behind Stereo Suelsquo and a world-famous neurologistlsquos discovery of vision therapy Optom Vis Dev 200637(2) 55-7

Levin HS Neuroplasticity and brain imaging research implications for rehabilitation Arch Phys Med Rehabil 2006 Dec87(12 Suppl

2)S1

Wiesel TN Hubel DH Single-cell responses in striate cortex of kittens deprived of vision in one eye J Neurophysiol 1963

Nov261003-17

Hook BM Chen C Critical periods in the visual system Changing views for a model of experience-dependent plasticity Neuron 2007

Oct56(2)312-26

Ramey CT Ramey SL Prevention of intellectual disabilities early interventions to improve cognitive development Prev Med 1998

Mar-Apr27(2)224-32

Heuninckx S Wenderoth N Swinnen SP Systems neuroplasticity in the aging brain recruiting additional neural resources for

successful motor performance in elderly persons J Neurosci 2008 Jan 228(1)91-9

Ge S Yang CH Hsu KS et al A critical period for enhanced synaptic plasticity in newly generated neurons of the adult brain Neuron

2007 May54(4)559-66

74

Draganski B Gaser C Busch V et al Neuroplasticity changes in grey matter induced by training Nature 2004 Jan 22427(6972)

311-2

Cannonieri GC Bonilha L Fernandes PT et al Practice and perfect length of training and structural brain changes in experienced

typists Neuroreport 2007 Jul 218(10)1063-6

Kleim JA Jones TA Principles of experience-dependent neural plasticity implications for rehabilitation after brain damage J

Speech Lang Hear Res 2008 Feb51(1)S225-39

Trojan S Porkorny J Theoretical aspects of neuroplasticity Physiol Res 199948(2)87-97

Ramamirtham R Kee CS Hung LF et al Wave aberrations in rhesus monkeys with vision-induced ametropias Vision Res 2007

Sep47(21)2751-66

Smith EL 3rd Ramamirtham R Qiao-Grider Y et al Effects of foveal ablation on emmetropization and form-deprivation myopia

Invest Ophthalmol Vis Sci 2007 Sep48(9)3914-22

Smith EL 3rd Kee CS Ramamirtham R et al Peripheral vision can influence eye growth and refractive development in infant

monkeys Invest Ophthalmol Vis Sci 2005 Nov46(11)3965-72

Ciuffreda KJ Vasudevan B Nearwork-induced transient myopia (NITM) and permanent myopiandashndashis there a link Ophthalmic

Physiol Opt 2008 Mar28(2)103-14

Hung GK Ciuffreda KJ Incremental retinal-defocus theory of myopia development--schematic analysis and computer simulation

Comput Biol Med 2007 Jul37(7)930-46

Hung GK Ciuffreda KJ A unifying theory of refractive error development Bull Math Biol 2000 Nov62(6)1087-108

75

Pang Y Maino D Zhang G Lu F Myopia Can its progress be controlled Optom Vis Dev 200637(2)75-9

Leung JT Brown B Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lenses Optom Vis Sci

1999 Jun76(6)346-54

Hasebe S Ohtsuki H Nonaka T et al Effect of progressive addition lenses on myopia progression in Japanese children a prospective

randomized double-masked crossover trial Invest Ophthalmol Vis Sci 2008 Jul49(7)2781-9

Gwiazda J Hyman L Hussein M et al A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression

of myopia in children Invest Ophthalmol Vis Sci 2003 Apr44(4)1492-500

Siatkowski RM Cotter SA Crockett RS et al Two-year multi-center randomized double-masked placebo-controlled parallel safety and

efficacy study of 2 pirenzepine ophthalmic gel in children with myopia J AAPOS 2008 Aug12(4)332-9

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged 7 to 17 years Arch Ophthalmol 2005

Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three to less than 10 years of age Am J

Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction Am J Ophthalmol 2007

Jun143(6)1060-3

Holmes JM Edwards AR Beck RW et al A randomized pilot study of near activities versus non-near activities during patching therapy for

amblyopia J AAPOS 2005 Apr9(2)129-36

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate

amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-57

76

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic

amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Convergence Insufficiency Treatment Trial Study Group Randomized clinical trial of treatments for symptomatic convergence insufficiency

in children Arch Ophthalmol 2008 Oct126(10)1336-49

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

Solan HA Shelley-Tremblay J Hansen PC et al M-cell deficit and reading disability a preliminary study of the effects of temporal vision-

processing therapy Optometry 2004 Oct75(10)640-50

Solan HA Larson S Shelley-Tremblay J et al Role of visual attention in cognitive control of oculomotor readiness in students with reading

disabilities J Learn Disabil 2001 Mar-Apr34(2)107-18

Gallaway M Boas MB The impact of vergence and accommodative therapy on reading eye movements and reading speed Optom Vis Dev

200738(3)115-20

Goss DA Downing DB Lowther AH et al The effect of HTS vision therapy conducted in a school setting on reading skills in third and

fourth grade students Optom Vis Dev 200738(1)27-32

Crutch SJ Warrington EK Foveal crowding in posterior cortical atrophy a specific early-visual-processing deficit affecting word reading

Cogn Neuropsychol 2007 Dec24(8)843-66

Helms D Sawtelle SM A study of the effectiveness of cognitive therapy delivered in a video game format Optom Vis Dev 200738 (1)19-

26

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

77

Lawton T Training direction-discrimination sensitivity remediates a wide spectrum of reading skills OptomVis Dev 200738(1) 33-47

Goldstand S Koslowe KC Parush S Vision visual-information processing and academic performance among seventh-grade schoolchildren a

more significant relationship than we thought Am J Occup Ther 2005 Jul-Aug59(4)377-89

Fischer B Koumlngeter A Hartnegg K Effects of daily practice on subitizing visual counting and basic arithmetic skills Optom Vis Dev

200839(1)30-4

Sands W Taub M Maino D Limited research and education on special populations in optometry and ophthalomology Optom Vis Dev

200839(2)60-1

Wesson M Maino D Oculo-visual findings in Down syndrome cerebral palsy and mental retardation with non-specific etiology In Maino D

(ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 199517-54 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

Cui Y Stapleton F Suttle C Developing an instrument to assess vision-related and subjective quality of life in children with intellectual

disability data collection and preliminary analysis in a Chinese population Ophthal Physiolog Optics 2008 May28(3) 238-46

Maino D Steele G Tahir S Sajja R Attitudes of optometry students toward individuals with disabilities Optom Ed 200227(2)45-50

Maino D Special populations in the optometric curriculum Optom Ed 200227(2)38-9

Maino D Overview of special populations In Scheiman M Rouse M (eds) Optometric Management of Learning-Related Vision Problems

St Louis Mosby Inc 200685-106

Maino D (ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 1995 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

78

McCarthy P Maino D Alport syndrome a review Clin Eye Vis Care 2000 Dec12(3-4)139-50

Block SS Brusca-Vega R Pizzi WJ et al Cognitive and visual processing skills and their relationship to mutation size in full and

permutation female fragile X carriers Optom Vis Sci 2000 Nov77 (11)592-9

Maino D The young child with developmental disabilities An introduction to mental retardation and genetic syndromes In Moore BD

(ed) Eye Care for Infants and Young Children Butter-worth--Heinemann Newton MA1997285-300

Amin V Maino D The Fragile X female Visual visual perceptual and ocular health anomalies J Am Optom Assoc 1995 May66

(5)290-95

Maino DM Maino JH Cibis GW Hecht F Ocular health anomalies in patients with developmental disabilities In Maino D (ed)

Diagnosis and Management of Special Populations Mosby-Year-book Inc St Louis MO 1995189-206 Reprinted Optometric

Education Program Foundation Santa Anna Calif 2001

Maino D Wesson M Schlange D Cibis G Maino J Optometric findings in the fragile X syndrome Optom Vis Sci 199168634-40

Scheiman MMOptometric findings in children with cerebral palsy Am J Optom Physiol Opt 1984 May61(5)321-3

Maino D Maino J Maino S Mental retardation syndromes with associated ocular defects J Am Optom Assoc 199061707-16

Stewart RE Woodhouse JM Cregg M Pakeman VH Association between accommodative accuracy hypermetropia and strabismus in

children with Downs syndrome Optom Vis Sci 2007 Feb84(2)149-55

Cregg M Woodhouse JM Pakeman VH et al Accommodation and refractive error in children with Down syndrome cross-sectional

and longitudinal studies Invest Ophthalmol Vis Sci 2001 Jan42 (1)55-63

79

McClelland JF Parkes J Hill N et al Accommodative dysfunction in children with cerebral palsy a population-

based study Invest Ophthalmol Vis Sci 2006 May47(5)1824-30

Duckman RH Vision therapy for the child with cerebral palsy J Am Optom Assoc 198758(1)28-35

Duckman R Accommodation in cerebral palsy function and remediation J Am Optom Assoc 198455(4)281-3

Scheiman M Understanding and managing vision deficits a guide for occupational therapists 2nd ed Slack

Thorofare NJ 2002

Maino D Binasal occlusion for the child with Cerebral Palsy J Ill Optom Assoc 198644(1)1218

Battaglia F Quartarone A Rizzo V et al Early impairment of synaptic plasticity in patients with Downs syndrome

Neurobiol Aging 2008 Aug29(8)1272-5

Bonnier C Evaluation of early stimulation programs for enhancing brain development Acta Paediatr 2008

Jul97(7)853-8

Morice E Andreae LC Cooke SF et al Preservation of long-term memory and synaptic plasticity despite short-term

impairments in the Tc1 mouse model of Down syndrome Learn Mem 2008 Jul 1415(7)492-500

Gordon AM Schneider JA Chinnan A Charles JR Efficacy of a hand-arm bimanual intensive therapy (HABIT) in

children with hemiplegic cerebral palsy a randomized control trial Dev Med Child Neurol 2007 Nov49(11)830-8

Kapoor N Ciuffreda KJ Vision disturbances following traumatic brain injury Curr Treat Options Neurol 2002

Jul4(4)271-80

80

Ciuffreda KJ Rutner D Kapoor N et al Vision therapy for oculomotor dysfunctions in acquired brain injury a

retrospective analysis Optometry 2008 Jan79(1)18-22

Ciuffreda KJ Han Y Kapoor N Ficarra AP Oculomotor rehabilitation for reading in acquired brain injury

NeuroRehabilitation 200621(1)9-21

Zost M Diagnosis and management of visual dysfunction in cerebral injury In Maino D (ed) Diagnosis and

Management of Special Populations Mosby-Yearbook Inc St Louis 199579 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001 [Figure used with permission of the editor]

DeGutis JM Bentin S Robertson LC DEsposito M Functional plasticity in ventral temporal cortex following

cognitive rehabilitation of a congenital prosopagnosic J Cogn Neurosci 2007 Nov19 (11)1790-802

Welbourne SR Ralph MA Exploring the impact of plasticity-related recovery after brain damage in a connectionist

model of single-word reading Cogn Affect Behav Neurosci 2005 Mar5(1)77-92

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements prevent cognitive decline A

systematic review of randomized controlled trials J Hum Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among preterm infants attributable to early

supplementation of human milk with docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings and structural-functional

synergies with cell membrane phospholipids Altern Med Rev 2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function Neuroscience 20089(7)568-78

81

Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

BMC Biol 2008 Sep 9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine improves neuropsychological disorders in a child with

creatine transporter defect Neurocase 200814(2) 151-61

Forrester LW Wheaton LA Luft AR Exercise-mediated locomotor recovery and lower-limb neuroplasticity after

stroke J Rehabil Res Dev 200845(2)205-20

82

Page 27: Neuroplasticity: A Paradigm Sea Change Latest Updated File

V Neuroplasticity and Optometry

The effects of plasticity can lead to either

positive or negative changes during

development (evolutionary plasticity) after

short-term exposure (reactive plasticity)

after long-term or continuous stimuli

(adaptational plasticity) and during

functional or structural recovery of damaged

neuronal circuits (reparation plasticity)

httpwwwciteulikeorguserjasonepriorarticle2856526

27

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

A Refractive error development

B Amblyopia

C Strabismus

28

D Non-strabismus non-amblyopic binocular vision disorders

E Learning related vision anomalies

F Vision developmentperception disorders

29

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

A Refractive error development

Several recent studies have noted that neuroplasticity may play a

role in refractive error development

retinal defocus use of progressive addition lenses

drug studies (M1-antagonist2 pirenzepine ) slow myopia

progression demonstrated nearly a 50 reduction in myopia

progression over a two-year period

30

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged

7 to 17 years Arch Ophthalmol 2005 Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three

to less than 10 years of age Am J Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction

Am J Ophthalmol 2007 Jun143(6)1060-3

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine

vs patching for treatment of moderate amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-

57

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for

strabismic and anisometropic amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Treatment of severe amblyopia with weekend atropine results from 2 randomized clinical trials

Levodopacarbidopa in the treatment of amblyopia

31

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

J Pediatr Ophthalmol Strabismus 2009 Mar-Apr46(2)87-90 quiz 91-2 Levodopacarbidopa in the

treatment of amblyopia Dadeya S Vats P Malik KP

PURPOSE To evaluate the role of levodopacarbidopa in the treatment of amblyopia METHODS

Thirty patients with strabismic amblyopia between the ages of 3 and 12 years were part of this double-

blind randomized study Patients were divided into two groups Group A received 050 mg + 125 mg of

levodopacarbidopa per kilogram body weight three times daily after meals with a protein rich drink

whereas Group B received placebo Both groups received full-time conventional occlusion until a visual

acuity of 66 was achieved or for a maximum of 3 months RESULTS The authors observed more than

two lines improvement in visual acuity that was greater in the levodopa group (15 of 15) than in the

placebo group (9 of 15) (P lt 005) Furthermore improvement in visual acuity of more than two lines

was greater in patients younger than 8 years (100) than in patients older than 8 years of age (60) (P =

0026) There was also no significant reversal of the improved visual acuity in up to 6 months of follow-

up CONCLUSION Levodopacarbidopa improves visual acuity in patients with

amblyopia and maintains improved visual acuity especially in patients

younger than 8 years

32

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

J Pediatr Ophthalmol Strabismus 2008 May-Jun45(3)174-6 The use of levodopa in the treatment of

bilateral amblyopia secondary to uncorrected high hypermetropia Abrams MS

The standard treatment of bilateral amblyopia secondary to uncorrected high bilateral hypermetropia has

been spectacles and time The patient described here failed to show adequate improvement in visual

acuity after 18 months of standard treatment Visual acuity improved dramatically when the

patient began taking levodopa dropped precipitously when the medication was

discontinued and returned quickly to post-treatment levels when levodopa was

restarted Visual acuity remained stable when the medication was slowly tapered

and discontinued This report suggests that dopamine may play a role in the pathophysiology of

bilateral amblyopia secondary to uncorrected high bilateral hypermetropia

33

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

Bottom Line

Amblyopia can be treated at any age

May be able to use neuro-enhancing drugs

as a part of basic amblyopia therapy

34

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

C Strabismus and non-strabismic non-amblyopic binocular

vision disorders

Clinical Trial of Treatments for Symptomatic Convergence Insufficiency in Children has

clearly demonstrated the superiority of in-office optometric vision therapy (in conjunction

with home therapy) vs out-of-office therapy alone The study concluded that optometric

vision therapyorthoptics was more effective than pencil push-ups or placebo vision

therapyorthoptics in reducing symptoms and improving clinical signs of convergence

insufficiency

Long-term effectiveness of treatments for symptomatic convergence insufficiency

in children (Optom Vis Sci 2009 Sep86(9)1096-103)

CITT patients improvements lasted a year

35

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

Strabismus 1999 Sep7(3)169-74 Convergence insufficiency in

idiopathic Parkinsons disease responsive to levodopa Racette BA

Gokden MS Tychsen LS Perlmutter JS

We report a patient with pathologically proven idiopathic Parkinsons

disease (IPD) who developed diplopia secondary to convergence

insufficiency during his motor off periods Diplopia resolved with

onset of motor benefit from levodopa Neuro-ophthalmologic

examination demonstrated convergence insufficiency during motor

off periods that was alleviated after onset of motor benefit from

levodopa This is the first reported case of convergence insufficiency

in IPD responsive to levodopa

36

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

Bottom Line

Optometric Vision Therapy is the most efficacious treatment available for binocular vision disorders and the

treatment effects are long lasting Neuro-enhancing drugs

may assist us as well

37

EF Learning related vision anomalies Vision

developmentperception disorders

hellipresearch includes an examination of the role vision plays in

reading the effect of oculomotor vergence and

accommodativecoherent motion therapy on reading eye movements

and reading speed the diagnosis and treatment of perceptual

disorders and the effect of therapy on various learning anomalies

38

EF Learning related vision anomalies Vision developmentperception disorders

magnocellular (MC) deficit in dyslexia

LM speed-matching ratio predicts reading in childrenChase C Dougherty RF Ray N

Fowler S Stein JOptom Vis Sci 2007 Mar84(3)229-36

Effect of attention therapy on reading comprehension Solan HA Shelley-Tremblay J

Ficarra A Silverman M Larson S J Learn Disabil 2003 Nov-Dec36(6)556-63

Is there a common linkage among reading comprehension visual attention and

magnocellular processing Solan HA Shelley-Tremblay JF Hansen PC Larson S

J Learn Disabil 2007 May-Jun40(3)270-8

Lawton T Filtered Text and Direction Discrimination Training Improved Reading

Fluency for Both Dyslexic and Normal Readers Optom Vis Dev 200839 (3)114

Fischer B Hartnegg K Saccade control in dyslexia Development deficits training

and transfer to reading Optom Vis Dev 200839(4)181-190

39

EF Learning related vision anomalies Vision developmentperception disorders

J Learn Disabil 2003 Nov-Dec36(6)556-63 Effect of attention therapy on reading

comprehension Solan HA Shelley-Tremblay J Ficarra A Silverman M Larson S

hellip At the completion of attention therapy the mean

standard attention and reading comprehension scores of

the experimental group had improved significantly The

control group however showed no significant

improvement in reading comprehension scores after 12

weeks Although uncertainties still exist this investigation

supports the notion that visual attention is malleable and

that attention therapy has a significant effect on reading

comprehension in this often neglected population

40

VII Vision dysfunction association with acquired brain injury

A Exotropia (or high exophoriaCI)

B Accommodative dysfunction

C Convergence insufficiency

41

D Decreased blink rate

E Spatial disorientation

F Pursuitsaccade dysfunction

G Unstable ambient vision (Magnocellular pathway)

42

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Stelmack JA Frith T Van Koevering D Rinne S Stelmack TR Visual function in patients

followed at a Veterans Affairs polytrauma network site an electronic medical record review

Optometry 2009 Aug80(8)419-24

RESULTS Visual symptoms were self-reported by 76 of patients

with polytrauma and 75 of the patients with TBI Problems with reading

(polytrauma 60 and TBI 50) and accommodation (polytrauma 30 and

TBI 47) were frequently found on eye examinations Spectacles were the

treatment most frequently prescribed (polytrauma 62 and TBI 78)

CONCLUSIONS It is important for optometrists to be aware of the high

rates of self-reported symptoms and visual problems in military personnel

returning from deployment to the wars in Iraq and Afghanistan Post-

traumatic stress disorder and depression may complicate optometric

evaluation and management

43

VII Vision dysfunction association with acquired brain injury

Avoidance of near tasks

Oculomotor-based reading difficulties

Eye tracking problems

Eye focusing problems

Eyestrain Diplopia

Dizziness Vertigo

Vision-derived nausea

44

VII Vision dysfunction association with acquired brain injury

Increased sensitivity to visual motion

Visual inattention and distractibility

Short-term visual memory loss

Difficulty judging distances (relative and absolute

Difficulty with global scanning

Difficulty with personal grooming especially involving the face

Inability to interactcope visually in a complex social situation

(eg minimal eye contact)

Inability to tolerate complex visual environments (eg grocery store

aisles and highly-patterned floors)

45

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Ciuffreda KJ Ludlam DP Kapoor N Clinical oculomotor training in traumatic brain injury Optom Vis

Dev 200940(1)16-23

Individuals with traumatic brain injury present with a constellation of

oculomotor dysfunctions and correlated symptoms Simple and

effective clinical oculomotor-based training procedures will be

presented with respect to the versional vergence and

accommodative systems and their interactions These therapeutic

procedures can also be applied as needed to individuals with either

low vision neurological dysfunctions or general visual skills cases

manifesting similar oculomotor deficits

46

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Leslie S Myopia and accommodative insufficiency associated with

moderate head trauma Opt Vis Dev 200940(1)25-31

The majority of subjects reviewed had developed a stable degree of

myopia between 100 and 200 diopters as well as an abnormally

high lag of accommodation When their distance and near spatial area

of focus was compared the majority were focused at an intermediate

area in space suggesting a loss of control of accommodation in

space

47

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

B Drugs

C Exercise

D Learning new and challenging things

48

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements

prevent cognitive decline A systematic review of randomized controlled trials J Hum

Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among

preterm infants attributable to early supplementation of human milk with

docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings

and structural-functional synergies with cell membrane phospholipids Altern Med Rev

2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function

Neuroscience 20089(7)568-78

49

VIII Improving Brain Function and Neuroplasticity

B Drugs Maya Vetencourt JF Sale A Viegi A et al The antidepressant

fluoxetine (PROZAC) restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the

antidepressant tianeptine CNS Drugs 200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances

hippocampal long-term potentiation and memory BMC Biol 2008 Sep

9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine

improves neuropsychological disorders in a child with creatine

transporter defect Neurocase 200814(2) 151-61

50

VIII Improving Brain Function and Neuroplasticity

C Exercise

Hunsberger JG et al Antidepressant actions of the exercise-

regulated gene VGF Nat Med 2007 Dec 2 131476

VGF may be a common pathway by which exercise induces

neuroplasticity and growth-factor genes at least one of these might act

similarly to antidepressants in promoting an adaptive response to stress

However the tests used here may be modeling stress-induced

helplessness not depression hellipexercise seems to induce multiple

interacting genes that enhance neuronal resilience

51

VIII Improving Brain Function and Neuroplasticity

D Learning new and challenging things

What have we (optometry amp ophthalmology)

been thinking all these years

Where did we miss the news about neuroplasticity

52

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Huang JC Neuroplasticity as a proposed mechanism for the efficacy of optometric vision therapy and rehabilitation J Bev Optom 200920(4)96-100

Homologous area adaptationCompensatory masqueradeCross-modal reassignment

Map expansion

EquipotentialityVicariation

53

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Homologous area adaptation a transfer of function from a damaged brain area to a non-damaged brain area May be limited to early stages of human development and may crowd a new brain area resulting in reduced functionality of that brain area (Competition between spatial amp verbal functioning)

54

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Compensatory masquerade reorganizing of existing neuro-pathways to us alternative cognitive strategies to perform a task

55

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Cross-modal reassignment using new sensory input in a brain structure deprived of its main input source (changing processing from visual to tactile stimuli in the blind)

56

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Map expansion increase in brain mass due to repeated behavior or exposure to stimuli

57

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Equipotentiality anatomical areas of the brain can perform disparate functions

Vicariation redundant neural systems can operate under abnormal conditions

This may explain why recovery is noted for many neurological conditions (degenerative psychiatric developmental vascular traumatic)

58

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Constraint therapy Use it and improve it

Patching penalization ldquonear activitiesrdquo during amblyopia therapy

59

IX Improving Brain Function and Neuroplasticity Optometric Clinical ApplicationsOptometric Vision Therapy

Kleim amp Jones

Use it or lose it If you do not drive specific brain functions

functional loss will occur

If you want to improve oculomotor brain neuroplastic function amp

structure therapy should be specific for that brain function

Use it and improve it Therapy that drives cortical function enhances

that particular function

If you use therapy to improve oculomotor dysfunction it should

improve

Specificity The therapy you choose determines the resultant

plasticity and function

You must choose therapy that is appropriate

60

IX Improving Brain Function and Neuroplasticity Optometric Clinical Applications

Kleim amp Jones

Repetition matters Plasticity that results in functional change

requires repetition

Do the therapy Do it again Do it yet again No quick fix

Intensity matters Induction of plasticity requires the appropriate

amount of intensity

Intensity means strength force concentration power and passion

Without these plasticity may not occur Function may not improve

Time matters Different forms of plasticity take place at different

times during therapy

Do the basics than the more advanced therapeutic procedures

61

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Salience matters It has to be important to the individual

Make the therapy matter to the patient

Age matters Plasticity is easier in a younger brain but is also

possible in an adult brain

Do not let age determine what therapy options you offer your

patients Think of Susan Barry PhD (StereoSue) and her success

Offer your patients options Let them choose Be realistic about

outcomeshelliphave outcome measures built into therapy program

62

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Transference Neuroplasticity and the change in function

that results from one therapy can augment the attainment

of similar behaviors

What you do during oculomotor therapy may affected

vergence therapy outcomes

Interference Plasticity in response to one experience can

interfere with the acquisition of other behaviors

Monitor Evaluate progress Discuss function in other areas

of your patientslsquo life

63

Why pay attention to binocular vision dysfunctions

and neuroplasticity

December 2009 issue of the Review of Optometry

The Binocular Vision Dysfunction Pandemic

In 2010 almost 170 million individuals will be wearing glasses In

2010 there will also be up to 93 million amblyopes and 12 and a half

million strabismics For children under 18 years of age that means

there will be more than 22 and a half million amblyopes and millions

of children with strabismus A clinical trial to determine the

prevalence of binocular vision dysfunction within the general

population suggested the possibility of up to 56 or 173 million men

women and children with symptoms associated with a binocular

vision dysfunction 189 million (61) with accommodative problems

and 118 million (38) demonstrating various vergence

anomalies

64

65

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Brain plasticity life long changes in the structure of the brain

Sensory substitution replacement of one sensory input by another

Measurement techniques

Voxel based morphometryhellipmeasures difference in brain volume

Fluorodeoxyglucose glucose analog PET scan tells you

distribution and metabolism of brain

Cortical thickness measures

Visual cortex of the blind turns somatic ―The eye of the tongue

Transcranial magnetic stmiulation non-invasive technique to

stimulate cortex

66

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Blind Braille readers report tingling in fingers when pressure

phosphenes are applied Blind feel tingling in tongue

Bind use tongue to perform orientation task motion perception

sensory perception Visual cortex recruited in a variety of sensory

and cognitive tasks (DM Can we use tongue as a VT tool)

Dilks Reorganizations of human adult visual system

When a region of sensory cortex is deprived of its bottom up

input the deprived region begins to respond to stimuli that

normally activate adjacent cortex

67

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Retinotopic map changes for stroke pts Cortical reorganization in

adults occurs Perceived objectshellipelongation in stroke amp AMD

What happens to deprived cortex in AMD

fMRI shows cortical reorganization in adults

Proposed mechanisms

hellipGrowth of new connections

hellipUnmasking of pre-existing connections this is true

happens within seconds

Bavelier

Action video games

68

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Bavelier

Action video games Looked at attention Gamers can track more

activities

Attention over space (me peripheral awarenress) Useful field

of view shrinks with age

Performance not VA relatedhellipis related to attention

Action game playing changes spatial resolutionhellipovercoming

crowding in VA assessment (me amblyopia therapy)

Temporal resolution of vision Backward masking

changehellipbrain changes

Visual sensitivity (contrast sensitivity) Post action game training

improves CSF

69

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Action video games correcting optics of the cortex (me this is

actualy OVT)

Games factor

Variable entry leanringhellipadapt task to skill level

Incremental learning tune task to subjectlsquos leanring steps

Motivationarousal

Rewards

Self masterself confidence

Action games factors

Pacingrate of exposure to infohellipincreasing processing speed

Dynamic display

Rich environment

Rich motor involvement

70

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Surgeons may be made to play action games

Pilot training

Amblyopia tx Dennis Levi research

PresenterTitle Contact info

Neuroplasticity-A Paradigm Sea Change

This presentation is available at

httpwwwslidesharenetDMAINOneuroplasticity-a-paradigm-sea-change-2459693

httpwwwmainosmemosblogspotcom

My FaceBook Page

and

Twitter

PresenterTitle Contact info

Questions About

Neuroplasticity-A Paradigm Sea Change

Dominick M Maino OD MEd FAAO FCOVD-A

Professor PediatricsBinocular VisionIllinois Eye InstituteIllinois College of Optometry

dmainoicoeduhttpwwwMainosMemosblogspotcom

Thanks to

httpwwwcovdorgHomeOVDJournalOVD401tabid263D

efaultaspx

httpbipolarblastfileswordpresscom200908neurojpg

httpwwwspecialcheerscomimagesanimated_braingif

httpblogmarsdencartoonscomwp-

contentuploads200810frankenstein-myspace-lightbeergif

httpwwwshangralafamilyfuncomgala-ecalvindreamgif

httppsychiatryjwatchorgcgicontentfull20082251

73

Chakraborty R Chatterjee A Choudhart S Chakraborty PK Neuroplasticitymdasha paradigm shift in neurosciences J Indian Med Assoc

2007105(9)513-4516-8520-1

Sacks O A neurologistlsquos notebook Stereo Sue Why two eyes are better than one The New Yorker 2006 Jun 1964-73

Krulwich R National Public Radio Going Binocular Susanlsquos First Snowfall Available at

wwwnprorgtemplatesstorystoryphpstoryId=5507789 (Accessed December 8 2008)

Press LJ The story behind Stereo Suelsquo and a world-famous neurologistlsquos discovery of vision therapy Optom Vis Dev 200637(2) 55-7

Levin HS Neuroplasticity and brain imaging research implications for rehabilitation Arch Phys Med Rehabil 2006 Dec87(12 Suppl

2)S1

Wiesel TN Hubel DH Single-cell responses in striate cortex of kittens deprived of vision in one eye J Neurophysiol 1963

Nov261003-17

Hook BM Chen C Critical periods in the visual system Changing views for a model of experience-dependent plasticity Neuron 2007

Oct56(2)312-26

Ramey CT Ramey SL Prevention of intellectual disabilities early interventions to improve cognitive development Prev Med 1998

Mar-Apr27(2)224-32

Heuninckx S Wenderoth N Swinnen SP Systems neuroplasticity in the aging brain recruiting additional neural resources for

successful motor performance in elderly persons J Neurosci 2008 Jan 228(1)91-9

Ge S Yang CH Hsu KS et al A critical period for enhanced synaptic plasticity in newly generated neurons of the adult brain Neuron

2007 May54(4)559-66

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Draganski B Gaser C Busch V et al Neuroplasticity changes in grey matter induced by training Nature 2004 Jan 22427(6972)

311-2

Cannonieri GC Bonilha L Fernandes PT et al Practice and perfect length of training and structural brain changes in experienced

typists Neuroreport 2007 Jul 218(10)1063-6

Kleim JA Jones TA Principles of experience-dependent neural plasticity implications for rehabilitation after brain damage J

Speech Lang Hear Res 2008 Feb51(1)S225-39

Trojan S Porkorny J Theoretical aspects of neuroplasticity Physiol Res 199948(2)87-97

Ramamirtham R Kee CS Hung LF et al Wave aberrations in rhesus monkeys with vision-induced ametropias Vision Res 2007

Sep47(21)2751-66

Smith EL 3rd Ramamirtham R Qiao-Grider Y et al Effects of foveal ablation on emmetropization and form-deprivation myopia

Invest Ophthalmol Vis Sci 2007 Sep48(9)3914-22

Smith EL 3rd Kee CS Ramamirtham R et al Peripheral vision can influence eye growth and refractive development in infant

monkeys Invest Ophthalmol Vis Sci 2005 Nov46(11)3965-72

Ciuffreda KJ Vasudevan B Nearwork-induced transient myopia (NITM) and permanent myopiandashndashis there a link Ophthalmic

Physiol Opt 2008 Mar28(2)103-14

Hung GK Ciuffreda KJ Incremental retinal-defocus theory of myopia development--schematic analysis and computer simulation

Comput Biol Med 2007 Jul37(7)930-46

Hung GK Ciuffreda KJ A unifying theory of refractive error development Bull Math Biol 2000 Nov62(6)1087-108

75

Pang Y Maino D Zhang G Lu F Myopia Can its progress be controlled Optom Vis Dev 200637(2)75-9

Leung JT Brown B Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lenses Optom Vis Sci

1999 Jun76(6)346-54

Hasebe S Ohtsuki H Nonaka T et al Effect of progressive addition lenses on myopia progression in Japanese children a prospective

randomized double-masked crossover trial Invest Ophthalmol Vis Sci 2008 Jul49(7)2781-9

Gwiazda J Hyman L Hussein M et al A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression

of myopia in children Invest Ophthalmol Vis Sci 2003 Apr44(4)1492-500

Siatkowski RM Cotter SA Crockett RS et al Two-year multi-center randomized double-masked placebo-controlled parallel safety and

efficacy study of 2 pirenzepine ophthalmic gel in children with myopia J AAPOS 2008 Aug12(4)332-9

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged 7 to 17 years Arch Ophthalmol 2005

Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three to less than 10 years of age Am J

Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction Am J Ophthalmol 2007

Jun143(6)1060-3

Holmes JM Edwards AR Beck RW et al A randomized pilot study of near activities versus non-near activities during patching therapy for

amblyopia J AAPOS 2005 Apr9(2)129-36

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate

amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-57

76

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic

amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Convergence Insufficiency Treatment Trial Study Group Randomized clinical trial of treatments for symptomatic convergence insufficiency

in children Arch Ophthalmol 2008 Oct126(10)1336-49

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

Solan HA Shelley-Tremblay J Hansen PC et al M-cell deficit and reading disability a preliminary study of the effects of temporal vision-

processing therapy Optometry 2004 Oct75(10)640-50

Solan HA Larson S Shelley-Tremblay J et al Role of visual attention in cognitive control of oculomotor readiness in students with reading

disabilities J Learn Disabil 2001 Mar-Apr34(2)107-18

Gallaway M Boas MB The impact of vergence and accommodative therapy on reading eye movements and reading speed Optom Vis Dev

200738(3)115-20

Goss DA Downing DB Lowther AH et al The effect of HTS vision therapy conducted in a school setting on reading skills in third and

fourth grade students Optom Vis Dev 200738(1)27-32

Crutch SJ Warrington EK Foveal crowding in posterior cortical atrophy a specific early-visual-processing deficit affecting word reading

Cogn Neuropsychol 2007 Dec24(8)843-66

Helms D Sawtelle SM A study of the effectiveness of cognitive therapy delivered in a video game format Optom Vis Dev 200738 (1)19-

26

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

77

Lawton T Training direction-discrimination sensitivity remediates a wide spectrum of reading skills OptomVis Dev 200738(1) 33-47

Goldstand S Koslowe KC Parush S Vision visual-information processing and academic performance among seventh-grade schoolchildren a

more significant relationship than we thought Am J Occup Ther 2005 Jul-Aug59(4)377-89

Fischer B Koumlngeter A Hartnegg K Effects of daily practice on subitizing visual counting and basic arithmetic skills Optom Vis Dev

200839(1)30-4

Sands W Taub M Maino D Limited research and education on special populations in optometry and ophthalomology Optom Vis Dev

200839(2)60-1

Wesson M Maino D Oculo-visual findings in Down syndrome cerebral palsy and mental retardation with non-specific etiology In Maino D

(ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 199517-54 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

Cui Y Stapleton F Suttle C Developing an instrument to assess vision-related and subjective quality of life in children with intellectual

disability data collection and preliminary analysis in a Chinese population Ophthal Physiolog Optics 2008 May28(3) 238-46

Maino D Steele G Tahir S Sajja R Attitudes of optometry students toward individuals with disabilities Optom Ed 200227(2)45-50

Maino D Special populations in the optometric curriculum Optom Ed 200227(2)38-9

Maino D Overview of special populations In Scheiman M Rouse M (eds) Optometric Management of Learning-Related Vision Problems

St Louis Mosby Inc 200685-106

Maino D (ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 1995 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

78

McCarthy P Maino D Alport syndrome a review Clin Eye Vis Care 2000 Dec12(3-4)139-50

Block SS Brusca-Vega R Pizzi WJ et al Cognitive and visual processing skills and their relationship to mutation size in full and

permutation female fragile X carriers Optom Vis Sci 2000 Nov77 (11)592-9

Maino D The young child with developmental disabilities An introduction to mental retardation and genetic syndromes In Moore BD

(ed) Eye Care for Infants and Young Children Butter-worth--Heinemann Newton MA1997285-300

Amin V Maino D The Fragile X female Visual visual perceptual and ocular health anomalies J Am Optom Assoc 1995 May66

(5)290-95

Maino DM Maino JH Cibis GW Hecht F Ocular health anomalies in patients with developmental disabilities In Maino D (ed)

Diagnosis and Management of Special Populations Mosby-Year-book Inc St Louis MO 1995189-206 Reprinted Optometric

Education Program Foundation Santa Anna Calif 2001

Maino D Wesson M Schlange D Cibis G Maino J Optometric findings in the fragile X syndrome Optom Vis Sci 199168634-40

Scheiman MMOptometric findings in children with cerebral palsy Am J Optom Physiol Opt 1984 May61(5)321-3

Maino D Maino J Maino S Mental retardation syndromes with associated ocular defects J Am Optom Assoc 199061707-16

Stewart RE Woodhouse JM Cregg M Pakeman VH Association between accommodative accuracy hypermetropia and strabismus in

children with Downs syndrome Optom Vis Sci 2007 Feb84(2)149-55

Cregg M Woodhouse JM Pakeman VH et al Accommodation and refractive error in children with Down syndrome cross-sectional

and longitudinal studies Invest Ophthalmol Vis Sci 2001 Jan42 (1)55-63

79

McClelland JF Parkes J Hill N et al Accommodative dysfunction in children with cerebral palsy a population-

based study Invest Ophthalmol Vis Sci 2006 May47(5)1824-30

Duckman RH Vision therapy for the child with cerebral palsy J Am Optom Assoc 198758(1)28-35

Duckman R Accommodation in cerebral palsy function and remediation J Am Optom Assoc 198455(4)281-3

Scheiman M Understanding and managing vision deficits a guide for occupational therapists 2nd ed Slack

Thorofare NJ 2002

Maino D Binasal occlusion for the child with Cerebral Palsy J Ill Optom Assoc 198644(1)1218

Battaglia F Quartarone A Rizzo V et al Early impairment of synaptic plasticity in patients with Downs syndrome

Neurobiol Aging 2008 Aug29(8)1272-5

Bonnier C Evaluation of early stimulation programs for enhancing brain development Acta Paediatr 2008

Jul97(7)853-8

Morice E Andreae LC Cooke SF et al Preservation of long-term memory and synaptic plasticity despite short-term

impairments in the Tc1 mouse model of Down syndrome Learn Mem 2008 Jul 1415(7)492-500

Gordon AM Schneider JA Chinnan A Charles JR Efficacy of a hand-arm bimanual intensive therapy (HABIT) in

children with hemiplegic cerebral palsy a randomized control trial Dev Med Child Neurol 2007 Nov49(11)830-8

Kapoor N Ciuffreda KJ Vision disturbances following traumatic brain injury Curr Treat Options Neurol 2002

Jul4(4)271-80

80

Ciuffreda KJ Rutner D Kapoor N et al Vision therapy for oculomotor dysfunctions in acquired brain injury a

retrospective analysis Optometry 2008 Jan79(1)18-22

Ciuffreda KJ Han Y Kapoor N Ficarra AP Oculomotor rehabilitation for reading in acquired brain injury

NeuroRehabilitation 200621(1)9-21

Zost M Diagnosis and management of visual dysfunction in cerebral injury In Maino D (ed) Diagnosis and

Management of Special Populations Mosby-Yearbook Inc St Louis 199579 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001 [Figure used with permission of the editor]

DeGutis JM Bentin S Robertson LC DEsposito M Functional plasticity in ventral temporal cortex following

cognitive rehabilitation of a congenital prosopagnosic J Cogn Neurosci 2007 Nov19 (11)1790-802

Welbourne SR Ralph MA Exploring the impact of plasticity-related recovery after brain damage in a connectionist

model of single-word reading Cogn Affect Behav Neurosci 2005 Mar5(1)77-92

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements prevent cognitive decline A

systematic review of randomized controlled trials J Hum Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among preterm infants attributable to early

supplementation of human milk with docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings and structural-functional

synergies with cell membrane phospholipids Altern Med Rev 2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function Neuroscience 20089(7)568-78

81

Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

BMC Biol 2008 Sep 9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine improves neuropsychological disorders in a child with

creatine transporter defect Neurocase 200814(2) 151-61

Forrester LW Wheaton LA Luft AR Exercise-mediated locomotor recovery and lower-limb neuroplasticity after

stroke J Rehabil Res Dev 200845(2)205-20

82

Page 28: Neuroplasticity: A Paradigm Sea Change Latest Updated File

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

A Refractive error development

B Amblyopia

C Strabismus

28

D Non-strabismus non-amblyopic binocular vision disorders

E Learning related vision anomalies

F Vision developmentperception disorders

29

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

A Refractive error development

Several recent studies have noted that neuroplasticity may play a

role in refractive error development

retinal defocus use of progressive addition lenses

drug studies (M1-antagonist2 pirenzepine ) slow myopia

progression demonstrated nearly a 50 reduction in myopia

progression over a two-year period

30

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged

7 to 17 years Arch Ophthalmol 2005 Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three

to less than 10 years of age Am J Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction

Am J Ophthalmol 2007 Jun143(6)1060-3

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine

vs patching for treatment of moderate amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-

57

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for

strabismic and anisometropic amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Treatment of severe amblyopia with weekend atropine results from 2 randomized clinical trials

Levodopacarbidopa in the treatment of amblyopia

31

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

J Pediatr Ophthalmol Strabismus 2009 Mar-Apr46(2)87-90 quiz 91-2 Levodopacarbidopa in the

treatment of amblyopia Dadeya S Vats P Malik KP

PURPOSE To evaluate the role of levodopacarbidopa in the treatment of amblyopia METHODS

Thirty patients with strabismic amblyopia between the ages of 3 and 12 years were part of this double-

blind randomized study Patients were divided into two groups Group A received 050 mg + 125 mg of

levodopacarbidopa per kilogram body weight three times daily after meals with a protein rich drink

whereas Group B received placebo Both groups received full-time conventional occlusion until a visual

acuity of 66 was achieved or for a maximum of 3 months RESULTS The authors observed more than

two lines improvement in visual acuity that was greater in the levodopa group (15 of 15) than in the

placebo group (9 of 15) (P lt 005) Furthermore improvement in visual acuity of more than two lines

was greater in patients younger than 8 years (100) than in patients older than 8 years of age (60) (P =

0026) There was also no significant reversal of the improved visual acuity in up to 6 months of follow-

up CONCLUSION Levodopacarbidopa improves visual acuity in patients with

amblyopia and maintains improved visual acuity especially in patients

younger than 8 years

32

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

J Pediatr Ophthalmol Strabismus 2008 May-Jun45(3)174-6 The use of levodopa in the treatment of

bilateral amblyopia secondary to uncorrected high hypermetropia Abrams MS

The standard treatment of bilateral amblyopia secondary to uncorrected high bilateral hypermetropia has

been spectacles and time The patient described here failed to show adequate improvement in visual

acuity after 18 months of standard treatment Visual acuity improved dramatically when the

patient began taking levodopa dropped precipitously when the medication was

discontinued and returned quickly to post-treatment levels when levodopa was

restarted Visual acuity remained stable when the medication was slowly tapered

and discontinued This report suggests that dopamine may play a role in the pathophysiology of

bilateral amblyopia secondary to uncorrected high bilateral hypermetropia

33

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

Bottom Line

Amblyopia can be treated at any age

May be able to use neuro-enhancing drugs

as a part of basic amblyopia therapy

34

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

C Strabismus and non-strabismic non-amblyopic binocular

vision disorders

Clinical Trial of Treatments for Symptomatic Convergence Insufficiency in Children has

clearly demonstrated the superiority of in-office optometric vision therapy (in conjunction

with home therapy) vs out-of-office therapy alone The study concluded that optometric

vision therapyorthoptics was more effective than pencil push-ups or placebo vision

therapyorthoptics in reducing symptoms and improving clinical signs of convergence

insufficiency

Long-term effectiveness of treatments for symptomatic convergence insufficiency

in children (Optom Vis Sci 2009 Sep86(9)1096-103)

CITT patients improvements lasted a year

35

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

Strabismus 1999 Sep7(3)169-74 Convergence insufficiency in

idiopathic Parkinsons disease responsive to levodopa Racette BA

Gokden MS Tychsen LS Perlmutter JS

We report a patient with pathologically proven idiopathic Parkinsons

disease (IPD) who developed diplopia secondary to convergence

insufficiency during his motor off periods Diplopia resolved with

onset of motor benefit from levodopa Neuro-ophthalmologic

examination demonstrated convergence insufficiency during motor

off periods that was alleviated after onset of motor benefit from

levodopa This is the first reported case of convergence insufficiency

in IPD responsive to levodopa

36

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

Bottom Line

Optometric Vision Therapy is the most efficacious treatment available for binocular vision disorders and the

treatment effects are long lasting Neuro-enhancing drugs

may assist us as well

37

EF Learning related vision anomalies Vision

developmentperception disorders

hellipresearch includes an examination of the role vision plays in

reading the effect of oculomotor vergence and

accommodativecoherent motion therapy on reading eye movements

and reading speed the diagnosis and treatment of perceptual

disorders and the effect of therapy on various learning anomalies

38

EF Learning related vision anomalies Vision developmentperception disorders

magnocellular (MC) deficit in dyslexia

LM speed-matching ratio predicts reading in childrenChase C Dougherty RF Ray N

Fowler S Stein JOptom Vis Sci 2007 Mar84(3)229-36

Effect of attention therapy on reading comprehension Solan HA Shelley-Tremblay J

Ficarra A Silverman M Larson S J Learn Disabil 2003 Nov-Dec36(6)556-63

Is there a common linkage among reading comprehension visual attention and

magnocellular processing Solan HA Shelley-Tremblay JF Hansen PC Larson S

J Learn Disabil 2007 May-Jun40(3)270-8

Lawton T Filtered Text and Direction Discrimination Training Improved Reading

Fluency for Both Dyslexic and Normal Readers Optom Vis Dev 200839 (3)114

Fischer B Hartnegg K Saccade control in dyslexia Development deficits training

and transfer to reading Optom Vis Dev 200839(4)181-190

39

EF Learning related vision anomalies Vision developmentperception disorders

J Learn Disabil 2003 Nov-Dec36(6)556-63 Effect of attention therapy on reading

comprehension Solan HA Shelley-Tremblay J Ficarra A Silverman M Larson S

hellip At the completion of attention therapy the mean

standard attention and reading comprehension scores of

the experimental group had improved significantly The

control group however showed no significant

improvement in reading comprehension scores after 12

weeks Although uncertainties still exist this investigation

supports the notion that visual attention is malleable and

that attention therapy has a significant effect on reading

comprehension in this often neglected population

40

VII Vision dysfunction association with acquired brain injury

A Exotropia (or high exophoriaCI)

B Accommodative dysfunction

C Convergence insufficiency

41

D Decreased blink rate

E Spatial disorientation

F Pursuitsaccade dysfunction

G Unstable ambient vision (Magnocellular pathway)

42

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Stelmack JA Frith T Van Koevering D Rinne S Stelmack TR Visual function in patients

followed at a Veterans Affairs polytrauma network site an electronic medical record review

Optometry 2009 Aug80(8)419-24

RESULTS Visual symptoms were self-reported by 76 of patients

with polytrauma and 75 of the patients with TBI Problems with reading

(polytrauma 60 and TBI 50) and accommodation (polytrauma 30 and

TBI 47) were frequently found on eye examinations Spectacles were the

treatment most frequently prescribed (polytrauma 62 and TBI 78)

CONCLUSIONS It is important for optometrists to be aware of the high

rates of self-reported symptoms and visual problems in military personnel

returning from deployment to the wars in Iraq and Afghanistan Post-

traumatic stress disorder and depression may complicate optometric

evaluation and management

43

VII Vision dysfunction association with acquired brain injury

Avoidance of near tasks

Oculomotor-based reading difficulties

Eye tracking problems

Eye focusing problems

Eyestrain Diplopia

Dizziness Vertigo

Vision-derived nausea

44

VII Vision dysfunction association with acquired brain injury

Increased sensitivity to visual motion

Visual inattention and distractibility

Short-term visual memory loss

Difficulty judging distances (relative and absolute

Difficulty with global scanning

Difficulty with personal grooming especially involving the face

Inability to interactcope visually in a complex social situation

(eg minimal eye contact)

Inability to tolerate complex visual environments (eg grocery store

aisles and highly-patterned floors)

45

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Ciuffreda KJ Ludlam DP Kapoor N Clinical oculomotor training in traumatic brain injury Optom Vis

Dev 200940(1)16-23

Individuals with traumatic brain injury present with a constellation of

oculomotor dysfunctions and correlated symptoms Simple and

effective clinical oculomotor-based training procedures will be

presented with respect to the versional vergence and

accommodative systems and their interactions These therapeutic

procedures can also be applied as needed to individuals with either

low vision neurological dysfunctions or general visual skills cases

manifesting similar oculomotor deficits

46

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Leslie S Myopia and accommodative insufficiency associated with

moderate head trauma Opt Vis Dev 200940(1)25-31

The majority of subjects reviewed had developed a stable degree of

myopia between 100 and 200 diopters as well as an abnormally

high lag of accommodation When their distance and near spatial area

of focus was compared the majority were focused at an intermediate

area in space suggesting a loss of control of accommodation in

space

47

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

B Drugs

C Exercise

D Learning new and challenging things

48

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements

prevent cognitive decline A systematic review of randomized controlled trials J Hum

Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among

preterm infants attributable to early supplementation of human milk with

docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings

and structural-functional synergies with cell membrane phospholipids Altern Med Rev

2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function

Neuroscience 20089(7)568-78

49

VIII Improving Brain Function and Neuroplasticity

B Drugs Maya Vetencourt JF Sale A Viegi A et al The antidepressant

fluoxetine (PROZAC) restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the

antidepressant tianeptine CNS Drugs 200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances

hippocampal long-term potentiation and memory BMC Biol 2008 Sep

9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine

improves neuropsychological disorders in a child with creatine

transporter defect Neurocase 200814(2) 151-61

50

VIII Improving Brain Function and Neuroplasticity

C Exercise

Hunsberger JG et al Antidepressant actions of the exercise-

regulated gene VGF Nat Med 2007 Dec 2 131476

VGF may be a common pathway by which exercise induces

neuroplasticity and growth-factor genes at least one of these might act

similarly to antidepressants in promoting an adaptive response to stress

However the tests used here may be modeling stress-induced

helplessness not depression hellipexercise seems to induce multiple

interacting genes that enhance neuronal resilience

51

VIII Improving Brain Function and Neuroplasticity

D Learning new and challenging things

What have we (optometry amp ophthalmology)

been thinking all these years

Where did we miss the news about neuroplasticity

52

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Huang JC Neuroplasticity as a proposed mechanism for the efficacy of optometric vision therapy and rehabilitation J Bev Optom 200920(4)96-100

Homologous area adaptationCompensatory masqueradeCross-modal reassignment

Map expansion

EquipotentialityVicariation

53

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Homologous area adaptation a transfer of function from a damaged brain area to a non-damaged brain area May be limited to early stages of human development and may crowd a new brain area resulting in reduced functionality of that brain area (Competition between spatial amp verbal functioning)

54

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Compensatory masquerade reorganizing of existing neuro-pathways to us alternative cognitive strategies to perform a task

55

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Cross-modal reassignment using new sensory input in a brain structure deprived of its main input source (changing processing from visual to tactile stimuli in the blind)

56

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Map expansion increase in brain mass due to repeated behavior or exposure to stimuli

57

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Equipotentiality anatomical areas of the brain can perform disparate functions

Vicariation redundant neural systems can operate under abnormal conditions

This may explain why recovery is noted for many neurological conditions (degenerative psychiatric developmental vascular traumatic)

58

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Constraint therapy Use it and improve it

Patching penalization ldquonear activitiesrdquo during amblyopia therapy

59

IX Improving Brain Function and Neuroplasticity Optometric Clinical ApplicationsOptometric Vision Therapy

Kleim amp Jones

Use it or lose it If you do not drive specific brain functions

functional loss will occur

If you want to improve oculomotor brain neuroplastic function amp

structure therapy should be specific for that brain function

Use it and improve it Therapy that drives cortical function enhances

that particular function

If you use therapy to improve oculomotor dysfunction it should

improve

Specificity The therapy you choose determines the resultant

plasticity and function

You must choose therapy that is appropriate

60

IX Improving Brain Function and Neuroplasticity Optometric Clinical Applications

Kleim amp Jones

Repetition matters Plasticity that results in functional change

requires repetition

Do the therapy Do it again Do it yet again No quick fix

Intensity matters Induction of plasticity requires the appropriate

amount of intensity

Intensity means strength force concentration power and passion

Without these plasticity may not occur Function may not improve

Time matters Different forms of plasticity take place at different

times during therapy

Do the basics than the more advanced therapeutic procedures

61

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Salience matters It has to be important to the individual

Make the therapy matter to the patient

Age matters Plasticity is easier in a younger brain but is also

possible in an adult brain

Do not let age determine what therapy options you offer your

patients Think of Susan Barry PhD (StereoSue) and her success

Offer your patients options Let them choose Be realistic about

outcomeshelliphave outcome measures built into therapy program

62

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Transference Neuroplasticity and the change in function

that results from one therapy can augment the attainment

of similar behaviors

What you do during oculomotor therapy may affected

vergence therapy outcomes

Interference Plasticity in response to one experience can

interfere with the acquisition of other behaviors

Monitor Evaluate progress Discuss function in other areas

of your patientslsquo life

63

Why pay attention to binocular vision dysfunctions

and neuroplasticity

December 2009 issue of the Review of Optometry

The Binocular Vision Dysfunction Pandemic

In 2010 almost 170 million individuals will be wearing glasses In

2010 there will also be up to 93 million amblyopes and 12 and a half

million strabismics For children under 18 years of age that means

there will be more than 22 and a half million amblyopes and millions

of children with strabismus A clinical trial to determine the

prevalence of binocular vision dysfunction within the general

population suggested the possibility of up to 56 or 173 million men

women and children with symptoms associated with a binocular

vision dysfunction 189 million (61) with accommodative problems

and 118 million (38) demonstrating various vergence

anomalies

64

65

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Brain plasticity life long changes in the structure of the brain

Sensory substitution replacement of one sensory input by another

Measurement techniques

Voxel based morphometryhellipmeasures difference in brain volume

Fluorodeoxyglucose glucose analog PET scan tells you

distribution and metabolism of brain

Cortical thickness measures

Visual cortex of the blind turns somatic ―The eye of the tongue

Transcranial magnetic stmiulation non-invasive technique to

stimulate cortex

66

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Blind Braille readers report tingling in fingers when pressure

phosphenes are applied Blind feel tingling in tongue

Bind use tongue to perform orientation task motion perception

sensory perception Visual cortex recruited in a variety of sensory

and cognitive tasks (DM Can we use tongue as a VT tool)

Dilks Reorganizations of human adult visual system

When a region of sensory cortex is deprived of its bottom up

input the deprived region begins to respond to stimuli that

normally activate adjacent cortex

67

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Retinotopic map changes for stroke pts Cortical reorganization in

adults occurs Perceived objectshellipelongation in stroke amp AMD

What happens to deprived cortex in AMD

fMRI shows cortical reorganization in adults

Proposed mechanisms

hellipGrowth of new connections

hellipUnmasking of pre-existing connections this is true

happens within seconds

Bavelier

Action video games

68

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Bavelier

Action video games Looked at attention Gamers can track more

activities

Attention over space (me peripheral awarenress) Useful field

of view shrinks with age

Performance not VA relatedhellipis related to attention

Action game playing changes spatial resolutionhellipovercoming

crowding in VA assessment (me amblyopia therapy)

Temporal resolution of vision Backward masking

changehellipbrain changes

Visual sensitivity (contrast sensitivity) Post action game training

improves CSF

69

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Action video games correcting optics of the cortex (me this is

actualy OVT)

Games factor

Variable entry leanringhellipadapt task to skill level

Incremental learning tune task to subjectlsquos leanring steps

Motivationarousal

Rewards

Self masterself confidence

Action games factors

Pacingrate of exposure to infohellipincreasing processing speed

Dynamic display

Rich environment

Rich motor involvement

70

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Surgeons may be made to play action games

Pilot training

Amblyopia tx Dennis Levi research

PresenterTitle Contact info

Neuroplasticity-A Paradigm Sea Change

This presentation is available at

httpwwwslidesharenetDMAINOneuroplasticity-a-paradigm-sea-change-2459693

httpwwwmainosmemosblogspotcom

My FaceBook Page

and

Twitter

PresenterTitle Contact info

Questions About

Neuroplasticity-A Paradigm Sea Change

Dominick M Maino OD MEd FAAO FCOVD-A

Professor PediatricsBinocular VisionIllinois Eye InstituteIllinois College of Optometry

dmainoicoeduhttpwwwMainosMemosblogspotcom

Thanks to

httpwwwcovdorgHomeOVDJournalOVD401tabid263D

efaultaspx

httpbipolarblastfileswordpresscom200908neurojpg

httpwwwspecialcheerscomimagesanimated_braingif

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contentuploads200810frankenstein-myspace-lightbeergif

httpwwwshangralafamilyfuncomgala-ecalvindreamgif

httppsychiatryjwatchorgcgicontentfull20082251

73

Chakraborty R Chatterjee A Choudhart S Chakraborty PK Neuroplasticitymdasha paradigm shift in neurosciences J Indian Med Assoc

2007105(9)513-4516-8520-1

Sacks O A neurologistlsquos notebook Stereo Sue Why two eyes are better than one The New Yorker 2006 Jun 1964-73

Krulwich R National Public Radio Going Binocular Susanlsquos First Snowfall Available at

wwwnprorgtemplatesstorystoryphpstoryId=5507789 (Accessed December 8 2008)

Press LJ The story behind Stereo Suelsquo and a world-famous neurologistlsquos discovery of vision therapy Optom Vis Dev 200637(2) 55-7

Levin HS Neuroplasticity and brain imaging research implications for rehabilitation Arch Phys Med Rehabil 2006 Dec87(12 Suppl

2)S1

Wiesel TN Hubel DH Single-cell responses in striate cortex of kittens deprived of vision in one eye J Neurophysiol 1963

Nov261003-17

Hook BM Chen C Critical periods in the visual system Changing views for a model of experience-dependent plasticity Neuron 2007

Oct56(2)312-26

Ramey CT Ramey SL Prevention of intellectual disabilities early interventions to improve cognitive development Prev Med 1998

Mar-Apr27(2)224-32

Heuninckx S Wenderoth N Swinnen SP Systems neuroplasticity in the aging brain recruiting additional neural resources for

successful motor performance in elderly persons J Neurosci 2008 Jan 228(1)91-9

Ge S Yang CH Hsu KS et al A critical period for enhanced synaptic plasticity in newly generated neurons of the adult brain Neuron

2007 May54(4)559-66

74

Draganski B Gaser C Busch V et al Neuroplasticity changes in grey matter induced by training Nature 2004 Jan 22427(6972)

311-2

Cannonieri GC Bonilha L Fernandes PT et al Practice and perfect length of training and structural brain changes in experienced

typists Neuroreport 2007 Jul 218(10)1063-6

Kleim JA Jones TA Principles of experience-dependent neural plasticity implications for rehabilitation after brain damage J

Speech Lang Hear Res 2008 Feb51(1)S225-39

Trojan S Porkorny J Theoretical aspects of neuroplasticity Physiol Res 199948(2)87-97

Ramamirtham R Kee CS Hung LF et al Wave aberrations in rhesus monkeys with vision-induced ametropias Vision Res 2007

Sep47(21)2751-66

Smith EL 3rd Ramamirtham R Qiao-Grider Y et al Effects of foveal ablation on emmetropization and form-deprivation myopia

Invest Ophthalmol Vis Sci 2007 Sep48(9)3914-22

Smith EL 3rd Kee CS Ramamirtham R et al Peripheral vision can influence eye growth and refractive development in infant

monkeys Invest Ophthalmol Vis Sci 2005 Nov46(11)3965-72

Ciuffreda KJ Vasudevan B Nearwork-induced transient myopia (NITM) and permanent myopiandashndashis there a link Ophthalmic

Physiol Opt 2008 Mar28(2)103-14

Hung GK Ciuffreda KJ Incremental retinal-defocus theory of myopia development--schematic analysis and computer simulation

Comput Biol Med 2007 Jul37(7)930-46

Hung GK Ciuffreda KJ A unifying theory of refractive error development Bull Math Biol 2000 Nov62(6)1087-108

75

Pang Y Maino D Zhang G Lu F Myopia Can its progress be controlled Optom Vis Dev 200637(2)75-9

Leung JT Brown B Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lenses Optom Vis Sci

1999 Jun76(6)346-54

Hasebe S Ohtsuki H Nonaka T et al Effect of progressive addition lenses on myopia progression in Japanese children a prospective

randomized double-masked crossover trial Invest Ophthalmol Vis Sci 2008 Jul49(7)2781-9

Gwiazda J Hyman L Hussein M et al A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression

of myopia in children Invest Ophthalmol Vis Sci 2003 Apr44(4)1492-500

Siatkowski RM Cotter SA Crockett RS et al Two-year multi-center randomized double-masked placebo-controlled parallel safety and

efficacy study of 2 pirenzepine ophthalmic gel in children with myopia J AAPOS 2008 Aug12(4)332-9

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged 7 to 17 years Arch Ophthalmol 2005

Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three to less than 10 years of age Am J

Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction Am J Ophthalmol 2007

Jun143(6)1060-3

Holmes JM Edwards AR Beck RW et al A randomized pilot study of near activities versus non-near activities during patching therapy for

amblyopia J AAPOS 2005 Apr9(2)129-36

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate

amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-57

76

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic

amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Convergence Insufficiency Treatment Trial Study Group Randomized clinical trial of treatments for symptomatic convergence insufficiency

in children Arch Ophthalmol 2008 Oct126(10)1336-49

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

Solan HA Shelley-Tremblay J Hansen PC et al M-cell deficit and reading disability a preliminary study of the effects of temporal vision-

processing therapy Optometry 2004 Oct75(10)640-50

Solan HA Larson S Shelley-Tremblay J et al Role of visual attention in cognitive control of oculomotor readiness in students with reading

disabilities J Learn Disabil 2001 Mar-Apr34(2)107-18

Gallaway M Boas MB The impact of vergence and accommodative therapy on reading eye movements and reading speed Optom Vis Dev

200738(3)115-20

Goss DA Downing DB Lowther AH et al The effect of HTS vision therapy conducted in a school setting on reading skills in third and

fourth grade students Optom Vis Dev 200738(1)27-32

Crutch SJ Warrington EK Foveal crowding in posterior cortical atrophy a specific early-visual-processing deficit affecting word reading

Cogn Neuropsychol 2007 Dec24(8)843-66

Helms D Sawtelle SM A study of the effectiveness of cognitive therapy delivered in a video game format Optom Vis Dev 200738 (1)19-

26

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

77

Lawton T Training direction-discrimination sensitivity remediates a wide spectrum of reading skills OptomVis Dev 200738(1) 33-47

Goldstand S Koslowe KC Parush S Vision visual-information processing and academic performance among seventh-grade schoolchildren a

more significant relationship than we thought Am J Occup Ther 2005 Jul-Aug59(4)377-89

Fischer B Koumlngeter A Hartnegg K Effects of daily practice on subitizing visual counting and basic arithmetic skills Optom Vis Dev

200839(1)30-4

Sands W Taub M Maino D Limited research and education on special populations in optometry and ophthalomology Optom Vis Dev

200839(2)60-1

Wesson M Maino D Oculo-visual findings in Down syndrome cerebral palsy and mental retardation with non-specific etiology In Maino D

(ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 199517-54 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

Cui Y Stapleton F Suttle C Developing an instrument to assess vision-related and subjective quality of life in children with intellectual

disability data collection and preliminary analysis in a Chinese population Ophthal Physiolog Optics 2008 May28(3) 238-46

Maino D Steele G Tahir S Sajja R Attitudes of optometry students toward individuals with disabilities Optom Ed 200227(2)45-50

Maino D Special populations in the optometric curriculum Optom Ed 200227(2)38-9

Maino D Overview of special populations In Scheiman M Rouse M (eds) Optometric Management of Learning-Related Vision Problems

St Louis Mosby Inc 200685-106

Maino D (ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 1995 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

78

McCarthy P Maino D Alport syndrome a review Clin Eye Vis Care 2000 Dec12(3-4)139-50

Block SS Brusca-Vega R Pizzi WJ et al Cognitive and visual processing skills and their relationship to mutation size in full and

permutation female fragile X carriers Optom Vis Sci 2000 Nov77 (11)592-9

Maino D The young child with developmental disabilities An introduction to mental retardation and genetic syndromes In Moore BD

(ed) Eye Care for Infants and Young Children Butter-worth--Heinemann Newton MA1997285-300

Amin V Maino D The Fragile X female Visual visual perceptual and ocular health anomalies J Am Optom Assoc 1995 May66

(5)290-95

Maino DM Maino JH Cibis GW Hecht F Ocular health anomalies in patients with developmental disabilities In Maino D (ed)

Diagnosis and Management of Special Populations Mosby-Year-book Inc St Louis MO 1995189-206 Reprinted Optometric

Education Program Foundation Santa Anna Calif 2001

Maino D Wesson M Schlange D Cibis G Maino J Optometric findings in the fragile X syndrome Optom Vis Sci 199168634-40

Scheiman MMOptometric findings in children with cerebral palsy Am J Optom Physiol Opt 1984 May61(5)321-3

Maino D Maino J Maino S Mental retardation syndromes with associated ocular defects J Am Optom Assoc 199061707-16

Stewart RE Woodhouse JM Cregg M Pakeman VH Association between accommodative accuracy hypermetropia and strabismus in

children with Downs syndrome Optom Vis Sci 2007 Feb84(2)149-55

Cregg M Woodhouse JM Pakeman VH et al Accommodation and refractive error in children with Down syndrome cross-sectional

and longitudinal studies Invest Ophthalmol Vis Sci 2001 Jan42 (1)55-63

79

McClelland JF Parkes J Hill N et al Accommodative dysfunction in children with cerebral palsy a population-

based study Invest Ophthalmol Vis Sci 2006 May47(5)1824-30

Duckman RH Vision therapy for the child with cerebral palsy J Am Optom Assoc 198758(1)28-35

Duckman R Accommodation in cerebral palsy function and remediation J Am Optom Assoc 198455(4)281-3

Scheiman M Understanding and managing vision deficits a guide for occupational therapists 2nd ed Slack

Thorofare NJ 2002

Maino D Binasal occlusion for the child with Cerebral Palsy J Ill Optom Assoc 198644(1)1218

Battaglia F Quartarone A Rizzo V et al Early impairment of synaptic plasticity in patients with Downs syndrome

Neurobiol Aging 2008 Aug29(8)1272-5

Bonnier C Evaluation of early stimulation programs for enhancing brain development Acta Paediatr 2008

Jul97(7)853-8

Morice E Andreae LC Cooke SF et al Preservation of long-term memory and synaptic plasticity despite short-term

impairments in the Tc1 mouse model of Down syndrome Learn Mem 2008 Jul 1415(7)492-500

Gordon AM Schneider JA Chinnan A Charles JR Efficacy of a hand-arm bimanual intensive therapy (HABIT) in

children with hemiplegic cerebral palsy a randomized control trial Dev Med Child Neurol 2007 Nov49(11)830-8

Kapoor N Ciuffreda KJ Vision disturbances following traumatic brain injury Curr Treat Options Neurol 2002

Jul4(4)271-80

80

Ciuffreda KJ Rutner D Kapoor N et al Vision therapy for oculomotor dysfunctions in acquired brain injury a

retrospective analysis Optometry 2008 Jan79(1)18-22

Ciuffreda KJ Han Y Kapoor N Ficarra AP Oculomotor rehabilitation for reading in acquired brain injury

NeuroRehabilitation 200621(1)9-21

Zost M Diagnosis and management of visual dysfunction in cerebral injury In Maino D (ed) Diagnosis and

Management of Special Populations Mosby-Yearbook Inc St Louis 199579 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001 [Figure used with permission of the editor]

DeGutis JM Bentin S Robertson LC DEsposito M Functional plasticity in ventral temporal cortex following

cognitive rehabilitation of a congenital prosopagnosic J Cogn Neurosci 2007 Nov19 (11)1790-802

Welbourne SR Ralph MA Exploring the impact of plasticity-related recovery after brain damage in a connectionist

model of single-word reading Cogn Affect Behav Neurosci 2005 Mar5(1)77-92

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements prevent cognitive decline A

systematic review of randomized controlled trials J Hum Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among preterm infants attributable to early

supplementation of human milk with docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings and structural-functional

synergies with cell membrane phospholipids Altern Med Rev 2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function Neuroscience 20089(7)568-78

81

Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

BMC Biol 2008 Sep 9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine improves neuropsychological disorders in a child with

creatine transporter defect Neurocase 200814(2) 151-61

Forrester LW Wheaton LA Luft AR Exercise-mediated locomotor recovery and lower-limb neuroplasticity after

stroke J Rehabil Res Dev 200845(2)205-20

82

Page 29: Neuroplasticity: A Paradigm Sea Change Latest Updated File

D Non-strabismus non-amblyopic binocular vision disorders

E Learning related vision anomalies

F Vision developmentperception disorders

29

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

A Refractive error development

Several recent studies have noted that neuroplasticity may play a

role in refractive error development

retinal defocus use of progressive addition lenses

drug studies (M1-antagonist2 pirenzepine ) slow myopia

progression demonstrated nearly a 50 reduction in myopia

progression over a two-year period

30

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged

7 to 17 years Arch Ophthalmol 2005 Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three

to less than 10 years of age Am J Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction

Am J Ophthalmol 2007 Jun143(6)1060-3

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine

vs patching for treatment of moderate amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-

57

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for

strabismic and anisometropic amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Treatment of severe amblyopia with weekend atropine results from 2 randomized clinical trials

Levodopacarbidopa in the treatment of amblyopia

31

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

J Pediatr Ophthalmol Strabismus 2009 Mar-Apr46(2)87-90 quiz 91-2 Levodopacarbidopa in the

treatment of amblyopia Dadeya S Vats P Malik KP

PURPOSE To evaluate the role of levodopacarbidopa in the treatment of amblyopia METHODS

Thirty patients with strabismic amblyopia between the ages of 3 and 12 years were part of this double-

blind randomized study Patients were divided into two groups Group A received 050 mg + 125 mg of

levodopacarbidopa per kilogram body weight three times daily after meals with a protein rich drink

whereas Group B received placebo Both groups received full-time conventional occlusion until a visual

acuity of 66 was achieved or for a maximum of 3 months RESULTS The authors observed more than

two lines improvement in visual acuity that was greater in the levodopa group (15 of 15) than in the

placebo group (9 of 15) (P lt 005) Furthermore improvement in visual acuity of more than two lines

was greater in patients younger than 8 years (100) than in patients older than 8 years of age (60) (P =

0026) There was also no significant reversal of the improved visual acuity in up to 6 months of follow-

up CONCLUSION Levodopacarbidopa improves visual acuity in patients with

amblyopia and maintains improved visual acuity especially in patients

younger than 8 years

32

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

J Pediatr Ophthalmol Strabismus 2008 May-Jun45(3)174-6 The use of levodopa in the treatment of

bilateral amblyopia secondary to uncorrected high hypermetropia Abrams MS

The standard treatment of bilateral amblyopia secondary to uncorrected high bilateral hypermetropia has

been spectacles and time The patient described here failed to show adequate improvement in visual

acuity after 18 months of standard treatment Visual acuity improved dramatically when the

patient began taking levodopa dropped precipitously when the medication was

discontinued and returned quickly to post-treatment levels when levodopa was

restarted Visual acuity remained stable when the medication was slowly tapered

and discontinued This report suggests that dopamine may play a role in the pathophysiology of

bilateral amblyopia secondary to uncorrected high bilateral hypermetropia

33

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

Bottom Line

Amblyopia can be treated at any age

May be able to use neuro-enhancing drugs

as a part of basic amblyopia therapy

34

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

C Strabismus and non-strabismic non-amblyopic binocular

vision disorders

Clinical Trial of Treatments for Symptomatic Convergence Insufficiency in Children has

clearly demonstrated the superiority of in-office optometric vision therapy (in conjunction

with home therapy) vs out-of-office therapy alone The study concluded that optometric

vision therapyorthoptics was more effective than pencil push-ups or placebo vision

therapyorthoptics in reducing symptoms and improving clinical signs of convergence

insufficiency

Long-term effectiveness of treatments for symptomatic convergence insufficiency

in children (Optom Vis Sci 2009 Sep86(9)1096-103)

CITT patients improvements lasted a year

35

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

Strabismus 1999 Sep7(3)169-74 Convergence insufficiency in

idiopathic Parkinsons disease responsive to levodopa Racette BA

Gokden MS Tychsen LS Perlmutter JS

We report a patient with pathologically proven idiopathic Parkinsons

disease (IPD) who developed diplopia secondary to convergence

insufficiency during his motor off periods Diplopia resolved with

onset of motor benefit from levodopa Neuro-ophthalmologic

examination demonstrated convergence insufficiency during motor

off periods that was alleviated after onset of motor benefit from

levodopa This is the first reported case of convergence insufficiency

in IPD responsive to levodopa

36

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

Bottom Line

Optometric Vision Therapy is the most efficacious treatment available for binocular vision disorders and the

treatment effects are long lasting Neuro-enhancing drugs

may assist us as well

37

EF Learning related vision anomalies Vision

developmentperception disorders

hellipresearch includes an examination of the role vision plays in

reading the effect of oculomotor vergence and

accommodativecoherent motion therapy on reading eye movements

and reading speed the diagnosis and treatment of perceptual

disorders and the effect of therapy on various learning anomalies

38

EF Learning related vision anomalies Vision developmentperception disorders

magnocellular (MC) deficit in dyslexia

LM speed-matching ratio predicts reading in childrenChase C Dougherty RF Ray N

Fowler S Stein JOptom Vis Sci 2007 Mar84(3)229-36

Effect of attention therapy on reading comprehension Solan HA Shelley-Tremblay J

Ficarra A Silverman M Larson S J Learn Disabil 2003 Nov-Dec36(6)556-63

Is there a common linkage among reading comprehension visual attention and

magnocellular processing Solan HA Shelley-Tremblay JF Hansen PC Larson S

J Learn Disabil 2007 May-Jun40(3)270-8

Lawton T Filtered Text and Direction Discrimination Training Improved Reading

Fluency for Both Dyslexic and Normal Readers Optom Vis Dev 200839 (3)114

Fischer B Hartnegg K Saccade control in dyslexia Development deficits training

and transfer to reading Optom Vis Dev 200839(4)181-190

39

EF Learning related vision anomalies Vision developmentperception disorders

J Learn Disabil 2003 Nov-Dec36(6)556-63 Effect of attention therapy on reading

comprehension Solan HA Shelley-Tremblay J Ficarra A Silverman M Larson S

hellip At the completion of attention therapy the mean

standard attention and reading comprehension scores of

the experimental group had improved significantly The

control group however showed no significant

improvement in reading comprehension scores after 12

weeks Although uncertainties still exist this investigation

supports the notion that visual attention is malleable and

that attention therapy has a significant effect on reading

comprehension in this often neglected population

40

VII Vision dysfunction association with acquired brain injury

A Exotropia (or high exophoriaCI)

B Accommodative dysfunction

C Convergence insufficiency

41

D Decreased blink rate

E Spatial disorientation

F Pursuitsaccade dysfunction

G Unstable ambient vision (Magnocellular pathway)

42

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Stelmack JA Frith T Van Koevering D Rinne S Stelmack TR Visual function in patients

followed at a Veterans Affairs polytrauma network site an electronic medical record review

Optometry 2009 Aug80(8)419-24

RESULTS Visual symptoms were self-reported by 76 of patients

with polytrauma and 75 of the patients with TBI Problems with reading

(polytrauma 60 and TBI 50) and accommodation (polytrauma 30 and

TBI 47) were frequently found on eye examinations Spectacles were the

treatment most frequently prescribed (polytrauma 62 and TBI 78)

CONCLUSIONS It is important for optometrists to be aware of the high

rates of self-reported symptoms and visual problems in military personnel

returning from deployment to the wars in Iraq and Afghanistan Post-

traumatic stress disorder and depression may complicate optometric

evaluation and management

43

VII Vision dysfunction association with acquired brain injury

Avoidance of near tasks

Oculomotor-based reading difficulties

Eye tracking problems

Eye focusing problems

Eyestrain Diplopia

Dizziness Vertigo

Vision-derived nausea

44

VII Vision dysfunction association with acquired brain injury

Increased sensitivity to visual motion

Visual inattention and distractibility

Short-term visual memory loss

Difficulty judging distances (relative and absolute

Difficulty with global scanning

Difficulty with personal grooming especially involving the face

Inability to interactcope visually in a complex social situation

(eg minimal eye contact)

Inability to tolerate complex visual environments (eg grocery store

aisles and highly-patterned floors)

45

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Ciuffreda KJ Ludlam DP Kapoor N Clinical oculomotor training in traumatic brain injury Optom Vis

Dev 200940(1)16-23

Individuals with traumatic brain injury present with a constellation of

oculomotor dysfunctions and correlated symptoms Simple and

effective clinical oculomotor-based training procedures will be

presented with respect to the versional vergence and

accommodative systems and their interactions These therapeutic

procedures can also be applied as needed to individuals with either

low vision neurological dysfunctions or general visual skills cases

manifesting similar oculomotor deficits

46

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Leslie S Myopia and accommodative insufficiency associated with

moderate head trauma Opt Vis Dev 200940(1)25-31

The majority of subjects reviewed had developed a stable degree of

myopia between 100 and 200 diopters as well as an abnormally

high lag of accommodation When their distance and near spatial area

of focus was compared the majority were focused at an intermediate

area in space suggesting a loss of control of accommodation in

space

47

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

B Drugs

C Exercise

D Learning new and challenging things

48

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements

prevent cognitive decline A systematic review of randomized controlled trials J Hum

Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among

preterm infants attributable to early supplementation of human milk with

docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings

and structural-functional synergies with cell membrane phospholipids Altern Med Rev

2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function

Neuroscience 20089(7)568-78

49

VIII Improving Brain Function and Neuroplasticity

B Drugs Maya Vetencourt JF Sale A Viegi A et al The antidepressant

fluoxetine (PROZAC) restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the

antidepressant tianeptine CNS Drugs 200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances

hippocampal long-term potentiation and memory BMC Biol 2008 Sep

9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine

improves neuropsychological disorders in a child with creatine

transporter defect Neurocase 200814(2) 151-61

50

VIII Improving Brain Function and Neuroplasticity

C Exercise

Hunsberger JG et al Antidepressant actions of the exercise-

regulated gene VGF Nat Med 2007 Dec 2 131476

VGF may be a common pathway by which exercise induces

neuroplasticity and growth-factor genes at least one of these might act

similarly to antidepressants in promoting an adaptive response to stress

However the tests used here may be modeling stress-induced

helplessness not depression hellipexercise seems to induce multiple

interacting genes that enhance neuronal resilience

51

VIII Improving Brain Function and Neuroplasticity

D Learning new and challenging things

What have we (optometry amp ophthalmology)

been thinking all these years

Where did we miss the news about neuroplasticity

52

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Huang JC Neuroplasticity as a proposed mechanism for the efficacy of optometric vision therapy and rehabilitation J Bev Optom 200920(4)96-100

Homologous area adaptationCompensatory masqueradeCross-modal reassignment

Map expansion

EquipotentialityVicariation

53

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Homologous area adaptation a transfer of function from a damaged brain area to a non-damaged brain area May be limited to early stages of human development and may crowd a new brain area resulting in reduced functionality of that brain area (Competition between spatial amp verbal functioning)

54

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Compensatory masquerade reorganizing of existing neuro-pathways to us alternative cognitive strategies to perform a task

55

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Cross-modal reassignment using new sensory input in a brain structure deprived of its main input source (changing processing from visual to tactile stimuli in the blind)

56

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Map expansion increase in brain mass due to repeated behavior or exposure to stimuli

57

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Equipotentiality anatomical areas of the brain can perform disparate functions

Vicariation redundant neural systems can operate under abnormal conditions

This may explain why recovery is noted for many neurological conditions (degenerative psychiatric developmental vascular traumatic)

58

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Constraint therapy Use it and improve it

Patching penalization ldquonear activitiesrdquo during amblyopia therapy

59

IX Improving Brain Function and Neuroplasticity Optometric Clinical ApplicationsOptometric Vision Therapy

Kleim amp Jones

Use it or lose it If you do not drive specific brain functions

functional loss will occur

If you want to improve oculomotor brain neuroplastic function amp

structure therapy should be specific for that brain function

Use it and improve it Therapy that drives cortical function enhances

that particular function

If you use therapy to improve oculomotor dysfunction it should

improve

Specificity The therapy you choose determines the resultant

plasticity and function

You must choose therapy that is appropriate

60

IX Improving Brain Function and Neuroplasticity Optometric Clinical Applications

Kleim amp Jones

Repetition matters Plasticity that results in functional change

requires repetition

Do the therapy Do it again Do it yet again No quick fix

Intensity matters Induction of plasticity requires the appropriate

amount of intensity

Intensity means strength force concentration power and passion

Without these plasticity may not occur Function may not improve

Time matters Different forms of plasticity take place at different

times during therapy

Do the basics than the more advanced therapeutic procedures

61

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Salience matters It has to be important to the individual

Make the therapy matter to the patient

Age matters Plasticity is easier in a younger brain but is also

possible in an adult brain

Do not let age determine what therapy options you offer your

patients Think of Susan Barry PhD (StereoSue) and her success

Offer your patients options Let them choose Be realistic about

outcomeshelliphave outcome measures built into therapy program

62

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Transference Neuroplasticity and the change in function

that results from one therapy can augment the attainment

of similar behaviors

What you do during oculomotor therapy may affected

vergence therapy outcomes

Interference Plasticity in response to one experience can

interfere with the acquisition of other behaviors

Monitor Evaluate progress Discuss function in other areas

of your patientslsquo life

63

Why pay attention to binocular vision dysfunctions

and neuroplasticity

December 2009 issue of the Review of Optometry

The Binocular Vision Dysfunction Pandemic

In 2010 almost 170 million individuals will be wearing glasses In

2010 there will also be up to 93 million amblyopes and 12 and a half

million strabismics For children under 18 years of age that means

there will be more than 22 and a half million amblyopes and millions

of children with strabismus A clinical trial to determine the

prevalence of binocular vision dysfunction within the general

population suggested the possibility of up to 56 or 173 million men

women and children with symptoms associated with a binocular

vision dysfunction 189 million (61) with accommodative problems

and 118 million (38) demonstrating various vergence

anomalies

64

65

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Brain plasticity life long changes in the structure of the brain

Sensory substitution replacement of one sensory input by another

Measurement techniques

Voxel based morphometryhellipmeasures difference in brain volume

Fluorodeoxyglucose glucose analog PET scan tells you

distribution and metabolism of brain

Cortical thickness measures

Visual cortex of the blind turns somatic ―The eye of the tongue

Transcranial magnetic stmiulation non-invasive technique to

stimulate cortex

66

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Blind Braille readers report tingling in fingers when pressure

phosphenes are applied Blind feel tingling in tongue

Bind use tongue to perform orientation task motion perception

sensory perception Visual cortex recruited in a variety of sensory

and cognitive tasks (DM Can we use tongue as a VT tool)

Dilks Reorganizations of human adult visual system

When a region of sensory cortex is deprived of its bottom up

input the deprived region begins to respond to stimuli that

normally activate adjacent cortex

67

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Retinotopic map changes for stroke pts Cortical reorganization in

adults occurs Perceived objectshellipelongation in stroke amp AMD

What happens to deprived cortex in AMD

fMRI shows cortical reorganization in adults

Proposed mechanisms

hellipGrowth of new connections

hellipUnmasking of pre-existing connections this is true

happens within seconds

Bavelier

Action video games

68

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Bavelier

Action video games Looked at attention Gamers can track more

activities

Attention over space (me peripheral awarenress) Useful field

of view shrinks with age

Performance not VA relatedhellipis related to attention

Action game playing changes spatial resolutionhellipovercoming

crowding in VA assessment (me amblyopia therapy)

Temporal resolution of vision Backward masking

changehellipbrain changes

Visual sensitivity (contrast sensitivity) Post action game training

improves CSF

69

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Action video games correcting optics of the cortex (me this is

actualy OVT)

Games factor

Variable entry leanringhellipadapt task to skill level

Incremental learning tune task to subjectlsquos leanring steps

Motivationarousal

Rewards

Self masterself confidence

Action games factors

Pacingrate of exposure to infohellipincreasing processing speed

Dynamic display

Rich environment

Rich motor involvement

70

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Surgeons may be made to play action games

Pilot training

Amblyopia tx Dennis Levi research

PresenterTitle Contact info

Neuroplasticity-A Paradigm Sea Change

This presentation is available at

httpwwwslidesharenetDMAINOneuroplasticity-a-paradigm-sea-change-2459693

httpwwwmainosmemosblogspotcom

My FaceBook Page

and

Twitter

PresenterTitle Contact info

Questions About

Neuroplasticity-A Paradigm Sea Change

Dominick M Maino OD MEd FAAO FCOVD-A

Professor PediatricsBinocular VisionIllinois Eye InstituteIllinois College of Optometry

dmainoicoeduhttpwwwMainosMemosblogspotcom

Thanks to

httpwwwcovdorgHomeOVDJournalOVD401tabid263D

efaultaspx

httpbipolarblastfileswordpresscom200908neurojpg

httpwwwspecialcheerscomimagesanimated_braingif

httpblogmarsdencartoonscomwp-

contentuploads200810frankenstein-myspace-lightbeergif

httpwwwshangralafamilyfuncomgala-ecalvindreamgif

httppsychiatryjwatchorgcgicontentfull20082251

73

Chakraborty R Chatterjee A Choudhart S Chakraborty PK Neuroplasticitymdasha paradigm shift in neurosciences J Indian Med Assoc

2007105(9)513-4516-8520-1

Sacks O A neurologistlsquos notebook Stereo Sue Why two eyes are better than one The New Yorker 2006 Jun 1964-73

Krulwich R National Public Radio Going Binocular Susanlsquos First Snowfall Available at

wwwnprorgtemplatesstorystoryphpstoryId=5507789 (Accessed December 8 2008)

Press LJ The story behind Stereo Suelsquo and a world-famous neurologistlsquos discovery of vision therapy Optom Vis Dev 200637(2) 55-7

Levin HS Neuroplasticity and brain imaging research implications for rehabilitation Arch Phys Med Rehabil 2006 Dec87(12 Suppl

2)S1

Wiesel TN Hubel DH Single-cell responses in striate cortex of kittens deprived of vision in one eye J Neurophysiol 1963

Nov261003-17

Hook BM Chen C Critical periods in the visual system Changing views for a model of experience-dependent plasticity Neuron 2007

Oct56(2)312-26

Ramey CT Ramey SL Prevention of intellectual disabilities early interventions to improve cognitive development Prev Med 1998

Mar-Apr27(2)224-32

Heuninckx S Wenderoth N Swinnen SP Systems neuroplasticity in the aging brain recruiting additional neural resources for

successful motor performance in elderly persons J Neurosci 2008 Jan 228(1)91-9

Ge S Yang CH Hsu KS et al A critical period for enhanced synaptic plasticity in newly generated neurons of the adult brain Neuron

2007 May54(4)559-66

74

Draganski B Gaser C Busch V et al Neuroplasticity changes in grey matter induced by training Nature 2004 Jan 22427(6972)

311-2

Cannonieri GC Bonilha L Fernandes PT et al Practice and perfect length of training and structural brain changes in experienced

typists Neuroreport 2007 Jul 218(10)1063-6

Kleim JA Jones TA Principles of experience-dependent neural plasticity implications for rehabilitation after brain damage J

Speech Lang Hear Res 2008 Feb51(1)S225-39

Trojan S Porkorny J Theoretical aspects of neuroplasticity Physiol Res 199948(2)87-97

Ramamirtham R Kee CS Hung LF et al Wave aberrations in rhesus monkeys with vision-induced ametropias Vision Res 2007

Sep47(21)2751-66

Smith EL 3rd Ramamirtham R Qiao-Grider Y et al Effects of foveal ablation on emmetropization and form-deprivation myopia

Invest Ophthalmol Vis Sci 2007 Sep48(9)3914-22

Smith EL 3rd Kee CS Ramamirtham R et al Peripheral vision can influence eye growth and refractive development in infant

monkeys Invest Ophthalmol Vis Sci 2005 Nov46(11)3965-72

Ciuffreda KJ Vasudevan B Nearwork-induced transient myopia (NITM) and permanent myopiandashndashis there a link Ophthalmic

Physiol Opt 2008 Mar28(2)103-14

Hung GK Ciuffreda KJ Incremental retinal-defocus theory of myopia development--schematic analysis and computer simulation

Comput Biol Med 2007 Jul37(7)930-46

Hung GK Ciuffreda KJ A unifying theory of refractive error development Bull Math Biol 2000 Nov62(6)1087-108

75

Pang Y Maino D Zhang G Lu F Myopia Can its progress be controlled Optom Vis Dev 200637(2)75-9

Leung JT Brown B Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lenses Optom Vis Sci

1999 Jun76(6)346-54

Hasebe S Ohtsuki H Nonaka T et al Effect of progressive addition lenses on myopia progression in Japanese children a prospective

randomized double-masked crossover trial Invest Ophthalmol Vis Sci 2008 Jul49(7)2781-9

Gwiazda J Hyman L Hussein M et al A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression

of myopia in children Invest Ophthalmol Vis Sci 2003 Apr44(4)1492-500

Siatkowski RM Cotter SA Crockett RS et al Two-year multi-center randomized double-masked placebo-controlled parallel safety and

efficacy study of 2 pirenzepine ophthalmic gel in children with myopia J AAPOS 2008 Aug12(4)332-9

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged 7 to 17 years Arch Ophthalmol 2005

Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three to less than 10 years of age Am J

Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction Am J Ophthalmol 2007

Jun143(6)1060-3

Holmes JM Edwards AR Beck RW et al A randomized pilot study of near activities versus non-near activities during patching therapy for

amblyopia J AAPOS 2005 Apr9(2)129-36

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate

amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-57

76

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic

amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Convergence Insufficiency Treatment Trial Study Group Randomized clinical trial of treatments for symptomatic convergence insufficiency

in children Arch Ophthalmol 2008 Oct126(10)1336-49

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

Solan HA Shelley-Tremblay J Hansen PC et al M-cell deficit and reading disability a preliminary study of the effects of temporal vision-

processing therapy Optometry 2004 Oct75(10)640-50

Solan HA Larson S Shelley-Tremblay J et al Role of visual attention in cognitive control of oculomotor readiness in students with reading

disabilities J Learn Disabil 2001 Mar-Apr34(2)107-18

Gallaway M Boas MB The impact of vergence and accommodative therapy on reading eye movements and reading speed Optom Vis Dev

200738(3)115-20

Goss DA Downing DB Lowther AH et al The effect of HTS vision therapy conducted in a school setting on reading skills in third and

fourth grade students Optom Vis Dev 200738(1)27-32

Crutch SJ Warrington EK Foveal crowding in posterior cortical atrophy a specific early-visual-processing deficit affecting word reading

Cogn Neuropsychol 2007 Dec24(8)843-66

Helms D Sawtelle SM A study of the effectiveness of cognitive therapy delivered in a video game format Optom Vis Dev 200738 (1)19-

26

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

77

Lawton T Training direction-discrimination sensitivity remediates a wide spectrum of reading skills OptomVis Dev 200738(1) 33-47

Goldstand S Koslowe KC Parush S Vision visual-information processing and academic performance among seventh-grade schoolchildren a

more significant relationship than we thought Am J Occup Ther 2005 Jul-Aug59(4)377-89

Fischer B Koumlngeter A Hartnegg K Effects of daily practice on subitizing visual counting and basic arithmetic skills Optom Vis Dev

200839(1)30-4

Sands W Taub M Maino D Limited research and education on special populations in optometry and ophthalomology Optom Vis Dev

200839(2)60-1

Wesson M Maino D Oculo-visual findings in Down syndrome cerebral palsy and mental retardation with non-specific etiology In Maino D

(ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 199517-54 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

Cui Y Stapleton F Suttle C Developing an instrument to assess vision-related and subjective quality of life in children with intellectual

disability data collection and preliminary analysis in a Chinese population Ophthal Physiolog Optics 2008 May28(3) 238-46

Maino D Steele G Tahir S Sajja R Attitudes of optometry students toward individuals with disabilities Optom Ed 200227(2)45-50

Maino D Special populations in the optometric curriculum Optom Ed 200227(2)38-9

Maino D Overview of special populations In Scheiman M Rouse M (eds) Optometric Management of Learning-Related Vision Problems

St Louis Mosby Inc 200685-106

Maino D (ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 1995 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

78

McCarthy P Maino D Alport syndrome a review Clin Eye Vis Care 2000 Dec12(3-4)139-50

Block SS Brusca-Vega R Pizzi WJ et al Cognitive and visual processing skills and their relationship to mutation size in full and

permutation female fragile X carriers Optom Vis Sci 2000 Nov77 (11)592-9

Maino D The young child with developmental disabilities An introduction to mental retardation and genetic syndromes In Moore BD

(ed) Eye Care for Infants and Young Children Butter-worth--Heinemann Newton MA1997285-300

Amin V Maino D The Fragile X female Visual visual perceptual and ocular health anomalies J Am Optom Assoc 1995 May66

(5)290-95

Maino DM Maino JH Cibis GW Hecht F Ocular health anomalies in patients with developmental disabilities In Maino D (ed)

Diagnosis and Management of Special Populations Mosby-Year-book Inc St Louis MO 1995189-206 Reprinted Optometric

Education Program Foundation Santa Anna Calif 2001

Maino D Wesson M Schlange D Cibis G Maino J Optometric findings in the fragile X syndrome Optom Vis Sci 199168634-40

Scheiman MMOptometric findings in children with cerebral palsy Am J Optom Physiol Opt 1984 May61(5)321-3

Maino D Maino J Maino S Mental retardation syndromes with associated ocular defects J Am Optom Assoc 199061707-16

Stewart RE Woodhouse JM Cregg M Pakeman VH Association between accommodative accuracy hypermetropia and strabismus in

children with Downs syndrome Optom Vis Sci 2007 Feb84(2)149-55

Cregg M Woodhouse JM Pakeman VH et al Accommodation and refractive error in children with Down syndrome cross-sectional

and longitudinal studies Invest Ophthalmol Vis Sci 2001 Jan42 (1)55-63

79

McClelland JF Parkes J Hill N et al Accommodative dysfunction in children with cerebral palsy a population-

based study Invest Ophthalmol Vis Sci 2006 May47(5)1824-30

Duckman RH Vision therapy for the child with cerebral palsy J Am Optom Assoc 198758(1)28-35

Duckman R Accommodation in cerebral palsy function and remediation J Am Optom Assoc 198455(4)281-3

Scheiman M Understanding and managing vision deficits a guide for occupational therapists 2nd ed Slack

Thorofare NJ 2002

Maino D Binasal occlusion for the child with Cerebral Palsy J Ill Optom Assoc 198644(1)1218

Battaglia F Quartarone A Rizzo V et al Early impairment of synaptic plasticity in patients with Downs syndrome

Neurobiol Aging 2008 Aug29(8)1272-5

Bonnier C Evaluation of early stimulation programs for enhancing brain development Acta Paediatr 2008

Jul97(7)853-8

Morice E Andreae LC Cooke SF et al Preservation of long-term memory and synaptic plasticity despite short-term

impairments in the Tc1 mouse model of Down syndrome Learn Mem 2008 Jul 1415(7)492-500

Gordon AM Schneider JA Chinnan A Charles JR Efficacy of a hand-arm bimanual intensive therapy (HABIT) in

children with hemiplegic cerebral palsy a randomized control trial Dev Med Child Neurol 2007 Nov49(11)830-8

Kapoor N Ciuffreda KJ Vision disturbances following traumatic brain injury Curr Treat Options Neurol 2002

Jul4(4)271-80

80

Ciuffreda KJ Rutner D Kapoor N et al Vision therapy for oculomotor dysfunctions in acquired brain injury a

retrospective analysis Optometry 2008 Jan79(1)18-22

Ciuffreda KJ Han Y Kapoor N Ficarra AP Oculomotor rehabilitation for reading in acquired brain injury

NeuroRehabilitation 200621(1)9-21

Zost M Diagnosis and management of visual dysfunction in cerebral injury In Maino D (ed) Diagnosis and

Management of Special Populations Mosby-Yearbook Inc St Louis 199579 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001 [Figure used with permission of the editor]

DeGutis JM Bentin S Robertson LC DEsposito M Functional plasticity in ventral temporal cortex following

cognitive rehabilitation of a congenital prosopagnosic J Cogn Neurosci 2007 Nov19 (11)1790-802

Welbourne SR Ralph MA Exploring the impact of plasticity-related recovery after brain damage in a connectionist

model of single-word reading Cogn Affect Behav Neurosci 2005 Mar5(1)77-92

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements prevent cognitive decline A

systematic review of randomized controlled trials J Hum Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among preterm infants attributable to early

supplementation of human milk with docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings and structural-functional

synergies with cell membrane phospholipids Altern Med Rev 2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function Neuroscience 20089(7)568-78

81

Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

BMC Biol 2008 Sep 9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine improves neuropsychological disorders in a child with

creatine transporter defect Neurocase 200814(2) 151-61

Forrester LW Wheaton LA Luft AR Exercise-mediated locomotor recovery and lower-limb neuroplasticity after

stroke J Rehabil Res Dev 200845(2)205-20

82

Page 30: Neuroplasticity: A Paradigm Sea Change Latest Updated File

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

A Refractive error development

Several recent studies have noted that neuroplasticity may play a

role in refractive error development

retinal defocus use of progressive addition lenses

drug studies (M1-antagonist2 pirenzepine ) slow myopia

progression demonstrated nearly a 50 reduction in myopia

progression over a two-year period

30

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged

7 to 17 years Arch Ophthalmol 2005 Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three

to less than 10 years of age Am J Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction

Am J Ophthalmol 2007 Jun143(6)1060-3

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine

vs patching for treatment of moderate amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-

57

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for

strabismic and anisometropic amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Treatment of severe amblyopia with weekend atropine results from 2 randomized clinical trials

Levodopacarbidopa in the treatment of amblyopia

31

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

J Pediatr Ophthalmol Strabismus 2009 Mar-Apr46(2)87-90 quiz 91-2 Levodopacarbidopa in the

treatment of amblyopia Dadeya S Vats P Malik KP

PURPOSE To evaluate the role of levodopacarbidopa in the treatment of amblyopia METHODS

Thirty patients with strabismic amblyopia between the ages of 3 and 12 years were part of this double-

blind randomized study Patients were divided into two groups Group A received 050 mg + 125 mg of

levodopacarbidopa per kilogram body weight three times daily after meals with a protein rich drink

whereas Group B received placebo Both groups received full-time conventional occlusion until a visual

acuity of 66 was achieved or for a maximum of 3 months RESULTS The authors observed more than

two lines improvement in visual acuity that was greater in the levodopa group (15 of 15) than in the

placebo group (9 of 15) (P lt 005) Furthermore improvement in visual acuity of more than two lines

was greater in patients younger than 8 years (100) than in patients older than 8 years of age (60) (P =

0026) There was also no significant reversal of the improved visual acuity in up to 6 months of follow-

up CONCLUSION Levodopacarbidopa improves visual acuity in patients with

amblyopia and maintains improved visual acuity especially in patients

younger than 8 years

32

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

J Pediatr Ophthalmol Strabismus 2008 May-Jun45(3)174-6 The use of levodopa in the treatment of

bilateral amblyopia secondary to uncorrected high hypermetropia Abrams MS

The standard treatment of bilateral amblyopia secondary to uncorrected high bilateral hypermetropia has

been spectacles and time The patient described here failed to show adequate improvement in visual

acuity after 18 months of standard treatment Visual acuity improved dramatically when the

patient began taking levodopa dropped precipitously when the medication was

discontinued and returned quickly to post-treatment levels when levodopa was

restarted Visual acuity remained stable when the medication was slowly tapered

and discontinued This report suggests that dopamine may play a role in the pathophysiology of

bilateral amblyopia secondary to uncorrected high bilateral hypermetropia

33

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

Bottom Line

Amblyopia can be treated at any age

May be able to use neuro-enhancing drugs

as a part of basic amblyopia therapy

34

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

C Strabismus and non-strabismic non-amblyopic binocular

vision disorders

Clinical Trial of Treatments for Symptomatic Convergence Insufficiency in Children has

clearly demonstrated the superiority of in-office optometric vision therapy (in conjunction

with home therapy) vs out-of-office therapy alone The study concluded that optometric

vision therapyorthoptics was more effective than pencil push-ups or placebo vision

therapyorthoptics in reducing symptoms and improving clinical signs of convergence

insufficiency

Long-term effectiveness of treatments for symptomatic convergence insufficiency

in children (Optom Vis Sci 2009 Sep86(9)1096-103)

CITT patients improvements lasted a year

35

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

Strabismus 1999 Sep7(3)169-74 Convergence insufficiency in

idiopathic Parkinsons disease responsive to levodopa Racette BA

Gokden MS Tychsen LS Perlmutter JS

We report a patient with pathologically proven idiopathic Parkinsons

disease (IPD) who developed diplopia secondary to convergence

insufficiency during his motor off periods Diplopia resolved with

onset of motor benefit from levodopa Neuro-ophthalmologic

examination demonstrated convergence insufficiency during motor

off periods that was alleviated after onset of motor benefit from

levodopa This is the first reported case of convergence insufficiency

in IPD responsive to levodopa

36

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

Bottom Line

Optometric Vision Therapy is the most efficacious treatment available for binocular vision disorders and the

treatment effects are long lasting Neuro-enhancing drugs

may assist us as well

37

EF Learning related vision anomalies Vision

developmentperception disorders

hellipresearch includes an examination of the role vision plays in

reading the effect of oculomotor vergence and

accommodativecoherent motion therapy on reading eye movements

and reading speed the diagnosis and treatment of perceptual

disorders and the effect of therapy on various learning anomalies

38

EF Learning related vision anomalies Vision developmentperception disorders

magnocellular (MC) deficit in dyslexia

LM speed-matching ratio predicts reading in childrenChase C Dougherty RF Ray N

Fowler S Stein JOptom Vis Sci 2007 Mar84(3)229-36

Effect of attention therapy on reading comprehension Solan HA Shelley-Tremblay J

Ficarra A Silverman M Larson S J Learn Disabil 2003 Nov-Dec36(6)556-63

Is there a common linkage among reading comprehension visual attention and

magnocellular processing Solan HA Shelley-Tremblay JF Hansen PC Larson S

J Learn Disabil 2007 May-Jun40(3)270-8

Lawton T Filtered Text and Direction Discrimination Training Improved Reading

Fluency for Both Dyslexic and Normal Readers Optom Vis Dev 200839 (3)114

Fischer B Hartnegg K Saccade control in dyslexia Development deficits training

and transfer to reading Optom Vis Dev 200839(4)181-190

39

EF Learning related vision anomalies Vision developmentperception disorders

J Learn Disabil 2003 Nov-Dec36(6)556-63 Effect of attention therapy on reading

comprehension Solan HA Shelley-Tremblay J Ficarra A Silverman M Larson S

hellip At the completion of attention therapy the mean

standard attention and reading comprehension scores of

the experimental group had improved significantly The

control group however showed no significant

improvement in reading comprehension scores after 12

weeks Although uncertainties still exist this investigation

supports the notion that visual attention is malleable and

that attention therapy has a significant effect on reading

comprehension in this often neglected population

40

VII Vision dysfunction association with acquired brain injury

A Exotropia (or high exophoriaCI)

B Accommodative dysfunction

C Convergence insufficiency

41

D Decreased blink rate

E Spatial disorientation

F Pursuitsaccade dysfunction

G Unstable ambient vision (Magnocellular pathway)

42

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Stelmack JA Frith T Van Koevering D Rinne S Stelmack TR Visual function in patients

followed at a Veterans Affairs polytrauma network site an electronic medical record review

Optometry 2009 Aug80(8)419-24

RESULTS Visual symptoms were self-reported by 76 of patients

with polytrauma and 75 of the patients with TBI Problems with reading

(polytrauma 60 and TBI 50) and accommodation (polytrauma 30 and

TBI 47) were frequently found on eye examinations Spectacles were the

treatment most frequently prescribed (polytrauma 62 and TBI 78)

CONCLUSIONS It is important for optometrists to be aware of the high

rates of self-reported symptoms and visual problems in military personnel

returning from deployment to the wars in Iraq and Afghanistan Post-

traumatic stress disorder and depression may complicate optometric

evaluation and management

43

VII Vision dysfunction association with acquired brain injury

Avoidance of near tasks

Oculomotor-based reading difficulties

Eye tracking problems

Eye focusing problems

Eyestrain Diplopia

Dizziness Vertigo

Vision-derived nausea

44

VII Vision dysfunction association with acquired brain injury

Increased sensitivity to visual motion

Visual inattention and distractibility

Short-term visual memory loss

Difficulty judging distances (relative and absolute

Difficulty with global scanning

Difficulty with personal grooming especially involving the face

Inability to interactcope visually in a complex social situation

(eg minimal eye contact)

Inability to tolerate complex visual environments (eg grocery store

aisles and highly-patterned floors)

45

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Ciuffreda KJ Ludlam DP Kapoor N Clinical oculomotor training in traumatic brain injury Optom Vis

Dev 200940(1)16-23

Individuals with traumatic brain injury present with a constellation of

oculomotor dysfunctions and correlated symptoms Simple and

effective clinical oculomotor-based training procedures will be

presented with respect to the versional vergence and

accommodative systems and their interactions These therapeutic

procedures can also be applied as needed to individuals with either

low vision neurological dysfunctions or general visual skills cases

manifesting similar oculomotor deficits

46

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Leslie S Myopia and accommodative insufficiency associated with

moderate head trauma Opt Vis Dev 200940(1)25-31

The majority of subjects reviewed had developed a stable degree of

myopia between 100 and 200 diopters as well as an abnormally

high lag of accommodation When their distance and near spatial area

of focus was compared the majority were focused at an intermediate

area in space suggesting a loss of control of accommodation in

space

47

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

B Drugs

C Exercise

D Learning new and challenging things

48

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements

prevent cognitive decline A systematic review of randomized controlled trials J Hum

Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among

preterm infants attributable to early supplementation of human milk with

docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings

and structural-functional synergies with cell membrane phospholipids Altern Med Rev

2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function

Neuroscience 20089(7)568-78

49

VIII Improving Brain Function and Neuroplasticity

B Drugs Maya Vetencourt JF Sale A Viegi A et al The antidepressant

fluoxetine (PROZAC) restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the

antidepressant tianeptine CNS Drugs 200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances

hippocampal long-term potentiation and memory BMC Biol 2008 Sep

9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine

improves neuropsychological disorders in a child with creatine

transporter defect Neurocase 200814(2) 151-61

50

VIII Improving Brain Function and Neuroplasticity

C Exercise

Hunsberger JG et al Antidepressant actions of the exercise-

regulated gene VGF Nat Med 2007 Dec 2 131476

VGF may be a common pathway by which exercise induces

neuroplasticity and growth-factor genes at least one of these might act

similarly to antidepressants in promoting an adaptive response to stress

However the tests used here may be modeling stress-induced

helplessness not depression hellipexercise seems to induce multiple

interacting genes that enhance neuronal resilience

51

VIII Improving Brain Function and Neuroplasticity

D Learning new and challenging things

What have we (optometry amp ophthalmology)

been thinking all these years

Where did we miss the news about neuroplasticity

52

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Huang JC Neuroplasticity as a proposed mechanism for the efficacy of optometric vision therapy and rehabilitation J Bev Optom 200920(4)96-100

Homologous area adaptationCompensatory masqueradeCross-modal reassignment

Map expansion

EquipotentialityVicariation

53

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Homologous area adaptation a transfer of function from a damaged brain area to a non-damaged brain area May be limited to early stages of human development and may crowd a new brain area resulting in reduced functionality of that brain area (Competition between spatial amp verbal functioning)

54

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Compensatory masquerade reorganizing of existing neuro-pathways to us alternative cognitive strategies to perform a task

55

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Cross-modal reassignment using new sensory input in a brain structure deprived of its main input source (changing processing from visual to tactile stimuli in the blind)

56

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Map expansion increase in brain mass due to repeated behavior or exposure to stimuli

57

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Equipotentiality anatomical areas of the brain can perform disparate functions

Vicariation redundant neural systems can operate under abnormal conditions

This may explain why recovery is noted for many neurological conditions (degenerative psychiatric developmental vascular traumatic)

58

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Constraint therapy Use it and improve it

Patching penalization ldquonear activitiesrdquo during amblyopia therapy

59

IX Improving Brain Function and Neuroplasticity Optometric Clinical ApplicationsOptometric Vision Therapy

Kleim amp Jones

Use it or lose it If you do not drive specific brain functions

functional loss will occur

If you want to improve oculomotor brain neuroplastic function amp

structure therapy should be specific for that brain function

Use it and improve it Therapy that drives cortical function enhances

that particular function

If you use therapy to improve oculomotor dysfunction it should

improve

Specificity The therapy you choose determines the resultant

plasticity and function

You must choose therapy that is appropriate

60

IX Improving Brain Function and Neuroplasticity Optometric Clinical Applications

Kleim amp Jones

Repetition matters Plasticity that results in functional change

requires repetition

Do the therapy Do it again Do it yet again No quick fix

Intensity matters Induction of plasticity requires the appropriate

amount of intensity

Intensity means strength force concentration power and passion

Without these plasticity may not occur Function may not improve

Time matters Different forms of plasticity take place at different

times during therapy

Do the basics than the more advanced therapeutic procedures

61

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Salience matters It has to be important to the individual

Make the therapy matter to the patient

Age matters Plasticity is easier in a younger brain but is also

possible in an adult brain

Do not let age determine what therapy options you offer your

patients Think of Susan Barry PhD (StereoSue) and her success

Offer your patients options Let them choose Be realistic about

outcomeshelliphave outcome measures built into therapy program

62

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Transference Neuroplasticity and the change in function

that results from one therapy can augment the attainment

of similar behaviors

What you do during oculomotor therapy may affected

vergence therapy outcomes

Interference Plasticity in response to one experience can

interfere with the acquisition of other behaviors

Monitor Evaluate progress Discuss function in other areas

of your patientslsquo life

63

Why pay attention to binocular vision dysfunctions

and neuroplasticity

December 2009 issue of the Review of Optometry

The Binocular Vision Dysfunction Pandemic

In 2010 almost 170 million individuals will be wearing glasses In

2010 there will also be up to 93 million amblyopes and 12 and a half

million strabismics For children under 18 years of age that means

there will be more than 22 and a half million amblyopes and millions

of children with strabismus A clinical trial to determine the

prevalence of binocular vision dysfunction within the general

population suggested the possibility of up to 56 or 173 million men

women and children with symptoms associated with a binocular

vision dysfunction 189 million (61) with accommodative problems

and 118 million (38) demonstrating various vergence

anomalies

64

65

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Brain plasticity life long changes in the structure of the brain

Sensory substitution replacement of one sensory input by another

Measurement techniques

Voxel based morphometryhellipmeasures difference in brain volume

Fluorodeoxyglucose glucose analog PET scan tells you

distribution and metabolism of brain

Cortical thickness measures

Visual cortex of the blind turns somatic ―The eye of the tongue

Transcranial magnetic stmiulation non-invasive technique to

stimulate cortex

66

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Blind Braille readers report tingling in fingers when pressure

phosphenes are applied Blind feel tingling in tongue

Bind use tongue to perform orientation task motion perception

sensory perception Visual cortex recruited in a variety of sensory

and cognitive tasks (DM Can we use tongue as a VT tool)

Dilks Reorganizations of human adult visual system

When a region of sensory cortex is deprived of its bottom up

input the deprived region begins to respond to stimuli that

normally activate adjacent cortex

67

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Retinotopic map changes for stroke pts Cortical reorganization in

adults occurs Perceived objectshellipelongation in stroke amp AMD

What happens to deprived cortex in AMD

fMRI shows cortical reorganization in adults

Proposed mechanisms

hellipGrowth of new connections

hellipUnmasking of pre-existing connections this is true

happens within seconds

Bavelier

Action video games

68

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Bavelier

Action video games Looked at attention Gamers can track more

activities

Attention over space (me peripheral awarenress) Useful field

of view shrinks with age

Performance not VA relatedhellipis related to attention

Action game playing changes spatial resolutionhellipovercoming

crowding in VA assessment (me amblyopia therapy)

Temporal resolution of vision Backward masking

changehellipbrain changes

Visual sensitivity (contrast sensitivity) Post action game training

improves CSF

69

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Action video games correcting optics of the cortex (me this is

actualy OVT)

Games factor

Variable entry leanringhellipadapt task to skill level

Incremental learning tune task to subjectlsquos leanring steps

Motivationarousal

Rewards

Self masterself confidence

Action games factors

Pacingrate of exposure to infohellipincreasing processing speed

Dynamic display

Rich environment

Rich motor involvement

70

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Surgeons may be made to play action games

Pilot training

Amblyopia tx Dennis Levi research

PresenterTitle Contact info

Neuroplasticity-A Paradigm Sea Change

This presentation is available at

httpwwwslidesharenetDMAINOneuroplasticity-a-paradigm-sea-change-2459693

httpwwwmainosmemosblogspotcom

My FaceBook Page

and

Twitter

PresenterTitle Contact info

Questions About

Neuroplasticity-A Paradigm Sea Change

Dominick M Maino OD MEd FAAO FCOVD-A

Professor PediatricsBinocular VisionIllinois Eye InstituteIllinois College of Optometry

dmainoicoeduhttpwwwMainosMemosblogspotcom

Thanks to

httpwwwcovdorgHomeOVDJournalOVD401tabid263D

efaultaspx

httpbipolarblastfileswordpresscom200908neurojpg

httpwwwspecialcheerscomimagesanimated_braingif

httpblogmarsdencartoonscomwp-

contentuploads200810frankenstein-myspace-lightbeergif

httpwwwshangralafamilyfuncomgala-ecalvindreamgif

httppsychiatryjwatchorgcgicontentfull20082251

73

Chakraborty R Chatterjee A Choudhart S Chakraborty PK Neuroplasticitymdasha paradigm shift in neurosciences J Indian Med Assoc

2007105(9)513-4516-8520-1

Sacks O A neurologistlsquos notebook Stereo Sue Why two eyes are better than one The New Yorker 2006 Jun 1964-73

Krulwich R National Public Radio Going Binocular Susanlsquos First Snowfall Available at

wwwnprorgtemplatesstorystoryphpstoryId=5507789 (Accessed December 8 2008)

Press LJ The story behind Stereo Suelsquo and a world-famous neurologistlsquos discovery of vision therapy Optom Vis Dev 200637(2) 55-7

Levin HS Neuroplasticity and brain imaging research implications for rehabilitation Arch Phys Med Rehabil 2006 Dec87(12 Suppl

2)S1

Wiesel TN Hubel DH Single-cell responses in striate cortex of kittens deprived of vision in one eye J Neurophysiol 1963

Nov261003-17

Hook BM Chen C Critical periods in the visual system Changing views for a model of experience-dependent plasticity Neuron 2007

Oct56(2)312-26

Ramey CT Ramey SL Prevention of intellectual disabilities early interventions to improve cognitive development Prev Med 1998

Mar-Apr27(2)224-32

Heuninckx S Wenderoth N Swinnen SP Systems neuroplasticity in the aging brain recruiting additional neural resources for

successful motor performance in elderly persons J Neurosci 2008 Jan 228(1)91-9

Ge S Yang CH Hsu KS et al A critical period for enhanced synaptic plasticity in newly generated neurons of the adult brain Neuron

2007 May54(4)559-66

74

Draganski B Gaser C Busch V et al Neuroplasticity changes in grey matter induced by training Nature 2004 Jan 22427(6972)

311-2

Cannonieri GC Bonilha L Fernandes PT et al Practice and perfect length of training and structural brain changes in experienced

typists Neuroreport 2007 Jul 218(10)1063-6

Kleim JA Jones TA Principles of experience-dependent neural plasticity implications for rehabilitation after brain damage J

Speech Lang Hear Res 2008 Feb51(1)S225-39

Trojan S Porkorny J Theoretical aspects of neuroplasticity Physiol Res 199948(2)87-97

Ramamirtham R Kee CS Hung LF et al Wave aberrations in rhesus monkeys with vision-induced ametropias Vision Res 2007

Sep47(21)2751-66

Smith EL 3rd Ramamirtham R Qiao-Grider Y et al Effects of foveal ablation on emmetropization and form-deprivation myopia

Invest Ophthalmol Vis Sci 2007 Sep48(9)3914-22

Smith EL 3rd Kee CS Ramamirtham R et al Peripheral vision can influence eye growth and refractive development in infant

monkeys Invest Ophthalmol Vis Sci 2005 Nov46(11)3965-72

Ciuffreda KJ Vasudevan B Nearwork-induced transient myopia (NITM) and permanent myopiandashndashis there a link Ophthalmic

Physiol Opt 2008 Mar28(2)103-14

Hung GK Ciuffreda KJ Incremental retinal-defocus theory of myopia development--schematic analysis and computer simulation

Comput Biol Med 2007 Jul37(7)930-46

Hung GK Ciuffreda KJ A unifying theory of refractive error development Bull Math Biol 2000 Nov62(6)1087-108

75

Pang Y Maino D Zhang G Lu F Myopia Can its progress be controlled Optom Vis Dev 200637(2)75-9

Leung JT Brown B Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lenses Optom Vis Sci

1999 Jun76(6)346-54

Hasebe S Ohtsuki H Nonaka T et al Effect of progressive addition lenses on myopia progression in Japanese children a prospective

randomized double-masked crossover trial Invest Ophthalmol Vis Sci 2008 Jul49(7)2781-9

Gwiazda J Hyman L Hussein M et al A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression

of myopia in children Invest Ophthalmol Vis Sci 2003 Apr44(4)1492-500

Siatkowski RM Cotter SA Crockett RS et al Two-year multi-center randomized double-masked placebo-controlled parallel safety and

efficacy study of 2 pirenzepine ophthalmic gel in children with myopia J AAPOS 2008 Aug12(4)332-9

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged 7 to 17 years Arch Ophthalmol 2005

Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three to less than 10 years of age Am J

Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction Am J Ophthalmol 2007

Jun143(6)1060-3

Holmes JM Edwards AR Beck RW et al A randomized pilot study of near activities versus non-near activities during patching therapy for

amblyopia J AAPOS 2005 Apr9(2)129-36

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate

amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-57

76

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic

amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Convergence Insufficiency Treatment Trial Study Group Randomized clinical trial of treatments for symptomatic convergence insufficiency

in children Arch Ophthalmol 2008 Oct126(10)1336-49

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

Solan HA Shelley-Tremblay J Hansen PC et al M-cell deficit and reading disability a preliminary study of the effects of temporal vision-

processing therapy Optometry 2004 Oct75(10)640-50

Solan HA Larson S Shelley-Tremblay J et al Role of visual attention in cognitive control of oculomotor readiness in students with reading

disabilities J Learn Disabil 2001 Mar-Apr34(2)107-18

Gallaway M Boas MB The impact of vergence and accommodative therapy on reading eye movements and reading speed Optom Vis Dev

200738(3)115-20

Goss DA Downing DB Lowther AH et al The effect of HTS vision therapy conducted in a school setting on reading skills in third and

fourth grade students Optom Vis Dev 200738(1)27-32

Crutch SJ Warrington EK Foveal crowding in posterior cortical atrophy a specific early-visual-processing deficit affecting word reading

Cogn Neuropsychol 2007 Dec24(8)843-66

Helms D Sawtelle SM A study of the effectiveness of cognitive therapy delivered in a video game format Optom Vis Dev 200738 (1)19-

26

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

77

Lawton T Training direction-discrimination sensitivity remediates a wide spectrum of reading skills OptomVis Dev 200738(1) 33-47

Goldstand S Koslowe KC Parush S Vision visual-information processing and academic performance among seventh-grade schoolchildren a

more significant relationship than we thought Am J Occup Ther 2005 Jul-Aug59(4)377-89

Fischer B Koumlngeter A Hartnegg K Effects of daily practice on subitizing visual counting and basic arithmetic skills Optom Vis Dev

200839(1)30-4

Sands W Taub M Maino D Limited research and education on special populations in optometry and ophthalomology Optom Vis Dev

200839(2)60-1

Wesson M Maino D Oculo-visual findings in Down syndrome cerebral palsy and mental retardation with non-specific etiology In Maino D

(ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 199517-54 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

Cui Y Stapleton F Suttle C Developing an instrument to assess vision-related and subjective quality of life in children with intellectual

disability data collection and preliminary analysis in a Chinese population Ophthal Physiolog Optics 2008 May28(3) 238-46

Maino D Steele G Tahir S Sajja R Attitudes of optometry students toward individuals with disabilities Optom Ed 200227(2)45-50

Maino D Special populations in the optometric curriculum Optom Ed 200227(2)38-9

Maino D Overview of special populations In Scheiman M Rouse M (eds) Optometric Management of Learning-Related Vision Problems

St Louis Mosby Inc 200685-106

Maino D (ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 1995 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

78

McCarthy P Maino D Alport syndrome a review Clin Eye Vis Care 2000 Dec12(3-4)139-50

Block SS Brusca-Vega R Pizzi WJ et al Cognitive and visual processing skills and their relationship to mutation size in full and

permutation female fragile X carriers Optom Vis Sci 2000 Nov77 (11)592-9

Maino D The young child with developmental disabilities An introduction to mental retardation and genetic syndromes In Moore BD

(ed) Eye Care for Infants and Young Children Butter-worth--Heinemann Newton MA1997285-300

Amin V Maino D The Fragile X female Visual visual perceptual and ocular health anomalies J Am Optom Assoc 1995 May66

(5)290-95

Maino DM Maino JH Cibis GW Hecht F Ocular health anomalies in patients with developmental disabilities In Maino D (ed)

Diagnosis and Management of Special Populations Mosby-Year-book Inc St Louis MO 1995189-206 Reprinted Optometric

Education Program Foundation Santa Anna Calif 2001

Maino D Wesson M Schlange D Cibis G Maino J Optometric findings in the fragile X syndrome Optom Vis Sci 199168634-40

Scheiman MMOptometric findings in children with cerebral palsy Am J Optom Physiol Opt 1984 May61(5)321-3

Maino D Maino J Maino S Mental retardation syndromes with associated ocular defects J Am Optom Assoc 199061707-16

Stewart RE Woodhouse JM Cregg M Pakeman VH Association between accommodative accuracy hypermetropia and strabismus in

children with Downs syndrome Optom Vis Sci 2007 Feb84(2)149-55

Cregg M Woodhouse JM Pakeman VH et al Accommodation and refractive error in children with Down syndrome cross-sectional

and longitudinal studies Invest Ophthalmol Vis Sci 2001 Jan42 (1)55-63

79

McClelland JF Parkes J Hill N et al Accommodative dysfunction in children with cerebral palsy a population-

based study Invest Ophthalmol Vis Sci 2006 May47(5)1824-30

Duckman RH Vision therapy for the child with cerebral palsy J Am Optom Assoc 198758(1)28-35

Duckman R Accommodation in cerebral palsy function and remediation J Am Optom Assoc 198455(4)281-3

Scheiman M Understanding and managing vision deficits a guide for occupational therapists 2nd ed Slack

Thorofare NJ 2002

Maino D Binasal occlusion for the child with Cerebral Palsy J Ill Optom Assoc 198644(1)1218

Battaglia F Quartarone A Rizzo V et al Early impairment of synaptic plasticity in patients with Downs syndrome

Neurobiol Aging 2008 Aug29(8)1272-5

Bonnier C Evaluation of early stimulation programs for enhancing brain development Acta Paediatr 2008

Jul97(7)853-8

Morice E Andreae LC Cooke SF et al Preservation of long-term memory and synaptic plasticity despite short-term

impairments in the Tc1 mouse model of Down syndrome Learn Mem 2008 Jul 1415(7)492-500

Gordon AM Schneider JA Chinnan A Charles JR Efficacy of a hand-arm bimanual intensive therapy (HABIT) in

children with hemiplegic cerebral palsy a randomized control trial Dev Med Child Neurol 2007 Nov49(11)830-8

Kapoor N Ciuffreda KJ Vision disturbances following traumatic brain injury Curr Treat Options Neurol 2002

Jul4(4)271-80

80

Ciuffreda KJ Rutner D Kapoor N et al Vision therapy for oculomotor dysfunctions in acquired brain injury a

retrospective analysis Optometry 2008 Jan79(1)18-22

Ciuffreda KJ Han Y Kapoor N Ficarra AP Oculomotor rehabilitation for reading in acquired brain injury

NeuroRehabilitation 200621(1)9-21

Zost M Diagnosis and management of visual dysfunction in cerebral injury In Maino D (ed) Diagnosis and

Management of Special Populations Mosby-Yearbook Inc St Louis 199579 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001 [Figure used with permission of the editor]

DeGutis JM Bentin S Robertson LC DEsposito M Functional plasticity in ventral temporal cortex following

cognitive rehabilitation of a congenital prosopagnosic J Cogn Neurosci 2007 Nov19 (11)1790-802

Welbourne SR Ralph MA Exploring the impact of plasticity-related recovery after brain damage in a connectionist

model of single-word reading Cogn Affect Behav Neurosci 2005 Mar5(1)77-92

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements prevent cognitive decline A

systematic review of randomized controlled trials J Hum Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among preterm infants attributable to early

supplementation of human milk with docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings and structural-functional

synergies with cell membrane phospholipids Altern Med Rev 2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function Neuroscience 20089(7)568-78

81

Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

BMC Biol 2008 Sep 9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine improves neuropsychological disorders in a child with

creatine transporter defect Neurocase 200814(2) 151-61

Forrester LW Wheaton LA Luft AR Exercise-mediated locomotor recovery and lower-limb neuroplasticity after

stroke J Rehabil Res Dev 200845(2)205-20

82

Page 31: Neuroplasticity: A Paradigm Sea Change Latest Updated File

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged

7 to 17 years Arch Ophthalmol 2005 Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three

to less than 10 years of age Am J Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction

Am J Ophthalmol 2007 Jun143(6)1060-3

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine

vs patching for treatment of moderate amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-

57

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for

strabismic and anisometropic amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Treatment of severe amblyopia with weekend atropine results from 2 randomized clinical trials

Levodopacarbidopa in the treatment of amblyopia

31

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

J Pediatr Ophthalmol Strabismus 2009 Mar-Apr46(2)87-90 quiz 91-2 Levodopacarbidopa in the

treatment of amblyopia Dadeya S Vats P Malik KP

PURPOSE To evaluate the role of levodopacarbidopa in the treatment of amblyopia METHODS

Thirty patients with strabismic amblyopia between the ages of 3 and 12 years were part of this double-

blind randomized study Patients were divided into two groups Group A received 050 mg + 125 mg of

levodopacarbidopa per kilogram body weight three times daily after meals with a protein rich drink

whereas Group B received placebo Both groups received full-time conventional occlusion until a visual

acuity of 66 was achieved or for a maximum of 3 months RESULTS The authors observed more than

two lines improvement in visual acuity that was greater in the levodopa group (15 of 15) than in the

placebo group (9 of 15) (P lt 005) Furthermore improvement in visual acuity of more than two lines

was greater in patients younger than 8 years (100) than in patients older than 8 years of age (60) (P =

0026) There was also no significant reversal of the improved visual acuity in up to 6 months of follow-

up CONCLUSION Levodopacarbidopa improves visual acuity in patients with

amblyopia and maintains improved visual acuity especially in patients

younger than 8 years

32

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

J Pediatr Ophthalmol Strabismus 2008 May-Jun45(3)174-6 The use of levodopa in the treatment of

bilateral amblyopia secondary to uncorrected high hypermetropia Abrams MS

The standard treatment of bilateral amblyopia secondary to uncorrected high bilateral hypermetropia has

been spectacles and time The patient described here failed to show adequate improvement in visual

acuity after 18 months of standard treatment Visual acuity improved dramatically when the

patient began taking levodopa dropped precipitously when the medication was

discontinued and returned quickly to post-treatment levels when levodopa was

restarted Visual acuity remained stable when the medication was slowly tapered

and discontinued This report suggests that dopamine may play a role in the pathophysiology of

bilateral amblyopia secondary to uncorrected high bilateral hypermetropia

33

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

Bottom Line

Amblyopia can be treated at any age

May be able to use neuro-enhancing drugs

as a part of basic amblyopia therapy

34

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

C Strabismus and non-strabismic non-amblyopic binocular

vision disorders

Clinical Trial of Treatments for Symptomatic Convergence Insufficiency in Children has

clearly demonstrated the superiority of in-office optometric vision therapy (in conjunction

with home therapy) vs out-of-office therapy alone The study concluded that optometric

vision therapyorthoptics was more effective than pencil push-ups or placebo vision

therapyorthoptics in reducing symptoms and improving clinical signs of convergence

insufficiency

Long-term effectiveness of treatments for symptomatic convergence insufficiency

in children (Optom Vis Sci 2009 Sep86(9)1096-103)

CITT patients improvements lasted a year

35

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

Strabismus 1999 Sep7(3)169-74 Convergence insufficiency in

idiopathic Parkinsons disease responsive to levodopa Racette BA

Gokden MS Tychsen LS Perlmutter JS

We report a patient with pathologically proven idiopathic Parkinsons

disease (IPD) who developed diplopia secondary to convergence

insufficiency during his motor off periods Diplopia resolved with

onset of motor benefit from levodopa Neuro-ophthalmologic

examination demonstrated convergence insufficiency during motor

off periods that was alleviated after onset of motor benefit from

levodopa This is the first reported case of convergence insufficiency

in IPD responsive to levodopa

36

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

Bottom Line

Optometric Vision Therapy is the most efficacious treatment available for binocular vision disorders and the

treatment effects are long lasting Neuro-enhancing drugs

may assist us as well

37

EF Learning related vision anomalies Vision

developmentperception disorders

hellipresearch includes an examination of the role vision plays in

reading the effect of oculomotor vergence and

accommodativecoherent motion therapy on reading eye movements

and reading speed the diagnosis and treatment of perceptual

disorders and the effect of therapy on various learning anomalies

38

EF Learning related vision anomalies Vision developmentperception disorders

magnocellular (MC) deficit in dyslexia

LM speed-matching ratio predicts reading in childrenChase C Dougherty RF Ray N

Fowler S Stein JOptom Vis Sci 2007 Mar84(3)229-36

Effect of attention therapy on reading comprehension Solan HA Shelley-Tremblay J

Ficarra A Silverman M Larson S J Learn Disabil 2003 Nov-Dec36(6)556-63

Is there a common linkage among reading comprehension visual attention and

magnocellular processing Solan HA Shelley-Tremblay JF Hansen PC Larson S

J Learn Disabil 2007 May-Jun40(3)270-8

Lawton T Filtered Text and Direction Discrimination Training Improved Reading

Fluency for Both Dyslexic and Normal Readers Optom Vis Dev 200839 (3)114

Fischer B Hartnegg K Saccade control in dyslexia Development deficits training

and transfer to reading Optom Vis Dev 200839(4)181-190

39

EF Learning related vision anomalies Vision developmentperception disorders

J Learn Disabil 2003 Nov-Dec36(6)556-63 Effect of attention therapy on reading

comprehension Solan HA Shelley-Tremblay J Ficarra A Silverman M Larson S

hellip At the completion of attention therapy the mean

standard attention and reading comprehension scores of

the experimental group had improved significantly The

control group however showed no significant

improvement in reading comprehension scores after 12

weeks Although uncertainties still exist this investigation

supports the notion that visual attention is malleable and

that attention therapy has a significant effect on reading

comprehension in this often neglected population

40

VII Vision dysfunction association with acquired brain injury

A Exotropia (or high exophoriaCI)

B Accommodative dysfunction

C Convergence insufficiency

41

D Decreased blink rate

E Spatial disorientation

F Pursuitsaccade dysfunction

G Unstable ambient vision (Magnocellular pathway)

42

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Stelmack JA Frith T Van Koevering D Rinne S Stelmack TR Visual function in patients

followed at a Veterans Affairs polytrauma network site an electronic medical record review

Optometry 2009 Aug80(8)419-24

RESULTS Visual symptoms were self-reported by 76 of patients

with polytrauma and 75 of the patients with TBI Problems with reading

(polytrauma 60 and TBI 50) and accommodation (polytrauma 30 and

TBI 47) were frequently found on eye examinations Spectacles were the

treatment most frequently prescribed (polytrauma 62 and TBI 78)

CONCLUSIONS It is important for optometrists to be aware of the high

rates of self-reported symptoms and visual problems in military personnel

returning from deployment to the wars in Iraq and Afghanistan Post-

traumatic stress disorder and depression may complicate optometric

evaluation and management

43

VII Vision dysfunction association with acquired brain injury

Avoidance of near tasks

Oculomotor-based reading difficulties

Eye tracking problems

Eye focusing problems

Eyestrain Diplopia

Dizziness Vertigo

Vision-derived nausea

44

VII Vision dysfunction association with acquired brain injury

Increased sensitivity to visual motion

Visual inattention and distractibility

Short-term visual memory loss

Difficulty judging distances (relative and absolute

Difficulty with global scanning

Difficulty with personal grooming especially involving the face

Inability to interactcope visually in a complex social situation

(eg minimal eye contact)

Inability to tolerate complex visual environments (eg grocery store

aisles and highly-patterned floors)

45

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Ciuffreda KJ Ludlam DP Kapoor N Clinical oculomotor training in traumatic brain injury Optom Vis

Dev 200940(1)16-23

Individuals with traumatic brain injury present with a constellation of

oculomotor dysfunctions and correlated symptoms Simple and

effective clinical oculomotor-based training procedures will be

presented with respect to the versional vergence and

accommodative systems and their interactions These therapeutic

procedures can also be applied as needed to individuals with either

low vision neurological dysfunctions or general visual skills cases

manifesting similar oculomotor deficits

46

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Leslie S Myopia and accommodative insufficiency associated with

moderate head trauma Opt Vis Dev 200940(1)25-31

The majority of subjects reviewed had developed a stable degree of

myopia between 100 and 200 diopters as well as an abnormally

high lag of accommodation When their distance and near spatial area

of focus was compared the majority were focused at an intermediate

area in space suggesting a loss of control of accommodation in

space

47

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

B Drugs

C Exercise

D Learning new and challenging things

48

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements

prevent cognitive decline A systematic review of randomized controlled trials J Hum

Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among

preterm infants attributable to early supplementation of human milk with

docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings

and structural-functional synergies with cell membrane phospholipids Altern Med Rev

2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function

Neuroscience 20089(7)568-78

49

VIII Improving Brain Function and Neuroplasticity

B Drugs Maya Vetencourt JF Sale A Viegi A et al The antidepressant

fluoxetine (PROZAC) restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the

antidepressant tianeptine CNS Drugs 200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances

hippocampal long-term potentiation and memory BMC Biol 2008 Sep

9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine

improves neuropsychological disorders in a child with creatine

transporter defect Neurocase 200814(2) 151-61

50

VIII Improving Brain Function and Neuroplasticity

C Exercise

Hunsberger JG et al Antidepressant actions of the exercise-

regulated gene VGF Nat Med 2007 Dec 2 131476

VGF may be a common pathway by which exercise induces

neuroplasticity and growth-factor genes at least one of these might act

similarly to antidepressants in promoting an adaptive response to stress

However the tests used here may be modeling stress-induced

helplessness not depression hellipexercise seems to induce multiple

interacting genes that enhance neuronal resilience

51

VIII Improving Brain Function and Neuroplasticity

D Learning new and challenging things

What have we (optometry amp ophthalmology)

been thinking all these years

Where did we miss the news about neuroplasticity

52

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Huang JC Neuroplasticity as a proposed mechanism for the efficacy of optometric vision therapy and rehabilitation J Bev Optom 200920(4)96-100

Homologous area adaptationCompensatory masqueradeCross-modal reassignment

Map expansion

EquipotentialityVicariation

53

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Homologous area adaptation a transfer of function from a damaged brain area to a non-damaged brain area May be limited to early stages of human development and may crowd a new brain area resulting in reduced functionality of that brain area (Competition between spatial amp verbal functioning)

54

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Compensatory masquerade reorganizing of existing neuro-pathways to us alternative cognitive strategies to perform a task

55

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Cross-modal reassignment using new sensory input in a brain structure deprived of its main input source (changing processing from visual to tactile stimuli in the blind)

56

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Map expansion increase in brain mass due to repeated behavior or exposure to stimuli

57

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Equipotentiality anatomical areas of the brain can perform disparate functions

Vicariation redundant neural systems can operate under abnormal conditions

This may explain why recovery is noted for many neurological conditions (degenerative psychiatric developmental vascular traumatic)

58

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Constraint therapy Use it and improve it

Patching penalization ldquonear activitiesrdquo during amblyopia therapy

59

IX Improving Brain Function and Neuroplasticity Optometric Clinical ApplicationsOptometric Vision Therapy

Kleim amp Jones

Use it or lose it If you do not drive specific brain functions

functional loss will occur

If you want to improve oculomotor brain neuroplastic function amp

structure therapy should be specific for that brain function

Use it and improve it Therapy that drives cortical function enhances

that particular function

If you use therapy to improve oculomotor dysfunction it should

improve

Specificity The therapy you choose determines the resultant

plasticity and function

You must choose therapy that is appropriate

60

IX Improving Brain Function and Neuroplasticity Optometric Clinical Applications

Kleim amp Jones

Repetition matters Plasticity that results in functional change

requires repetition

Do the therapy Do it again Do it yet again No quick fix

Intensity matters Induction of plasticity requires the appropriate

amount of intensity

Intensity means strength force concentration power and passion

Without these plasticity may not occur Function may not improve

Time matters Different forms of plasticity take place at different

times during therapy

Do the basics than the more advanced therapeutic procedures

61

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Salience matters It has to be important to the individual

Make the therapy matter to the patient

Age matters Plasticity is easier in a younger brain but is also

possible in an adult brain

Do not let age determine what therapy options you offer your

patients Think of Susan Barry PhD (StereoSue) and her success

Offer your patients options Let them choose Be realistic about

outcomeshelliphave outcome measures built into therapy program

62

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Transference Neuroplasticity and the change in function

that results from one therapy can augment the attainment

of similar behaviors

What you do during oculomotor therapy may affected

vergence therapy outcomes

Interference Plasticity in response to one experience can

interfere with the acquisition of other behaviors

Monitor Evaluate progress Discuss function in other areas

of your patientslsquo life

63

Why pay attention to binocular vision dysfunctions

and neuroplasticity

December 2009 issue of the Review of Optometry

The Binocular Vision Dysfunction Pandemic

In 2010 almost 170 million individuals will be wearing glasses In

2010 there will also be up to 93 million amblyopes and 12 and a half

million strabismics For children under 18 years of age that means

there will be more than 22 and a half million amblyopes and millions

of children with strabismus A clinical trial to determine the

prevalence of binocular vision dysfunction within the general

population suggested the possibility of up to 56 or 173 million men

women and children with symptoms associated with a binocular

vision dysfunction 189 million (61) with accommodative problems

and 118 million (38) demonstrating various vergence

anomalies

64

65

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Brain plasticity life long changes in the structure of the brain

Sensory substitution replacement of one sensory input by another

Measurement techniques

Voxel based morphometryhellipmeasures difference in brain volume

Fluorodeoxyglucose glucose analog PET scan tells you

distribution and metabolism of brain

Cortical thickness measures

Visual cortex of the blind turns somatic ―The eye of the tongue

Transcranial magnetic stmiulation non-invasive technique to

stimulate cortex

66

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Blind Braille readers report tingling in fingers when pressure

phosphenes are applied Blind feel tingling in tongue

Bind use tongue to perform orientation task motion perception

sensory perception Visual cortex recruited in a variety of sensory

and cognitive tasks (DM Can we use tongue as a VT tool)

Dilks Reorganizations of human adult visual system

When a region of sensory cortex is deprived of its bottom up

input the deprived region begins to respond to stimuli that

normally activate adjacent cortex

67

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Retinotopic map changes for stroke pts Cortical reorganization in

adults occurs Perceived objectshellipelongation in stroke amp AMD

What happens to deprived cortex in AMD

fMRI shows cortical reorganization in adults

Proposed mechanisms

hellipGrowth of new connections

hellipUnmasking of pre-existing connections this is true

happens within seconds

Bavelier

Action video games

68

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Bavelier

Action video games Looked at attention Gamers can track more

activities

Attention over space (me peripheral awarenress) Useful field

of view shrinks with age

Performance not VA relatedhellipis related to attention

Action game playing changes spatial resolutionhellipovercoming

crowding in VA assessment (me amblyopia therapy)

Temporal resolution of vision Backward masking

changehellipbrain changes

Visual sensitivity (contrast sensitivity) Post action game training

improves CSF

69

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Action video games correcting optics of the cortex (me this is

actualy OVT)

Games factor

Variable entry leanringhellipadapt task to skill level

Incremental learning tune task to subjectlsquos leanring steps

Motivationarousal

Rewards

Self masterself confidence

Action games factors

Pacingrate of exposure to infohellipincreasing processing speed

Dynamic display

Rich environment

Rich motor involvement

70

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Surgeons may be made to play action games

Pilot training

Amblyopia tx Dennis Levi research

PresenterTitle Contact info

Neuroplasticity-A Paradigm Sea Change

This presentation is available at

httpwwwslidesharenetDMAINOneuroplasticity-a-paradigm-sea-change-2459693

httpwwwmainosmemosblogspotcom

My FaceBook Page

and

Twitter

PresenterTitle Contact info

Questions About

Neuroplasticity-A Paradigm Sea Change

Dominick M Maino OD MEd FAAO FCOVD-A

Professor PediatricsBinocular VisionIllinois Eye InstituteIllinois College of Optometry

dmainoicoeduhttpwwwMainosMemosblogspotcom

Thanks to

httpwwwcovdorgHomeOVDJournalOVD401tabid263D

efaultaspx

httpbipolarblastfileswordpresscom200908neurojpg

httpwwwspecialcheerscomimagesanimated_braingif

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contentuploads200810frankenstein-myspace-lightbeergif

httpwwwshangralafamilyfuncomgala-ecalvindreamgif

httppsychiatryjwatchorgcgicontentfull20082251

73

Chakraborty R Chatterjee A Choudhart S Chakraborty PK Neuroplasticitymdasha paradigm shift in neurosciences J Indian Med Assoc

2007105(9)513-4516-8520-1

Sacks O A neurologistlsquos notebook Stereo Sue Why two eyes are better than one The New Yorker 2006 Jun 1964-73

Krulwich R National Public Radio Going Binocular Susanlsquos First Snowfall Available at

wwwnprorgtemplatesstorystoryphpstoryId=5507789 (Accessed December 8 2008)

Press LJ The story behind Stereo Suelsquo and a world-famous neurologistlsquos discovery of vision therapy Optom Vis Dev 200637(2) 55-7

Levin HS Neuroplasticity and brain imaging research implications for rehabilitation Arch Phys Med Rehabil 2006 Dec87(12 Suppl

2)S1

Wiesel TN Hubel DH Single-cell responses in striate cortex of kittens deprived of vision in one eye J Neurophysiol 1963

Nov261003-17

Hook BM Chen C Critical periods in the visual system Changing views for a model of experience-dependent plasticity Neuron 2007

Oct56(2)312-26

Ramey CT Ramey SL Prevention of intellectual disabilities early interventions to improve cognitive development Prev Med 1998

Mar-Apr27(2)224-32

Heuninckx S Wenderoth N Swinnen SP Systems neuroplasticity in the aging brain recruiting additional neural resources for

successful motor performance in elderly persons J Neurosci 2008 Jan 228(1)91-9

Ge S Yang CH Hsu KS et al A critical period for enhanced synaptic plasticity in newly generated neurons of the adult brain Neuron

2007 May54(4)559-66

74

Draganski B Gaser C Busch V et al Neuroplasticity changes in grey matter induced by training Nature 2004 Jan 22427(6972)

311-2

Cannonieri GC Bonilha L Fernandes PT et al Practice and perfect length of training and structural brain changes in experienced

typists Neuroreport 2007 Jul 218(10)1063-6

Kleim JA Jones TA Principles of experience-dependent neural plasticity implications for rehabilitation after brain damage J

Speech Lang Hear Res 2008 Feb51(1)S225-39

Trojan S Porkorny J Theoretical aspects of neuroplasticity Physiol Res 199948(2)87-97

Ramamirtham R Kee CS Hung LF et al Wave aberrations in rhesus monkeys with vision-induced ametropias Vision Res 2007

Sep47(21)2751-66

Smith EL 3rd Ramamirtham R Qiao-Grider Y et al Effects of foveal ablation on emmetropization and form-deprivation myopia

Invest Ophthalmol Vis Sci 2007 Sep48(9)3914-22

Smith EL 3rd Kee CS Ramamirtham R et al Peripheral vision can influence eye growth and refractive development in infant

monkeys Invest Ophthalmol Vis Sci 2005 Nov46(11)3965-72

Ciuffreda KJ Vasudevan B Nearwork-induced transient myopia (NITM) and permanent myopiandashndashis there a link Ophthalmic

Physiol Opt 2008 Mar28(2)103-14

Hung GK Ciuffreda KJ Incremental retinal-defocus theory of myopia development--schematic analysis and computer simulation

Comput Biol Med 2007 Jul37(7)930-46

Hung GK Ciuffreda KJ A unifying theory of refractive error development Bull Math Biol 2000 Nov62(6)1087-108

75

Pang Y Maino D Zhang G Lu F Myopia Can its progress be controlled Optom Vis Dev 200637(2)75-9

Leung JT Brown B Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lenses Optom Vis Sci

1999 Jun76(6)346-54

Hasebe S Ohtsuki H Nonaka T et al Effect of progressive addition lenses on myopia progression in Japanese children a prospective

randomized double-masked crossover trial Invest Ophthalmol Vis Sci 2008 Jul49(7)2781-9

Gwiazda J Hyman L Hussein M et al A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression

of myopia in children Invest Ophthalmol Vis Sci 2003 Apr44(4)1492-500

Siatkowski RM Cotter SA Crockett RS et al Two-year multi-center randomized double-masked placebo-controlled parallel safety and

efficacy study of 2 pirenzepine ophthalmic gel in children with myopia J AAPOS 2008 Aug12(4)332-9

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged 7 to 17 years Arch Ophthalmol 2005

Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three to less than 10 years of age Am J

Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction Am J Ophthalmol 2007

Jun143(6)1060-3

Holmes JM Edwards AR Beck RW et al A randomized pilot study of near activities versus non-near activities during patching therapy for

amblyopia J AAPOS 2005 Apr9(2)129-36

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate

amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-57

76

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic

amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Convergence Insufficiency Treatment Trial Study Group Randomized clinical trial of treatments for symptomatic convergence insufficiency

in children Arch Ophthalmol 2008 Oct126(10)1336-49

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

Solan HA Shelley-Tremblay J Hansen PC et al M-cell deficit and reading disability a preliminary study of the effects of temporal vision-

processing therapy Optometry 2004 Oct75(10)640-50

Solan HA Larson S Shelley-Tremblay J et al Role of visual attention in cognitive control of oculomotor readiness in students with reading

disabilities J Learn Disabil 2001 Mar-Apr34(2)107-18

Gallaway M Boas MB The impact of vergence and accommodative therapy on reading eye movements and reading speed Optom Vis Dev

200738(3)115-20

Goss DA Downing DB Lowther AH et al The effect of HTS vision therapy conducted in a school setting on reading skills in third and

fourth grade students Optom Vis Dev 200738(1)27-32

Crutch SJ Warrington EK Foveal crowding in posterior cortical atrophy a specific early-visual-processing deficit affecting word reading

Cogn Neuropsychol 2007 Dec24(8)843-66

Helms D Sawtelle SM A study of the effectiveness of cognitive therapy delivered in a video game format Optom Vis Dev 200738 (1)19-

26

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

77

Lawton T Training direction-discrimination sensitivity remediates a wide spectrum of reading skills OptomVis Dev 200738(1) 33-47

Goldstand S Koslowe KC Parush S Vision visual-information processing and academic performance among seventh-grade schoolchildren a

more significant relationship than we thought Am J Occup Ther 2005 Jul-Aug59(4)377-89

Fischer B Koumlngeter A Hartnegg K Effects of daily practice on subitizing visual counting and basic arithmetic skills Optom Vis Dev

200839(1)30-4

Sands W Taub M Maino D Limited research and education on special populations in optometry and ophthalomology Optom Vis Dev

200839(2)60-1

Wesson M Maino D Oculo-visual findings in Down syndrome cerebral palsy and mental retardation with non-specific etiology In Maino D

(ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 199517-54 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

Cui Y Stapleton F Suttle C Developing an instrument to assess vision-related and subjective quality of life in children with intellectual

disability data collection and preliminary analysis in a Chinese population Ophthal Physiolog Optics 2008 May28(3) 238-46

Maino D Steele G Tahir S Sajja R Attitudes of optometry students toward individuals with disabilities Optom Ed 200227(2)45-50

Maino D Special populations in the optometric curriculum Optom Ed 200227(2)38-9

Maino D Overview of special populations In Scheiman M Rouse M (eds) Optometric Management of Learning-Related Vision Problems

St Louis Mosby Inc 200685-106

Maino D (ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 1995 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

78

McCarthy P Maino D Alport syndrome a review Clin Eye Vis Care 2000 Dec12(3-4)139-50

Block SS Brusca-Vega R Pizzi WJ et al Cognitive and visual processing skills and their relationship to mutation size in full and

permutation female fragile X carriers Optom Vis Sci 2000 Nov77 (11)592-9

Maino D The young child with developmental disabilities An introduction to mental retardation and genetic syndromes In Moore BD

(ed) Eye Care for Infants and Young Children Butter-worth--Heinemann Newton MA1997285-300

Amin V Maino D The Fragile X female Visual visual perceptual and ocular health anomalies J Am Optom Assoc 1995 May66

(5)290-95

Maino DM Maino JH Cibis GW Hecht F Ocular health anomalies in patients with developmental disabilities In Maino D (ed)

Diagnosis and Management of Special Populations Mosby-Year-book Inc St Louis MO 1995189-206 Reprinted Optometric

Education Program Foundation Santa Anna Calif 2001

Maino D Wesson M Schlange D Cibis G Maino J Optometric findings in the fragile X syndrome Optom Vis Sci 199168634-40

Scheiman MMOptometric findings in children with cerebral palsy Am J Optom Physiol Opt 1984 May61(5)321-3

Maino D Maino J Maino S Mental retardation syndromes with associated ocular defects J Am Optom Assoc 199061707-16

Stewart RE Woodhouse JM Cregg M Pakeman VH Association between accommodative accuracy hypermetropia and strabismus in

children with Downs syndrome Optom Vis Sci 2007 Feb84(2)149-55

Cregg M Woodhouse JM Pakeman VH et al Accommodation and refractive error in children with Down syndrome cross-sectional

and longitudinal studies Invest Ophthalmol Vis Sci 2001 Jan42 (1)55-63

79

McClelland JF Parkes J Hill N et al Accommodative dysfunction in children with cerebral palsy a population-

based study Invest Ophthalmol Vis Sci 2006 May47(5)1824-30

Duckman RH Vision therapy for the child with cerebral palsy J Am Optom Assoc 198758(1)28-35

Duckman R Accommodation in cerebral palsy function and remediation J Am Optom Assoc 198455(4)281-3

Scheiman M Understanding and managing vision deficits a guide for occupational therapists 2nd ed Slack

Thorofare NJ 2002

Maino D Binasal occlusion for the child with Cerebral Palsy J Ill Optom Assoc 198644(1)1218

Battaglia F Quartarone A Rizzo V et al Early impairment of synaptic plasticity in patients with Downs syndrome

Neurobiol Aging 2008 Aug29(8)1272-5

Bonnier C Evaluation of early stimulation programs for enhancing brain development Acta Paediatr 2008

Jul97(7)853-8

Morice E Andreae LC Cooke SF et al Preservation of long-term memory and synaptic plasticity despite short-term

impairments in the Tc1 mouse model of Down syndrome Learn Mem 2008 Jul 1415(7)492-500

Gordon AM Schneider JA Chinnan A Charles JR Efficacy of a hand-arm bimanual intensive therapy (HABIT) in

children with hemiplegic cerebral palsy a randomized control trial Dev Med Child Neurol 2007 Nov49(11)830-8

Kapoor N Ciuffreda KJ Vision disturbances following traumatic brain injury Curr Treat Options Neurol 2002

Jul4(4)271-80

80

Ciuffreda KJ Rutner D Kapoor N et al Vision therapy for oculomotor dysfunctions in acquired brain injury a

retrospective analysis Optometry 2008 Jan79(1)18-22

Ciuffreda KJ Han Y Kapoor N Ficarra AP Oculomotor rehabilitation for reading in acquired brain injury

NeuroRehabilitation 200621(1)9-21

Zost M Diagnosis and management of visual dysfunction in cerebral injury In Maino D (ed) Diagnosis and

Management of Special Populations Mosby-Yearbook Inc St Louis 199579 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001 [Figure used with permission of the editor]

DeGutis JM Bentin S Robertson LC DEsposito M Functional plasticity in ventral temporal cortex following

cognitive rehabilitation of a congenital prosopagnosic J Cogn Neurosci 2007 Nov19 (11)1790-802

Welbourne SR Ralph MA Exploring the impact of plasticity-related recovery after brain damage in a connectionist

model of single-word reading Cogn Affect Behav Neurosci 2005 Mar5(1)77-92

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements prevent cognitive decline A

systematic review of randomized controlled trials J Hum Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among preterm infants attributable to early

supplementation of human milk with docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings and structural-functional

synergies with cell membrane phospholipids Altern Med Rev 2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function Neuroscience 20089(7)568-78

81

Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

BMC Biol 2008 Sep 9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine improves neuropsychological disorders in a child with

creatine transporter defect Neurocase 200814(2) 151-61

Forrester LW Wheaton LA Luft AR Exercise-mediated locomotor recovery and lower-limb neuroplasticity after

stroke J Rehabil Res Dev 200845(2)205-20

82

Page 32: Neuroplasticity: A Paradigm Sea Change Latest Updated File

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

J Pediatr Ophthalmol Strabismus 2009 Mar-Apr46(2)87-90 quiz 91-2 Levodopacarbidopa in the

treatment of amblyopia Dadeya S Vats P Malik KP

PURPOSE To evaluate the role of levodopacarbidopa in the treatment of amblyopia METHODS

Thirty patients with strabismic amblyopia between the ages of 3 and 12 years were part of this double-

blind randomized study Patients were divided into two groups Group A received 050 mg + 125 mg of

levodopacarbidopa per kilogram body weight three times daily after meals with a protein rich drink

whereas Group B received placebo Both groups received full-time conventional occlusion until a visual

acuity of 66 was achieved or for a maximum of 3 months RESULTS The authors observed more than

two lines improvement in visual acuity that was greater in the levodopa group (15 of 15) than in the

placebo group (9 of 15) (P lt 005) Furthermore improvement in visual acuity of more than two lines

was greater in patients younger than 8 years (100) than in patients older than 8 years of age (60) (P =

0026) There was also no significant reversal of the improved visual acuity in up to 6 months of follow-

up CONCLUSION Levodopacarbidopa improves visual acuity in patients with

amblyopia and maintains improved visual acuity especially in patients

younger than 8 years

32

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

J Pediatr Ophthalmol Strabismus 2008 May-Jun45(3)174-6 The use of levodopa in the treatment of

bilateral amblyopia secondary to uncorrected high hypermetropia Abrams MS

The standard treatment of bilateral amblyopia secondary to uncorrected high bilateral hypermetropia has

been spectacles and time The patient described here failed to show adequate improvement in visual

acuity after 18 months of standard treatment Visual acuity improved dramatically when the

patient began taking levodopa dropped precipitously when the medication was

discontinued and returned quickly to post-treatment levels when levodopa was

restarted Visual acuity remained stable when the medication was slowly tapered

and discontinued This report suggests that dopamine may play a role in the pathophysiology of

bilateral amblyopia secondary to uncorrected high bilateral hypermetropia

33

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

Bottom Line

Amblyopia can be treated at any age

May be able to use neuro-enhancing drugs

as a part of basic amblyopia therapy

34

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

C Strabismus and non-strabismic non-amblyopic binocular

vision disorders

Clinical Trial of Treatments for Symptomatic Convergence Insufficiency in Children has

clearly demonstrated the superiority of in-office optometric vision therapy (in conjunction

with home therapy) vs out-of-office therapy alone The study concluded that optometric

vision therapyorthoptics was more effective than pencil push-ups or placebo vision

therapyorthoptics in reducing symptoms and improving clinical signs of convergence

insufficiency

Long-term effectiveness of treatments for symptomatic convergence insufficiency

in children (Optom Vis Sci 2009 Sep86(9)1096-103)

CITT patients improvements lasted a year

35

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

Strabismus 1999 Sep7(3)169-74 Convergence insufficiency in

idiopathic Parkinsons disease responsive to levodopa Racette BA

Gokden MS Tychsen LS Perlmutter JS

We report a patient with pathologically proven idiopathic Parkinsons

disease (IPD) who developed diplopia secondary to convergence

insufficiency during his motor off periods Diplopia resolved with

onset of motor benefit from levodopa Neuro-ophthalmologic

examination demonstrated convergence insufficiency during motor

off periods that was alleviated after onset of motor benefit from

levodopa This is the first reported case of convergence insufficiency

in IPD responsive to levodopa

36

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

Bottom Line

Optometric Vision Therapy is the most efficacious treatment available for binocular vision disorders and the

treatment effects are long lasting Neuro-enhancing drugs

may assist us as well

37

EF Learning related vision anomalies Vision

developmentperception disorders

hellipresearch includes an examination of the role vision plays in

reading the effect of oculomotor vergence and

accommodativecoherent motion therapy on reading eye movements

and reading speed the diagnosis and treatment of perceptual

disorders and the effect of therapy on various learning anomalies

38

EF Learning related vision anomalies Vision developmentperception disorders

magnocellular (MC) deficit in dyslexia

LM speed-matching ratio predicts reading in childrenChase C Dougherty RF Ray N

Fowler S Stein JOptom Vis Sci 2007 Mar84(3)229-36

Effect of attention therapy on reading comprehension Solan HA Shelley-Tremblay J

Ficarra A Silverman M Larson S J Learn Disabil 2003 Nov-Dec36(6)556-63

Is there a common linkage among reading comprehension visual attention and

magnocellular processing Solan HA Shelley-Tremblay JF Hansen PC Larson S

J Learn Disabil 2007 May-Jun40(3)270-8

Lawton T Filtered Text and Direction Discrimination Training Improved Reading

Fluency for Both Dyslexic and Normal Readers Optom Vis Dev 200839 (3)114

Fischer B Hartnegg K Saccade control in dyslexia Development deficits training

and transfer to reading Optom Vis Dev 200839(4)181-190

39

EF Learning related vision anomalies Vision developmentperception disorders

J Learn Disabil 2003 Nov-Dec36(6)556-63 Effect of attention therapy on reading

comprehension Solan HA Shelley-Tremblay J Ficarra A Silverman M Larson S

hellip At the completion of attention therapy the mean

standard attention and reading comprehension scores of

the experimental group had improved significantly The

control group however showed no significant

improvement in reading comprehension scores after 12

weeks Although uncertainties still exist this investigation

supports the notion that visual attention is malleable and

that attention therapy has a significant effect on reading

comprehension in this often neglected population

40

VII Vision dysfunction association with acquired brain injury

A Exotropia (or high exophoriaCI)

B Accommodative dysfunction

C Convergence insufficiency

41

D Decreased blink rate

E Spatial disorientation

F Pursuitsaccade dysfunction

G Unstable ambient vision (Magnocellular pathway)

42

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Stelmack JA Frith T Van Koevering D Rinne S Stelmack TR Visual function in patients

followed at a Veterans Affairs polytrauma network site an electronic medical record review

Optometry 2009 Aug80(8)419-24

RESULTS Visual symptoms were self-reported by 76 of patients

with polytrauma and 75 of the patients with TBI Problems with reading

(polytrauma 60 and TBI 50) and accommodation (polytrauma 30 and

TBI 47) were frequently found on eye examinations Spectacles were the

treatment most frequently prescribed (polytrauma 62 and TBI 78)

CONCLUSIONS It is important for optometrists to be aware of the high

rates of self-reported symptoms and visual problems in military personnel

returning from deployment to the wars in Iraq and Afghanistan Post-

traumatic stress disorder and depression may complicate optometric

evaluation and management

43

VII Vision dysfunction association with acquired brain injury

Avoidance of near tasks

Oculomotor-based reading difficulties

Eye tracking problems

Eye focusing problems

Eyestrain Diplopia

Dizziness Vertigo

Vision-derived nausea

44

VII Vision dysfunction association with acquired brain injury

Increased sensitivity to visual motion

Visual inattention and distractibility

Short-term visual memory loss

Difficulty judging distances (relative and absolute

Difficulty with global scanning

Difficulty with personal grooming especially involving the face

Inability to interactcope visually in a complex social situation

(eg minimal eye contact)

Inability to tolerate complex visual environments (eg grocery store

aisles and highly-patterned floors)

45

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Ciuffreda KJ Ludlam DP Kapoor N Clinical oculomotor training in traumatic brain injury Optom Vis

Dev 200940(1)16-23

Individuals with traumatic brain injury present with a constellation of

oculomotor dysfunctions and correlated symptoms Simple and

effective clinical oculomotor-based training procedures will be

presented with respect to the versional vergence and

accommodative systems and their interactions These therapeutic

procedures can also be applied as needed to individuals with either

low vision neurological dysfunctions or general visual skills cases

manifesting similar oculomotor deficits

46

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Leslie S Myopia and accommodative insufficiency associated with

moderate head trauma Opt Vis Dev 200940(1)25-31

The majority of subjects reviewed had developed a stable degree of

myopia between 100 and 200 diopters as well as an abnormally

high lag of accommodation When their distance and near spatial area

of focus was compared the majority were focused at an intermediate

area in space suggesting a loss of control of accommodation in

space

47

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

B Drugs

C Exercise

D Learning new and challenging things

48

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements

prevent cognitive decline A systematic review of randomized controlled trials J Hum

Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among

preterm infants attributable to early supplementation of human milk with

docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings

and structural-functional synergies with cell membrane phospholipids Altern Med Rev

2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function

Neuroscience 20089(7)568-78

49

VIII Improving Brain Function and Neuroplasticity

B Drugs Maya Vetencourt JF Sale A Viegi A et al The antidepressant

fluoxetine (PROZAC) restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the

antidepressant tianeptine CNS Drugs 200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances

hippocampal long-term potentiation and memory BMC Biol 2008 Sep

9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine

improves neuropsychological disorders in a child with creatine

transporter defect Neurocase 200814(2) 151-61

50

VIII Improving Brain Function and Neuroplasticity

C Exercise

Hunsberger JG et al Antidepressant actions of the exercise-

regulated gene VGF Nat Med 2007 Dec 2 131476

VGF may be a common pathway by which exercise induces

neuroplasticity and growth-factor genes at least one of these might act

similarly to antidepressants in promoting an adaptive response to stress

However the tests used here may be modeling stress-induced

helplessness not depression hellipexercise seems to induce multiple

interacting genes that enhance neuronal resilience

51

VIII Improving Brain Function and Neuroplasticity

D Learning new and challenging things

What have we (optometry amp ophthalmology)

been thinking all these years

Where did we miss the news about neuroplasticity

52

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Huang JC Neuroplasticity as a proposed mechanism for the efficacy of optometric vision therapy and rehabilitation J Bev Optom 200920(4)96-100

Homologous area adaptationCompensatory masqueradeCross-modal reassignment

Map expansion

EquipotentialityVicariation

53

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Homologous area adaptation a transfer of function from a damaged brain area to a non-damaged brain area May be limited to early stages of human development and may crowd a new brain area resulting in reduced functionality of that brain area (Competition between spatial amp verbal functioning)

54

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Compensatory masquerade reorganizing of existing neuro-pathways to us alternative cognitive strategies to perform a task

55

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Cross-modal reassignment using new sensory input in a brain structure deprived of its main input source (changing processing from visual to tactile stimuli in the blind)

56

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Map expansion increase in brain mass due to repeated behavior or exposure to stimuli

57

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Equipotentiality anatomical areas of the brain can perform disparate functions

Vicariation redundant neural systems can operate under abnormal conditions

This may explain why recovery is noted for many neurological conditions (degenerative psychiatric developmental vascular traumatic)

58

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Constraint therapy Use it and improve it

Patching penalization ldquonear activitiesrdquo during amblyopia therapy

59

IX Improving Brain Function and Neuroplasticity Optometric Clinical ApplicationsOptometric Vision Therapy

Kleim amp Jones

Use it or lose it If you do not drive specific brain functions

functional loss will occur

If you want to improve oculomotor brain neuroplastic function amp

structure therapy should be specific for that brain function

Use it and improve it Therapy that drives cortical function enhances

that particular function

If you use therapy to improve oculomotor dysfunction it should

improve

Specificity The therapy you choose determines the resultant

plasticity and function

You must choose therapy that is appropriate

60

IX Improving Brain Function and Neuroplasticity Optometric Clinical Applications

Kleim amp Jones

Repetition matters Plasticity that results in functional change

requires repetition

Do the therapy Do it again Do it yet again No quick fix

Intensity matters Induction of plasticity requires the appropriate

amount of intensity

Intensity means strength force concentration power and passion

Without these plasticity may not occur Function may not improve

Time matters Different forms of plasticity take place at different

times during therapy

Do the basics than the more advanced therapeutic procedures

61

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Salience matters It has to be important to the individual

Make the therapy matter to the patient

Age matters Plasticity is easier in a younger brain but is also

possible in an adult brain

Do not let age determine what therapy options you offer your

patients Think of Susan Barry PhD (StereoSue) and her success

Offer your patients options Let them choose Be realistic about

outcomeshelliphave outcome measures built into therapy program

62

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Transference Neuroplasticity and the change in function

that results from one therapy can augment the attainment

of similar behaviors

What you do during oculomotor therapy may affected

vergence therapy outcomes

Interference Plasticity in response to one experience can

interfere with the acquisition of other behaviors

Monitor Evaluate progress Discuss function in other areas

of your patientslsquo life

63

Why pay attention to binocular vision dysfunctions

and neuroplasticity

December 2009 issue of the Review of Optometry

The Binocular Vision Dysfunction Pandemic

In 2010 almost 170 million individuals will be wearing glasses In

2010 there will also be up to 93 million amblyopes and 12 and a half

million strabismics For children under 18 years of age that means

there will be more than 22 and a half million amblyopes and millions

of children with strabismus A clinical trial to determine the

prevalence of binocular vision dysfunction within the general

population suggested the possibility of up to 56 or 173 million men

women and children with symptoms associated with a binocular

vision dysfunction 189 million (61) with accommodative problems

and 118 million (38) demonstrating various vergence

anomalies

64

65

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Brain plasticity life long changes in the structure of the brain

Sensory substitution replacement of one sensory input by another

Measurement techniques

Voxel based morphometryhellipmeasures difference in brain volume

Fluorodeoxyglucose glucose analog PET scan tells you

distribution and metabolism of brain

Cortical thickness measures

Visual cortex of the blind turns somatic ―The eye of the tongue

Transcranial magnetic stmiulation non-invasive technique to

stimulate cortex

66

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Blind Braille readers report tingling in fingers when pressure

phosphenes are applied Blind feel tingling in tongue

Bind use tongue to perform orientation task motion perception

sensory perception Visual cortex recruited in a variety of sensory

and cognitive tasks (DM Can we use tongue as a VT tool)

Dilks Reorganizations of human adult visual system

When a region of sensory cortex is deprived of its bottom up

input the deprived region begins to respond to stimuli that

normally activate adjacent cortex

67

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Retinotopic map changes for stroke pts Cortical reorganization in

adults occurs Perceived objectshellipelongation in stroke amp AMD

What happens to deprived cortex in AMD

fMRI shows cortical reorganization in adults

Proposed mechanisms

hellipGrowth of new connections

hellipUnmasking of pre-existing connections this is true

happens within seconds

Bavelier

Action video games

68

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Bavelier

Action video games Looked at attention Gamers can track more

activities

Attention over space (me peripheral awarenress) Useful field

of view shrinks with age

Performance not VA relatedhellipis related to attention

Action game playing changes spatial resolutionhellipovercoming

crowding in VA assessment (me amblyopia therapy)

Temporal resolution of vision Backward masking

changehellipbrain changes

Visual sensitivity (contrast sensitivity) Post action game training

improves CSF

69

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Action video games correcting optics of the cortex (me this is

actualy OVT)

Games factor

Variable entry leanringhellipadapt task to skill level

Incremental learning tune task to subjectlsquos leanring steps

Motivationarousal

Rewards

Self masterself confidence

Action games factors

Pacingrate of exposure to infohellipincreasing processing speed

Dynamic display

Rich environment

Rich motor involvement

70

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Surgeons may be made to play action games

Pilot training

Amblyopia tx Dennis Levi research

PresenterTitle Contact info

Neuroplasticity-A Paradigm Sea Change

This presentation is available at

httpwwwslidesharenetDMAINOneuroplasticity-a-paradigm-sea-change-2459693

httpwwwmainosmemosblogspotcom

My FaceBook Page

and

Twitter

PresenterTitle Contact info

Questions About

Neuroplasticity-A Paradigm Sea Change

Dominick M Maino OD MEd FAAO FCOVD-A

Professor PediatricsBinocular VisionIllinois Eye InstituteIllinois College of Optometry

dmainoicoeduhttpwwwMainosMemosblogspotcom

Thanks to

httpwwwcovdorgHomeOVDJournalOVD401tabid263D

efaultaspx

httpbipolarblastfileswordpresscom200908neurojpg

httpwwwspecialcheerscomimagesanimated_braingif

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contentuploads200810frankenstein-myspace-lightbeergif

httpwwwshangralafamilyfuncomgala-ecalvindreamgif

httppsychiatryjwatchorgcgicontentfull20082251

73

Chakraborty R Chatterjee A Choudhart S Chakraborty PK Neuroplasticitymdasha paradigm shift in neurosciences J Indian Med Assoc

2007105(9)513-4516-8520-1

Sacks O A neurologistlsquos notebook Stereo Sue Why two eyes are better than one The New Yorker 2006 Jun 1964-73

Krulwich R National Public Radio Going Binocular Susanlsquos First Snowfall Available at

wwwnprorgtemplatesstorystoryphpstoryId=5507789 (Accessed December 8 2008)

Press LJ The story behind Stereo Suelsquo and a world-famous neurologistlsquos discovery of vision therapy Optom Vis Dev 200637(2) 55-7

Levin HS Neuroplasticity and brain imaging research implications for rehabilitation Arch Phys Med Rehabil 2006 Dec87(12 Suppl

2)S1

Wiesel TN Hubel DH Single-cell responses in striate cortex of kittens deprived of vision in one eye J Neurophysiol 1963

Nov261003-17

Hook BM Chen C Critical periods in the visual system Changing views for a model of experience-dependent plasticity Neuron 2007

Oct56(2)312-26

Ramey CT Ramey SL Prevention of intellectual disabilities early interventions to improve cognitive development Prev Med 1998

Mar-Apr27(2)224-32

Heuninckx S Wenderoth N Swinnen SP Systems neuroplasticity in the aging brain recruiting additional neural resources for

successful motor performance in elderly persons J Neurosci 2008 Jan 228(1)91-9

Ge S Yang CH Hsu KS et al A critical period for enhanced synaptic plasticity in newly generated neurons of the adult brain Neuron

2007 May54(4)559-66

74

Draganski B Gaser C Busch V et al Neuroplasticity changes in grey matter induced by training Nature 2004 Jan 22427(6972)

311-2

Cannonieri GC Bonilha L Fernandes PT et al Practice and perfect length of training and structural brain changes in experienced

typists Neuroreport 2007 Jul 218(10)1063-6

Kleim JA Jones TA Principles of experience-dependent neural plasticity implications for rehabilitation after brain damage J

Speech Lang Hear Res 2008 Feb51(1)S225-39

Trojan S Porkorny J Theoretical aspects of neuroplasticity Physiol Res 199948(2)87-97

Ramamirtham R Kee CS Hung LF et al Wave aberrations in rhesus monkeys with vision-induced ametropias Vision Res 2007

Sep47(21)2751-66

Smith EL 3rd Ramamirtham R Qiao-Grider Y et al Effects of foveal ablation on emmetropization and form-deprivation myopia

Invest Ophthalmol Vis Sci 2007 Sep48(9)3914-22

Smith EL 3rd Kee CS Ramamirtham R et al Peripheral vision can influence eye growth and refractive development in infant

monkeys Invest Ophthalmol Vis Sci 2005 Nov46(11)3965-72

Ciuffreda KJ Vasudevan B Nearwork-induced transient myopia (NITM) and permanent myopiandashndashis there a link Ophthalmic

Physiol Opt 2008 Mar28(2)103-14

Hung GK Ciuffreda KJ Incremental retinal-defocus theory of myopia development--schematic analysis and computer simulation

Comput Biol Med 2007 Jul37(7)930-46

Hung GK Ciuffreda KJ A unifying theory of refractive error development Bull Math Biol 2000 Nov62(6)1087-108

75

Pang Y Maino D Zhang G Lu F Myopia Can its progress be controlled Optom Vis Dev 200637(2)75-9

Leung JT Brown B Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lenses Optom Vis Sci

1999 Jun76(6)346-54

Hasebe S Ohtsuki H Nonaka T et al Effect of progressive addition lenses on myopia progression in Japanese children a prospective

randomized double-masked crossover trial Invest Ophthalmol Vis Sci 2008 Jul49(7)2781-9

Gwiazda J Hyman L Hussein M et al A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression

of myopia in children Invest Ophthalmol Vis Sci 2003 Apr44(4)1492-500

Siatkowski RM Cotter SA Crockett RS et al Two-year multi-center randomized double-masked placebo-controlled parallel safety and

efficacy study of 2 pirenzepine ophthalmic gel in children with myopia J AAPOS 2008 Aug12(4)332-9

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged 7 to 17 years Arch Ophthalmol 2005

Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three to less than 10 years of age Am J

Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction Am J Ophthalmol 2007

Jun143(6)1060-3

Holmes JM Edwards AR Beck RW et al A randomized pilot study of near activities versus non-near activities during patching therapy for

amblyopia J AAPOS 2005 Apr9(2)129-36

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate

amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-57

76

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic

amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Convergence Insufficiency Treatment Trial Study Group Randomized clinical trial of treatments for symptomatic convergence insufficiency

in children Arch Ophthalmol 2008 Oct126(10)1336-49

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

Solan HA Shelley-Tremblay J Hansen PC et al M-cell deficit and reading disability a preliminary study of the effects of temporal vision-

processing therapy Optometry 2004 Oct75(10)640-50

Solan HA Larson S Shelley-Tremblay J et al Role of visual attention in cognitive control of oculomotor readiness in students with reading

disabilities J Learn Disabil 2001 Mar-Apr34(2)107-18

Gallaway M Boas MB The impact of vergence and accommodative therapy on reading eye movements and reading speed Optom Vis Dev

200738(3)115-20

Goss DA Downing DB Lowther AH et al The effect of HTS vision therapy conducted in a school setting on reading skills in third and

fourth grade students Optom Vis Dev 200738(1)27-32

Crutch SJ Warrington EK Foveal crowding in posterior cortical atrophy a specific early-visual-processing deficit affecting word reading

Cogn Neuropsychol 2007 Dec24(8)843-66

Helms D Sawtelle SM A study of the effectiveness of cognitive therapy delivered in a video game format Optom Vis Dev 200738 (1)19-

26

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

77

Lawton T Training direction-discrimination sensitivity remediates a wide spectrum of reading skills OptomVis Dev 200738(1) 33-47

Goldstand S Koslowe KC Parush S Vision visual-information processing and academic performance among seventh-grade schoolchildren a

more significant relationship than we thought Am J Occup Ther 2005 Jul-Aug59(4)377-89

Fischer B Koumlngeter A Hartnegg K Effects of daily practice on subitizing visual counting and basic arithmetic skills Optom Vis Dev

200839(1)30-4

Sands W Taub M Maino D Limited research and education on special populations in optometry and ophthalomology Optom Vis Dev

200839(2)60-1

Wesson M Maino D Oculo-visual findings in Down syndrome cerebral palsy and mental retardation with non-specific etiology In Maino D

(ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 199517-54 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

Cui Y Stapleton F Suttle C Developing an instrument to assess vision-related and subjective quality of life in children with intellectual

disability data collection and preliminary analysis in a Chinese population Ophthal Physiolog Optics 2008 May28(3) 238-46

Maino D Steele G Tahir S Sajja R Attitudes of optometry students toward individuals with disabilities Optom Ed 200227(2)45-50

Maino D Special populations in the optometric curriculum Optom Ed 200227(2)38-9

Maino D Overview of special populations In Scheiman M Rouse M (eds) Optometric Management of Learning-Related Vision Problems

St Louis Mosby Inc 200685-106

Maino D (ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 1995 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

78

McCarthy P Maino D Alport syndrome a review Clin Eye Vis Care 2000 Dec12(3-4)139-50

Block SS Brusca-Vega R Pizzi WJ et al Cognitive and visual processing skills and their relationship to mutation size in full and

permutation female fragile X carriers Optom Vis Sci 2000 Nov77 (11)592-9

Maino D The young child with developmental disabilities An introduction to mental retardation and genetic syndromes In Moore BD

(ed) Eye Care for Infants and Young Children Butter-worth--Heinemann Newton MA1997285-300

Amin V Maino D The Fragile X female Visual visual perceptual and ocular health anomalies J Am Optom Assoc 1995 May66

(5)290-95

Maino DM Maino JH Cibis GW Hecht F Ocular health anomalies in patients with developmental disabilities In Maino D (ed)

Diagnosis and Management of Special Populations Mosby-Year-book Inc St Louis MO 1995189-206 Reprinted Optometric

Education Program Foundation Santa Anna Calif 2001

Maino D Wesson M Schlange D Cibis G Maino J Optometric findings in the fragile X syndrome Optom Vis Sci 199168634-40

Scheiman MMOptometric findings in children with cerebral palsy Am J Optom Physiol Opt 1984 May61(5)321-3

Maino D Maino J Maino S Mental retardation syndromes with associated ocular defects J Am Optom Assoc 199061707-16

Stewart RE Woodhouse JM Cregg M Pakeman VH Association between accommodative accuracy hypermetropia and strabismus in

children with Downs syndrome Optom Vis Sci 2007 Feb84(2)149-55

Cregg M Woodhouse JM Pakeman VH et al Accommodation and refractive error in children with Down syndrome cross-sectional

and longitudinal studies Invest Ophthalmol Vis Sci 2001 Jan42 (1)55-63

79

McClelland JF Parkes J Hill N et al Accommodative dysfunction in children with cerebral palsy a population-

based study Invest Ophthalmol Vis Sci 2006 May47(5)1824-30

Duckman RH Vision therapy for the child with cerebral palsy J Am Optom Assoc 198758(1)28-35

Duckman R Accommodation in cerebral palsy function and remediation J Am Optom Assoc 198455(4)281-3

Scheiman M Understanding and managing vision deficits a guide for occupational therapists 2nd ed Slack

Thorofare NJ 2002

Maino D Binasal occlusion for the child with Cerebral Palsy J Ill Optom Assoc 198644(1)1218

Battaglia F Quartarone A Rizzo V et al Early impairment of synaptic plasticity in patients with Downs syndrome

Neurobiol Aging 2008 Aug29(8)1272-5

Bonnier C Evaluation of early stimulation programs for enhancing brain development Acta Paediatr 2008

Jul97(7)853-8

Morice E Andreae LC Cooke SF et al Preservation of long-term memory and synaptic plasticity despite short-term

impairments in the Tc1 mouse model of Down syndrome Learn Mem 2008 Jul 1415(7)492-500

Gordon AM Schneider JA Chinnan A Charles JR Efficacy of a hand-arm bimanual intensive therapy (HABIT) in

children with hemiplegic cerebral palsy a randomized control trial Dev Med Child Neurol 2007 Nov49(11)830-8

Kapoor N Ciuffreda KJ Vision disturbances following traumatic brain injury Curr Treat Options Neurol 2002

Jul4(4)271-80

80

Ciuffreda KJ Rutner D Kapoor N et al Vision therapy for oculomotor dysfunctions in acquired brain injury a

retrospective analysis Optometry 2008 Jan79(1)18-22

Ciuffreda KJ Han Y Kapoor N Ficarra AP Oculomotor rehabilitation for reading in acquired brain injury

NeuroRehabilitation 200621(1)9-21

Zost M Diagnosis and management of visual dysfunction in cerebral injury In Maino D (ed) Diagnosis and

Management of Special Populations Mosby-Yearbook Inc St Louis 199579 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001 [Figure used with permission of the editor]

DeGutis JM Bentin S Robertson LC DEsposito M Functional plasticity in ventral temporal cortex following

cognitive rehabilitation of a congenital prosopagnosic J Cogn Neurosci 2007 Nov19 (11)1790-802

Welbourne SR Ralph MA Exploring the impact of plasticity-related recovery after brain damage in a connectionist

model of single-word reading Cogn Affect Behav Neurosci 2005 Mar5(1)77-92

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements prevent cognitive decline A

systematic review of randomized controlled trials J Hum Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among preterm infants attributable to early

supplementation of human milk with docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings and structural-functional

synergies with cell membrane phospholipids Altern Med Rev 2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function Neuroscience 20089(7)568-78

81

Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

BMC Biol 2008 Sep 9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine improves neuropsychological disorders in a child with

creatine transporter defect Neurocase 200814(2) 151-61

Forrester LW Wheaton LA Luft AR Exercise-mediated locomotor recovery and lower-limb neuroplasticity after

stroke J Rehabil Res Dev 200845(2)205-20

82

Page 33: Neuroplasticity: A Paradigm Sea Change Latest Updated File

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

J Pediatr Ophthalmol Strabismus 2008 May-Jun45(3)174-6 The use of levodopa in the treatment of

bilateral amblyopia secondary to uncorrected high hypermetropia Abrams MS

The standard treatment of bilateral amblyopia secondary to uncorrected high bilateral hypermetropia has

been spectacles and time The patient described here failed to show adequate improvement in visual

acuity after 18 months of standard treatment Visual acuity improved dramatically when the

patient began taking levodopa dropped precipitously when the medication was

discontinued and returned quickly to post-treatment levels when levodopa was

restarted Visual acuity remained stable when the medication was slowly tapered

and discontinued This report suggests that dopamine may play a role in the pathophysiology of

bilateral amblyopia secondary to uncorrected high bilateral hypermetropia

33

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

Bottom Line

Amblyopia can be treated at any age

May be able to use neuro-enhancing drugs

as a part of basic amblyopia therapy

34

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

C Strabismus and non-strabismic non-amblyopic binocular

vision disorders

Clinical Trial of Treatments for Symptomatic Convergence Insufficiency in Children has

clearly demonstrated the superiority of in-office optometric vision therapy (in conjunction

with home therapy) vs out-of-office therapy alone The study concluded that optometric

vision therapyorthoptics was more effective than pencil push-ups or placebo vision

therapyorthoptics in reducing symptoms and improving clinical signs of convergence

insufficiency

Long-term effectiveness of treatments for symptomatic convergence insufficiency

in children (Optom Vis Sci 2009 Sep86(9)1096-103)

CITT patients improvements lasted a year

35

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

Strabismus 1999 Sep7(3)169-74 Convergence insufficiency in

idiopathic Parkinsons disease responsive to levodopa Racette BA

Gokden MS Tychsen LS Perlmutter JS

We report a patient with pathologically proven idiopathic Parkinsons

disease (IPD) who developed diplopia secondary to convergence

insufficiency during his motor off periods Diplopia resolved with

onset of motor benefit from levodopa Neuro-ophthalmologic

examination demonstrated convergence insufficiency during motor

off periods that was alleviated after onset of motor benefit from

levodopa This is the first reported case of convergence insufficiency

in IPD responsive to levodopa

36

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

Bottom Line

Optometric Vision Therapy is the most efficacious treatment available for binocular vision disorders and the

treatment effects are long lasting Neuro-enhancing drugs

may assist us as well

37

EF Learning related vision anomalies Vision

developmentperception disorders

hellipresearch includes an examination of the role vision plays in

reading the effect of oculomotor vergence and

accommodativecoherent motion therapy on reading eye movements

and reading speed the diagnosis and treatment of perceptual

disorders and the effect of therapy on various learning anomalies

38

EF Learning related vision anomalies Vision developmentperception disorders

magnocellular (MC) deficit in dyslexia

LM speed-matching ratio predicts reading in childrenChase C Dougherty RF Ray N

Fowler S Stein JOptom Vis Sci 2007 Mar84(3)229-36

Effect of attention therapy on reading comprehension Solan HA Shelley-Tremblay J

Ficarra A Silverman M Larson S J Learn Disabil 2003 Nov-Dec36(6)556-63

Is there a common linkage among reading comprehension visual attention and

magnocellular processing Solan HA Shelley-Tremblay JF Hansen PC Larson S

J Learn Disabil 2007 May-Jun40(3)270-8

Lawton T Filtered Text and Direction Discrimination Training Improved Reading

Fluency for Both Dyslexic and Normal Readers Optom Vis Dev 200839 (3)114

Fischer B Hartnegg K Saccade control in dyslexia Development deficits training

and transfer to reading Optom Vis Dev 200839(4)181-190

39

EF Learning related vision anomalies Vision developmentperception disorders

J Learn Disabil 2003 Nov-Dec36(6)556-63 Effect of attention therapy on reading

comprehension Solan HA Shelley-Tremblay J Ficarra A Silverman M Larson S

hellip At the completion of attention therapy the mean

standard attention and reading comprehension scores of

the experimental group had improved significantly The

control group however showed no significant

improvement in reading comprehension scores after 12

weeks Although uncertainties still exist this investigation

supports the notion that visual attention is malleable and

that attention therapy has a significant effect on reading

comprehension in this often neglected population

40

VII Vision dysfunction association with acquired brain injury

A Exotropia (or high exophoriaCI)

B Accommodative dysfunction

C Convergence insufficiency

41

D Decreased blink rate

E Spatial disorientation

F Pursuitsaccade dysfunction

G Unstable ambient vision (Magnocellular pathway)

42

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Stelmack JA Frith T Van Koevering D Rinne S Stelmack TR Visual function in patients

followed at a Veterans Affairs polytrauma network site an electronic medical record review

Optometry 2009 Aug80(8)419-24

RESULTS Visual symptoms were self-reported by 76 of patients

with polytrauma and 75 of the patients with TBI Problems with reading

(polytrauma 60 and TBI 50) and accommodation (polytrauma 30 and

TBI 47) were frequently found on eye examinations Spectacles were the

treatment most frequently prescribed (polytrauma 62 and TBI 78)

CONCLUSIONS It is important for optometrists to be aware of the high

rates of self-reported symptoms and visual problems in military personnel

returning from deployment to the wars in Iraq and Afghanistan Post-

traumatic stress disorder and depression may complicate optometric

evaluation and management

43

VII Vision dysfunction association with acquired brain injury

Avoidance of near tasks

Oculomotor-based reading difficulties

Eye tracking problems

Eye focusing problems

Eyestrain Diplopia

Dizziness Vertigo

Vision-derived nausea

44

VII Vision dysfunction association with acquired brain injury

Increased sensitivity to visual motion

Visual inattention and distractibility

Short-term visual memory loss

Difficulty judging distances (relative and absolute

Difficulty with global scanning

Difficulty with personal grooming especially involving the face

Inability to interactcope visually in a complex social situation

(eg minimal eye contact)

Inability to tolerate complex visual environments (eg grocery store

aisles and highly-patterned floors)

45

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Ciuffreda KJ Ludlam DP Kapoor N Clinical oculomotor training in traumatic brain injury Optom Vis

Dev 200940(1)16-23

Individuals with traumatic brain injury present with a constellation of

oculomotor dysfunctions and correlated symptoms Simple and

effective clinical oculomotor-based training procedures will be

presented with respect to the versional vergence and

accommodative systems and their interactions These therapeutic

procedures can also be applied as needed to individuals with either

low vision neurological dysfunctions or general visual skills cases

manifesting similar oculomotor deficits

46

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Leslie S Myopia and accommodative insufficiency associated with

moderate head trauma Opt Vis Dev 200940(1)25-31

The majority of subjects reviewed had developed a stable degree of

myopia between 100 and 200 diopters as well as an abnormally

high lag of accommodation When their distance and near spatial area

of focus was compared the majority were focused at an intermediate

area in space suggesting a loss of control of accommodation in

space

47

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

B Drugs

C Exercise

D Learning new and challenging things

48

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements

prevent cognitive decline A systematic review of randomized controlled trials J Hum

Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among

preterm infants attributable to early supplementation of human milk with

docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings

and structural-functional synergies with cell membrane phospholipids Altern Med Rev

2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function

Neuroscience 20089(7)568-78

49

VIII Improving Brain Function and Neuroplasticity

B Drugs Maya Vetencourt JF Sale A Viegi A et al The antidepressant

fluoxetine (PROZAC) restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the

antidepressant tianeptine CNS Drugs 200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances

hippocampal long-term potentiation and memory BMC Biol 2008 Sep

9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine

improves neuropsychological disorders in a child with creatine

transporter defect Neurocase 200814(2) 151-61

50

VIII Improving Brain Function and Neuroplasticity

C Exercise

Hunsberger JG et al Antidepressant actions of the exercise-

regulated gene VGF Nat Med 2007 Dec 2 131476

VGF may be a common pathway by which exercise induces

neuroplasticity and growth-factor genes at least one of these might act

similarly to antidepressants in promoting an adaptive response to stress

However the tests used here may be modeling stress-induced

helplessness not depression hellipexercise seems to induce multiple

interacting genes that enhance neuronal resilience

51

VIII Improving Brain Function and Neuroplasticity

D Learning new and challenging things

What have we (optometry amp ophthalmology)

been thinking all these years

Where did we miss the news about neuroplasticity

52

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Huang JC Neuroplasticity as a proposed mechanism for the efficacy of optometric vision therapy and rehabilitation J Bev Optom 200920(4)96-100

Homologous area adaptationCompensatory masqueradeCross-modal reassignment

Map expansion

EquipotentialityVicariation

53

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Homologous area adaptation a transfer of function from a damaged brain area to a non-damaged brain area May be limited to early stages of human development and may crowd a new brain area resulting in reduced functionality of that brain area (Competition between spatial amp verbal functioning)

54

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Compensatory masquerade reorganizing of existing neuro-pathways to us alternative cognitive strategies to perform a task

55

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Cross-modal reassignment using new sensory input in a brain structure deprived of its main input source (changing processing from visual to tactile stimuli in the blind)

56

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Map expansion increase in brain mass due to repeated behavior or exposure to stimuli

57

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Equipotentiality anatomical areas of the brain can perform disparate functions

Vicariation redundant neural systems can operate under abnormal conditions

This may explain why recovery is noted for many neurological conditions (degenerative psychiatric developmental vascular traumatic)

58

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Constraint therapy Use it and improve it

Patching penalization ldquonear activitiesrdquo during amblyopia therapy

59

IX Improving Brain Function and Neuroplasticity Optometric Clinical ApplicationsOptometric Vision Therapy

Kleim amp Jones

Use it or lose it If you do not drive specific brain functions

functional loss will occur

If you want to improve oculomotor brain neuroplastic function amp

structure therapy should be specific for that brain function

Use it and improve it Therapy that drives cortical function enhances

that particular function

If you use therapy to improve oculomotor dysfunction it should

improve

Specificity The therapy you choose determines the resultant

plasticity and function

You must choose therapy that is appropriate

60

IX Improving Brain Function and Neuroplasticity Optometric Clinical Applications

Kleim amp Jones

Repetition matters Plasticity that results in functional change

requires repetition

Do the therapy Do it again Do it yet again No quick fix

Intensity matters Induction of plasticity requires the appropriate

amount of intensity

Intensity means strength force concentration power and passion

Without these plasticity may not occur Function may not improve

Time matters Different forms of plasticity take place at different

times during therapy

Do the basics than the more advanced therapeutic procedures

61

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Salience matters It has to be important to the individual

Make the therapy matter to the patient

Age matters Plasticity is easier in a younger brain but is also

possible in an adult brain

Do not let age determine what therapy options you offer your

patients Think of Susan Barry PhD (StereoSue) and her success

Offer your patients options Let them choose Be realistic about

outcomeshelliphave outcome measures built into therapy program

62

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Transference Neuroplasticity and the change in function

that results from one therapy can augment the attainment

of similar behaviors

What you do during oculomotor therapy may affected

vergence therapy outcomes

Interference Plasticity in response to one experience can

interfere with the acquisition of other behaviors

Monitor Evaluate progress Discuss function in other areas

of your patientslsquo life

63

Why pay attention to binocular vision dysfunctions

and neuroplasticity

December 2009 issue of the Review of Optometry

The Binocular Vision Dysfunction Pandemic

In 2010 almost 170 million individuals will be wearing glasses In

2010 there will also be up to 93 million amblyopes and 12 and a half

million strabismics For children under 18 years of age that means

there will be more than 22 and a half million amblyopes and millions

of children with strabismus A clinical trial to determine the

prevalence of binocular vision dysfunction within the general

population suggested the possibility of up to 56 or 173 million men

women and children with symptoms associated with a binocular

vision dysfunction 189 million (61) with accommodative problems

and 118 million (38) demonstrating various vergence

anomalies

64

65

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Brain plasticity life long changes in the structure of the brain

Sensory substitution replacement of one sensory input by another

Measurement techniques

Voxel based morphometryhellipmeasures difference in brain volume

Fluorodeoxyglucose glucose analog PET scan tells you

distribution and metabolism of brain

Cortical thickness measures

Visual cortex of the blind turns somatic ―The eye of the tongue

Transcranial magnetic stmiulation non-invasive technique to

stimulate cortex

66

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Blind Braille readers report tingling in fingers when pressure

phosphenes are applied Blind feel tingling in tongue

Bind use tongue to perform orientation task motion perception

sensory perception Visual cortex recruited in a variety of sensory

and cognitive tasks (DM Can we use tongue as a VT tool)

Dilks Reorganizations of human adult visual system

When a region of sensory cortex is deprived of its bottom up

input the deprived region begins to respond to stimuli that

normally activate adjacent cortex

67

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Retinotopic map changes for stroke pts Cortical reorganization in

adults occurs Perceived objectshellipelongation in stroke amp AMD

What happens to deprived cortex in AMD

fMRI shows cortical reorganization in adults

Proposed mechanisms

hellipGrowth of new connections

hellipUnmasking of pre-existing connections this is true

happens within seconds

Bavelier

Action video games

68

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Bavelier

Action video games Looked at attention Gamers can track more

activities

Attention over space (me peripheral awarenress) Useful field

of view shrinks with age

Performance not VA relatedhellipis related to attention

Action game playing changes spatial resolutionhellipovercoming

crowding in VA assessment (me amblyopia therapy)

Temporal resolution of vision Backward masking

changehellipbrain changes

Visual sensitivity (contrast sensitivity) Post action game training

improves CSF

69

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Action video games correcting optics of the cortex (me this is

actualy OVT)

Games factor

Variable entry leanringhellipadapt task to skill level

Incremental learning tune task to subjectlsquos leanring steps

Motivationarousal

Rewards

Self masterself confidence

Action games factors

Pacingrate of exposure to infohellipincreasing processing speed

Dynamic display

Rich environment

Rich motor involvement

70

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Surgeons may be made to play action games

Pilot training

Amblyopia tx Dennis Levi research

PresenterTitle Contact info

Neuroplasticity-A Paradigm Sea Change

This presentation is available at

httpwwwslidesharenetDMAINOneuroplasticity-a-paradigm-sea-change-2459693

httpwwwmainosmemosblogspotcom

My FaceBook Page

and

Twitter

PresenterTitle Contact info

Questions About

Neuroplasticity-A Paradigm Sea Change

Dominick M Maino OD MEd FAAO FCOVD-A

Professor PediatricsBinocular VisionIllinois Eye InstituteIllinois College of Optometry

dmainoicoeduhttpwwwMainosMemosblogspotcom

Thanks to

httpwwwcovdorgHomeOVDJournalOVD401tabid263D

efaultaspx

httpbipolarblastfileswordpresscom200908neurojpg

httpwwwspecialcheerscomimagesanimated_braingif

httpblogmarsdencartoonscomwp-

contentuploads200810frankenstein-myspace-lightbeergif

httpwwwshangralafamilyfuncomgala-ecalvindreamgif

httppsychiatryjwatchorgcgicontentfull20082251

73

Chakraborty R Chatterjee A Choudhart S Chakraborty PK Neuroplasticitymdasha paradigm shift in neurosciences J Indian Med Assoc

2007105(9)513-4516-8520-1

Sacks O A neurologistlsquos notebook Stereo Sue Why two eyes are better than one The New Yorker 2006 Jun 1964-73

Krulwich R National Public Radio Going Binocular Susanlsquos First Snowfall Available at

wwwnprorgtemplatesstorystoryphpstoryId=5507789 (Accessed December 8 2008)

Press LJ The story behind Stereo Suelsquo and a world-famous neurologistlsquos discovery of vision therapy Optom Vis Dev 200637(2) 55-7

Levin HS Neuroplasticity and brain imaging research implications for rehabilitation Arch Phys Med Rehabil 2006 Dec87(12 Suppl

2)S1

Wiesel TN Hubel DH Single-cell responses in striate cortex of kittens deprived of vision in one eye J Neurophysiol 1963

Nov261003-17

Hook BM Chen C Critical periods in the visual system Changing views for a model of experience-dependent plasticity Neuron 2007

Oct56(2)312-26

Ramey CT Ramey SL Prevention of intellectual disabilities early interventions to improve cognitive development Prev Med 1998

Mar-Apr27(2)224-32

Heuninckx S Wenderoth N Swinnen SP Systems neuroplasticity in the aging brain recruiting additional neural resources for

successful motor performance in elderly persons J Neurosci 2008 Jan 228(1)91-9

Ge S Yang CH Hsu KS et al A critical period for enhanced synaptic plasticity in newly generated neurons of the adult brain Neuron

2007 May54(4)559-66

74

Draganski B Gaser C Busch V et al Neuroplasticity changes in grey matter induced by training Nature 2004 Jan 22427(6972)

311-2

Cannonieri GC Bonilha L Fernandes PT et al Practice and perfect length of training and structural brain changes in experienced

typists Neuroreport 2007 Jul 218(10)1063-6

Kleim JA Jones TA Principles of experience-dependent neural plasticity implications for rehabilitation after brain damage J

Speech Lang Hear Res 2008 Feb51(1)S225-39

Trojan S Porkorny J Theoretical aspects of neuroplasticity Physiol Res 199948(2)87-97

Ramamirtham R Kee CS Hung LF et al Wave aberrations in rhesus monkeys with vision-induced ametropias Vision Res 2007

Sep47(21)2751-66

Smith EL 3rd Ramamirtham R Qiao-Grider Y et al Effects of foveal ablation on emmetropization and form-deprivation myopia

Invest Ophthalmol Vis Sci 2007 Sep48(9)3914-22

Smith EL 3rd Kee CS Ramamirtham R et al Peripheral vision can influence eye growth and refractive development in infant

monkeys Invest Ophthalmol Vis Sci 2005 Nov46(11)3965-72

Ciuffreda KJ Vasudevan B Nearwork-induced transient myopia (NITM) and permanent myopiandashndashis there a link Ophthalmic

Physiol Opt 2008 Mar28(2)103-14

Hung GK Ciuffreda KJ Incremental retinal-defocus theory of myopia development--schematic analysis and computer simulation

Comput Biol Med 2007 Jul37(7)930-46

Hung GK Ciuffreda KJ A unifying theory of refractive error development Bull Math Biol 2000 Nov62(6)1087-108

75

Pang Y Maino D Zhang G Lu F Myopia Can its progress be controlled Optom Vis Dev 200637(2)75-9

Leung JT Brown B Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lenses Optom Vis Sci

1999 Jun76(6)346-54

Hasebe S Ohtsuki H Nonaka T et al Effect of progressive addition lenses on myopia progression in Japanese children a prospective

randomized double-masked crossover trial Invest Ophthalmol Vis Sci 2008 Jul49(7)2781-9

Gwiazda J Hyman L Hussein M et al A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression

of myopia in children Invest Ophthalmol Vis Sci 2003 Apr44(4)1492-500

Siatkowski RM Cotter SA Crockett RS et al Two-year multi-center randomized double-masked placebo-controlled parallel safety and

efficacy study of 2 pirenzepine ophthalmic gel in children with myopia J AAPOS 2008 Aug12(4)332-9

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged 7 to 17 years Arch Ophthalmol 2005

Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three to less than 10 years of age Am J

Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction Am J Ophthalmol 2007

Jun143(6)1060-3

Holmes JM Edwards AR Beck RW et al A randomized pilot study of near activities versus non-near activities during patching therapy for

amblyopia J AAPOS 2005 Apr9(2)129-36

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate

amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-57

76

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic

amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Convergence Insufficiency Treatment Trial Study Group Randomized clinical trial of treatments for symptomatic convergence insufficiency

in children Arch Ophthalmol 2008 Oct126(10)1336-49

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

Solan HA Shelley-Tremblay J Hansen PC et al M-cell deficit and reading disability a preliminary study of the effects of temporal vision-

processing therapy Optometry 2004 Oct75(10)640-50

Solan HA Larson S Shelley-Tremblay J et al Role of visual attention in cognitive control of oculomotor readiness in students with reading

disabilities J Learn Disabil 2001 Mar-Apr34(2)107-18

Gallaway M Boas MB The impact of vergence and accommodative therapy on reading eye movements and reading speed Optom Vis Dev

200738(3)115-20

Goss DA Downing DB Lowther AH et al The effect of HTS vision therapy conducted in a school setting on reading skills in third and

fourth grade students Optom Vis Dev 200738(1)27-32

Crutch SJ Warrington EK Foveal crowding in posterior cortical atrophy a specific early-visual-processing deficit affecting word reading

Cogn Neuropsychol 2007 Dec24(8)843-66

Helms D Sawtelle SM A study of the effectiveness of cognitive therapy delivered in a video game format Optom Vis Dev 200738 (1)19-

26

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

77

Lawton T Training direction-discrimination sensitivity remediates a wide spectrum of reading skills OptomVis Dev 200738(1) 33-47

Goldstand S Koslowe KC Parush S Vision visual-information processing and academic performance among seventh-grade schoolchildren a

more significant relationship than we thought Am J Occup Ther 2005 Jul-Aug59(4)377-89

Fischer B Koumlngeter A Hartnegg K Effects of daily practice on subitizing visual counting and basic arithmetic skills Optom Vis Dev

200839(1)30-4

Sands W Taub M Maino D Limited research and education on special populations in optometry and ophthalomology Optom Vis Dev

200839(2)60-1

Wesson M Maino D Oculo-visual findings in Down syndrome cerebral palsy and mental retardation with non-specific etiology In Maino D

(ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 199517-54 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

Cui Y Stapleton F Suttle C Developing an instrument to assess vision-related and subjective quality of life in children with intellectual

disability data collection and preliminary analysis in a Chinese population Ophthal Physiolog Optics 2008 May28(3) 238-46

Maino D Steele G Tahir S Sajja R Attitudes of optometry students toward individuals with disabilities Optom Ed 200227(2)45-50

Maino D Special populations in the optometric curriculum Optom Ed 200227(2)38-9

Maino D Overview of special populations In Scheiman M Rouse M (eds) Optometric Management of Learning-Related Vision Problems

St Louis Mosby Inc 200685-106

Maino D (ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 1995 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

78

McCarthy P Maino D Alport syndrome a review Clin Eye Vis Care 2000 Dec12(3-4)139-50

Block SS Brusca-Vega R Pizzi WJ et al Cognitive and visual processing skills and their relationship to mutation size in full and

permutation female fragile X carriers Optom Vis Sci 2000 Nov77 (11)592-9

Maino D The young child with developmental disabilities An introduction to mental retardation and genetic syndromes In Moore BD

(ed) Eye Care for Infants and Young Children Butter-worth--Heinemann Newton MA1997285-300

Amin V Maino D The Fragile X female Visual visual perceptual and ocular health anomalies J Am Optom Assoc 1995 May66

(5)290-95

Maino DM Maino JH Cibis GW Hecht F Ocular health anomalies in patients with developmental disabilities In Maino D (ed)

Diagnosis and Management of Special Populations Mosby-Year-book Inc St Louis MO 1995189-206 Reprinted Optometric

Education Program Foundation Santa Anna Calif 2001

Maino D Wesson M Schlange D Cibis G Maino J Optometric findings in the fragile X syndrome Optom Vis Sci 199168634-40

Scheiman MMOptometric findings in children with cerebral palsy Am J Optom Physiol Opt 1984 May61(5)321-3

Maino D Maino J Maino S Mental retardation syndromes with associated ocular defects J Am Optom Assoc 199061707-16

Stewart RE Woodhouse JM Cregg M Pakeman VH Association between accommodative accuracy hypermetropia and strabismus in

children with Downs syndrome Optom Vis Sci 2007 Feb84(2)149-55

Cregg M Woodhouse JM Pakeman VH et al Accommodation and refractive error in children with Down syndrome cross-sectional

and longitudinal studies Invest Ophthalmol Vis Sci 2001 Jan42 (1)55-63

79

McClelland JF Parkes J Hill N et al Accommodative dysfunction in children with cerebral palsy a population-

based study Invest Ophthalmol Vis Sci 2006 May47(5)1824-30

Duckman RH Vision therapy for the child with cerebral palsy J Am Optom Assoc 198758(1)28-35

Duckman R Accommodation in cerebral palsy function and remediation J Am Optom Assoc 198455(4)281-3

Scheiman M Understanding and managing vision deficits a guide for occupational therapists 2nd ed Slack

Thorofare NJ 2002

Maino D Binasal occlusion for the child with Cerebral Palsy J Ill Optom Assoc 198644(1)1218

Battaglia F Quartarone A Rizzo V et al Early impairment of synaptic plasticity in patients with Downs syndrome

Neurobiol Aging 2008 Aug29(8)1272-5

Bonnier C Evaluation of early stimulation programs for enhancing brain development Acta Paediatr 2008

Jul97(7)853-8

Morice E Andreae LC Cooke SF et al Preservation of long-term memory and synaptic plasticity despite short-term

impairments in the Tc1 mouse model of Down syndrome Learn Mem 2008 Jul 1415(7)492-500

Gordon AM Schneider JA Chinnan A Charles JR Efficacy of a hand-arm bimanual intensive therapy (HABIT) in

children with hemiplegic cerebral palsy a randomized control trial Dev Med Child Neurol 2007 Nov49(11)830-8

Kapoor N Ciuffreda KJ Vision disturbances following traumatic brain injury Curr Treat Options Neurol 2002

Jul4(4)271-80

80

Ciuffreda KJ Rutner D Kapoor N et al Vision therapy for oculomotor dysfunctions in acquired brain injury a

retrospective analysis Optometry 2008 Jan79(1)18-22

Ciuffreda KJ Han Y Kapoor N Ficarra AP Oculomotor rehabilitation for reading in acquired brain injury

NeuroRehabilitation 200621(1)9-21

Zost M Diagnosis and management of visual dysfunction in cerebral injury In Maino D (ed) Diagnosis and

Management of Special Populations Mosby-Yearbook Inc St Louis 199579 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001 [Figure used with permission of the editor]

DeGutis JM Bentin S Robertson LC DEsposito M Functional plasticity in ventral temporal cortex following

cognitive rehabilitation of a congenital prosopagnosic J Cogn Neurosci 2007 Nov19 (11)1790-802

Welbourne SR Ralph MA Exploring the impact of plasticity-related recovery after brain damage in a connectionist

model of single-word reading Cogn Affect Behav Neurosci 2005 Mar5(1)77-92

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements prevent cognitive decline A

systematic review of randomized controlled trials J Hum Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among preterm infants attributable to early

supplementation of human milk with docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings and structural-functional

synergies with cell membrane phospholipids Altern Med Rev 2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function Neuroscience 20089(7)568-78

81

Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

BMC Biol 2008 Sep 9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine improves neuropsychological disorders in a child with

creatine transporter defect Neurocase 200814(2) 151-61

Forrester LW Wheaton LA Luft AR Exercise-mediated locomotor recovery and lower-limb neuroplasticity after

stroke J Rehabil Res Dev 200845(2)205-20

82

Page 34: Neuroplasticity: A Paradigm Sea Change Latest Updated File

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

B Amblyopia

Bottom Line

Amblyopia can be treated at any age

May be able to use neuro-enhancing drugs

as a part of basic amblyopia therapy

34

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

C Strabismus and non-strabismic non-amblyopic binocular

vision disorders

Clinical Trial of Treatments for Symptomatic Convergence Insufficiency in Children has

clearly demonstrated the superiority of in-office optometric vision therapy (in conjunction

with home therapy) vs out-of-office therapy alone The study concluded that optometric

vision therapyorthoptics was more effective than pencil push-ups or placebo vision

therapyorthoptics in reducing symptoms and improving clinical signs of convergence

insufficiency

Long-term effectiveness of treatments for symptomatic convergence insufficiency

in children (Optom Vis Sci 2009 Sep86(9)1096-103)

CITT patients improvements lasted a year

35

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

Strabismus 1999 Sep7(3)169-74 Convergence insufficiency in

idiopathic Parkinsons disease responsive to levodopa Racette BA

Gokden MS Tychsen LS Perlmutter JS

We report a patient with pathologically proven idiopathic Parkinsons

disease (IPD) who developed diplopia secondary to convergence

insufficiency during his motor off periods Diplopia resolved with

onset of motor benefit from levodopa Neuro-ophthalmologic

examination demonstrated convergence insufficiency during motor

off periods that was alleviated after onset of motor benefit from

levodopa This is the first reported case of convergence insufficiency

in IPD responsive to levodopa

36

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

Bottom Line

Optometric Vision Therapy is the most efficacious treatment available for binocular vision disorders and the

treatment effects are long lasting Neuro-enhancing drugs

may assist us as well

37

EF Learning related vision anomalies Vision

developmentperception disorders

hellipresearch includes an examination of the role vision plays in

reading the effect of oculomotor vergence and

accommodativecoherent motion therapy on reading eye movements

and reading speed the diagnosis and treatment of perceptual

disorders and the effect of therapy on various learning anomalies

38

EF Learning related vision anomalies Vision developmentperception disorders

magnocellular (MC) deficit in dyslexia

LM speed-matching ratio predicts reading in childrenChase C Dougherty RF Ray N

Fowler S Stein JOptom Vis Sci 2007 Mar84(3)229-36

Effect of attention therapy on reading comprehension Solan HA Shelley-Tremblay J

Ficarra A Silverman M Larson S J Learn Disabil 2003 Nov-Dec36(6)556-63

Is there a common linkage among reading comprehension visual attention and

magnocellular processing Solan HA Shelley-Tremblay JF Hansen PC Larson S

J Learn Disabil 2007 May-Jun40(3)270-8

Lawton T Filtered Text and Direction Discrimination Training Improved Reading

Fluency for Both Dyslexic and Normal Readers Optom Vis Dev 200839 (3)114

Fischer B Hartnegg K Saccade control in dyslexia Development deficits training

and transfer to reading Optom Vis Dev 200839(4)181-190

39

EF Learning related vision anomalies Vision developmentperception disorders

J Learn Disabil 2003 Nov-Dec36(6)556-63 Effect of attention therapy on reading

comprehension Solan HA Shelley-Tremblay J Ficarra A Silverman M Larson S

hellip At the completion of attention therapy the mean

standard attention and reading comprehension scores of

the experimental group had improved significantly The

control group however showed no significant

improvement in reading comprehension scores after 12

weeks Although uncertainties still exist this investigation

supports the notion that visual attention is malleable and

that attention therapy has a significant effect on reading

comprehension in this often neglected population

40

VII Vision dysfunction association with acquired brain injury

A Exotropia (or high exophoriaCI)

B Accommodative dysfunction

C Convergence insufficiency

41

D Decreased blink rate

E Spatial disorientation

F Pursuitsaccade dysfunction

G Unstable ambient vision (Magnocellular pathway)

42

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Stelmack JA Frith T Van Koevering D Rinne S Stelmack TR Visual function in patients

followed at a Veterans Affairs polytrauma network site an electronic medical record review

Optometry 2009 Aug80(8)419-24

RESULTS Visual symptoms were self-reported by 76 of patients

with polytrauma and 75 of the patients with TBI Problems with reading

(polytrauma 60 and TBI 50) and accommodation (polytrauma 30 and

TBI 47) were frequently found on eye examinations Spectacles were the

treatment most frequently prescribed (polytrauma 62 and TBI 78)

CONCLUSIONS It is important for optometrists to be aware of the high

rates of self-reported symptoms and visual problems in military personnel

returning from deployment to the wars in Iraq and Afghanistan Post-

traumatic stress disorder and depression may complicate optometric

evaluation and management

43

VII Vision dysfunction association with acquired brain injury

Avoidance of near tasks

Oculomotor-based reading difficulties

Eye tracking problems

Eye focusing problems

Eyestrain Diplopia

Dizziness Vertigo

Vision-derived nausea

44

VII Vision dysfunction association with acquired brain injury

Increased sensitivity to visual motion

Visual inattention and distractibility

Short-term visual memory loss

Difficulty judging distances (relative and absolute

Difficulty with global scanning

Difficulty with personal grooming especially involving the face

Inability to interactcope visually in a complex social situation

(eg minimal eye contact)

Inability to tolerate complex visual environments (eg grocery store

aisles and highly-patterned floors)

45

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Ciuffreda KJ Ludlam DP Kapoor N Clinical oculomotor training in traumatic brain injury Optom Vis

Dev 200940(1)16-23

Individuals with traumatic brain injury present with a constellation of

oculomotor dysfunctions and correlated symptoms Simple and

effective clinical oculomotor-based training procedures will be

presented with respect to the versional vergence and

accommodative systems and their interactions These therapeutic

procedures can also be applied as needed to individuals with either

low vision neurological dysfunctions or general visual skills cases

manifesting similar oculomotor deficits

46

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Leslie S Myopia and accommodative insufficiency associated with

moderate head trauma Opt Vis Dev 200940(1)25-31

The majority of subjects reviewed had developed a stable degree of

myopia between 100 and 200 diopters as well as an abnormally

high lag of accommodation When their distance and near spatial area

of focus was compared the majority were focused at an intermediate

area in space suggesting a loss of control of accommodation in

space

47

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

B Drugs

C Exercise

D Learning new and challenging things

48

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements

prevent cognitive decline A systematic review of randomized controlled trials J Hum

Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among

preterm infants attributable to early supplementation of human milk with

docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings

and structural-functional synergies with cell membrane phospholipids Altern Med Rev

2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function

Neuroscience 20089(7)568-78

49

VIII Improving Brain Function and Neuroplasticity

B Drugs Maya Vetencourt JF Sale A Viegi A et al The antidepressant

fluoxetine (PROZAC) restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the

antidepressant tianeptine CNS Drugs 200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances

hippocampal long-term potentiation and memory BMC Biol 2008 Sep

9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine

improves neuropsychological disorders in a child with creatine

transporter defect Neurocase 200814(2) 151-61

50

VIII Improving Brain Function and Neuroplasticity

C Exercise

Hunsberger JG et al Antidepressant actions of the exercise-

regulated gene VGF Nat Med 2007 Dec 2 131476

VGF may be a common pathway by which exercise induces

neuroplasticity and growth-factor genes at least one of these might act

similarly to antidepressants in promoting an adaptive response to stress

However the tests used here may be modeling stress-induced

helplessness not depression hellipexercise seems to induce multiple

interacting genes that enhance neuronal resilience

51

VIII Improving Brain Function and Neuroplasticity

D Learning new and challenging things

What have we (optometry amp ophthalmology)

been thinking all these years

Where did we miss the news about neuroplasticity

52

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Huang JC Neuroplasticity as a proposed mechanism for the efficacy of optometric vision therapy and rehabilitation J Bev Optom 200920(4)96-100

Homologous area adaptationCompensatory masqueradeCross-modal reassignment

Map expansion

EquipotentialityVicariation

53

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Homologous area adaptation a transfer of function from a damaged brain area to a non-damaged brain area May be limited to early stages of human development and may crowd a new brain area resulting in reduced functionality of that brain area (Competition between spatial amp verbal functioning)

54

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Compensatory masquerade reorganizing of existing neuro-pathways to us alternative cognitive strategies to perform a task

55

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Cross-modal reassignment using new sensory input in a brain structure deprived of its main input source (changing processing from visual to tactile stimuli in the blind)

56

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Map expansion increase in brain mass due to repeated behavior or exposure to stimuli

57

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Equipotentiality anatomical areas of the brain can perform disparate functions

Vicariation redundant neural systems can operate under abnormal conditions

This may explain why recovery is noted for many neurological conditions (degenerative psychiatric developmental vascular traumatic)

58

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Constraint therapy Use it and improve it

Patching penalization ldquonear activitiesrdquo during amblyopia therapy

59

IX Improving Brain Function and Neuroplasticity Optometric Clinical ApplicationsOptometric Vision Therapy

Kleim amp Jones

Use it or lose it If you do not drive specific brain functions

functional loss will occur

If you want to improve oculomotor brain neuroplastic function amp

structure therapy should be specific for that brain function

Use it and improve it Therapy that drives cortical function enhances

that particular function

If you use therapy to improve oculomotor dysfunction it should

improve

Specificity The therapy you choose determines the resultant

plasticity and function

You must choose therapy that is appropriate

60

IX Improving Brain Function and Neuroplasticity Optometric Clinical Applications

Kleim amp Jones

Repetition matters Plasticity that results in functional change

requires repetition

Do the therapy Do it again Do it yet again No quick fix

Intensity matters Induction of plasticity requires the appropriate

amount of intensity

Intensity means strength force concentration power and passion

Without these plasticity may not occur Function may not improve

Time matters Different forms of plasticity take place at different

times during therapy

Do the basics than the more advanced therapeutic procedures

61

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Salience matters It has to be important to the individual

Make the therapy matter to the patient

Age matters Plasticity is easier in a younger brain but is also

possible in an adult brain

Do not let age determine what therapy options you offer your

patients Think of Susan Barry PhD (StereoSue) and her success

Offer your patients options Let them choose Be realistic about

outcomeshelliphave outcome measures built into therapy program

62

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Transference Neuroplasticity and the change in function

that results from one therapy can augment the attainment

of similar behaviors

What you do during oculomotor therapy may affected

vergence therapy outcomes

Interference Plasticity in response to one experience can

interfere with the acquisition of other behaviors

Monitor Evaluate progress Discuss function in other areas

of your patientslsquo life

63

Why pay attention to binocular vision dysfunctions

and neuroplasticity

December 2009 issue of the Review of Optometry

The Binocular Vision Dysfunction Pandemic

In 2010 almost 170 million individuals will be wearing glasses In

2010 there will also be up to 93 million amblyopes and 12 and a half

million strabismics For children under 18 years of age that means

there will be more than 22 and a half million amblyopes and millions

of children with strabismus A clinical trial to determine the

prevalence of binocular vision dysfunction within the general

population suggested the possibility of up to 56 or 173 million men

women and children with symptoms associated with a binocular

vision dysfunction 189 million (61) with accommodative problems

and 118 million (38) demonstrating various vergence

anomalies

64

65

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Brain plasticity life long changes in the structure of the brain

Sensory substitution replacement of one sensory input by another

Measurement techniques

Voxel based morphometryhellipmeasures difference in brain volume

Fluorodeoxyglucose glucose analog PET scan tells you

distribution and metabolism of brain

Cortical thickness measures

Visual cortex of the blind turns somatic ―The eye of the tongue

Transcranial magnetic stmiulation non-invasive technique to

stimulate cortex

66

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Blind Braille readers report tingling in fingers when pressure

phosphenes are applied Blind feel tingling in tongue

Bind use tongue to perform orientation task motion perception

sensory perception Visual cortex recruited in a variety of sensory

and cognitive tasks (DM Can we use tongue as a VT tool)

Dilks Reorganizations of human adult visual system

When a region of sensory cortex is deprived of its bottom up

input the deprived region begins to respond to stimuli that

normally activate adjacent cortex

67

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Retinotopic map changes for stroke pts Cortical reorganization in

adults occurs Perceived objectshellipelongation in stroke amp AMD

What happens to deprived cortex in AMD

fMRI shows cortical reorganization in adults

Proposed mechanisms

hellipGrowth of new connections

hellipUnmasking of pre-existing connections this is true

happens within seconds

Bavelier

Action video games

68

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Bavelier

Action video games Looked at attention Gamers can track more

activities

Attention over space (me peripheral awarenress) Useful field

of view shrinks with age

Performance not VA relatedhellipis related to attention

Action game playing changes spatial resolutionhellipovercoming

crowding in VA assessment (me amblyopia therapy)

Temporal resolution of vision Backward masking

changehellipbrain changes

Visual sensitivity (contrast sensitivity) Post action game training

improves CSF

69

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Action video games correcting optics of the cortex (me this is

actualy OVT)

Games factor

Variable entry leanringhellipadapt task to skill level

Incremental learning tune task to subjectlsquos leanring steps

Motivationarousal

Rewards

Self masterself confidence

Action games factors

Pacingrate of exposure to infohellipincreasing processing speed

Dynamic display

Rich environment

Rich motor involvement

70

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Surgeons may be made to play action games

Pilot training

Amblyopia tx Dennis Levi research

PresenterTitle Contact info

Neuroplasticity-A Paradigm Sea Change

This presentation is available at

httpwwwslidesharenetDMAINOneuroplasticity-a-paradigm-sea-change-2459693

httpwwwmainosmemosblogspotcom

My FaceBook Page

and

Twitter

PresenterTitle Contact info

Questions About

Neuroplasticity-A Paradigm Sea Change

Dominick M Maino OD MEd FAAO FCOVD-A

Professor PediatricsBinocular VisionIllinois Eye InstituteIllinois College of Optometry

dmainoicoeduhttpwwwMainosMemosblogspotcom

Thanks to

httpwwwcovdorgHomeOVDJournalOVD401tabid263D

efaultaspx

httpbipolarblastfileswordpresscom200908neurojpg

httpwwwspecialcheerscomimagesanimated_braingif

httpblogmarsdencartoonscomwp-

contentuploads200810frankenstein-myspace-lightbeergif

httpwwwshangralafamilyfuncomgala-ecalvindreamgif

httppsychiatryjwatchorgcgicontentfull20082251

73

Chakraborty R Chatterjee A Choudhart S Chakraborty PK Neuroplasticitymdasha paradigm shift in neurosciences J Indian Med Assoc

2007105(9)513-4516-8520-1

Sacks O A neurologistlsquos notebook Stereo Sue Why two eyes are better than one The New Yorker 2006 Jun 1964-73

Krulwich R National Public Radio Going Binocular Susanlsquos First Snowfall Available at

wwwnprorgtemplatesstorystoryphpstoryId=5507789 (Accessed December 8 2008)

Press LJ The story behind Stereo Suelsquo and a world-famous neurologistlsquos discovery of vision therapy Optom Vis Dev 200637(2) 55-7

Levin HS Neuroplasticity and brain imaging research implications for rehabilitation Arch Phys Med Rehabil 2006 Dec87(12 Suppl

2)S1

Wiesel TN Hubel DH Single-cell responses in striate cortex of kittens deprived of vision in one eye J Neurophysiol 1963

Nov261003-17

Hook BM Chen C Critical periods in the visual system Changing views for a model of experience-dependent plasticity Neuron 2007

Oct56(2)312-26

Ramey CT Ramey SL Prevention of intellectual disabilities early interventions to improve cognitive development Prev Med 1998

Mar-Apr27(2)224-32

Heuninckx S Wenderoth N Swinnen SP Systems neuroplasticity in the aging brain recruiting additional neural resources for

successful motor performance in elderly persons J Neurosci 2008 Jan 228(1)91-9

Ge S Yang CH Hsu KS et al A critical period for enhanced synaptic plasticity in newly generated neurons of the adult brain Neuron

2007 May54(4)559-66

74

Draganski B Gaser C Busch V et al Neuroplasticity changes in grey matter induced by training Nature 2004 Jan 22427(6972)

311-2

Cannonieri GC Bonilha L Fernandes PT et al Practice and perfect length of training and structural brain changes in experienced

typists Neuroreport 2007 Jul 218(10)1063-6

Kleim JA Jones TA Principles of experience-dependent neural plasticity implications for rehabilitation after brain damage J

Speech Lang Hear Res 2008 Feb51(1)S225-39

Trojan S Porkorny J Theoretical aspects of neuroplasticity Physiol Res 199948(2)87-97

Ramamirtham R Kee CS Hung LF et al Wave aberrations in rhesus monkeys with vision-induced ametropias Vision Res 2007

Sep47(21)2751-66

Smith EL 3rd Ramamirtham R Qiao-Grider Y et al Effects of foveal ablation on emmetropization and form-deprivation myopia

Invest Ophthalmol Vis Sci 2007 Sep48(9)3914-22

Smith EL 3rd Kee CS Ramamirtham R et al Peripheral vision can influence eye growth and refractive development in infant

monkeys Invest Ophthalmol Vis Sci 2005 Nov46(11)3965-72

Ciuffreda KJ Vasudevan B Nearwork-induced transient myopia (NITM) and permanent myopiandashndashis there a link Ophthalmic

Physiol Opt 2008 Mar28(2)103-14

Hung GK Ciuffreda KJ Incremental retinal-defocus theory of myopia development--schematic analysis and computer simulation

Comput Biol Med 2007 Jul37(7)930-46

Hung GK Ciuffreda KJ A unifying theory of refractive error development Bull Math Biol 2000 Nov62(6)1087-108

75

Pang Y Maino D Zhang G Lu F Myopia Can its progress be controlled Optom Vis Dev 200637(2)75-9

Leung JT Brown B Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lenses Optom Vis Sci

1999 Jun76(6)346-54

Hasebe S Ohtsuki H Nonaka T et al Effect of progressive addition lenses on myopia progression in Japanese children a prospective

randomized double-masked crossover trial Invest Ophthalmol Vis Sci 2008 Jul49(7)2781-9

Gwiazda J Hyman L Hussein M et al A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression

of myopia in children Invest Ophthalmol Vis Sci 2003 Apr44(4)1492-500

Siatkowski RM Cotter SA Crockett RS et al Two-year multi-center randomized double-masked placebo-controlled parallel safety and

efficacy study of 2 pirenzepine ophthalmic gel in children with myopia J AAPOS 2008 Aug12(4)332-9

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged 7 to 17 years Arch Ophthalmol 2005

Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three to less than 10 years of age Am J

Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction Am J Ophthalmol 2007

Jun143(6)1060-3

Holmes JM Edwards AR Beck RW et al A randomized pilot study of near activities versus non-near activities during patching therapy for

amblyopia J AAPOS 2005 Apr9(2)129-36

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate

amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-57

76

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic

amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Convergence Insufficiency Treatment Trial Study Group Randomized clinical trial of treatments for symptomatic convergence insufficiency

in children Arch Ophthalmol 2008 Oct126(10)1336-49

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

Solan HA Shelley-Tremblay J Hansen PC et al M-cell deficit and reading disability a preliminary study of the effects of temporal vision-

processing therapy Optometry 2004 Oct75(10)640-50

Solan HA Larson S Shelley-Tremblay J et al Role of visual attention in cognitive control of oculomotor readiness in students with reading

disabilities J Learn Disabil 2001 Mar-Apr34(2)107-18

Gallaway M Boas MB The impact of vergence and accommodative therapy on reading eye movements and reading speed Optom Vis Dev

200738(3)115-20

Goss DA Downing DB Lowther AH et al The effect of HTS vision therapy conducted in a school setting on reading skills in third and

fourth grade students Optom Vis Dev 200738(1)27-32

Crutch SJ Warrington EK Foveal crowding in posterior cortical atrophy a specific early-visual-processing deficit affecting word reading

Cogn Neuropsychol 2007 Dec24(8)843-66

Helms D Sawtelle SM A study of the effectiveness of cognitive therapy delivered in a video game format Optom Vis Dev 200738 (1)19-

26

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

77

Lawton T Training direction-discrimination sensitivity remediates a wide spectrum of reading skills OptomVis Dev 200738(1) 33-47

Goldstand S Koslowe KC Parush S Vision visual-information processing and academic performance among seventh-grade schoolchildren a

more significant relationship than we thought Am J Occup Ther 2005 Jul-Aug59(4)377-89

Fischer B Koumlngeter A Hartnegg K Effects of daily practice on subitizing visual counting and basic arithmetic skills Optom Vis Dev

200839(1)30-4

Sands W Taub M Maino D Limited research and education on special populations in optometry and ophthalomology Optom Vis Dev

200839(2)60-1

Wesson M Maino D Oculo-visual findings in Down syndrome cerebral palsy and mental retardation with non-specific etiology In Maino D

(ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 199517-54 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

Cui Y Stapleton F Suttle C Developing an instrument to assess vision-related and subjective quality of life in children with intellectual

disability data collection and preliminary analysis in a Chinese population Ophthal Physiolog Optics 2008 May28(3) 238-46

Maino D Steele G Tahir S Sajja R Attitudes of optometry students toward individuals with disabilities Optom Ed 200227(2)45-50

Maino D Special populations in the optometric curriculum Optom Ed 200227(2)38-9

Maino D Overview of special populations In Scheiman M Rouse M (eds) Optometric Management of Learning-Related Vision Problems

St Louis Mosby Inc 200685-106

Maino D (ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 1995 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

78

McCarthy P Maino D Alport syndrome a review Clin Eye Vis Care 2000 Dec12(3-4)139-50

Block SS Brusca-Vega R Pizzi WJ et al Cognitive and visual processing skills and their relationship to mutation size in full and

permutation female fragile X carriers Optom Vis Sci 2000 Nov77 (11)592-9

Maino D The young child with developmental disabilities An introduction to mental retardation and genetic syndromes In Moore BD

(ed) Eye Care for Infants and Young Children Butter-worth--Heinemann Newton MA1997285-300

Amin V Maino D The Fragile X female Visual visual perceptual and ocular health anomalies J Am Optom Assoc 1995 May66

(5)290-95

Maino DM Maino JH Cibis GW Hecht F Ocular health anomalies in patients with developmental disabilities In Maino D (ed)

Diagnosis and Management of Special Populations Mosby-Year-book Inc St Louis MO 1995189-206 Reprinted Optometric

Education Program Foundation Santa Anna Calif 2001

Maino D Wesson M Schlange D Cibis G Maino J Optometric findings in the fragile X syndrome Optom Vis Sci 199168634-40

Scheiman MMOptometric findings in children with cerebral palsy Am J Optom Physiol Opt 1984 May61(5)321-3

Maino D Maino J Maino S Mental retardation syndromes with associated ocular defects J Am Optom Assoc 199061707-16

Stewart RE Woodhouse JM Cregg M Pakeman VH Association between accommodative accuracy hypermetropia and strabismus in

children with Downs syndrome Optom Vis Sci 2007 Feb84(2)149-55

Cregg M Woodhouse JM Pakeman VH et al Accommodation and refractive error in children with Down syndrome cross-sectional

and longitudinal studies Invest Ophthalmol Vis Sci 2001 Jan42 (1)55-63

79

McClelland JF Parkes J Hill N et al Accommodative dysfunction in children with cerebral palsy a population-

based study Invest Ophthalmol Vis Sci 2006 May47(5)1824-30

Duckman RH Vision therapy for the child with cerebral palsy J Am Optom Assoc 198758(1)28-35

Duckman R Accommodation in cerebral palsy function and remediation J Am Optom Assoc 198455(4)281-3

Scheiman M Understanding and managing vision deficits a guide for occupational therapists 2nd ed Slack

Thorofare NJ 2002

Maino D Binasal occlusion for the child with Cerebral Palsy J Ill Optom Assoc 198644(1)1218

Battaglia F Quartarone A Rizzo V et al Early impairment of synaptic plasticity in patients with Downs syndrome

Neurobiol Aging 2008 Aug29(8)1272-5

Bonnier C Evaluation of early stimulation programs for enhancing brain development Acta Paediatr 2008

Jul97(7)853-8

Morice E Andreae LC Cooke SF et al Preservation of long-term memory and synaptic plasticity despite short-term

impairments in the Tc1 mouse model of Down syndrome Learn Mem 2008 Jul 1415(7)492-500

Gordon AM Schneider JA Chinnan A Charles JR Efficacy of a hand-arm bimanual intensive therapy (HABIT) in

children with hemiplegic cerebral palsy a randomized control trial Dev Med Child Neurol 2007 Nov49(11)830-8

Kapoor N Ciuffreda KJ Vision disturbances following traumatic brain injury Curr Treat Options Neurol 2002

Jul4(4)271-80

80

Ciuffreda KJ Rutner D Kapoor N et al Vision therapy for oculomotor dysfunctions in acquired brain injury a

retrospective analysis Optometry 2008 Jan79(1)18-22

Ciuffreda KJ Han Y Kapoor N Ficarra AP Oculomotor rehabilitation for reading in acquired brain injury

NeuroRehabilitation 200621(1)9-21

Zost M Diagnosis and management of visual dysfunction in cerebral injury In Maino D (ed) Diagnosis and

Management of Special Populations Mosby-Yearbook Inc St Louis 199579 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001 [Figure used with permission of the editor]

DeGutis JM Bentin S Robertson LC DEsposito M Functional plasticity in ventral temporal cortex following

cognitive rehabilitation of a congenital prosopagnosic J Cogn Neurosci 2007 Nov19 (11)1790-802

Welbourne SR Ralph MA Exploring the impact of plasticity-related recovery after brain damage in a connectionist

model of single-word reading Cogn Affect Behav Neurosci 2005 Mar5(1)77-92

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements prevent cognitive decline A

systematic review of randomized controlled trials J Hum Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among preterm infants attributable to early

supplementation of human milk with docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings and structural-functional

synergies with cell membrane phospholipids Altern Med Rev 2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function Neuroscience 20089(7)568-78

81

Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

BMC Biol 2008 Sep 9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine improves neuropsychological disorders in a child with

creatine transporter defect Neurocase 200814(2) 151-61

Forrester LW Wheaton LA Luft AR Exercise-mediated locomotor recovery and lower-limb neuroplasticity after

stroke J Rehabil Res Dev 200845(2)205-20

82

Page 35: Neuroplasticity: A Paradigm Sea Change Latest Updated File

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

C Strabismus and non-strabismic non-amblyopic binocular

vision disorders

Clinical Trial of Treatments for Symptomatic Convergence Insufficiency in Children has

clearly demonstrated the superiority of in-office optometric vision therapy (in conjunction

with home therapy) vs out-of-office therapy alone The study concluded that optometric

vision therapyorthoptics was more effective than pencil push-ups or placebo vision

therapyorthoptics in reducing symptoms and improving clinical signs of convergence

insufficiency

Long-term effectiveness of treatments for symptomatic convergence insufficiency

in children (Optom Vis Sci 2009 Sep86(9)1096-103)

CITT patients improvements lasted a year

35

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

Strabismus 1999 Sep7(3)169-74 Convergence insufficiency in

idiopathic Parkinsons disease responsive to levodopa Racette BA

Gokden MS Tychsen LS Perlmutter JS

We report a patient with pathologically proven idiopathic Parkinsons

disease (IPD) who developed diplopia secondary to convergence

insufficiency during his motor off periods Diplopia resolved with

onset of motor benefit from levodopa Neuro-ophthalmologic

examination demonstrated convergence insufficiency during motor

off periods that was alleviated after onset of motor benefit from

levodopa This is the first reported case of convergence insufficiency

in IPD responsive to levodopa

36

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

Bottom Line

Optometric Vision Therapy is the most efficacious treatment available for binocular vision disorders and the

treatment effects are long lasting Neuro-enhancing drugs

may assist us as well

37

EF Learning related vision anomalies Vision

developmentperception disorders

hellipresearch includes an examination of the role vision plays in

reading the effect of oculomotor vergence and

accommodativecoherent motion therapy on reading eye movements

and reading speed the diagnosis and treatment of perceptual

disorders and the effect of therapy on various learning anomalies

38

EF Learning related vision anomalies Vision developmentperception disorders

magnocellular (MC) deficit in dyslexia

LM speed-matching ratio predicts reading in childrenChase C Dougherty RF Ray N

Fowler S Stein JOptom Vis Sci 2007 Mar84(3)229-36

Effect of attention therapy on reading comprehension Solan HA Shelley-Tremblay J

Ficarra A Silverman M Larson S J Learn Disabil 2003 Nov-Dec36(6)556-63

Is there a common linkage among reading comprehension visual attention and

magnocellular processing Solan HA Shelley-Tremblay JF Hansen PC Larson S

J Learn Disabil 2007 May-Jun40(3)270-8

Lawton T Filtered Text and Direction Discrimination Training Improved Reading

Fluency for Both Dyslexic and Normal Readers Optom Vis Dev 200839 (3)114

Fischer B Hartnegg K Saccade control in dyslexia Development deficits training

and transfer to reading Optom Vis Dev 200839(4)181-190

39

EF Learning related vision anomalies Vision developmentperception disorders

J Learn Disabil 2003 Nov-Dec36(6)556-63 Effect of attention therapy on reading

comprehension Solan HA Shelley-Tremblay J Ficarra A Silverman M Larson S

hellip At the completion of attention therapy the mean

standard attention and reading comprehension scores of

the experimental group had improved significantly The

control group however showed no significant

improvement in reading comprehension scores after 12

weeks Although uncertainties still exist this investigation

supports the notion that visual attention is malleable and

that attention therapy has a significant effect on reading

comprehension in this often neglected population

40

VII Vision dysfunction association with acquired brain injury

A Exotropia (or high exophoriaCI)

B Accommodative dysfunction

C Convergence insufficiency

41

D Decreased blink rate

E Spatial disorientation

F Pursuitsaccade dysfunction

G Unstable ambient vision (Magnocellular pathway)

42

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Stelmack JA Frith T Van Koevering D Rinne S Stelmack TR Visual function in patients

followed at a Veterans Affairs polytrauma network site an electronic medical record review

Optometry 2009 Aug80(8)419-24

RESULTS Visual symptoms were self-reported by 76 of patients

with polytrauma and 75 of the patients with TBI Problems with reading

(polytrauma 60 and TBI 50) and accommodation (polytrauma 30 and

TBI 47) were frequently found on eye examinations Spectacles were the

treatment most frequently prescribed (polytrauma 62 and TBI 78)

CONCLUSIONS It is important for optometrists to be aware of the high

rates of self-reported symptoms and visual problems in military personnel

returning from deployment to the wars in Iraq and Afghanistan Post-

traumatic stress disorder and depression may complicate optometric

evaluation and management

43

VII Vision dysfunction association with acquired brain injury

Avoidance of near tasks

Oculomotor-based reading difficulties

Eye tracking problems

Eye focusing problems

Eyestrain Diplopia

Dizziness Vertigo

Vision-derived nausea

44

VII Vision dysfunction association with acquired brain injury

Increased sensitivity to visual motion

Visual inattention and distractibility

Short-term visual memory loss

Difficulty judging distances (relative and absolute

Difficulty with global scanning

Difficulty with personal grooming especially involving the face

Inability to interactcope visually in a complex social situation

(eg minimal eye contact)

Inability to tolerate complex visual environments (eg grocery store

aisles and highly-patterned floors)

45

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Ciuffreda KJ Ludlam DP Kapoor N Clinical oculomotor training in traumatic brain injury Optom Vis

Dev 200940(1)16-23

Individuals with traumatic brain injury present with a constellation of

oculomotor dysfunctions and correlated symptoms Simple and

effective clinical oculomotor-based training procedures will be

presented with respect to the versional vergence and

accommodative systems and their interactions These therapeutic

procedures can also be applied as needed to individuals with either

low vision neurological dysfunctions or general visual skills cases

manifesting similar oculomotor deficits

46

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Leslie S Myopia and accommodative insufficiency associated with

moderate head trauma Opt Vis Dev 200940(1)25-31

The majority of subjects reviewed had developed a stable degree of

myopia between 100 and 200 diopters as well as an abnormally

high lag of accommodation When their distance and near spatial area

of focus was compared the majority were focused at an intermediate

area in space suggesting a loss of control of accommodation in

space

47

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

B Drugs

C Exercise

D Learning new and challenging things

48

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements

prevent cognitive decline A systematic review of randomized controlled trials J Hum

Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among

preterm infants attributable to early supplementation of human milk with

docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings

and structural-functional synergies with cell membrane phospholipids Altern Med Rev

2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function

Neuroscience 20089(7)568-78

49

VIII Improving Brain Function and Neuroplasticity

B Drugs Maya Vetencourt JF Sale A Viegi A et al The antidepressant

fluoxetine (PROZAC) restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the

antidepressant tianeptine CNS Drugs 200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances

hippocampal long-term potentiation and memory BMC Biol 2008 Sep

9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine

improves neuropsychological disorders in a child with creatine

transporter defect Neurocase 200814(2) 151-61

50

VIII Improving Brain Function and Neuroplasticity

C Exercise

Hunsberger JG et al Antidepressant actions of the exercise-

regulated gene VGF Nat Med 2007 Dec 2 131476

VGF may be a common pathway by which exercise induces

neuroplasticity and growth-factor genes at least one of these might act

similarly to antidepressants in promoting an adaptive response to stress

However the tests used here may be modeling stress-induced

helplessness not depression hellipexercise seems to induce multiple

interacting genes that enhance neuronal resilience

51

VIII Improving Brain Function and Neuroplasticity

D Learning new and challenging things

What have we (optometry amp ophthalmology)

been thinking all these years

Where did we miss the news about neuroplasticity

52

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Huang JC Neuroplasticity as a proposed mechanism for the efficacy of optometric vision therapy and rehabilitation J Bev Optom 200920(4)96-100

Homologous area adaptationCompensatory masqueradeCross-modal reassignment

Map expansion

EquipotentialityVicariation

53

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Homologous area adaptation a transfer of function from a damaged brain area to a non-damaged brain area May be limited to early stages of human development and may crowd a new brain area resulting in reduced functionality of that brain area (Competition between spatial amp verbal functioning)

54

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Compensatory masquerade reorganizing of existing neuro-pathways to us alternative cognitive strategies to perform a task

55

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Cross-modal reassignment using new sensory input in a brain structure deprived of its main input source (changing processing from visual to tactile stimuli in the blind)

56

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Map expansion increase in brain mass due to repeated behavior or exposure to stimuli

57

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Equipotentiality anatomical areas of the brain can perform disparate functions

Vicariation redundant neural systems can operate under abnormal conditions

This may explain why recovery is noted for many neurological conditions (degenerative psychiatric developmental vascular traumatic)

58

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Constraint therapy Use it and improve it

Patching penalization ldquonear activitiesrdquo during amblyopia therapy

59

IX Improving Brain Function and Neuroplasticity Optometric Clinical ApplicationsOptometric Vision Therapy

Kleim amp Jones

Use it or lose it If you do not drive specific brain functions

functional loss will occur

If you want to improve oculomotor brain neuroplastic function amp

structure therapy should be specific for that brain function

Use it and improve it Therapy that drives cortical function enhances

that particular function

If you use therapy to improve oculomotor dysfunction it should

improve

Specificity The therapy you choose determines the resultant

plasticity and function

You must choose therapy that is appropriate

60

IX Improving Brain Function and Neuroplasticity Optometric Clinical Applications

Kleim amp Jones

Repetition matters Plasticity that results in functional change

requires repetition

Do the therapy Do it again Do it yet again No quick fix

Intensity matters Induction of plasticity requires the appropriate

amount of intensity

Intensity means strength force concentration power and passion

Without these plasticity may not occur Function may not improve

Time matters Different forms of plasticity take place at different

times during therapy

Do the basics than the more advanced therapeutic procedures

61

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Salience matters It has to be important to the individual

Make the therapy matter to the patient

Age matters Plasticity is easier in a younger brain but is also

possible in an adult brain

Do not let age determine what therapy options you offer your

patients Think of Susan Barry PhD (StereoSue) and her success

Offer your patients options Let them choose Be realistic about

outcomeshelliphave outcome measures built into therapy program

62

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Transference Neuroplasticity and the change in function

that results from one therapy can augment the attainment

of similar behaviors

What you do during oculomotor therapy may affected

vergence therapy outcomes

Interference Plasticity in response to one experience can

interfere with the acquisition of other behaviors

Monitor Evaluate progress Discuss function in other areas

of your patientslsquo life

63

Why pay attention to binocular vision dysfunctions

and neuroplasticity

December 2009 issue of the Review of Optometry

The Binocular Vision Dysfunction Pandemic

In 2010 almost 170 million individuals will be wearing glasses In

2010 there will also be up to 93 million amblyopes and 12 and a half

million strabismics For children under 18 years of age that means

there will be more than 22 and a half million amblyopes and millions

of children with strabismus A clinical trial to determine the

prevalence of binocular vision dysfunction within the general

population suggested the possibility of up to 56 or 173 million men

women and children with symptoms associated with a binocular

vision dysfunction 189 million (61) with accommodative problems

and 118 million (38) demonstrating various vergence

anomalies

64

65

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Brain plasticity life long changes in the structure of the brain

Sensory substitution replacement of one sensory input by another

Measurement techniques

Voxel based morphometryhellipmeasures difference in brain volume

Fluorodeoxyglucose glucose analog PET scan tells you

distribution and metabolism of brain

Cortical thickness measures

Visual cortex of the blind turns somatic ―The eye of the tongue

Transcranial magnetic stmiulation non-invasive technique to

stimulate cortex

66

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Blind Braille readers report tingling in fingers when pressure

phosphenes are applied Blind feel tingling in tongue

Bind use tongue to perform orientation task motion perception

sensory perception Visual cortex recruited in a variety of sensory

and cognitive tasks (DM Can we use tongue as a VT tool)

Dilks Reorganizations of human adult visual system

When a region of sensory cortex is deprived of its bottom up

input the deprived region begins to respond to stimuli that

normally activate adjacent cortex

67

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Retinotopic map changes for stroke pts Cortical reorganization in

adults occurs Perceived objectshellipelongation in stroke amp AMD

What happens to deprived cortex in AMD

fMRI shows cortical reorganization in adults

Proposed mechanisms

hellipGrowth of new connections

hellipUnmasking of pre-existing connections this is true

happens within seconds

Bavelier

Action video games

68

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Bavelier

Action video games Looked at attention Gamers can track more

activities

Attention over space (me peripheral awarenress) Useful field

of view shrinks with age

Performance not VA relatedhellipis related to attention

Action game playing changes spatial resolutionhellipovercoming

crowding in VA assessment (me amblyopia therapy)

Temporal resolution of vision Backward masking

changehellipbrain changes

Visual sensitivity (contrast sensitivity) Post action game training

improves CSF

69

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Action video games correcting optics of the cortex (me this is

actualy OVT)

Games factor

Variable entry leanringhellipadapt task to skill level

Incremental learning tune task to subjectlsquos leanring steps

Motivationarousal

Rewards

Self masterself confidence

Action games factors

Pacingrate of exposure to infohellipincreasing processing speed

Dynamic display

Rich environment

Rich motor involvement

70

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Surgeons may be made to play action games

Pilot training

Amblyopia tx Dennis Levi research

PresenterTitle Contact info

Neuroplasticity-A Paradigm Sea Change

This presentation is available at

httpwwwslidesharenetDMAINOneuroplasticity-a-paradigm-sea-change-2459693

httpwwwmainosmemosblogspotcom

My FaceBook Page

and

Twitter

PresenterTitle Contact info

Questions About

Neuroplasticity-A Paradigm Sea Change

Dominick M Maino OD MEd FAAO FCOVD-A

Professor PediatricsBinocular VisionIllinois Eye InstituteIllinois College of Optometry

dmainoicoeduhttpwwwMainosMemosblogspotcom

Thanks to

httpwwwcovdorgHomeOVDJournalOVD401tabid263D

efaultaspx

httpbipolarblastfileswordpresscom200908neurojpg

httpwwwspecialcheerscomimagesanimated_braingif

httpblogmarsdencartoonscomwp-

contentuploads200810frankenstein-myspace-lightbeergif

httpwwwshangralafamilyfuncomgala-ecalvindreamgif

httppsychiatryjwatchorgcgicontentfull20082251

73

Chakraborty R Chatterjee A Choudhart S Chakraborty PK Neuroplasticitymdasha paradigm shift in neurosciences J Indian Med Assoc

2007105(9)513-4516-8520-1

Sacks O A neurologistlsquos notebook Stereo Sue Why two eyes are better than one The New Yorker 2006 Jun 1964-73

Krulwich R National Public Radio Going Binocular Susanlsquos First Snowfall Available at

wwwnprorgtemplatesstorystoryphpstoryId=5507789 (Accessed December 8 2008)

Press LJ The story behind Stereo Suelsquo and a world-famous neurologistlsquos discovery of vision therapy Optom Vis Dev 200637(2) 55-7

Levin HS Neuroplasticity and brain imaging research implications for rehabilitation Arch Phys Med Rehabil 2006 Dec87(12 Suppl

2)S1

Wiesel TN Hubel DH Single-cell responses in striate cortex of kittens deprived of vision in one eye J Neurophysiol 1963

Nov261003-17

Hook BM Chen C Critical periods in the visual system Changing views for a model of experience-dependent plasticity Neuron 2007

Oct56(2)312-26

Ramey CT Ramey SL Prevention of intellectual disabilities early interventions to improve cognitive development Prev Med 1998

Mar-Apr27(2)224-32

Heuninckx S Wenderoth N Swinnen SP Systems neuroplasticity in the aging brain recruiting additional neural resources for

successful motor performance in elderly persons J Neurosci 2008 Jan 228(1)91-9

Ge S Yang CH Hsu KS et al A critical period for enhanced synaptic plasticity in newly generated neurons of the adult brain Neuron

2007 May54(4)559-66

74

Draganski B Gaser C Busch V et al Neuroplasticity changes in grey matter induced by training Nature 2004 Jan 22427(6972)

311-2

Cannonieri GC Bonilha L Fernandes PT et al Practice and perfect length of training and structural brain changes in experienced

typists Neuroreport 2007 Jul 218(10)1063-6

Kleim JA Jones TA Principles of experience-dependent neural plasticity implications for rehabilitation after brain damage J

Speech Lang Hear Res 2008 Feb51(1)S225-39

Trojan S Porkorny J Theoretical aspects of neuroplasticity Physiol Res 199948(2)87-97

Ramamirtham R Kee CS Hung LF et al Wave aberrations in rhesus monkeys with vision-induced ametropias Vision Res 2007

Sep47(21)2751-66

Smith EL 3rd Ramamirtham R Qiao-Grider Y et al Effects of foveal ablation on emmetropization and form-deprivation myopia

Invest Ophthalmol Vis Sci 2007 Sep48(9)3914-22

Smith EL 3rd Kee CS Ramamirtham R et al Peripheral vision can influence eye growth and refractive development in infant

monkeys Invest Ophthalmol Vis Sci 2005 Nov46(11)3965-72

Ciuffreda KJ Vasudevan B Nearwork-induced transient myopia (NITM) and permanent myopiandashndashis there a link Ophthalmic

Physiol Opt 2008 Mar28(2)103-14

Hung GK Ciuffreda KJ Incremental retinal-defocus theory of myopia development--schematic analysis and computer simulation

Comput Biol Med 2007 Jul37(7)930-46

Hung GK Ciuffreda KJ A unifying theory of refractive error development Bull Math Biol 2000 Nov62(6)1087-108

75

Pang Y Maino D Zhang G Lu F Myopia Can its progress be controlled Optom Vis Dev 200637(2)75-9

Leung JT Brown B Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lenses Optom Vis Sci

1999 Jun76(6)346-54

Hasebe S Ohtsuki H Nonaka T et al Effect of progressive addition lenses on myopia progression in Japanese children a prospective

randomized double-masked crossover trial Invest Ophthalmol Vis Sci 2008 Jul49(7)2781-9

Gwiazda J Hyman L Hussein M et al A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression

of myopia in children Invest Ophthalmol Vis Sci 2003 Apr44(4)1492-500

Siatkowski RM Cotter SA Crockett RS et al Two-year multi-center randomized double-masked placebo-controlled parallel safety and

efficacy study of 2 pirenzepine ophthalmic gel in children with myopia J AAPOS 2008 Aug12(4)332-9

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged 7 to 17 years Arch Ophthalmol 2005

Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three to less than 10 years of age Am J

Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction Am J Ophthalmol 2007

Jun143(6)1060-3

Holmes JM Edwards AR Beck RW et al A randomized pilot study of near activities versus non-near activities during patching therapy for

amblyopia J AAPOS 2005 Apr9(2)129-36

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate

amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-57

76

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic

amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Convergence Insufficiency Treatment Trial Study Group Randomized clinical trial of treatments for symptomatic convergence insufficiency

in children Arch Ophthalmol 2008 Oct126(10)1336-49

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

Solan HA Shelley-Tremblay J Hansen PC et al M-cell deficit and reading disability a preliminary study of the effects of temporal vision-

processing therapy Optometry 2004 Oct75(10)640-50

Solan HA Larson S Shelley-Tremblay J et al Role of visual attention in cognitive control of oculomotor readiness in students with reading

disabilities J Learn Disabil 2001 Mar-Apr34(2)107-18

Gallaway M Boas MB The impact of vergence and accommodative therapy on reading eye movements and reading speed Optom Vis Dev

200738(3)115-20

Goss DA Downing DB Lowther AH et al The effect of HTS vision therapy conducted in a school setting on reading skills in third and

fourth grade students Optom Vis Dev 200738(1)27-32

Crutch SJ Warrington EK Foveal crowding in posterior cortical atrophy a specific early-visual-processing deficit affecting word reading

Cogn Neuropsychol 2007 Dec24(8)843-66

Helms D Sawtelle SM A study of the effectiveness of cognitive therapy delivered in a video game format Optom Vis Dev 200738 (1)19-

26

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

77

Lawton T Training direction-discrimination sensitivity remediates a wide spectrum of reading skills OptomVis Dev 200738(1) 33-47

Goldstand S Koslowe KC Parush S Vision visual-information processing and academic performance among seventh-grade schoolchildren a

more significant relationship than we thought Am J Occup Ther 2005 Jul-Aug59(4)377-89

Fischer B Koumlngeter A Hartnegg K Effects of daily practice on subitizing visual counting and basic arithmetic skills Optom Vis Dev

200839(1)30-4

Sands W Taub M Maino D Limited research and education on special populations in optometry and ophthalomology Optom Vis Dev

200839(2)60-1

Wesson M Maino D Oculo-visual findings in Down syndrome cerebral palsy and mental retardation with non-specific etiology In Maino D

(ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 199517-54 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

Cui Y Stapleton F Suttle C Developing an instrument to assess vision-related and subjective quality of life in children with intellectual

disability data collection and preliminary analysis in a Chinese population Ophthal Physiolog Optics 2008 May28(3) 238-46

Maino D Steele G Tahir S Sajja R Attitudes of optometry students toward individuals with disabilities Optom Ed 200227(2)45-50

Maino D Special populations in the optometric curriculum Optom Ed 200227(2)38-9

Maino D Overview of special populations In Scheiman M Rouse M (eds) Optometric Management of Learning-Related Vision Problems

St Louis Mosby Inc 200685-106

Maino D (ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 1995 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

78

McCarthy P Maino D Alport syndrome a review Clin Eye Vis Care 2000 Dec12(3-4)139-50

Block SS Brusca-Vega R Pizzi WJ et al Cognitive and visual processing skills and their relationship to mutation size in full and

permutation female fragile X carriers Optom Vis Sci 2000 Nov77 (11)592-9

Maino D The young child with developmental disabilities An introduction to mental retardation and genetic syndromes In Moore BD

(ed) Eye Care for Infants and Young Children Butter-worth--Heinemann Newton MA1997285-300

Amin V Maino D The Fragile X female Visual visual perceptual and ocular health anomalies J Am Optom Assoc 1995 May66

(5)290-95

Maino DM Maino JH Cibis GW Hecht F Ocular health anomalies in patients with developmental disabilities In Maino D (ed)

Diagnosis and Management of Special Populations Mosby-Year-book Inc St Louis MO 1995189-206 Reprinted Optometric

Education Program Foundation Santa Anna Calif 2001

Maino D Wesson M Schlange D Cibis G Maino J Optometric findings in the fragile X syndrome Optom Vis Sci 199168634-40

Scheiman MMOptometric findings in children with cerebral palsy Am J Optom Physiol Opt 1984 May61(5)321-3

Maino D Maino J Maino S Mental retardation syndromes with associated ocular defects J Am Optom Assoc 199061707-16

Stewart RE Woodhouse JM Cregg M Pakeman VH Association between accommodative accuracy hypermetropia and strabismus in

children with Downs syndrome Optom Vis Sci 2007 Feb84(2)149-55

Cregg M Woodhouse JM Pakeman VH et al Accommodation and refractive error in children with Down syndrome cross-sectional

and longitudinal studies Invest Ophthalmol Vis Sci 2001 Jan42 (1)55-63

79

McClelland JF Parkes J Hill N et al Accommodative dysfunction in children with cerebral palsy a population-

based study Invest Ophthalmol Vis Sci 2006 May47(5)1824-30

Duckman RH Vision therapy for the child with cerebral palsy J Am Optom Assoc 198758(1)28-35

Duckman R Accommodation in cerebral palsy function and remediation J Am Optom Assoc 198455(4)281-3

Scheiman M Understanding and managing vision deficits a guide for occupational therapists 2nd ed Slack

Thorofare NJ 2002

Maino D Binasal occlusion for the child with Cerebral Palsy J Ill Optom Assoc 198644(1)1218

Battaglia F Quartarone A Rizzo V et al Early impairment of synaptic plasticity in patients with Downs syndrome

Neurobiol Aging 2008 Aug29(8)1272-5

Bonnier C Evaluation of early stimulation programs for enhancing brain development Acta Paediatr 2008

Jul97(7)853-8

Morice E Andreae LC Cooke SF et al Preservation of long-term memory and synaptic plasticity despite short-term

impairments in the Tc1 mouse model of Down syndrome Learn Mem 2008 Jul 1415(7)492-500

Gordon AM Schneider JA Chinnan A Charles JR Efficacy of a hand-arm bimanual intensive therapy (HABIT) in

children with hemiplegic cerebral palsy a randomized control trial Dev Med Child Neurol 2007 Nov49(11)830-8

Kapoor N Ciuffreda KJ Vision disturbances following traumatic brain injury Curr Treat Options Neurol 2002

Jul4(4)271-80

80

Ciuffreda KJ Rutner D Kapoor N et al Vision therapy for oculomotor dysfunctions in acquired brain injury a

retrospective analysis Optometry 2008 Jan79(1)18-22

Ciuffreda KJ Han Y Kapoor N Ficarra AP Oculomotor rehabilitation for reading in acquired brain injury

NeuroRehabilitation 200621(1)9-21

Zost M Diagnosis and management of visual dysfunction in cerebral injury In Maino D (ed) Diagnosis and

Management of Special Populations Mosby-Yearbook Inc St Louis 199579 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001 [Figure used with permission of the editor]

DeGutis JM Bentin S Robertson LC DEsposito M Functional plasticity in ventral temporal cortex following

cognitive rehabilitation of a congenital prosopagnosic J Cogn Neurosci 2007 Nov19 (11)1790-802

Welbourne SR Ralph MA Exploring the impact of plasticity-related recovery after brain damage in a connectionist

model of single-word reading Cogn Affect Behav Neurosci 2005 Mar5(1)77-92

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements prevent cognitive decline A

systematic review of randomized controlled trials J Hum Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among preterm infants attributable to early

supplementation of human milk with docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings and structural-functional

synergies with cell membrane phospholipids Altern Med Rev 2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function Neuroscience 20089(7)568-78

81

Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

BMC Biol 2008 Sep 9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine improves neuropsychological disorders in a child with

creatine transporter defect Neurocase 200814(2) 151-61

Forrester LW Wheaton LA Luft AR Exercise-mediated locomotor recovery and lower-limb neuroplasticity after

stroke J Rehabil Res Dev 200845(2)205-20

82

Page 36: Neuroplasticity: A Paradigm Sea Change Latest Updated File

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

Strabismus 1999 Sep7(3)169-74 Convergence insufficiency in

idiopathic Parkinsons disease responsive to levodopa Racette BA

Gokden MS Tychsen LS Perlmutter JS

We report a patient with pathologically proven idiopathic Parkinsons

disease (IPD) who developed diplopia secondary to convergence

insufficiency during his motor off periods Diplopia resolved with

onset of motor benefit from levodopa Neuro-ophthalmologic

examination demonstrated convergence insufficiency during motor

off periods that was alleviated after onset of motor benefit from

levodopa This is the first reported case of convergence insufficiency

in IPD responsive to levodopa

36

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

Bottom Line

Optometric Vision Therapy is the most efficacious treatment available for binocular vision disorders and the

treatment effects are long lasting Neuro-enhancing drugs

may assist us as well

37

EF Learning related vision anomalies Vision

developmentperception disorders

hellipresearch includes an examination of the role vision plays in

reading the effect of oculomotor vergence and

accommodativecoherent motion therapy on reading eye movements

and reading speed the diagnosis and treatment of perceptual

disorders and the effect of therapy on various learning anomalies

38

EF Learning related vision anomalies Vision developmentperception disorders

magnocellular (MC) deficit in dyslexia

LM speed-matching ratio predicts reading in childrenChase C Dougherty RF Ray N

Fowler S Stein JOptom Vis Sci 2007 Mar84(3)229-36

Effect of attention therapy on reading comprehension Solan HA Shelley-Tremblay J

Ficarra A Silverman M Larson S J Learn Disabil 2003 Nov-Dec36(6)556-63

Is there a common linkage among reading comprehension visual attention and

magnocellular processing Solan HA Shelley-Tremblay JF Hansen PC Larson S

J Learn Disabil 2007 May-Jun40(3)270-8

Lawton T Filtered Text and Direction Discrimination Training Improved Reading

Fluency for Both Dyslexic and Normal Readers Optom Vis Dev 200839 (3)114

Fischer B Hartnegg K Saccade control in dyslexia Development deficits training

and transfer to reading Optom Vis Dev 200839(4)181-190

39

EF Learning related vision anomalies Vision developmentperception disorders

J Learn Disabil 2003 Nov-Dec36(6)556-63 Effect of attention therapy on reading

comprehension Solan HA Shelley-Tremblay J Ficarra A Silverman M Larson S

hellip At the completion of attention therapy the mean

standard attention and reading comprehension scores of

the experimental group had improved significantly The

control group however showed no significant

improvement in reading comprehension scores after 12

weeks Although uncertainties still exist this investigation

supports the notion that visual attention is malleable and

that attention therapy has a significant effect on reading

comprehension in this often neglected population

40

VII Vision dysfunction association with acquired brain injury

A Exotropia (or high exophoriaCI)

B Accommodative dysfunction

C Convergence insufficiency

41

D Decreased blink rate

E Spatial disorientation

F Pursuitsaccade dysfunction

G Unstable ambient vision (Magnocellular pathway)

42

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Stelmack JA Frith T Van Koevering D Rinne S Stelmack TR Visual function in patients

followed at a Veterans Affairs polytrauma network site an electronic medical record review

Optometry 2009 Aug80(8)419-24

RESULTS Visual symptoms were self-reported by 76 of patients

with polytrauma and 75 of the patients with TBI Problems with reading

(polytrauma 60 and TBI 50) and accommodation (polytrauma 30 and

TBI 47) were frequently found on eye examinations Spectacles were the

treatment most frequently prescribed (polytrauma 62 and TBI 78)

CONCLUSIONS It is important for optometrists to be aware of the high

rates of self-reported symptoms and visual problems in military personnel

returning from deployment to the wars in Iraq and Afghanistan Post-

traumatic stress disorder and depression may complicate optometric

evaluation and management

43

VII Vision dysfunction association with acquired brain injury

Avoidance of near tasks

Oculomotor-based reading difficulties

Eye tracking problems

Eye focusing problems

Eyestrain Diplopia

Dizziness Vertigo

Vision-derived nausea

44

VII Vision dysfunction association with acquired brain injury

Increased sensitivity to visual motion

Visual inattention and distractibility

Short-term visual memory loss

Difficulty judging distances (relative and absolute

Difficulty with global scanning

Difficulty with personal grooming especially involving the face

Inability to interactcope visually in a complex social situation

(eg minimal eye contact)

Inability to tolerate complex visual environments (eg grocery store

aisles and highly-patterned floors)

45

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Ciuffreda KJ Ludlam DP Kapoor N Clinical oculomotor training in traumatic brain injury Optom Vis

Dev 200940(1)16-23

Individuals with traumatic brain injury present with a constellation of

oculomotor dysfunctions and correlated symptoms Simple and

effective clinical oculomotor-based training procedures will be

presented with respect to the versional vergence and

accommodative systems and their interactions These therapeutic

procedures can also be applied as needed to individuals with either

low vision neurological dysfunctions or general visual skills cases

manifesting similar oculomotor deficits

46

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Leslie S Myopia and accommodative insufficiency associated with

moderate head trauma Opt Vis Dev 200940(1)25-31

The majority of subjects reviewed had developed a stable degree of

myopia between 100 and 200 diopters as well as an abnormally

high lag of accommodation When their distance and near spatial area

of focus was compared the majority were focused at an intermediate

area in space suggesting a loss of control of accommodation in

space

47

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

B Drugs

C Exercise

D Learning new and challenging things

48

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements

prevent cognitive decline A systematic review of randomized controlled trials J Hum

Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among

preterm infants attributable to early supplementation of human milk with

docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings

and structural-functional synergies with cell membrane phospholipids Altern Med Rev

2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function

Neuroscience 20089(7)568-78

49

VIII Improving Brain Function and Neuroplasticity

B Drugs Maya Vetencourt JF Sale A Viegi A et al The antidepressant

fluoxetine (PROZAC) restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the

antidepressant tianeptine CNS Drugs 200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances

hippocampal long-term potentiation and memory BMC Biol 2008 Sep

9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine

improves neuropsychological disorders in a child with creatine

transporter defect Neurocase 200814(2) 151-61

50

VIII Improving Brain Function and Neuroplasticity

C Exercise

Hunsberger JG et al Antidepressant actions of the exercise-

regulated gene VGF Nat Med 2007 Dec 2 131476

VGF may be a common pathway by which exercise induces

neuroplasticity and growth-factor genes at least one of these might act

similarly to antidepressants in promoting an adaptive response to stress

However the tests used here may be modeling stress-induced

helplessness not depression hellipexercise seems to induce multiple

interacting genes that enhance neuronal resilience

51

VIII Improving Brain Function and Neuroplasticity

D Learning new and challenging things

What have we (optometry amp ophthalmology)

been thinking all these years

Where did we miss the news about neuroplasticity

52

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Huang JC Neuroplasticity as a proposed mechanism for the efficacy of optometric vision therapy and rehabilitation J Bev Optom 200920(4)96-100

Homologous area adaptationCompensatory masqueradeCross-modal reassignment

Map expansion

EquipotentialityVicariation

53

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Homologous area adaptation a transfer of function from a damaged brain area to a non-damaged brain area May be limited to early stages of human development and may crowd a new brain area resulting in reduced functionality of that brain area (Competition between spatial amp verbal functioning)

54

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Compensatory masquerade reorganizing of existing neuro-pathways to us alternative cognitive strategies to perform a task

55

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Cross-modal reassignment using new sensory input in a brain structure deprived of its main input source (changing processing from visual to tactile stimuli in the blind)

56

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Map expansion increase in brain mass due to repeated behavior or exposure to stimuli

57

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Equipotentiality anatomical areas of the brain can perform disparate functions

Vicariation redundant neural systems can operate under abnormal conditions

This may explain why recovery is noted for many neurological conditions (degenerative psychiatric developmental vascular traumatic)

58

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Constraint therapy Use it and improve it

Patching penalization ldquonear activitiesrdquo during amblyopia therapy

59

IX Improving Brain Function and Neuroplasticity Optometric Clinical ApplicationsOptometric Vision Therapy

Kleim amp Jones

Use it or lose it If you do not drive specific brain functions

functional loss will occur

If you want to improve oculomotor brain neuroplastic function amp

structure therapy should be specific for that brain function

Use it and improve it Therapy that drives cortical function enhances

that particular function

If you use therapy to improve oculomotor dysfunction it should

improve

Specificity The therapy you choose determines the resultant

plasticity and function

You must choose therapy that is appropriate

60

IX Improving Brain Function and Neuroplasticity Optometric Clinical Applications

Kleim amp Jones

Repetition matters Plasticity that results in functional change

requires repetition

Do the therapy Do it again Do it yet again No quick fix

Intensity matters Induction of plasticity requires the appropriate

amount of intensity

Intensity means strength force concentration power and passion

Without these plasticity may not occur Function may not improve

Time matters Different forms of plasticity take place at different

times during therapy

Do the basics than the more advanced therapeutic procedures

61

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Salience matters It has to be important to the individual

Make the therapy matter to the patient

Age matters Plasticity is easier in a younger brain but is also

possible in an adult brain

Do not let age determine what therapy options you offer your

patients Think of Susan Barry PhD (StereoSue) and her success

Offer your patients options Let them choose Be realistic about

outcomeshelliphave outcome measures built into therapy program

62

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Transference Neuroplasticity and the change in function

that results from one therapy can augment the attainment

of similar behaviors

What you do during oculomotor therapy may affected

vergence therapy outcomes

Interference Plasticity in response to one experience can

interfere with the acquisition of other behaviors

Monitor Evaluate progress Discuss function in other areas

of your patientslsquo life

63

Why pay attention to binocular vision dysfunctions

and neuroplasticity

December 2009 issue of the Review of Optometry

The Binocular Vision Dysfunction Pandemic

In 2010 almost 170 million individuals will be wearing glasses In

2010 there will also be up to 93 million amblyopes and 12 and a half

million strabismics For children under 18 years of age that means

there will be more than 22 and a half million amblyopes and millions

of children with strabismus A clinical trial to determine the

prevalence of binocular vision dysfunction within the general

population suggested the possibility of up to 56 or 173 million men

women and children with symptoms associated with a binocular

vision dysfunction 189 million (61) with accommodative problems

and 118 million (38) demonstrating various vergence

anomalies

64

65

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Brain plasticity life long changes in the structure of the brain

Sensory substitution replacement of one sensory input by another

Measurement techniques

Voxel based morphometryhellipmeasures difference in brain volume

Fluorodeoxyglucose glucose analog PET scan tells you

distribution and metabolism of brain

Cortical thickness measures

Visual cortex of the blind turns somatic ―The eye of the tongue

Transcranial magnetic stmiulation non-invasive technique to

stimulate cortex

66

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Blind Braille readers report tingling in fingers when pressure

phosphenes are applied Blind feel tingling in tongue

Bind use tongue to perform orientation task motion perception

sensory perception Visual cortex recruited in a variety of sensory

and cognitive tasks (DM Can we use tongue as a VT tool)

Dilks Reorganizations of human adult visual system

When a region of sensory cortex is deprived of its bottom up

input the deprived region begins to respond to stimuli that

normally activate adjacent cortex

67

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Retinotopic map changes for stroke pts Cortical reorganization in

adults occurs Perceived objectshellipelongation in stroke amp AMD

What happens to deprived cortex in AMD

fMRI shows cortical reorganization in adults

Proposed mechanisms

hellipGrowth of new connections

hellipUnmasking of pre-existing connections this is true

happens within seconds

Bavelier

Action video games

68

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Bavelier

Action video games Looked at attention Gamers can track more

activities

Attention over space (me peripheral awarenress) Useful field

of view shrinks with age

Performance not VA relatedhellipis related to attention

Action game playing changes spatial resolutionhellipovercoming

crowding in VA assessment (me amblyopia therapy)

Temporal resolution of vision Backward masking

changehellipbrain changes

Visual sensitivity (contrast sensitivity) Post action game training

improves CSF

69

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Action video games correcting optics of the cortex (me this is

actualy OVT)

Games factor

Variable entry leanringhellipadapt task to skill level

Incremental learning tune task to subjectlsquos leanring steps

Motivationarousal

Rewards

Self masterself confidence

Action games factors

Pacingrate of exposure to infohellipincreasing processing speed

Dynamic display

Rich environment

Rich motor involvement

70

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Surgeons may be made to play action games

Pilot training

Amblyopia tx Dennis Levi research

PresenterTitle Contact info

Neuroplasticity-A Paradigm Sea Change

This presentation is available at

httpwwwslidesharenetDMAINOneuroplasticity-a-paradigm-sea-change-2459693

httpwwwmainosmemosblogspotcom

My FaceBook Page

and

Twitter

PresenterTitle Contact info

Questions About

Neuroplasticity-A Paradigm Sea Change

Dominick M Maino OD MEd FAAO FCOVD-A

Professor PediatricsBinocular VisionIllinois Eye InstituteIllinois College of Optometry

dmainoicoeduhttpwwwMainosMemosblogspotcom

Thanks to

httpwwwcovdorgHomeOVDJournalOVD401tabid263D

efaultaspx

httpbipolarblastfileswordpresscom200908neurojpg

httpwwwspecialcheerscomimagesanimated_braingif

httpblogmarsdencartoonscomwp-

contentuploads200810frankenstein-myspace-lightbeergif

httpwwwshangralafamilyfuncomgala-ecalvindreamgif

httppsychiatryjwatchorgcgicontentfull20082251

73

Chakraborty R Chatterjee A Choudhart S Chakraborty PK Neuroplasticitymdasha paradigm shift in neurosciences J Indian Med Assoc

2007105(9)513-4516-8520-1

Sacks O A neurologistlsquos notebook Stereo Sue Why two eyes are better than one The New Yorker 2006 Jun 1964-73

Krulwich R National Public Radio Going Binocular Susanlsquos First Snowfall Available at

wwwnprorgtemplatesstorystoryphpstoryId=5507789 (Accessed December 8 2008)

Press LJ The story behind Stereo Suelsquo and a world-famous neurologistlsquos discovery of vision therapy Optom Vis Dev 200637(2) 55-7

Levin HS Neuroplasticity and brain imaging research implications for rehabilitation Arch Phys Med Rehabil 2006 Dec87(12 Suppl

2)S1

Wiesel TN Hubel DH Single-cell responses in striate cortex of kittens deprived of vision in one eye J Neurophysiol 1963

Nov261003-17

Hook BM Chen C Critical periods in the visual system Changing views for a model of experience-dependent plasticity Neuron 2007

Oct56(2)312-26

Ramey CT Ramey SL Prevention of intellectual disabilities early interventions to improve cognitive development Prev Med 1998

Mar-Apr27(2)224-32

Heuninckx S Wenderoth N Swinnen SP Systems neuroplasticity in the aging brain recruiting additional neural resources for

successful motor performance in elderly persons J Neurosci 2008 Jan 228(1)91-9

Ge S Yang CH Hsu KS et al A critical period for enhanced synaptic plasticity in newly generated neurons of the adult brain Neuron

2007 May54(4)559-66

74

Draganski B Gaser C Busch V et al Neuroplasticity changes in grey matter induced by training Nature 2004 Jan 22427(6972)

311-2

Cannonieri GC Bonilha L Fernandes PT et al Practice and perfect length of training and structural brain changes in experienced

typists Neuroreport 2007 Jul 218(10)1063-6

Kleim JA Jones TA Principles of experience-dependent neural plasticity implications for rehabilitation after brain damage J

Speech Lang Hear Res 2008 Feb51(1)S225-39

Trojan S Porkorny J Theoretical aspects of neuroplasticity Physiol Res 199948(2)87-97

Ramamirtham R Kee CS Hung LF et al Wave aberrations in rhesus monkeys with vision-induced ametropias Vision Res 2007

Sep47(21)2751-66

Smith EL 3rd Ramamirtham R Qiao-Grider Y et al Effects of foveal ablation on emmetropization and form-deprivation myopia

Invest Ophthalmol Vis Sci 2007 Sep48(9)3914-22

Smith EL 3rd Kee CS Ramamirtham R et al Peripheral vision can influence eye growth and refractive development in infant

monkeys Invest Ophthalmol Vis Sci 2005 Nov46(11)3965-72

Ciuffreda KJ Vasudevan B Nearwork-induced transient myopia (NITM) and permanent myopiandashndashis there a link Ophthalmic

Physiol Opt 2008 Mar28(2)103-14

Hung GK Ciuffreda KJ Incremental retinal-defocus theory of myopia development--schematic analysis and computer simulation

Comput Biol Med 2007 Jul37(7)930-46

Hung GK Ciuffreda KJ A unifying theory of refractive error development Bull Math Biol 2000 Nov62(6)1087-108

75

Pang Y Maino D Zhang G Lu F Myopia Can its progress be controlled Optom Vis Dev 200637(2)75-9

Leung JT Brown B Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lenses Optom Vis Sci

1999 Jun76(6)346-54

Hasebe S Ohtsuki H Nonaka T et al Effect of progressive addition lenses on myopia progression in Japanese children a prospective

randomized double-masked crossover trial Invest Ophthalmol Vis Sci 2008 Jul49(7)2781-9

Gwiazda J Hyman L Hussein M et al A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression

of myopia in children Invest Ophthalmol Vis Sci 2003 Apr44(4)1492-500

Siatkowski RM Cotter SA Crockett RS et al Two-year multi-center randomized double-masked placebo-controlled parallel safety and

efficacy study of 2 pirenzepine ophthalmic gel in children with myopia J AAPOS 2008 Aug12(4)332-9

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged 7 to 17 years Arch Ophthalmol 2005

Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three to less than 10 years of age Am J

Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction Am J Ophthalmol 2007

Jun143(6)1060-3

Holmes JM Edwards AR Beck RW et al A randomized pilot study of near activities versus non-near activities during patching therapy for

amblyopia J AAPOS 2005 Apr9(2)129-36

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate

amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-57

76

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic

amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Convergence Insufficiency Treatment Trial Study Group Randomized clinical trial of treatments for symptomatic convergence insufficiency

in children Arch Ophthalmol 2008 Oct126(10)1336-49

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

Solan HA Shelley-Tremblay J Hansen PC et al M-cell deficit and reading disability a preliminary study of the effects of temporal vision-

processing therapy Optometry 2004 Oct75(10)640-50

Solan HA Larson S Shelley-Tremblay J et al Role of visual attention in cognitive control of oculomotor readiness in students with reading

disabilities J Learn Disabil 2001 Mar-Apr34(2)107-18

Gallaway M Boas MB The impact of vergence and accommodative therapy on reading eye movements and reading speed Optom Vis Dev

200738(3)115-20

Goss DA Downing DB Lowther AH et al The effect of HTS vision therapy conducted in a school setting on reading skills in third and

fourth grade students Optom Vis Dev 200738(1)27-32

Crutch SJ Warrington EK Foveal crowding in posterior cortical atrophy a specific early-visual-processing deficit affecting word reading

Cogn Neuropsychol 2007 Dec24(8)843-66

Helms D Sawtelle SM A study of the effectiveness of cognitive therapy delivered in a video game format Optom Vis Dev 200738 (1)19-

26

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

77

Lawton T Training direction-discrimination sensitivity remediates a wide spectrum of reading skills OptomVis Dev 200738(1) 33-47

Goldstand S Koslowe KC Parush S Vision visual-information processing and academic performance among seventh-grade schoolchildren a

more significant relationship than we thought Am J Occup Ther 2005 Jul-Aug59(4)377-89

Fischer B Koumlngeter A Hartnegg K Effects of daily practice on subitizing visual counting and basic arithmetic skills Optom Vis Dev

200839(1)30-4

Sands W Taub M Maino D Limited research and education on special populations in optometry and ophthalomology Optom Vis Dev

200839(2)60-1

Wesson M Maino D Oculo-visual findings in Down syndrome cerebral palsy and mental retardation with non-specific etiology In Maino D

(ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 199517-54 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

Cui Y Stapleton F Suttle C Developing an instrument to assess vision-related and subjective quality of life in children with intellectual

disability data collection and preliminary analysis in a Chinese population Ophthal Physiolog Optics 2008 May28(3) 238-46

Maino D Steele G Tahir S Sajja R Attitudes of optometry students toward individuals with disabilities Optom Ed 200227(2)45-50

Maino D Special populations in the optometric curriculum Optom Ed 200227(2)38-9

Maino D Overview of special populations In Scheiman M Rouse M (eds) Optometric Management of Learning-Related Vision Problems

St Louis Mosby Inc 200685-106

Maino D (ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 1995 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

78

McCarthy P Maino D Alport syndrome a review Clin Eye Vis Care 2000 Dec12(3-4)139-50

Block SS Brusca-Vega R Pizzi WJ et al Cognitive and visual processing skills and their relationship to mutation size in full and

permutation female fragile X carriers Optom Vis Sci 2000 Nov77 (11)592-9

Maino D The young child with developmental disabilities An introduction to mental retardation and genetic syndromes In Moore BD

(ed) Eye Care for Infants and Young Children Butter-worth--Heinemann Newton MA1997285-300

Amin V Maino D The Fragile X female Visual visual perceptual and ocular health anomalies J Am Optom Assoc 1995 May66

(5)290-95

Maino DM Maino JH Cibis GW Hecht F Ocular health anomalies in patients with developmental disabilities In Maino D (ed)

Diagnosis and Management of Special Populations Mosby-Year-book Inc St Louis MO 1995189-206 Reprinted Optometric

Education Program Foundation Santa Anna Calif 2001

Maino D Wesson M Schlange D Cibis G Maino J Optometric findings in the fragile X syndrome Optom Vis Sci 199168634-40

Scheiman MMOptometric findings in children with cerebral palsy Am J Optom Physiol Opt 1984 May61(5)321-3

Maino D Maino J Maino S Mental retardation syndromes with associated ocular defects J Am Optom Assoc 199061707-16

Stewart RE Woodhouse JM Cregg M Pakeman VH Association between accommodative accuracy hypermetropia and strabismus in

children with Downs syndrome Optom Vis Sci 2007 Feb84(2)149-55

Cregg M Woodhouse JM Pakeman VH et al Accommodation and refractive error in children with Down syndrome cross-sectional

and longitudinal studies Invest Ophthalmol Vis Sci 2001 Jan42 (1)55-63

79

McClelland JF Parkes J Hill N et al Accommodative dysfunction in children with cerebral palsy a population-

based study Invest Ophthalmol Vis Sci 2006 May47(5)1824-30

Duckman RH Vision therapy for the child with cerebral palsy J Am Optom Assoc 198758(1)28-35

Duckman R Accommodation in cerebral palsy function and remediation J Am Optom Assoc 198455(4)281-3

Scheiman M Understanding and managing vision deficits a guide for occupational therapists 2nd ed Slack

Thorofare NJ 2002

Maino D Binasal occlusion for the child with Cerebral Palsy J Ill Optom Assoc 198644(1)1218

Battaglia F Quartarone A Rizzo V et al Early impairment of synaptic plasticity in patients with Downs syndrome

Neurobiol Aging 2008 Aug29(8)1272-5

Bonnier C Evaluation of early stimulation programs for enhancing brain development Acta Paediatr 2008

Jul97(7)853-8

Morice E Andreae LC Cooke SF et al Preservation of long-term memory and synaptic plasticity despite short-term

impairments in the Tc1 mouse model of Down syndrome Learn Mem 2008 Jul 1415(7)492-500

Gordon AM Schneider JA Chinnan A Charles JR Efficacy of a hand-arm bimanual intensive therapy (HABIT) in

children with hemiplegic cerebral palsy a randomized control trial Dev Med Child Neurol 2007 Nov49(11)830-8

Kapoor N Ciuffreda KJ Vision disturbances following traumatic brain injury Curr Treat Options Neurol 2002

Jul4(4)271-80

80

Ciuffreda KJ Rutner D Kapoor N et al Vision therapy for oculomotor dysfunctions in acquired brain injury a

retrospective analysis Optometry 2008 Jan79(1)18-22

Ciuffreda KJ Han Y Kapoor N Ficarra AP Oculomotor rehabilitation for reading in acquired brain injury

NeuroRehabilitation 200621(1)9-21

Zost M Diagnosis and management of visual dysfunction in cerebral injury In Maino D (ed) Diagnosis and

Management of Special Populations Mosby-Yearbook Inc St Louis 199579 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001 [Figure used with permission of the editor]

DeGutis JM Bentin S Robertson LC DEsposito M Functional plasticity in ventral temporal cortex following

cognitive rehabilitation of a congenital prosopagnosic J Cogn Neurosci 2007 Nov19 (11)1790-802

Welbourne SR Ralph MA Exploring the impact of plasticity-related recovery after brain damage in a connectionist

model of single-word reading Cogn Affect Behav Neurosci 2005 Mar5(1)77-92

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements prevent cognitive decline A

systematic review of randomized controlled trials J Hum Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among preterm infants attributable to early

supplementation of human milk with docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings and structural-functional

synergies with cell membrane phospholipids Altern Med Rev 2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function Neuroscience 20089(7)568-78

81

Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

BMC Biol 2008 Sep 9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine improves neuropsychological disorders in a child with

creatine transporter defect Neurocase 200814(2) 151-61

Forrester LW Wheaton LA Luft AR Exercise-mediated locomotor recovery and lower-limb neuroplasticity after

stroke J Rehabil Res Dev 200845(2)205-20

82

Page 37: Neuroplasticity: A Paradigm Sea Change Latest Updated File

VI Management and Treatment of Disorders of the Visual System and Neuroplasticity

Bottom Line

Optometric Vision Therapy is the most efficacious treatment available for binocular vision disorders and the

treatment effects are long lasting Neuro-enhancing drugs

may assist us as well

37

EF Learning related vision anomalies Vision

developmentperception disorders

hellipresearch includes an examination of the role vision plays in

reading the effect of oculomotor vergence and

accommodativecoherent motion therapy on reading eye movements

and reading speed the diagnosis and treatment of perceptual

disorders and the effect of therapy on various learning anomalies

38

EF Learning related vision anomalies Vision developmentperception disorders

magnocellular (MC) deficit in dyslexia

LM speed-matching ratio predicts reading in childrenChase C Dougherty RF Ray N

Fowler S Stein JOptom Vis Sci 2007 Mar84(3)229-36

Effect of attention therapy on reading comprehension Solan HA Shelley-Tremblay J

Ficarra A Silverman M Larson S J Learn Disabil 2003 Nov-Dec36(6)556-63

Is there a common linkage among reading comprehension visual attention and

magnocellular processing Solan HA Shelley-Tremblay JF Hansen PC Larson S

J Learn Disabil 2007 May-Jun40(3)270-8

Lawton T Filtered Text and Direction Discrimination Training Improved Reading

Fluency for Both Dyslexic and Normal Readers Optom Vis Dev 200839 (3)114

Fischer B Hartnegg K Saccade control in dyslexia Development deficits training

and transfer to reading Optom Vis Dev 200839(4)181-190

39

EF Learning related vision anomalies Vision developmentperception disorders

J Learn Disabil 2003 Nov-Dec36(6)556-63 Effect of attention therapy on reading

comprehension Solan HA Shelley-Tremblay J Ficarra A Silverman M Larson S

hellip At the completion of attention therapy the mean

standard attention and reading comprehension scores of

the experimental group had improved significantly The

control group however showed no significant

improvement in reading comprehension scores after 12

weeks Although uncertainties still exist this investigation

supports the notion that visual attention is malleable and

that attention therapy has a significant effect on reading

comprehension in this often neglected population

40

VII Vision dysfunction association with acquired brain injury

A Exotropia (or high exophoriaCI)

B Accommodative dysfunction

C Convergence insufficiency

41

D Decreased blink rate

E Spatial disorientation

F Pursuitsaccade dysfunction

G Unstable ambient vision (Magnocellular pathway)

42

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Stelmack JA Frith T Van Koevering D Rinne S Stelmack TR Visual function in patients

followed at a Veterans Affairs polytrauma network site an electronic medical record review

Optometry 2009 Aug80(8)419-24

RESULTS Visual symptoms were self-reported by 76 of patients

with polytrauma and 75 of the patients with TBI Problems with reading

(polytrauma 60 and TBI 50) and accommodation (polytrauma 30 and

TBI 47) were frequently found on eye examinations Spectacles were the

treatment most frequently prescribed (polytrauma 62 and TBI 78)

CONCLUSIONS It is important for optometrists to be aware of the high

rates of self-reported symptoms and visual problems in military personnel

returning from deployment to the wars in Iraq and Afghanistan Post-

traumatic stress disorder and depression may complicate optometric

evaluation and management

43

VII Vision dysfunction association with acquired brain injury

Avoidance of near tasks

Oculomotor-based reading difficulties

Eye tracking problems

Eye focusing problems

Eyestrain Diplopia

Dizziness Vertigo

Vision-derived nausea

44

VII Vision dysfunction association with acquired brain injury

Increased sensitivity to visual motion

Visual inattention and distractibility

Short-term visual memory loss

Difficulty judging distances (relative and absolute

Difficulty with global scanning

Difficulty with personal grooming especially involving the face

Inability to interactcope visually in a complex social situation

(eg minimal eye contact)

Inability to tolerate complex visual environments (eg grocery store

aisles and highly-patterned floors)

45

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Ciuffreda KJ Ludlam DP Kapoor N Clinical oculomotor training in traumatic brain injury Optom Vis

Dev 200940(1)16-23

Individuals with traumatic brain injury present with a constellation of

oculomotor dysfunctions and correlated symptoms Simple and

effective clinical oculomotor-based training procedures will be

presented with respect to the versional vergence and

accommodative systems and their interactions These therapeutic

procedures can also be applied as needed to individuals with either

low vision neurological dysfunctions or general visual skills cases

manifesting similar oculomotor deficits

46

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Leslie S Myopia and accommodative insufficiency associated with

moderate head trauma Opt Vis Dev 200940(1)25-31

The majority of subjects reviewed had developed a stable degree of

myopia between 100 and 200 diopters as well as an abnormally

high lag of accommodation When their distance and near spatial area

of focus was compared the majority were focused at an intermediate

area in space suggesting a loss of control of accommodation in

space

47

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

B Drugs

C Exercise

D Learning new and challenging things

48

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements

prevent cognitive decline A systematic review of randomized controlled trials J Hum

Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among

preterm infants attributable to early supplementation of human milk with

docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings

and structural-functional synergies with cell membrane phospholipids Altern Med Rev

2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function

Neuroscience 20089(7)568-78

49

VIII Improving Brain Function and Neuroplasticity

B Drugs Maya Vetencourt JF Sale A Viegi A et al The antidepressant

fluoxetine (PROZAC) restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the

antidepressant tianeptine CNS Drugs 200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances

hippocampal long-term potentiation and memory BMC Biol 2008 Sep

9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine

improves neuropsychological disorders in a child with creatine

transporter defect Neurocase 200814(2) 151-61

50

VIII Improving Brain Function and Neuroplasticity

C Exercise

Hunsberger JG et al Antidepressant actions of the exercise-

regulated gene VGF Nat Med 2007 Dec 2 131476

VGF may be a common pathway by which exercise induces

neuroplasticity and growth-factor genes at least one of these might act

similarly to antidepressants in promoting an adaptive response to stress

However the tests used here may be modeling stress-induced

helplessness not depression hellipexercise seems to induce multiple

interacting genes that enhance neuronal resilience

51

VIII Improving Brain Function and Neuroplasticity

D Learning new and challenging things

What have we (optometry amp ophthalmology)

been thinking all these years

Where did we miss the news about neuroplasticity

52

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Huang JC Neuroplasticity as a proposed mechanism for the efficacy of optometric vision therapy and rehabilitation J Bev Optom 200920(4)96-100

Homologous area adaptationCompensatory masqueradeCross-modal reassignment

Map expansion

EquipotentialityVicariation

53

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Homologous area adaptation a transfer of function from a damaged brain area to a non-damaged brain area May be limited to early stages of human development and may crowd a new brain area resulting in reduced functionality of that brain area (Competition between spatial amp verbal functioning)

54

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Compensatory masquerade reorganizing of existing neuro-pathways to us alternative cognitive strategies to perform a task

55

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Cross-modal reassignment using new sensory input in a brain structure deprived of its main input source (changing processing from visual to tactile stimuli in the blind)

56

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Map expansion increase in brain mass due to repeated behavior or exposure to stimuli

57

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Equipotentiality anatomical areas of the brain can perform disparate functions

Vicariation redundant neural systems can operate under abnormal conditions

This may explain why recovery is noted for many neurological conditions (degenerative psychiatric developmental vascular traumatic)

58

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Constraint therapy Use it and improve it

Patching penalization ldquonear activitiesrdquo during amblyopia therapy

59

IX Improving Brain Function and Neuroplasticity Optometric Clinical ApplicationsOptometric Vision Therapy

Kleim amp Jones

Use it or lose it If you do not drive specific brain functions

functional loss will occur

If you want to improve oculomotor brain neuroplastic function amp

structure therapy should be specific for that brain function

Use it and improve it Therapy that drives cortical function enhances

that particular function

If you use therapy to improve oculomotor dysfunction it should

improve

Specificity The therapy you choose determines the resultant

plasticity and function

You must choose therapy that is appropriate

60

IX Improving Brain Function and Neuroplasticity Optometric Clinical Applications

Kleim amp Jones

Repetition matters Plasticity that results in functional change

requires repetition

Do the therapy Do it again Do it yet again No quick fix

Intensity matters Induction of plasticity requires the appropriate

amount of intensity

Intensity means strength force concentration power and passion

Without these plasticity may not occur Function may not improve

Time matters Different forms of plasticity take place at different

times during therapy

Do the basics than the more advanced therapeutic procedures

61

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Salience matters It has to be important to the individual

Make the therapy matter to the patient

Age matters Plasticity is easier in a younger brain but is also

possible in an adult brain

Do not let age determine what therapy options you offer your

patients Think of Susan Barry PhD (StereoSue) and her success

Offer your patients options Let them choose Be realistic about

outcomeshelliphave outcome measures built into therapy program

62

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Transference Neuroplasticity and the change in function

that results from one therapy can augment the attainment

of similar behaviors

What you do during oculomotor therapy may affected

vergence therapy outcomes

Interference Plasticity in response to one experience can

interfere with the acquisition of other behaviors

Monitor Evaluate progress Discuss function in other areas

of your patientslsquo life

63

Why pay attention to binocular vision dysfunctions

and neuroplasticity

December 2009 issue of the Review of Optometry

The Binocular Vision Dysfunction Pandemic

In 2010 almost 170 million individuals will be wearing glasses In

2010 there will also be up to 93 million amblyopes and 12 and a half

million strabismics For children under 18 years of age that means

there will be more than 22 and a half million amblyopes and millions

of children with strabismus A clinical trial to determine the

prevalence of binocular vision dysfunction within the general

population suggested the possibility of up to 56 or 173 million men

women and children with symptoms associated with a binocular

vision dysfunction 189 million (61) with accommodative problems

and 118 million (38) demonstrating various vergence

anomalies

64

65

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Brain plasticity life long changes in the structure of the brain

Sensory substitution replacement of one sensory input by another

Measurement techniques

Voxel based morphometryhellipmeasures difference in brain volume

Fluorodeoxyglucose glucose analog PET scan tells you

distribution and metabolism of brain

Cortical thickness measures

Visual cortex of the blind turns somatic ―The eye of the tongue

Transcranial magnetic stmiulation non-invasive technique to

stimulate cortex

66

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Blind Braille readers report tingling in fingers when pressure

phosphenes are applied Blind feel tingling in tongue

Bind use tongue to perform orientation task motion perception

sensory perception Visual cortex recruited in a variety of sensory

and cognitive tasks (DM Can we use tongue as a VT tool)

Dilks Reorganizations of human adult visual system

When a region of sensory cortex is deprived of its bottom up

input the deprived region begins to respond to stimuli that

normally activate adjacent cortex

67

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Retinotopic map changes for stroke pts Cortical reorganization in

adults occurs Perceived objectshellipelongation in stroke amp AMD

What happens to deprived cortex in AMD

fMRI shows cortical reorganization in adults

Proposed mechanisms

hellipGrowth of new connections

hellipUnmasking of pre-existing connections this is true

happens within seconds

Bavelier

Action video games

68

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Bavelier

Action video games Looked at attention Gamers can track more

activities

Attention over space (me peripheral awarenress) Useful field

of view shrinks with age

Performance not VA relatedhellipis related to attention

Action game playing changes spatial resolutionhellipovercoming

crowding in VA assessment (me amblyopia therapy)

Temporal resolution of vision Backward masking

changehellipbrain changes

Visual sensitivity (contrast sensitivity) Post action game training

improves CSF

69

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Action video games correcting optics of the cortex (me this is

actualy OVT)

Games factor

Variable entry leanringhellipadapt task to skill level

Incremental learning tune task to subjectlsquos leanring steps

Motivationarousal

Rewards

Self masterself confidence

Action games factors

Pacingrate of exposure to infohellipincreasing processing speed

Dynamic display

Rich environment

Rich motor involvement

70

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Surgeons may be made to play action games

Pilot training

Amblyopia tx Dennis Levi research

PresenterTitle Contact info

Neuroplasticity-A Paradigm Sea Change

This presentation is available at

httpwwwslidesharenetDMAINOneuroplasticity-a-paradigm-sea-change-2459693

httpwwwmainosmemosblogspotcom

My FaceBook Page

and

Twitter

PresenterTitle Contact info

Questions About

Neuroplasticity-A Paradigm Sea Change

Dominick M Maino OD MEd FAAO FCOVD-A

Professor PediatricsBinocular VisionIllinois Eye InstituteIllinois College of Optometry

dmainoicoeduhttpwwwMainosMemosblogspotcom

Thanks to

httpwwwcovdorgHomeOVDJournalOVD401tabid263D

efaultaspx

httpbipolarblastfileswordpresscom200908neurojpg

httpwwwspecialcheerscomimagesanimated_braingif

httpblogmarsdencartoonscomwp-

contentuploads200810frankenstein-myspace-lightbeergif

httpwwwshangralafamilyfuncomgala-ecalvindreamgif

httppsychiatryjwatchorgcgicontentfull20082251

73

Chakraborty R Chatterjee A Choudhart S Chakraborty PK Neuroplasticitymdasha paradigm shift in neurosciences J Indian Med Assoc

2007105(9)513-4516-8520-1

Sacks O A neurologistlsquos notebook Stereo Sue Why two eyes are better than one The New Yorker 2006 Jun 1964-73

Krulwich R National Public Radio Going Binocular Susanlsquos First Snowfall Available at

wwwnprorgtemplatesstorystoryphpstoryId=5507789 (Accessed December 8 2008)

Press LJ The story behind Stereo Suelsquo and a world-famous neurologistlsquos discovery of vision therapy Optom Vis Dev 200637(2) 55-7

Levin HS Neuroplasticity and brain imaging research implications for rehabilitation Arch Phys Med Rehabil 2006 Dec87(12 Suppl

2)S1

Wiesel TN Hubel DH Single-cell responses in striate cortex of kittens deprived of vision in one eye J Neurophysiol 1963

Nov261003-17

Hook BM Chen C Critical periods in the visual system Changing views for a model of experience-dependent plasticity Neuron 2007

Oct56(2)312-26

Ramey CT Ramey SL Prevention of intellectual disabilities early interventions to improve cognitive development Prev Med 1998

Mar-Apr27(2)224-32

Heuninckx S Wenderoth N Swinnen SP Systems neuroplasticity in the aging brain recruiting additional neural resources for

successful motor performance in elderly persons J Neurosci 2008 Jan 228(1)91-9

Ge S Yang CH Hsu KS et al A critical period for enhanced synaptic plasticity in newly generated neurons of the adult brain Neuron

2007 May54(4)559-66

74

Draganski B Gaser C Busch V et al Neuroplasticity changes in grey matter induced by training Nature 2004 Jan 22427(6972)

311-2

Cannonieri GC Bonilha L Fernandes PT et al Practice and perfect length of training and structural brain changes in experienced

typists Neuroreport 2007 Jul 218(10)1063-6

Kleim JA Jones TA Principles of experience-dependent neural plasticity implications for rehabilitation after brain damage J

Speech Lang Hear Res 2008 Feb51(1)S225-39

Trojan S Porkorny J Theoretical aspects of neuroplasticity Physiol Res 199948(2)87-97

Ramamirtham R Kee CS Hung LF et al Wave aberrations in rhesus monkeys with vision-induced ametropias Vision Res 2007

Sep47(21)2751-66

Smith EL 3rd Ramamirtham R Qiao-Grider Y et al Effects of foveal ablation on emmetropization and form-deprivation myopia

Invest Ophthalmol Vis Sci 2007 Sep48(9)3914-22

Smith EL 3rd Kee CS Ramamirtham R et al Peripheral vision can influence eye growth and refractive development in infant

monkeys Invest Ophthalmol Vis Sci 2005 Nov46(11)3965-72

Ciuffreda KJ Vasudevan B Nearwork-induced transient myopia (NITM) and permanent myopiandashndashis there a link Ophthalmic

Physiol Opt 2008 Mar28(2)103-14

Hung GK Ciuffreda KJ Incremental retinal-defocus theory of myopia development--schematic analysis and computer simulation

Comput Biol Med 2007 Jul37(7)930-46

Hung GK Ciuffreda KJ A unifying theory of refractive error development Bull Math Biol 2000 Nov62(6)1087-108

75

Pang Y Maino D Zhang G Lu F Myopia Can its progress be controlled Optom Vis Dev 200637(2)75-9

Leung JT Brown B Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lenses Optom Vis Sci

1999 Jun76(6)346-54

Hasebe S Ohtsuki H Nonaka T et al Effect of progressive addition lenses on myopia progression in Japanese children a prospective

randomized double-masked crossover trial Invest Ophthalmol Vis Sci 2008 Jul49(7)2781-9

Gwiazda J Hyman L Hussein M et al A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression

of myopia in children Invest Ophthalmol Vis Sci 2003 Apr44(4)1492-500

Siatkowski RM Cotter SA Crockett RS et al Two-year multi-center randomized double-masked placebo-controlled parallel safety and

efficacy study of 2 pirenzepine ophthalmic gel in children with myopia J AAPOS 2008 Aug12(4)332-9

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged 7 to 17 years Arch Ophthalmol 2005

Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three to less than 10 years of age Am J

Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction Am J Ophthalmol 2007

Jun143(6)1060-3

Holmes JM Edwards AR Beck RW et al A randomized pilot study of near activities versus non-near activities during patching therapy for

amblyopia J AAPOS 2005 Apr9(2)129-36

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate

amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-57

76

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic

amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Convergence Insufficiency Treatment Trial Study Group Randomized clinical trial of treatments for symptomatic convergence insufficiency

in children Arch Ophthalmol 2008 Oct126(10)1336-49

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

Solan HA Shelley-Tremblay J Hansen PC et al M-cell deficit and reading disability a preliminary study of the effects of temporal vision-

processing therapy Optometry 2004 Oct75(10)640-50

Solan HA Larson S Shelley-Tremblay J et al Role of visual attention in cognitive control of oculomotor readiness in students with reading

disabilities J Learn Disabil 2001 Mar-Apr34(2)107-18

Gallaway M Boas MB The impact of vergence and accommodative therapy on reading eye movements and reading speed Optom Vis Dev

200738(3)115-20

Goss DA Downing DB Lowther AH et al The effect of HTS vision therapy conducted in a school setting on reading skills in third and

fourth grade students Optom Vis Dev 200738(1)27-32

Crutch SJ Warrington EK Foveal crowding in posterior cortical atrophy a specific early-visual-processing deficit affecting word reading

Cogn Neuropsychol 2007 Dec24(8)843-66

Helms D Sawtelle SM A study of the effectiveness of cognitive therapy delivered in a video game format Optom Vis Dev 200738 (1)19-

26

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

77

Lawton T Training direction-discrimination sensitivity remediates a wide spectrum of reading skills OptomVis Dev 200738(1) 33-47

Goldstand S Koslowe KC Parush S Vision visual-information processing and academic performance among seventh-grade schoolchildren a

more significant relationship than we thought Am J Occup Ther 2005 Jul-Aug59(4)377-89

Fischer B Koumlngeter A Hartnegg K Effects of daily practice on subitizing visual counting and basic arithmetic skills Optom Vis Dev

200839(1)30-4

Sands W Taub M Maino D Limited research and education on special populations in optometry and ophthalomology Optom Vis Dev

200839(2)60-1

Wesson M Maino D Oculo-visual findings in Down syndrome cerebral palsy and mental retardation with non-specific etiology In Maino D

(ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 199517-54 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

Cui Y Stapleton F Suttle C Developing an instrument to assess vision-related and subjective quality of life in children with intellectual

disability data collection and preliminary analysis in a Chinese population Ophthal Physiolog Optics 2008 May28(3) 238-46

Maino D Steele G Tahir S Sajja R Attitudes of optometry students toward individuals with disabilities Optom Ed 200227(2)45-50

Maino D Special populations in the optometric curriculum Optom Ed 200227(2)38-9

Maino D Overview of special populations In Scheiman M Rouse M (eds) Optometric Management of Learning-Related Vision Problems

St Louis Mosby Inc 200685-106

Maino D (ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 1995 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

78

McCarthy P Maino D Alport syndrome a review Clin Eye Vis Care 2000 Dec12(3-4)139-50

Block SS Brusca-Vega R Pizzi WJ et al Cognitive and visual processing skills and their relationship to mutation size in full and

permutation female fragile X carriers Optom Vis Sci 2000 Nov77 (11)592-9

Maino D The young child with developmental disabilities An introduction to mental retardation and genetic syndromes In Moore BD

(ed) Eye Care for Infants and Young Children Butter-worth--Heinemann Newton MA1997285-300

Amin V Maino D The Fragile X female Visual visual perceptual and ocular health anomalies J Am Optom Assoc 1995 May66

(5)290-95

Maino DM Maino JH Cibis GW Hecht F Ocular health anomalies in patients with developmental disabilities In Maino D (ed)

Diagnosis and Management of Special Populations Mosby-Year-book Inc St Louis MO 1995189-206 Reprinted Optometric

Education Program Foundation Santa Anna Calif 2001

Maino D Wesson M Schlange D Cibis G Maino J Optometric findings in the fragile X syndrome Optom Vis Sci 199168634-40

Scheiman MMOptometric findings in children with cerebral palsy Am J Optom Physiol Opt 1984 May61(5)321-3

Maino D Maino J Maino S Mental retardation syndromes with associated ocular defects J Am Optom Assoc 199061707-16

Stewart RE Woodhouse JM Cregg M Pakeman VH Association between accommodative accuracy hypermetropia and strabismus in

children with Downs syndrome Optom Vis Sci 2007 Feb84(2)149-55

Cregg M Woodhouse JM Pakeman VH et al Accommodation and refractive error in children with Down syndrome cross-sectional

and longitudinal studies Invest Ophthalmol Vis Sci 2001 Jan42 (1)55-63

79

McClelland JF Parkes J Hill N et al Accommodative dysfunction in children with cerebral palsy a population-

based study Invest Ophthalmol Vis Sci 2006 May47(5)1824-30

Duckman RH Vision therapy for the child with cerebral palsy J Am Optom Assoc 198758(1)28-35

Duckman R Accommodation in cerebral palsy function and remediation J Am Optom Assoc 198455(4)281-3

Scheiman M Understanding and managing vision deficits a guide for occupational therapists 2nd ed Slack

Thorofare NJ 2002

Maino D Binasal occlusion for the child with Cerebral Palsy J Ill Optom Assoc 198644(1)1218

Battaglia F Quartarone A Rizzo V et al Early impairment of synaptic plasticity in patients with Downs syndrome

Neurobiol Aging 2008 Aug29(8)1272-5

Bonnier C Evaluation of early stimulation programs for enhancing brain development Acta Paediatr 2008

Jul97(7)853-8

Morice E Andreae LC Cooke SF et al Preservation of long-term memory and synaptic plasticity despite short-term

impairments in the Tc1 mouse model of Down syndrome Learn Mem 2008 Jul 1415(7)492-500

Gordon AM Schneider JA Chinnan A Charles JR Efficacy of a hand-arm bimanual intensive therapy (HABIT) in

children with hemiplegic cerebral palsy a randomized control trial Dev Med Child Neurol 2007 Nov49(11)830-8

Kapoor N Ciuffreda KJ Vision disturbances following traumatic brain injury Curr Treat Options Neurol 2002

Jul4(4)271-80

80

Ciuffreda KJ Rutner D Kapoor N et al Vision therapy for oculomotor dysfunctions in acquired brain injury a

retrospective analysis Optometry 2008 Jan79(1)18-22

Ciuffreda KJ Han Y Kapoor N Ficarra AP Oculomotor rehabilitation for reading in acquired brain injury

NeuroRehabilitation 200621(1)9-21

Zost M Diagnosis and management of visual dysfunction in cerebral injury In Maino D (ed) Diagnosis and

Management of Special Populations Mosby-Yearbook Inc St Louis 199579 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001 [Figure used with permission of the editor]

DeGutis JM Bentin S Robertson LC DEsposito M Functional plasticity in ventral temporal cortex following

cognitive rehabilitation of a congenital prosopagnosic J Cogn Neurosci 2007 Nov19 (11)1790-802

Welbourne SR Ralph MA Exploring the impact of plasticity-related recovery after brain damage in a connectionist

model of single-word reading Cogn Affect Behav Neurosci 2005 Mar5(1)77-92

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements prevent cognitive decline A

systematic review of randomized controlled trials J Hum Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among preterm infants attributable to early

supplementation of human milk with docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings and structural-functional

synergies with cell membrane phospholipids Altern Med Rev 2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function Neuroscience 20089(7)568-78

81

Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

BMC Biol 2008 Sep 9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine improves neuropsychological disorders in a child with

creatine transporter defect Neurocase 200814(2) 151-61

Forrester LW Wheaton LA Luft AR Exercise-mediated locomotor recovery and lower-limb neuroplasticity after

stroke J Rehabil Res Dev 200845(2)205-20

82

Page 38: Neuroplasticity: A Paradigm Sea Change Latest Updated File

EF Learning related vision anomalies Vision

developmentperception disorders

hellipresearch includes an examination of the role vision plays in

reading the effect of oculomotor vergence and

accommodativecoherent motion therapy on reading eye movements

and reading speed the diagnosis and treatment of perceptual

disorders and the effect of therapy on various learning anomalies

38

EF Learning related vision anomalies Vision developmentperception disorders

magnocellular (MC) deficit in dyslexia

LM speed-matching ratio predicts reading in childrenChase C Dougherty RF Ray N

Fowler S Stein JOptom Vis Sci 2007 Mar84(3)229-36

Effect of attention therapy on reading comprehension Solan HA Shelley-Tremblay J

Ficarra A Silverman M Larson S J Learn Disabil 2003 Nov-Dec36(6)556-63

Is there a common linkage among reading comprehension visual attention and

magnocellular processing Solan HA Shelley-Tremblay JF Hansen PC Larson S

J Learn Disabil 2007 May-Jun40(3)270-8

Lawton T Filtered Text and Direction Discrimination Training Improved Reading

Fluency for Both Dyslexic and Normal Readers Optom Vis Dev 200839 (3)114

Fischer B Hartnegg K Saccade control in dyslexia Development deficits training

and transfer to reading Optom Vis Dev 200839(4)181-190

39

EF Learning related vision anomalies Vision developmentperception disorders

J Learn Disabil 2003 Nov-Dec36(6)556-63 Effect of attention therapy on reading

comprehension Solan HA Shelley-Tremblay J Ficarra A Silverman M Larson S

hellip At the completion of attention therapy the mean

standard attention and reading comprehension scores of

the experimental group had improved significantly The

control group however showed no significant

improvement in reading comprehension scores after 12

weeks Although uncertainties still exist this investigation

supports the notion that visual attention is malleable and

that attention therapy has a significant effect on reading

comprehension in this often neglected population

40

VII Vision dysfunction association with acquired brain injury

A Exotropia (or high exophoriaCI)

B Accommodative dysfunction

C Convergence insufficiency

41

D Decreased blink rate

E Spatial disorientation

F Pursuitsaccade dysfunction

G Unstable ambient vision (Magnocellular pathway)

42

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Stelmack JA Frith T Van Koevering D Rinne S Stelmack TR Visual function in patients

followed at a Veterans Affairs polytrauma network site an electronic medical record review

Optometry 2009 Aug80(8)419-24

RESULTS Visual symptoms were self-reported by 76 of patients

with polytrauma and 75 of the patients with TBI Problems with reading

(polytrauma 60 and TBI 50) and accommodation (polytrauma 30 and

TBI 47) were frequently found on eye examinations Spectacles were the

treatment most frequently prescribed (polytrauma 62 and TBI 78)

CONCLUSIONS It is important for optometrists to be aware of the high

rates of self-reported symptoms and visual problems in military personnel

returning from deployment to the wars in Iraq and Afghanistan Post-

traumatic stress disorder and depression may complicate optometric

evaluation and management

43

VII Vision dysfunction association with acquired brain injury

Avoidance of near tasks

Oculomotor-based reading difficulties

Eye tracking problems

Eye focusing problems

Eyestrain Diplopia

Dizziness Vertigo

Vision-derived nausea

44

VII Vision dysfunction association with acquired brain injury

Increased sensitivity to visual motion

Visual inattention and distractibility

Short-term visual memory loss

Difficulty judging distances (relative and absolute

Difficulty with global scanning

Difficulty with personal grooming especially involving the face

Inability to interactcope visually in a complex social situation

(eg minimal eye contact)

Inability to tolerate complex visual environments (eg grocery store

aisles and highly-patterned floors)

45

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Ciuffreda KJ Ludlam DP Kapoor N Clinical oculomotor training in traumatic brain injury Optom Vis

Dev 200940(1)16-23

Individuals with traumatic brain injury present with a constellation of

oculomotor dysfunctions and correlated symptoms Simple and

effective clinical oculomotor-based training procedures will be

presented with respect to the versional vergence and

accommodative systems and their interactions These therapeutic

procedures can also be applied as needed to individuals with either

low vision neurological dysfunctions or general visual skills cases

manifesting similar oculomotor deficits

46

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Leslie S Myopia and accommodative insufficiency associated with

moderate head trauma Opt Vis Dev 200940(1)25-31

The majority of subjects reviewed had developed a stable degree of

myopia between 100 and 200 diopters as well as an abnormally

high lag of accommodation When their distance and near spatial area

of focus was compared the majority were focused at an intermediate

area in space suggesting a loss of control of accommodation in

space

47

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

B Drugs

C Exercise

D Learning new and challenging things

48

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements

prevent cognitive decline A systematic review of randomized controlled trials J Hum

Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among

preterm infants attributable to early supplementation of human milk with

docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings

and structural-functional synergies with cell membrane phospholipids Altern Med Rev

2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function

Neuroscience 20089(7)568-78

49

VIII Improving Brain Function and Neuroplasticity

B Drugs Maya Vetencourt JF Sale A Viegi A et al The antidepressant

fluoxetine (PROZAC) restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the

antidepressant tianeptine CNS Drugs 200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances

hippocampal long-term potentiation and memory BMC Biol 2008 Sep

9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine

improves neuropsychological disorders in a child with creatine

transporter defect Neurocase 200814(2) 151-61

50

VIII Improving Brain Function and Neuroplasticity

C Exercise

Hunsberger JG et al Antidepressant actions of the exercise-

regulated gene VGF Nat Med 2007 Dec 2 131476

VGF may be a common pathway by which exercise induces

neuroplasticity and growth-factor genes at least one of these might act

similarly to antidepressants in promoting an adaptive response to stress

However the tests used here may be modeling stress-induced

helplessness not depression hellipexercise seems to induce multiple

interacting genes that enhance neuronal resilience

51

VIII Improving Brain Function and Neuroplasticity

D Learning new and challenging things

What have we (optometry amp ophthalmology)

been thinking all these years

Where did we miss the news about neuroplasticity

52

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Huang JC Neuroplasticity as a proposed mechanism for the efficacy of optometric vision therapy and rehabilitation J Bev Optom 200920(4)96-100

Homologous area adaptationCompensatory masqueradeCross-modal reassignment

Map expansion

EquipotentialityVicariation

53

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Homologous area adaptation a transfer of function from a damaged brain area to a non-damaged brain area May be limited to early stages of human development and may crowd a new brain area resulting in reduced functionality of that brain area (Competition between spatial amp verbal functioning)

54

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Compensatory masquerade reorganizing of existing neuro-pathways to us alternative cognitive strategies to perform a task

55

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Cross-modal reassignment using new sensory input in a brain structure deprived of its main input source (changing processing from visual to tactile stimuli in the blind)

56

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Map expansion increase in brain mass due to repeated behavior or exposure to stimuli

57

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Equipotentiality anatomical areas of the brain can perform disparate functions

Vicariation redundant neural systems can operate under abnormal conditions

This may explain why recovery is noted for many neurological conditions (degenerative psychiatric developmental vascular traumatic)

58

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Constraint therapy Use it and improve it

Patching penalization ldquonear activitiesrdquo during amblyopia therapy

59

IX Improving Brain Function and Neuroplasticity Optometric Clinical ApplicationsOptometric Vision Therapy

Kleim amp Jones

Use it or lose it If you do not drive specific brain functions

functional loss will occur

If you want to improve oculomotor brain neuroplastic function amp

structure therapy should be specific for that brain function

Use it and improve it Therapy that drives cortical function enhances

that particular function

If you use therapy to improve oculomotor dysfunction it should

improve

Specificity The therapy you choose determines the resultant

plasticity and function

You must choose therapy that is appropriate

60

IX Improving Brain Function and Neuroplasticity Optometric Clinical Applications

Kleim amp Jones

Repetition matters Plasticity that results in functional change

requires repetition

Do the therapy Do it again Do it yet again No quick fix

Intensity matters Induction of plasticity requires the appropriate

amount of intensity

Intensity means strength force concentration power and passion

Without these plasticity may not occur Function may not improve

Time matters Different forms of plasticity take place at different

times during therapy

Do the basics than the more advanced therapeutic procedures

61

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Salience matters It has to be important to the individual

Make the therapy matter to the patient

Age matters Plasticity is easier in a younger brain but is also

possible in an adult brain

Do not let age determine what therapy options you offer your

patients Think of Susan Barry PhD (StereoSue) and her success

Offer your patients options Let them choose Be realistic about

outcomeshelliphave outcome measures built into therapy program

62

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Transference Neuroplasticity and the change in function

that results from one therapy can augment the attainment

of similar behaviors

What you do during oculomotor therapy may affected

vergence therapy outcomes

Interference Plasticity in response to one experience can

interfere with the acquisition of other behaviors

Monitor Evaluate progress Discuss function in other areas

of your patientslsquo life

63

Why pay attention to binocular vision dysfunctions

and neuroplasticity

December 2009 issue of the Review of Optometry

The Binocular Vision Dysfunction Pandemic

In 2010 almost 170 million individuals will be wearing glasses In

2010 there will also be up to 93 million amblyopes and 12 and a half

million strabismics For children under 18 years of age that means

there will be more than 22 and a half million amblyopes and millions

of children with strabismus A clinical trial to determine the

prevalence of binocular vision dysfunction within the general

population suggested the possibility of up to 56 or 173 million men

women and children with symptoms associated with a binocular

vision dysfunction 189 million (61) with accommodative problems

and 118 million (38) demonstrating various vergence

anomalies

64

65

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Brain plasticity life long changes in the structure of the brain

Sensory substitution replacement of one sensory input by another

Measurement techniques

Voxel based morphometryhellipmeasures difference in brain volume

Fluorodeoxyglucose glucose analog PET scan tells you

distribution and metabolism of brain

Cortical thickness measures

Visual cortex of the blind turns somatic ―The eye of the tongue

Transcranial magnetic stmiulation non-invasive technique to

stimulate cortex

66

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Blind Braille readers report tingling in fingers when pressure

phosphenes are applied Blind feel tingling in tongue

Bind use tongue to perform orientation task motion perception

sensory perception Visual cortex recruited in a variety of sensory

and cognitive tasks (DM Can we use tongue as a VT tool)

Dilks Reorganizations of human adult visual system

When a region of sensory cortex is deprived of its bottom up

input the deprived region begins to respond to stimuli that

normally activate adjacent cortex

67

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Retinotopic map changes for stroke pts Cortical reorganization in

adults occurs Perceived objectshellipelongation in stroke amp AMD

What happens to deprived cortex in AMD

fMRI shows cortical reorganization in adults

Proposed mechanisms

hellipGrowth of new connections

hellipUnmasking of pre-existing connections this is true

happens within seconds

Bavelier

Action video games

68

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Bavelier

Action video games Looked at attention Gamers can track more

activities

Attention over space (me peripheral awarenress) Useful field

of view shrinks with age

Performance not VA relatedhellipis related to attention

Action game playing changes spatial resolutionhellipovercoming

crowding in VA assessment (me amblyopia therapy)

Temporal resolution of vision Backward masking

changehellipbrain changes

Visual sensitivity (contrast sensitivity) Post action game training

improves CSF

69

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Action video games correcting optics of the cortex (me this is

actualy OVT)

Games factor

Variable entry leanringhellipadapt task to skill level

Incremental learning tune task to subjectlsquos leanring steps

Motivationarousal

Rewards

Self masterself confidence

Action games factors

Pacingrate of exposure to infohellipincreasing processing speed

Dynamic display

Rich environment

Rich motor involvement

70

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Surgeons may be made to play action games

Pilot training

Amblyopia tx Dennis Levi research

PresenterTitle Contact info

Neuroplasticity-A Paradigm Sea Change

This presentation is available at

httpwwwslidesharenetDMAINOneuroplasticity-a-paradigm-sea-change-2459693

httpwwwmainosmemosblogspotcom

My FaceBook Page

and

Twitter

PresenterTitle Contact info

Questions About

Neuroplasticity-A Paradigm Sea Change

Dominick M Maino OD MEd FAAO FCOVD-A

Professor PediatricsBinocular VisionIllinois Eye InstituteIllinois College of Optometry

dmainoicoeduhttpwwwMainosMemosblogspotcom

Thanks to

httpwwwcovdorgHomeOVDJournalOVD401tabid263D

efaultaspx

httpbipolarblastfileswordpresscom200908neurojpg

httpwwwspecialcheerscomimagesanimated_braingif

httpblogmarsdencartoonscomwp-

contentuploads200810frankenstein-myspace-lightbeergif

httpwwwshangralafamilyfuncomgala-ecalvindreamgif

httppsychiatryjwatchorgcgicontentfull20082251

73

Chakraborty R Chatterjee A Choudhart S Chakraborty PK Neuroplasticitymdasha paradigm shift in neurosciences J Indian Med Assoc

2007105(9)513-4516-8520-1

Sacks O A neurologistlsquos notebook Stereo Sue Why two eyes are better than one The New Yorker 2006 Jun 1964-73

Krulwich R National Public Radio Going Binocular Susanlsquos First Snowfall Available at

wwwnprorgtemplatesstorystoryphpstoryId=5507789 (Accessed December 8 2008)

Press LJ The story behind Stereo Suelsquo and a world-famous neurologistlsquos discovery of vision therapy Optom Vis Dev 200637(2) 55-7

Levin HS Neuroplasticity and brain imaging research implications for rehabilitation Arch Phys Med Rehabil 2006 Dec87(12 Suppl

2)S1

Wiesel TN Hubel DH Single-cell responses in striate cortex of kittens deprived of vision in one eye J Neurophysiol 1963

Nov261003-17

Hook BM Chen C Critical periods in the visual system Changing views for a model of experience-dependent plasticity Neuron 2007

Oct56(2)312-26

Ramey CT Ramey SL Prevention of intellectual disabilities early interventions to improve cognitive development Prev Med 1998

Mar-Apr27(2)224-32

Heuninckx S Wenderoth N Swinnen SP Systems neuroplasticity in the aging brain recruiting additional neural resources for

successful motor performance in elderly persons J Neurosci 2008 Jan 228(1)91-9

Ge S Yang CH Hsu KS et al A critical period for enhanced synaptic plasticity in newly generated neurons of the adult brain Neuron

2007 May54(4)559-66

74

Draganski B Gaser C Busch V et al Neuroplasticity changes in grey matter induced by training Nature 2004 Jan 22427(6972)

311-2

Cannonieri GC Bonilha L Fernandes PT et al Practice and perfect length of training and structural brain changes in experienced

typists Neuroreport 2007 Jul 218(10)1063-6

Kleim JA Jones TA Principles of experience-dependent neural plasticity implications for rehabilitation after brain damage J

Speech Lang Hear Res 2008 Feb51(1)S225-39

Trojan S Porkorny J Theoretical aspects of neuroplasticity Physiol Res 199948(2)87-97

Ramamirtham R Kee CS Hung LF et al Wave aberrations in rhesus monkeys with vision-induced ametropias Vision Res 2007

Sep47(21)2751-66

Smith EL 3rd Ramamirtham R Qiao-Grider Y et al Effects of foveal ablation on emmetropization and form-deprivation myopia

Invest Ophthalmol Vis Sci 2007 Sep48(9)3914-22

Smith EL 3rd Kee CS Ramamirtham R et al Peripheral vision can influence eye growth and refractive development in infant

monkeys Invest Ophthalmol Vis Sci 2005 Nov46(11)3965-72

Ciuffreda KJ Vasudevan B Nearwork-induced transient myopia (NITM) and permanent myopiandashndashis there a link Ophthalmic

Physiol Opt 2008 Mar28(2)103-14

Hung GK Ciuffreda KJ Incremental retinal-defocus theory of myopia development--schematic analysis and computer simulation

Comput Biol Med 2007 Jul37(7)930-46

Hung GK Ciuffreda KJ A unifying theory of refractive error development Bull Math Biol 2000 Nov62(6)1087-108

75

Pang Y Maino D Zhang G Lu F Myopia Can its progress be controlled Optom Vis Dev 200637(2)75-9

Leung JT Brown B Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lenses Optom Vis Sci

1999 Jun76(6)346-54

Hasebe S Ohtsuki H Nonaka T et al Effect of progressive addition lenses on myopia progression in Japanese children a prospective

randomized double-masked crossover trial Invest Ophthalmol Vis Sci 2008 Jul49(7)2781-9

Gwiazda J Hyman L Hussein M et al A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression

of myopia in children Invest Ophthalmol Vis Sci 2003 Apr44(4)1492-500

Siatkowski RM Cotter SA Crockett RS et al Two-year multi-center randomized double-masked placebo-controlled parallel safety and

efficacy study of 2 pirenzepine ophthalmic gel in children with myopia J AAPOS 2008 Aug12(4)332-9

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged 7 to 17 years Arch Ophthalmol 2005

Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three to less than 10 years of age Am J

Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction Am J Ophthalmol 2007

Jun143(6)1060-3

Holmes JM Edwards AR Beck RW et al A randomized pilot study of near activities versus non-near activities during patching therapy for

amblyopia J AAPOS 2005 Apr9(2)129-36

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate

amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-57

76

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic

amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Convergence Insufficiency Treatment Trial Study Group Randomized clinical trial of treatments for symptomatic convergence insufficiency

in children Arch Ophthalmol 2008 Oct126(10)1336-49

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

Solan HA Shelley-Tremblay J Hansen PC et al M-cell deficit and reading disability a preliminary study of the effects of temporal vision-

processing therapy Optometry 2004 Oct75(10)640-50

Solan HA Larson S Shelley-Tremblay J et al Role of visual attention in cognitive control of oculomotor readiness in students with reading

disabilities J Learn Disabil 2001 Mar-Apr34(2)107-18

Gallaway M Boas MB The impact of vergence and accommodative therapy on reading eye movements and reading speed Optom Vis Dev

200738(3)115-20

Goss DA Downing DB Lowther AH et al The effect of HTS vision therapy conducted in a school setting on reading skills in third and

fourth grade students Optom Vis Dev 200738(1)27-32

Crutch SJ Warrington EK Foveal crowding in posterior cortical atrophy a specific early-visual-processing deficit affecting word reading

Cogn Neuropsychol 2007 Dec24(8)843-66

Helms D Sawtelle SM A study of the effectiveness of cognitive therapy delivered in a video game format Optom Vis Dev 200738 (1)19-

26

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

77

Lawton T Training direction-discrimination sensitivity remediates a wide spectrum of reading skills OptomVis Dev 200738(1) 33-47

Goldstand S Koslowe KC Parush S Vision visual-information processing and academic performance among seventh-grade schoolchildren a

more significant relationship than we thought Am J Occup Ther 2005 Jul-Aug59(4)377-89

Fischer B Koumlngeter A Hartnegg K Effects of daily practice on subitizing visual counting and basic arithmetic skills Optom Vis Dev

200839(1)30-4

Sands W Taub M Maino D Limited research and education on special populations in optometry and ophthalomology Optom Vis Dev

200839(2)60-1

Wesson M Maino D Oculo-visual findings in Down syndrome cerebral palsy and mental retardation with non-specific etiology In Maino D

(ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 199517-54 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

Cui Y Stapleton F Suttle C Developing an instrument to assess vision-related and subjective quality of life in children with intellectual

disability data collection and preliminary analysis in a Chinese population Ophthal Physiolog Optics 2008 May28(3) 238-46

Maino D Steele G Tahir S Sajja R Attitudes of optometry students toward individuals with disabilities Optom Ed 200227(2)45-50

Maino D Special populations in the optometric curriculum Optom Ed 200227(2)38-9

Maino D Overview of special populations In Scheiman M Rouse M (eds) Optometric Management of Learning-Related Vision Problems

St Louis Mosby Inc 200685-106

Maino D (ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 1995 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

78

McCarthy P Maino D Alport syndrome a review Clin Eye Vis Care 2000 Dec12(3-4)139-50

Block SS Brusca-Vega R Pizzi WJ et al Cognitive and visual processing skills and their relationship to mutation size in full and

permutation female fragile X carriers Optom Vis Sci 2000 Nov77 (11)592-9

Maino D The young child with developmental disabilities An introduction to mental retardation and genetic syndromes In Moore BD

(ed) Eye Care for Infants and Young Children Butter-worth--Heinemann Newton MA1997285-300

Amin V Maino D The Fragile X female Visual visual perceptual and ocular health anomalies J Am Optom Assoc 1995 May66

(5)290-95

Maino DM Maino JH Cibis GW Hecht F Ocular health anomalies in patients with developmental disabilities In Maino D (ed)

Diagnosis and Management of Special Populations Mosby-Year-book Inc St Louis MO 1995189-206 Reprinted Optometric

Education Program Foundation Santa Anna Calif 2001

Maino D Wesson M Schlange D Cibis G Maino J Optometric findings in the fragile X syndrome Optom Vis Sci 199168634-40

Scheiman MMOptometric findings in children with cerebral palsy Am J Optom Physiol Opt 1984 May61(5)321-3

Maino D Maino J Maino S Mental retardation syndromes with associated ocular defects J Am Optom Assoc 199061707-16

Stewart RE Woodhouse JM Cregg M Pakeman VH Association between accommodative accuracy hypermetropia and strabismus in

children with Downs syndrome Optom Vis Sci 2007 Feb84(2)149-55

Cregg M Woodhouse JM Pakeman VH et al Accommodation and refractive error in children with Down syndrome cross-sectional

and longitudinal studies Invest Ophthalmol Vis Sci 2001 Jan42 (1)55-63

79

McClelland JF Parkes J Hill N et al Accommodative dysfunction in children with cerebral palsy a population-

based study Invest Ophthalmol Vis Sci 2006 May47(5)1824-30

Duckman RH Vision therapy for the child with cerebral palsy J Am Optom Assoc 198758(1)28-35

Duckman R Accommodation in cerebral palsy function and remediation J Am Optom Assoc 198455(4)281-3

Scheiman M Understanding and managing vision deficits a guide for occupational therapists 2nd ed Slack

Thorofare NJ 2002

Maino D Binasal occlusion for the child with Cerebral Palsy J Ill Optom Assoc 198644(1)1218

Battaglia F Quartarone A Rizzo V et al Early impairment of synaptic plasticity in patients with Downs syndrome

Neurobiol Aging 2008 Aug29(8)1272-5

Bonnier C Evaluation of early stimulation programs for enhancing brain development Acta Paediatr 2008

Jul97(7)853-8

Morice E Andreae LC Cooke SF et al Preservation of long-term memory and synaptic plasticity despite short-term

impairments in the Tc1 mouse model of Down syndrome Learn Mem 2008 Jul 1415(7)492-500

Gordon AM Schneider JA Chinnan A Charles JR Efficacy of a hand-arm bimanual intensive therapy (HABIT) in

children with hemiplegic cerebral palsy a randomized control trial Dev Med Child Neurol 2007 Nov49(11)830-8

Kapoor N Ciuffreda KJ Vision disturbances following traumatic brain injury Curr Treat Options Neurol 2002

Jul4(4)271-80

80

Ciuffreda KJ Rutner D Kapoor N et al Vision therapy for oculomotor dysfunctions in acquired brain injury a

retrospective analysis Optometry 2008 Jan79(1)18-22

Ciuffreda KJ Han Y Kapoor N Ficarra AP Oculomotor rehabilitation for reading in acquired brain injury

NeuroRehabilitation 200621(1)9-21

Zost M Diagnosis and management of visual dysfunction in cerebral injury In Maino D (ed) Diagnosis and

Management of Special Populations Mosby-Yearbook Inc St Louis 199579 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001 [Figure used with permission of the editor]

DeGutis JM Bentin S Robertson LC DEsposito M Functional plasticity in ventral temporal cortex following

cognitive rehabilitation of a congenital prosopagnosic J Cogn Neurosci 2007 Nov19 (11)1790-802

Welbourne SR Ralph MA Exploring the impact of plasticity-related recovery after brain damage in a connectionist

model of single-word reading Cogn Affect Behav Neurosci 2005 Mar5(1)77-92

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements prevent cognitive decline A

systematic review of randomized controlled trials J Hum Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among preterm infants attributable to early

supplementation of human milk with docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings and structural-functional

synergies with cell membrane phospholipids Altern Med Rev 2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function Neuroscience 20089(7)568-78

81

Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

BMC Biol 2008 Sep 9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine improves neuropsychological disorders in a child with

creatine transporter defect Neurocase 200814(2) 151-61

Forrester LW Wheaton LA Luft AR Exercise-mediated locomotor recovery and lower-limb neuroplasticity after

stroke J Rehabil Res Dev 200845(2)205-20

82

Page 39: Neuroplasticity: A Paradigm Sea Change Latest Updated File

EF Learning related vision anomalies Vision developmentperception disorders

magnocellular (MC) deficit in dyslexia

LM speed-matching ratio predicts reading in childrenChase C Dougherty RF Ray N

Fowler S Stein JOptom Vis Sci 2007 Mar84(3)229-36

Effect of attention therapy on reading comprehension Solan HA Shelley-Tremblay J

Ficarra A Silverman M Larson S J Learn Disabil 2003 Nov-Dec36(6)556-63

Is there a common linkage among reading comprehension visual attention and

magnocellular processing Solan HA Shelley-Tremblay JF Hansen PC Larson S

J Learn Disabil 2007 May-Jun40(3)270-8

Lawton T Filtered Text and Direction Discrimination Training Improved Reading

Fluency for Both Dyslexic and Normal Readers Optom Vis Dev 200839 (3)114

Fischer B Hartnegg K Saccade control in dyslexia Development deficits training

and transfer to reading Optom Vis Dev 200839(4)181-190

39

EF Learning related vision anomalies Vision developmentperception disorders

J Learn Disabil 2003 Nov-Dec36(6)556-63 Effect of attention therapy on reading

comprehension Solan HA Shelley-Tremblay J Ficarra A Silverman M Larson S

hellip At the completion of attention therapy the mean

standard attention and reading comprehension scores of

the experimental group had improved significantly The

control group however showed no significant

improvement in reading comprehension scores after 12

weeks Although uncertainties still exist this investigation

supports the notion that visual attention is malleable and

that attention therapy has a significant effect on reading

comprehension in this often neglected population

40

VII Vision dysfunction association with acquired brain injury

A Exotropia (or high exophoriaCI)

B Accommodative dysfunction

C Convergence insufficiency

41

D Decreased blink rate

E Spatial disorientation

F Pursuitsaccade dysfunction

G Unstable ambient vision (Magnocellular pathway)

42

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Stelmack JA Frith T Van Koevering D Rinne S Stelmack TR Visual function in patients

followed at a Veterans Affairs polytrauma network site an electronic medical record review

Optometry 2009 Aug80(8)419-24

RESULTS Visual symptoms were self-reported by 76 of patients

with polytrauma and 75 of the patients with TBI Problems with reading

(polytrauma 60 and TBI 50) and accommodation (polytrauma 30 and

TBI 47) were frequently found on eye examinations Spectacles were the

treatment most frequently prescribed (polytrauma 62 and TBI 78)

CONCLUSIONS It is important for optometrists to be aware of the high

rates of self-reported symptoms and visual problems in military personnel

returning from deployment to the wars in Iraq and Afghanistan Post-

traumatic stress disorder and depression may complicate optometric

evaluation and management

43

VII Vision dysfunction association with acquired brain injury

Avoidance of near tasks

Oculomotor-based reading difficulties

Eye tracking problems

Eye focusing problems

Eyestrain Diplopia

Dizziness Vertigo

Vision-derived nausea

44

VII Vision dysfunction association with acquired brain injury

Increased sensitivity to visual motion

Visual inattention and distractibility

Short-term visual memory loss

Difficulty judging distances (relative and absolute

Difficulty with global scanning

Difficulty with personal grooming especially involving the face

Inability to interactcope visually in a complex social situation

(eg minimal eye contact)

Inability to tolerate complex visual environments (eg grocery store

aisles and highly-patterned floors)

45

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Ciuffreda KJ Ludlam DP Kapoor N Clinical oculomotor training in traumatic brain injury Optom Vis

Dev 200940(1)16-23

Individuals with traumatic brain injury present with a constellation of

oculomotor dysfunctions and correlated symptoms Simple and

effective clinical oculomotor-based training procedures will be

presented with respect to the versional vergence and

accommodative systems and their interactions These therapeutic

procedures can also be applied as needed to individuals with either

low vision neurological dysfunctions or general visual skills cases

manifesting similar oculomotor deficits

46

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Leslie S Myopia and accommodative insufficiency associated with

moderate head trauma Opt Vis Dev 200940(1)25-31

The majority of subjects reviewed had developed a stable degree of

myopia between 100 and 200 diopters as well as an abnormally

high lag of accommodation When their distance and near spatial area

of focus was compared the majority were focused at an intermediate

area in space suggesting a loss of control of accommodation in

space

47

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

B Drugs

C Exercise

D Learning new and challenging things

48

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements

prevent cognitive decline A systematic review of randomized controlled trials J Hum

Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among

preterm infants attributable to early supplementation of human milk with

docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings

and structural-functional synergies with cell membrane phospholipids Altern Med Rev

2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function

Neuroscience 20089(7)568-78

49

VIII Improving Brain Function and Neuroplasticity

B Drugs Maya Vetencourt JF Sale A Viegi A et al The antidepressant

fluoxetine (PROZAC) restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the

antidepressant tianeptine CNS Drugs 200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances

hippocampal long-term potentiation and memory BMC Biol 2008 Sep

9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine

improves neuropsychological disorders in a child with creatine

transporter defect Neurocase 200814(2) 151-61

50

VIII Improving Brain Function and Neuroplasticity

C Exercise

Hunsberger JG et al Antidepressant actions of the exercise-

regulated gene VGF Nat Med 2007 Dec 2 131476

VGF may be a common pathway by which exercise induces

neuroplasticity and growth-factor genes at least one of these might act

similarly to antidepressants in promoting an adaptive response to stress

However the tests used here may be modeling stress-induced

helplessness not depression hellipexercise seems to induce multiple

interacting genes that enhance neuronal resilience

51

VIII Improving Brain Function and Neuroplasticity

D Learning new and challenging things

What have we (optometry amp ophthalmology)

been thinking all these years

Where did we miss the news about neuroplasticity

52

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Huang JC Neuroplasticity as a proposed mechanism for the efficacy of optometric vision therapy and rehabilitation J Bev Optom 200920(4)96-100

Homologous area adaptationCompensatory masqueradeCross-modal reassignment

Map expansion

EquipotentialityVicariation

53

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Homologous area adaptation a transfer of function from a damaged brain area to a non-damaged brain area May be limited to early stages of human development and may crowd a new brain area resulting in reduced functionality of that brain area (Competition between spatial amp verbal functioning)

54

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Compensatory masquerade reorganizing of existing neuro-pathways to us alternative cognitive strategies to perform a task

55

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Cross-modal reassignment using new sensory input in a brain structure deprived of its main input source (changing processing from visual to tactile stimuli in the blind)

56

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Map expansion increase in brain mass due to repeated behavior or exposure to stimuli

57

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Equipotentiality anatomical areas of the brain can perform disparate functions

Vicariation redundant neural systems can operate under abnormal conditions

This may explain why recovery is noted for many neurological conditions (degenerative psychiatric developmental vascular traumatic)

58

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Constraint therapy Use it and improve it

Patching penalization ldquonear activitiesrdquo during amblyopia therapy

59

IX Improving Brain Function and Neuroplasticity Optometric Clinical ApplicationsOptometric Vision Therapy

Kleim amp Jones

Use it or lose it If you do not drive specific brain functions

functional loss will occur

If you want to improve oculomotor brain neuroplastic function amp

structure therapy should be specific for that brain function

Use it and improve it Therapy that drives cortical function enhances

that particular function

If you use therapy to improve oculomotor dysfunction it should

improve

Specificity The therapy you choose determines the resultant

plasticity and function

You must choose therapy that is appropriate

60

IX Improving Brain Function and Neuroplasticity Optometric Clinical Applications

Kleim amp Jones

Repetition matters Plasticity that results in functional change

requires repetition

Do the therapy Do it again Do it yet again No quick fix

Intensity matters Induction of plasticity requires the appropriate

amount of intensity

Intensity means strength force concentration power and passion

Without these plasticity may not occur Function may not improve

Time matters Different forms of plasticity take place at different

times during therapy

Do the basics than the more advanced therapeutic procedures

61

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Salience matters It has to be important to the individual

Make the therapy matter to the patient

Age matters Plasticity is easier in a younger brain but is also

possible in an adult brain

Do not let age determine what therapy options you offer your

patients Think of Susan Barry PhD (StereoSue) and her success

Offer your patients options Let them choose Be realistic about

outcomeshelliphave outcome measures built into therapy program

62

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Transference Neuroplasticity and the change in function

that results from one therapy can augment the attainment

of similar behaviors

What you do during oculomotor therapy may affected

vergence therapy outcomes

Interference Plasticity in response to one experience can

interfere with the acquisition of other behaviors

Monitor Evaluate progress Discuss function in other areas

of your patientslsquo life

63

Why pay attention to binocular vision dysfunctions

and neuroplasticity

December 2009 issue of the Review of Optometry

The Binocular Vision Dysfunction Pandemic

In 2010 almost 170 million individuals will be wearing glasses In

2010 there will also be up to 93 million amblyopes and 12 and a half

million strabismics For children under 18 years of age that means

there will be more than 22 and a half million amblyopes and millions

of children with strabismus A clinical trial to determine the

prevalence of binocular vision dysfunction within the general

population suggested the possibility of up to 56 or 173 million men

women and children with symptoms associated with a binocular

vision dysfunction 189 million (61) with accommodative problems

and 118 million (38) demonstrating various vergence

anomalies

64

65

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Brain plasticity life long changes in the structure of the brain

Sensory substitution replacement of one sensory input by another

Measurement techniques

Voxel based morphometryhellipmeasures difference in brain volume

Fluorodeoxyglucose glucose analog PET scan tells you

distribution and metabolism of brain

Cortical thickness measures

Visual cortex of the blind turns somatic ―The eye of the tongue

Transcranial magnetic stmiulation non-invasive technique to

stimulate cortex

66

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Blind Braille readers report tingling in fingers when pressure

phosphenes are applied Blind feel tingling in tongue

Bind use tongue to perform orientation task motion perception

sensory perception Visual cortex recruited in a variety of sensory

and cognitive tasks (DM Can we use tongue as a VT tool)

Dilks Reorganizations of human adult visual system

When a region of sensory cortex is deprived of its bottom up

input the deprived region begins to respond to stimuli that

normally activate adjacent cortex

67

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Retinotopic map changes for stroke pts Cortical reorganization in

adults occurs Perceived objectshellipelongation in stroke amp AMD

What happens to deprived cortex in AMD

fMRI shows cortical reorganization in adults

Proposed mechanisms

hellipGrowth of new connections

hellipUnmasking of pre-existing connections this is true

happens within seconds

Bavelier

Action video games

68

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Bavelier

Action video games Looked at attention Gamers can track more

activities

Attention over space (me peripheral awarenress) Useful field

of view shrinks with age

Performance not VA relatedhellipis related to attention

Action game playing changes spatial resolutionhellipovercoming

crowding in VA assessment (me amblyopia therapy)

Temporal resolution of vision Backward masking

changehellipbrain changes

Visual sensitivity (contrast sensitivity) Post action game training

improves CSF

69

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Action video games correcting optics of the cortex (me this is

actualy OVT)

Games factor

Variable entry leanringhellipadapt task to skill level

Incremental learning tune task to subjectlsquos leanring steps

Motivationarousal

Rewards

Self masterself confidence

Action games factors

Pacingrate of exposure to infohellipincreasing processing speed

Dynamic display

Rich environment

Rich motor involvement

70

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Surgeons may be made to play action games

Pilot training

Amblyopia tx Dennis Levi research

PresenterTitle Contact info

Neuroplasticity-A Paradigm Sea Change

This presentation is available at

httpwwwslidesharenetDMAINOneuroplasticity-a-paradigm-sea-change-2459693

httpwwwmainosmemosblogspotcom

My FaceBook Page

and

Twitter

PresenterTitle Contact info

Questions About

Neuroplasticity-A Paradigm Sea Change

Dominick M Maino OD MEd FAAO FCOVD-A

Professor PediatricsBinocular VisionIllinois Eye InstituteIllinois College of Optometry

dmainoicoeduhttpwwwMainosMemosblogspotcom

Thanks to

httpwwwcovdorgHomeOVDJournalOVD401tabid263D

efaultaspx

httpbipolarblastfileswordpresscom200908neurojpg

httpwwwspecialcheerscomimagesanimated_braingif

httpblogmarsdencartoonscomwp-

contentuploads200810frankenstein-myspace-lightbeergif

httpwwwshangralafamilyfuncomgala-ecalvindreamgif

httppsychiatryjwatchorgcgicontentfull20082251

73

Chakraborty R Chatterjee A Choudhart S Chakraborty PK Neuroplasticitymdasha paradigm shift in neurosciences J Indian Med Assoc

2007105(9)513-4516-8520-1

Sacks O A neurologistlsquos notebook Stereo Sue Why two eyes are better than one The New Yorker 2006 Jun 1964-73

Krulwich R National Public Radio Going Binocular Susanlsquos First Snowfall Available at

wwwnprorgtemplatesstorystoryphpstoryId=5507789 (Accessed December 8 2008)

Press LJ The story behind Stereo Suelsquo and a world-famous neurologistlsquos discovery of vision therapy Optom Vis Dev 200637(2) 55-7

Levin HS Neuroplasticity and brain imaging research implications for rehabilitation Arch Phys Med Rehabil 2006 Dec87(12 Suppl

2)S1

Wiesel TN Hubel DH Single-cell responses in striate cortex of kittens deprived of vision in one eye J Neurophysiol 1963

Nov261003-17

Hook BM Chen C Critical periods in the visual system Changing views for a model of experience-dependent plasticity Neuron 2007

Oct56(2)312-26

Ramey CT Ramey SL Prevention of intellectual disabilities early interventions to improve cognitive development Prev Med 1998

Mar-Apr27(2)224-32

Heuninckx S Wenderoth N Swinnen SP Systems neuroplasticity in the aging brain recruiting additional neural resources for

successful motor performance in elderly persons J Neurosci 2008 Jan 228(1)91-9

Ge S Yang CH Hsu KS et al A critical period for enhanced synaptic plasticity in newly generated neurons of the adult brain Neuron

2007 May54(4)559-66

74

Draganski B Gaser C Busch V et al Neuroplasticity changes in grey matter induced by training Nature 2004 Jan 22427(6972)

311-2

Cannonieri GC Bonilha L Fernandes PT et al Practice and perfect length of training and structural brain changes in experienced

typists Neuroreport 2007 Jul 218(10)1063-6

Kleim JA Jones TA Principles of experience-dependent neural plasticity implications for rehabilitation after brain damage J

Speech Lang Hear Res 2008 Feb51(1)S225-39

Trojan S Porkorny J Theoretical aspects of neuroplasticity Physiol Res 199948(2)87-97

Ramamirtham R Kee CS Hung LF et al Wave aberrations in rhesus monkeys with vision-induced ametropias Vision Res 2007

Sep47(21)2751-66

Smith EL 3rd Ramamirtham R Qiao-Grider Y et al Effects of foveal ablation on emmetropization and form-deprivation myopia

Invest Ophthalmol Vis Sci 2007 Sep48(9)3914-22

Smith EL 3rd Kee CS Ramamirtham R et al Peripheral vision can influence eye growth and refractive development in infant

monkeys Invest Ophthalmol Vis Sci 2005 Nov46(11)3965-72

Ciuffreda KJ Vasudevan B Nearwork-induced transient myopia (NITM) and permanent myopiandashndashis there a link Ophthalmic

Physiol Opt 2008 Mar28(2)103-14

Hung GK Ciuffreda KJ Incremental retinal-defocus theory of myopia development--schematic analysis and computer simulation

Comput Biol Med 2007 Jul37(7)930-46

Hung GK Ciuffreda KJ A unifying theory of refractive error development Bull Math Biol 2000 Nov62(6)1087-108

75

Pang Y Maino D Zhang G Lu F Myopia Can its progress be controlled Optom Vis Dev 200637(2)75-9

Leung JT Brown B Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lenses Optom Vis Sci

1999 Jun76(6)346-54

Hasebe S Ohtsuki H Nonaka T et al Effect of progressive addition lenses on myopia progression in Japanese children a prospective

randomized double-masked crossover trial Invest Ophthalmol Vis Sci 2008 Jul49(7)2781-9

Gwiazda J Hyman L Hussein M et al A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression

of myopia in children Invest Ophthalmol Vis Sci 2003 Apr44(4)1492-500

Siatkowski RM Cotter SA Crockett RS et al Two-year multi-center randomized double-masked placebo-controlled parallel safety and

efficacy study of 2 pirenzepine ophthalmic gel in children with myopia J AAPOS 2008 Aug12(4)332-9

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged 7 to 17 years Arch Ophthalmol 2005

Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three to less than 10 years of age Am J

Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction Am J Ophthalmol 2007

Jun143(6)1060-3

Holmes JM Edwards AR Beck RW et al A randomized pilot study of near activities versus non-near activities during patching therapy for

amblyopia J AAPOS 2005 Apr9(2)129-36

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate

amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-57

76

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic

amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Convergence Insufficiency Treatment Trial Study Group Randomized clinical trial of treatments for symptomatic convergence insufficiency

in children Arch Ophthalmol 2008 Oct126(10)1336-49

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

Solan HA Shelley-Tremblay J Hansen PC et al M-cell deficit and reading disability a preliminary study of the effects of temporal vision-

processing therapy Optometry 2004 Oct75(10)640-50

Solan HA Larson S Shelley-Tremblay J et al Role of visual attention in cognitive control of oculomotor readiness in students with reading

disabilities J Learn Disabil 2001 Mar-Apr34(2)107-18

Gallaway M Boas MB The impact of vergence and accommodative therapy on reading eye movements and reading speed Optom Vis Dev

200738(3)115-20

Goss DA Downing DB Lowther AH et al The effect of HTS vision therapy conducted in a school setting on reading skills in third and

fourth grade students Optom Vis Dev 200738(1)27-32

Crutch SJ Warrington EK Foveal crowding in posterior cortical atrophy a specific early-visual-processing deficit affecting word reading

Cogn Neuropsychol 2007 Dec24(8)843-66

Helms D Sawtelle SM A study of the effectiveness of cognitive therapy delivered in a video game format Optom Vis Dev 200738 (1)19-

26

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

77

Lawton T Training direction-discrimination sensitivity remediates a wide spectrum of reading skills OptomVis Dev 200738(1) 33-47

Goldstand S Koslowe KC Parush S Vision visual-information processing and academic performance among seventh-grade schoolchildren a

more significant relationship than we thought Am J Occup Ther 2005 Jul-Aug59(4)377-89

Fischer B Koumlngeter A Hartnegg K Effects of daily practice on subitizing visual counting and basic arithmetic skills Optom Vis Dev

200839(1)30-4

Sands W Taub M Maino D Limited research and education on special populations in optometry and ophthalomology Optom Vis Dev

200839(2)60-1

Wesson M Maino D Oculo-visual findings in Down syndrome cerebral palsy and mental retardation with non-specific etiology In Maino D

(ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 199517-54 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

Cui Y Stapleton F Suttle C Developing an instrument to assess vision-related and subjective quality of life in children with intellectual

disability data collection and preliminary analysis in a Chinese population Ophthal Physiolog Optics 2008 May28(3) 238-46

Maino D Steele G Tahir S Sajja R Attitudes of optometry students toward individuals with disabilities Optom Ed 200227(2)45-50

Maino D Special populations in the optometric curriculum Optom Ed 200227(2)38-9

Maino D Overview of special populations In Scheiman M Rouse M (eds) Optometric Management of Learning-Related Vision Problems

St Louis Mosby Inc 200685-106

Maino D (ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 1995 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

78

McCarthy P Maino D Alport syndrome a review Clin Eye Vis Care 2000 Dec12(3-4)139-50

Block SS Brusca-Vega R Pizzi WJ et al Cognitive and visual processing skills and their relationship to mutation size in full and

permutation female fragile X carriers Optom Vis Sci 2000 Nov77 (11)592-9

Maino D The young child with developmental disabilities An introduction to mental retardation and genetic syndromes In Moore BD

(ed) Eye Care for Infants and Young Children Butter-worth--Heinemann Newton MA1997285-300

Amin V Maino D The Fragile X female Visual visual perceptual and ocular health anomalies J Am Optom Assoc 1995 May66

(5)290-95

Maino DM Maino JH Cibis GW Hecht F Ocular health anomalies in patients with developmental disabilities In Maino D (ed)

Diagnosis and Management of Special Populations Mosby-Year-book Inc St Louis MO 1995189-206 Reprinted Optometric

Education Program Foundation Santa Anna Calif 2001

Maino D Wesson M Schlange D Cibis G Maino J Optometric findings in the fragile X syndrome Optom Vis Sci 199168634-40

Scheiman MMOptometric findings in children with cerebral palsy Am J Optom Physiol Opt 1984 May61(5)321-3

Maino D Maino J Maino S Mental retardation syndromes with associated ocular defects J Am Optom Assoc 199061707-16

Stewart RE Woodhouse JM Cregg M Pakeman VH Association between accommodative accuracy hypermetropia and strabismus in

children with Downs syndrome Optom Vis Sci 2007 Feb84(2)149-55

Cregg M Woodhouse JM Pakeman VH et al Accommodation and refractive error in children with Down syndrome cross-sectional

and longitudinal studies Invest Ophthalmol Vis Sci 2001 Jan42 (1)55-63

79

McClelland JF Parkes J Hill N et al Accommodative dysfunction in children with cerebral palsy a population-

based study Invest Ophthalmol Vis Sci 2006 May47(5)1824-30

Duckman RH Vision therapy for the child with cerebral palsy J Am Optom Assoc 198758(1)28-35

Duckman R Accommodation in cerebral palsy function and remediation J Am Optom Assoc 198455(4)281-3

Scheiman M Understanding and managing vision deficits a guide for occupational therapists 2nd ed Slack

Thorofare NJ 2002

Maino D Binasal occlusion for the child with Cerebral Palsy J Ill Optom Assoc 198644(1)1218

Battaglia F Quartarone A Rizzo V et al Early impairment of synaptic plasticity in patients with Downs syndrome

Neurobiol Aging 2008 Aug29(8)1272-5

Bonnier C Evaluation of early stimulation programs for enhancing brain development Acta Paediatr 2008

Jul97(7)853-8

Morice E Andreae LC Cooke SF et al Preservation of long-term memory and synaptic plasticity despite short-term

impairments in the Tc1 mouse model of Down syndrome Learn Mem 2008 Jul 1415(7)492-500

Gordon AM Schneider JA Chinnan A Charles JR Efficacy of a hand-arm bimanual intensive therapy (HABIT) in

children with hemiplegic cerebral palsy a randomized control trial Dev Med Child Neurol 2007 Nov49(11)830-8

Kapoor N Ciuffreda KJ Vision disturbances following traumatic brain injury Curr Treat Options Neurol 2002

Jul4(4)271-80

80

Ciuffreda KJ Rutner D Kapoor N et al Vision therapy for oculomotor dysfunctions in acquired brain injury a

retrospective analysis Optometry 2008 Jan79(1)18-22

Ciuffreda KJ Han Y Kapoor N Ficarra AP Oculomotor rehabilitation for reading in acquired brain injury

NeuroRehabilitation 200621(1)9-21

Zost M Diagnosis and management of visual dysfunction in cerebral injury In Maino D (ed) Diagnosis and

Management of Special Populations Mosby-Yearbook Inc St Louis 199579 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001 [Figure used with permission of the editor]

DeGutis JM Bentin S Robertson LC DEsposito M Functional plasticity in ventral temporal cortex following

cognitive rehabilitation of a congenital prosopagnosic J Cogn Neurosci 2007 Nov19 (11)1790-802

Welbourne SR Ralph MA Exploring the impact of plasticity-related recovery after brain damage in a connectionist

model of single-word reading Cogn Affect Behav Neurosci 2005 Mar5(1)77-92

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements prevent cognitive decline A

systematic review of randomized controlled trials J Hum Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among preterm infants attributable to early

supplementation of human milk with docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings and structural-functional

synergies with cell membrane phospholipids Altern Med Rev 2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function Neuroscience 20089(7)568-78

81

Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

BMC Biol 2008 Sep 9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine improves neuropsychological disorders in a child with

creatine transporter defect Neurocase 200814(2) 151-61

Forrester LW Wheaton LA Luft AR Exercise-mediated locomotor recovery and lower-limb neuroplasticity after

stroke J Rehabil Res Dev 200845(2)205-20

82

Page 40: Neuroplasticity: A Paradigm Sea Change Latest Updated File

EF Learning related vision anomalies Vision developmentperception disorders

J Learn Disabil 2003 Nov-Dec36(6)556-63 Effect of attention therapy on reading

comprehension Solan HA Shelley-Tremblay J Ficarra A Silverman M Larson S

hellip At the completion of attention therapy the mean

standard attention and reading comprehension scores of

the experimental group had improved significantly The

control group however showed no significant

improvement in reading comprehension scores after 12

weeks Although uncertainties still exist this investigation

supports the notion that visual attention is malleable and

that attention therapy has a significant effect on reading

comprehension in this often neglected population

40

VII Vision dysfunction association with acquired brain injury

A Exotropia (or high exophoriaCI)

B Accommodative dysfunction

C Convergence insufficiency

41

D Decreased blink rate

E Spatial disorientation

F Pursuitsaccade dysfunction

G Unstable ambient vision (Magnocellular pathway)

42

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Stelmack JA Frith T Van Koevering D Rinne S Stelmack TR Visual function in patients

followed at a Veterans Affairs polytrauma network site an electronic medical record review

Optometry 2009 Aug80(8)419-24

RESULTS Visual symptoms were self-reported by 76 of patients

with polytrauma and 75 of the patients with TBI Problems with reading

(polytrauma 60 and TBI 50) and accommodation (polytrauma 30 and

TBI 47) were frequently found on eye examinations Spectacles were the

treatment most frequently prescribed (polytrauma 62 and TBI 78)

CONCLUSIONS It is important for optometrists to be aware of the high

rates of self-reported symptoms and visual problems in military personnel

returning from deployment to the wars in Iraq and Afghanistan Post-

traumatic stress disorder and depression may complicate optometric

evaluation and management

43

VII Vision dysfunction association with acquired brain injury

Avoidance of near tasks

Oculomotor-based reading difficulties

Eye tracking problems

Eye focusing problems

Eyestrain Diplopia

Dizziness Vertigo

Vision-derived nausea

44

VII Vision dysfunction association with acquired brain injury

Increased sensitivity to visual motion

Visual inattention and distractibility

Short-term visual memory loss

Difficulty judging distances (relative and absolute

Difficulty with global scanning

Difficulty with personal grooming especially involving the face

Inability to interactcope visually in a complex social situation

(eg minimal eye contact)

Inability to tolerate complex visual environments (eg grocery store

aisles and highly-patterned floors)

45

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Ciuffreda KJ Ludlam DP Kapoor N Clinical oculomotor training in traumatic brain injury Optom Vis

Dev 200940(1)16-23

Individuals with traumatic brain injury present with a constellation of

oculomotor dysfunctions and correlated symptoms Simple and

effective clinical oculomotor-based training procedures will be

presented with respect to the versional vergence and

accommodative systems and their interactions These therapeutic

procedures can also be applied as needed to individuals with either

low vision neurological dysfunctions or general visual skills cases

manifesting similar oculomotor deficits

46

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Leslie S Myopia and accommodative insufficiency associated with

moderate head trauma Opt Vis Dev 200940(1)25-31

The majority of subjects reviewed had developed a stable degree of

myopia between 100 and 200 diopters as well as an abnormally

high lag of accommodation When their distance and near spatial area

of focus was compared the majority were focused at an intermediate

area in space suggesting a loss of control of accommodation in

space

47

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

B Drugs

C Exercise

D Learning new and challenging things

48

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements

prevent cognitive decline A systematic review of randomized controlled trials J Hum

Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among

preterm infants attributable to early supplementation of human milk with

docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings

and structural-functional synergies with cell membrane phospholipids Altern Med Rev

2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function

Neuroscience 20089(7)568-78

49

VIII Improving Brain Function and Neuroplasticity

B Drugs Maya Vetencourt JF Sale A Viegi A et al The antidepressant

fluoxetine (PROZAC) restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the

antidepressant tianeptine CNS Drugs 200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances

hippocampal long-term potentiation and memory BMC Biol 2008 Sep

9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine

improves neuropsychological disorders in a child with creatine

transporter defect Neurocase 200814(2) 151-61

50

VIII Improving Brain Function and Neuroplasticity

C Exercise

Hunsberger JG et al Antidepressant actions of the exercise-

regulated gene VGF Nat Med 2007 Dec 2 131476

VGF may be a common pathway by which exercise induces

neuroplasticity and growth-factor genes at least one of these might act

similarly to antidepressants in promoting an adaptive response to stress

However the tests used here may be modeling stress-induced

helplessness not depression hellipexercise seems to induce multiple

interacting genes that enhance neuronal resilience

51

VIII Improving Brain Function and Neuroplasticity

D Learning new and challenging things

What have we (optometry amp ophthalmology)

been thinking all these years

Where did we miss the news about neuroplasticity

52

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Huang JC Neuroplasticity as a proposed mechanism for the efficacy of optometric vision therapy and rehabilitation J Bev Optom 200920(4)96-100

Homologous area adaptationCompensatory masqueradeCross-modal reassignment

Map expansion

EquipotentialityVicariation

53

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Homologous area adaptation a transfer of function from a damaged brain area to a non-damaged brain area May be limited to early stages of human development and may crowd a new brain area resulting in reduced functionality of that brain area (Competition between spatial amp verbal functioning)

54

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Compensatory masquerade reorganizing of existing neuro-pathways to us alternative cognitive strategies to perform a task

55

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Cross-modal reassignment using new sensory input in a brain structure deprived of its main input source (changing processing from visual to tactile stimuli in the blind)

56

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Map expansion increase in brain mass due to repeated behavior or exposure to stimuli

57

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Equipotentiality anatomical areas of the brain can perform disparate functions

Vicariation redundant neural systems can operate under abnormal conditions

This may explain why recovery is noted for many neurological conditions (degenerative psychiatric developmental vascular traumatic)

58

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Constraint therapy Use it and improve it

Patching penalization ldquonear activitiesrdquo during amblyopia therapy

59

IX Improving Brain Function and Neuroplasticity Optometric Clinical ApplicationsOptometric Vision Therapy

Kleim amp Jones

Use it or lose it If you do not drive specific brain functions

functional loss will occur

If you want to improve oculomotor brain neuroplastic function amp

structure therapy should be specific for that brain function

Use it and improve it Therapy that drives cortical function enhances

that particular function

If you use therapy to improve oculomotor dysfunction it should

improve

Specificity The therapy you choose determines the resultant

plasticity and function

You must choose therapy that is appropriate

60

IX Improving Brain Function and Neuroplasticity Optometric Clinical Applications

Kleim amp Jones

Repetition matters Plasticity that results in functional change

requires repetition

Do the therapy Do it again Do it yet again No quick fix

Intensity matters Induction of plasticity requires the appropriate

amount of intensity

Intensity means strength force concentration power and passion

Without these plasticity may not occur Function may not improve

Time matters Different forms of plasticity take place at different

times during therapy

Do the basics than the more advanced therapeutic procedures

61

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Salience matters It has to be important to the individual

Make the therapy matter to the patient

Age matters Plasticity is easier in a younger brain but is also

possible in an adult brain

Do not let age determine what therapy options you offer your

patients Think of Susan Barry PhD (StereoSue) and her success

Offer your patients options Let them choose Be realistic about

outcomeshelliphave outcome measures built into therapy program

62

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Transference Neuroplasticity and the change in function

that results from one therapy can augment the attainment

of similar behaviors

What you do during oculomotor therapy may affected

vergence therapy outcomes

Interference Plasticity in response to one experience can

interfere with the acquisition of other behaviors

Monitor Evaluate progress Discuss function in other areas

of your patientslsquo life

63

Why pay attention to binocular vision dysfunctions

and neuroplasticity

December 2009 issue of the Review of Optometry

The Binocular Vision Dysfunction Pandemic

In 2010 almost 170 million individuals will be wearing glasses In

2010 there will also be up to 93 million amblyopes and 12 and a half

million strabismics For children under 18 years of age that means

there will be more than 22 and a half million amblyopes and millions

of children with strabismus A clinical trial to determine the

prevalence of binocular vision dysfunction within the general

population suggested the possibility of up to 56 or 173 million men

women and children with symptoms associated with a binocular

vision dysfunction 189 million (61) with accommodative problems

and 118 million (38) demonstrating various vergence

anomalies

64

65

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Brain plasticity life long changes in the structure of the brain

Sensory substitution replacement of one sensory input by another

Measurement techniques

Voxel based morphometryhellipmeasures difference in brain volume

Fluorodeoxyglucose glucose analog PET scan tells you

distribution and metabolism of brain

Cortical thickness measures

Visual cortex of the blind turns somatic ―The eye of the tongue

Transcranial magnetic stmiulation non-invasive technique to

stimulate cortex

66

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Blind Braille readers report tingling in fingers when pressure

phosphenes are applied Blind feel tingling in tongue

Bind use tongue to perform orientation task motion perception

sensory perception Visual cortex recruited in a variety of sensory

and cognitive tasks (DM Can we use tongue as a VT tool)

Dilks Reorganizations of human adult visual system

When a region of sensory cortex is deprived of its bottom up

input the deprived region begins to respond to stimuli that

normally activate adjacent cortex

67

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Retinotopic map changes for stroke pts Cortical reorganization in

adults occurs Perceived objectshellipelongation in stroke amp AMD

What happens to deprived cortex in AMD

fMRI shows cortical reorganization in adults

Proposed mechanisms

hellipGrowth of new connections

hellipUnmasking of pre-existing connections this is true

happens within seconds

Bavelier

Action video games

68

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Bavelier

Action video games Looked at attention Gamers can track more

activities

Attention over space (me peripheral awarenress) Useful field

of view shrinks with age

Performance not VA relatedhellipis related to attention

Action game playing changes spatial resolutionhellipovercoming

crowding in VA assessment (me amblyopia therapy)

Temporal resolution of vision Backward masking

changehellipbrain changes

Visual sensitivity (contrast sensitivity) Post action game training

improves CSF

69

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Action video games correcting optics of the cortex (me this is

actualy OVT)

Games factor

Variable entry leanringhellipadapt task to skill level

Incremental learning tune task to subjectlsquos leanring steps

Motivationarousal

Rewards

Self masterself confidence

Action games factors

Pacingrate of exposure to infohellipincreasing processing speed

Dynamic display

Rich environment

Rich motor involvement

70

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Surgeons may be made to play action games

Pilot training

Amblyopia tx Dennis Levi research

PresenterTitle Contact info

Neuroplasticity-A Paradigm Sea Change

This presentation is available at

httpwwwslidesharenetDMAINOneuroplasticity-a-paradigm-sea-change-2459693

httpwwwmainosmemosblogspotcom

My FaceBook Page

and

Twitter

PresenterTitle Contact info

Questions About

Neuroplasticity-A Paradigm Sea Change

Dominick M Maino OD MEd FAAO FCOVD-A

Professor PediatricsBinocular VisionIllinois Eye InstituteIllinois College of Optometry

dmainoicoeduhttpwwwMainosMemosblogspotcom

Thanks to

httpwwwcovdorgHomeOVDJournalOVD401tabid263D

efaultaspx

httpbipolarblastfileswordpresscom200908neurojpg

httpwwwspecialcheerscomimagesanimated_braingif

httpblogmarsdencartoonscomwp-

contentuploads200810frankenstein-myspace-lightbeergif

httpwwwshangralafamilyfuncomgala-ecalvindreamgif

httppsychiatryjwatchorgcgicontentfull20082251

73

Chakraborty R Chatterjee A Choudhart S Chakraborty PK Neuroplasticitymdasha paradigm shift in neurosciences J Indian Med Assoc

2007105(9)513-4516-8520-1

Sacks O A neurologistlsquos notebook Stereo Sue Why two eyes are better than one The New Yorker 2006 Jun 1964-73

Krulwich R National Public Radio Going Binocular Susanlsquos First Snowfall Available at

wwwnprorgtemplatesstorystoryphpstoryId=5507789 (Accessed December 8 2008)

Press LJ The story behind Stereo Suelsquo and a world-famous neurologistlsquos discovery of vision therapy Optom Vis Dev 200637(2) 55-7

Levin HS Neuroplasticity and brain imaging research implications for rehabilitation Arch Phys Med Rehabil 2006 Dec87(12 Suppl

2)S1

Wiesel TN Hubel DH Single-cell responses in striate cortex of kittens deprived of vision in one eye J Neurophysiol 1963

Nov261003-17

Hook BM Chen C Critical periods in the visual system Changing views for a model of experience-dependent plasticity Neuron 2007

Oct56(2)312-26

Ramey CT Ramey SL Prevention of intellectual disabilities early interventions to improve cognitive development Prev Med 1998

Mar-Apr27(2)224-32

Heuninckx S Wenderoth N Swinnen SP Systems neuroplasticity in the aging brain recruiting additional neural resources for

successful motor performance in elderly persons J Neurosci 2008 Jan 228(1)91-9

Ge S Yang CH Hsu KS et al A critical period for enhanced synaptic plasticity in newly generated neurons of the adult brain Neuron

2007 May54(4)559-66

74

Draganski B Gaser C Busch V et al Neuroplasticity changes in grey matter induced by training Nature 2004 Jan 22427(6972)

311-2

Cannonieri GC Bonilha L Fernandes PT et al Practice and perfect length of training and structural brain changes in experienced

typists Neuroreport 2007 Jul 218(10)1063-6

Kleim JA Jones TA Principles of experience-dependent neural plasticity implications for rehabilitation after brain damage J

Speech Lang Hear Res 2008 Feb51(1)S225-39

Trojan S Porkorny J Theoretical aspects of neuroplasticity Physiol Res 199948(2)87-97

Ramamirtham R Kee CS Hung LF et al Wave aberrations in rhesus monkeys with vision-induced ametropias Vision Res 2007

Sep47(21)2751-66

Smith EL 3rd Ramamirtham R Qiao-Grider Y et al Effects of foveal ablation on emmetropization and form-deprivation myopia

Invest Ophthalmol Vis Sci 2007 Sep48(9)3914-22

Smith EL 3rd Kee CS Ramamirtham R et al Peripheral vision can influence eye growth and refractive development in infant

monkeys Invest Ophthalmol Vis Sci 2005 Nov46(11)3965-72

Ciuffreda KJ Vasudevan B Nearwork-induced transient myopia (NITM) and permanent myopiandashndashis there a link Ophthalmic

Physiol Opt 2008 Mar28(2)103-14

Hung GK Ciuffreda KJ Incremental retinal-defocus theory of myopia development--schematic analysis and computer simulation

Comput Biol Med 2007 Jul37(7)930-46

Hung GK Ciuffreda KJ A unifying theory of refractive error development Bull Math Biol 2000 Nov62(6)1087-108

75

Pang Y Maino D Zhang G Lu F Myopia Can its progress be controlled Optom Vis Dev 200637(2)75-9

Leung JT Brown B Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lenses Optom Vis Sci

1999 Jun76(6)346-54

Hasebe S Ohtsuki H Nonaka T et al Effect of progressive addition lenses on myopia progression in Japanese children a prospective

randomized double-masked crossover trial Invest Ophthalmol Vis Sci 2008 Jul49(7)2781-9

Gwiazda J Hyman L Hussein M et al A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression

of myopia in children Invest Ophthalmol Vis Sci 2003 Apr44(4)1492-500

Siatkowski RM Cotter SA Crockett RS et al Two-year multi-center randomized double-masked placebo-controlled parallel safety and

efficacy study of 2 pirenzepine ophthalmic gel in children with myopia J AAPOS 2008 Aug12(4)332-9

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged 7 to 17 years Arch Ophthalmol 2005

Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three to less than 10 years of age Am J

Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction Am J Ophthalmol 2007

Jun143(6)1060-3

Holmes JM Edwards AR Beck RW et al A randomized pilot study of near activities versus non-near activities during patching therapy for

amblyopia J AAPOS 2005 Apr9(2)129-36

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate

amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-57

76

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic

amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Convergence Insufficiency Treatment Trial Study Group Randomized clinical trial of treatments for symptomatic convergence insufficiency

in children Arch Ophthalmol 2008 Oct126(10)1336-49

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

Solan HA Shelley-Tremblay J Hansen PC et al M-cell deficit and reading disability a preliminary study of the effects of temporal vision-

processing therapy Optometry 2004 Oct75(10)640-50

Solan HA Larson S Shelley-Tremblay J et al Role of visual attention in cognitive control of oculomotor readiness in students with reading

disabilities J Learn Disabil 2001 Mar-Apr34(2)107-18

Gallaway M Boas MB The impact of vergence and accommodative therapy on reading eye movements and reading speed Optom Vis Dev

200738(3)115-20

Goss DA Downing DB Lowther AH et al The effect of HTS vision therapy conducted in a school setting on reading skills in third and

fourth grade students Optom Vis Dev 200738(1)27-32

Crutch SJ Warrington EK Foveal crowding in posterior cortical atrophy a specific early-visual-processing deficit affecting word reading

Cogn Neuropsychol 2007 Dec24(8)843-66

Helms D Sawtelle SM A study of the effectiveness of cognitive therapy delivered in a video game format Optom Vis Dev 200738 (1)19-

26

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

77

Lawton T Training direction-discrimination sensitivity remediates a wide spectrum of reading skills OptomVis Dev 200738(1) 33-47

Goldstand S Koslowe KC Parush S Vision visual-information processing and academic performance among seventh-grade schoolchildren a

more significant relationship than we thought Am J Occup Ther 2005 Jul-Aug59(4)377-89

Fischer B Koumlngeter A Hartnegg K Effects of daily practice on subitizing visual counting and basic arithmetic skills Optom Vis Dev

200839(1)30-4

Sands W Taub M Maino D Limited research and education on special populations in optometry and ophthalomology Optom Vis Dev

200839(2)60-1

Wesson M Maino D Oculo-visual findings in Down syndrome cerebral palsy and mental retardation with non-specific etiology In Maino D

(ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 199517-54 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

Cui Y Stapleton F Suttle C Developing an instrument to assess vision-related and subjective quality of life in children with intellectual

disability data collection and preliminary analysis in a Chinese population Ophthal Physiolog Optics 2008 May28(3) 238-46

Maino D Steele G Tahir S Sajja R Attitudes of optometry students toward individuals with disabilities Optom Ed 200227(2)45-50

Maino D Special populations in the optometric curriculum Optom Ed 200227(2)38-9

Maino D Overview of special populations In Scheiman M Rouse M (eds) Optometric Management of Learning-Related Vision Problems

St Louis Mosby Inc 200685-106

Maino D (ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 1995 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

78

McCarthy P Maino D Alport syndrome a review Clin Eye Vis Care 2000 Dec12(3-4)139-50

Block SS Brusca-Vega R Pizzi WJ et al Cognitive and visual processing skills and their relationship to mutation size in full and

permutation female fragile X carriers Optom Vis Sci 2000 Nov77 (11)592-9

Maino D The young child with developmental disabilities An introduction to mental retardation and genetic syndromes In Moore BD

(ed) Eye Care for Infants and Young Children Butter-worth--Heinemann Newton MA1997285-300

Amin V Maino D The Fragile X female Visual visual perceptual and ocular health anomalies J Am Optom Assoc 1995 May66

(5)290-95

Maino DM Maino JH Cibis GW Hecht F Ocular health anomalies in patients with developmental disabilities In Maino D (ed)

Diagnosis and Management of Special Populations Mosby-Year-book Inc St Louis MO 1995189-206 Reprinted Optometric

Education Program Foundation Santa Anna Calif 2001

Maino D Wesson M Schlange D Cibis G Maino J Optometric findings in the fragile X syndrome Optom Vis Sci 199168634-40

Scheiman MMOptometric findings in children with cerebral palsy Am J Optom Physiol Opt 1984 May61(5)321-3

Maino D Maino J Maino S Mental retardation syndromes with associated ocular defects J Am Optom Assoc 199061707-16

Stewart RE Woodhouse JM Cregg M Pakeman VH Association between accommodative accuracy hypermetropia and strabismus in

children with Downs syndrome Optom Vis Sci 2007 Feb84(2)149-55

Cregg M Woodhouse JM Pakeman VH et al Accommodation and refractive error in children with Down syndrome cross-sectional

and longitudinal studies Invest Ophthalmol Vis Sci 2001 Jan42 (1)55-63

79

McClelland JF Parkes J Hill N et al Accommodative dysfunction in children with cerebral palsy a population-

based study Invest Ophthalmol Vis Sci 2006 May47(5)1824-30

Duckman RH Vision therapy for the child with cerebral palsy J Am Optom Assoc 198758(1)28-35

Duckman R Accommodation in cerebral palsy function and remediation J Am Optom Assoc 198455(4)281-3

Scheiman M Understanding and managing vision deficits a guide for occupational therapists 2nd ed Slack

Thorofare NJ 2002

Maino D Binasal occlusion for the child with Cerebral Palsy J Ill Optom Assoc 198644(1)1218

Battaglia F Quartarone A Rizzo V et al Early impairment of synaptic plasticity in patients with Downs syndrome

Neurobiol Aging 2008 Aug29(8)1272-5

Bonnier C Evaluation of early stimulation programs for enhancing brain development Acta Paediatr 2008

Jul97(7)853-8

Morice E Andreae LC Cooke SF et al Preservation of long-term memory and synaptic plasticity despite short-term

impairments in the Tc1 mouse model of Down syndrome Learn Mem 2008 Jul 1415(7)492-500

Gordon AM Schneider JA Chinnan A Charles JR Efficacy of a hand-arm bimanual intensive therapy (HABIT) in

children with hemiplegic cerebral palsy a randomized control trial Dev Med Child Neurol 2007 Nov49(11)830-8

Kapoor N Ciuffreda KJ Vision disturbances following traumatic brain injury Curr Treat Options Neurol 2002

Jul4(4)271-80

80

Ciuffreda KJ Rutner D Kapoor N et al Vision therapy for oculomotor dysfunctions in acquired brain injury a

retrospective analysis Optometry 2008 Jan79(1)18-22

Ciuffreda KJ Han Y Kapoor N Ficarra AP Oculomotor rehabilitation for reading in acquired brain injury

NeuroRehabilitation 200621(1)9-21

Zost M Diagnosis and management of visual dysfunction in cerebral injury In Maino D (ed) Diagnosis and

Management of Special Populations Mosby-Yearbook Inc St Louis 199579 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001 [Figure used with permission of the editor]

DeGutis JM Bentin S Robertson LC DEsposito M Functional plasticity in ventral temporal cortex following

cognitive rehabilitation of a congenital prosopagnosic J Cogn Neurosci 2007 Nov19 (11)1790-802

Welbourne SR Ralph MA Exploring the impact of plasticity-related recovery after brain damage in a connectionist

model of single-word reading Cogn Affect Behav Neurosci 2005 Mar5(1)77-92

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements prevent cognitive decline A

systematic review of randomized controlled trials J Hum Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among preterm infants attributable to early

supplementation of human milk with docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings and structural-functional

synergies with cell membrane phospholipids Altern Med Rev 2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function Neuroscience 20089(7)568-78

81

Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

BMC Biol 2008 Sep 9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine improves neuropsychological disorders in a child with

creatine transporter defect Neurocase 200814(2) 151-61

Forrester LW Wheaton LA Luft AR Exercise-mediated locomotor recovery and lower-limb neuroplasticity after

stroke J Rehabil Res Dev 200845(2)205-20

82

Page 41: Neuroplasticity: A Paradigm Sea Change Latest Updated File

VII Vision dysfunction association with acquired brain injury

A Exotropia (or high exophoriaCI)

B Accommodative dysfunction

C Convergence insufficiency

41

D Decreased blink rate

E Spatial disorientation

F Pursuitsaccade dysfunction

G Unstable ambient vision (Magnocellular pathway)

42

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Stelmack JA Frith T Van Koevering D Rinne S Stelmack TR Visual function in patients

followed at a Veterans Affairs polytrauma network site an electronic medical record review

Optometry 2009 Aug80(8)419-24

RESULTS Visual symptoms were self-reported by 76 of patients

with polytrauma and 75 of the patients with TBI Problems with reading

(polytrauma 60 and TBI 50) and accommodation (polytrauma 30 and

TBI 47) were frequently found on eye examinations Spectacles were the

treatment most frequently prescribed (polytrauma 62 and TBI 78)

CONCLUSIONS It is important for optometrists to be aware of the high

rates of self-reported symptoms and visual problems in military personnel

returning from deployment to the wars in Iraq and Afghanistan Post-

traumatic stress disorder and depression may complicate optometric

evaluation and management

43

VII Vision dysfunction association with acquired brain injury

Avoidance of near tasks

Oculomotor-based reading difficulties

Eye tracking problems

Eye focusing problems

Eyestrain Diplopia

Dizziness Vertigo

Vision-derived nausea

44

VII Vision dysfunction association with acquired brain injury

Increased sensitivity to visual motion

Visual inattention and distractibility

Short-term visual memory loss

Difficulty judging distances (relative and absolute

Difficulty with global scanning

Difficulty with personal grooming especially involving the face

Inability to interactcope visually in a complex social situation

(eg minimal eye contact)

Inability to tolerate complex visual environments (eg grocery store

aisles and highly-patterned floors)

45

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Ciuffreda KJ Ludlam DP Kapoor N Clinical oculomotor training in traumatic brain injury Optom Vis

Dev 200940(1)16-23

Individuals with traumatic brain injury present with a constellation of

oculomotor dysfunctions and correlated symptoms Simple and

effective clinical oculomotor-based training procedures will be

presented with respect to the versional vergence and

accommodative systems and their interactions These therapeutic

procedures can also be applied as needed to individuals with either

low vision neurological dysfunctions or general visual skills cases

manifesting similar oculomotor deficits

46

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Leslie S Myopia and accommodative insufficiency associated with

moderate head trauma Opt Vis Dev 200940(1)25-31

The majority of subjects reviewed had developed a stable degree of

myopia between 100 and 200 diopters as well as an abnormally

high lag of accommodation When their distance and near spatial area

of focus was compared the majority were focused at an intermediate

area in space suggesting a loss of control of accommodation in

space

47

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

B Drugs

C Exercise

D Learning new and challenging things

48

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements

prevent cognitive decline A systematic review of randomized controlled trials J Hum

Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among

preterm infants attributable to early supplementation of human milk with

docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings

and structural-functional synergies with cell membrane phospholipids Altern Med Rev

2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function

Neuroscience 20089(7)568-78

49

VIII Improving Brain Function and Neuroplasticity

B Drugs Maya Vetencourt JF Sale A Viegi A et al The antidepressant

fluoxetine (PROZAC) restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the

antidepressant tianeptine CNS Drugs 200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances

hippocampal long-term potentiation and memory BMC Biol 2008 Sep

9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine

improves neuropsychological disorders in a child with creatine

transporter defect Neurocase 200814(2) 151-61

50

VIII Improving Brain Function and Neuroplasticity

C Exercise

Hunsberger JG et al Antidepressant actions of the exercise-

regulated gene VGF Nat Med 2007 Dec 2 131476

VGF may be a common pathway by which exercise induces

neuroplasticity and growth-factor genes at least one of these might act

similarly to antidepressants in promoting an adaptive response to stress

However the tests used here may be modeling stress-induced

helplessness not depression hellipexercise seems to induce multiple

interacting genes that enhance neuronal resilience

51

VIII Improving Brain Function and Neuroplasticity

D Learning new and challenging things

What have we (optometry amp ophthalmology)

been thinking all these years

Where did we miss the news about neuroplasticity

52

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Huang JC Neuroplasticity as a proposed mechanism for the efficacy of optometric vision therapy and rehabilitation J Bev Optom 200920(4)96-100

Homologous area adaptationCompensatory masqueradeCross-modal reassignment

Map expansion

EquipotentialityVicariation

53

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Homologous area adaptation a transfer of function from a damaged brain area to a non-damaged brain area May be limited to early stages of human development and may crowd a new brain area resulting in reduced functionality of that brain area (Competition between spatial amp verbal functioning)

54

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Compensatory masquerade reorganizing of existing neuro-pathways to us alternative cognitive strategies to perform a task

55

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Cross-modal reassignment using new sensory input in a brain structure deprived of its main input source (changing processing from visual to tactile stimuli in the blind)

56

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Map expansion increase in brain mass due to repeated behavior or exposure to stimuli

57

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Equipotentiality anatomical areas of the brain can perform disparate functions

Vicariation redundant neural systems can operate under abnormal conditions

This may explain why recovery is noted for many neurological conditions (degenerative psychiatric developmental vascular traumatic)

58

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Constraint therapy Use it and improve it

Patching penalization ldquonear activitiesrdquo during amblyopia therapy

59

IX Improving Brain Function and Neuroplasticity Optometric Clinical ApplicationsOptometric Vision Therapy

Kleim amp Jones

Use it or lose it If you do not drive specific brain functions

functional loss will occur

If you want to improve oculomotor brain neuroplastic function amp

structure therapy should be specific for that brain function

Use it and improve it Therapy that drives cortical function enhances

that particular function

If you use therapy to improve oculomotor dysfunction it should

improve

Specificity The therapy you choose determines the resultant

plasticity and function

You must choose therapy that is appropriate

60

IX Improving Brain Function and Neuroplasticity Optometric Clinical Applications

Kleim amp Jones

Repetition matters Plasticity that results in functional change

requires repetition

Do the therapy Do it again Do it yet again No quick fix

Intensity matters Induction of plasticity requires the appropriate

amount of intensity

Intensity means strength force concentration power and passion

Without these plasticity may not occur Function may not improve

Time matters Different forms of plasticity take place at different

times during therapy

Do the basics than the more advanced therapeutic procedures

61

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Salience matters It has to be important to the individual

Make the therapy matter to the patient

Age matters Plasticity is easier in a younger brain but is also

possible in an adult brain

Do not let age determine what therapy options you offer your

patients Think of Susan Barry PhD (StereoSue) and her success

Offer your patients options Let them choose Be realistic about

outcomeshelliphave outcome measures built into therapy program

62

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Transference Neuroplasticity and the change in function

that results from one therapy can augment the attainment

of similar behaviors

What you do during oculomotor therapy may affected

vergence therapy outcomes

Interference Plasticity in response to one experience can

interfere with the acquisition of other behaviors

Monitor Evaluate progress Discuss function in other areas

of your patientslsquo life

63

Why pay attention to binocular vision dysfunctions

and neuroplasticity

December 2009 issue of the Review of Optometry

The Binocular Vision Dysfunction Pandemic

In 2010 almost 170 million individuals will be wearing glasses In

2010 there will also be up to 93 million amblyopes and 12 and a half

million strabismics For children under 18 years of age that means

there will be more than 22 and a half million amblyopes and millions

of children with strabismus A clinical trial to determine the

prevalence of binocular vision dysfunction within the general

population suggested the possibility of up to 56 or 173 million men

women and children with symptoms associated with a binocular

vision dysfunction 189 million (61) with accommodative problems

and 118 million (38) demonstrating various vergence

anomalies

64

65

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Brain plasticity life long changes in the structure of the brain

Sensory substitution replacement of one sensory input by another

Measurement techniques

Voxel based morphometryhellipmeasures difference in brain volume

Fluorodeoxyglucose glucose analog PET scan tells you

distribution and metabolism of brain

Cortical thickness measures

Visual cortex of the blind turns somatic ―The eye of the tongue

Transcranial magnetic stmiulation non-invasive technique to

stimulate cortex

66

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Blind Braille readers report tingling in fingers when pressure

phosphenes are applied Blind feel tingling in tongue

Bind use tongue to perform orientation task motion perception

sensory perception Visual cortex recruited in a variety of sensory

and cognitive tasks (DM Can we use tongue as a VT tool)

Dilks Reorganizations of human adult visual system

When a region of sensory cortex is deprived of its bottom up

input the deprived region begins to respond to stimuli that

normally activate adjacent cortex

67

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Retinotopic map changes for stroke pts Cortical reorganization in

adults occurs Perceived objectshellipelongation in stroke amp AMD

What happens to deprived cortex in AMD

fMRI shows cortical reorganization in adults

Proposed mechanisms

hellipGrowth of new connections

hellipUnmasking of pre-existing connections this is true

happens within seconds

Bavelier

Action video games

68

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Bavelier

Action video games Looked at attention Gamers can track more

activities

Attention over space (me peripheral awarenress) Useful field

of view shrinks with age

Performance not VA relatedhellipis related to attention

Action game playing changes spatial resolutionhellipovercoming

crowding in VA assessment (me amblyopia therapy)

Temporal resolution of vision Backward masking

changehellipbrain changes

Visual sensitivity (contrast sensitivity) Post action game training

improves CSF

69

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Action video games correcting optics of the cortex (me this is

actualy OVT)

Games factor

Variable entry leanringhellipadapt task to skill level

Incremental learning tune task to subjectlsquos leanring steps

Motivationarousal

Rewards

Self masterself confidence

Action games factors

Pacingrate of exposure to infohellipincreasing processing speed

Dynamic display

Rich environment

Rich motor involvement

70

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Surgeons may be made to play action games

Pilot training

Amblyopia tx Dennis Levi research

PresenterTitle Contact info

Neuroplasticity-A Paradigm Sea Change

This presentation is available at

httpwwwslidesharenetDMAINOneuroplasticity-a-paradigm-sea-change-2459693

httpwwwmainosmemosblogspotcom

My FaceBook Page

and

Twitter

PresenterTitle Contact info

Questions About

Neuroplasticity-A Paradigm Sea Change

Dominick M Maino OD MEd FAAO FCOVD-A

Professor PediatricsBinocular VisionIllinois Eye InstituteIllinois College of Optometry

dmainoicoeduhttpwwwMainosMemosblogspotcom

Thanks to

httpwwwcovdorgHomeOVDJournalOVD401tabid263D

efaultaspx

httpbipolarblastfileswordpresscom200908neurojpg

httpwwwspecialcheerscomimagesanimated_braingif

httpblogmarsdencartoonscomwp-

contentuploads200810frankenstein-myspace-lightbeergif

httpwwwshangralafamilyfuncomgala-ecalvindreamgif

httppsychiatryjwatchorgcgicontentfull20082251

73

Chakraborty R Chatterjee A Choudhart S Chakraborty PK Neuroplasticitymdasha paradigm shift in neurosciences J Indian Med Assoc

2007105(9)513-4516-8520-1

Sacks O A neurologistlsquos notebook Stereo Sue Why two eyes are better than one The New Yorker 2006 Jun 1964-73

Krulwich R National Public Radio Going Binocular Susanlsquos First Snowfall Available at

wwwnprorgtemplatesstorystoryphpstoryId=5507789 (Accessed December 8 2008)

Press LJ The story behind Stereo Suelsquo and a world-famous neurologistlsquos discovery of vision therapy Optom Vis Dev 200637(2) 55-7

Levin HS Neuroplasticity and brain imaging research implications for rehabilitation Arch Phys Med Rehabil 2006 Dec87(12 Suppl

2)S1

Wiesel TN Hubel DH Single-cell responses in striate cortex of kittens deprived of vision in one eye J Neurophysiol 1963

Nov261003-17

Hook BM Chen C Critical periods in the visual system Changing views for a model of experience-dependent plasticity Neuron 2007

Oct56(2)312-26

Ramey CT Ramey SL Prevention of intellectual disabilities early interventions to improve cognitive development Prev Med 1998

Mar-Apr27(2)224-32

Heuninckx S Wenderoth N Swinnen SP Systems neuroplasticity in the aging brain recruiting additional neural resources for

successful motor performance in elderly persons J Neurosci 2008 Jan 228(1)91-9

Ge S Yang CH Hsu KS et al A critical period for enhanced synaptic plasticity in newly generated neurons of the adult brain Neuron

2007 May54(4)559-66

74

Draganski B Gaser C Busch V et al Neuroplasticity changes in grey matter induced by training Nature 2004 Jan 22427(6972)

311-2

Cannonieri GC Bonilha L Fernandes PT et al Practice and perfect length of training and structural brain changes in experienced

typists Neuroreport 2007 Jul 218(10)1063-6

Kleim JA Jones TA Principles of experience-dependent neural plasticity implications for rehabilitation after brain damage J

Speech Lang Hear Res 2008 Feb51(1)S225-39

Trojan S Porkorny J Theoretical aspects of neuroplasticity Physiol Res 199948(2)87-97

Ramamirtham R Kee CS Hung LF et al Wave aberrations in rhesus monkeys with vision-induced ametropias Vision Res 2007

Sep47(21)2751-66

Smith EL 3rd Ramamirtham R Qiao-Grider Y et al Effects of foveal ablation on emmetropization and form-deprivation myopia

Invest Ophthalmol Vis Sci 2007 Sep48(9)3914-22

Smith EL 3rd Kee CS Ramamirtham R et al Peripheral vision can influence eye growth and refractive development in infant

monkeys Invest Ophthalmol Vis Sci 2005 Nov46(11)3965-72

Ciuffreda KJ Vasudevan B Nearwork-induced transient myopia (NITM) and permanent myopiandashndashis there a link Ophthalmic

Physiol Opt 2008 Mar28(2)103-14

Hung GK Ciuffreda KJ Incremental retinal-defocus theory of myopia development--schematic analysis and computer simulation

Comput Biol Med 2007 Jul37(7)930-46

Hung GK Ciuffreda KJ A unifying theory of refractive error development Bull Math Biol 2000 Nov62(6)1087-108

75

Pang Y Maino D Zhang G Lu F Myopia Can its progress be controlled Optom Vis Dev 200637(2)75-9

Leung JT Brown B Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lenses Optom Vis Sci

1999 Jun76(6)346-54

Hasebe S Ohtsuki H Nonaka T et al Effect of progressive addition lenses on myopia progression in Japanese children a prospective

randomized double-masked crossover trial Invest Ophthalmol Vis Sci 2008 Jul49(7)2781-9

Gwiazda J Hyman L Hussein M et al A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression

of myopia in children Invest Ophthalmol Vis Sci 2003 Apr44(4)1492-500

Siatkowski RM Cotter SA Crockett RS et al Two-year multi-center randomized double-masked placebo-controlled parallel safety and

efficacy study of 2 pirenzepine ophthalmic gel in children with myopia J AAPOS 2008 Aug12(4)332-9

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged 7 to 17 years Arch Ophthalmol 2005

Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three to less than 10 years of age Am J

Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction Am J Ophthalmol 2007

Jun143(6)1060-3

Holmes JM Edwards AR Beck RW et al A randomized pilot study of near activities versus non-near activities during patching therapy for

amblyopia J AAPOS 2005 Apr9(2)129-36

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate

amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-57

76

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic

amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Convergence Insufficiency Treatment Trial Study Group Randomized clinical trial of treatments for symptomatic convergence insufficiency

in children Arch Ophthalmol 2008 Oct126(10)1336-49

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

Solan HA Shelley-Tremblay J Hansen PC et al M-cell deficit and reading disability a preliminary study of the effects of temporal vision-

processing therapy Optometry 2004 Oct75(10)640-50

Solan HA Larson S Shelley-Tremblay J et al Role of visual attention in cognitive control of oculomotor readiness in students with reading

disabilities J Learn Disabil 2001 Mar-Apr34(2)107-18

Gallaway M Boas MB The impact of vergence and accommodative therapy on reading eye movements and reading speed Optom Vis Dev

200738(3)115-20

Goss DA Downing DB Lowther AH et al The effect of HTS vision therapy conducted in a school setting on reading skills in third and

fourth grade students Optom Vis Dev 200738(1)27-32

Crutch SJ Warrington EK Foveal crowding in posterior cortical atrophy a specific early-visual-processing deficit affecting word reading

Cogn Neuropsychol 2007 Dec24(8)843-66

Helms D Sawtelle SM A study of the effectiveness of cognitive therapy delivered in a video game format Optom Vis Dev 200738 (1)19-

26

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

77

Lawton T Training direction-discrimination sensitivity remediates a wide spectrum of reading skills OptomVis Dev 200738(1) 33-47

Goldstand S Koslowe KC Parush S Vision visual-information processing and academic performance among seventh-grade schoolchildren a

more significant relationship than we thought Am J Occup Ther 2005 Jul-Aug59(4)377-89

Fischer B Koumlngeter A Hartnegg K Effects of daily practice on subitizing visual counting and basic arithmetic skills Optom Vis Dev

200839(1)30-4

Sands W Taub M Maino D Limited research and education on special populations in optometry and ophthalomology Optom Vis Dev

200839(2)60-1

Wesson M Maino D Oculo-visual findings in Down syndrome cerebral palsy and mental retardation with non-specific etiology In Maino D

(ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 199517-54 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

Cui Y Stapleton F Suttle C Developing an instrument to assess vision-related and subjective quality of life in children with intellectual

disability data collection and preliminary analysis in a Chinese population Ophthal Physiolog Optics 2008 May28(3) 238-46

Maino D Steele G Tahir S Sajja R Attitudes of optometry students toward individuals with disabilities Optom Ed 200227(2)45-50

Maino D Special populations in the optometric curriculum Optom Ed 200227(2)38-9

Maino D Overview of special populations In Scheiman M Rouse M (eds) Optometric Management of Learning-Related Vision Problems

St Louis Mosby Inc 200685-106

Maino D (ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 1995 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

78

McCarthy P Maino D Alport syndrome a review Clin Eye Vis Care 2000 Dec12(3-4)139-50

Block SS Brusca-Vega R Pizzi WJ et al Cognitive and visual processing skills and their relationship to mutation size in full and

permutation female fragile X carriers Optom Vis Sci 2000 Nov77 (11)592-9

Maino D The young child with developmental disabilities An introduction to mental retardation and genetic syndromes In Moore BD

(ed) Eye Care for Infants and Young Children Butter-worth--Heinemann Newton MA1997285-300

Amin V Maino D The Fragile X female Visual visual perceptual and ocular health anomalies J Am Optom Assoc 1995 May66

(5)290-95

Maino DM Maino JH Cibis GW Hecht F Ocular health anomalies in patients with developmental disabilities In Maino D (ed)

Diagnosis and Management of Special Populations Mosby-Year-book Inc St Louis MO 1995189-206 Reprinted Optometric

Education Program Foundation Santa Anna Calif 2001

Maino D Wesson M Schlange D Cibis G Maino J Optometric findings in the fragile X syndrome Optom Vis Sci 199168634-40

Scheiman MMOptometric findings in children with cerebral palsy Am J Optom Physiol Opt 1984 May61(5)321-3

Maino D Maino J Maino S Mental retardation syndromes with associated ocular defects J Am Optom Assoc 199061707-16

Stewart RE Woodhouse JM Cregg M Pakeman VH Association between accommodative accuracy hypermetropia and strabismus in

children with Downs syndrome Optom Vis Sci 2007 Feb84(2)149-55

Cregg M Woodhouse JM Pakeman VH et al Accommodation and refractive error in children with Down syndrome cross-sectional

and longitudinal studies Invest Ophthalmol Vis Sci 2001 Jan42 (1)55-63

79

McClelland JF Parkes J Hill N et al Accommodative dysfunction in children with cerebral palsy a population-

based study Invest Ophthalmol Vis Sci 2006 May47(5)1824-30

Duckman RH Vision therapy for the child with cerebral palsy J Am Optom Assoc 198758(1)28-35

Duckman R Accommodation in cerebral palsy function and remediation J Am Optom Assoc 198455(4)281-3

Scheiman M Understanding and managing vision deficits a guide for occupational therapists 2nd ed Slack

Thorofare NJ 2002

Maino D Binasal occlusion for the child with Cerebral Palsy J Ill Optom Assoc 198644(1)1218

Battaglia F Quartarone A Rizzo V et al Early impairment of synaptic plasticity in patients with Downs syndrome

Neurobiol Aging 2008 Aug29(8)1272-5

Bonnier C Evaluation of early stimulation programs for enhancing brain development Acta Paediatr 2008

Jul97(7)853-8

Morice E Andreae LC Cooke SF et al Preservation of long-term memory and synaptic plasticity despite short-term

impairments in the Tc1 mouse model of Down syndrome Learn Mem 2008 Jul 1415(7)492-500

Gordon AM Schneider JA Chinnan A Charles JR Efficacy of a hand-arm bimanual intensive therapy (HABIT) in

children with hemiplegic cerebral palsy a randomized control trial Dev Med Child Neurol 2007 Nov49(11)830-8

Kapoor N Ciuffreda KJ Vision disturbances following traumatic brain injury Curr Treat Options Neurol 2002

Jul4(4)271-80

80

Ciuffreda KJ Rutner D Kapoor N et al Vision therapy for oculomotor dysfunctions in acquired brain injury a

retrospective analysis Optometry 2008 Jan79(1)18-22

Ciuffreda KJ Han Y Kapoor N Ficarra AP Oculomotor rehabilitation for reading in acquired brain injury

NeuroRehabilitation 200621(1)9-21

Zost M Diagnosis and management of visual dysfunction in cerebral injury In Maino D (ed) Diagnosis and

Management of Special Populations Mosby-Yearbook Inc St Louis 199579 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001 [Figure used with permission of the editor]

DeGutis JM Bentin S Robertson LC DEsposito M Functional plasticity in ventral temporal cortex following

cognitive rehabilitation of a congenital prosopagnosic J Cogn Neurosci 2007 Nov19 (11)1790-802

Welbourne SR Ralph MA Exploring the impact of plasticity-related recovery after brain damage in a connectionist

model of single-word reading Cogn Affect Behav Neurosci 2005 Mar5(1)77-92

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements prevent cognitive decline A

systematic review of randomized controlled trials J Hum Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among preterm infants attributable to early

supplementation of human milk with docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings and structural-functional

synergies with cell membrane phospholipids Altern Med Rev 2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function Neuroscience 20089(7)568-78

81

Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

BMC Biol 2008 Sep 9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine improves neuropsychological disorders in a child with

creatine transporter defect Neurocase 200814(2) 151-61

Forrester LW Wheaton LA Luft AR Exercise-mediated locomotor recovery and lower-limb neuroplasticity after

stroke J Rehabil Res Dev 200845(2)205-20

82

Page 42: Neuroplasticity: A Paradigm Sea Change Latest Updated File

D Decreased blink rate

E Spatial disorientation

F Pursuitsaccade dysfunction

G Unstable ambient vision (Magnocellular pathway)

42

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Stelmack JA Frith T Van Koevering D Rinne S Stelmack TR Visual function in patients

followed at a Veterans Affairs polytrauma network site an electronic medical record review

Optometry 2009 Aug80(8)419-24

RESULTS Visual symptoms were self-reported by 76 of patients

with polytrauma and 75 of the patients with TBI Problems with reading

(polytrauma 60 and TBI 50) and accommodation (polytrauma 30 and

TBI 47) were frequently found on eye examinations Spectacles were the

treatment most frequently prescribed (polytrauma 62 and TBI 78)

CONCLUSIONS It is important for optometrists to be aware of the high

rates of self-reported symptoms and visual problems in military personnel

returning from deployment to the wars in Iraq and Afghanistan Post-

traumatic stress disorder and depression may complicate optometric

evaluation and management

43

VII Vision dysfunction association with acquired brain injury

Avoidance of near tasks

Oculomotor-based reading difficulties

Eye tracking problems

Eye focusing problems

Eyestrain Diplopia

Dizziness Vertigo

Vision-derived nausea

44

VII Vision dysfunction association with acquired brain injury

Increased sensitivity to visual motion

Visual inattention and distractibility

Short-term visual memory loss

Difficulty judging distances (relative and absolute

Difficulty with global scanning

Difficulty with personal grooming especially involving the face

Inability to interactcope visually in a complex social situation

(eg minimal eye contact)

Inability to tolerate complex visual environments (eg grocery store

aisles and highly-patterned floors)

45

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Ciuffreda KJ Ludlam DP Kapoor N Clinical oculomotor training in traumatic brain injury Optom Vis

Dev 200940(1)16-23

Individuals with traumatic brain injury present with a constellation of

oculomotor dysfunctions and correlated symptoms Simple and

effective clinical oculomotor-based training procedures will be

presented with respect to the versional vergence and

accommodative systems and their interactions These therapeutic

procedures can also be applied as needed to individuals with either

low vision neurological dysfunctions or general visual skills cases

manifesting similar oculomotor deficits

46

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Leslie S Myopia and accommodative insufficiency associated with

moderate head trauma Opt Vis Dev 200940(1)25-31

The majority of subjects reviewed had developed a stable degree of

myopia between 100 and 200 diopters as well as an abnormally

high lag of accommodation When their distance and near spatial area

of focus was compared the majority were focused at an intermediate

area in space suggesting a loss of control of accommodation in

space

47

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

B Drugs

C Exercise

D Learning new and challenging things

48

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements

prevent cognitive decline A systematic review of randomized controlled trials J Hum

Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among

preterm infants attributable to early supplementation of human milk with

docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings

and structural-functional synergies with cell membrane phospholipids Altern Med Rev

2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function

Neuroscience 20089(7)568-78

49

VIII Improving Brain Function and Neuroplasticity

B Drugs Maya Vetencourt JF Sale A Viegi A et al The antidepressant

fluoxetine (PROZAC) restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the

antidepressant tianeptine CNS Drugs 200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances

hippocampal long-term potentiation and memory BMC Biol 2008 Sep

9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine

improves neuropsychological disorders in a child with creatine

transporter defect Neurocase 200814(2) 151-61

50

VIII Improving Brain Function and Neuroplasticity

C Exercise

Hunsberger JG et al Antidepressant actions of the exercise-

regulated gene VGF Nat Med 2007 Dec 2 131476

VGF may be a common pathway by which exercise induces

neuroplasticity and growth-factor genes at least one of these might act

similarly to antidepressants in promoting an adaptive response to stress

However the tests used here may be modeling stress-induced

helplessness not depression hellipexercise seems to induce multiple

interacting genes that enhance neuronal resilience

51

VIII Improving Brain Function and Neuroplasticity

D Learning new and challenging things

What have we (optometry amp ophthalmology)

been thinking all these years

Where did we miss the news about neuroplasticity

52

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Huang JC Neuroplasticity as a proposed mechanism for the efficacy of optometric vision therapy and rehabilitation J Bev Optom 200920(4)96-100

Homologous area adaptationCompensatory masqueradeCross-modal reassignment

Map expansion

EquipotentialityVicariation

53

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Homologous area adaptation a transfer of function from a damaged brain area to a non-damaged brain area May be limited to early stages of human development and may crowd a new brain area resulting in reduced functionality of that brain area (Competition between spatial amp verbal functioning)

54

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Compensatory masquerade reorganizing of existing neuro-pathways to us alternative cognitive strategies to perform a task

55

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Cross-modal reassignment using new sensory input in a brain structure deprived of its main input source (changing processing from visual to tactile stimuli in the blind)

56

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Map expansion increase in brain mass due to repeated behavior or exposure to stimuli

57

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Equipotentiality anatomical areas of the brain can perform disparate functions

Vicariation redundant neural systems can operate under abnormal conditions

This may explain why recovery is noted for many neurological conditions (degenerative psychiatric developmental vascular traumatic)

58

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Constraint therapy Use it and improve it

Patching penalization ldquonear activitiesrdquo during amblyopia therapy

59

IX Improving Brain Function and Neuroplasticity Optometric Clinical ApplicationsOptometric Vision Therapy

Kleim amp Jones

Use it or lose it If you do not drive specific brain functions

functional loss will occur

If you want to improve oculomotor brain neuroplastic function amp

structure therapy should be specific for that brain function

Use it and improve it Therapy that drives cortical function enhances

that particular function

If you use therapy to improve oculomotor dysfunction it should

improve

Specificity The therapy you choose determines the resultant

plasticity and function

You must choose therapy that is appropriate

60

IX Improving Brain Function and Neuroplasticity Optometric Clinical Applications

Kleim amp Jones

Repetition matters Plasticity that results in functional change

requires repetition

Do the therapy Do it again Do it yet again No quick fix

Intensity matters Induction of plasticity requires the appropriate

amount of intensity

Intensity means strength force concentration power and passion

Without these plasticity may not occur Function may not improve

Time matters Different forms of plasticity take place at different

times during therapy

Do the basics than the more advanced therapeutic procedures

61

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Salience matters It has to be important to the individual

Make the therapy matter to the patient

Age matters Plasticity is easier in a younger brain but is also

possible in an adult brain

Do not let age determine what therapy options you offer your

patients Think of Susan Barry PhD (StereoSue) and her success

Offer your patients options Let them choose Be realistic about

outcomeshelliphave outcome measures built into therapy program

62

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Transference Neuroplasticity and the change in function

that results from one therapy can augment the attainment

of similar behaviors

What you do during oculomotor therapy may affected

vergence therapy outcomes

Interference Plasticity in response to one experience can

interfere with the acquisition of other behaviors

Monitor Evaluate progress Discuss function in other areas

of your patientslsquo life

63

Why pay attention to binocular vision dysfunctions

and neuroplasticity

December 2009 issue of the Review of Optometry

The Binocular Vision Dysfunction Pandemic

In 2010 almost 170 million individuals will be wearing glasses In

2010 there will also be up to 93 million amblyopes and 12 and a half

million strabismics For children under 18 years of age that means

there will be more than 22 and a half million amblyopes and millions

of children with strabismus A clinical trial to determine the

prevalence of binocular vision dysfunction within the general

population suggested the possibility of up to 56 or 173 million men

women and children with symptoms associated with a binocular

vision dysfunction 189 million (61) with accommodative problems

and 118 million (38) demonstrating various vergence

anomalies

64

65

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Brain plasticity life long changes in the structure of the brain

Sensory substitution replacement of one sensory input by another

Measurement techniques

Voxel based morphometryhellipmeasures difference in brain volume

Fluorodeoxyglucose glucose analog PET scan tells you

distribution and metabolism of brain

Cortical thickness measures

Visual cortex of the blind turns somatic ―The eye of the tongue

Transcranial magnetic stmiulation non-invasive technique to

stimulate cortex

66

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Blind Braille readers report tingling in fingers when pressure

phosphenes are applied Blind feel tingling in tongue

Bind use tongue to perform orientation task motion perception

sensory perception Visual cortex recruited in a variety of sensory

and cognitive tasks (DM Can we use tongue as a VT tool)

Dilks Reorganizations of human adult visual system

When a region of sensory cortex is deprived of its bottom up

input the deprived region begins to respond to stimuli that

normally activate adjacent cortex

67

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Retinotopic map changes for stroke pts Cortical reorganization in

adults occurs Perceived objectshellipelongation in stroke amp AMD

What happens to deprived cortex in AMD

fMRI shows cortical reorganization in adults

Proposed mechanisms

hellipGrowth of new connections

hellipUnmasking of pre-existing connections this is true

happens within seconds

Bavelier

Action video games

68

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Bavelier

Action video games Looked at attention Gamers can track more

activities

Attention over space (me peripheral awarenress) Useful field

of view shrinks with age

Performance not VA relatedhellipis related to attention

Action game playing changes spatial resolutionhellipovercoming

crowding in VA assessment (me amblyopia therapy)

Temporal resolution of vision Backward masking

changehellipbrain changes

Visual sensitivity (contrast sensitivity) Post action game training

improves CSF

69

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Action video games correcting optics of the cortex (me this is

actualy OVT)

Games factor

Variable entry leanringhellipadapt task to skill level

Incremental learning tune task to subjectlsquos leanring steps

Motivationarousal

Rewards

Self masterself confidence

Action games factors

Pacingrate of exposure to infohellipincreasing processing speed

Dynamic display

Rich environment

Rich motor involvement

70

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Surgeons may be made to play action games

Pilot training

Amblyopia tx Dennis Levi research

PresenterTitle Contact info

Neuroplasticity-A Paradigm Sea Change

This presentation is available at

httpwwwslidesharenetDMAINOneuroplasticity-a-paradigm-sea-change-2459693

httpwwwmainosmemosblogspotcom

My FaceBook Page

and

Twitter

PresenterTitle Contact info

Questions About

Neuroplasticity-A Paradigm Sea Change

Dominick M Maino OD MEd FAAO FCOVD-A

Professor PediatricsBinocular VisionIllinois Eye InstituteIllinois College of Optometry

dmainoicoeduhttpwwwMainosMemosblogspotcom

Thanks to

httpwwwcovdorgHomeOVDJournalOVD401tabid263D

efaultaspx

httpbipolarblastfileswordpresscom200908neurojpg

httpwwwspecialcheerscomimagesanimated_braingif

httpblogmarsdencartoonscomwp-

contentuploads200810frankenstein-myspace-lightbeergif

httpwwwshangralafamilyfuncomgala-ecalvindreamgif

httppsychiatryjwatchorgcgicontentfull20082251

73

Chakraborty R Chatterjee A Choudhart S Chakraborty PK Neuroplasticitymdasha paradigm shift in neurosciences J Indian Med Assoc

2007105(9)513-4516-8520-1

Sacks O A neurologistlsquos notebook Stereo Sue Why two eyes are better than one The New Yorker 2006 Jun 1964-73

Krulwich R National Public Radio Going Binocular Susanlsquos First Snowfall Available at

wwwnprorgtemplatesstorystoryphpstoryId=5507789 (Accessed December 8 2008)

Press LJ The story behind Stereo Suelsquo and a world-famous neurologistlsquos discovery of vision therapy Optom Vis Dev 200637(2) 55-7

Levin HS Neuroplasticity and brain imaging research implications for rehabilitation Arch Phys Med Rehabil 2006 Dec87(12 Suppl

2)S1

Wiesel TN Hubel DH Single-cell responses in striate cortex of kittens deprived of vision in one eye J Neurophysiol 1963

Nov261003-17

Hook BM Chen C Critical periods in the visual system Changing views for a model of experience-dependent plasticity Neuron 2007

Oct56(2)312-26

Ramey CT Ramey SL Prevention of intellectual disabilities early interventions to improve cognitive development Prev Med 1998

Mar-Apr27(2)224-32

Heuninckx S Wenderoth N Swinnen SP Systems neuroplasticity in the aging brain recruiting additional neural resources for

successful motor performance in elderly persons J Neurosci 2008 Jan 228(1)91-9

Ge S Yang CH Hsu KS et al A critical period for enhanced synaptic plasticity in newly generated neurons of the adult brain Neuron

2007 May54(4)559-66

74

Draganski B Gaser C Busch V et al Neuroplasticity changes in grey matter induced by training Nature 2004 Jan 22427(6972)

311-2

Cannonieri GC Bonilha L Fernandes PT et al Practice and perfect length of training and structural brain changes in experienced

typists Neuroreport 2007 Jul 218(10)1063-6

Kleim JA Jones TA Principles of experience-dependent neural plasticity implications for rehabilitation after brain damage J

Speech Lang Hear Res 2008 Feb51(1)S225-39

Trojan S Porkorny J Theoretical aspects of neuroplasticity Physiol Res 199948(2)87-97

Ramamirtham R Kee CS Hung LF et al Wave aberrations in rhesus monkeys with vision-induced ametropias Vision Res 2007

Sep47(21)2751-66

Smith EL 3rd Ramamirtham R Qiao-Grider Y et al Effects of foveal ablation on emmetropization and form-deprivation myopia

Invest Ophthalmol Vis Sci 2007 Sep48(9)3914-22

Smith EL 3rd Kee CS Ramamirtham R et al Peripheral vision can influence eye growth and refractive development in infant

monkeys Invest Ophthalmol Vis Sci 2005 Nov46(11)3965-72

Ciuffreda KJ Vasudevan B Nearwork-induced transient myopia (NITM) and permanent myopiandashndashis there a link Ophthalmic

Physiol Opt 2008 Mar28(2)103-14

Hung GK Ciuffreda KJ Incremental retinal-defocus theory of myopia development--schematic analysis and computer simulation

Comput Biol Med 2007 Jul37(7)930-46

Hung GK Ciuffreda KJ A unifying theory of refractive error development Bull Math Biol 2000 Nov62(6)1087-108

75

Pang Y Maino D Zhang G Lu F Myopia Can its progress be controlled Optom Vis Dev 200637(2)75-9

Leung JT Brown B Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lenses Optom Vis Sci

1999 Jun76(6)346-54

Hasebe S Ohtsuki H Nonaka T et al Effect of progressive addition lenses on myopia progression in Japanese children a prospective

randomized double-masked crossover trial Invest Ophthalmol Vis Sci 2008 Jul49(7)2781-9

Gwiazda J Hyman L Hussein M et al A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression

of myopia in children Invest Ophthalmol Vis Sci 2003 Apr44(4)1492-500

Siatkowski RM Cotter SA Crockett RS et al Two-year multi-center randomized double-masked placebo-controlled parallel safety and

efficacy study of 2 pirenzepine ophthalmic gel in children with myopia J AAPOS 2008 Aug12(4)332-9

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged 7 to 17 years Arch Ophthalmol 2005

Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three to less than 10 years of age Am J

Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction Am J Ophthalmol 2007

Jun143(6)1060-3

Holmes JM Edwards AR Beck RW et al A randomized pilot study of near activities versus non-near activities during patching therapy for

amblyopia J AAPOS 2005 Apr9(2)129-36

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate

amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-57

76

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic

amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Convergence Insufficiency Treatment Trial Study Group Randomized clinical trial of treatments for symptomatic convergence insufficiency

in children Arch Ophthalmol 2008 Oct126(10)1336-49

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

Solan HA Shelley-Tremblay J Hansen PC et al M-cell deficit and reading disability a preliminary study of the effects of temporal vision-

processing therapy Optometry 2004 Oct75(10)640-50

Solan HA Larson S Shelley-Tremblay J et al Role of visual attention in cognitive control of oculomotor readiness in students with reading

disabilities J Learn Disabil 2001 Mar-Apr34(2)107-18

Gallaway M Boas MB The impact of vergence and accommodative therapy on reading eye movements and reading speed Optom Vis Dev

200738(3)115-20

Goss DA Downing DB Lowther AH et al The effect of HTS vision therapy conducted in a school setting on reading skills in third and

fourth grade students Optom Vis Dev 200738(1)27-32

Crutch SJ Warrington EK Foveal crowding in posterior cortical atrophy a specific early-visual-processing deficit affecting word reading

Cogn Neuropsychol 2007 Dec24(8)843-66

Helms D Sawtelle SM A study of the effectiveness of cognitive therapy delivered in a video game format Optom Vis Dev 200738 (1)19-

26

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

77

Lawton T Training direction-discrimination sensitivity remediates a wide spectrum of reading skills OptomVis Dev 200738(1) 33-47

Goldstand S Koslowe KC Parush S Vision visual-information processing and academic performance among seventh-grade schoolchildren a

more significant relationship than we thought Am J Occup Ther 2005 Jul-Aug59(4)377-89

Fischer B Koumlngeter A Hartnegg K Effects of daily practice on subitizing visual counting and basic arithmetic skills Optom Vis Dev

200839(1)30-4

Sands W Taub M Maino D Limited research and education on special populations in optometry and ophthalomology Optom Vis Dev

200839(2)60-1

Wesson M Maino D Oculo-visual findings in Down syndrome cerebral palsy and mental retardation with non-specific etiology In Maino D

(ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 199517-54 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

Cui Y Stapleton F Suttle C Developing an instrument to assess vision-related and subjective quality of life in children with intellectual

disability data collection and preliminary analysis in a Chinese population Ophthal Physiolog Optics 2008 May28(3) 238-46

Maino D Steele G Tahir S Sajja R Attitudes of optometry students toward individuals with disabilities Optom Ed 200227(2)45-50

Maino D Special populations in the optometric curriculum Optom Ed 200227(2)38-9

Maino D Overview of special populations In Scheiman M Rouse M (eds) Optometric Management of Learning-Related Vision Problems

St Louis Mosby Inc 200685-106

Maino D (ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 1995 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

78

McCarthy P Maino D Alport syndrome a review Clin Eye Vis Care 2000 Dec12(3-4)139-50

Block SS Brusca-Vega R Pizzi WJ et al Cognitive and visual processing skills and their relationship to mutation size in full and

permutation female fragile X carriers Optom Vis Sci 2000 Nov77 (11)592-9

Maino D The young child with developmental disabilities An introduction to mental retardation and genetic syndromes In Moore BD

(ed) Eye Care for Infants and Young Children Butter-worth--Heinemann Newton MA1997285-300

Amin V Maino D The Fragile X female Visual visual perceptual and ocular health anomalies J Am Optom Assoc 1995 May66

(5)290-95

Maino DM Maino JH Cibis GW Hecht F Ocular health anomalies in patients with developmental disabilities In Maino D (ed)

Diagnosis and Management of Special Populations Mosby-Year-book Inc St Louis MO 1995189-206 Reprinted Optometric

Education Program Foundation Santa Anna Calif 2001

Maino D Wesson M Schlange D Cibis G Maino J Optometric findings in the fragile X syndrome Optom Vis Sci 199168634-40

Scheiman MMOptometric findings in children with cerebral palsy Am J Optom Physiol Opt 1984 May61(5)321-3

Maino D Maino J Maino S Mental retardation syndromes with associated ocular defects J Am Optom Assoc 199061707-16

Stewart RE Woodhouse JM Cregg M Pakeman VH Association between accommodative accuracy hypermetropia and strabismus in

children with Downs syndrome Optom Vis Sci 2007 Feb84(2)149-55

Cregg M Woodhouse JM Pakeman VH et al Accommodation and refractive error in children with Down syndrome cross-sectional

and longitudinal studies Invest Ophthalmol Vis Sci 2001 Jan42 (1)55-63

79

McClelland JF Parkes J Hill N et al Accommodative dysfunction in children with cerebral palsy a population-

based study Invest Ophthalmol Vis Sci 2006 May47(5)1824-30

Duckman RH Vision therapy for the child with cerebral palsy J Am Optom Assoc 198758(1)28-35

Duckman R Accommodation in cerebral palsy function and remediation J Am Optom Assoc 198455(4)281-3

Scheiman M Understanding and managing vision deficits a guide for occupational therapists 2nd ed Slack

Thorofare NJ 2002

Maino D Binasal occlusion for the child with Cerebral Palsy J Ill Optom Assoc 198644(1)1218

Battaglia F Quartarone A Rizzo V et al Early impairment of synaptic plasticity in patients with Downs syndrome

Neurobiol Aging 2008 Aug29(8)1272-5

Bonnier C Evaluation of early stimulation programs for enhancing brain development Acta Paediatr 2008

Jul97(7)853-8

Morice E Andreae LC Cooke SF et al Preservation of long-term memory and synaptic plasticity despite short-term

impairments in the Tc1 mouse model of Down syndrome Learn Mem 2008 Jul 1415(7)492-500

Gordon AM Schneider JA Chinnan A Charles JR Efficacy of a hand-arm bimanual intensive therapy (HABIT) in

children with hemiplegic cerebral palsy a randomized control trial Dev Med Child Neurol 2007 Nov49(11)830-8

Kapoor N Ciuffreda KJ Vision disturbances following traumatic brain injury Curr Treat Options Neurol 2002

Jul4(4)271-80

80

Ciuffreda KJ Rutner D Kapoor N et al Vision therapy for oculomotor dysfunctions in acquired brain injury a

retrospective analysis Optometry 2008 Jan79(1)18-22

Ciuffreda KJ Han Y Kapoor N Ficarra AP Oculomotor rehabilitation for reading in acquired brain injury

NeuroRehabilitation 200621(1)9-21

Zost M Diagnosis and management of visual dysfunction in cerebral injury In Maino D (ed) Diagnosis and

Management of Special Populations Mosby-Yearbook Inc St Louis 199579 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001 [Figure used with permission of the editor]

DeGutis JM Bentin S Robertson LC DEsposito M Functional plasticity in ventral temporal cortex following

cognitive rehabilitation of a congenital prosopagnosic J Cogn Neurosci 2007 Nov19 (11)1790-802

Welbourne SR Ralph MA Exploring the impact of plasticity-related recovery after brain damage in a connectionist

model of single-word reading Cogn Affect Behav Neurosci 2005 Mar5(1)77-92

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements prevent cognitive decline A

systematic review of randomized controlled trials J Hum Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among preterm infants attributable to early

supplementation of human milk with docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings and structural-functional

synergies with cell membrane phospholipids Altern Med Rev 2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function Neuroscience 20089(7)568-78

81

Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

BMC Biol 2008 Sep 9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine improves neuropsychological disorders in a child with

creatine transporter defect Neurocase 200814(2) 151-61

Forrester LW Wheaton LA Luft AR Exercise-mediated locomotor recovery and lower-limb neuroplasticity after

stroke J Rehabil Res Dev 200845(2)205-20

82

Page 43: Neuroplasticity: A Paradigm Sea Change Latest Updated File

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Stelmack JA Frith T Van Koevering D Rinne S Stelmack TR Visual function in patients

followed at a Veterans Affairs polytrauma network site an electronic medical record review

Optometry 2009 Aug80(8)419-24

RESULTS Visual symptoms were self-reported by 76 of patients

with polytrauma and 75 of the patients with TBI Problems with reading

(polytrauma 60 and TBI 50) and accommodation (polytrauma 30 and

TBI 47) were frequently found on eye examinations Spectacles were the

treatment most frequently prescribed (polytrauma 62 and TBI 78)

CONCLUSIONS It is important for optometrists to be aware of the high

rates of self-reported symptoms and visual problems in military personnel

returning from deployment to the wars in Iraq and Afghanistan Post-

traumatic stress disorder and depression may complicate optometric

evaluation and management

43

VII Vision dysfunction association with acquired brain injury

Avoidance of near tasks

Oculomotor-based reading difficulties

Eye tracking problems

Eye focusing problems

Eyestrain Diplopia

Dizziness Vertigo

Vision-derived nausea

44

VII Vision dysfunction association with acquired brain injury

Increased sensitivity to visual motion

Visual inattention and distractibility

Short-term visual memory loss

Difficulty judging distances (relative and absolute

Difficulty with global scanning

Difficulty with personal grooming especially involving the face

Inability to interactcope visually in a complex social situation

(eg minimal eye contact)

Inability to tolerate complex visual environments (eg grocery store

aisles and highly-patterned floors)

45

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Ciuffreda KJ Ludlam DP Kapoor N Clinical oculomotor training in traumatic brain injury Optom Vis

Dev 200940(1)16-23

Individuals with traumatic brain injury present with a constellation of

oculomotor dysfunctions and correlated symptoms Simple and

effective clinical oculomotor-based training procedures will be

presented with respect to the versional vergence and

accommodative systems and their interactions These therapeutic

procedures can also be applied as needed to individuals with either

low vision neurological dysfunctions or general visual skills cases

manifesting similar oculomotor deficits

46

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Leslie S Myopia and accommodative insufficiency associated with

moderate head trauma Opt Vis Dev 200940(1)25-31

The majority of subjects reviewed had developed a stable degree of

myopia between 100 and 200 diopters as well as an abnormally

high lag of accommodation When their distance and near spatial area

of focus was compared the majority were focused at an intermediate

area in space suggesting a loss of control of accommodation in

space

47

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

B Drugs

C Exercise

D Learning new and challenging things

48

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements

prevent cognitive decline A systematic review of randomized controlled trials J Hum

Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among

preterm infants attributable to early supplementation of human milk with

docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings

and structural-functional synergies with cell membrane phospholipids Altern Med Rev

2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function

Neuroscience 20089(7)568-78

49

VIII Improving Brain Function and Neuroplasticity

B Drugs Maya Vetencourt JF Sale A Viegi A et al The antidepressant

fluoxetine (PROZAC) restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the

antidepressant tianeptine CNS Drugs 200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances

hippocampal long-term potentiation and memory BMC Biol 2008 Sep

9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine

improves neuropsychological disorders in a child with creatine

transporter defect Neurocase 200814(2) 151-61

50

VIII Improving Brain Function and Neuroplasticity

C Exercise

Hunsberger JG et al Antidepressant actions of the exercise-

regulated gene VGF Nat Med 2007 Dec 2 131476

VGF may be a common pathway by which exercise induces

neuroplasticity and growth-factor genes at least one of these might act

similarly to antidepressants in promoting an adaptive response to stress

However the tests used here may be modeling stress-induced

helplessness not depression hellipexercise seems to induce multiple

interacting genes that enhance neuronal resilience

51

VIII Improving Brain Function and Neuroplasticity

D Learning new and challenging things

What have we (optometry amp ophthalmology)

been thinking all these years

Where did we miss the news about neuroplasticity

52

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Huang JC Neuroplasticity as a proposed mechanism for the efficacy of optometric vision therapy and rehabilitation J Bev Optom 200920(4)96-100

Homologous area adaptationCompensatory masqueradeCross-modal reassignment

Map expansion

EquipotentialityVicariation

53

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Homologous area adaptation a transfer of function from a damaged brain area to a non-damaged brain area May be limited to early stages of human development and may crowd a new brain area resulting in reduced functionality of that brain area (Competition between spatial amp verbal functioning)

54

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Compensatory masquerade reorganizing of existing neuro-pathways to us alternative cognitive strategies to perform a task

55

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Cross-modal reassignment using new sensory input in a brain structure deprived of its main input source (changing processing from visual to tactile stimuli in the blind)

56

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Map expansion increase in brain mass due to repeated behavior or exposure to stimuli

57

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Equipotentiality anatomical areas of the brain can perform disparate functions

Vicariation redundant neural systems can operate under abnormal conditions

This may explain why recovery is noted for many neurological conditions (degenerative psychiatric developmental vascular traumatic)

58

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Constraint therapy Use it and improve it

Patching penalization ldquonear activitiesrdquo during amblyopia therapy

59

IX Improving Brain Function and Neuroplasticity Optometric Clinical ApplicationsOptometric Vision Therapy

Kleim amp Jones

Use it or lose it If you do not drive specific brain functions

functional loss will occur

If you want to improve oculomotor brain neuroplastic function amp

structure therapy should be specific for that brain function

Use it and improve it Therapy that drives cortical function enhances

that particular function

If you use therapy to improve oculomotor dysfunction it should

improve

Specificity The therapy you choose determines the resultant

plasticity and function

You must choose therapy that is appropriate

60

IX Improving Brain Function and Neuroplasticity Optometric Clinical Applications

Kleim amp Jones

Repetition matters Plasticity that results in functional change

requires repetition

Do the therapy Do it again Do it yet again No quick fix

Intensity matters Induction of plasticity requires the appropriate

amount of intensity

Intensity means strength force concentration power and passion

Without these plasticity may not occur Function may not improve

Time matters Different forms of plasticity take place at different

times during therapy

Do the basics than the more advanced therapeutic procedures

61

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Salience matters It has to be important to the individual

Make the therapy matter to the patient

Age matters Plasticity is easier in a younger brain but is also

possible in an adult brain

Do not let age determine what therapy options you offer your

patients Think of Susan Barry PhD (StereoSue) and her success

Offer your patients options Let them choose Be realistic about

outcomeshelliphave outcome measures built into therapy program

62

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Transference Neuroplasticity and the change in function

that results from one therapy can augment the attainment

of similar behaviors

What you do during oculomotor therapy may affected

vergence therapy outcomes

Interference Plasticity in response to one experience can

interfere with the acquisition of other behaviors

Monitor Evaluate progress Discuss function in other areas

of your patientslsquo life

63

Why pay attention to binocular vision dysfunctions

and neuroplasticity

December 2009 issue of the Review of Optometry

The Binocular Vision Dysfunction Pandemic

In 2010 almost 170 million individuals will be wearing glasses In

2010 there will also be up to 93 million amblyopes and 12 and a half

million strabismics For children under 18 years of age that means

there will be more than 22 and a half million amblyopes and millions

of children with strabismus A clinical trial to determine the

prevalence of binocular vision dysfunction within the general

population suggested the possibility of up to 56 or 173 million men

women and children with symptoms associated with a binocular

vision dysfunction 189 million (61) with accommodative problems

and 118 million (38) demonstrating various vergence

anomalies

64

65

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Brain plasticity life long changes in the structure of the brain

Sensory substitution replacement of one sensory input by another

Measurement techniques

Voxel based morphometryhellipmeasures difference in brain volume

Fluorodeoxyglucose glucose analog PET scan tells you

distribution and metabolism of brain

Cortical thickness measures

Visual cortex of the blind turns somatic ―The eye of the tongue

Transcranial magnetic stmiulation non-invasive technique to

stimulate cortex

66

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Blind Braille readers report tingling in fingers when pressure

phosphenes are applied Blind feel tingling in tongue

Bind use tongue to perform orientation task motion perception

sensory perception Visual cortex recruited in a variety of sensory

and cognitive tasks (DM Can we use tongue as a VT tool)

Dilks Reorganizations of human adult visual system

When a region of sensory cortex is deprived of its bottom up

input the deprived region begins to respond to stimuli that

normally activate adjacent cortex

67

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Retinotopic map changes for stroke pts Cortical reorganization in

adults occurs Perceived objectshellipelongation in stroke amp AMD

What happens to deprived cortex in AMD

fMRI shows cortical reorganization in adults

Proposed mechanisms

hellipGrowth of new connections

hellipUnmasking of pre-existing connections this is true

happens within seconds

Bavelier

Action video games

68

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Bavelier

Action video games Looked at attention Gamers can track more

activities

Attention over space (me peripheral awarenress) Useful field

of view shrinks with age

Performance not VA relatedhellipis related to attention

Action game playing changes spatial resolutionhellipovercoming

crowding in VA assessment (me amblyopia therapy)

Temporal resolution of vision Backward masking

changehellipbrain changes

Visual sensitivity (contrast sensitivity) Post action game training

improves CSF

69

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Action video games correcting optics of the cortex (me this is

actualy OVT)

Games factor

Variable entry leanringhellipadapt task to skill level

Incremental learning tune task to subjectlsquos leanring steps

Motivationarousal

Rewards

Self masterself confidence

Action games factors

Pacingrate of exposure to infohellipincreasing processing speed

Dynamic display

Rich environment

Rich motor involvement

70

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Surgeons may be made to play action games

Pilot training

Amblyopia tx Dennis Levi research

PresenterTitle Contact info

Neuroplasticity-A Paradigm Sea Change

This presentation is available at

httpwwwslidesharenetDMAINOneuroplasticity-a-paradigm-sea-change-2459693

httpwwwmainosmemosblogspotcom

My FaceBook Page

and

Twitter

PresenterTitle Contact info

Questions About

Neuroplasticity-A Paradigm Sea Change

Dominick M Maino OD MEd FAAO FCOVD-A

Professor PediatricsBinocular VisionIllinois Eye InstituteIllinois College of Optometry

dmainoicoeduhttpwwwMainosMemosblogspotcom

Thanks to

httpwwwcovdorgHomeOVDJournalOVD401tabid263D

efaultaspx

httpbipolarblastfileswordpresscom200908neurojpg

httpwwwspecialcheerscomimagesanimated_braingif

httpblogmarsdencartoonscomwp-

contentuploads200810frankenstein-myspace-lightbeergif

httpwwwshangralafamilyfuncomgala-ecalvindreamgif

httppsychiatryjwatchorgcgicontentfull20082251

73

Chakraborty R Chatterjee A Choudhart S Chakraborty PK Neuroplasticitymdasha paradigm shift in neurosciences J Indian Med Assoc

2007105(9)513-4516-8520-1

Sacks O A neurologistlsquos notebook Stereo Sue Why two eyes are better than one The New Yorker 2006 Jun 1964-73

Krulwich R National Public Radio Going Binocular Susanlsquos First Snowfall Available at

wwwnprorgtemplatesstorystoryphpstoryId=5507789 (Accessed December 8 2008)

Press LJ The story behind Stereo Suelsquo and a world-famous neurologistlsquos discovery of vision therapy Optom Vis Dev 200637(2) 55-7

Levin HS Neuroplasticity and brain imaging research implications for rehabilitation Arch Phys Med Rehabil 2006 Dec87(12 Suppl

2)S1

Wiesel TN Hubel DH Single-cell responses in striate cortex of kittens deprived of vision in one eye J Neurophysiol 1963

Nov261003-17

Hook BM Chen C Critical periods in the visual system Changing views for a model of experience-dependent plasticity Neuron 2007

Oct56(2)312-26

Ramey CT Ramey SL Prevention of intellectual disabilities early interventions to improve cognitive development Prev Med 1998

Mar-Apr27(2)224-32

Heuninckx S Wenderoth N Swinnen SP Systems neuroplasticity in the aging brain recruiting additional neural resources for

successful motor performance in elderly persons J Neurosci 2008 Jan 228(1)91-9

Ge S Yang CH Hsu KS et al A critical period for enhanced synaptic plasticity in newly generated neurons of the adult brain Neuron

2007 May54(4)559-66

74

Draganski B Gaser C Busch V et al Neuroplasticity changes in grey matter induced by training Nature 2004 Jan 22427(6972)

311-2

Cannonieri GC Bonilha L Fernandes PT et al Practice and perfect length of training and structural brain changes in experienced

typists Neuroreport 2007 Jul 218(10)1063-6

Kleim JA Jones TA Principles of experience-dependent neural plasticity implications for rehabilitation after brain damage J

Speech Lang Hear Res 2008 Feb51(1)S225-39

Trojan S Porkorny J Theoretical aspects of neuroplasticity Physiol Res 199948(2)87-97

Ramamirtham R Kee CS Hung LF et al Wave aberrations in rhesus monkeys with vision-induced ametropias Vision Res 2007

Sep47(21)2751-66

Smith EL 3rd Ramamirtham R Qiao-Grider Y et al Effects of foveal ablation on emmetropization and form-deprivation myopia

Invest Ophthalmol Vis Sci 2007 Sep48(9)3914-22

Smith EL 3rd Kee CS Ramamirtham R et al Peripheral vision can influence eye growth and refractive development in infant

monkeys Invest Ophthalmol Vis Sci 2005 Nov46(11)3965-72

Ciuffreda KJ Vasudevan B Nearwork-induced transient myopia (NITM) and permanent myopiandashndashis there a link Ophthalmic

Physiol Opt 2008 Mar28(2)103-14

Hung GK Ciuffreda KJ Incremental retinal-defocus theory of myopia development--schematic analysis and computer simulation

Comput Biol Med 2007 Jul37(7)930-46

Hung GK Ciuffreda KJ A unifying theory of refractive error development Bull Math Biol 2000 Nov62(6)1087-108

75

Pang Y Maino D Zhang G Lu F Myopia Can its progress be controlled Optom Vis Dev 200637(2)75-9

Leung JT Brown B Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lenses Optom Vis Sci

1999 Jun76(6)346-54

Hasebe S Ohtsuki H Nonaka T et al Effect of progressive addition lenses on myopia progression in Japanese children a prospective

randomized double-masked crossover trial Invest Ophthalmol Vis Sci 2008 Jul49(7)2781-9

Gwiazda J Hyman L Hussein M et al A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression

of myopia in children Invest Ophthalmol Vis Sci 2003 Apr44(4)1492-500

Siatkowski RM Cotter SA Crockett RS et al Two-year multi-center randomized double-masked placebo-controlled parallel safety and

efficacy study of 2 pirenzepine ophthalmic gel in children with myopia J AAPOS 2008 Aug12(4)332-9

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged 7 to 17 years Arch Ophthalmol 2005

Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three to less than 10 years of age Am J

Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction Am J Ophthalmol 2007

Jun143(6)1060-3

Holmes JM Edwards AR Beck RW et al A randomized pilot study of near activities versus non-near activities during patching therapy for

amblyopia J AAPOS 2005 Apr9(2)129-36

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate

amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-57

76

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic

amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Convergence Insufficiency Treatment Trial Study Group Randomized clinical trial of treatments for symptomatic convergence insufficiency

in children Arch Ophthalmol 2008 Oct126(10)1336-49

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

Solan HA Shelley-Tremblay J Hansen PC et al M-cell deficit and reading disability a preliminary study of the effects of temporal vision-

processing therapy Optometry 2004 Oct75(10)640-50

Solan HA Larson S Shelley-Tremblay J et al Role of visual attention in cognitive control of oculomotor readiness in students with reading

disabilities J Learn Disabil 2001 Mar-Apr34(2)107-18

Gallaway M Boas MB The impact of vergence and accommodative therapy on reading eye movements and reading speed Optom Vis Dev

200738(3)115-20

Goss DA Downing DB Lowther AH et al The effect of HTS vision therapy conducted in a school setting on reading skills in third and

fourth grade students Optom Vis Dev 200738(1)27-32

Crutch SJ Warrington EK Foveal crowding in posterior cortical atrophy a specific early-visual-processing deficit affecting word reading

Cogn Neuropsychol 2007 Dec24(8)843-66

Helms D Sawtelle SM A study of the effectiveness of cognitive therapy delivered in a video game format Optom Vis Dev 200738 (1)19-

26

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

77

Lawton T Training direction-discrimination sensitivity remediates a wide spectrum of reading skills OptomVis Dev 200738(1) 33-47

Goldstand S Koslowe KC Parush S Vision visual-information processing and academic performance among seventh-grade schoolchildren a

more significant relationship than we thought Am J Occup Ther 2005 Jul-Aug59(4)377-89

Fischer B Koumlngeter A Hartnegg K Effects of daily practice on subitizing visual counting and basic arithmetic skills Optom Vis Dev

200839(1)30-4

Sands W Taub M Maino D Limited research and education on special populations in optometry and ophthalomology Optom Vis Dev

200839(2)60-1

Wesson M Maino D Oculo-visual findings in Down syndrome cerebral palsy and mental retardation with non-specific etiology In Maino D

(ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 199517-54 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

Cui Y Stapleton F Suttle C Developing an instrument to assess vision-related and subjective quality of life in children with intellectual

disability data collection and preliminary analysis in a Chinese population Ophthal Physiolog Optics 2008 May28(3) 238-46

Maino D Steele G Tahir S Sajja R Attitudes of optometry students toward individuals with disabilities Optom Ed 200227(2)45-50

Maino D Special populations in the optometric curriculum Optom Ed 200227(2)38-9

Maino D Overview of special populations In Scheiman M Rouse M (eds) Optometric Management of Learning-Related Vision Problems

St Louis Mosby Inc 200685-106

Maino D (ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 1995 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

78

McCarthy P Maino D Alport syndrome a review Clin Eye Vis Care 2000 Dec12(3-4)139-50

Block SS Brusca-Vega R Pizzi WJ et al Cognitive and visual processing skills and their relationship to mutation size in full and

permutation female fragile X carriers Optom Vis Sci 2000 Nov77 (11)592-9

Maino D The young child with developmental disabilities An introduction to mental retardation and genetic syndromes In Moore BD

(ed) Eye Care for Infants and Young Children Butter-worth--Heinemann Newton MA1997285-300

Amin V Maino D The Fragile X female Visual visual perceptual and ocular health anomalies J Am Optom Assoc 1995 May66

(5)290-95

Maino DM Maino JH Cibis GW Hecht F Ocular health anomalies in patients with developmental disabilities In Maino D (ed)

Diagnosis and Management of Special Populations Mosby-Year-book Inc St Louis MO 1995189-206 Reprinted Optometric

Education Program Foundation Santa Anna Calif 2001

Maino D Wesson M Schlange D Cibis G Maino J Optometric findings in the fragile X syndrome Optom Vis Sci 199168634-40

Scheiman MMOptometric findings in children with cerebral palsy Am J Optom Physiol Opt 1984 May61(5)321-3

Maino D Maino J Maino S Mental retardation syndromes with associated ocular defects J Am Optom Assoc 199061707-16

Stewart RE Woodhouse JM Cregg M Pakeman VH Association between accommodative accuracy hypermetropia and strabismus in

children with Downs syndrome Optom Vis Sci 2007 Feb84(2)149-55

Cregg M Woodhouse JM Pakeman VH et al Accommodation and refractive error in children with Down syndrome cross-sectional

and longitudinal studies Invest Ophthalmol Vis Sci 2001 Jan42 (1)55-63

79

McClelland JF Parkes J Hill N et al Accommodative dysfunction in children with cerebral palsy a population-

based study Invest Ophthalmol Vis Sci 2006 May47(5)1824-30

Duckman RH Vision therapy for the child with cerebral palsy J Am Optom Assoc 198758(1)28-35

Duckman R Accommodation in cerebral palsy function and remediation J Am Optom Assoc 198455(4)281-3

Scheiman M Understanding and managing vision deficits a guide for occupational therapists 2nd ed Slack

Thorofare NJ 2002

Maino D Binasal occlusion for the child with Cerebral Palsy J Ill Optom Assoc 198644(1)1218

Battaglia F Quartarone A Rizzo V et al Early impairment of synaptic plasticity in patients with Downs syndrome

Neurobiol Aging 2008 Aug29(8)1272-5

Bonnier C Evaluation of early stimulation programs for enhancing brain development Acta Paediatr 2008

Jul97(7)853-8

Morice E Andreae LC Cooke SF et al Preservation of long-term memory and synaptic plasticity despite short-term

impairments in the Tc1 mouse model of Down syndrome Learn Mem 2008 Jul 1415(7)492-500

Gordon AM Schneider JA Chinnan A Charles JR Efficacy of a hand-arm bimanual intensive therapy (HABIT) in

children with hemiplegic cerebral palsy a randomized control trial Dev Med Child Neurol 2007 Nov49(11)830-8

Kapoor N Ciuffreda KJ Vision disturbances following traumatic brain injury Curr Treat Options Neurol 2002

Jul4(4)271-80

80

Ciuffreda KJ Rutner D Kapoor N et al Vision therapy for oculomotor dysfunctions in acquired brain injury a

retrospective analysis Optometry 2008 Jan79(1)18-22

Ciuffreda KJ Han Y Kapoor N Ficarra AP Oculomotor rehabilitation for reading in acquired brain injury

NeuroRehabilitation 200621(1)9-21

Zost M Diagnosis and management of visual dysfunction in cerebral injury In Maino D (ed) Diagnosis and

Management of Special Populations Mosby-Yearbook Inc St Louis 199579 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001 [Figure used with permission of the editor]

DeGutis JM Bentin S Robertson LC DEsposito M Functional plasticity in ventral temporal cortex following

cognitive rehabilitation of a congenital prosopagnosic J Cogn Neurosci 2007 Nov19 (11)1790-802

Welbourne SR Ralph MA Exploring the impact of plasticity-related recovery after brain damage in a connectionist

model of single-word reading Cogn Affect Behav Neurosci 2005 Mar5(1)77-92

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements prevent cognitive decline A

systematic review of randomized controlled trials J Hum Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among preterm infants attributable to early

supplementation of human milk with docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings and structural-functional

synergies with cell membrane phospholipids Altern Med Rev 2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function Neuroscience 20089(7)568-78

81

Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

BMC Biol 2008 Sep 9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine improves neuropsychological disorders in a child with

creatine transporter defect Neurocase 200814(2) 151-61

Forrester LW Wheaton LA Luft AR Exercise-mediated locomotor recovery and lower-limb neuroplasticity after

stroke J Rehabil Res Dev 200845(2)205-20

82

Page 44: Neuroplasticity: A Paradigm Sea Change Latest Updated File

VII Vision dysfunction association with acquired brain injury

Avoidance of near tasks

Oculomotor-based reading difficulties

Eye tracking problems

Eye focusing problems

Eyestrain Diplopia

Dizziness Vertigo

Vision-derived nausea

44

VII Vision dysfunction association with acquired brain injury

Increased sensitivity to visual motion

Visual inattention and distractibility

Short-term visual memory loss

Difficulty judging distances (relative and absolute

Difficulty with global scanning

Difficulty with personal grooming especially involving the face

Inability to interactcope visually in a complex social situation

(eg minimal eye contact)

Inability to tolerate complex visual environments (eg grocery store

aisles and highly-patterned floors)

45

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Ciuffreda KJ Ludlam DP Kapoor N Clinical oculomotor training in traumatic brain injury Optom Vis

Dev 200940(1)16-23

Individuals with traumatic brain injury present with a constellation of

oculomotor dysfunctions and correlated symptoms Simple and

effective clinical oculomotor-based training procedures will be

presented with respect to the versional vergence and

accommodative systems and their interactions These therapeutic

procedures can also be applied as needed to individuals with either

low vision neurological dysfunctions or general visual skills cases

manifesting similar oculomotor deficits

46

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Leslie S Myopia and accommodative insufficiency associated with

moderate head trauma Opt Vis Dev 200940(1)25-31

The majority of subjects reviewed had developed a stable degree of

myopia between 100 and 200 diopters as well as an abnormally

high lag of accommodation When their distance and near spatial area

of focus was compared the majority were focused at an intermediate

area in space suggesting a loss of control of accommodation in

space

47

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

B Drugs

C Exercise

D Learning new and challenging things

48

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements

prevent cognitive decline A systematic review of randomized controlled trials J Hum

Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among

preterm infants attributable to early supplementation of human milk with

docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings

and structural-functional synergies with cell membrane phospholipids Altern Med Rev

2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function

Neuroscience 20089(7)568-78

49

VIII Improving Brain Function and Neuroplasticity

B Drugs Maya Vetencourt JF Sale A Viegi A et al The antidepressant

fluoxetine (PROZAC) restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the

antidepressant tianeptine CNS Drugs 200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances

hippocampal long-term potentiation and memory BMC Biol 2008 Sep

9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine

improves neuropsychological disorders in a child with creatine

transporter defect Neurocase 200814(2) 151-61

50

VIII Improving Brain Function and Neuroplasticity

C Exercise

Hunsberger JG et al Antidepressant actions of the exercise-

regulated gene VGF Nat Med 2007 Dec 2 131476

VGF may be a common pathway by which exercise induces

neuroplasticity and growth-factor genes at least one of these might act

similarly to antidepressants in promoting an adaptive response to stress

However the tests used here may be modeling stress-induced

helplessness not depression hellipexercise seems to induce multiple

interacting genes that enhance neuronal resilience

51

VIII Improving Brain Function and Neuroplasticity

D Learning new and challenging things

What have we (optometry amp ophthalmology)

been thinking all these years

Where did we miss the news about neuroplasticity

52

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Huang JC Neuroplasticity as a proposed mechanism for the efficacy of optometric vision therapy and rehabilitation J Bev Optom 200920(4)96-100

Homologous area adaptationCompensatory masqueradeCross-modal reassignment

Map expansion

EquipotentialityVicariation

53

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Homologous area adaptation a transfer of function from a damaged brain area to a non-damaged brain area May be limited to early stages of human development and may crowd a new brain area resulting in reduced functionality of that brain area (Competition between spatial amp verbal functioning)

54

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Compensatory masquerade reorganizing of existing neuro-pathways to us alternative cognitive strategies to perform a task

55

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Cross-modal reassignment using new sensory input in a brain structure deprived of its main input source (changing processing from visual to tactile stimuli in the blind)

56

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Map expansion increase in brain mass due to repeated behavior or exposure to stimuli

57

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Equipotentiality anatomical areas of the brain can perform disparate functions

Vicariation redundant neural systems can operate under abnormal conditions

This may explain why recovery is noted for many neurological conditions (degenerative psychiatric developmental vascular traumatic)

58

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Constraint therapy Use it and improve it

Patching penalization ldquonear activitiesrdquo during amblyopia therapy

59

IX Improving Brain Function and Neuroplasticity Optometric Clinical ApplicationsOptometric Vision Therapy

Kleim amp Jones

Use it or lose it If you do not drive specific brain functions

functional loss will occur

If you want to improve oculomotor brain neuroplastic function amp

structure therapy should be specific for that brain function

Use it and improve it Therapy that drives cortical function enhances

that particular function

If you use therapy to improve oculomotor dysfunction it should

improve

Specificity The therapy you choose determines the resultant

plasticity and function

You must choose therapy that is appropriate

60

IX Improving Brain Function and Neuroplasticity Optometric Clinical Applications

Kleim amp Jones

Repetition matters Plasticity that results in functional change

requires repetition

Do the therapy Do it again Do it yet again No quick fix

Intensity matters Induction of plasticity requires the appropriate

amount of intensity

Intensity means strength force concentration power and passion

Without these plasticity may not occur Function may not improve

Time matters Different forms of plasticity take place at different

times during therapy

Do the basics than the more advanced therapeutic procedures

61

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Salience matters It has to be important to the individual

Make the therapy matter to the patient

Age matters Plasticity is easier in a younger brain but is also

possible in an adult brain

Do not let age determine what therapy options you offer your

patients Think of Susan Barry PhD (StereoSue) and her success

Offer your patients options Let them choose Be realistic about

outcomeshelliphave outcome measures built into therapy program

62

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Transference Neuroplasticity and the change in function

that results from one therapy can augment the attainment

of similar behaviors

What you do during oculomotor therapy may affected

vergence therapy outcomes

Interference Plasticity in response to one experience can

interfere with the acquisition of other behaviors

Monitor Evaluate progress Discuss function in other areas

of your patientslsquo life

63

Why pay attention to binocular vision dysfunctions

and neuroplasticity

December 2009 issue of the Review of Optometry

The Binocular Vision Dysfunction Pandemic

In 2010 almost 170 million individuals will be wearing glasses In

2010 there will also be up to 93 million amblyopes and 12 and a half

million strabismics For children under 18 years of age that means

there will be more than 22 and a half million amblyopes and millions

of children with strabismus A clinical trial to determine the

prevalence of binocular vision dysfunction within the general

population suggested the possibility of up to 56 or 173 million men

women and children with symptoms associated with a binocular

vision dysfunction 189 million (61) with accommodative problems

and 118 million (38) demonstrating various vergence

anomalies

64

65

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Brain plasticity life long changes in the structure of the brain

Sensory substitution replacement of one sensory input by another

Measurement techniques

Voxel based morphometryhellipmeasures difference in brain volume

Fluorodeoxyglucose glucose analog PET scan tells you

distribution and metabolism of brain

Cortical thickness measures

Visual cortex of the blind turns somatic ―The eye of the tongue

Transcranial magnetic stmiulation non-invasive technique to

stimulate cortex

66

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Blind Braille readers report tingling in fingers when pressure

phosphenes are applied Blind feel tingling in tongue

Bind use tongue to perform orientation task motion perception

sensory perception Visual cortex recruited in a variety of sensory

and cognitive tasks (DM Can we use tongue as a VT tool)

Dilks Reorganizations of human adult visual system

When a region of sensory cortex is deprived of its bottom up

input the deprived region begins to respond to stimuli that

normally activate adjacent cortex

67

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Retinotopic map changes for stroke pts Cortical reorganization in

adults occurs Perceived objectshellipelongation in stroke amp AMD

What happens to deprived cortex in AMD

fMRI shows cortical reorganization in adults

Proposed mechanisms

hellipGrowth of new connections

hellipUnmasking of pre-existing connections this is true

happens within seconds

Bavelier

Action video games

68

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Bavelier

Action video games Looked at attention Gamers can track more

activities

Attention over space (me peripheral awarenress) Useful field

of view shrinks with age

Performance not VA relatedhellipis related to attention

Action game playing changes spatial resolutionhellipovercoming

crowding in VA assessment (me amblyopia therapy)

Temporal resolution of vision Backward masking

changehellipbrain changes

Visual sensitivity (contrast sensitivity) Post action game training

improves CSF

69

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Action video games correcting optics of the cortex (me this is

actualy OVT)

Games factor

Variable entry leanringhellipadapt task to skill level

Incremental learning tune task to subjectlsquos leanring steps

Motivationarousal

Rewards

Self masterself confidence

Action games factors

Pacingrate of exposure to infohellipincreasing processing speed

Dynamic display

Rich environment

Rich motor involvement

70

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Surgeons may be made to play action games

Pilot training

Amblyopia tx Dennis Levi research

PresenterTitle Contact info

Neuroplasticity-A Paradigm Sea Change

This presentation is available at

httpwwwslidesharenetDMAINOneuroplasticity-a-paradigm-sea-change-2459693

httpwwwmainosmemosblogspotcom

My FaceBook Page

and

Twitter

PresenterTitle Contact info

Questions About

Neuroplasticity-A Paradigm Sea Change

Dominick M Maino OD MEd FAAO FCOVD-A

Professor PediatricsBinocular VisionIllinois Eye InstituteIllinois College of Optometry

dmainoicoeduhttpwwwMainosMemosblogspotcom

Thanks to

httpwwwcovdorgHomeOVDJournalOVD401tabid263D

efaultaspx

httpbipolarblastfileswordpresscom200908neurojpg

httpwwwspecialcheerscomimagesanimated_braingif

httpblogmarsdencartoonscomwp-

contentuploads200810frankenstein-myspace-lightbeergif

httpwwwshangralafamilyfuncomgala-ecalvindreamgif

httppsychiatryjwatchorgcgicontentfull20082251

73

Chakraborty R Chatterjee A Choudhart S Chakraborty PK Neuroplasticitymdasha paradigm shift in neurosciences J Indian Med Assoc

2007105(9)513-4516-8520-1

Sacks O A neurologistlsquos notebook Stereo Sue Why two eyes are better than one The New Yorker 2006 Jun 1964-73

Krulwich R National Public Radio Going Binocular Susanlsquos First Snowfall Available at

wwwnprorgtemplatesstorystoryphpstoryId=5507789 (Accessed December 8 2008)

Press LJ The story behind Stereo Suelsquo and a world-famous neurologistlsquos discovery of vision therapy Optom Vis Dev 200637(2) 55-7

Levin HS Neuroplasticity and brain imaging research implications for rehabilitation Arch Phys Med Rehabil 2006 Dec87(12 Suppl

2)S1

Wiesel TN Hubel DH Single-cell responses in striate cortex of kittens deprived of vision in one eye J Neurophysiol 1963

Nov261003-17

Hook BM Chen C Critical periods in the visual system Changing views for a model of experience-dependent plasticity Neuron 2007

Oct56(2)312-26

Ramey CT Ramey SL Prevention of intellectual disabilities early interventions to improve cognitive development Prev Med 1998

Mar-Apr27(2)224-32

Heuninckx S Wenderoth N Swinnen SP Systems neuroplasticity in the aging brain recruiting additional neural resources for

successful motor performance in elderly persons J Neurosci 2008 Jan 228(1)91-9

Ge S Yang CH Hsu KS et al A critical period for enhanced synaptic plasticity in newly generated neurons of the adult brain Neuron

2007 May54(4)559-66

74

Draganski B Gaser C Busch V et al Neuroplasticity changes in grey matter induced by training Nature 2004 Jan 22427(6972)

311-2

Cannonieri GC Bonilha L Fernandes PT et al Practice and perfect length of training and structural brain changes in experienced

typists Neuroreport 2007 Jul 218(10)1063-6

Kleim JA Jones TA Principles of experience-dependent neural plasticity implications for rehabilitation after brain damage J

Speech Lang Hear Res 2008 Feb51(1)S225-39

Trojan S Porkorny J Theoretical aspects of neuroplasticity Physiol Res 199948(2)87-97

Ramamirtham R Kee CS Hung LF et al Wave aberrations in rhesus monkeys with vision-induced ametropias Vision Res 2007

Sep47(21)2751-66

Smith EL 3rd Ramamirtham R Qiao-Grider Y et al Effects of foveal ablation on emmetropization and form-deprivation myopia

Invest Ophthalmol Vis Sci 2007 Sep48(9)3914-22

Smith EL 3rd Kee CS Ramamirtham R et al Peripheral vision can influence eye growth and refractive development in infant

monkeys Invest Ophthalmol Vis Sci 2005 Nov46(11)3965-72

Ciuffreda KJ Vasudevan B Nearwork-induced transient myopia (NITM) and permanent myopiandashndashis there a link Ophthalmic

Physiol Opt 2008 Mar28(2)103-14

Hung GK Ciuffreda KJ Incremental retinal-defocus theory of myopia development--schematic analysis and computer simulation

Comput Biol Med 2007 Jul37(7)930-46

Hung GK Ciuffreda KJ A unifying theory of refractive error development Bull Math Biol 2000 Nov62(6)1087-108

75

Pang Y Maino D Zhang G Lu F Myopia Can its progress be controlled Optom Vis Dev 200637(2)75-9

Leung JT Brown B Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lenses Optom Vis Sci

1999 Jun76(6)346-54

Hasebe S Ohtsuki H Nonaka T et al Effect of progressive addition lenses on myopia progression in Japanese children a prospective

randomized double-masked crossover trial Invest Ophthalmol Vis Sci 2008 Jul49(7)2781-9

Gwiazda J Hyman L Hussein M et al A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression

of myopia in children Invest Ophthalmol Vis Sci 2003 Apr44(4)1492-500

Siatkowski RM Cotter SA Crockett RS et al Two-year multi-center randomized double-masked placebo-controlled parallel safety and

efficacy study of 2 pirenzepine ophthalmic gel in children with myopia J AAPOS 2008 Aug12(4)332-9

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged 7 to 17 years Arch Ophthalmol 2005

Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three to less than 10 years of age Am J

Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction Am J Ophthalmol 2007

Jun143(6)1060-3

Holmes JM Edwards AR Beck RW et al A randomized pilot study of near activities versus non-near activities during patching therapy for

amblyopia J AAPOS 2005 Apr9(2)129-36

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate

amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-57

76

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic

amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Convergence Insufficiency Treatment Trial Study Group Randomized clinical trial of treatments for symptomatic convergence insufficiency

in children Arch Ophthalmol 2008 Oct126(10)1336-49

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

Solan HA Shelley-Tremblay J Hansen PC et al M-cell deficit and reading disability a preliminary study of the effects of temporal vision-

processing therapy Optometry 2004 Oct75(10)640-50

Solan HA Larson S Shelley-Tremblay J et al Role of visual attention in cognitive control of oculomotor readiness in students with reading

disabilities J Learn Disabil 2001 Mar-Apr34(2)107-18

Gallaway M Boas MB The impact of vergence and accommodative therapy on reading eye movements and reading speed Optom Vis Dev

200738(3)115-20

Goss DA Downing DB Lowther AH et al The effect of HTS vision therapy conducted in a school setting on reading skills in third and

fourth grade students Optom Vis Dev 200738(1)27-32

Crutch SJ Warrington EK Foveal crowding in posterior cortical atrophy a specific early-visual-processing deficit affecting word reading

Cogn Neuropsychol 2007 Dec24(8)843-66

Helms D Sawtelle SM A study of the effectiveness of cognitive therapy delivered in a video game format Optom Vis Dev 200738 (1)19-

26

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

77

Lawton T Training direction-discrimination sensitivity remediates a wide spectrum of reading skills OptomVis Dev 200738(1) 33-47

Goldstand S Koslowe KC Parush S Vision visual-information processing and academic performance among seventh-grade schoolchildren a

more significant relationship than we thought Am J Occup Ther 2005 Jul-Aug59(4)377-89

Fischer B Koumlngeter A Hartnegg K Effects of daily practice on subitizing visual counting and basic arithmetic skills Optom Vis Dev

200839(1)30-4

Sands W Taub M Maino D Limited research and education on special populations in optometry and ophthalomology Optom Vis Dev

200839(2)60-1

Wesson M Maino D Oculo-visual findings in Down syndrome cerebral palsy and mental retardation with non-specific etiology In Maino D

(ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 199517-54 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

Cui Y Stapleton F Suttle C Developing an instrument to assess vision-related and subjective quality of life in children with intellectual

disability data collection and preliminary analysis in a Chinese population Ophthal Physiolog Optics 2008 May28(3) 238-46

Maino D Steele G Tahir S Sajja R Attitudes of optometry students toward individuals with disabilities Optom Ed 200227(2)45-50

Maino D Special populations in the optometric curriculum Optom Ed 200227(2)38-9

Maino D Overview of special populations In Scheiman M Rouse M (eds) Optometric Management of Learning-Related Vision Problems

St Louis Mosby Inc 200685-106

Maino D (ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 1995 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

78

McCarthy P Maino D Alport syndrome a review Clin Eye Vis Care 2000 Dec12(3-4)139-50

Block SS Brusca-Vega R Pizzi WJ et al Cognitive and visual processing skills and their relationship to mutation size in full and

permutation female fragile X carriers Optom Vis Sci 2000 Nov77 (11)592-9

Maino D The young child with developmental disabilities An introduction to mental retardation and genetic syndromes In Moore BD

(ed) Eye Care for Infants and Young Children Butter-worth--Heinemann Newton MA1997285-300

Amin V Maino D The Fragile X female Visual visual perceptual and ocular health anomalies J Am Optom Assoc 1995 May66

(5)290-95

Maino DM Maino JH Cibis GW Hecht F Ocular health anomalies in patients with developmental disabilities In Maino D (ed)

Diagnosis and Management of Special Populations Mosby-Year-book Inc St Louis MO 1995189-206 Reprinted Optometric

Education Program Foundation Santa Anna Calif 2001

Maino D Wesson M Schlange D Cibis G Maino J Optometric findings in the fragile X syndrome Optom Vis Sci 199168634-40

Scheiman MMOptometric findings in children with cerebral palsy Am J Optom Physiol Opt 1984 May61(5)321-3

Maino D Maino J Maino S Mental retardation syndromes with associated ocular defects J Am Optom Assoc 199061707-16

Stewart RE Woodhouse JM Cregg M Pakeman VH Association between accommodative accuracy hypermetropia and strabismus in

children with Downs syndrome Optom Vis Sci 2007 Feb84(2)149-55

Cregg M Woodhouse JM Pakeman VH et al Accommodation and refractive error in children with Down syndrome cross-sectional

and longitudinal studies Invest Ophthalmol Vis Sci 2001 Jan42 (1)55-63

79

McClelland JF Parkes J Hill N et al Accommodative dysfunction in children with cerebral palsy a population-

based study Invest Ophthalmol Vis Sci 2006 May47(5)1824-30

Duckman RH Vision therapy for the child with cerebral palsy J Am Optom Assoc 198758(1)28-35

Duckman R Accommodation in cerebral palsy function and remediation J Am Optom Assoc 198455(4)281-3

Scheiman M Understanding and managing vision deficits a guide for occupational therapists 2nd ed Slack

Thorofare NJ 2002

Maino D Binasal occlusion for the child with Cerebral Palsy J Ill Optom Assoc 198644(1)1218

Battaglia F Quartarone A Rizzo V et al Early impairment of synaptic plasticity in patients with Downs syndrome

Neurobiol Aging 2008 Aug29(8)1272-5

Bonnier C Evaluation of early stimulation programs for enhancing brain development Acta Paediatr 2008

Jul97(7)853-8

Morice E Andreae LC Cooke SF et al Preservation of long-term memory and synaptic plasticity despite short-term

impairments in the Tc1 mouse model of Down syndrome Learn Mem 2008 Jul 1415(7)492-500

Gordon AM Schneider JA Chinnan A Charles JR Efficacy of a hand-arm bimanual intensive therapy (HABIT) in

children with hemiplegic cerebral palsy a randomized control trial Dev Med Child Neurol 2007 Nov49(11)830-8

Kapoor N Ciuffreda KJ Vision disturbances following traumatic brain injury Curr Treat Options Neurol 2002

Jul4(4)271-80

80

Ciuffreda KJ Rutner D Kapoor N et al Vision therapy for oculomotor dysfunctions in acquired brain injury a

retrospective analysis Optometry 2008 Jan79(1)18-22

Ciuffreda KJ Han Y Kapoor N Ficarra AP Oculomotor rehabilitation for reading in acquired brain injury

NeuroRehabilitation 200621(1)9-21

Zost M Diagnosis and management of visual dysfunction in cerebral injury In Maino D (ed) Diagnosis and

Management of Special Populations Mosby-Yearbook Inc St Louis 199579 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001 [Figure used with permission of the editor]

DeGutis JM Bentin S Robertson LC DEsposito M Functional plasticity in ventral temporal cortex following

cognitive rehabilitation of a congenital prosopagnosic J Cogn Neurosci 2007 Nov19 (11)1790-802

Welbourne SR Ralph MA Exploring the impact of plasticity-related recovery after brain damage in a connectionist

model of single-word reading Cogn Affect Behav Neurosci 2005 Mar5(1)77-92

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements prevent cognitive decline A

systematic review of randomized controlled trials J Hum Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among preterm infants attributable to early

supplementation of human milk with docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings and structural-functional

synergies with cell membrane phospholipids Altern Med Rev 2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function Neuroscience 20089(7)568-78

81

Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

BMC Biol 2008 Sep 9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine improves neuropsychological disorders in a child with

creatine transporter defect Neurocase 200814(2) 151-61

Forrester LW Wheaton LA Luft AR Exercise-mediated locomotor recovery and lower-limb neuroplasticity after

stroke J Rehabil Res Dev 200845(2)205-20

82

Page 45: Neuroplasticity: A Paradigm Sea Change Latest Updated File

VII Vision dysfunction association with acquired brain injury

Increased sensitivity to visual motion

Visual inattention and distractibility

Short-term visual memory loss

Difficulty judging distances (relative and absolute

Difficulty with global scanning

Difficulty with personal grooming especially involving the face

Inability to interactcope visually in a complex social situation

(eg minimal eye contact)

Inability to tolerate complex visual environments (eg grocery store

aisles and highly-patterned floors)

45

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Ciuffreda KJ Ludlam DP Kapoor N Clinical oculomotor training in traumatic brain injury Optom Vis

Dev 200940(1)16-23

Individuals with traumatic brain injury present with a constellation of

oculomotor dysfunctions and correlated symptoms Simple and

effective clinical oculomotor-based training procedures will be

presented with respect to the versional vergence and

accommodative systems and their interactions These therapeutic

procedures can also be applied as needed to individuals with either

low vision neurological dysfunctions or general visual skills cases

manifesting similar oculomotor deficits

46

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Leslie S Myopia and accommodative insufficiency associated with

moderate head trauma Opt Vis Dev 200940(1)25-31

The majority of subjects reviewed had developed a stable degree of

myopia between 100 and 200 diopters as well as an abnormally

high lag of accommodation When their distance and near spatial area

of focus was compared the majority were focused at an intermediate

area in space suggesting a loss of control of accommodation in

space

47

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

B Drugs

C Exercise

D Learning new and challenging things

48

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements

prevent cognitive decline A systematic review of randomized controlled trials J Hum

Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among

preterm infants attributable to early supplementation of human milk with

docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings

and structural-functional synergies with cell membrane phospholipids Altern Med Rev

2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function

Neuroscience 20089(7)568-78

49

VIII Improving Brain Function and Neuroplasticity

B Drugs Maya Vetencourt JF Sale A Viegi A et al The antidepressant

fluoxetine (PROZAC) restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the

antidepressant tianeptine CNS Drugs 200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances

hippocampal long-term potentiation and memory BMC Biol 2008 Sep

9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine

improves neuropsychological disorders in a child with creatine

transporter defect Neurocase 200814(2) 151-61

50

VIII Improving Brain Function and Neuroplasticity

C Exercise

Hunsberger JG et al Antidepressant actions of the exercise-

regulated gene VGF Nat Med 2007 Dec 2 131476

VGF may be a common pathway by which exercise induces

neuroplasticity and growth-factor genes at least one of these might act

similarly to antidepressants in promoting an adaptive response to stress

However the tests used here may be modeling stress-induced

helplessness not depression hellipexercise seems to induce multiple

interacting genes that enhance neuronal resilience

51

VIII Improving Brain Function and Neuroplasticity

D Learning new and challenging things

What have we (optometry amp ophthalmology)

been thinking all these years

Where did we miss the news about neuroplasticity

52

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Huang JC Neuroplasticity as a proposed mechanism for the efficacy of optometric vision therapy and rehabilitation J Bev Optom 200920(4)96-100

Homologous area adaptationCompensatory masqueradeCross-modal reassignment

Map expansion

EquipotentialityVicariation

53

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Homologous area adaptation a transfer of function from a damaged brain area to a non-damaged brain area May be limited to early stages of human development and may crowd a new brain area resulting in reduced functionality of that brain area (Competition between spatial amp verbal functioning)

54

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Compensatory masquerade reorganizing of existing neuro-pathways to us alternative cognitive strategies to perform a task

55

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Cross-modal reassignment using new sensory input in a brain structure deprived of its main input source (changing processing from visual to tactile stimuli in the blind)

56

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Map expansion increase in brain mass due to repeated behavior or exposure to stimuli

57

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Equipotentiality anatomical areas of the brain can perform disparate functions

Vicariation redundant neural systems can operate under abnormal conditions

This may explain why recovery is noted for many neurological conditions (degenerative psychiatric developmental vascular traumatic)

58

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Constraint therapy Use it and improve it

Patching penalization ldquonear activitiesrdquo during amblyopia therapy

59

IX Improving Brain Function and Neuroplasticity Optometric Clinical ApplicationsOptometric Vision Therapy

Kleim amp Jones

Use it or lose it If you do not drive specific brain functions

functional loss will occur

If you want to improve oculomotor brain neuroplastic function amp

structure therapy should be specific for that brain function

Use it and improve it Therapy that drives cortical function enhances

that particular function

If you use therapy to improve oculomotor dysfunction it should

improve

Specificity The therapy you choose determines the resultant

plasticity and function

You must choose therapy that is appropriate

60

IX Improving Brain Function and Neuroplasticity Optometric Clinical Applications

Kleim amp Jones

Repetition matters Plasticity that results in functional change

requires repetition

Do the therapy Do it again Do it yet again No quick fix

Intensity matters Induction of plasticity requires the appropriate

amount of intensity

Intensity means strength force concentration power and passion

Without these plasticity may not occur Function may not improve

Time matters Different forms of plasticity take place at different

times during therapy

Do the basics than the more advanced therapeutic procedures

61

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Salience matters It has to be important to the individual

Make the therapy matter to the patient

Age matters Plasticity is easier in a younger brain but is also

possible in an adult brain

Do not let age determine what therapy options you offer your

patients Think of Susan Barry PhD (StereoSue) and her success

Offer your patients options Let them choose Be realistic about

outcomeshelliphave outcome measures built into therapy program

62

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Transference Neuroplasticity and the change in function

that results from one therapy can augment the attainment

of similar behaviors

What you do during oculomotor therapy may affected

vergence therapy outcomes

Interference Plasticity in response to one experience can

interfere with the acquisition of other behaviors

Monitor Evaluate progress Discuss function in other areas

of your patientslsquo life

63

Why pay attention to binocular vision dysfunctions

and neuroplasticity

December 2009 issue of the Review of Optometry

The Binocular Vision Dysfunction Pandemic

In 2010 almost 170 million individuals will be wearing glasses In

2010 there will also be up to 93 million amblyopes and 12 and a half

million strabismics For children under 18 years of age that means

there will be more than 22 and a half million amblyopes and millions

of children with strabismus A clinical trial to determine the

prevalence of binocular vision dysfunction within the general

population suggested the possibility of up to 56 or 173 million men

women and children with symptoms associated with a binocular

vision dysfunction 189 million (61) with accommodative problems

and 118 million (38) demonstrating various vergence

anomalies

64

65

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Brain plasticity life long changes in the structure of the brain

Sensory substitution replacement of one sensory input by another

Measurement techniques

Voxel based morphometryhellipmeasures difference in brain volume

Fluorodeoxyglucose glucose analog PET scan tells you

distribution and metabolism of brain

Cortical thickness measures

Visual cortex of the blind turns somatic ―The eye of the tongue

Transcranial magnetic stmiulation non-invasive technique to

stimulate cortex

66

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Blind Braille readers report tingling in fingers when pressure

phosphenes are applied Blind feel tingling in tongue

Bind use tongue to perform orientation task motion perception

sensory perception Visual cortex recruited in a variety of sensory

and cognitive tasks (DM Can we use tongue as a VT tool)

Dilks Reorganizations of human adult visual system

When a region of sensory cortex is deprived of its bottom up

input the deprived region begins to respond to stimuli that

normally activate adjacent cortex

67

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Retinotopic map changes for stroke pts Cortical reorganization in

adults occurs Perceived objectshellipelongation in stroke amp AMD

What happens to deprived cortex in AMD

fMRI shows cortical reorganization in adults

Proposed mechanisms

hellipGrowth of new connections

hellipUnmasking of pre-existing connections this is true

happens within seconds

Bavelier

Action video games

68

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Bavelier

Action video games Looked at attention Gamers can track more

activities

Attention over space (me peripheral awarenress) Useful field

of view shrinks with age

Performance not VA relatedhellipis related to attention

Action game playing changes spatial resolutionhellipovercoming

crowding in VA assessment (me amblyopia therapy)

Temporal resolution of vision Backward masking

changehellipbrain changes

Visual sensitivity (contrast sensitivity) Post action game training

improves CSF

69

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Action video games correcting optics of the cortex (me this is

actualy OVT)

Games factor

Variable entry leanringhellipadapt task to skill level

Incremental learning tune task to subjectlsquos leanring steps

Motivationarousal

Rewards

Self masterself confidence

Action games factors

Pacingrate of exposure to infohellipincreasing processing speed

Dynamic display

Rich environment

Rich motor involvement

70

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Surgeons may be made to play action games

Pilot training

Amblyopia tx Dennis Levi research

PresenterTitle Contact info

Neuroplasticity-A Paradigm Sea Change

This presentation is available at

httpwwwslidesharenetDMAINOneuroplasticity-a-paradigm-sea-change-2459693

httpwwwmainosmemosblogspotcom

My FaceBook Page

and

Twitter

PresenterTitle Contact info

Questions About

Neuroplasticity-A Paradigm Sea Change

Dominick M Maino OD MEd FAAO FCOVD-A

Professor PediatricsBinocular VisionIllinois Eye InstituteIllinois College of Optometry

dmainoicoeduhttpwwwMainosMemosblogspotcom

Thanks to

httpwwwcovdorgHomeOVDJournalOVD401tabid263D

efaultaspx

httpbipolarblastfileswordpresscom200908neurojpg

httpwwwspecialcheerscomimagesanimated_braingif

httpblogmarsdencartoonscomwp-

contentuploads200810frankenstein-myspace-lightbeergif

httpwwwshangralafamilyfuncomgala-ecalvindreamgif

httppsychiatryjwatchorgcgicontentfull20082251

73

Chakraborty R Chatterjee A Choudhart S Chakraborty PK Neuroplasticitymdasha paradigm shift in neurosciences J Indian Med Assoc

2007105(9)513-4516-8520-1

Sacks O A neurologistlsquos notebook Stereo Sue Why two eyes are better than one The New Yorker 2006 Jun 1964-73

Krulwich R National Public Radio Going Binocular Susanlsquos First Snowfall Available at

wwwnprorgtemplatesstorystoryphpstoryId=5507789 (Accessed December 8 2008)

Press LJ The story behind Stereo Suelsquo and a world-famous neurologistlsquos discovery of vision therapy Optom Vis Dev 200637(2) 55-7

Levin HS Neuroplasticity and brain imaging research implications for rehabilitation Arch Phys Med Rehabil 2006 Dec87(12 Suppl

2)S1

Wiesel TN Hubel DH Single-cell responses in striate cortex of kittens deprived of vision in one eye J Neurophysiol 1963

Nov261003-17

Hook BM Chen C Critical periods in the visual system Changing views for a model of experience-dependent plasticity Neuron 2007

Oct56(2)312-26

Ramey CT Ramey SL Prevention of intellectual disabilities early interventions to improve cognitive development Prev Med 1998

Mar-Apr27(2)224-32

Heuninckx S Wenderoth N Swinnen SP Systems neuroplasticity in the aging brain recruiting additional neural resources for

successful motor performance in elderly persons J Neurosci 2008 Jan 228(1)91-9

Ge S Yang CH Hsu KS et al A critical period for enhanced synaptic plasticity in newly generated neurons of the adult brain Neuron

2007 May54(4)559-66

74

Draganski B Gaser C Busch V et al Neuroplasticity changes in grey matter induced by training Nature 2004 Jan 22427(6972)

311-2

Cannonieri GC Bonilha L Fernandes PT et al Practice and perfect length of training and structural brain changes in experienced

typists Neuroreport 2007 Jul 218(10)1063-6

Kleim JA Jones TA Principles of experience-dependent neural plasticity implications for rehabilitation after brain damage J

Speech Lang Hear Res 2008 Feb51(1)S225-39

Trojan S Porkorny J Theoretical aspects of neuroplasticity Physiol Res 199948(2)87-97

Ramamirtham R Kee CS Hung LF et al Wave aberrations in rhesus monkeys with vision-induced ametropias Vision Res 2007

Sep47(21)2751-66

Smith EL 3rd Ramamirtham R Qiao-Grider Y et al Effects of foveal ablation on emmetropization and form-deprivation myopia

Invest Ophthalmol Vis Sci 2007 Sep48(9)3914-22

Smith EL 3rd Kee CS Ramamirtham R et al Peripheral vision can influence eye growth and refractive development in infant

monkeys Invest Ophthalmol Vis Sci 2005 Nov46(11)3965-72

Ciuffreda KJ Vasudevan B Nearwork-induced transient myopia (NITM) and permanent myopiandashndashis there a link Ophthalmic

Physiol Opt 2008 Mar28(2)103-14

Hung GK Ciuffreda KJ Incremental retinal-defocus theory of myopia development--schematic analysis and computer simulation

Comput Biol Med 2007 Jul37(7)930-46

Hung GK Ciuffreda KJ A unifying theory of refractive error development Bull Math Biol 2000 Nov62(6)1087-108

75

Pang Y Maino D Zhang G Lu F Myopia Can its progress be controlled Optom Vis Dev 200637(2)75-9

Leung JT Brown B Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lenses Optom Vis Sci

1999 Jun76(6)346-54

Hasebe S Ohtsuki H Nonaka T et al Effect of progressive addition lenses on myopia progression in Japanese children a prospective

randomized double-masked crossover trial Invest Ophthalmol Vis Sci 2008 Jul49(7)2781-9

Gwiazda J Hyman L Hussein M et al A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression

of myopia in children Invest Ophthalmol Vis Sci 2003 Apr44(4)1492-500

Siatkowski RM Cotter SA Crockett RS et al Two-year multi-center randomized double-masked placebo-controlled parallel safety and

efficacy study of 2 pirenzepine ophthalmic gel in children with myopia J AAPOS 2008 Aug12(4)332-9

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged 7 to 17 years Arch Ophthalmol 2005

Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three to less than 10 years of age Am J

Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction Am J Ophthalmol 2007

Jun143(6)1060-3

Holmes JM Edwards AR Beck RW et al A randomized pilot study of near activities versus non-near activities during patching therapy for

amblyopia J AAPOS 2005 Apr9(2)129-36

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate

amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-57

76

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic

amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Convergence Insufficiency Treatment Trial Study Group Randomized clinical trial of treatments for symptomatic convergence insufficiency

in children Arch Ophthalmol 2008 Oct126(10)1336-49

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

Solan HA Shelley-Tremblay J Hansen PC et al M-cell deficit and reading disability a preliminary study of the effects of temporal vision-

processing therapy Optometry 2004 Oct75(10)640-50

Solan HA Larson S Shelley-Tremblay J et al Role of visual attention in cognitive control of oculomotor readiness in students with reading

disabilities J Learn Disabil 2001 Mar-Apr34(2)107-18

Gallaway M Boas MB The impact of vergence and accommodative therapy on reading eye movements and reading speed Optom Vis Dev

200738(3)115-20

Goss DA Downing DB Lowther AH et al The effect of HTS vision therapy conducted in a school setting on reading skills in third and

fourth grade students Optom Vis Dev 200738(1)27-32

Crutch SJ Warrington EK Foveal crowding in posterior cortical atrophy a specific early-visual-processing deficit affecting word reading

Cogn Neuropsychol 2007 Dec24(8)843-66

Helms D Sawtelle SM A study of the effectiveness of cognitive therapy delivered in a video game format Optom Vis Dev 200738 (1)19-

26

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

77

Lawton T Training direction-discrimination sensitivity remediates a wide spectrum of reading skills OptomVis Dev 200738(1) 33-47

Goldstand S Koslowe KC Parush S Vision visual-information processing and academic performance among seventh-grade schoolchildren a

more significant relationship than we thought Am J Occup Ther 2005 Jul-Aug59(4)377-89

Fischer B Koumlngeter A Hartnegg K Effects of daily practice on subitizing visual counting and basic arithmetic skills Optom Vis Dev

200839(1)30-4

Sands W Taub M Maino D Limited research and education on special populations in optometry and ophthalomology Optom Vis Dev

200839(2)60-1

Wesson M Maino D Oculo-visual findings in Down syndrome cerebral palsy and mental retardation with non-specific etiology In Maino D

(ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 199517-54 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

Cui Y Stapleton F Suttle C Developing an instrument to assess vision-related and subjective quality of life in children with intellectual

disability data collection and preliminary analysis in a Chinese population Ophthal Physiolog Optics 2008 May28(3) 238-46

Maino D Steele G Tahir S Sajja R Attitudes of optometry students toward individuals with disabilities Optom Ed 200227(2)45-50

Maino D Special populations in the optometric curriculum Optom Ed 200227(2)38-9

Maino D Overview of special populations In Scheiman M Rouse M (eds) Optometric Management of Learning-Related Vision Problems

St Louis Mosby Inc 200685-106

Maino D (ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 1995 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

78

McCarthy P Maino D Alport syndrome a review Clin Eye Vis Care 2000 Dec12(3-4)139-50

Block SS Brusca-Vega R Pizzi WJ et al Cognitive and visual processing skills and their relationship to mutation size in full and

permutation female fragile X carriers Optom Vis Sci 2000 Nov77 (11)592-9

Maino D The young child with developmental disabilities An introduction to mental retardation and genetic syndromes In Moore BD

(ed) Eye Care for Infants and Young Children Butter-worth--Heinemann Newton MA1997285-300

Amin V Maino D The Fragile X female Visual visual perceptual and ocular health anomalies J Am Optom Assoc 1995 May66

(5)290-95

Maino DM Maino JH Cibis GW Hecht F Ocular health anomalies in patients with developmental disabilities In Maino D (ed)

Diagnosis and Management of Special Populations Mosby-Year-book Inc St Louis MO 1995189-206 Reprinted Optometric

Education Program Foundation Santa Anna Calif 2001

Maino D Wesson M Schlange D Cibis G Maino J Optometric findings in the fragile X syndrome Optom Vis Sci 199168634-40

Scheiman MMOptometric findings in children with cerebral palsy Am J Optom Physiol Opt 1984 May61(5)321-3

Maino D Maino J Maino S Mental retardation syndromes with associated ocular defects J Am Optom Assoc 199061707-16

Stewart RE Woodhouse JM Cregg M Pakeman VH Association between accommodative accuracy hypermetropia and strabismus in

children with Downs syndrome Optom Vis Sci 2007 Feb84(2)149-55

Cregg M Woodhouse JM Pakeman VH et al Accommodation and refractive error in children with Down syndrome cross-sectional

and longitudinal studies Invest Ophthalmol Vis Sci 2001 Jan42 (1)55-63

79

McClelland JF Parkes J Hill N et al Accommodative dysfunction in children with cerebral palsy a population-

based study Invest Ophthalmol Vis Sci 2006 May47(5)1824-30

Duckman RH Vision therapy for the child with cerebral palsy J Am Optom Assoc 198758(1)28-35

Duckman R Accommodation in cerebral palsy function and remediation J Am Optom Assoc 198455(4)281-3

Scheiman M Understanding and managing vision deficits a guide for occupational therapists 2nd ed Slack

Thorofare NJ 2002

Maino D Binasal occlusion for the child with Cerebral Palsy J Ill Optom Assoc 198644(1)1218

Battaglia F Quartarone A Rizzo V et al Early impairment of synaptic plasticity in patients with Downs syndrome

Neurobiol Aging 2008 Aug29(8)1272-5

Bonnier C Evaluation of early stimulation programs for enhancing brain development Acta Paediatr 2008

Jul97(7)853-8

Morice E Andreae LC Cooke SF et al Preservation of long-term memory and synaptic plasticity despite short-term

impairments in the Tc1 mouse model of Down syndrome Learn Mem 2008 Jul 1415(7)492-500

Gordon AM Schneider JA Chinnan A Charles JR Efficacy of a hand-arm bimanual intensive therapy (HABIT) in

children with hemiplegic cerebral palsy a randomized control trial Dev Med Child Neurol 2007 Nov49(11)830-8

Kapoor N Ciuffreda KJ Vision disturbances following traumatic brain injury Curr Treat Options Neurol 2002

Jul4(4)271-80

80

Ciuffreda KJ Rutner D Kapoor N et al Vision therapy for oculomotor dysfunctions in acquired brain injury a

retrospective analysis Optometry 2008 Jan79(1)18-22

Ciuffreda KJ Han Y Kapoor N Ficarra AP Oculomotor rehabilitation for reading in acquired brain injury

NeuroRehabilitation 200621(1)9-21

Zost M Diagnosis and management of visual dysfunction in cerebral injury In Maino D (ed) Diagnosis and

Management of Special Populations Mosby-Yearbook Inc St Louis 199579 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001 [Figure used with permission of the editor]

DeGutis JM Bentin S Robertson LC DEsposito M Functional plasticity in ventral temporal cortex following

cognitive rehabilitation of a congenital prosopagnosic J Cogn Neurosci 2007 Nov19 (11)1790-802

Welbourne SR Ralph MA Exploring the impact of plasticity-related recovery after brain damage in a connectionist

model of single-word reading Cogn Affect Behav Neurosci 2005 Mar5(1)77-92

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements prevent cognitive decline A

systematic review of randomized controlled trials J Hum Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among preterm infants attributable to early

supplementation of human milk with docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings and structural-functional

synergies with cell membrane phospholipids Altern Med Rev 2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function Neuroscience 20089(7)568-78

81

Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

BMC Biol 2008 Sep 9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine improves neuropsychological disorders in a child with

creatine transporter defect Neurocase 200814(2) 151-61

Forrester LW Wheaton LA Luft AR Exercise-mediated locomotor recovery and lower-limb neuroplasticity after

stroke J Rehabil Res Dev 200845(2)205-20

82

Page 46: Neuroplasticity: A Paradigm Sea Change Latest Updated File

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Ciuffreda KJ Ludlam DP Kapoor N Clinical oculomotor training in traumatic brain injury Optom Vis

Dev 200940(1)16-23

Individuals with traumatic brain injury present with a constellation of

oculomotor dysfunctions and correlated symptoms Simple and

effective clinical oculomotor-based training procedures will be

presented with respect to the versional vergence and

accommodative systems and their interactions These therapeutic

procedures can also be applied as needed to individuals with either

low vision neurological dysfunctions or general visual skills cases

manifesting similar oculomotor deficits

46

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Leslie S Myopia and accommodative insufficiency associated with

moderate head trauma Opt Vis Dev 200940(1)25-31

The majority of subjects reviewed had developed a stable degree of

myopia between 100 and 200 diopters as well as an abnormally

high lag of accommodation When their distance and near spatial area

of focus was compared the majority were focused at an intermediate

area in space suggesting a loss of control of accommodation in

space

47

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

B Drugs

C Exercise

D Learning new and challenging things

48

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements

prevent cognitive decline A systematic review of randomized controlled trials J Hum

Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among

preterm infants attributable to early supplementation of human milk with

docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings

and structural-functional synergies with cell membrane phospholipids Altern Med Rev

2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function

Neuroscience 20089(7)568-78

49

VIII Improving Brain Function and Neuroplasticity

B Drugs Maya Vetencourt JF Sale A Viegi A et al The antidepressant

fluoxetine (PROZAC) restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the

antidepressant tianeptine CNS Drugs 200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances

hippocampal long-term potentiation and memory BMC Biol 2008 Sep

9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine

improves neuropsychological disorders in a child with creatine

transporter defect Neurocase 200814(2) 151-61

50

VIII Improving Brain Function and Neuroplasticity

C Exercise

Hunsberger JG et al Antidepressant actions of the exercise-

regulated gene VGF Nat Med 2007 Dec 2 131476

VGF may be a common pathway by which exercise induces

neuroplasticity and growth-factor genes at least one of these might act

similarly to antidepressants in promoting an adaptive response to stress

However the tests used here may be modeling stress-induced

helplessness not depression hellipexercise seems to induce multiple

interacting genes that enhance neuronal resilience

51

VIII Improving Brain Function and Neuroplasticity

D Learning new and challenging things

What have we (optometry amp ophthalmology)

been thinking all these years

Where did we miss the news about neuroplasticity

52

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Huang JC Neuroplasticity as a proposed mechanism for the efficacy of optometric vision therapy and rehabilitation J Bev Optom 200920(4)96-100

Homologous area adaptationCompensatory masqueradeCross-modal reassignment

Map expansion

EquipotentialityVicariation

53

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Homologous area adaptation a transfer of function from a damaged brain area to a non-damaged brain area May be limited to early stages of human development and may crowd a new brain area resulting in reduced functionality of that brain area (Competition between spatial amp verbal functioning)

54

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Compensatory masquerade reorganizing of existing neuro-pathways to us alternative cognitive strategies to perform a task

55

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Cross-modal reassignment using new sensory input in a brain structure deprived of its main input source (changing processing from visual to tactile stimuli in the blind)

56

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Map expansion increase in brain mass due to repeated behavior or exposure to stimuli

57

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Equipotentiality anatomical areas of the brain can perform disparate functions

Vicariation redundant neural systems can operate under abnormal conditions

This may explain why recovery is noted for many neurological conditions (degenerative psychiatric developmental vascular traumatic)

58

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Constraint therapy Use it and improve it

Patching penalization ldquonear activitiesrdquo during amblyopia therapy

59

IX Improving Brain Function and Neuroplasticity Optometric Clinical ApplicationsOptometric Vision Therapy

Kleim amp Jones

Use it or lose it If you do not drive specific brain functions

functional loss will occur

If you want to improve oculomotor brain neuroplastic function amp

structure therapy should be specific for that brain function

Use it and improve it Therapy that drives cortical function enhances

that particular function

If you use therapy to improve oculomotor dysfunction it should

improve

Specificity The therapy you choose determines the resultant

plasticity and function

You must choose therapy that is appropriate

60

IX Improving Brain Function and Neuroplasticity Optometric Clinical Applications

Kleim amp Jones

Repetition matters Plasticity that results in functional change

requires repetition

Do the therapy Do it again Do it yet again No quick fix

Intensity matters Induction of plasticity requires the appropriate

amount of intensity

Intensity means strength force concentration power and passion

Without these plasticity may not occur Function may not improve

Time matters Different forms of plasticity take place at different

times during therapy

Do the basics than the more advanced therapeutic procedures

61

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Salience matters It has to be important to the individual

Make the therapy matter to the patient

Age matters Plasticity is easier in a younger brain but is also

possible in an adult brain

Do not let age determine what therapy options you offer your

patients Think of Susan Barry PhD (StereoSue) and her success

Offer your patients options Let them choose Be realistic about

outcomeshelliphave outcome measures built into therapy program

62

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Transference Neuroplasticity and the change in function

that results from one therapy can augment the attainment

of similar behaviors

What you do during oculomotor therapy may affected

vergence therapy outcomes

Interference Plasticity in response to one experience can

interfere with the acquisition of other behaviors

Monitor Evaluate progress Discuss function in other areas

of your patientslsquo life

63

Why pay attention to binocular vision dysfunctions

and neuroplasticity

December 2009 issue of the Review of Optometry

The Binocular Vision Dysfunction Pandemic

In 2010 almost 170 million individuals will be wearing glasses In

2010 there will also be up to 93 million amblyopes and 12 and a half

million strabismics For children under 18 years of age that means

there will be more than 22 and a half million amblyopes and millions

of children with strabismus A clinical trial to determine the

prevalence of binocular vision dysfunction within the general

population suggested the possibility of up to 56 or 173 million men

women and children with symptoms associated with a binocular

vision dysfunction 189 million (61) with accommodative problems

and 118 million (38) demonstrating various vergence

anomalies

64

65

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Brain plasticity life long changes in the structure of the brain

Sensory substitution replacement of one sensory input by another

Measurement techniques

Voxel based morphometryhellipmeasures difference in brain volume

Fluorodeoxyglucose glucose analog PET scan tells you

distribution and metabolism of brain

Cortical thickness measures

Visual cortex of the blind turns somatic ―The eye of the tongue

Transcranial magnetic stmiulation non-invasive technique to

stimulate cortex

66

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Blind Braille readers report tingling in fingers when pressure

phosphenes are applied Blind feel tingling in tongue

Bind use tongue to perform orientation task motion perception

sensory perception Visual cortex recruited in a variety of sensory

and cognitive tasks (DM Can we use tongue as a VT tool)

Dilks Reorganizations of human adult visual system

When a region of sensory cortex is deprived of its bottom up

input the deprived region begins to respond to stimuli that

normally activate adjacent cortex

67

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Retinotopic map changes for stroke pts Cortical reorganization in

adults occurs Perceived objectshellipelongation in stroke amp AMD

What happens to deprived cortex in AMD

fMRI shows cortical reorganization in adults

Proposed mechanisms

hellipGrowth of new connections

hellipUnmasking of pre-existing connections this is true

happens within seconds

Bavelier

Action video games

68

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Bavelier

Action video games Looked at attention Gamers can track more

activities

Attention over space (me peripheral awarenress) Useful field

of view shrinks with age

Performance not VA relatedhellipis related to attention

Action game playing changes spatial resolutionhellipovercoming

crowding in VA assessment (me amblyopia therapy)

Temporal resolution of vision Backward masking

changehellipbrain changes

Visual sensitivity (contrast sensitivity) Post action game training

improves CSF

69

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Action video games correcting optics of the cortex (me this is

actualy OVT)

Games factor

Variable entry leanringhellipadapt task to skill level

Incremental learning tune task to subjectlsquos leanring steps

Motivationarousal

Rewards

Self masterself confidence

Action games factors

Pacingrate of exposure to infohellipincreasing processing speed

Dynamic display

Rich environment

Rich motor involvement

70

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Surgeons may be made to play action games

Pilot training

Amblyopia tx Dennis Levi research

PresenterTitle Contact info

Neuroplasticity-A Paradigm Sea Change

This presentation is available at

httpwwwslidesharenetDMAINOneuroplasticity-a-paradigm-sea-change-2459693

httpwwwmainosmemosblogspotcom

My FaceBook Page

and

Twitter

PresenterTitle Contact info

Questions About

Neuroplasticity-A Paradigm Sea Change

Dominick M Maino OD MEd FAAO FCOVD-A

Professor PediatricsBinocular VisionIllinois Eye InstituteIllinois College of Optometry

dmainoicoeduhttpwwwMainosMemosblogspotcom

Thanks to

httpwwwcovdorgHomeOVDJournalOVD401tabid263D

efaultaspx

httpbipolarblastfileswordpresscom200908neurojpg

httpwwwspecialcheerscomimagesanimated_braingif

httpblogmarsdencartoonscomwp-

contentuploads200810frankenstein-myspace-lightbeergif

httpwwwshangralafamilyfuncomgala-ecalvindreamgif

httppsychiatryjwatchorgcgicontentfull20082251

73

Chakraborty R Chatterjee A Choudhart S Chakraborty PK Neuroplasticitymdasha paradigm shift in neurosciences J Indian Med Assoc

2007105(9)513-4516-8520-1

Sacks O A neurologistlsquos notebook Stereo Sue Why two eyes are better than one The New Yorker 2006 Jun 1964-73

Krulwich R National Public Radio Going Binocular Susanlsquos First Snowfall Available at

wwwnprorgtemplatesstorystoryphpstoryId=5507789 (Accessed December 8 2008)

Press LJ The story behind Stereo Suelsquo and a world-famous neurologistlsquos discovery of vision therapy Optom Vis Dev 200637(2) 55-7

Levin HS Neuroplasticity and brain imaging research implications for rehabilitation Arch Phys Med Rehabil 2006 Dec87(12 Suppl

2)S1

Wiesel TN Hubel DH Single-cell responses in striate cortex of kittens deprived of vision in one eye J Neurophysiol 1963

Nov261003-17

Hook BM Chen C Critical periods in the visual system Changing views for a model of experience-dependent plasticity Neuron 2007

Oct56(2)312-26

Ramey CT Ramey SL Prevention of intellectual disabilities early interventions to improve cognitive development Prev Med 1998

Mar-Apr27(2)224-32

Heuninckx S Wenderoth N Swinnen SP Systems neuroplasticity in the aging brain recruiting additional neural resources for

successful motor performance in elderly persons J Neurosci 2008 Jan 228(1)91-9

Ge S Yang CH Hsu KS et al A critical period for enhanced synaptic plasticity in newly generated neurons of the adult brain Neuron

2007 May54(4)559-66

74

Draganski B Gaser C Busch V et al Neuroplasticity changes in grey matter induced by training Nature 2004 Jan 22427(6972)

311-2

Cannonieri GC Bonilha L Fernandes PT et al Practice and perfect length of training and structural brain changes in experienced

typists Neuroreport 2007 Jul 218(10)1063-6

Kleim JA Jones TA Principles of experience-dependent neural plasticity implications for rehabilitation after brain damage J

Speech Lang Hear Res 2008 Feb51(1)S225-39

Trojan S Porkorny J Theoretical aspects of neuroplasticity Physiol Res 199948(2)87-97

Ramamirtham R Kee CS Hung LF et al Wave aberrations in rhesus monkeys with vision-induced ametropias Vision Res 2007

Sep47(21)2751-66

Smith EL 3rd Ramamirtham R Qiao-Grider Y et al Effects of foveal ablation on emmetropization and form-deprivation myopia

Invest Ophthalmol Vis Sci 2007 Sep48(9)3914-22

Smith EL 3rd Kee CS Ramamirtham R et al Peripheral vision can influence eye growth and refractive development in infant

monkeys Invest Ophthalmol Vis Sci 2005 Nov46(11)3965-72

Ciuffreda KJ Vasudevan B Nearwork-induced transient myopia (NITM) and permanent myopiandashndashis there a link Ophthalmic

Physiol Opt 2008 Mar28(2)103-14

Hung GK Ciuffreda KJ Incremental retinal-defocus theory of myopia development--schematic analysis and computer simulation

Comput Biol Med 2007 Jul37(7)930-46

Hung GK Ciuffreda KJ A unifying theory of refractive error development Bull Math Biol 2000 Nov62(6)1087-108

75

Pang Y Maino D Zhang G Lu F Myopia Can its progress be controlled Optom Vis Dev 200637(2)75-9

Leung JT Brown B Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lenses Optom Vis Sci

1999 Jun76(6)346-54

Hasebe S Ohtsuki H Nonaka T et al Effect of progressive addition lenses on myopia progression in Japanese children a prospective

randomized double-masked crossover trial Invest Ophthalmol Vis Sci 2008 Jul49(7)2781-9

Gwiazda J Hyman L Hussein M et al A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression

of myopia in children Invest Ophthalmol Vis Sci 2003 Apr44(4)1492-500

Siatkowski RM Cotter SA Crockett RS et al Two-year multi-center randomized double-masked placebo-controlled parallel safety and

efficacy study of 2 pirenzepine ophthalmic gel in children with myopia J AAPOS 2008 Aug12(4)332-9

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged 7 to 17 years Arch Ophthalmol 2005

Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three to less than 10 years of age Am J

Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction Am J Ophthalmol 2007

Jun143(6)1060-3

Holmes JM Edwards AR Beck RW et al A randomized pilot study of near activities versus non-near activities during patching therapy for

amblyopia J AAPOS 2005 Apr9(2)129-36

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate

amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-57

76

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic

amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Convergence Insufficiency Treatment Trial Study Group Randomized clinical trial of treatments for symptomatic convergence insufficiency

in children Arch Ophthalmol 2008 Oct126(10)1336-49

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

Solan HA Shelley-Tremblay J Hansen PC et al M-cell deficit and reading disability a preliminary study of the effects of temporal vision-

processing therapy Optometry 2004 Oct75(10)640-50

Solan HA Larson S Shelley-Tremblay J et al Role of visual attention in cognitive control of oculomotor readiness in students with reading

disabilities J Learn Disabil 2001 Mar-Apr34(2)107-18

Gallaway M Boas MB The impact of vergence and accommodative therapy on reading eye movements and reading speed Optom Vis Dev

200738(3)115-20

Goss DA Downing DB Lowther AH et al The effect of HTS vision therapy conducted in a school setting on reading skills in third and

fourth grade students Optom Vis Dev 200738(1)27-32

Crutch SJ Warrington EK Foveal crowding in posterior cortical atrophy a specific early-visual-processing deficit affecting word reading

Cogn Neuropsychol 2007 Dec24(8)843-66

Helms D Sawtelle SM A study of the effectiveness of cognitive therapy delivered in a video game format Optom Vis Dev 200738 (1)19-

26

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

77

Lawton T Training direction-discrimination sensitivity remediates a wide spectrum of reading skills OptomVis Dev 200738(1) 33-47

Goldstand S Koslowe KC Parush S Vision visual-information processing and academic performance among seventh-grade schoolchildren a

more significant relationship than we thought Am J Occup Ther 2005 Jul-Aug59(4)377-89

Fischer B Koumlngeter A Hartnegg K Effects of daily practice on subitizing visual counting and basic arithmetic skills Optom Vis Dev

200839(1)30-4

Sands W Taub M Maino D Limited research and education on special populations in optometry and ophthalomology Optom Vis Dev

200839(2)60-1

Wesson M Maino D Oculo-visual findings in Down syndrome cerebral palsy and mental retardation with non-specific etiology In Maino D

(ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 199517-54 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

Cui Y Stapleton F Suttle C Developing an instrument to assess vision-related and subjective quality of life in children with intellectual

disability data collection and preliminary analysis in a Chinese population Ophthal Physiolog Optics 2008 May28(3) 238-46

Maino D Steele G Tahir S Sajja R Attitudes of optometry students toward individuals with disabilities Optom Ed 200227(2)45-50

Maino D Special populations in the optometric curriculum Optom Ed 200227(2)38-9

Maino D Overview of special populations In Scheiman M Rouse M (eds) Optometric Management of Learning-Related Vision Problems

St Louis Mosby Inc 200685-106

Maino D (ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 1995 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

78

McCarthy P Maino D Alport syndrome a review Clin Eye Vis Care 2000 Dec12(3-4)139-50

Block SS Brusca-Vega R Pizzi WJ et al Cognitive and visual processing skills and their relationship to mutation size in full and

permutation female fragile X carriers Optom Vis Sci 2000 Nov77 (11)592-9

Maino D The young child with developmental disabilities An introduction to mental retardation and genetic syndromes In Moore BD

(ed) Eye Care for Infants and Young Children Butter-worth--Heinemann Newton MA1997285-300

Amin V Maino D The Fragile X female Visual visual perceptual and ocular health anomalies J Am Optom Assoc 1995 May66

(5)290-95

Maino DM Maino JH Cibis GW Hecht F Ocular health anomalies in patients with developmental disabilities In Maino D (ed)

Diagnosis and Management of Special Populations Mosby-Year-book Inc St Louis MO 1995189-206 Reprinted Optometric

Education Program Foundation Santa Anna Calif 2001

Maino D Wesson M Schlange D Cibis G Maino J Optometric findings in the fragile X syndrome Optom Vis Sci 199168634-40

Scheiman MMOptometric findings in children with cerebral palsy Am J Optom Physiol Opt 1984 May61(5)321-3

Maino D Maino J Maino S Mental retardation syndromes with associated ocular defects J Am Optom Assoc 199061707-16

Stewart RE Woodhouse JM Cregg M Pakeman VH Association between accommodative accuracy hypermetropia and strabismus in

children with Downs syndrome Optom Vis Sci 2007 Feb84(2)149-55

Cregg M Woodhouse JM Pakeman VH et al Accommodation and refractive error in children with Down syndrome cross-sectional

and longitudinal studies Invest Ophthalmol Vis Sci 2001 Jan42 (1)55-63

79

McClelland JF Parkes J Hill N et al Accommodative dysfunction in children with cerebral palsy a population-

based study Invest Ophthalmol Vis Sci 2006 May47(5)1824-30

Duckman RH Vision therapy for the child with cerebral palsy J Am Optom Assoc 198758(1)28-35

Duckman R Accommodation in cerebral palsy function and remediation J Am Optom Assoc 198455(4)281-3

Scheiman M Understanding and managing vision deficits a guide for occupational therapists 2nd ed Slack

Thorofare NJ 2002

Maino D Binasal occlusion for the child with Cerebral Palsy J Ill Optom Assoc 198644(1)1218

Battaglia F Quartarone A Rizzo V et al Early impairment of synaptic plasticity in patients with Downs syndrome

Neurobiol Aging 2008 Aug29(8)1272-5

Bonnier C Evaluation of early stimulation programs for enhancing brain development Acta Paediatr 2008

Jul97(7)853-8

Morice E Andreae LC Cooke SF et al Preservation of long-term memory and synaptic plasticity despite short-term

impairments in the Tc1 mouse model of Down syndrome Learn Mem 2008 Jul 1415(7)492-500

Gordon AM Schneider JA Chinnan A Charles JR Efficacy of a hand-arm bimanual intensive therapy (HABIT) in

children with hemiplegic cerebral palsy a randomized control trial Dev Med Child Neurol 2007 Nov49(11)830-8

Kapoor N Ciuffreda KJ Vision disturbances following traumatic brain injury Curr Treat Options Neurol 2002

Jul4(4)271-80

80

Ciuffreda KJ Rutner D Kapoor N et al Vision therapy for oculomotor dysfunctions in acquired brain injury a

retrospective analysis Optometry 2008 Jan79(1)18-22

Ciuffreda KJ Han Y Kapoor N Ficarra AP Oculomotor rehabilitation for reading in acquired brain injury

NeuroRehabilitation 200621(1)9-21

Zost M Diagnosis and management of visual dysfunction in cerebral injury In Maino D (ed) Diagnosis and

Management of Special Populations Mosby-Yearbook Inc St Louis 199579 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001 [Figure used with permission of the editor]

DeGutis JM Bentin S Robertson LC DEsposito M Functional plasticity in ventral temporal cortex following

cognitive rehabilitation of a congenital prosopagnosic J Cogn Neurosci 2007 Nov19 (11)1790-802

Welbourne SR Ralph MA Exploring the impact of plasticity-related recovery after brain damage in a connectionist

model of single-word reading Cogn Affect Behav Neurosci 2005 Mar5(1)77-92

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements prevent cognitive decline A

systematic review of randomized controlled trials J Hum Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among preterm infants attributable to early

supplementation of human milk with docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings and structural-functional

synergies with cell membrane phospholipids Altern Med Rev 2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function Neuroscience 20089(7)568-78

81

Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

BMC Biol 2008 Sep 9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine improves neuropsychological disorders in a child with

creatine transporter defect Neurocase 200814(2) 151-61

Forrester LW Wheaton LA Luft AR Exercise-mediated locomotor recovery and lower-limb neuroplasticity after

stroke J Rehabil Res Dev 200845(2)205-20

82

Page 47: Neuroplasticity: A Paradigm Sea Change Latest Updated File

VII Vision dysfunction association with acquired brain injury

Current ResearchLiterature ReviewsInternet Resources

Leslie S Myopia and accommodative insufficiency associated with

moderate head trauma Opt Vis Dev 200940(1)25-31

The majority of subjects reviewed had developed a stable degree of

myopia between 100 and 200 diopters as well as an abnormally

high lag of accommodation When their distance and near spatial area

of focus was compared the majority were focused at an intermediate

area in space suggesting a loss of control of accommodation in

space

47

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

B Drugs

C Exercise

D Learning new and challenging things

48

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements

prevent cognitive decline A systematic review of randomized controlled trials J Hum

Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among

preterm infants attributable to early supplementation of human milk with

docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings

and structural-functional synergies with cell membrane phospholipids Altern Med Rev

2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function

Neuroscience 20089(7)568-78

49

VIII Improving Brain Function and Neuroplasticity

B Drugs Maya Vetencourt JF Sale A Viegi A et al The antidepressant

fluoxetine (PROZAC) restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the

antidepressant tianeptine CNS Drugs 200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances

hippocampal long-term potentiation and memory BMC Biol 2008 Sep

9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine

improves neuropsychological disorders in a child with creatine

transporter defect Neurocase 200814(2) 151-61

50

VIII Improving Brain Function and Neuroplasticity

C Exercise

Hunsberger JG et al Antidepressant actions of the exercise-

regulated gene VGF Nat Med 2007 Dec 2 131476

VGF may be a common pathway by which exercise induces

neuroplasticity and growth-factor genes at least one of these might act

similarly to antidepressants in promoting an adaptive response to stress

However the tests used here may be modeling stress-induced

helplessness not depression hellipexercise seems to induce multiple

interacting genes that enhance neuronal resilience

51

VIII Improving Brain Function and Neuroplasticity

D Learning new and challenging things

What have we (optometry amp ophthalmology)

been thinking all these years

Where did we miss the news about neuroplasticity

52

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Huang JC Neuroplasticity as a proposed mechanism for the efficacy of optometric vision therapy and rehabilitation J Bev Optom 200920(4)96-100

Homologous area adaptationCompensatory masqueradeCross-modal reassignment

Map expansion

EquipotentialityVicariation

53

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Homologous area adaptation a transfer of function from a damaged brain area to a non-damaged brain area May be limited to early stages of human development and may crowd a new brain area resulting in reduced functionality of that brain area (Competition between spatial amp verbal functioning)

54

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Compensatory masquerade reorganizing of existing neuro-pathways to us alternative cognitive strategies to perform a task

55

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Cross-modal reassignment using new sensory input in a brain structure deprived of its main input source (changing processing from visual to tactile stimuli in the blind)

56

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Map expansion increase in brain mass due to repeated behavior or exposure to stimuli

57

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Equipotentiality anatomical areas of the brain can perform disparate functions

Vicariation redundant neural systems can operate under abnormal conditions

This may explain why recovery is noted for many neurological conditions (degenerative psychiatric developmental vascular traumatic)

58

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Constraint therapy Use it and improve it

Patching penalization ldquonear activitiesrdquo during amblyopia therapy

59

IX Improving Brain Function and Neuroplasticity Optometric Clinical ApplicationsOptometric Vision Therapy

Kleim amp Jones

Use it or lose it If you do not drive specific brain functions

functional loss will occur

If you want to improve oculomotor brain neuroplastic function amp

structure therapy should be specific for that brain function

Use it and improve it Therapy that drives cortical function enhances

that particular function

If you use therapy to improve oculomotor dysfunction it should

improve

Specificity The therapy you choose determines the resultant

plasticity and function

You must choose therapy that is appropriate

60

IX Improving Brain Function and Neuroplasticity Optometric Clinical Applications

Kleim amp Jones

Repetition matters Plasticity that results in functional change

requires repetition

Do the therapy Do it again Do it yet again No quick fix

Intensity matters Induction of plasticity requires the appropriate

amount of intensity

Intensity means strength force concentration power and passion

Without these plasticity may not occur Function may not improve

Time matters Different forms of plasticity take place at different

times during therapy

Do the basics than the more advanced therapeutic procedures

61

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Salience matters It has to be important to the individual

Make the therapy matter to the patient

Age matters Plasticity is easier in a younger brain but is also

possible in an adult brain

Do not let age determine what therapy options you offer your

patients Think of Susan Barry PhD (StereoSue) and her success

Offer your patients options Let them choose Be realistic about

outcomeshelliphave outcome measures built into therapy program

62

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Transference Neuroplasticity and the change in function

that results from one therapy can augment the attainment

of similar behaviors

What you do during oculomotor therapy may affected

vergence therapy outcomes

Interference Plasticity in response to one experience can

interfere with the acquisition of other behaviors

Monitor Evaluate progress Discuss function in other areas

of your patientslsquo life

63

Why pay attention to binocular vision dysfunctions

and neuroplasticity

December 2009 issue of the Review of Optometry

The Binocular Vision Dysfunction Pandemic

In 2010 almost 170 million individuals will be wearing glasses In

2010 there will also be up to 93 million amblyopes and 12 and a half

million strabismics For children under 18 years of age that means

there will be more than 22 and a half million amblyopes and millions

of children with strabismus A clinical trial to determine the

prevalence of binocular vision dysfunction within the general

population suggested the possibility of up to 56 or 173 million men

women and children with symptoms associated with a binocular

vision dysfunction 189 million (61) with accommodative problems

and 118 million (38) demonstrating various vergence

anomalies

64

65

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Brain plasticity life long changes in the structure of the brain

Sensory substitution replacement of one sensory input by another

Measurement techniques

Voxel based morphometryhellipmeasures difference in brain volume

Fluorodeoxyglucose glucose analog PET scan tells you

distribution and metabolism of brain

Cortical thickness measures

Visual cortex of the blind turns somatic ―The eye of the tongue

Transcranial magnetic stmiulation non-invasive technique to

stimulate cortex

66

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Blind Braille readers report tingling in fingers when pressure

phosphenes are applied Blind feel tingling in tongue

Bind use tongue to perform orientation task motion perception

sensory perception Visual cortex recruited in a variety of sensory

and cognitive tasks (DM Can we use tongue as a VT tool)

Dilks Reorganizations of human adult visual system

When a region of sensory cortex is deprived of its bottom up

input the deprived region begins to respond to stimuli that

normally activate adjacent cortex

67

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Retinotopic map changes for stroke pts Cortical reorganization in

adults occurs Perceived objectshellipelongation in stroke amp AMD

What happens to deprived cortex in AMD

fMRI shows cortical reorganization in adults

Proposed mechanisms

hellipGrowth of new connections

hellipUnmasking of pre-existing connections this is true

happens within seconds

Bavelier

Action video games

68

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Bavelier

Action video games Looked at attention Gamers can track more

activities

Attention over space (me peripheral awarenress) Useful field

of view shrinks with age

Performance not VA relatedhellipis related to attention

Action game playing changes spatial resolutionhellipovercoming

crowding in VA assessment (me amblyopia therapy)

Temporal resolution of vision Backward masking

changehellipbrain changes

Visual sensitivity (contrast sensitivity) Post action game training

improves CSF

69

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Action video games correcting optics of the cortex (me this is

actualy OVT)

Games factor

Variable entry leanringhellipadapt task to skill level

Incremental learning tune task to subjectlsquos leanring steps

Motivationarousal

Rewards

Self masterself confidence

Action games factors

Pacingrate of exposure to infohellipincreasing processing speed

Dynamic display

Rich environment

Rich motor involvement

70

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Surgeons may be made to play action games

Pilot training

Amblyopia tx Dennis Levi research

PresenterTitle Contact info

Neuroplasticity-A Paradigm Sea Change

This presentation is available at

httpwwwslidesharenetDMAINOneuroplasticity-a-paradigm-sea-change-2459693

httpwwwmainosmemosblogspotcom

My FaceBook Page

and

Twitter

PresenterTitle Contact info

Questions About

Neuroplasticity-A Paradigm Sea Change

Dominick M Maino OD MEd FAAO FCOVD-A

Professor PediatricsBinocular VisionIllinois Eye InstituteIllinois College of Optometry

dmainoicoeduhttpwwwMainosMemosblogspotcom

Thanks to

httpwwwcovdorgHomeOVDJournalOVD401tabid263D

efaultaspx

httpbipolarblastfileswordpresscom200908neurojpg

httpwwwspecialcheerscomimagesanimated_braingif

httpblogmarsdencartoonscomwp-

contentuploads200810frankenstein-myspace-lightbeergif

httpwwwshangralafamilyfuncomgala-ecalvindreamgif

httppsychiatryjwatchorgcgicontentfull20082251

73

Chakraborty R Chatterjee A Choudhart S Chakraborty PK Neuroplasticitymdasha paradigm shift in neurosciences J Indian Med Assoc

2007105(9)513-4516-8520-1

Sacks O A neurologistlsquos notebook Stereo Sue Why two eyes are better than one The New Yorker 2006 Jun 1964-73

Krulwich R National Public Radio Going Binocular Susanlsquos First Snowfall Available at

wwwnprorgtemplatesstorystoryphpstoryId=5507789 (Accessed December 8 2008)

Press LJ The story behind Stereo Suelsquo and a world-famous neurologistlsquos discovery of vision therapy Optom Vis Dev 200637(2) 55-7

Levin HS Neuroplasticity and brain imaging research implications for rehabilitation Arch Phys Med Rehabil 2006 Dec87(12 Suppl

2)S1

Wiesel TN Hubel DH Single-cell responses in striate cortex of kittens deprived of vision in one eye J Neurophysiol 1963

Nov261003-17

Hook BM Chen C Critical periods in the visual system Changing views for a model of experience-dependent plasticity Neuron 2007

Oct56(2)312-26

Ramey CT Ramey SL Prevention of intellectual disabilities early interventions to improve cognitive development Prev Med 1998

Mar-Apr27(2)224-32

Heuninckx S Wenderoth N Swinnen SP Systems neuroplasticity in the aging brain recruiting additional neural resources for

successful motor performance in elderly persons J Neurosci 2008 Jan 228(1)91-9

Ge S Yang CH Hsu KS et al A critical period for enhanced synaptic plasticity in newly generated neurons of the adult brain Neuron

2007 May54(4)559-66

74

Draganski B Gaser C Busch V et al Neuroplasticity changes in grey matter induced by training Nature 2004 Jan 22427(6972)

311-2

Cannonieri GC Bonilha L Fernandes PT et al Practice and perfect length of training and structural brain changes in experienced

typists Neuroreport 2007 Jul 218(10)1063-6

Kleim JA Jones TA Principles of experience-dependent neural plasticity implications for rehabilitation after brain damage J

Speech Lang Hear Res 2008 Feb51(1)S225-39

Trojan S Porkorny J Theoretical aspects of neuroplasticity Physiol Res 199948(2)87-97

Ramamirtham R Kee CS Hung LF et al Wave aberrations in rhesus monkeys with vision-induced ametropias Vision Res 2007

Sep47(21)2751-66

Smith EL 3rd Ramamirtham R Qiao-Grider Y et al Effects of foveal ablation on emmetropization and form-deprivation myopia

Invest Ophthalmol Vis Sci 2007 Sep48(9)3914-22

Smith EL 3rd Kee CS Ramamirtham R et al Peripheral vision can influence eye growth and refractive development in infant

monkeys Invest Ophthalmol Vis Sci 2005 Nov46(11)3965-72

Ciuffreda KJ Vasudevan B Nearwork-induced transient myopia (NITM) and permanent myopiandashndashis there a link Ophthalmic

Physiol Opt 2008 Mar28(2)103-14

Hung GK Ciuffreda KJ Incremental retinal-defocus theory of myopia development--schematic analysis and computer simulation

Comput Biol Med 2007 Jul37(7)930-46

Hung GK Ciuffreda KJ A unifying theory of refractive error development Bull Math Biol 2000 Nov62(6)1087-108

75

Pang Y Maino D Zhang G Lu F Myopia Can its progress be controlled Optom Vis Dev 200637(2)75-9

Leung JT Brown B Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lenses Optom Vis Sci

1999 Jun76(6)346-54

Hasebe S Ohtsuki H Nonaka T et al Effect of progressive addition lenses on myopia progression in Japanese children a prospective

randomized double-masked crossover trial Invest Ophthalmol Vis Sci 2008 Jul49(7)2781-9

Gwiazda J Hyman L Hussein M et al A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression

of myopia in children Invest Ophthalmol Vis Sci 2003 Apr44(4)1492-500

Siatkowski RM Cotter SA Crockett RS et al Two-year multi-center randomized double-masked placebo-controlled parallel safety and

efficacy study of 2 pirenzepine ophthalmic gel in children with myopia J AAPOS 2008 Aug12(4)332-9

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged 7 to 17 years Arch Ophthalmol 2005

Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three to less than 10 years of age Am J

Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction Am J Ophthalmol 2007

Jun143(6)1060-3

Holmes JM Edwards AR Beck RW et al A randomized pilot study of near activities versus non-near activities during patching therapy for

amblyopia J AAPOS 2005 Apr9(2)129-36

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate

amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-57

76

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic

amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Convergence Insufficiency Treatment Trial Study Group Randomized clinical trial of treatments for symptomatic convergence insufficiency

in children Arch Ophthalmol 2008 Oct126(10)1336-49

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

Solan HA Shelley-Tremblay J Hansen PC et al M-cell deficit and reading disability a preliminary study of the effects of temporal vision-

processing therapy Optometry 2004 Oct75(10)640-50

Solan HA Larson S Shelley-Tremblay J et al Role of visual attention in cognitive control of oculomotor readiness in students with reading

disabilities J Learn Disabil 2001 Mar-Apr34(2)107-18

Gallaway M Boas MB The impact of vergence and accommodative therapy on reading eye movements and reading speed Optom Vis Dev

200738(3)115-20

Goss DA Downing DB Lowther AH et al The effect of HTS vision therapy conducted in a school setting on reading skills in third and

fourth grade students Optom Vis Dev 200738(1)27-32

Crutch SJ Warrington EK Foveal crowding in posterior cortical atrophy a specific early-visual-processing deficit affecting word reading

Cogn Neuropsychol 2007 Dec24(8)843-66

Helms D Sawtelle SM A study of the effectiveness of cognitive therapy delivered in a video game format Optom Vis Dev 200738 (1)19-

26

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

77

Lawton T Training direction-discrimination sensitivity remediates a wide spectrum of reading skills OptomVis Dev 200738(1) 33-47

Goldstand S Koslowe KC Parush S Vision visual-information processing and academic performance among seventh-grade schoolchildren a

more significant relationship than we thought Am J Occup Ther 2005 Jul-Aug59(4)377-89

Fischer B Koumlngeter A Hartnegg K Effects of daily practice on subitizing visual counting and basic arithmetic skills Optom Vis Dev

200839(1)30-4

Sands W Taub M Maino D Limited research and education on special populations in optometry and ophthalomology Optom Vis Dev

200839(2)60-1

Wesson M Maino D Oculo-visual findings in Down syndrome cerebral palsy and mental retardation with non-specific etiology In Maino D

(ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 199517-54 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

Cui Y Stapleton F Suttle C Developing an instrument to assess vision-related and subjective quality of life in children with intellectual

disability data collection and preliminary analysis in a Chinese population Ophthal Physiolog Optics 2008 May28(3) 238-46

Maino D Steele G Tahir S Sajja R Attitudes of optometry students toward individuals with disabilities Optom Ed 200227(2)45-50

Maino D Special populations in the optometric curriculum Optom Ed 200227(2)38-9

Maino D Overview of special populations In Scheiman M Rouse M (eds) Optometric Management of Learning-Related Vision Problems

St Louis Mosby Inc 200685-106

Maino D (ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 1995 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

78

McCarthy P Maino D Alport syndrome a review Clin Eye Vis Care 2000 Dec12(3-4)139-50

Block SS Brusca-Vega R Pizzi WJ et al Cognitive and visual processing skills and their relationship to mutation size in full and

permutation female fragile X carriers Optom Vis Sci 2000 Nov77 (11)592-9

Maino D The young child with developmental disabilities An introduction to mental retardation and genetic syndromes In Moore BD

(ed) Eye Care for Infants and Young Children Butter-worth--Heinemann Newton MA1997285-300

Amin V Maino D The Fragile X female Visual visual perceptual and ocular health anomalies J Am Optom Assoc 1995 May66

(5)290-95

Maino DM Maino JH Cibis GW Hecht F Ocular health anomalies in patients with developmental disabilities In Maino D (ed)

Diagnosis and Management of Special Populations Mosby-Year-book Inc St Louis MO 1995189-206 Reprinted Optometric

Education Program Foundation Santa Anna Calif 2001

Maino D Wesson M Schlange D Cibis G Maino J Optometric findings in the fragile X syndrome Optom Vis Sci 199168634-40

Scheiman MMOptometric findings in children with cerebral palsy Am J Optom Physiol Opt 1984 May61(5)321-3

Maino D Maino J Maino S Mental retardation syndromes with associated ocular defects J Am Optom Assoc 199061707-16

Stewart RE Woodhouse JM Cregg M Pakeman VH Association between accommodative accuracy hypermetropia and strabismus in

children with Downs syndrome Optom Vis Sci 2007 Feb84(2)149-55

Cregg M Woodhouse JM Pakeman VH et al Accommodation and refractive error in children with Down syndrome cross-sectional

and longitudinal studies Invest Ophthalmol Vis Sci 2001 Jan42 (1)55-63

79

McClelland JF Parkes J Hill N et al Accommodative dysfunction in children with cerebral palsy a population-

based study Invest Ophthalmol Vis Sci 2006 May47(5)1824-30

Duckman RH Vision therapy for the child with cerebral palsy J Am Optom Assoc 198758(1)28-35

Duckman R Accommodation in cerebral palsy function and remediation J Am Optom Assoc 198455(4)281-3

Scheiman M Understanding and managing vision deficits a guide for occupational therapists 2nd ed Slack

Thorofare NJ 2002

Maino D Binasal occlusion for the child with Cerebral Palsy J Ill Optom Assoc 198644(1)1218

Battaglia F Quartarone A Rizzo V et al Early impairment of synaptic plasticity in patients with Downs syndrome

Neurobiol Aging 2008 Aug29(8)1272-5

Bonnier C Evaluation of early stimulation programs for enhancing brain development Acta Paediatr 2008

Jul97(7)853-8

Morice E Andreae LC Cooke SF et al Preservation of long-term memory and synaptic plasticity despite short-term

impairments in the Tc1 mouse model of Down syndrome Learn Mem 2008 Jul 1415(7)492-500

Gordon AM Schneider JA Chinnan A Charles JR Efficacy of a hand-arm bimanual intensive therapy (HABIT) in

children with hemiplegic cerebral palsy a randomized control trial Dev Med Child Neurol 2007 Nov49(11)830-8

Kapoor N Ciuffreda KJ Vision disturbances following traumatic brain injury Curr Treat Options Neurol 2002

Jul4(4)271-80

80

Ciuffreda KJ Rutner D Kapoor N et al Vision therapy for oculomotor dysfunctions in acquired brain injury a

retrospective analysis Optometry 2008 Jan79(1)18-22

Ciuffreda KJ Han Y Kapoor N Ficarra AP Oculomotor rehabilitation for reading in acquired brain injury

NeuroRehabilitation 200621(1)9-21

Zost M Diagnosis and management of visual dysfunction in cerebral injury In Maino D (ed) Diagnosis and

Management of Special Populations Mosby-Yearbook Inc St Louis 199579 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001 [Figure used with permission of the editor]

DeGutis JM Bentin S Robertson LC DEsposito M Functional plasticity in ventral temporal cortex following

cognitive rehabilitation of a congenital prosopagnosic J Cogn Neurosci 2007 Nov19 (11)1790-802

Welbourne SR Ralph MA Exploring the impact of plasticity-related recovery after brain damage in a connectionist

model of single-word reading Cogn Affect Behav Neurosci 2005 Mar5(1)77-92

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements prevent cognitive decline A

systematic review of randomized controlled trials J Hum Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among preterm infants attributable to early

supplementation of human milk with docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings and structural-functional

synergies with cell membrane phospholipids Altern Med Rev 2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function Neuroscience 20089(7)568-78

81

Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

BMC Biol 2008 Sep 9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine improves neuropsychological disorders in a child with

creatine transporter defect Neurocase 200814(2) 151-61

Forrester LW Wheaton LA Luft AR Exercise-mediated locomotor recovery and lower-limb neuroplasticity after

stroke J Rehabil Res Dev 200845(2)205-20

82

Page 48: Neuroplasticity: A Paradigm Sea Change Latest Updated File

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

B Drugs

C Exercise

D Learning new and challenging things

48

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements

prevent cognitive decline A systematic review of randomized controlled trials J Hum

Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among

preterm infants attributable to early supplementation of human milk with

docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings

and structural-functional synergies with cell membrane phospholipids Altern Med Rev

2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function

Neuroscience 20089(7)568-78

49

VIII Improving Brain Function and Neuroplasticity

B Drugs Maya Vetencourt JF Sale A Viegi A et al The antidepressant

fluoxetine (PROZAC) restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the

antidepressant tianeptine CNS Drugs 200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances

hippocampal long-term potentiation and memory BMC Biol 2008 Sep

9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine

improves neuropsychological disorders in a child with creatine

transporter defect Neurocase 200814(2) 151-61

50

VIII Improving Brain Function and Neuroplasticity

C Exercise

Hunsberger JG et al Antidepressant actions of the exercise-

regulated gene VGF Nat Med 2007 Dec 2 131476

VGF may be a common pathway by which exercise induces

neuroplasticity and growth-factor genes at least one of these might act

similarly to antidepressants in promoting an adaptive response to stress

However the tests used here may be modeling stress-induced

helplessness not depression hellipexercise seems to induce multiple

interacting genes that enhance neuronal resilience

51

VIII Improving Brain Function and Neuroplasticity

D Learning new and challenging things

What have we (optometry amp ophthalmology)

been thinking all these years

Where did we miss the news about neuroplasticity

52

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Huang JC Neuroplasticity as a proposed mechanism for the efficacy of optometric vision therapy and rehabilitation J Bev Optom 200920(4)96-100

Homologous area adaptationCompensatory masqueradeCross-modal reassignment

Map expansion

EquipotentialityVicariation

53

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Homologous area adaptation a transfer of function from a damaged brain area to a non-damaged brain area May be limited to early stages of human development and may crowd a new brain area resulting in reduced functionality of that brain area (Competition between spatial amp verbal functioning)

54

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Compensatory masquerade reorganizing of existing neuro-pathways to us alternative cognitive strategies to perform a task

55

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Cross-modal reassignment using new sensory input in a brain structure deprived of its main input source (changing processing from visual to tactile stimuli in the blind)

56

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Map expansion increase in brain mass due to repeated behavior or exposure to stimuli

57

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Equipotentiality anatomical areas of the brain can perform disparate functions

Vicariation redundant neural systems can operate under abnormal conditions

This may explain why recovery is noted for many neurological conditions (degenerative psychiatric developmental vascular traumatic)

58

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Constraint therapy Use it and improve it

Patching penalization ldquonear activitiesrdquo during amblyopia therapy

59

IX Improving Brain Function and Neuroplasticity Optometric Clinical ApplicationsOptometric Vision Therapy

Kleim amp Jones

Use it or lose it If you do not drive specific brain functions

functional loss will occur

If you want to improve oculomotor brain neuroplastic function amp

structure therapy should be specific for that brain function

Use it and improve it Therapy that drives cortical function enhances

that particular function

If you use therapy to improve oculomotor dysfunction it should

improve

Specificity The therapy you choose determines the resultant

plasticity and function

You must choose therapy that is appropriate

60

IX Improving Brain Function and Neuroplasticity Optometric Clinical Applications

Kleim amp Jones

Repetition matters Plasticity that results in functional change

requires repetition

Do the therapy Do it again Do it yet again No quick fix

Intensity matters Induction of plasticity requires the appropriate

amount of intensity

Intensity means strength force concentration power and passion

Without these plasticity may not occur Function may not improve

Time matters Different forms of plasticity take place at different

times during therapy

Do the basics than the more advanced therapeutic procedures

61

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Salience matters It has to be important to the individual

Make the therapy matter to the patient

Age matters Plasticity is easier in a younger brain but is also

possible in an adult brain

Do not let age determine what therapy options you offer your

patients Think of Susan Barry PhD (StereoSue) and her success

Offer your patients options Let them choose Be realistic about

outcomeshelliphave outcome measures built into therapy program

62

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Transference Neuroplasticity and the change in function

that results from one therapy can augment the attainment

of similar behaviors

What you do during oculomotor therapy may affected

vergence therapy outcomes

Interference Plasticity in response to one experience can

interfere with the acquisition of other behaviors

Monitor Evaluate progress Discuss function in other areas

of your patientslsquo life

63

Why pay attention to binocular vision dysfunctions

and neuroplasticity

December 2009 issue of the Review of Optometry

The Binocular Vision Dysfunction Pandemic

In 2010 almost 170 million individuals will be wearing glasses In

2010 there will also be up to 93 million amblyopes and 12 and a half

million strabismics For children under 18 years of age that means

there will be more than 22 and a half million amblyopes and millions

of children with strabismus A clinical trial to determine the

prevalence of binocular vision dysfunction within the general

population suggested the possibility of up to 56 or 173 million men

women and children with symptoms associated with a binocular

vision dysfunction 189 million (61) with accommodative problems

and 118 million (38) demonstrating various vergence

anomalies

64

65

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Brain plasticity life long changes in the structure of the brain

Sensory substitution replacement of one sensory input by another

Measurement techniques

Voxel based morphometryhellipmeasures difference in brain volume

Fluorodeoxyglucose glucose analog PET scan tells you

distribution and metabolism of brain

Cortical thickness measures

Visual cortex of the blind turns somatic ―The eye of the tongue

Transcranial magnetic stmiulation non-invasive technique to

stimulate cortex

66

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Blind Braille readers report tingling in fingers when pressure

phosphenes are applied Blind feel tingling in tongue

Bind use tongue to perform orientation task motion perception

sensory perception Visual cortex recruited in a variety of sensory

and cognitive tasks (DM Can we use tongue as a VT tool)

Dilks Reorganizations of human adult visual system

When a region of sensory cortex is deprived of its bottom up

input the deprived region begins to respond to stimuli that

normally activate adjacent cortex

67

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Retinotopic map changes for stroke pts Cortical reorganization in

adults occurs Perceived objectshellipelongation in stroke amp AMD

What happens to deprived cortex in AMD

fMRI shows cortical reorganization in adults

Proposed mechanisms

hellipGrowth of new connections

hellipUnmasking of pre-existing connections this is true

happens within seconds

Bavelier

Action video games

68

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Bavelier

Action video games Looked at attention Gamers can track more

activities

Attention over space (me peripheral awarenress) Useful field

of view shrinks with age

Performance not VA relatedhellipis related to attention

Action game playing changes spatial resolutionhellipovercoming

crowding in VA assessment (me amblyopia therapy)

Temporal resolution of vision Backward masking

changehellipbrain changes

Visual sensitivity (contrast sensitivity) Post action game training

improves CSF

69

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Action video games correcting optics of the cortex (me this is

actualy OVT)

Games factor

Variable entry leanringhellipadapt task to skill level

Incremental learning tune task to subjectlsquos leanring steps

Motivationarousal

Rewards

Self masterself confidence

Action games factors

Pacingrate of exposure to infohellipincreasing processing speed

Dynamic display

Rich environment

Rich motor involvement

70

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Surgeons may be made to play action games

Pilot training

Amblyopia tx Dennis Levi research

PresenterTitle Contact info

Neuroplasticity-A Paradigm Sea Change

This presentation is available at

httpwwwslidesharenetDMAINOneuroplasticity-a-paradigm-sea-change-2459693

httpwwwmainosmemosblogspotcom

My FaceBook Page

and

Twitter

PresenterTitle Contact info

Questions About

Neuroplasticity-A Paradigm Sea Change

Dominick M Maino OD MEd FAAO FCOVD-A

Professor PediatricsBinocular VisionIllinois Eye InstituteIllinois College of Optometry

dmainoicoeduhttpwwwMainosMemosblogspotcom

Thanks to

httpwwwcovdorgHomeOVDJournalOVD401tabid263D

efaultaspx

httpbipolarblastfileswordpresscom200908neurojpg

httpwwwspecialcheerscomimagesanimated_braingif

httpblogmarsdencartoonscomwp-

contentuploads200810frankenstein-myspace-lightbeergif

httpwwwshangralafamilyfuncomgala-ecalvindreamgif

httppsychiatryjwatchorgcgicontentfull20082251

73

Chakraborty R Chatterjee A Choudhart S Chakraborty PK Neuroplasticitymdasha paradigm shift in neurosciences J Indian Med Assoc

2007105(9)513-4516-8520-1

Sacks O A neurologistlsquos notebook Stereo Sue Why two eyes are better than one The New Yorker 2006 Jun 1964-73

Krulwich R National Public Radio Going Binocular Susanlsquos First Snowfall Available at

wwwnprorgtemplatesstorystoryphpstoryId=5507789 (Accessed December 8 2008)

Press LJ The story behind Stereo Suelsquo and a world-famous neurologistlsquos discovery of vision therapy Optom Vis Dev 200637(2) 55-7

Levin HS Neuroplasticity and brain imaging research implications for rehabilitation Arch Phys Med Rehabil 2006 Dec87(12 Suppl

2)S1

Wiesel TN Hubel DH Single-cell responses in striate cortex of kittens deprived of vision in one eye J Neurophysiol 1963

Nov261003-17

Hook BM Chen C Critical periods in the visual system Changing views for a model of experience-dependent plasticity Neuron 2007

Oct56(2)312-26

Ramey CT Ramey SL Prevention of intellectual disabilities early interventions to improve cognitive development Prev Med 1998

Mar-Apr27(2)224-32

Heuninckx S Wenderoth N Swinnen SP Systems neuroplasticity in the aging brain recruiting additional neural resources for

successful motor performance in elderly persons J Neurosci 2008 Jan 228(1)91-9

Ge S Yang CH Hsu KS et al A critical period for enhanced synaptic plasticity in newly generated neurons of the adult brain Neuron

2007 May54(4)559-66

74

Draganski B Gaser C Busch V et al Neuroplasticity changes in grey matter induced by training Nature 2004 Jan 22427(6972)

311-2

Cannonieri GC Bonilha L Fernandes PT et al Practice and perfect length of training and structural brain changes in experienced

typists Neuroreport 2007 Jul 218(10)1063-6

Kleim JA Jones TA Principles of experience-dependent neural plasticity implications for rehabilitation after brain damage J

Speech Lang Hear Res 2008 Feb51(1)S225-39

Trojan S Porkorny J Theoretical aspects of neuroplasticity Physiol Res 199948(2)87-97

Ramamirtham R Kee CS Hung LF et al Wave aberrations in rhesus monkeys with vision-induced ametropias Vision Res 2007

Sep47(21)2751-66

Smith EL 3rd Ramamirtham R Qiao-Grider Y et al Effects of foveal ablation on emmetropization and form-deprivation myopia

Invest Ophthalmol Vis Sci 2007 Sep48(9)3914-22

Smith EL 3rd Kee CS Ramamirtham R et al Peripheral vision can influence eye growth and refractive development in infant

monkeys Invest Ophthalmol Vis Sci 2005 Nov46(11)3965-72

Ciuffreda KJ Vasudevan B Nearwork-induced transient myopia (NITM) and permanent myopiandashndashis there a link Ophthalmic

Physiol Opt 2008 Mar28(2)103-14

Hung GK Ciuffreda KJ Incremental retinal-defocus theory of myopia development--schematic analysis and computer simulation

Comput Biol Med 2007 Jul37(7)930-46

Hung GK Ciuffreda KJ A unifying theory of refractive error development Bull Math Biol 2000 Nov62(6)1087-108

75

Pang Y Maino D Zhang G Lu F Myopia Can its progress be controlled Optom Vis Dev 200637(2)75-9

Leung JT Brown B Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lenses Optom Vis Sci

1999 Jun76(6)346-54

Hasebe S Ohtsuki H Nonaka T et al Effect of progressive addition lenses on myopia progression in Japanese children a prospective

randomized double-masked crossover trial Invest Ophthalmol Vis Sci 2008 Jul49(7)2781-9

Gwiazda J Hyman L Hussein M et al A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression

of myopia in children Invest Ophthalmol Vis Sci 2003 Apr44(4)1492-500

Siatkowski RM Cotter SA Crockett RS et al Two-year multi-center randomized double-masked placebo-controlled parallel safety and

efficacy study of 2 pirenzepine ophthalmic gel in children with myopia J AAPOS 2008 Aug12(4)332-9

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged 7 to 17 years Arch Ophthalmol 2005

Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three to less than 10 years of age Am J

Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction Am J Ophthalmol 2007

Jun143(6)1060-3

Holmes JM Edwards AR Beck RW et al A randomized pilot study of near activities versus non-near activities during patching therapy for

amblyopia J AAPOS 2005 Apr9(2)129-36

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate

amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-57

76

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic

amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Convergence Insufficiency Treatment Trial Study Group Randomized clinical trial of treatments for symptomatic convergence insufficiency

in children Arch Ophthalmol 2008 Oct126(10)1336-49

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

Solan HA Shelley-Tremblay J Hansen PC et al M-cell deficit and reading disability a preliminary study of the effects of temporal vision-

processing therapy Optometry 2004 Oct75(10)640-50

Solan HA Larson S Shelley-Tremblay J et al Role of visual attention in cognitive control of oculomotor readiness in students with reading

disabilities J Learn Disabil 2001 Mar-Apr34(2)107-18

Gallaway M Boas MB The impact of vergence and accommodative therapy on reading eye movements and reading speed Optom Vis Dev

200738(3)115-20

Goss DA Downing DB Lowther AH et al The effect of HTS vision therapy conducted in a school setting on reading skills in third and

fourth grade students Optom Vis Dev 200738(1)27-32

Crutch SJ Warrington EK Foveal crowding in posterior cortical atrophy a specific early-visual-processing deficit affecting word reading

Cogn Neuropsychol 2007 Dec24(8)843-66

Helms D Sawtelle SM A study of the effectiveness of cognitive therapy delivered in a video game format Optom Vis Dev 200738 (1)19-

26

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

77

Lawton T Training direction-discrimination sensitivity remediates a wide spectrum of reading skills OptomVis Dev 200738(1) 33-47

Goldstand S Koslowe KC Parush S Vision visual-information processing and academic performance among seventh-grade schoolchildren a

more significant relationship than we thought Am J Occup Ther 2005 Jul-Aug59(4)377-89

Fischer B Koumlngeter A Hartnegg K Effects of daily practice on subitizing visual counting and basic arithmetic skills Optom Vis Dev

200839(1)30-4

Sands W Taub M Maino D Limited research and education on special populations in optometry and ophthalomology Optom Vis Dev

200839(2)60-1

Wesson M Maino D Oculo-visual findings in Down syndrome cerebral palsy and mental retardation with non-specific etiology In Maino D

(ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 199517-54 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

Cui Y Stapleton F Suttle C Developing an instrument to assess vision-related and subjective quality of life in children with intellectual

disability data collection and preliminary analysis in a Chinese population Ophthal Physiolog Optics 2008 May28(3) 238-46

Maino D Steele G Tahir S Sajja R Attitudes of optometry students toward individuals with disabilities Optom Ed 200227(2)45-50

Maino D Special populations in the optometric curriculum Optom Ed 200227(2)38-9

Maino D Overview of special populations In Scheiman M Rouse M (eds) Optometric Management of Learning-Related Vision Problems

St Louis Mosby Inc 200685-106

Maino D (ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 1995 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

78

McCarthy P Maino D Alport syndrome a review Clin Eye Vis Care 2000 Dec12(3-4)139-50

Block SS Brusca-Vega R Pizzi WJ et al Cognitive and visual processing skills and their relationship to mutation size in full and

permutation female fragile X carriers Optom Vis Sci 2000 Nov77 (11)592-9

Maino D The young child with developmental disabilities An introduction to mental retardation and genetic syndromes In Moore BD

(ed) Eye Care for Infants and Young Children Butter-worth--Heinemann Newton MA1997285-300

Amin V Maino D The Fragile X female Visual visual perceptual and ocular health anomalies J Am Optom Assoc 1995 May66

(5)290-95

Maino DM Maino JH Cibis GW Hecht F Ocular health anomalies in patients with developmental disabilities In Maino D (ed)

Diagnosis and Management of Special Populations Mosby-Year-book Inc St Louis MO 1995189-206 Reprinted Optometric

Education Program Foundation Santa Anna Calif 2001

Maino D Wesson M Schlange D Cibis G Maino J Optometric findings in the fragile X syndrome Optom Vis Sci 199168634-40

Scheiman MMOptometric findings in children with cerebral palsy Am J Optom Physiol Opt 1984 May61(5)321-3

Maino D Maino J Maino S Mental retardation syndromes with associated ocular defects J Am Optom Assoc 199061707-16

Stewart RE Woodhouse JM Cregg M Pakeman VH Association between accommodative accuracy hypermetropia and strabismus in

children with Downs syndrome Optom Vis Sci 2007 Feb84(2)149-55

Cregg M Woodhouse JM Pakeman VH et al Accommodation and refractive error in children with Down syndrome cross-sectional

and longitudinal studies Invest Ophthalmol Vis Sci 2001 Jan42 (1)55-63

79

McClelland JF Parkes J Hill N et al Accommodative dysfunction in children with cerebral palsy a population-

based study Invest Ophthalmol Vis Sci 2006 May47(5)1824-30

Duckman RH Vision therapy for the child with cerebral palsy J Am Optom Assoc 198758(1)28-35

Duckman R Accommodation in cerebral palsy function and remediation J Am Optom Assoc 198455(4)281-3

Scheiman M Understanding and managing vision deficits a guide for occupational therapists 2nd ed Slack

Thorofare NJ 2002

Maino D Binasal occlusion for the child with Cerebral Palsy J Ill Optom Assoc 198644(1)1218

Battaglia F Quartarone A Rizzo V et al Early impairment of synaptic plasticity in patients with Downs syndrome

Neurobiol Aging 2008 Aug29(8)1272-5

Bonnier C Evaluation of early stimulation programs for enhancing brain development Acta Paediatr 2008

Jul97(7)853-8

Morice E Andreae LC Cooke SF et al Preservation of long-term memory and synaptic plasticity despite short-term

impairments in the Tc1 mouse model of Down syndrome Learn Mem 2008 Jul 1415(7)492-500

Gordon AM Schneider JA Chinnan A Charles JR Efficacy of a hand-arm bimanual intensive therapy (HABIT) in

children with hemiplegic cerebral palsy a randomized control trial Dev Med Child Neurol 2007 Nov49(11)830-8

Kapoor N Ciuffreda KJ Vision disturbances following traumatic brain injury Curr Treat Options Neurol 2002

Jul4(4)271-80

80

Ciuffreda KJ Rutner D Kapoor N et al Vision therapy for oculomotor dysfunctions in acquired brain injury a

retrospective analysis Optometry 2008 Jan79(1)18-22

Ciuffreda KJ Han Y Kapoor N Ficarra AP Oculomotor rehabilitation for reading in acquired brain injury

NeuroRehabilitation 200621(1)9-21

Zost M Diagnosis and management of visual dysfunction in cerebral injury In Maino D (ed) Diagnosis and

Management of Special Populations Mosby-Yearbook Inc St Louis 199579 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001 [Figure used with permission of the editor]

DeGutis JM Bentin S Robertson LC DEsposito M Functional plasticity in ventral temporal cortex following

cognitive rehabilitation of a congenital prosopagnosic J Cogn Neurosci 2007 Nov19 (11)1790-802

Welbourne SR Ralph MA Exploring the impact of plasticity-related recovery after brain damage in a connectionist

model of single-word reading Cogn Affect Behav Neurosci 2005 Mar5(1)77-92

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements prevent cognitive decline A

systematic review of randomized controlled trials J Hum Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among preterm infants attributable to early

supplementation of human milk with docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings and structural-functional

synergies with cell membrane phospholipids Altern Med Rev 2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function Neuroscience 20089(7)568-78

81

Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

BMC Biol 2008 Sep 9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine improves neuropsychological disorders in a child with

creatine transporter defect Neurocase 200814(2) 151-61

Forrester LW Wheaton LA Luft AR Exercise-mediated locomotor recovery and lower-limb neuroplasticity after

stroke J Rehabil Res Dev 200845(2)205-20

82

Page 49: Neuroplasticity: A Paradigm Sea Change Latest Updated File

VIII Improving Brain Function and Neuroplasticity

A Brain Foods

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements

prevent cognitive decline A systematic review of randomized controlled trials J Hum

Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among

preterm infants attributable to early supplementation of human milk with

docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings

and structural-functional synergies with cell membrane phospholipids Altern Med Rev

2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function

Neuroscience 20089(7)568-78

49

VIII Improving Brain Function and Neuroplasticity

B Drugs Maya Vetencourt JF Sale A Viegi A et al The antidepressant

fluoxetine (PROZAC) restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the

antidepressant tianeptine CNS Drugs 200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances

hippocampal long-term potentiation and memory BMC Biol 2008 Sep

9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine

improves neuropsychological disorders in a child with creatine

transporter defect Neurocase 200814(2) 151-61

50

VIII Improving Brain Function and Neuroplasticity

C Exercise

Hunsberger JG et al Antidepressant actions of the exercise-

regulated gene VGF Nat Med 2007 Dec 2 131476

VGF may be a common pathway by which exercise induces

neuroplasticity and growth-factor genes at least one of these might act

similarly to antidepressants in promoting an adaptive response to stress

However the tests used here may be modeling stress-induced

helplessness not depression hellipexercise seems to induce multiple

interacting genes that enhance neuronal resilience

51

VIII Improving Brain Function and Neuroplasticity

D Learning new and challenging things

What have we (optometry amp ophthalmology)

been thinking all these years

Where did we miss the news about neuroplasticity

52

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Huang JC Neuroplasticity as a proposed mechanism for the efficacy of optometric vision therapy and rehabilitation J Bev Optom 200920(4)96-100

Homologous area adaptationCompensatory masqueradeCross-modal reassignment

Map expansion

EquipotentialityVicariation

53

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Homologous area adaptation a transfer of function from a damaged brain area to a non-damaged brain area May be limited to early stages of human development and may crowd a new brain area resulting in reduced functionality of that brain area (Competition between spatial amp verbal functioning)

54

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Compensatory masquerade reorganizing of existing neuro-pathways to us alternative cognitive strategies to perform a task

55

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Cross-modal reassignment using new sensory input in a brain structure deprived of its main input source (changing processing from visual to tactile stimuli in the blind)

56

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Map expansion increase in brain mass due to repeated behavior or exposure to stimuli

57

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Equipotentiality anatomical areas of the brain can perform disparate functions

Vicariation redundant neural systems can operate under abnormal conditions

This may explain why recovery is noted for many neurological conditions (degenerative psychiatric developmental vascular traumatic)

58

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Constraint therapy Use it and improve it

Patching penalization ldquonear activitiesrdquo during amblyopia therapy

59

IX Improving Brain Function and Neuroplasticity Optometric Clinical ApplicationsOptometric Vision Therapy

Kleim amp Jones

Use it or lose it If you do not drive specific brain functions

functional loss will occur

If you want to improve oculomotor brain neuroplastic function amp

structure therapy should be specific for that brain function

Use it and improve it Therapy that drives cortical function enhances

that particular function

If you use therapy to improve oculomotor dysfunction it should

improve

Specificity The therapy you choose determines the resultant

plasticity and function

You must choose therapy that is appropriate

60

IX Improving Brain Function and Neuroplasticity Optometric Clinical Applications

Kleim amp Jones

Repetition matters Plasticity that results in functional change

requires repetition

Do the therapy Do it again Do it yet again No quick fix

Intensity matters Induction of plasticity requires the appropriate

amount of intensity

Intensity means strength force concentration power and passion

Without these plasticity may not occur Function may not improve

Time matters Different forms of plasticity take place at different

times during therapy

Do the basics than the more advanced therapeutic procedures

61

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Salience matters It has to be important to the individual

Make the therapy matter to the patient

Age matters Plasticity is easier in a younger brain but is also

possible in an adult brain

Do not let age determine what therapy options you offer your

patients Think of Susan Barry PhD (StereoSue) and her success

Offer your patients options Let them choose Be realistic about

outcomeshelliphave outcome measures built into therapy program

62

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Transference Neuroplasticity and the change in function

that results from one therapy can augment the attainment

of similar behaviors

What you do during oculomotor therapy may affected

vergence therapy outcomes

Interference Plasticity in response to one experience can

interfere with the acquisition of other behaviors

Monitor Evaluate progress Discuss function in other areas

of your patientslsquo life

63

Why pay attention to binocular vision dysfunctions

and neuroplasticity

December 2009 issue of the Review of Optometry

The Binocular Vision Dysfunction Pandemic

In 2010 almost 170 million individuals will be wearing glasses In

2010 there will also be up to 93 million amblyopes and 12 and a half

million strabismics For children under 18 years of age that means

there will be more than 22 and a half million amblyopes and millions

of children with strabismus A clinical trial to determine the

prevalence of binocular vision dysfunction within the general

population suggested the possibility of up to 56 or 173 million men

women and children with symptoms associated with a binocular

vision dysfunction 189 million (61) with accommodative problems

and 118 million (38) demonstrating various vergence

anomalies

64

65

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Brain plasticity life long changes in the structure of the brain

Sensory substitution replacement of one sensory input by another

Measurement techniques

Voxel based morphometryhellipmeasures difference in brain volume

Fluorodeoxyglucose glucose analog PET scan tells you

distribution and metabolism of brain

Cortical thickness measures

Visual cortex of the blind turns somatic ―The eye of the tongue

Transcranial magnetic stmiulation non-invasive technique to

stimulate cortex

66

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Blind Braille readers report tingling in fingers when pressure

phosphenes are applied Blind feel tingling in tongue

Bind use tongue to perform orientation task motion perception

sensory perception Visual cortex recruited in a variety of sensory

and cognitive tasks (DM Can we use tongue as a VT tool)

Dilks Reorganizations of human adult visual system

When a region of sensory cortex is deprived of its bottom up

input the deprived region begins to respond to stimuli that

normally activate adjacent cortex

67

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Retinotopic map changes for stroke pts Cortical reorganization in

adults occurs Perceived objectshellipelongation in stroke amp AMD

What happens to deprived cortex in AMD

fMRI shows cortical reorganization in adults

Proposed mechanisms

hellipGrowth of new connections

hellipUnmasking of pre-existing connections this is true

happens within seconds

Bavelier

Action video games

68

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Bavelier

Action video games Looked at attention Gamers can track more

activities

Attention over space (me peripheral awarenress) Useful field

of view shrinks with age

Performance not VA relatedhellipis related to attention

Action game playing changes spatial resolutionhellipovercoming

crowding in VA assessment (me amblyopia therapy)

Temporal resolution of vision Backward masking

changehellipbrain changes

Visual sensitivity (contrast sensitivity) Post action game training

improves CSF

69

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Action video games correcting optics of the cortex (me this is

actualy OVT)

Games factor

Variable entry leanringhellipadapt task to skill level

Incremental learning tune task to subjectlsquos leanring steps

Motivationarousal

Rewards

Self masterself confidence

Action games factors

Pacingrate of exposure to infohellipincreasing processing speed

Dynamic display

Rich environment

Rich motor involvement

70

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Surgeons may be made to play action games

Pilot training

Amblyopia tx Dennis Levi research

PresenterTitle Contact info

Neuroplasticity-A Paradigm Sea Change

This presentation is available at

httpwwwslidesharenetDMAINOneuroplasticity-a-paradigm-sea-change-2459693

httpwwwmainosmemosblogspotcom

My FaceBook Page

and

Twitter

PresenterTitle Contact info

Questions About

Neuroplasticity-A Paradigm Sea Change

Dominick M Maino OD MEd FAAO FCOVD-A

Professor PediatricsBinocular VisionIllinois Eye InstituteIllinois College of Optometry

dmainoicoeduhttpwwwMainosMemosblogspotcom

Thanks to

httpwwwcovdorgHomeOVDJournalOVD401tabid263D

efaultaspx

httpbipolarblastfileswordpresscom200908neurojpg

httpwwwspecialcheerscomimagesanimated_braingif

httpblogmarsdencartoonscomwp-

contentuploads200810frankenstein-myspace-lightbeergif

httpwwwshangralafamilyfuncomgala-ecalvindreamgif

httppsychiatryjwatchorgcgicontentfull20082251

73

Chakraborty R Chatterjee A Choudhart S Chakraborty PK Neuroplasticitymdasha paradigm shift in neurosciences J Indian Med Assoc

2007105(9)513-4516-8520-1

Sacks O A neurologistlsquos notebook Stereo Sue Why two eyes are better than one The New Yorker 2006 Jun 1964-73

Krulwich R National Public Radio Going Binocular Susanlsquos First Snowfall Available at

wwwnprorgtemplatesstorystoryphpstoryId=5507789 (Accessed December 8 2008)

Press LJ The story behind Stereo Suelsquo and a world-famous neurologistlsquos discovery of vision therapy Optom Vis Dev 200637(2) 55-7

Levin HS Neuroplasticity and brain imaging research implications for rehabilitation Arch Phys Med Rehabil 2006 Dec87(12 Suppl

2)S1

Wiesel TN Hubel DH Single-cell responses in striate cortex of kittens deprived of vision in one eye J Neurophysiol 1963

Nov261003-17

Hook BM Chen C Critical periods in the visual system Changing views for a model of experience-dependent plasticity Neuron 2007

Oct56(2)312-26

Ramey CT Ramey SL Prevention of intellectual disabilities early interventions to improve cognitive development Prev Med 1998

Mar-Apr27(2)224-32

Heuninckx S Wenderoth N Swinnen SP Systems neuroplasticity in the aging brain recruiting additional neural resources for

successful motor performance in elderly persons J Neurosci 2008 Jan 228(1)91-9

Ge S Yang CH Hsu KS et al A critical period for enhanced synaptic plasticity in newly generated neurons of the adult brain Neuron

2007 May54(4)559-66

74

Draganski B Gaser C Busch V et al Neuroplasticity changes in grey matter induced by training Nature 2004 Jan 22427(6972)

311-2

Cannonieri GC Bonilha L Fernandes PT et al Practice and perfect length of training and structural brain changes in experienced

typists Neuroreport 2007 Jul 218(10)1063-6

Kleim JA Jones TA Principles of experience-dependent neural plasticity implications for rehabilitation after brain damage J

Speech Lang Hear Res 2008 Feb51(1)S225-39

Trojan S Porkorny J Theoretical aspects of neuroplasticity Physiol Res 199948(2)87-97

Ramamirtham R Kee CS Hung LF et al Wave aberrations in rhesus monkeys with vision-induced ametropias Vision Res 2007

Sep47(21)2751-66

Smith EL 3rd Ramamirtham R Qiao-Grider Y et al Effects of foveal ablation on emmetropization and form-deprivation myopia

Invest Ophthalmol Vis Sci 2007 Sep48(9)3914-22

Smith EL 3rd Kee CS Ramamirtham R et al Peripheral vision can influence eye growth and refractive development in infant

monkeys Invest Ophthalmol Vis Sci 2005 Nov46(11)3965-72

Ciuffreda KJ Vasudevan B Nearwork-induced transient myopia (NITM) and permanent myopiandashndashis there a link Ophthalmic

Physiol Opt 2008 Mar28(2)103-14

Hung GK Ciuffreda KJ Incremental retinal-defocus theory of myopia development--schematic analysis and computer simulation

Comput Biol Med 2007 Jul37(7)930-46

Hung GK Ciuffreda KJ A unifying theory of refractive error development Bull Math Biol 2000 Nov62(6)1087-108

75

Pang Y Maino D Zhang G Lu F Myopia Can its progress be controlled Optom Vis Dev 200637(2)75-9

Leung JT Brown B Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lenses Optom Vis Sci

1999 Jun76(6)346-54

Hasebe S Ohtsuki H Nonaka T et al Effect of progressive addition lenses on myopia progression in Japanese children a prospective

randomized double-masked crossover trial Invest Ophthalmol Vis Sci 2008 Jul49(7)2781-9

Gwiazda J Hyman L Hussein M et al A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression

of myopia in children Invest Ophthalmol Vis Sci 2003 Apr44(4)1492-500

Siatkowski RM Cotter SA Crockett RS et al Two-year multi-center randomized double-masked placebo-controlled parallel safety and

efficacy study of 2 pirenzepine ophthalmic gel in children with myopia J AAPOS 2008 Aug12(4)332-9

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged 7 to 17 years Arch Ophthalmol 2005

Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three to less than 10 years of age Am J

Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction Am J Ophthalmol 2007

Jun143(6)1060-3

Holmes JM Edwards AR Beck RW et al A randomized pilot study of near activities versus non-near activities during patching therapy for

amblyopia J AAPOS 2005 Apr9(2)129-36

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate

amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-57

76

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic

amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Convergence Insufficiency Treatment Trial Study Group Randomized clinical trial of treatments for symptomatic convergence insufficiency

in children Arch Ophthalmol 2008 Oct126(10)1336-49

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

Solan HA Shelley-Tremblay J Hansen PC et al M-cell deficit and reading disability a preliminary study of the effects of temporal vision-

processing therapy Optometry 2004 Oct75(10)640-50

Solan HA Larson S Shelley-Tremblay J et al Role of visual attention in cognitive control of oculomotor readiness in students with reading

disabilities J Learn Disabil 2001 Mar-Apr34(2)107-18

Gallaway M Boas MB The impact of vergence and accommodative therapy on reading eye movements and reading speed Optom Vis Dev

200738(3)115-20

Goss DA Downing DB Lowther AH et al The effect of HTS vision therapy conducted in a school setting on reading skills in third and

fourth grade students Optom Vis Dev 200738(1)27-32

Crutch SJ Warrington EK Foveal crowding in posterior cortical atrophy a specific early-visual-processing deficit affecting word reading

Cogn Neuropsychol 2007 Dec24(8)843-66

Helms D Sawtelle SM A study of the effectiveness of cognitive therapy delivered in a video game format Optom Vis Dev 200738 (1)19-

26

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

77

Lawton T Training direction-discrimination sensitivity remediates a wide spectrum of reading skills OptomVis Dev 200738(1) 33-47

Goldstand S Koslowe KC Parush S Vision visual-information processing and academic performance among seventh-grade schoolchildren a

more significant relationship than we thought Am J Occup Ther 2005 Jul-Aug59(4)377-89

Fischer B Koumlngeter A Hartnegg K Effects of daily practice on subitizing visual counting and basic arithmetic skills Optom Vis Dev

200839(1)30-4

Sands W Taub M Maino D Limited research and education on special populations in optometry and ophthalomology Optom Vis Dev

200839(2)60-1

Wesson M Maino D Oculo-visual findings in Down syndrome cerebral palsy and mental retardation with non-specific etiology In Maino D

(ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 199517-54 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

Cui Y Stapleton F Suttle C Developing an instrument to assess vision-related and subjective quality of life in children with intellectual

disability data collection and preliminary analysis in a Chinese population Ophthal Physiolog Optics 2008 May28(3) 238-46

Maino D Steele G Tahir S Sajja R Attitudes of optometry students toward individuals with disabilities Optom Ed 200227(2)45-50

Maino D Special populations in the optometric curriculum Optom Ed 200227(2)38-9

Maino D Overview of special populations In Scheiman M Rouse M (eds) Optometric Management of Learning-Related Vision Problems

St Louis Mosby Inc 200685-106

Maino D (ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 1995 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

78

McCarthy P Maino D Alport syndrome a review Clin Eye Vis Care 2000 Dec12(3-4)139-50

Block SS Brusca-Vega R Pizzi WJ et al Cognitive and visual processing skills and their relationship to mutation size in full and

permutation female fragile X carriers Optom Vis Sci 2000 Nov77 (11)592-9

Maino D The young child with developmental disabilities An introduction to mental retardation and genetic syndromes In Moore BD

(ed) Eye Care for Infants and Young Children Butter-worth--Heinemann Newton MA1997285-300

Amin V Maino D The Fragile X female Visual visual perceptual and ocular health anomalies J Am Optom Assoc 1995 May66

(5)290-95

Maino DM Maino JH Cibis GW Hecht F Ocular health anomalies in patients with developmental disabilities In Maino D (ed)

Diagnosis and Management of Special Populations Mosby-Year-book Inc St Louis MO 1995189-206 Reprinted Optometric

Education Program Foundation Santa Anna Calif 2001

Maino D Wesson M Schlange D Cibis G Maino J Optometric findings in the fragile X syndrome Optom Vis Sci 199168634-40

Scheiman MMOptometric findings in children with cerebral palsy Am J Optom Physiol Opt 1984 May61(5)321-3

Maino D Maino J Maino S Mental retardation syndromes with associated ocular defects J Am Optom Assoc 199061707-16

Stewart RE Woodhouse JM Cregg M Pakeman VH Association between accommodative accuracy hypermetropia and strabismus in

children with Downs syndrome Optom Vis Sci 2007 Feb84(2)149-55

Cregg M Woodhouse JM Pakeman VH et al Accommodation and refractive error in children with Down syndrome cross-sectional

and longitudinal studies Invest Ophthalmol Vis Sci 2001 Jan42 (1)55-63

79

McClelland JF Parkes J Hill N et al Accommodative dysfunction in children with cerebral palsy a population-

based study Invest Ophthalmol Vis Sci 2006 May47(5)1824-30

Duckman RH Vision therapy for the child with cerebral palsy J Am Optom Assoc 198758(1)28-35

Duckman R Accommodation in cerebral palsy function and remediation J Am Optom Assoc 198455(4)281-3

Scheiman M Understanding and managing vision deficits a guide for occupational therapists 2nd ed Slack

Thorofare NJ 2002

Maino D Binasal occlusion for the child with Cerebral Palsy J Ill Optom Assoc 198644(1)1218

Battaglia F Quartarone A Rizzo V et al Early impairment of synaptic plasticity in patients with Downs syndrome

Neurobiol Aging 2008 Aug29(8)1272-5

Bonnier C Evaluation of early stimulation programs for enhancing brain development Acta Paediatr 2008

Jul97(7)853-8

Morice E Andreae LC Cooke SF et al Preservation of long-term memory and synaptic plasticity despite short-term

impairments in the Tc1 mouse model of Down syndrome Learn Mem 2008 Jul 1415(7)492-500

Gordon AM Schneider JA Chinnan A Charles JR Efficacy of a hand-arm bimanual intensive therapy (HABIT) in

children with hemiplegic cerebral palsy a randomized control trial Dev Med Child Neurol 2007 Nov49(11)830-8

Kapoor N Ciuffreda KJ Vision disturbances following traumatic brain injury Curr Treat Options Neurol 2002

Jul4(4)271-80

80

Ciuffreda KJ Rutner D Kapoor N et al Vision therapy for oculomotor dysfunctions in acquired brain injury a

retrospective analysis Optometry 2008 Jan79(1)18-22

Ciuffreda KJ Han Y Kapoor N Ficarra AP Oculomotor rehabilitation for reading in acquired brain injury

NeuroRehabilitation 200621(1)9-21

Zost M Diagnosis and management of visual dysfunction in cerebral injury In Maino D (ed) Diagnosis and

Management of Special Populations Mosby-Yearbook Inc St Louis 199579 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001 [Figure used with permission of the editor]

DeGutis JM Bentin S Robertson LC DEsposito M Functional plasticity in ventral temporal cortex following

cognitive rehabilitation of a congenital prosopagnosic J Cogn Neurosci 2007 Nov19 (11)1790-802

Welbourne SR Ralph MA Exploring the impact of plasticity-related recovery after brain damage in a connectionist

model of single-word reading Cogn Affect Behav Neurosci 2005 Mar5(1)77-92

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements prevent cognitive decline A

systematic review of randomized controlled trials J Hum Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among preterm infants attributable to early

supplementation of human milk with docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings and structural-functional

synergies with cell membrane phospholipids Altern Med Rev 2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function Neuroscience 20089(7)568-78

81

Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

BMC Biol 2008 Sep 9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine improves neuropsychological disorders in a child with

creatine transporter defect Neurocase 200814(2) 151-61

Forrester LW Wheaton LA Luft AR Exercise-mediated locomotor recovery and lower-limb neuroplasticity after

stroke J Rehabil Res Dev 200845(2)205-20

82

Page 50: Neuroplasticity: A Paradigm Sea Change Latest Updated File

VIII Improving Brain Function and Neuroplasticity

B Drugs Maya Vetencourt JF Sale A Viegi A et al The antidepressant

fluoxetine (PROZAC) restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the

antidepressant tianeptine CNS Drugs 200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances

hippocampal long-term potentiation and memory BMC Biol 2008 Sep

9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine

improves neuropsychological disorders in a child with creatine

transporter defect Neurocase 200814(2) 151-61

50

VIII Improving Brain Function and Neuroplasticity

C Exercise

Hunsberger JG et al Antidepressant actions of the exercise-

regulated gene VGF Nat Med 2007 Dec 2 131476

VGF may be a common pathway by which exercise induces

neuroplasticity and growth-factor genes at least one of these might act

similarly to antidepressants in promoting an adaptive response to stress

However the tests used here may be modeling stress-induced

helplessness not depression hellipexercise seems to induce multiple

interacting genes that enhance neuronal resilience

51

VIII Improving Brain Function and Neuroplasticity

D Learning new and challenging things

What have we (optometry amp ophthalmology)

been thinking all these years

Where did we miss the news about neuroplasticity

52

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Huang JC Neuroplasticity as a proposed mechanism for the efficacy of optometric vision therapy and rehabilitation J Bev Optom 200920(4)96-100

Homologous area adaptationCompensatory masqueradeCross-modal reassignment

Map expansion

EquipotentialityVicariation

53

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Homologous area adaptation a transfer of function from a damaged brain area to a non-damaged brain area May be limited to early stages of human development and may crowd a new brain area resulting in reduced functionality of that brain area (Competition between spatial amp verbal functioning)

54

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Compensatory masquerade reorganizing of existing neuro-pathways to us alternative cognitive strategies to perform a task

55

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Cross-modal reassignment using new sensory input in a brain structure deprived of its main input source (changing processing from visual to tactile stimuli in the blind)

56

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Map expansion increase in brain mass due to repeated behavior or exposure to stimuli

57

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Equipotentiality anatomical areas of the brain can perform disparate functions

Vicariation redundant neural systems can operate under abnormal conditions

This may explain why recovery is noted for many neurological conditions (degenerative psychiatric developmental vascular traumatic)

58

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Constraint therapy Use it and improve it

Patching penalization ldquonear activitiesrdquo during amblyopia therapy

59

IX Improving Brain Function and Neuroplasticity Optometric Clinical ApplicationsOptometric Vision Therapy

Kleim amp Jones

Use it or lose it If you do not drive specific brain functions

functional loss will occur

If you want to improve oculomotor brain neuroplastic function amp

structure therapy should be specific for that brain function

Use it and improve it Therapy that drives cortical function enhances

that particular function

If you use therapy to improve oculomotor dysfunction it should

improve

Specificity The therapy you choose determines the resultant

plasticity and function

You must choose therapy that is appropriate

60

IX Improving Brain Function and Neuroplasticity Optometric Clinical Applications

Kleim amp Jones

Repetition matters Plasticity that results in functional change

requires repetition

Do the therapy Do it again Do it yet again No quick fix

Intensity matters Induction of plasticity requires the appropriate

amount of intensity

Intensity means strength force concentration power and passion

Without these plasticity may not occur Function may not improve

Time matters Different forms of plasticity take place at different

times during therapy

Do the basics than the more advanced therapeutic procedures

61

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Salience matters It has to be important to the individual

Make the therapy matter to the patient

Age matters Plasticity is easier in a younger brain but is also

possible in an adult brain

Do not let age determine what therapy options you offer your

patients Think of Susan Barry PhD (StereoSue) and her success

Offer your patients options Let them choose Be realistic about

outcomeshelliphave outcome measures built into therapy program

62

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Transference Neuroplasticity and the change in function

that results from one therapy can augment the attainment

of similar behaviors

What you do during oculomotor therapy may affected

vergence therapy outcomes

Interference Plasticity in response to one experience can

interfere with the acquisition of other behaviors

Monitor Evaluate progress Discuss function in other areas

of your patientslsquo life

63

Why pay attention to binocular vision dysfunctions

and neuroplasticity

December 2009 issue of the Review of Optometry

The Binocular Vision Dysfunction Pandemic

In 2010 almost 170 million individuals will be wearing glasses In

2010 there will also be up to 93 million amblyopes and 12 and a half

million strabismics For children under 18 years of age that means

there will be more than 22 and a half million amblyopes and millions

of children with strabismus A clinical trial to determine the

prevalence of binocular vision dysfunction within the general

population suggested the possibility of up to 56 or 173 million men

women and children with symptoms associated with a binocular

vision dysfunction 189 million (61) with accommodative problems

and 118 million (38) demonstrating various vergence

anomalies

64

65

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Brain plasticity life long changes in the structure of the brain

Sensory substitution replacement of one sensory input by another

Measurement techniques

Voxel based morphometryhellipmeasures difference in brain volume

Fluorodeoxyglucose glucose analog PET scan tells you

distribution and metabolism of brain

Cortical thickness measures

Visual cortex of the blind turns somatic ―The eye of the tongue

Transcranial magnetic stmiulation non-invasive technique to

stimulate cortex

66

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Blind Braille readers report tingling in fingers when pressure

phosphenes are applied Blind feel tingling in tongue

Bind use tongue to perform orientation task motion perception

sensory perception Visual cortex recruited in a variety of sensory

and cognitive tasks (DM Can we use tongue as a VT tool)

Dilks Reorganizations of human adult visual system

When a region of sensory cortex is deprived of its bottom up

input the deprived region begins to respond to stimuli that

normally activate adjacent cortex

67

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Retinotopic map changes for stroke pts Cortical reorganization in

adults occurs Perceived objectshellipelongation in stroke amp AMD

What happens to deprived cortex in AMD

fMRI shows cortical reorganization in adults

Proposed mechanisms

hellipGrowth of new connections

hellipUnmasking of pre-existing connections this is true

happens within seconds

Bavelier

Action video games

68

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Bavelier

Action video games Looked at attention Gamers can track more

activities

Attention over space (me peripheral awarenress) Useful field

of view shrinks with age

Performance not VA relatedhellipis related to attention

Action game playing changes spatial resolutionhellipovercoming

crowding in VA assessment (me amblyopia therapy)

Temporal resolution of vision Backward masking

changehellipbrain changes

Visual sensitivity (contrast sensitivity) Post action game training

improves CSF

69

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Action video games correcting optics of the cortex (me this is

actualy OVT)

Games factor

Variable entry leanringhellipadapt task to skill level

Incremental learning tune task to subjectlsquos leanring steps

Motivationarousal

Rewards

Self masterself confidence

Action games factors

Pacingrate of exposure to infohellipincreasing processing speed

Dynamic display

Rich environment

Rich motor involvement

70

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Surgeons may be made to play action games

Pilot training

Amblyopia tx Dennis Levi research

PresenterTitle Contact info

Neuroplasticity-A Paradigm Sea Change

This presentation is available at

httpwwwslidesharenetDMAINOneuroplasticity-a-paradigm-sea-change-2459693

httpwwwmainosmemosblogspotcom

My FaceBook Page

and

Twitter

PresenterTitle Contact info

Questions About

Neuroplasticity-A Paradigm Sea Change

Dominick M Maino OD MEd FAAO FCOVD-A

Professor PediatricsBinocular VisionIllinois Eye InstituteIllinois College of Optometry

dmainoicoeduhttpwwwMainosMemosblogspotcom

Thanks to

httpwwwcovdorgHomeOVDJournalOVD401tabid263D

efaultaspx

httpbipolarblastfileswordpresscom200908neurojpg

httpwwwspecialcheerscomimagesanimated_braingif

httpblogmarsdencartoonscomwp-

contentuploads200810frankenstein-myspace-lightbeergif

httpwwwshangralafamilyfuncomgala-ecalvindreamgif

httppsychiatryjwatchorgcgicontentfull20082251

73

Chakraborty R Chatterjee A Choudhart S Chakraborty PK Neuroplasticitymdasha paradigm shift in neurosciences J Indian Med Assoc

2007105(9)513-4516-8520-1

Sacks O A neurologistlsquos notebook Stereo Sue Why two eyes are better than one The New Yorker 2006 Jun 1964-73

Krulwich R National Public Radio Going Binocular Susanlsquos First Snowfall Available at

wwwnprorgtemplatesstorystoryphpstoryId=5507789 (Accessed December 8 2008)

Press LJ The story behind Stereo Suelsquo and a world-famous neurologistlsquos discovery of vision therapy Optom Vis Dev 200637(2) 55-7

Levin HS Neuroplasticity and brain imaging research implications for rehabilitation Arch Phys Med Rehabil 2006 Dec87(12 Suppl

2)S1

Wiesel TN Hubel DH Single-cell responses in striate cortex of kittens deprived of vision in one eye J Neurophysiol 1963

Nov261003-17

Hook BM Chen C Critical periods in the visual system Changing views for a model of experience-dependent plasticity Neuron 2007

Oct56(2)312-26

Ramey CT Ramey SL Prevention of intellectual disabilities early interventions to improve cognitive development Prev Med 1998

Mar-Apr27(2)224-32

Heuninckx S Wenderoth N Swinnen SP Systems neuroplasticity in the aging brain recruiting additional neural resources for

successful motor performance in elderly persons J Neurosci 2008 Jan 228(1)91-9

Ge S Yang CH Hsu KS et al A critical period for enhanced synaptic plasticity in newly generated neurons of the adult brain Neuron

2007 May54(4)559-66

74

Draganski B Gaser C Busch V et al Neuroplasticity changes in grey matter induced by training Nature 2004 Jan 22427(6972)

311-2

Cannonieri GC Bonilha L Fernandes PT et al Practice and perfect length of training and structural brain changes in experienced

typists Neuroreport 2007 Jul 218(10)1063-6

Kleim JA Jones TA Principles of experience-dependent neural plasticity implications for rehabilitation after brain damage J

Speech Lang Hear Res 2008 Feb51(1)S225-39

Trojan S Porkorny J Theoretical aspects of neuroplasticity Physiol Res 199948(2)87-97

Ramamirtham R Kee CS Hung LF et al Wave aberrations in rhesus monkeys with vision-induced ametropias Vision Res 2007

Sep47(21)2751-66

Smith EL 3rd Ramamirtham R Qiao-Grider Y et al Effects of foveal ablation on emmetropization and form-deprivation myopia

Invest Ophthalmol Vis Sci 2007 Sep48(9)3914-22

Smith EL 3rd Kee CS Ramamirtham R et al Peripheral vision can influence eye growth and refractive development in infant

monkeys Invest Ophthalmol Vis Sci 2005 Nov46(11)3965-72

Ciuffreda KJ Vasudevan B Nearwork-induced transient myopia (NITM) and permanent myopiandashndashis there a link Ophthalmic

Physiol Opt 2008 Mar28(2)103-14

Hung GK Ciuffreda KJ Incremental retinal-defocus theory of myopia development--schematic analysis and computer simulation

Comput Biol Med 2007 Jul37(7)930-46

Hung GK Ciuffreda KJ A unifying theory of refractive error development Bull Math Biol 2000 Nov62(6)1087-108

75

Pang Y Maino D Zhang G Lu F Myopia Can its progress be controlled Optom Vis Dev 200637(2)75-9

Leung JT Brown B Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lenses Optom Vis Sci

1999 Jun76(6)346-54

Hasebe S Ohtsuki H Nonaka T et al Effect of progressive addition lenses on myopia progression in Japanese children a prospective

randomized double-masked crossover trial Invest Ophthalmol Vis Sci 2008 Jul49(7)2781-9

Gwiazda J Hyman L Hussein M et al A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression

of myopia in children Invest Ophthalmol Vis Sci 2003 Apr44(4)1492-500

Siatkowski RM Cotter SA Crockett RS et al Two-year multi-center randomized double-masked placebo-controlled parallel safety and

efficacy study of 2 pirenzepine ophthalmic gel in children with myopia J AAPOS 2008 Aug12(4)332-9

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged 7 to 17 years Arch Ophthalmol 2005

Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three to less than 10 years of age Am J

Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction Am J Ophthalmol 2007

Jun143(6)1060-3

Holmes JM Edwards AR Beck RW et al A randomized pilot study of near activities versus non-near activities during patching therapy for

amblyopia J AAPOS 2005 Apr9(2)129-36

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate

amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-57

76

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic

amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Convergence Insufficiency Treatment Trial Study Group Randomized clinical trial of treatments for symptomatic convergence insufficiency

in children Arch Ophthalmol 2008 Oct126(10)1336-49

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

Solan HA Shelley-Tremblay J Hansen PC et al M-cell deficit and reading disability a preliminary study of the effects of temporal vision-

processing therapy Optometry 2004 Oct75(10)640-50

Solan HA Larson S Shelley-Tremblay J et al Role of visual attention in cognitive control of oculomotor readiness in students with reading

disabilities J Learn Disabil 2001 Mar-Apr34(2)107-18

Gallaway M Boas MB The impact of vergence and accommodative therapy on reading eye movements and reading speed Optom Vis Dev

200738(3)115-20

Goss DA Downing DB Lowther AH et al The effect of HTS vision therapy conducted in a school setting on reading skills in third and

fourth grade students Optom Vis Dev 200738(1)27-32

Crutch SJ Warrington EK Foveal crowding in posterior cortical atrophy a specific early-visual-processing deficit affecting word reading

Cogn Neuropsychol 2007 Dec24(8)843-66

Helms D Sawtelle SM A study of the effectiveness of cognitive therapy delivered in a video game format Optom Vis Dev 200738 (1)19-

26

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

77

Lawton T Training direction-discrimination sensitivity remediates a wide spectrum of reading skills OptomVis Dev 200738(1) 33-47

Goldstand S Koslowe KC Parush S Vision visual-information processing and academic performance among seventh-grade schoolchildren a

more significant relationship than we thought Am J Occup Ther 2005 Jul-Aug59(4)377-89

Fischer B Koumlngeter A Hartnegg K Effects of daily practice on subitizing visual counting and basic arithmetic skills Optom Vis Dev

200839(1)30-4

Sands W Taub M Maino D Limited research and education on special populations in optometry and ophthalomology Optom Vis Dev

200839(2)60-1

Wesson M Maino D Oculo-visual findings in Down syndrome cerebral palsy and mental retardation with non-specific etiology In Maino D

(ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 199517-54 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

Cui Y Stapleton F Suttle C Developing an instrument to assess vision-related and subjective quality of life in children with intellectual

disability data collection and preliminary analysis in a Chinese population Ophthal Physiolog Optics 2008 May28(3) 238-46

Maino D Steele G Tahir S Sajja R Attitudes of optometry students toward individuals with disabilities Optom Ed 200227(2)45-50

Maino D Special populations in the optometric curriculum Optom Ed 200227(2)38-9

Maino D Overview of special populations In Scheiman M Rouse M (eds) Optometric Management of Learning-Related Vision Problems

St Louis Mosby Inc 200685-106

Maino D (ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 1995 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

78

McCarthy P Maino D Alport syndrome a review Clin Eye Vis Care 2000 Dec12(3-4)139-50

Block SS Brusca-Vega R Pizzi WJ et al Cognitive and visual processing skills and their relationship to mutation size in full and

permutation female fragile X carriers Optom Vis Sci 2000 Nov77 (11)592-9

Maino D The young child with developmental disabilities An introduction to mental retardation and genetic syndromes In Moore BD

(ed) Eye Care for Infants and Young Children Butter-worth--Heinemann Newton MA1997285-300

Amin V Maino D The Fragile X female Visual visual perceptual and ocular health anomalies J Am Optom Assoc 1995 May66

(5)290-95

Maino DM Maino JH Cibis GW Hecht F Ocular health anomalies in patients with developmental disabilities In Maino D (ed)

Diagnosis and Management of Special Populations Mosby-Year-book Inc St Louis MO 1995189-206 Reprinted Optometric

Education Program Foundation Santa Anna Calif 2001

Maino D Wesson M Schlange D Cibis G Maino J Optometric findings in the fragile X syndrome Optom Vis Sci 199168634-40

Scheiman MMOptometric findings in children with cerebral palsy Am J Optom Physiol Opt 1984 May61(5)321-3

Maino D Maino J Maino S Mental retardation syndromes with associated ocular defects J Am Optom Assoc 199061707-16

Stewart RE Woodhouse JM Cregg M Pakeman VH Association between accommodative accuracy hypermetropia and strabismus in

children with Downs syndrome Optom Vis Sci 2007 Feb84(2)149-55

Cregg M Woodhouse JM Pakeman VH et al Accommodation and refractive error in children with Down syndrome cross-sectional

and longitudinal studies Invest Ophthalmol Vis Sci 2001 Jan42 (1)55-63

79

McClelland JF Parkes J Hill N et al Accommodative dysfunction in children with cerebral palsy a population-

based study Invest Ophthalmol Vis Sci 2006 May47(5)1824-30

Duckman RH Vision therapy for the child with cerebral palsy J Am Optom Assoc 198758(1)28-35

Duckman R Accommodation in cerebral palsy function and remediation J Am Optom Assoc 198455(4)281-3

Scheiman M Understanding and managing vision deficits a guide for occupational therapists 2nd ed Slack

Thorofare NJ 2002

Maino D Binasal occlusion for the child with Cerebral Palsy J Ill Optom Assoc 198644(1)1218

Battaglia F Quartarone A Rizzo V et al Early impairment of synaptic plasticity in patients with Downs syndrome

Neurobiol Aging 2008 Aug29(8)1272-5

Bonnier C Evaluation of early stimulation programs for enhancing brain development Acta Paediatr 2008

Jul97(7)853-8

Morice E Andreae LC Cooke SF et al Preservation of long-term memory and synaptic plasticity despite short-term

impairments in the Tc1 mouse model of Down syndrome Learn Mem 2008 Jul 1415(7)492-500

Gordon AM Schneider JA Chinnan A Charles JR Efficacy of a hand-arm bimanual intensive therapy (HABIT) in

children with hemiplegic cerebral palsy a randomized control trial Dev Med Child Neurol 2007 Nov49(11)830-8

Kapoor N Ciuffreda KJ Vision disturbances following traumatic brain injury Curr Treat Options Neurol 2002

Jul4(4)271-80

80

Ciuffreda KJ Rutner D Kapoor N et al Vision therapy for oculomotor dysfunctions in acquired brain injury a

retrospective analysis Optometry 2008 Jan79(1)18-22

Ciuffreda KJ Han Y Kapoor N Ficarra AP Oculomotor rehabilitation for reading in acquired brain injury

NeuroRehabilitation 200621(1)9-21

Zost M Diagnosis and management of visual dysfunction in cerebral injury In Maino D (ed) Diagnosis and

Management of Special Populations Mosby-Yearbook Inc St Louis 199579 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001 [Figure used with permission of the editor]

DeGutis JM Bentin S Robertson LC DEsposito M Functional plasticity in ventral temporal cortex following

cognitive rehabilitation of a congenital prosopagnosic J Cogn Neurosci 2007 Nov19 (11)1790-802

Welbourne SR Ralph MA Exploring the impact of plasticity-related recovery after brain damage in a connectionist

model of single-word reading Cogn Affect Behav Neurosci 2005 Mar5(1)77-92

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements prevent cognitive decline A

systematic review of randomized controlled trials J Hum Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among preterm infants attributable to early

supplementation of human milk with docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings and structural-functional

synergies with cell membrane phospholipids Altern Med Rev 2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function Neuroscience 20089(7)568-78

81

Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

BMC Biol 2008 Sep 9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine improves neuropsychological disorders in a child with

creatine transporter defect Neurocase 200814(2) 151-61

Forrester LW Wheaton LA Luft AR Exercise-mediated locomotor recovery and lower-limb neuroplasticity after

stroke J Rehabil Res Dev 200845(2)205-20

82

Page 51: Neuroplasticity: A Paradigm Sea Change Latest Updated File

VIII Improving Brain Function and Neuroplasticity

C Exercise

Hunsberger JG et al Antidepressant actions of the exercise-

regulated gene VGF Nat Med 2007 Dec 2 131476

VGF may be a common pathway by which exercise induces

neuroplasticity and growth-factor genes at least one of these might act

similarly to antidepressants in promoting an adaptive response to stress

However the tests used here may be modeling stress-induced

helplessness not depression hellipexercise seems to induce multiple

interacting genes that enhance neuronal resilience

51

VIII Improving Brain Function and Neuroplasticity

D Learning new and challenging things

What have we (optometry amp ophthalmology)

been thinking all these years

Where did we miss the news about neuroplasticity

52

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Huang JC Neuroplasticity as a proposed mechanism for the efficacy of optometric vision therapy and rehabilitation J Bev Optom 200920(4)96-100

Homologous area adaptationCompensatory masqueradeCross-modal reassignment

Map expansion

EquipotentialityVicariation

53

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Homologous area adaptation a transfer of function from a damaged brain area to a non-damaged brain area May be limited to early stages of human development and may crowd a new brain area resulting in reduced functionality of that brain area (Competition between spatial amp verbal functioning)

54

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Compensatory masquerade reorganizing of existing neuro-pathways to us alternative cognitive strategies to perform a task

55

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Cross-modal reassignment using new sensory input in a brain structure deprived of its main input source (changing processing from visual to tactile stimuli in the blind)

56

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Map expansion increase in brain mass due to repeated behavior or exposure to stimuli

57

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Equipotentiality anatomical areas of the brain can perform disparate functions

Vicariation redundant neural systems can operate under abnormal conditions

This may explain why recovery is noted for many neurological conditions (degenerative psychiatric developmental vascular traumatic)

58

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Constraint therapy Use it and improve it

Patching penalization ldquonear activitiesrdquo during amblyopia therapy

59

IX Improving Brain Function and Neuroplasticity Optometric Clinical ApplicationsOptometric Vision Therapy

Kleim amp Jones

Use it or lose it If you do not drive specific brain functions

functional loss will occur

If you want to improve oculomotor brain neuroplastic function amp

structure therapy should be specific for that brain function

Use it and improve it Therapy that drives cortical function enhances

that particular function

If you use therapy to improve oculomotor dysfunction it should

improve

Specificity The therapy you choose determines the resultant

plasticity and function

You must choose therapy that is appropriate

60

IX Improving Brain Function and Neuroplasticity Optometric Clinical Applications

Kleim amp Jones

Repetition matters Plasticity that results in functional change

requires repetition

Do the therapy Do it again Do it yet again No quick fix

Intensity matters Induction of plasticity requires the appropriate

amount of intensity

Intensity means strength force concentration power and passion

Without these plasticity may not occur Function may not improve

Time matters Different forms of plasticity take place at different

times during therapy

Do the basics than the more advanced therapeutic procedures

61

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Salience matters It has to be important to the individual

Make the therapy matter to the patient

Age matters Plasticity is easier in a younger brain but is also

possible in an adult brain

Do not let age determine what therapy options you offer your

patients Think of Susan Barry PhD (StereoSue) and her success

Offer your patients options Let them choose Be realistic about

outcomeshelliphave outcome measures built into therapy program

62

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Transference Neuroplasticity and the change in function

that results from one therapy can augment the attainment

of similar behaviors

What you do during oculomotor therapy may affected

vergence therapy outcomes

Interference Plasticity in response to one experience can

interfere with the acquisition of other behaviors

Monitor Evaluate progress Discuss function in other areas

of your patientslsquo life

63

Why pay attention to binocular vision dysfunctions

and neuroplasticity

December 2009 issue of the Review of Optometry

The Binocular Vision Dysfunction Pandemic

In 2010 almost 170 million individuals will be wearing glasses In

2010 there will also be up to 93 million amblyopes and 12 and a half

million strabismics For children under 18 years of age that means

there will be more than 22 and a half million amblyopes and millions

of children with strabismus A clinical trial to determine the

prevalence of binocular vision dysfunction within the general

population suggested the possibility of up to 56 or 173 million men

women and children with symptoms associated with a binocular

vision dysfunction 189 million (61) with accommodative problems

and 118 million (38) demonstrating various vergence

anomalies

64

65

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Brain plasticity life long changes in the structure of the brain

Sensory substitution replacement of one sensory input by another

Measurement techniques

Voxel based morphometryhellipmeasures difference in brain volume

Fluorodeoxyglucose glucose analog PET scan tells you

distribution and metabolism of brain

Cortical thickness measures

Visual cortex of the blind turns somatic ―The eye of the tongue

Transcranial magnetic stmiulation non-invasive technique to

stimulate cortex

66

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Blind Braille readers report tingling in fingers when pressure

phosphenes are applied Blind feel tingling in tongue

Bind use tongue to perform orientation task motion perception

sensory perception Visual cortex recruited in a variety of sensory

and cognitive tasks (DM Can we use tongue as a VT tool)

Dilks Reorganizations of human adult visual system

When a region of sensory cortex is deprived of its bottom up

input the deprived region begins to respond to stimuli that

normally activate adjacent cortex

67

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Retinotopic map changes for stroke pts Cortical reorganization in

adults occurs Perceived objectshellipelongation in stroke amp AMD

What happens to deprived cortex in AMD

fMRI shows cortical reorganization in adults

Proposed mechanisms

hellipGrowth of new connections

hellipUnmasking of pre-existing connections this is true

happens within seconds

Bavelier

Action video games

68

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Bavelier

Action video games Looked at attention Gamers can track more

activities

Attention over space (me peripheral awarenress) Useful field

of view shrinks with age

Performance not VA relatedhellipis related to attention

Action game playing changes spatial resolutionhellipovercoming

crowding in VA assessment (me amblyopia therapy)

Temporal resolution of vision Backward masking

changehellipbrain changes

Visual sensitivity (contrast sensitivity) Post action game training

improves CSF

69

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Action video games correcting optics of the cortex (me this is

actualy OVT)

Games factor

Variable entry leanringhellipadapt task to skill level

Incremental learning tune task to subjectlsquos leanring steps

Motivationarousal

Rewards

Self masterself confidence

Action games factors

Pacingrate of exposure to infohellipincreasing processing speed

Dynamic display

Rich environment

Rich motor involvement

70

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Surgeons may be made to play action games

Pilot training

Amblyopia tx Dennis Levi research

PresenterTitle Contact info

Neuroplasticity-A Paradigm Sea Change

This presentation is available at

httpwwwslidesharenetDMAINOneuroplasticity-a-paradigm-sea-change-2459693

httpwwwmainosmemosblogspotcom

My FaceBook Page

and

Twitter

PresenterTitle Contact info

Questions About

Neuroplasticity-A Paradigm Sea Change

Dominick M Maino OD MEd FAAO FCOVD-A

Professor PediatricsBinocular VisionIllinois Eye InstituteIllinois College of Optometry

dmainoicoeduhttpwwwMainosMemosblogspotcom

Thanks to

httpwwwcovdorgHomeOVDJournalOVD401tabid263D

efaultaspx

httpbipolarblastfileswordpresscom200908neurojpg

httpwwwspecialcheerscomimagesanimated_braingif

httpblogmarsdencartoonscomwp-

contentuploads200810frankenstein-myspace-lightbeergif

httpwwwshangralafamilyfuncomgala-ecalvindreamgif

httppsychiatryjwatchorgcgicontentfull20082251

73

Chakraborty R Chatterjee A Choudhart S Chakraborty PK Neuroplasticitymdasha paradigm shift in neurosciences J Indian Med Assoc

2007105(9)513-4516-8520-1

Sacks O A neurologistlsquos notebook Stereo Sue Why two eyes are better than one The New Yorker 2006 Jun 1964-73

Krulwich R National Public Radio Going Binocular Susanlsquos First Snowfall Available at

wwwnprorgtemplatesstorystoryphpstoryId=5507789 (Accessed December 8 2008)

Press LJ The story behind Stereo Suelsquo and a world-famous neurologistlsquos discovery of vision therapy Optom Vis Dev 200637(2) 55-7

Levin HS Neuroplasticity and brain imaging research implications for rehabilitation Arch Phys Med Rehabil 2006 Dec87(12 Suppl

2)S1

Wiesel TN Hubel DH Single-cell responses in striate cortex of kittens deprived of vision in one eye J Neurophysiol 1963

Nov261003-17

Hook BM Chen C Critical periods in the visual system Changing views for a model of experience-dependent plasticity Neuron 2007

Oct56(2)312-26

Ramey CT Ramey SL Prevention of intellectual disabilities early interventions to improve cognitive development Prev Med 1998

Mar-Apr27(2)224-32

Heuninckx S Wenderoth N Swinnen SP Systems neuroplasticity in the aging brain recruiting additional neural resources for

successful motor performance in elderly persons J Neurosci 2008 Jan 228(1)91-9

Ge S Yang CH Hsu KS et al A critical period for enhanced synaptic plasticity in newly generated neurons of the adult brain Neuron

2007 May54(4)559-66

74

Draganski B Gaser C Busch V et al Neuroplasticity changes in grey matter induced by training Nature 2004 Jan 22427(6972)

311-2

Cannonieri GC Bonilha L Fernandes PT et al Practice and perfect length of training and structural brain changes in experienced

typists Neuroreport 2007 Jul 218(10)1063-6

Kleim JA Jones TA Principles of experience-dependent neural plasticity implications for rehabilitation after brain damage J

Speech Lang Hear Res 2008 Feb51(1)S225-39

Trojan S Porkorny J Theoretical aspects of neuroplasticity Physiol Res 199948(2)87-97

Ramamirtham R Kee CS Hung LF et al Wave aberrations in rhesus monkeys with vision-induced ametropias Vision Res 2007

Sep47(21)2751-66

Smith EL 3rd Ramamirtham R Qiao-Grider Y et al Effects of foveal ablation on emmetropization and form-deprivation myopia

Invest Ophthalmol Vis Sci 2007 Sep48(9)3914-22

Smith EL 3rd Kee CS Ramamirtham R et al Peripheral vision can influence eye growth and refractive development in infant

monkeys Invest Ophthalmol Vis Sci 2005 Nov46(11)3965-72

Ciuffreda KJ Vasudevan B Nearwork-induced transient myopia (NITM) and permanent myopiandashndashis there a link Ophthalmic

Physiol Opt 2008 Mar28(2)103-14

Hung GK Ciuffreda KJ Incremental retinal-defocus theory of myopia development--schematic analysis and computer simulation

Comput Biol Med 2007 Jul37(7)930-46

Hung GK Ciuffreda KJ A unifying theory of refractive error development Bull Math Biol 2000 Nov62(6)1087-108

75

Pang Y Maino D Zhang G Lu F Myopia Can its progress be controlled Optom Vis Dev 200637(2)75-9

Leung JT Brown B Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lenses Optom Vis Sci

1999 Jun76(6)346-54

Hasebe S Ohtsuki H Nonaka T et al Effect of progressive addition lenses on myopia progression in Japanese children a prospective

randomized double-masked crossover trial Invest Ophthalmol Vis Sci 2008 Jul49(7)2781-9

Gwiazda J Hyman L Hussein M et al A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression

of myopia in children Invest Ophthalmol Vis Sci 2003 Apr44(4)1492-500

Siatkowski RM Cotter SA Crockett RS et al Two-year multi-center randomized double-masked placebo-controlled parallel safety and

efficacy study of 2 pirenzepine ophthalmic gel in children with myopia J AAPOS 2008 Aug12(4)332-9

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged 7 to 17 years Arch Ophthalmol 2005

Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three to less than 10 years of age Am J

Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction Am J Ophthalmol 2007

Jun143(6)1060-3

Holmes JM Edwards AR Beck RW et al A randomized pilot study of near activities versus non-near activities during patching therapy for

amblyopia J AAPOS 2005 Apr9(2)129-36

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate

amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-57

76

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic

amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Convergence Insufficiency Treatment Trial Study Group Randomized clinical trial of treatments for symptomatic convergence insufficiency

in children Arch Ophthalmol 2008 Oct126(10)1336-49

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

Solan HA Shelley-Tremblay J Hansen PC et al M-cell deficit and reading disability a preliminary study of the effects of temporal vision-

processing therapy Optometry 2004 Oct75(10)640-50

Solan HA Larson S Shelley-Tremblay J et al Role of visual attention in cognitive control of oculomotor readiness in students with reading

disabilities J Learn Disabil 2001 Mar-Apr34(2)107-18

Gallaway M Boas MB The impact of vergence and accommodative therapy on reading eye movements and reading speed Optom Vis Dev

200738(3)115-20

Goss DA Downing DB Lowther AH et al The effect of HTS vision therapy conducted in a school setting on reading skills in third and

fourth grade students Optom Vis Dev 200738(1)27-32

Crutch SJ Warrington EK Foveal crowding in posterior cortical atrophy a specific early-visual-processing deficit affecting word reading

Cogn Neuropsychol 2007 Dec24(8)843-66

Helms D Sawtelle SM A study of the effectiveness of cognitive therapy delivered in a video game format Optom Vis Dev 200738 (1)19-

26

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

77

Lawton T Training direction-discrimination sensitivity remediates a wide spectrum of reading skills OptomVis Dev 200738(1) 33-47

Goldstand S Koslowe KC Parush S Vision visual-information processing and academic performance among seventh-grade schoolchildren a

more significant relationship than we thought Am J Occup Ther 2005 Jul-Aug59(4)377-89

Fischer B Koumlngeter A Hartnegg K Effects of daily practice on subitizing visual counting and basic arithmetic skills Optom Vis Dev

200839(1)30-4

Sands W Taub M Maino D Limited research and education on special populations in optometry and ophthalomology Optom Vis Dev

200839(2)60-1

Wesson M Maino D Oculo-visual findings in Down syndrome cerebral palsy and mental retardation with non-specific etiology In Maino D

(ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 199517-54 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

Cui Y Stapleton F Suttle C Developing an instrument to assess vision-related and subjective quality of life in children with intellectual

disability data collection and preliminary analysis in a Chinese population Ophthal Physiolog Optics 2008 May28(3) 238-46

Maino D Steele G Tahir S Sajja R Attitudes of optometry students toward individuals with disabilities Optom Ed 200227(2)45-50

Maino D Special populations in the optometric curriculum Optom Ed 200227(2)38-9

Maino D Overview of special populations In Scheiman M Rouse M (eds) Optometric Management of Learning-Related Vision Problems

St Louis Mosby Inc 200685-106

Maino D (ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 1995 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

78

McCarthy P Maino D Alport syndrome a review Clin Eye Vis Care 2000 Dec12(3-4)139-50

Block SS Brusca-Vega R Pizzi WJ et al Cognitive and visual processing skills and their relationship to mutation size in full and

permutation female fragile X carriers Optom Vis Sci 2000 Nov77 (11)592-9

Maino D The young child with developmental disabilities An introduction to mental retardation and genetic syndromes In Moore BD

(ed) Eye Care for Infants and Young Children Butter-worth--Heinemann Newton MA1997285-300

Amin V Maino D The Fragile X female Visual visual perceptual and ocular health anomalies J Am Optom Assoc 1995 May66

(5)290-95

Maino DM Maino JH Cibis GW Hecht F Ocular health anomalies in patients with developmental disabilities In Maino D (ed)

Diagnosis and Management of Special Populations Mosby-Year-book Inc St Louis MO 1995189-206 Reprinted Optometric

Education Program Foundation Santa Anna Calif 2001

Maino D Wesson M Schlange D Cibis G Maino J Optometric findings in the fragile X syndrome Optom Vis Sci 199168634-40

Scheiman MMOptometric findings in children with cerebral palsy Am J Optom Physiol Opt 1984 May61(5)321-3

Maino D Maino J Maino S Mental retardation syndromes with associated ocular defects J Am Optom Assoc 199061707-16

Stewart RE Woodhouse JM Cregg M Pakeman VH Association between accommodative accuracy hypermetropia and strabismus in

children with Downs syndrome Optom Vis Sci 2007 Feb84(2)149-55

Cregg M Woodhouse JM Pakeman VH et al Accommodation and refractive error in children with Down syndrome cross-sectional

and longitudinal studies Invest Ophthalmol Vis Sci 2001 Jan42 (1)55-63

79

McClelland JF Parkes J Hill N et al Accommodative dysfunction in children with cerebral palsy a population-

based study Invest Ophthalmol Vis Sci 2006 May47(5)1824-30

Duckman RH Vision therapy for the child with cerebral palsy J Am Optom Assoc 198758(1)28-35

Duckman R Accommodation in cerebral palsy function and remediation J Am Optom Assoc 198455(4)281-3

Scheiman M Understanding and managing vision deficits a guide for occupational therapists 2nd ed Slack

Thorofare NJ 2002

Maino D Binasal occlusion for the child with Cerebral Palsy J Ill Optom Assoc 198644(1)1218

Battaglia F Quartarone A Rizzo V et al Early impairment of synaptic plasticity in patients with Downs syndrome

Neurobiol Aging 2008 Aug29(8)1272-5

Bonnier C Evaluation of early stimulation programs for enhancing brain development Acta Paediatr 2008

Jul97(7)853-8

Morice E Andreae LC Cooke SF et al Preservation of long-term memory and synaptic plasticity despite short-term

impairments in the Tc1 mouse model of Down syndrome Learn Mem 2008 Jul 1415(7)492-500

Gordon AM Schneider JA Chinnan A Charles JR Efficacy of a hand-arm bimanual intensive therapy (HABIT) in

children with hemiplegic cerebral palsy a randomized control trial Dev Med Child Neurol 2007 Nov49(11)830-8

Kapoor N Ciuffreda KJ Vision disturbances following traumatic brain injury Curr Treat Options Neurol 2002

Jul4(4)271-80

80

Ciuffreda KJ Rutner D Kapoor N et al Vision therapy for oculomotor dysfunctions in acquired brain injury a

retrospective analysis Optometry 2008 Jan79(1)18-22

Ciuffreda KJ Han Y Kapoor N Ficarra AP Oculomotor rehabilitation for reading in acquired brain injury

NeuroRehabilitation 200621(1)9-21

Zost M Diagnosis and management of visual dysfunction in cerebral injury In Maino D (ed) Diagnosis and

Management of Special Populations Mosby-Yearbook Inc St Louis 199579 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001 [Figure used with permission of the editor]

DeGutis JM Bentin S Robertson LC DEsposito M Functional plasticity in ventral temporal cortex following

cognitive rehabilitation of a congenital prosopagnosic J Cogn Neurosci 2007 Nov19 (11)1790-802

Welbourne SR Ralph MA Exploring the impact of plasticity-related recovery after brain damage in a connectionist

model of single-word reading Cogn Affect Behav Neurosci 2005 Mar5(1)77-92

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements prevent cognitive decline A

systematic review of randomized controlled trials J Hum Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among preterm infants attributable to early

supplementation of human milk with docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings and structural-functional

synergies with cell membrane phospholipids Altern Med Rev 2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function Neuroscience 20089(7)568-78

81

Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

BMC Biol 2008 Sep 9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine improves neuropsychological disorders in a child with

creatine transporter defect Neurocase 200814(2) 151-61

Forrester LW Wheaton LA Luft AR Exercise-mediated locomotor recovery and lower-limb neuroplasticity after

stroke J Rehabil Res Dev 200845(2)205-20

82

Page 52: Neuroplasticity: A Paradigm Sea Change Latest Updated File

VIII Improving Brain Function and Neuroplasticity

D Learning new and challenging things

What have we (optometry amp ophthalmology)

been thinking all these years

Where did we miss the news about neuroplasticity

52

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Huang JC Neuroplasticity as a proposed mechanism for the efficacy of optometric vision therapy and rehabilitation J Bev Optom 200920(4)96-100

Homologous area adaptationCompensatory masqueradeCross-modal reassignment

Map expansion

EquipotentialityVicariation

53

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Homologous area adaptation a transfer of function from a damaged brain area to a non-damaged brain area May be limited to early stages of human development and may crowd a new brain area resulting in reduced functionality of that brain area (Competition between spatial amp verbal functioning)

54

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Compensatory masquerade reorganizing of existing neuro-pathways to us alternative cognitive strategies to perform a task

55

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Cross-modal reassignment using new sensory input in a brain structure deprived of its main input source (changing processing from visual to tactile stimuli in the blind)

56

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Map expansion increase in brain mass due to repeated behavior or exposure to stimuli

57

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Equipotentiality anatomical areas of the brain can perform disparate functions

Vicariation redundant neural systems can operate under abnormal conditions

This may explain why recovery is noted for many neurological conditions (degenerative psychiatric developmental vascular traumatic)

58

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Constraint therapy Use it and improve it

Patching penalization ldquonear activitiesrdquo during amblyopia therapy

59

IX Improving Brain Function and Neuroplasticity Optometric Clinical ApplicationsOptometric Vision Therapy

Kleim amp Jones

Use it or lose it If you do not drive specific brain functions

functional loss will occur

If you want to improve oculomotor brain neuroplastic function amp

structure therapy should be specific for that brain function

Use it and improve it Therapy that drives cortical function enhances

that particular function

If you use therapy to improve oculomotor dysfunction it should

improve

Specificity The therapy you choose determines the resultant

plasticity and function

You must choose therapy that is appropriate

60

IX Improving Brain Function and Neuroplasticity Optometric Clinical Applications

Kleim amp Jones

Repetition matters Plasticity that results in functional change

requires repetition

Do the therapy Do it again Do it yet again No quick fix

Intensity matters Induction of plasticity requires the appropriate

amount of intensity

Intensity means strength force concentration power and passion

Without these plasticity may not occur Function may not improve

Time matters Different forms of plasticity take place at different

times during therapy

Do the basics than the more advanced therapeutic procedures

61

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Salience matters It has to be important to the individual

Make the therapy matter to the patient

Age matters Plasticity is easier in a younger brain but is also

possible in an adult brain

Do not let age determine what therapy options you offer your

patients Think of Susan Barry PhD (StereoSue) and her success

Offer your patients options Let them choose Be realistic about

outcomeshelliphave outcome measures built into therapy program

62

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Transference Neuroplasticity and the change in function

that results from one therapy can augment the attainment

of similar behaviors

What you do during oculomotor therapy may affected

vergence therapy outcomes

Interference Plasticity in response to one experience can

interfere with the acquisition of other behaviors

Monitor Evaluate progress Discuss function in other areas

of your patientslsquo life

63

Why pay attention to binocular vision dysfunctions

and neuroplasticity

December 2009 issue of the Review of Optometry

The Binocular Vision Dysfunction Pandemic

In 2010 almost 170 million individuals will be wearing glasses In

2010 there will also be up to 93 million amblyopes and 12 and a half

million strabismics For children under 18 years of age that means

there will be more than 22 and a half million amblyopes and millions

of children with strabismus A clinical trial to determine the

prevalence of binocular vision dysfunction within the general

population suggested the possibility of up to 56 or 173 million men

women and children with symptoms associated with a binocular

vision dysfunction 189 million (61) with accommodative problems

and 118 million (38) demonstrating various vergence

anomalies

64

65

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Brain plasticity life long changes in the structure of the brain

Sensory substitution replacement of one sensory input by another

Measurement techniques

Voxel based morphometryhellipmeasures difference in brain volume

Fluorodeoxyglucose glucose analog PET scan tells you

distribution and metabolism of brain

Cortical thickness measures

Visual cortex of the blind turns somatic ―The eye of the tongue

Transcranial magnetic stmiulation non-invasive technique to

stimulate cortex

66

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Blind Braille readers report tingling in fingers when pressure

phosphenes are applied Blind feel tingling in tongue

Bind use tongue to perform orientation task motion perception

sensory perception Visual cortex recruited in a variety of sensory

and cognitive tasks (DM Can we use tongue as a VT tool)

Dilks Reorganizations of human adult visual system

When a region of sensory cortex is deprived of its bottom up

input the deprived region begins to respond to stimuli that

normally activate adjacent cortex

67

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Retinotopic map changes for stroke pts Cortical reorganization in

adults occurs Perceived objectshellipelongation in stroke amp AMD

What happens to deprived cortex in AMD

fMRI shows cortical reorganization in adults

Proposed mechanisms

hellipGrowth of new connections

hellipUnmasking of pre-existing connections this is true

happens within seconds

Bavelier

Action video games

68

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Bavelier

Action video games Looked at attention Gamers can track more

activities

Attention over space (me peripheral awarenress) Useful field

of view shrinks with age

Performance not VA relatedhellipis related to attention

Action game playing changes spatial resolutionhellipovercoming

crowding in VA assessment (me amblyopia therapy)

Temporal resolution of vision Backward masking

changehellipbrain changes

Visual sensitivity (contrast sensitivity) Post action game training

improves CSF

69

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Action video games correcting optics of the cortex (me this is

actualy OVT)

Games factor

Variable entry leanringhellipadapt task to skill level

Incremental learning tune task to subjectlsquos leanring steps

Motivationarousal

Rewards

Self masterself confidence

Action games factors

Pacingrate of exposure to infohellipincreasing processing speed

Dynamic display

Rich environment

Rich motor involvement

70

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Surgeons may be made to play action games

Pilot training

Amblyopia tx Dennis Levi research

PresenterTitle Contact info

Neuroplasticity-A Paradigm Sea Change

This presentation is available at

httpwwwslidesharenetDMAINOneuroplasticity-a-paradigm-sea-change-2459693

httpwwwmainosmemosblogspotcom

My FaceBook Page

and

Twitter

PresenterTitle Contact info

Questions About

Neuroplasticity-A Paradigm Sea Change

Dominick M Maino OD MEd FAAO FCOVD-A

Professor PediatricsBinocular VisionIllinois Eye InstituteIllinois College of Optometry

dmainoicoeduhttpwwwMainosMemosblogspotcom

Thanks to

httpwwwcovdorgHomeOVDJournalOVD401tabid263D

efaultaspx

httpbipolarblastfileswordpresscom200908neurojpg

httpwwwspecialcheerscomimagesanimated_braingif

httpblogmarsdencartoonscomwp-

contentuploads200810frankenstein-myspace-lightbeergif

httpwwwshangralafamilyfuncomgala-ecalvindreamgif

httppsychiatryjwatchorgcgicontentfull20082251

73

Chakraborty R Chatterjee A Choudhart S Chakraborty PK Neuroplasticitymdasha paradigm shift in neurosciences J Indian Med Assoc

2007105(9)513-4516-8520-1

Sacks O A neurologistlsquos notebook Stereo Sue Why two eyes are better than one The New Yorker 2006 Jun 1964-73

Krulwich R National Public Radio Going Binocular Susanlsquos First Snowfall Available at

wwwnprorgtemplatesstorystoryphpstoryId=5507789 (Accessed December 8 2008)

Press LJ The story behind Stereo Suelsquo and a world-famous neurologistlsquos discovery of vision therapy Optom Vis Dev 200637(2) 55-7

Levin HS Neuroplasticity and brain imaging research implications for rehabilitation Arch Phys Med Rehabil 2006 Dec87(12 Suppl

2)S1

Wiesel TN Hubel DH Single-cell responses in striate cortex of kittens deprived of vision in one eye J Neurophysiol 1963

Nov261003-17

Hook BM Chen C Critical periods in the visual system Changing views for a model of experience-dependent plasticity Neuron 2007

Oct56(2)312-26

Ramey CT Ramey SL Prevention of intellectual disabilities early interventions to improve cognitive development Prev Med 1998

Mar-Apr27(2)224-32

Heuninckx S Wenderoth N Swinnen SP Systems neuroplasticity in the aging brain recruiting additional neural resources for

successful motor performance in elderly persons J Neurosci 2008 Jan 228(1)91-9

Ge S Yang CH Hsu KS et al A critical period for enhanced synaptic plasticity in newly generated neurons of the adult brain Neuron

2007 May54(4)559-66

74

Draganski B Gaser C Busch V et al Neuroplasticity changes in grey matter induced by training Nature 2004 Jan 22427(6972)

311-2

Cannonieri GC Bonilha L Fernandes PT et al Practice and perfect length of training and structural brain changes in experienced

typists Neuroreport 2007 Jul 218(10)1063-6

Kleim JA Jones TA Principles of experience-dependent neural plasticity implications for rehabilitation after brain damage J

Speech Lang Hear Res 2008 Feb51(1)S225-39

Trojan S Porkorny J Theoretical aspects of neuroplasticity Physiol Res 199948(2)87-97

Ramamirtham R Kee CS Hung LF et al Wave aberrations in rhesus monkeys with vision-induced ametropias Vision Res 2007

Sep47(21)2751-66

Smith EL 3rd Ramamirtham R Qiao-Grider Y et al Effects of foveal ablation on emmetropization and form-deprivation myopia

Invest Ophthalmol Vis Sci 2007 Sep48(9)3914-22

Smith EL 3rd Kee CS Ramamirtham R et al Peripheral vision can influence eye growth and refractive development in infant

monkeys Invest Ophthalmol Vis Sci 2005 Nov46(11)3965-72

Ciuffreda KJ Vasudevan B Nearwork-induced transient myopia (NITM) and permanent myopiandashndashis there a link Ophthalmic

Physiol Opt 2008 Mar28(2)103-14

Hung GK Ciuffreda KJ Incremental retinal-defocus theory of myopia development--schematic analysis and computer simulation

Comput Biol Med 2007 Jul37(7)930-46

Hung GK Ciuffreda KJ A unifying theory of refractive error development Bull Math Biol 2000 Nov62(6)1087-108

75

Pang Y Maino D Zhang G Lu F Myopia Can its progress be controlled Optom Vis Dev 200637(2)75-9

Leung JT Brown B Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lenses Optom Vis Sci

1999 Jun76(6)346-54

Hasebe S Ohtsuki H Nonaka T et al Effect of progressive addition lenses on myopia progression in Japanese children a prospective

randomized double-masked crossover trial Invest Ophthalmol Vis Sci 2008 Jul49(7)2781-9

Gwiazda J Hyman L Hussein M et al A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression

of myopia in children Invest Ophthalmol Vis Sci 2003 Apr44(4)1492-500

Siatkowski RM Cotter SA Crockett RS et al Two-year multi-center randomized double-masked placebo-controlled parallel safety and

efficacy study of 2 pirenzepine ophthalmic gel in children with myopia J AAPOS 2008 Aug12(4)332-9

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged 7 to 17 years Arch Ophthalmol 2005

Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three to less than 10 years of age Am J

Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction Am J Ophthalmol 2007

Jun143(6)1060-3

Holmes JM Edwards AR Beck RW et al A randomized pilot study of near activities versus non-near activities during patching therapy for

amblyopia J AAPOS 2005 Apr9(2)129-36

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate

amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-57

76

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic

amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Convergence Insufficiency Treatment Trial Study Group Randomized clinical trial of treatments for symptomatic convergence insufficiency

in children Arch Ophthalmol 2008 Oct126(10)1336-49

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

Solan HA Shelley-Tremblay J Hansen PC et al M-cell deficit and reading disability a preliminary study of the effects of temporal vision-

processing therapy Optometry 2004 Oct75(10)640-50

Solan HA Larson S Shelley-Tremblay J et al Role of visual attention in cognitive control of oculomotor readiness in students with reading

disabilities J Learn Disabil 2001 Mar-Apr34(2)107-18

Gallaway M Boas MB The impact of vergence and accommodative therapy on reading eye movements and reading speed Optom Vis Dev

200738(3)115-20

Goss DA Downing DB Lowther AH et al The effect of HTS vision therapy conducted in a school setting on reading skills in third and

fourth grade students Optom Vis Dev 200738(1)27-32

Crutch SJ Warrington EK Foveal crowding in posterior cortical atrophy a specific early-visual-processing deficit affecting word reading

Cogn Neuropsychol 2007 Dec24(8)843-66

Helms D Sawtelle SM A study of the effectiveness of cognitive therapy delivered in a video game format Optom Vis Dev 200738 (1)19-

26

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

77

Lawton T Training direction-discrimination sensitivity remediates a wide spectrum of reading skills OptomVis Dev 200738(1) 33-47

Goldstand S Koslowe KC Parush S Vision visual-information processing and academic performance among seventh-grade schoolchildren a

more significant relationship than we thought Am J Occup Ther 2005 Jul-Aug59(4)377-89

Fischer B Koumlngeter A Hartnegg K Effects of daily practice on subitizing visual counting and basic arithmetic skills Optom Vis Dev

200839(1)30-4

Sands W Taub M Maino D Limited research and education on special populations in optometry and ophthalomology Optom Vis Dev

200839(2)60-1

Wesson M Maino D Oculo-visual findings in Down syndrome cerebral palsy and mental retardation with non-specific etiology In Maino D

(ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 199517-54 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

Cui Y Stapleton F Suttle C Developing an instrument to assess vision-related and subjective quality of life in children with intellectual

disability data collection and preliminary analysis in a Chinese population Ophthal Physiolog Optics 2008 May28(3) 238-46

Maino D Steele G Tahir S Sajja R Attitudes of optometry students toward individuals with disabilities Optom Ed 200227(2)45-50

Maino D Special populations in the optometric curriculum Optom Ed 200227(2)38-9

Maino D Overview of special populations In Scheiman M Rouse M (eds) Optometric Management of Learning-Related Vision Problems

St Louis Mosby Inc 200685-106

Maino D (ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 1995 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

78

McCarthy P Maino D Alport syndrome a review Clin Eye Vis Care 2000 Dec12(3-4)139-50

Block SS Brusca-Vega R Pizzi WJ et al Cognitive and visual processing skills and their relationship to mutation size in full and

permutation female fragile X carriers Optom Vis Sci 2000 Nov77 (11)592-9

Maino D The young child with developmental disabilities An introduction to mental retardation and genetic syndromes In Moore BD

(ed) Eye Care for Infants and Young Children Butter-worth--Heinemann Newton MA1997285-300

Amin V Maino D The Fragile X female Visual visual perceptual and ocular health anomalies J Am Optom Assoc 1995 May66

(5)290-95

Maino DM Maino JH Cibis GW Hecht F Ocular health anomalies in patients with developmental disabilities In Maino D (ed)

Diagnosis and Management of Special Populations Mosby-Year-book Inc St Louis MO 1995189-206 Reprinted Optometric

Education Program Foundation Santa Anna Calif 2001

Maino D Wesson M Schlange D Cibis G Maino J Optometric findings in the fragile X syndrome Optom Vis Sci 199168634-40

Scheiman MMOptometric findings in children with cerebral palsy Am J Optom Physiol Opt 1984 May61(5)321-3

Maino D Maino J Maino S Mental retardation syndromes with associated ocular defects J Am Optom Assoc 199061707-16

Stewart RE Woodhouse JM Cregg M Pakeman VH Association between accommodative accuracy hypermetropia and strabismus in

children with Downs syndrome Optom Vis Sci 2007 Feb84(2)149-55

Cregg M Woodhouse JM Pakeman VH et al Accommodation and refractive error in children with Down syndrome cross-sectional

and longitudinal studies Invest Ophthalmol Vis Sci 2001 Jan42 (1)55-63

79

McClelland JF Parkes J Hill N et al Accommodative dysfunction in children with cerebral palsy a population-

based study Invest Ophthalmol Vis Sci 2006 May47(5)1824-30

Duckman RH Vision therapy for the child with cerebral palsy J Am Optom Assoc 198758(1)28-35

Duckman R Accommodation in cerebral palsy function and remediation J Am Optom Assoc 198455(4)281-3

Scheiman M Understanding and managing vision deficits a guide for occupational therapists 2nd ed Slack

Thorofare NJ 2002

Maino D Binasal occlusion for the child with Cerebral Palsy J Ill Optom Assoc 198644(1)1218

Battaglia F Quartarone A Rizzo V et al Early impairment of synaptic plasticity in patients with Downs syndrome

Neurobiol Aging 2008 Aug29(8)1272-5

Bonnier C Evaluation of early stimulation programs for enhancing brain development Acta Paediatr 2008

Jul97(7)853-8

Morice E Andreae LC Cooke SF et al Preservation of long-term memory and synaptic plasticity despite short-term

impairments in the Tc1 mouse model of Down syndrome Learn Mem 2008 Jul 1415(7)492-500

Gordon AM Schneider JA Chinnan A Charles JR Efficacy of a hand-arm bimanual intensive therapy (HABIT) in

children with hemiplegic cerebral palsy a randomized control trial Dev Med Child Neurol 2007 Nov49(11)830-8

Kapoor N Ciuffreda KJ Vision disturbances following traumatic brain injury Curr Treat Options Neurol 2002

Jul4(4)271-80

80

Ciuffreda KJ Rutner D Kapoor N et al Vision therapy for oculomotor dysfunctions in acquired brain injury a

retrospective analysis Optometry 2008 Jan79(1)18-22

Ciuffreda KJ Han Y Kapoor N Ficarra AP Oculomotor rehabilitation for reading in acquired brain injury

NeuroRehabilitation 200621(1)9-21

Zost M Diagnosis and management of visual dysfunction in cerebral injury In Maino D (ed) Diagnosis and

Management of Special Populations Mosby-Yearbook Inc St Louis 199579 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001 [Figure used with permission of the editor]

DeGutis JM Bentin S Robertson LC DEsposito M Functional plasticity in ventral temporal cortex following

cognitive rehabilitation of a congenital prosopagnosic J Cogn Neurosci 2007 Nov19 (11)1790-802

Welbourne SR Ralph MA Exploring the impact of plasticity-related recovery after brain damage in a connectionist

model of single-word reading Cogn Affect Behav Neurosci 2005 Mar5(1)77-92

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements prevent cognitive decline A

systematic review of randomized controlled trials J Hum Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among preterm infants attributable to early

supplementation of human milk with docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings and structural-functional

synergies with cell membrane phospholipids Altern Med Rev 2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function Neuroscience 20089(7)568-78

81

Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

BMC Biol 2008 Sep 9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine improves neuropsychological disorders in a child with

creatine transporter defect Neurocase 200814(2) 151-61

Forrester LW Wheaton LA Luft AR Exercise-mediated locomotor recovery and lower-limb neuroplasticity after

stroke J Rehabil Res Dev 200845(2)205-20

82

Page 53: Neuroplasticity: A Paradigm Sea Change Latest Updated File

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Huang JC Neuroplasticity as a proposed mechanism for the efficacy of optometric vision therapy and rehabilitation J Bev Optom 200920(4)96-100

Homologous area adaptationCompensatory masqueradeCross-modal reassignment

Map expansion

EquipotentialityVicariation

53

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Homologous area adaptation a transfer of function from a damaged brain area to a non-damaged brain area May be limited to early stages of human development and may crowd a new brain area resulting in reduced functionality of that brain area (Competition between spatial amp verbal functioning)

54

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Compensatory masquerade reorganizing of existing neuro-pathways to us alternative cognitive strategies to perform a task

55

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Cross-modal reassignment using new sensory input in a brain structure deprived of its main input source (changing processing from visual to tactile stimuli in the blind)

56

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Map expansion increase in brain mass due to repeated behavior or exposure to stimuli

57

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Equipotentiality anatomical areas of the brain can perform disparate functions

Vicariation redundant neural systems can operate under abnormal conditions

This may explain why recovery is noted for many neurological conditions (degenerative psychiatric developmental vascular traumatic)

58

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Constraint therapy Use it and improve it

Patching penalization ldquonear activitiesrdquo during amblyopia therapy

59

IX Improving Brain Function and Neuroplasticity Optometric Clinical ApplicationsOptometric Vision Therapy

Kleim amp Jones

Use it or lose it If you do not drive specific brain functions

functional loss will occur

If you want to improve oculomotor brain neuroplastic function amp

structure therapy should be specific for that brain function

Use it and improve it Therapy that drives cortical function enhances

that particular function

If you use therapy to improve oculomotor dysfunction it should

improve

Specificity The therapy you choose determines the resultant

plasticity and function

You must choose therapy that is appropriate

60

IX Improving Brain Function and Neuroplasticity Optometric Clinical Applications

Kleim amp Jones

Repetition matters Plasticity that results in functional change

requires repetition

Do the therapy Do it again Do it yet again No quick fix

Intensity matters Induction of plasticity requires the appropriate

amount of intensity

Intensity means strength force concentration power and passion

Without these plasticity may not occur Function may not improve

Time matters Different forms of plasticity take place at different

times during therapy

Do the basics than the more advanced therapeutic procedures

61

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Salience matters It has to be important to the individual

Make the therapy matter to the patient

Age matters Plasticity is easier in a younger brain but is also

possible in an adult brain

Do not let age determine what therapy options you offer your

patients Think of Susan Barry PhD (StereoSue) and her success

Offer your patients options Let them choose Be realistic about

outcomeshelliphave outcome measures built into therapy program

62

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Transference Neuroplasticity and the change in function

that results from one therapy can augment the attainment

of similar behaviors

What you do during oculomotor therapy may affected

vergence therapy outcomes

Interference Plasticity in response to one experience can

interfere with the acquisition of other behaviors

Monitor Evaluate progress Discuss function in other areas

of your patientslsquo life

63

Why pay attention to binocular vision dysfunctions

and neuroplasticity

December 2009 issue of the Review of Optometry

The Binocular Vision Dysfunction Pandemic

In 2010 almost 170 million individuals will be wearing glasses In

2010 there will also be up to 93 million amblyopes and 12 and a half

million strabismics For children under 18 years of age that means

there will be more than 22 and a half million amblyopes and millions

of children with strabismus A clinical trial to determine the

prevalence of binocular vision dysfunction within the general

population suggested the possibility of up to 56 or 173 million men

women and children with symptoms associated with a binocular

vision dysfunction 189 million (61) with accommodative problems

and 118 million (38) demonstrating various vergence

anomalies

64

65

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Brain plasticity life long changes in the structure of the brain

Sensory substitution replacement of one sensory input by another

Measurement techniques

Voxel based morphometryhellipmeasures difference in brain volume

Fluorodeoxyglucose glucose analog PET scan tells you

distribution and metabolism of brain

Cortical thickness measures

Visual cortex of the blind turns somatic ―The eye of the tongue

Transcranial magnetic stmiulation non-invasive technique to

stimulate cortex

66

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Blind Braille readers report tingling in fingers when pressure

phosphenes are applied Blind feel tingling in tongue

Bind use tongue to perform orientation task motion perception

sensory perception Visual cortex recruited in a variety of sensory

and cognitive tasks (DM Can we use tongue as a VT tool)

Dilks Reorganizations of human adult visual system

When a region of sensory cortex is deprived of its bottom up

input the deprived region begins to respond to stimuli that

normally activate adjacent cortex

67

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Retinotopic map changes for stroke pts Cortical reorganization in

adults occurs Perceived objectshellipelongation in stroke amp AMD

What happens to deprived cortex in AMD

fMRI shows cortical reorganization in adults

Proposed mechanisms

hellipGrowth of new connections

hellipUnmasking of pre-existing connections this is true

happens within seconds

Bavelier

Action video games

68

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Bavelier

Action video games Looked at attention Gamers can track more

activities

Attention over space (me peripheral awarenress) Useful field

of view shrinks with age

Performance not VA relatedhellipis related to attention

Action game playing changes spatial resolutionhellipovercoming

crowding in VA assessment (me amblyopia therapy)

Temporal resolution of vision Backward masking

changehellipbrain changes

Visual sensitivity (contrast sensitivity) Post action game training

improves CSF

69

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Action video games correcting optics of the cortex (me this is

actualy OVT)

Games factor

Variable entry leanringhellipadapt task to skill level

Incremental learning tune task to subjectlsquos leanring steps

Motivationarousal

Rewards

Self masterself confidence

Action games factors

Pacingrate of exposure to infohellipincreasing processing speed

Dynamic display

Rich environment

Rich motor involvement

70

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Surgeons may be made to play action games

Pilot training

Amblyopia tx Dennis Levi research

PresenterTitle Contact info

Neuroplasticity-A Paradigm Sea Change

This presentation is available at

httpwwwslidesharenetDMAINOneuroplasticity-a-paradigm-sea-change-2459693

httpwwwmainosmemosblogspotcom

My FaceBook Page

and

Twitter

PresenterTitle Contact info

Questions About

Neuroplasticity-A Paradigm Sea Change

Dominick M Maino OD MEd FAAO FCOVD-A

Professor PediatricsBinocular VisionIllinois Eye InstituteIllinois College of Optometry

dmainoicoeduhttpwwwMainosMemosblogspotcom

Thanks to

httpwwwcovdorgHomeOVDJournalOVD401tabid263D

efaultaspx

httpbipolarblastfileswordpresscom200908neurojpg

httpwwwspecialcheerscomimagesanimated_braingif

httpblogmarsdencartoonscomwp-

contentuploads200810frankenstein-myspace-lightbeergif

httpwwwshangralafamilyfuncomgala-ecalvindreamgif

httppsychiatryjwatchorgcgicontentfull20082251

73

Chakraborty R Chatterjee A Choudhart S Chakraborty PK Neuroplasticitymdasha paradigm shift in neurosciences J Indian Med Assoc

2007105(9)513-4516-8520-1

Sacks O A neurologistlsquos notebook Stereo Sue Why two eyes are better than one The New Yorker 2006 Jun 1964-73

Krulwich R National Public Radio Going Binocular Susanlsquos First Snowfall Available at

wwwnprorgtemplatesstorystoryphpstoryId=5507789 (Accessed December 8 2008)

Press LJ The story behind Stereo Suelsquo and a world-famous neurologistlsquos discovery of vision therapy Optom Vis Dev 200637(2) 55-7

Levin HS Neuroplasticity and brain imaging research implications for rehabilitation Arch Phys Med Rehabil 2006 Dec87(12 Suppl

2)S1

Wiesel TN Hubel DH Single-cell responses in striate cortex of kittens deprived of vision in one eye J Neurophysiol 1963

Nov261003-17

Hook BM Chen C Critical periods in the visual system Changing views for a model of experience-dependent plasticity Neuron 2007

Oct56(2)312-26

Ramey CT Ramey SL Prevention of intellectual disabilities early interventions to improve cognitive development Prev Med 1998

Mar-Apr27(2)224-32

Heuninckx S Wenderoth N Swinnen SP Systems neuroplasticity in the aging brain recruiting additional neural resources for

successful motor performance in elderly persons J Neurosci 2008 Jan 228(1)91-9

Ge S Yang CH Hsu KS et al A critical period for enhanced synaptic plasticity in newly generated neurons of the adult brain Neuron

2007 May54(4)559-66

74

Draganski B Gaser C Busch V et al Neuroplasticity changes in grey matter induced by training Nature 2004 Jan 22427(6972)

311-2

Cannonieri GC Bonilha L Fernandes PT et al Practice and perfect length of training and structural brain changes in experienced

typists Neuroreport 2007 Jul 218(10)1063-6

Kleim JA Jones TA Principles of experience-dependent neural plasticity implications for rehabilitation after brain damage J

Speech Lang Hear Res 2008 Feb51(1)S225-39

Trojan S Porkorny J Theoretical aspects of neuroplasticity Physiol Res 199948(2)87-97

Ramamirtham R Kee CS Hung LF et al Wave aberrations in rhesus monkeys with vision-induced ametropias Vision Res 2007

Sep47(21)2751-66

Smith EL 3rd Ramamirtham R Qiao-Grider Y et al Effects of foveal ablation on emmetropization and form-deprivation myopia

Invest Ophthalmol Vis Sci 2007 Sep48(9)3914-22

Smith EL 3rd Kee CS Ramamirtham R et al Peripheral vision can influence eye growth and refractive development in infant

monkeys Invest Ophthalmol Vis Sci 2005 Nov46(11)3965-72

Ciuffreda KJ Vasudevan B Nearwork-induced transient myopia (NITM) and permanent myopiandashndashis there a link Ophthalmic

Physiol Opt 2008 Mar28(2)103-14

Hung GK Ciuffreda KJ Incremental retinal-defocus theory of myopia development--schematic analysis and computer simulation

Comput Biol Med 2007 Jul37(7)930-46

Hung GK Ciuffreda KJ A unifying theory of refractive error development Bull Math Biol 2000 Nov62(6)1087-108

75

Pang Y Maino D Zhang G Lu F Myopia Can its progress be controlled Optom Vis Dev 200637(2)75-9

Leung JT Brown B Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lenses Optom Vis Sci

1999 Jun76(6)346-54

Hasebe S Ohtsuki H Nonaka T et al Effect of progressive addition lenses on myopia progression in Japanese children a prospective

randomized double-masked crossover trial Invest Ophthalmol Vis Sci 2008 Jul49(7)2781-9

Gwiazda J Hyman L Hussein M et al A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression

of myopia in children Invest Ophthalmol Vis Sci 2003 Apr44(4)1492-500

Siatkowski RM Cotter SA Crockett RS et al Two-year multi-center randomized double-masked placebo-controlled parallel safety and

efficacy study of 2 pirenzepine ophthalmic gel in children with myopia J AAPOS 2008 Aug12(4)332-9

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged 7 to 17 years Arch Ophthalmol 2005

Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three to less than 10 years of age Am J

Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction Am J Ophthalmol 2007

Jun143(6)1060-3

Holmes JM Edwards AR Beck RW et al A randomized pilot study of near activities versus non-near activities during patching therapy for

amblyopia J AAPOS 2005 Apr9(2)129-36

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate

amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-57

76

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic

amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Convergence Insufficiency Treatment Trial Study Group Randomized clinical trial of treatments for symptomatic convergence insufficiency

in children Arch Ophthalmol 2008 Oct126(10)1336-49

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

Solan HA Shelley-Tremblay J Hansen PC et al M-cell deficit and reading disability a preliminary study of the effects of temporal vision-

processing therapy Optometry 2004 Oct75(10)640-50

Solan HA Larson S Shelley-Tremblay J et al Role of visual attention in cognitive control of oculomotor readiness in students with reading

disabilities J Learn Disabil 2001 Mar-Apr34(2)107-18

Gallaway M Boas MB The impact of vergence and accommodative therapy on reading eye movements and reading speed Optom Vis Dev

200738(3)115-20

Goss DA Downing DB Lowther AH et al The effect of HTS vision therapy conducted in a school setting on reading skills in third and

fourth grade students Optom Vis Dev 200738(1)27-32

Crutch SJ Warrington EK Foveal crowding in posterior cortical atrophy a specific early-visual-processing deficit affecting word reading

Cogn Neuropsychol 2007 Dec24(8)843-66

Helms D Sawtelle SM A study of the effectiveness of cognitive therapy delivered in a video game format Optom Vis Dev 200738 (1)19-

26

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

77

Lawton T Training direction-discrimination sensitivity remediates a wide spectrum of reading skills OptomVis Dev 200738(1) 33-47

Goldstand S Koslowe KC Parush S Vision visual-information processing and academic performance among seventh-grade schoolchildren a

more significant relationship than we thought Am J Occup Ther 2005 Jul-Aug59(4)377-89

Fischer B Koumlngeter A Hartnegg K Effects of daily practice on subitizing visual counting and basic arithmetic skills Optom Vis Dev

200839(1)30-4

Sands W Taub M Maino D Limited research and education on special populations in optometry and ophthalomology Optom Vis Dev

200839(2)60-1

Wesson M Maino D Oculo-visual findings in Down syndrome cerebral palsy and mental retardation with non-specific etiology In Maino D

(ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 199517-54 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

Cui Y Stapleton F Suttle C Developing an instrument to assess vision-related and subjective quality of life in children with intellectual

disability data collection and preliminary analysis in a Chinese population Ophthal Physiolog Optics 2008 May28(3) 238-46

Maino D Steele G Tahir S Sajja R Attitudes of optometry students toward individuals with disabilities Optom Ed 200227(2)45-50

Maino D Special populations in the optometric curriculum Optom Ed 200227(2)38-9

Maino D Overview of special populations In Scheiman M Rouse M (eds) Optometric Management of Learning-Related Vision Problems

St Louis Mosby Inc 200685-106

Maino D (ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 1995 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

78

McCarthy P Maino D Alport syndrome a review Clin Eye Vis Care 2000 Dec12(3-4)139-50

Block SS Brusca-Vega R Pizzi WJ et al Cognitive and visual processing skills and their relationship to mutation size in full and

permutation female fragile X carriers Optom Vis Sci 2000 Nov77 (11)592-9

Maino D The young child with developmental disabilities An introduction to mental retardation and genetic syndromes In Moore BD

(ed) Eye Care for Infants and Young Children Butter-worth--Heinemann Newton MA1997285-300

Amin V Maino D The Fragile X female Visual visual perceptual and ocular health anomalies J Am Optom Assoc 1995 May66

(5)290-95

Maino DM Maino JH Cibis GW Hecht F Ocular health anomalies in patients with developmental disabilities In Maino D (ed)

Diagnosis and Management of Special Populations Mosby-Year-book Inc St Louis MO 1995189-206 Reprinted Optometric

Education Program Foundation Santa Anna Calif 2001

Maino D Wesson M Schlange D Cibis G Maino J Optometric findings in the fragile X syndrome Optom Vis Sci 199168634-40

Scheiman MMOptometric findings in children with cerebral palsy Am J Optom Physiol Opt 1984 May61(5)321-3

Maino D Maino J Maino S Mental retardation syndromes with associated ocular defects J Am Optom Assoc 199061707-16

Stewart RE Woodhouse JM Cregg M Pakeman VH Association between accommodative accuracy hypermetropia and strabismus in

children with Downs syndrome Optom Vis Sci 2007 Feb84(2)149-55

Cregg M Woodhouse JM Pakeman VH et al Accommodation and refractive error in children with Down syndrome cross-sectional

and longitudinal studies Invest Ophthalmol Vis Sci 2001 Jan42 (1)55-63

79

McClelland JF Parkes J Hill N et al Accommodative dysfunction in children with cerebral palsy a population-

based study Invest Ophthalmol Vis Sci 2006 May47(5)1824-30

Duckman RH Vision therapy for the child with cerebral palsy J Am Optom Assoc 198758(1)28-35

Duckman R Accommodation in cerebral palsy function and remediation J Am Optom Assoc 198455(4)281-3

Scheiman M Understanding and managing vision deficits a guide for occupational therapists 2nd ed Slack

Thorofare NJ 2002

Maino D Binasal occlusion for the child with Cerebral Palsy J Ill Optom Assoc 198644(1)1218

Battaglia F Quartarone A Rizzo V et al Early impairment of synaptic plasticity in patients with Downs syndrome

Neurobiol Aging 2008 Aug29(8)1272-5

Bonnier C Evaluation of early stimulation programs for enhancing brain development Acta Paediatr 2008

Jul97(7)853-8

Morice E Andreae LC Cooke SF et al Preservation of long-term memory and synaptic plasticity despite short-term

impairments in the Tc1 mouse model of Down syndrome Learn Mem 2008 Jul 1415(7)492-500

Gordon AM Schneider JA Chinnan A Charles JR Efficacy of a hand-arm bimanual intensive therapy (HABIT) in

children with hemiplegic cerebral palsy a randomized control trial Dev Med Child Neurol 2007 Nov49(11)830-8

Kapoor N Ciuffreda KJ Vision disturbances following traumatic brain injury Curr Treat Options Neurol 2002

Jul4(4)271-80

80

Ciuffreda KJ Rutner D Kapoor N et al Vision therapy for oculomotor dysfunctions in acquired brain injury a

retrospective analysis Optometry 2008 Jan79(1)18-22

Ciuffreda KJ Han Y Kapoor N Ficarra AP Oculomotor rehabilitation for reading in acquired brain injury

NeuroRehabilitation 200621(1)9-21

Zost M Diagnosis and management of visual dysfunction in cerebral injury In Maino D (ed) Diagnosis and

Management of Special Populations Mosby-Yearbook Inc St Louis 199579 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001 [Figure used with permission of the editor]

DeGutis JM Bentin S Robertson LC DEsposito M Functional plasticity in ventral temporal cortex following

cognitive rehabilitation of a congenital prosopagnosic J Cogn Neurosci 2007 Nov19 (11)1790-802

Welbourne SR Ralph MA Exploring the impact of plasticity-related recovery after brain damage in a connectionist

model of single-word reading Cogn Affect Behav Neurosci 2005 Mar5(1)77-92

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements prevent cognitive decline A

systematic review of randomized controlled trials J Hum Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among preterm infants attributable to early

supplementation of human milk with docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings and structural-functional

synergies with cell membrane phospholipids Altern Med Rev 2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function Neuroscience 20089(7)568-78

81

Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

BMC Biol 2008 Sep 9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine improves neuropsychological disorders in a child with

creatine transporter defect Neurocase 200814(2) 151-61

Forrester LW Wheaton LA Luft AR Exercise-mediated locomotor recovery and lower-limb neuroplasticity after

stroke J Rehabil Res Dev 200845(2)205-20

82

Page 54: Neuroplasticity: A Paradigm Sea Change Latest Updated File

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Homologous area adaptation a transfer of function from a damaged brain area to a non-damaged brain area May be limited to early stages of human development and may crowd a new brain area resulting in reduced functionality of that brain area (Competition between spatial amp verbal functioning)

54

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Compensatory masquerade reorganizing of existing neuro-pathways to us alternative cognitive strategies to perform a task

55

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Cross-modal reassignment using new sensory input in a brain structure deprived of its main input source (changing processing from visual to tactile stimuli in the blind)

56

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Map expansion increase in brain mass due to repeated behavior or exposure to stimuli

57

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Equipotentiality anatomical areas of the brain can perform disparate functions

Vicariation redundant neural systems can operate under abnormal conditions

This may explain why recovery is noted for many neurological conditions (degenerative psychiatric developmental vascular traumatic)

58

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Constraint therapy Use it and improve it

Patching penalization ldquonear activitiesrdquo during amblyopia therapy

59

IX Improving Brain Function and Neuroplasticity Optometric Clinical ApplicationsOptometric Vision Therapy

Kleim amp Jones

Use it or lose it If you do not drive specific brain functions

functional loss will occur

If you want to improve oculomotor brain neuroplastic function amp

structure therapy should be specific for that brain function

Use it and improve it Therapy that drives cortical function enhances

that particular function

If you use therapy to improve oculomotor dysfunction it should

improve

Specificity The therapy you choose determines the resultant

plasticity and function

You must choose therapy that is appropriate

60

IX Improving Brain Function and Neuroplasticity Optometric Clinical Applications

Kleim amp Jones

Repetition matters Plasticity that results in functional change

requires repetition

Do the therapy Do it again Do it yet again No quick fix

Intensity matters Induction of plasticity requires the appropriate

amount of intensity

Intensity means strength force concentration power and passion

Without these plasticity may not occur Function may not improve

Time matters Different forms of plasticity take place at different

times during therapy

Do the basics than the more advanced therapeutic procedures

61

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Salience matters It has to be important to the individual

Make the therapy matter to the patient

Age matters Plasticity is easier in a younger brain but is also

possible in an adult brain

Do not let age determine what therapy options you offer your

patients Think of Susan Barry PhD (StereoSue) and her success

Offer your patients options Let them choose Be realistic about

outcomeshelliphave outcome measures built into therapy program

62

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Transference Neuroplasticity and the change in function

that results from one therapy can augment the attainment

of similar behaviors

What you do during oculomotor therapy may affected

vergence therapy outcomes

Interference Plasticity in response to one experience can

interfere with the acquisition of other behaviors

Monitor Evaluate progress Discuss function in other areas

of your patientslsquo life

63

Why pay attention to binocular vision dysfunctions

and neuroplasticity

December 2009 issue of the Review of Optometry

The Binocular Vision Dysfunction Pandemic

In 2010 almost 170 million individuals will be wearing glasses In

2010 there will also be up to 93 million amblyopes and 12 and a half

million strabismics For children under 18 years of age that means

there will be more than 22 and a half million amblyopes and millions

of children with strabismus A clinical trial to determine the

prevalence of binocular vision dysfunction within the general

population suggested the possibility of up to 56 or 173 million men

women and children with symptoms associated with a binocular

vision dysfunction 189 million (61) with accommodative problems

and 118 million (38) demonstrating various vergence

anomalies

64

65

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Brain plasticity life long changes in the structure of the brain

Sensory substitution replacement of one sensory input by another

Measurement techniques

Voxel based morphometryhellipmeasures difference in brain volume

Fluorodeoxyglucose glucose analog PET scan tells you

distribution and metabolism of brain

Cortical thickness measures

Visual cortex of the blind turns somatic ―The eye of the tongue

Transcranial magnetic stmiulation non-invasive technique to

stimulate cortex

66

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Blind Braille readers report tingling in fingers when pressure

phosphenes are applied Blind feel tingling in tongue

Bind use tongue to perform orientation task motion perception

sensory perception Visual cortex recruited in a variety of sensory

and cognitive tasks (DM Can we use tongue as a VT tool)

Dilks Reorganizations of human adult visual system

When a region of sensory cortex is deprived of its bottom up

input the deprived region begins to respond to stimuli that

normally activate adjacent cortex

67

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Retinotopic map changes for stroke pts Cortical reorganization in

adults occurs Perceived objectshellipelongation in stroke amp AMD

What happens to deprived cortex in AMD

fMRI shows cortical reorganization in adults

Proposed mechanisms

hellipGrowth of new connections

hellipUnmasking of pre-existing connections this is true

happens within seconds

Bavelier

Action video games

68

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Bavelier

Action video games Looked at attention Gamers can track more

activities

Attention over space (me peripheral awarenress) Useful field

of view shrinks with age

Performance not VA relatedhellipis related to attention

Action game playing changes spatial resolutionhellipovercoming

crowding in VA assessment (me amblyopia therapy)

Temporal resolution of vision Backward masking

changehellipbrain changes

Visual sensitivity (contrast sensitivity) Post action game training

improves CSF

69

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Action video games correcting optics of the cortex (me this is

actualy OVT)

Games factor

Variable entry leanringhellipadapt task to skill level

Incremental learning tune task to subjectlsquos leanring steps

Motivationarousal

Rewards

Self masterself confidence

Action games factors

Pacingrate of exposure to infohellipincreasing processing speed

Dynamic display

Rich environment

Rich motor involvement

70

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Surgeons may be made to play action games

Pilot training

Amblyopia tx Dennis Levi research

PresenterTitle Contact info

Neuroplasticity-A Paradigm Sea Change

This presentation is available at

httpwwwslidesharenetDMAINOneuroplasticity-a-paradigm-sea-change-2459693

httpwwwmainosmemosblogspotcom

My FaceBook Page

and

Twitter

PresenterTitle Contact info

Questions About

Neuroplasticity-A Paradigm Sea Change

Dominick M Maino OD MEd FAAO FCOVD-A

Professor PediatricsBinocular VisionIllinois Eye InstituteIllinois College of Optometry

dmainoicoeduhttpwwwMainosMemosblogspotcom

Thanks to

httpwwwcovdorgHomeOVDJournalOVD401tabid263D

efaultaspx

httpbipolarblastfileswordpresscom200908neurojpg

httpwwwspecialcheerscomimagesanimated_braingif

httpblogmarsdencartoonscomwp-

contentuploads200810frankenstein-myspace-lightbeergif

httpwwwshangralafamilyfuncomgala-ecalvindreamgif

httppsychiatryjwatchorgcgicontentfull20082251

73

Chakraborty R Chatterjee A Choudhart S Chakraborty PK Neuroplasticitymdasha paradigm shift in neurosciences J Indian Med Assoc

2007105(9)513-4516-8520-1

Sacks O A neurologistlsquos notebook Stereo Sue Why two eyes are better than one The New Yorker 2006 Jun 1964-73

Krulwich R National Public Radio Going Binocular Susanlsquos First Snowfall Available at

wwwnprorgtemplatesstorystoryphpstoryId=5507789 (Accessed December 8 2008)

Press LJ The story behind Stereo Suelsquo and a world-famous neurologistlsquos discovery of vision therapy Optom Vis Dev 200637(2) 55-7

Levin HS Neuroplasticity and brain imaging research implications for rehabilitation Arch Phys Med Rehabil 2006 Dec87(12 Suppl

2)S1

Wiesel TN Hubel DH Single-cell responses in striate cortex of kittens deprived of vision in one eye J Neurophysiol 1963

Nov261003-17

Hook BM Chen C Critical periods in the visual system Changing views for a model of experience-dependent plasticity Neuron 2007

Oct56(2)312-26

Ramey CT Ramey SL Prevention of intellectual disabilities early interventions to improve cognitive development Prev Med 1998

Mar-Apr27(2)224-32

Heuninckx S Wenderoth N Swinnen SP Systems neuroplasticity in the aging brain recruiting additional neural resources for

successful motor performance in elderly persons J Neurosci 2008 Jan 228(1)91-9

Ge S Yang CH Hsu KS et al A critical period for enhanced synaptic plasticity in newly generated neurons of the adult brain Neuron

2007 May54(4)559-66

74

Draganski B Gaser C Busch V et al Neuroplasticity changes in grey matter induced by training Nature 2004 Jan 22427(6972)

311-2

Cannonieri GC Bonilha L Fernandes PT et al Practice and perfect length of training and structural brain changes in experienced

typists Neuroreport 2007 Jul 218(10)1063-6

Kleim JA Jones TA Principles of experience-dependent neural plasticity implications for rehabilitation after brain damage J

Speech Lang Hear Res 2008 Feb51(1)S225-39

Trojan S Porkorny J Theoretical aspects of neuroplasticity Physiol Res 199948(2)87-97

Ramamirtham R Kee CS Hung LF et al Wave aberrations in rhesus monkeys with vision-induced ametropias Vision Res 2007

Sep47(21)2751-66

Smith EL 3rd Ramamirtham R Qiao-Grider Y et al Effects of foveal ablation on emmetropization and form-deprivation myopia

Invest Ophthalmol Vis Sci 2007 Sep48(9)3914-22

Smith EL 3rd Kee CS Ramamirtham R et al Peripheral vision can influence eye growth and refractive development in infant

monkeys Invest Ophthalmol Vis Sci 2005 Nov46(11)3965-72

Ciuffreda KJ Vasudevan B Nearwork-induced transient myopia (NITM) and permanent myopiandashndashis there a link Ophthalmic

Physiol Opt 2008 Mar28(2)103-14

Hung GK Ciuffreda KJ Incremental retinal-defocus theory of myopia development--schematic analysis and computer simulation

Comput Biol Med 2007 Jul37(7)930-46

Hung GK Ciuffreda KJ A unifying theory of refractive error development Bull Math Biol 2000 Nov62(6)1087-108

75

Pang Y Maino D Zhang G Lu F Myopia Can its progress be controlled Optom Vis Dev 200637(2)75-9

Leung JT Brown B Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lenses Optom Vis Sci

1999 Jun76(6)346-54

Hasebe S Ohtsuki H Nonaka T et al Effect of progressive addition lenses on myopia progression in Japanese children a prospective

randomized double-masked crossover trial Invest Ophthalmol Vis Sci 2008 Jul49(7)2781-9

Gwiazda J Hyman L Hussein M et al A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression

of myopia in children Invest Ophthalmol Vis Sci 2003 Apr44(4)1492-500

Siatkowski RM Cotter SA Crockett RS et al Two-year multi-center randomized double-masked placebo-controlled parallel safety and

efficacy study of 2 pirenzepine ophthalmic gel in children with myopia J AAPOS 2008 Aug12(4)332-9

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged 7 to 17 years Arch Ophthalmol 2005

Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three to less than 10 years of age Am J

Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction Am J Ophthalmol 2007

Jun143(6)1060-3

Holmes JM Edwards AR Beck RW et al A randomized pilot study of near activities versus non-near activities during patching therapy for

amblyopia J AAPOS 2005 Apr9(2)129-36

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate

amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-57

76

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic

amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Convergence Insufficiency Treatment Trial Study Group Randomized clinical trial of treatments for symptomatic convergence insufficiency

in children Arch Ophthalmol 2008 Oct126(10)1336-49

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

Solan HA Shelley-Tremblay J Hansen PC et al M-cell deficit and reading disability a preliminary study of the effects of temporal vision-

processing therapy Optometry 2004 Oct75(10)640-50

Solan HA Larson S Shelley-Tremblay J et al Role of visual attention in cognitive control of oculomotor readiness in students with reading

disabilities J Learn Disabil 2001 Mar-Apr34(2)107-18

Gallaway M Boas MB The impact of vergence and accommodative therapy on reading eye movements and reading speed Optom Vis Dev

200738(3)115-20

Goss DA Downing DB Lowther AH et al The effect of HTS vision therapy conducted in a school setting on reading skills in third and

fourth grade students Optom Vis Dev 200738(1)27-32

Crutch SJ Warrington EK Foveal crowding in posterior cortical atrophy a specific early-visual-processing deficit affecting word reading

Cogn Neuropsychol 2007 Dec24(8)843-66

Helms D Sawtelle SM A study of the effectiveness of cognitive therapy delivered in a video game format Optom Vis Dev 200738 (1)19-

26

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

77

Lawton T Training direction-discrimination sensitivity remediates a wide spectrum of reading skills OptomVis Dev 200738(1) 33-47

Goldstand S Koslowe KC Parush S Vision visual-information processing and academic performance among seventh-grade schoolchildren a

more significant relationship than we thought Am J Occup Ther 2005 Jul-Aug59(4)377-89

Fischer B Koumlngeter A Hartnegg K Effects of daily practice on subitizing visual counting and basic arithmetic skills Optom Vis Dev

200839(1)30-4

Sands W Taub M Maino D Limited research and education on special populations in optometry and ophthalomology Optom Vis Dev

200839(2)60-1

Wesson M Maino D Oculo-visual findings in Down syndrome cerebral palsy and mental retardation with non-specific etiology In Maino D

(ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 199517-54 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

Cui Y Stapleton F Suttle C Developing an instrument to assess vision-related and subjective quality of life in children with intellectual

disability data collection and preliminary analysis in a Chinese population Ophthal Physiolog Optics 2008 May28(3) 238-46

Maino D Steele G Tahir S Sajja R Attitudes of optometry students toward individuals with disabilities Optom Ed 200227(2)45-50

Maino D Special populations in the optometric curriculum Optom Ed 200227(2)38-9

Maino D Overview of special populations In Scheiman M Rouse M (eds) Optometric Management of Learning-Related Vision Problems

St Louis Mosby Inc 200685-106

Maino D (ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 1995 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

78

McCarthy P Maino D Alport syndrome a review Clin Eye Vis Care 2000 Dec12(3-4)139-50

Block SS Brusca-Vega R Pizzi WJ et al Cognitive and visual processing skills and their relationship to mutation size in full and

permutation female fragile X carriers Optom Vis Sci 2000 Nov77 (11)592-9

Maino D The young child with developmental disabilities An introduction to mental retardation and genetic syndromes In Moore BD

(ed) Eye Care for Infants and Young Children Butter-worth--Heinemann Newton MA1997285-300

Amin V Maino D The Fragile X female Visual visual perceptual and ocular health anomalies J Am Optom Assoc 1995 May66

(5)290-95

Maino DM Maino JH Cibis GW Hecht F Ocular health anomalies in patients with developmental disabilities In Maino D (ed)

Diagnosis and Management of Special Populations Mosby-Year-book Inc St Louis MO 1995189-206 Reprinted Optometric

Education Program Foundation Santa Anna Calif 2001

Maino D Wesson M Schlange D Cibis G Maino J Optometric findings in the fragile X syndrome Optom Vis Sci 199168634-40

Scheiman MMOptometric findings in children with cerebral palsy Am J Optom Physiol Opt 1984 May61(5)321-3

Maino D Maino J Maino S Mental retardation syndromes with associated ocular defects J Am Optom Assoc 199061707-16

Stewart RE Woodhouse JM Cregg M Pakeman VH Association between accommodative accuracy hypermetropia and strabismus in

children with Downs syndrome Optom Vis Sci 2007 Feb84(2)149-55

Cregg M Woodhouse JM Pakeman VH et al Accommodation and refractive error in children with Down syndrome cross-sectional

and longitudinal studies Invest Ophthalmol Vis Sci 2001 Jan42 (1)55-63

79

McClelland JF Parkes J Hill N et al Accommodative dysfunction in children with cerebral palsy a population-

based study Invest Ophthalmol Vis Sci 2006 May47(5)1824-30

Duckman RH Vision therapy for the child with cerebral palsy J Am Optom Assoc 198758(1)28-35

Duckman R Accommodation in cerebral palsy function and remediation J Am Optom Assoc 198455(4)281-3

Scheiman M Understanding and managing vision deficits a guide for occupational therapists 2nd ed Slack

Thorofare NJ 2002

Maino D Binasal occlusion for the child with Cerebral Palsy J Ill Optom Assoc 198644(1)1218

Battaglia F Quartarone A Rizzo V et al Early impairment of synaptic plasticity in patients with Downs syndrome

Neurobiol Aging 2008 Aug29(8)1272-5

Bonnier C Evaluation of early stimulation programs for enhancing brain development Acta Paediatr 2008

Jul97(7)853-8

Morice E Andreae LC Cooke SF et al Preservation of long-term memory and synaptic plasticity despite short-term

impairments in the Tc1 mouse model of Down syndrome Learn Mem 2008 Jul 1415(7)492-500

Gordon AM Schneider JA Chinnan A Charles JR Efficacy of a hand-arm bimanual intensive therapy (HABIT) in

children with hemiplegic cerebral palsy a randomized control trial Dev Med Child Neurol 2007 Nov49(11)830-8

Kapoor N Ciuffreda KJ Vision disturbances following traumatic brain injury Curr Treat Options Neurol 2002

Jul4(4)271-80

80

Ciuffreda KJ Rutner D Kapoor N et al Vision therapy for oculomotor dysfunctions in acquired brain injury a

retrospective analysis Optometry 2008 Jan79(1)18-22

Ciuffreda KJ Han Y Kapoor N Ficarra AP Oculomotor rehabilitation for reading in acquired brain injury

NeuroRehabilitation 200621(1)9-21

Zost M Diagnosis and management of visual dysfunction in cerebral injury In Maino D (ed) Diagnosis and

Management of Special Populations Mosby-Yearbook Inc St Louis 199579 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001 [Figure used with permission of the editor]

DeGutis JM Bentin S Robertson LC DEsposito M Functional plasticity in ventral temporal cortex following

cognitive rehabilitation of a congenital prosopagnosic J Cogn Neurosci 2007 Nov19 (11)1790-802

Welbourne SR Ralph MA Exploring the impact of plasticity-related recovery after brain damage in a connectionist

model of single-word reading Cogn Affect Behav Neurosci 2005 Mar5(1)77-92

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements prevent cognitive decline A

systematic review of randomized controlled trials J Hum Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among preterm infants attributable to early

supplementation of human milk with docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings and structural-functional

synergies with cell membrane phospholipids Altern Med Rev 2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function Neuroscience 20089(7)568-78

81

Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

BMC Biol 2008 Sep 9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine improves neuropsychological disorders in a child with

creatine transporter defect Neurocase 200814(2) 151-61

Forrester LW Wheaton LA Luft AR Exercise-mediated locomotor recovery and lower-limb neuroplasticity after

stroke J Rehabil Res Dev 200845(2)205-20

82

Page 55: Neuroplasticity: A Paradigm Sea Change Latest Updated File

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Compensatory masquerade reorganizing of existing neuro-pathways to us alternative cognitive strategies to perform a task

55

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Cross-modal reassignment using new sensory input in a brain structure deprived of its main input source (changing processing from visual to tactile stimuli in the blind)

56

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Map expansion increase in brain mass due to repeated behavior or exposure to stimuli

57

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Equipotentiality anatomical areas of the brain can perform disparate functions

Vicariation redundant neural systems can operate under abnormal conditions

This may explain why recovery is noted for many neurological conditions (degenerative psychiatric developmental vascular traumatic)

58

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Constraint therapy Use it and improve it

Patching penalization ldquonear activitiesrdquo during amblyopia therapy

59

IX Improving Brain Function and Neuroplasticity Optometric Clinical ApplicationsOptometric Vision Therapy

Kleim amp Jones

Use it or lose it If you do not drive specific brain functions

functional loss will occur

If you want to improve oculomotor brain neuroplastic function amp

structure therapy should be specific for that brain function

Use it and improve it Therapy that drives cortical function enhances

that particular function

If you use therapy to improve oculomotor dysfunction it should

improve

Specificity The therapy you choose determines the resultant

plasticity and function

You must choose therapy that is appropriate

60

IX Improving Brain Function and Neuroplasticity Optometric Clinical Applications

Kleim amp Jones

Repetition matters Plasticity that results in functional change

requires repetition

Do the therapy Do it again Do it yet again No quick fix

Intensity matters Induction of plasticity requires the appropriate

amount of intensity

Intensity means strength force concentration power and passion

Without these plasticity may not occur Function may not improve

Time matters Different forms of plasticity take place at different

times during therapy

Do the basics than the more advanced therapeutic procedures

61

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Salience matters It has to be important to the individual

Make the therapy matter to the patient

Age matters Plasticity is easier in a younger brain but is also

possible in an adult brain

Do not let age determine what therapy options you offer your

patients Think of Susan Barry PhD (StereoSue) and her success

Offer your patients options Let them choose Be realistic about

outcomeshelliphave outcome measures built into therapy program

62

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Transference Neuroplasticity and the change in function

that results from one therapy can augment the attainment

of similar behaviors

What you do during oculomotor therapy may affected

vergence therapy outcomes

Interference Plasticity in response to one experience can

interfere with the acquisition of other behaviors

Monitor Evaluate progress Discuss function in other areas

of your patientslsquo life

63

Why pay attention to binocular vision dysfunctions

and neuroplasticity

December 2009 issue of the Review of Optometry

The Binocular Vision Dysfunction Pandemic

In 2010 almost 170 million individuals will be wearing glasses In

2010 there will also be up to 93 million amblyopes and 12 and a half

million strabismics For children under 18 years of age that means

there will be more than 22 and a half million amblyopes and millions

of children with strabismus A clinical trial to determine the

prevalence of binocular vision dysfunction within the general

population suggested the possibility of up to 56 or 173 million men

women and children with symptoms associated with a binocular

vision dysfunction 189 million (61) with accommodative problems

and 118 million (38) demonstrating various vergence

anomalies

64

65

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Brain plasticity life long changes in the structure of the brain

Sensory substitution replacement of one sensory input by another

Measurement techniques

Voxel based morphometryhellipmeasures difference in brain volume

Fluorodeoxyglucose glucose analog PET scan tells you

distribution and metabolism of brain

Cortical thickness measures

Visual cortex of the blind turns somatic ―The eye of the tongue

Transcranial magnetic stmiulation non-invasive technique to

stimulate cortex

66

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Blind Braille readers report tingling in fingers when pressure

phosphenes are applied Blind feel tingling in tongue

Bind use tongue to perform orientation task motion perception

sensory perception Visual cortex recruited in a variety of sensory

and cognitive tasks (DM Can we use tongue as a VT tool)

Dilks Reorganizations of human adult visual system

When a region of sensory cortex is deprived of its bottom up

input the deprived region begins to respond to stimuli that

normally activate adjacent cortex

67

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Retinotopic map changes for stroke pts Cortical reorganization in

adults occurs Perceived objectshellipelongation in stroke amp AMD

What happens to deprived cortex in AMD

fMRI shows cortical reorganization in adults

Proposed mechanisms

hellipGrowth of new connections

hellipUnmasking of pre-existing connections this is true

happens within seconds

Bavelier

Action video games

68

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Bavelier

Action video games Looked at attention Gamers can track more

activities

Attention over space (me peripheral awarenress) Useful field

of view shrinks with age

Performance not VA relatedhellipis related to attention

Action game playing changes spatial resolutionhellipovercoming

crowding in VA assessment (me amblyopia therapy)

Temporal resolution of vision Backward masking

changehellipbrain changes

Visual sensitivity (contrast sensitivity) Post action game training

improves CSF

69

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Action video games correcting optics of the cortex (me this is

actualy OVT)

Games factor

Variable entry leanringhellipadapt task to skill level

Incremental learning tune task to subjectlsquos leanring steps

Motivationarousal

Rewards

Self masterself confidence

Action games factors

Pacingrate of exposure to infohellipincreasing processing speed

Dynamic display

Rich environment

Rich motor involvement

70

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Surgeons may be made to play action games

Pilot training

Amblyopia tx Dennis Levi research

PresenterTitle Contact info

Neuroplasticity-A Paradigm Sea Change

This presentation is available at

httpwwwslidesharenetDMAINOneuroplasticity-a-paradigm-sea-change-2459693

httpwwwmainosmemosblogspotcom

My FaceBook Page

and

Twitter

PresenterTitle Contact info

Questions About

Neuroplasticity-A Paradigm Sea Change

Dominick M Maino OD MEd FAAO FCOVD-A

Professor PediatricsBinocular VisionIllinois Eye InstituteIllinois College of Optometry

dmainoicoeduhttpwwwMainosMemosblogspotcom

Thanks to

httpwwwcovdorgHomeOVDJournalOVD401tabid263D

efaultaspx

httpbipolarblastfileswordpresscom200908neurojpg

httpwwwspecialcheerscomimagesanimated_braingif

httpblogmarsdencartoonscomwp-

contentuploads200810frankenstein-myspace-lightbeergif

httpwwwshangralafamilyfuncomgala-ecalvindreamgif

httppsychiatryjwatchorgcgicontentfull20082251

73

Chakraborty R Chatterjee A Choudhart S Chakraborty PK Neuroplasticitymdasha paradigm shift in neurosciences J Indian Med Assoc

2007105(9)513-4516-8520-1

Sacks O A neurologistlsquos notebook Stereo Sue Why two eyes are better than one The New Yorker 2006 Jun 1964-73

Krulwich R National Public Radio Going Binocular Susanlsquos First Snowfall Available at

wwwnprorgtemplatesstorystoryphpstoryId=5507789 (Accessed December 8 2008)

Press LJ The story behind Stereo Suelsquo and a world-famous neurologistlsquos discovery of vision therapy Optom Vis Dev 200637(2) 55-7

Levin HS Neuroplasticity and brain imaging research implications for rehabilitation Arch Phys Med Rehabil 2006 Dec87(12 Suppl

2)S1

Wiesel TN Hubel DH Single-cell responses in striate cortex of kittens deprived of vision in one eye J Neurophysiol 1963

Nov261003-17

Hook BM Chen C Critical periods in the visual system Changing views for a model of experience-dependent plasticity Neuron 2007

Oct56(2)312-26

Ramey CT Ramey SL Prevention of intellectual disabilities early interventions to improve cognitive development Prev Med 1998

Mar-Apr27(2)224-32

Heuninckx S Wenderoth N Swinnen SP Systems neuroplasticity in the aging brain recruiting additional neural resources for

successful motor performance in elderly persons J Neurosci 2008 Jan 228(1)91-9

Ge S Yang CH Hsu KS et al A critical period for enhanced synaptic plasticity in newly generated neurons of the adult brain Neuron

2007 May54(4)559-66

74

Draganski B Gaser C Busch V et al Neuroplasticity changes in grey matter induced by training Nature 2004 Jan 22427(6972)

311-2

Cannonieri GC Bonilha L Fernandes PT et al Practice and perfect length of training and structural brain changes in experienced

typists Neuroreport 2007 Jul 218(10)1063-6

Kleim JA Jones TA Principles of experience-dependent neural plasticity implications for rehabilitation after brain damage J

Speech Lang Hear Res 2008 Feb51(1)S225-39

Trojan S Porkorny J Theoretical aspects of neuroplasticity Physiol Res 199948(2)87-97

Ramamirtham R Kee CS Hung LF et al Wave aberrations in rhesus monkeys with vision-induced ametropias Vision Res 2007

Sep47(21)2751-66

Smith EL 3rd Ramamirtham R Qiao-Grider Y et al Effects of foveal ablation on emmetropization and form-deprivation myopia

Invest Ophthalmol Vis Sci 2007 Sep48(9)3914-22

Smith EL 3rd Kee CS Ramamirtham R et al Peripheral vision can influence eye growth and refractive development in infant

monkeys Invest Ophthalmol Vis Sci 2005 Nov46(11)3965-72

Ciuffreda KJ Vasudevan B Nearwork-induced transient myopia (NITM) and permanent myopiandashndashis there a link Ophthalmic

Physiol Opt 2008 Mar28(2)103-14

Hung GK Ciuffreda KJ Incremental retinal-defocus theory of myopia development--schematic analysis and computer simulation

Comput Biol Med 2007 Jul37(7)930-46

Hung GK Ciuffreda KJ A unifying theory of refractive error development Bull Math Biol 2000 Nov62(6)1087-108

75

Pang Y Maino D Zhang G Lu F Myopia Can its progress be controlled Optom Vis Dev 200637(2)75-9

Leung JT Brown B Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lenses Optom Vis Sci

1999 Jun76(6)346-54

Hasebe S Ohtsuki H Nonaka T et al Effect of progressive addition lenses on myopia progression in Japanese children a prospective

randomized double-masked crossover trial Invest Ophthalmol Vis Sci 2008 Jul49(7)2781-9

Gwiazda J Hyman L Hussein M et al A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression

of myopia in children Invest Ophthalmol Vis Sci 2003 Apr44(4)1492-500

Siatkowski RM Cotter SA Crockett RS et al Two-year multi-center randomized double-masked placebo-controlled parallel safety and

efficacy study of 2 pirenzepine ophthalmic gel in children with myopia J AAPOS 2008 Aug12(4)332-9

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged 7 to 17 years Arch Ophthalmol 2005

Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three to less than 10 years of age Am J

Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction Am J Ophthalmol 2007

Jun143(6)1060-3

Holmes JM Edwards AR Beck RW et al A randomized pilot study of near activities versus non-near activities during patching therapy for

amblyopia J AAPOS 2005 Apr9(2)129-36

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate

amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-57

76

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic

amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Convergence Insufficiency Treatment Trial Study Group Randomized clinical trial of treatments for symptomatic convergence insufficiency

in children Arch Ophthalmol 2008 Oct126(10)1336-49

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

Solan HA Shelley-Tremblay J Hansen PC et al M-cell deficit and reading disability a preliminary study of the effects of temporal vision-

processing therapy Optometry 2004 Oct75(10)640-50

Solan HA Larson S Shelley-Tremblay J et al Role of visual attention in cognitive control of oculomotor readiness in students with reading

disabilities J Learn Disabil 2001 Mar-Apr34(2)107-18

Gallaway M Boas MB The impact of vergence and accommodative therapy on reading eye movements and reading speed Optom Vis Dev

200738(3)115-20

Goss DA Downing DB Lowther AH et al The effect of HTS vision therapy conducted in a school setting on reading skills in third and

fourth grade students Optom Vis Dev 200738(1)27-32

Crutch SJ Warrington EK Foveal crowding in posterior cortical atrophy a specific early-visual-processing deficit affecting word reading

Cogn Neuropsychol 2007 Dec24(8)843-66

Helms D Sawtelle SM A study of the effectiveness of cognitive therapy delivered in a video game format Optom Vis Dev 200738 (1)19-

26

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

77

Lawton T Training direction-discrimination sensitivity remediates a wide spectrum of reading skills OptomVis Dev 200738(1) 33-47

Goldstand S Koslowe KC Parush S Vision visual-information processing and academic performance among seventh-grade schoolchildren a

more significant relationship than we thought Am J Occup Ther 2005 Jul-Aug59(4)377-89

Fischer B Koumlngeter A Hartnegg K Effects of daily practice on subitizing visual counting and basic arithmetic skills Optom Vis Dev

200839(1)30-4

Sands W Taub M Maino D Limited research and education on special populations in optometry and ophthalomology Optom Vis Dev

200839(2)60-1

Wesson M Maino D Oculo-visual findings in Down syndrome cerebral palsy and mental retardation with non-specific etiology In Maino D

(ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 199517-54 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

Cui Y Stapleton F Suttle C Developing an instrument to assess vision-related and subjective quality of life in children with intellectual

disability data collection and preliminary analysis in a Chinese population Ophthal Physiolog Optics 2008 May28(3) 238-46

Maino D Steele G Tahir S Sajja R Attitudes of optometry students toward individuals with disabilities Optom Ed 200227(2)45-50

Maino D Special populations in the optometric curriculum Optom Ed 200227(2)38-9

Maino D Overview of special populations In Scheiman M Rouse M (eds) Optometric Management of Learning-Related Vision Problems

St Louis Mosby Inc 200685-106

Maino D (ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 1995 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

78

McCarthy P Maino D Alport syndrome a review Clin Eye Vis Care 2000 Dec12(3-4)139-50

Block SS Brusca-Vega R Pizzi WJ et al Cognitive and visual processing skills and their relationship to mutation size in full and

permutation female fragile X carriers Optom Vis Sci 2000 Nov77 (11)592-9

Maino D The young child with developmental disabilities An introduction to mental retardation and genetic syndromes In Moore BD

(ed) Eye Care for Infants and Young Children Butter-worth--Heinemann Newton MA1997285-300

Amin V Maino D The Fragile X female Visual visual perceptual and ocular health anomalies J Am Optom Assoc 1995 May66

(5)290-95

Maino DM Maino JH Cibis GW Hecht F Ocular health anomalies in patients with developmental disabilities In Maino D (ed)

Diagnosis and Management of Special Populations Mosby-Year-book Inc St Louis MO 1995189-206 Reprinted Optometric

Education Program Foundation Santa Anna Calif 2001

Maino D Wesson M Schlange D Cibis G Maino J Optometric findings in the fragile X syndrome Optom Vis Sci 199168634-40

Scheiman MMOptometric findings in children with cerebral palsy Am J Optom Physiol Opt 1984 May61(5)321-3

Maino D Maino J Maino S Mental retardation syndromes with associated ocular defects J Am Optom Assoc 199061707-16

Stewart RE Woodhouse JM Cregg M Pakeman VH Association between accommodative accuracy hypermetropia and strabismus in

children with Downs syndrome Optom Vis Sci 2007 Feb84(2)149-55

Cregg M Woodhouse JM Pakeman VH et al Accommodation and refractive error in children with Down syndrome cross-sectional

and longitudinal studies Invest Ophthalmol Vis Sci 2001 Jan42 (1)55-63

79

McClelland JF Parkes J Hill N et al Accommodative dysfunction in children with cerebral palsy a population-

based study Invest Ophthalmol Vis Sci 2006 May47(5)1824-30

Duckman RH Vision therapy for the child with cerebral palsy J Am Optom Assoc 198758(1)28-35

Duckman R Accommodation in cerebral palsy function and remediation J Am Optom Assoc 198455(4)281-3

Scheiman M Understanding and managing vision deficits a guide for occupational therapists 2nd ed Slack

Thorofare NJ 2002

Maino D Binasal occlusion for the child with Cerebral Palsy J Ill Optom Assoc 198644(1)1218

Battaglia F Quartarone A Rizzo V et al Early impairment of synaptic plasticity in patients with Downs syndrome

Neurobiol Aging 2008 Aug29(8)1272-5

Bonnier C Evaluation of early stimulation programs for enhancing brain development Acta Paediatr 2008

Jul97(7)853-8

Morice E Andreae LC Cooke SF et al Preservation of long-term memory and synaptic plasticity despite short-term

impairments in the Tc1 mouse model of Down syndrome Learn Mem 2008 Jul 1415(7)492-500

Gordon AM Schneider JA Chinnan A Charles JR Efficacy of a hand-arm bimanual intensive therapy (HABIT) in

children with hemiplegic cerebral palsy a randomized control trial Dev Med Child Neurol 2007 Nov49(11)830-8

Kapoor N Ciuffreda KJ Vision disturbances following traumatic brain injury Curr Treat Options Neurol 2002

Jul4(4)271-80

80

Ciuffreda KJ Rutner D Kapoor N et al Vision therapy for oculomotor dysfunctions in acquired brain injury a

retrospective analysis Optometry 2008 Jan79(1)18-22

Ciuffreda KJ Han Y Kapoor N Ficarra AP Oculomotor rehabilitation for reading in acquired brain injury

NeuroRehabilitation 200621(1)9-21

Zost M Diagnosis and management of visual dysfunction in cerebral injury In Maino D (ed) Diagnosis and

Management of Special Populations Mosby-Yearbook Inc St Louis 199579 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001 [Figure used with permission of the editor]

DeGutis JM Bentin S Robertson LC DEsposito M Functional plasticity in ventral temporal cortex following

cognitive rehabilitation of a congenital prosopagnosic J Cogn Neurosci 2007 Nov19 (11)1790-802

Welbourne SR Ralph MA Exploring the impact of plasticity-related recovery after brain damage in a connectionist

model of single-word reading Cogn Affect Behav Neurosci 2005 Mar5(1)77-92

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements prevent cognitive decline A

systematic review of randomized controlled trials J Hum Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among preterm infants attributable to early

supplementation of human milk with docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings and structural-functional

synergies with cell membrane phospholipids Altern Med Rev 2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function Neuroscience 20089(7)568-78

81

Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

BMC Biol 2008 Sep 9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine improves neuropsychological disorders in a child with

creatine transporter defect Neurocase 200814(2) 151-61

Forrester LW Wheaton LA Luft AR Exercise-mediated locomotor recovery and lower-limb neuroplasticity after

stroke J Rehabil Res Dev 200845(2)205-20

82

Page 56: Neuroplasticity: A Paradigm Sea Change Latest Updated File

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Cross-modal reassignment using new sensory input in a brain structure deprived of its main input source (changing processing from visual to tactile stimuli in the blind)

56

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Map expansion increase in brain mass due to repeated behavior or exposure to stimuli

57

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Equipotentiality anatomical areas of the brain can perform disparate functions

Vicariation redundant neural systems can operate under abnormal conditions

This may explain why recovery is noted for many neurological conditions (degenerative psychiatric developmental vascular traumatic)

58

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Constraint therapy Use it and improve it

Patching penalization ldquonear activitiesrdquo during amblyopia therapy

59

IX Improving Brain Function and Neuroplasticity Optometric Clinical ApplicationsOptometric Vision Therapy

Kleim amp Jones

Use it or lose it If you do not drive specific brain functions

functional loss will occur

If you want to improve oculomotor brain neuroplastic function amp

structure therapy should be specific for that brain function

Use it and improve it Therapy that drives cortical function enhances

that particular function

If you use therapy to improve oculomotor dysfunction it should

improve

Specificity The therapy you choose determines the resultant

plasticity and function

You must choose therapy that is appropriate

60

IX Improving Brain Function and Neuroplasticity Optometric Clinical Applications

Kleim amp Jones

Repetition matters Plasticity that results in functional change

requires repetition

Do the therapy Do it again Do it yet again No quick fix

Intensity matters Induction of plasticity requires the appropriate

amount of intensity

Intensity means strength force concentration power and passion

Without these plasticity may not occur Function may not improve

Time matters Different forms of plasticity take place at different

times during therapy

Do the basics than the more advanced therapeutic procedures

61

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Salience matters It has to be important to the individual

Make the therapy matter to the patient

Age matters Plasticity is easier in a younger brain but is also

possible in an adult brain

Do not let age determine what therapy options you offer your

patients Think of Susan Barry PhD (StereoSue) and her success

Offer your patients options Let them choose Be realistic about

outcomeshelliphave outcome measures built into therapy program

62

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Transference Neuroplasticity and the change in function

that results from one therapy can augment the attainment

of similar behaviors

What you do during oculomotor therapy may affected

vergence therapy outcomes

Interference Plasticity in response to one experience can

interfere with the acquisition of other behaviors

Monitor Evaluate progress Discuss function in other areas

of your patientslsquo life

63

Why pay attention to binocular vision dysfunctions

and neuroplasticity

December 2009 issue of the Review of Optometry

The Binocular Vision Dysfunction Pandemic

In 2010 almost 170 million individuals will be wearing glasses In

2010 there will also be up to 93 million amblyopes and 12 and a half

million strabismics For children under 18 years of age that means

there will be more than 22 and a half million amblyopes and millions

of children with strabismus A clinical trial to determine the

prevalence of binocular vision dysfunction within the general

population suggested the possibility of up to 56 or 173 million men

women and children with symptoms associated with a binocular

vision dysfunction 189 million (61) with accommodative problems

and 118 million (38) demonstrating various vergence

anomalies

64

65

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Brain plasticity life long changes in the structure of the brain

Sensory substitution replacement of one sensory input by another

Measurement techniques

Voxel based morphometryhellipmeasures difference in brain volume

Fluorodeoxyglucose glucose analog PET scan tells you

distribution and metabolism of brain

Cortical thickness measures

Visual cortex of the blind turns somatic ―The eye of the tongue

Transcranial magnetic stmiulation non-invasive technique to

stimulate cortex

66

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Blind Braille readers report tingling in fingers when pressure

phosphenes are applied Blind feel tingling in tongue

Bind use tongue to perform orientation task motion perception

sensory perception Visual cortex recruited in a variety of sensory

and cognitive tasks (DM Can we use tongue as a VT tool)

Dilks Reorganizations of human adult visual system

When a region of sensory cortex is deprived of its bottom up

input the deprived region begins to respond to stimuli that

normally activate adjacent cortex

67

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Retinotopic map changes for stroke pts Cortical reorganization in

adults occurs Perceived objectshellipelongation in stroke amp AMD

What happens to deprived cortex in AMD

fMRI shows cortical reorganization in adults

Proposed mechanisms

hellipGrowth of new connections

hellipUnmasking of pre-existing connections this is true

happens within seconds

Bavelier

Action video games

68

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Bavelier

Action video games Looked at attention Gamers can track more

activities

Attention over space (me peripheral awarenress) Useful field

of view shrinks with age

Performance not VA relatedhellipis related to attention

Action game playing changes spatial resolutionhellipovercoming

crowding in VA assessment (me amblyopia therapy)

Temporal resolution of vision Backward masking

changehellipbrain changes

Visual sensitivity (contrast sensitivity) Post action game training

improves CSF

69

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Action video games correcting optics of the cortex (me this is

actualy OVT)

Games factor

Variable entry leanringhellipadapt task to skill level

Incremental learning tune task to subjectlsquos leanring steps

Motivationarousal

Rewards

Self masterself confidence

Action games factors

Pacingrate of exposure to infohellipincreasing processing speed

Dynamic display

Rich environment

Rich motor involvement

70

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Surgeons may be made to play action games

Pilot training

Amblyopia tx Dennis Levi research

PresenterTitle Contact info

Neuroplasticity-A Paradigm Sea Change

This presentation is available at

httpwwwslidesharenetDMAINOneuroplasticity-a-paradigm-sea-change-2459693

httpwwwmainosmemosblogspotcom

My FaceBook Page

and

Twitter

PresenterTitle Contact info

Questions About

Neuroplasticity-A Paradigm Sea Change

Dominick M Maino OD MEd FAAO FCOVD-A

Professor PediatricsBinocular VisionIllinois Eye InstituteIllinois College of Optometry

dmainoicoeduhttpwwwMainosMemosblogspotcom

Thanks to

httpwwwcovdorgHomeOVDJournalOVD401tabid263D

efaultaspx

httpbipolarblastfileswordpresscom200908neurojpg

httpwwwspecialcheerscomimagesanimated_braingif

httpblogmarsdencartoonscomwp-

contentuploads200810frankenstein-myspace-lightbeergif

httpwwwshangralafamilyfuncomgala-ecalvindreamgif

httppsychiatryjwatchorgcgicontentfull20082251

73

Chakraborty R Chatterjee A Choudhart S Chakraborty PK Neuroplasticitymdasha paradigm shift in neurosciences J Indian Med Assoc

2007105(9)513-4516-8520-1

Sacks O A neurologistlsquos notebook Stereo Sue Why two eyes are better than one The New Yorker 2006 Jun 1964-73

Krulwich R National Public Radio Going Binocular Susanlsquos First Snowfall Available at

wwwnprorgtemplatesstorystoryphpstoryId=5507789 (Accessed December 8 2008)

Press LJ The story behind Stereo Suelsquo and a world-famous neurologistlsquos discovery of vision therapy Optom Vis Dev 200637(2) 55-7

Levin HS Neuroplasticity and brain imaging research implications for rehabilitation Arch Phys Med Rehabil 2006 Dec87(12 Suppl

2)S1

Wiesel TN Hubel DH Single-cell responses in striate cortex of kittens deprived of vision in one eye J Neurophysiol 1963

Nov261003-17

Hook BM Chen C Critical periods in the visual system Changing views for a model of experience-dependent plasticity Neuron 2007

Oct56(2)312-26

Ramey CT Ramey SL Prevention of intellectual disabilities early interventions to improve cognitive development Prev Med 1998

Mar-Apr27(2)224-32

Heuninckx S Wenderoth N Swinnen SP Systems neuroplasticity in the aging brain recruiting additional neural resources for

successful motor performance in elderly persons J Neurosci 2008 Jan 228(1)91-9

Ge S Yang CH Hsu KS et al A critical period for enhanced synaptic plasticity in newly generated neurons of the adult brain Neuron

2007 May54(4)559-66

74

Draganski B Gaser C Busch V et al Neuroplasticity changes in grey matter induced by training Nature 2004 Jan 22427(6972)

311-2

Cannonieri GC Bonilha L Fernandes PT et al Practice and perfect length of training and structural brain changes in experienced

typists Neuroreport 2007 Jul 218(10)1063-6

Kleim JA Jones TA Principles of experience-dependent neural plasticity implications for rehabilitation after brain damage J

Speech Lang Hear Res 2008 Feb51(1)S225-39

Trojan S Porkorny J Theoretical aspects of neuroplasticity Physiol Res 199948(2)87-97

Ramamirtham R Kee CS Hung LF et al Wave aberrations in rhesus monkeys with vision-induced ametropias Vision Res 2007

Sep47(21)2751-66

Smith EL 3rd Ramamirtham R Qiao-Grider Y et al Effects of foveal ablation on emmetropization and form-deprivation myopia

Invest Ophthalmol Vis Sci 2007 Sep48(9)3914-22

Smith EL 3rd Kee CS Ramamirtham R et al Peripheral vision can influence eye growth and refractive development in infant

monkeys Invest Ophthalmol Vis Sci 2005 Nov46(11)3965-72

Ciuffreda KJ Vasudevan B Nearwork-induced transient myopia (NITM) and permanent myopiandashndashis there a link Ophthalmic

Physiol Opt 2008 Mar28(2)103-14

Hung GK Ciuffreda KJ Incremental retinal-defocus theory of myopia development--schematic analysis and computer simulation

Comput Biol Med 2007 Jul37(7)930-46

Hung GK Ciuffreda KJ A unifying theory of refractive error development Bull Math Biol 2000 Nov62(6)1087-108

75

Pang Y Maino D Zhang G Lu F Myopia Can its progress be controlled Optom Vis Dev 200637(2)75-9

Leung JT Brown B Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lenses Optom Vis Sci

1999 Jun76(6)346-54

Hasebe S Ohtsuki H Nonaka T et al Effect of progressive addition lenses on myopia progression in Japanese children a prospective

randomized double-masked crossover trial Invest Ophthalmol Vis Sci 2008 Jul49(7)2781-9

Gwiazda J Hyman L Hussein M et al A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression

of myopia in children Invest Ophthalmol Vis Sci 2003 Apr44(4)1492-500

Siatkowski RM Cotter SA Crockett RS et al Two-year multi-center randomized double-masked placebo-controlled parallel safety and

efficacy study of 2 pirenzepine ophthalmic gel in children with myopia J AAPOS 2008 Aug12(4)332-9

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged 7 to 17 years Arch Ophthalmol 2005

Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three to less than 10 years of age Am J

Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction Am J Ophthalmol 2007

Jun143(6)1060-3

Holmes JM Edwards AR Beck RW et al A randomized pilot study of near activities versus non-near activities during patching therapy for

amblyopia J AAPOS 2005 Apr9(2)129-36

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate

amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-57

76

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic

amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Convergence Insufficiency Treatment Trial Study Group Randomized clinical trial of treatments for symptomatic convergence insufficiency

in children Arch Ophthalmol 2008 Oct126(10)1336-49

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

Solan HA Shelley-Tremblay J Hansen PC et al M-cell deficit and reading disability a preliminary study of the effects of temporal vision-

processing therapy Optometry 2004 Oct75(10)640-50

Solan HA Larson S Shelley-Tremblay J et al Role of visual attention in cognitive control of oculomotor readiness in students with reading

disabilities J Learn Disabil 2001 Mar-Apr34(2)107-18

Gallaway M Boas MB The impact of vergence and accommodative therapy on reading eye movements and reading speed Optom Vis Dev

200738(3)115-20

Goss DA Downing DB Lowther AH et al The effect of HTS vision therapy conducted in a school setting on reading skills in third and

fourth grade students Optom Vis Dev 200738(1)27-32

Crutch SJ Warrington EK Foveal crowding in posterior cortical atrophy a specific early-visual-processing deficit affecting word reading

Cogn Neuropsychol 2007 Dec24(8)843-66

Helms D Sawtelle SM A study of the effectiveness of cognitive therapy delivered in a video game format Optom Vis Dev 200738 (1)19-

26

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

77

Lawton T Training direction-discrimination sensitivity remediates a wide spectrum of reading skills OptomVis Dev 200738(1) 33-47

Goldstand S Koslowe KC Parush S Vision visual-information processing and academic performance among seventh-grade schoolchildren a

more significant relationship than we thought Am J Occup Ther 2005 Jul-Aug59(4)377-89

Fischer B Koumlngeter A Hartnegg K Effects of daily practice on subitizing visual counting and basic arithmetic skills Optom Vis Dev

200839(1)30-4

Sands W Taub M Maino D Limited research and education on special populations in optometry and ophthalomology Optom Vis Dev

200839(2)60-1

Wesson M Maino D Oculo-visual findings in Down syndrome cerebral palsy and mental retardation with non-specific etiology In Maino D

(ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 199517-54 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

Cui Y Stapleton F Suttle C Developing an instrument to assess vision-related and subjective quality of life in children with intellectual

disability data collection and preliminary analysis in a Chinese population Ophthal Physiolog Optics 2008 May28(3) 238-46

Maino D Steele G Tahir S Sajja R Attitudes of optometry students toward individuals with disabilities Optom Ed 200227(2)45-50

Maino D Special populations in the optometric curriculum Optom Ed 200227(2)38-9

Maino D Overview of special populations In Scheiman M Rouse M (eds) Optometric Management of Learning-Related Vision Problems

St Louis Mosby Inc 200685-106

Maino D (ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 1995 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

78

McCarthy P Maino D Alport syndrome a review Clin Eye Vis Care 2000 Dec12(3-4)139-50

Block SS Brusca-Vega R Pizzi WJ et al Cognitive and visual processing skills and their relationship to mutation size in full and

permutation female fragile X carriers Optom Vis Sci 2000 Nov77 (11)592-9

Maino D The young child with developmental disabilities An introduction to mental retardation and genetic syndromes In Moore BD

(ed) Eye Care for Infants and Young Children Butter-worth--Heinemann Newton MA1997285-300

Amin V Maino D The Fragile X female Visual visual perceptual and ocular health anomalies J Am Optom Assoc 1995 May66

(5)290-95

Maino DM Maino JH Cibis GW Hecht F Ocular health anomalies in patients with developmental disabilities In Maino D (ed)

Diagnosis and Management of Special Populations Mosby-Year-book Inc St Louis MO 1995189-206 Reprinted Optometric

Education Program Foundation Santa Anna Calif 2001

Maino D Wesson M Schlange D Cibis G Maino J Optometric findings in the fragile X syndrome Optom Vis Sci 199168634-40

Scheiman MMOptometric findings in children with cerebral palsy Am J Optom Physiol Opt 1984 May61(5)321-3

Maino D Maino J Maino S Mental retardation syndromes with associated ocular defects J Am Optom Assoc 199061707-16

Stewart RE Woodhouse JM Cregg M Pakeman VH Association between accommodative accuracy hypermetropia and strabismus in

children with Downs syndrome Optom Vis Sci 2007 Feb84(2)149-55

Cregg M Woodhouse JM Pakeman VH et al Accommodation and refractive error in children with Down syndrome cross-sectional

and longitudinal studies Invest Ophthalmol Vis Sci 2001 Jan42 (1)55-63

79

McClelland JF Parkes J Hill N et al Accommodative dysfunction in children with cerebral palsy a population-

based study Invest Ophthalmol Vis Sci 2006 May47(5)1824-30

Duckman RH Vision therapy for the child with cerebral palsy J Am Optom Assoc 198758(1)28-35

Duckman R Accommodation in cerebral palsy function and remediation J Am Optom Assoc 198455(4)281-3

Scheiman M Understanding and managing vision deficits a guide for occupational therapists 2nd ed Slack

Thorofare NJ 2002

Maino D Binasal occlusion for the child with Cerebral Palsy J Ill Optom Assoc 198644(1)1218

Battaglia F Quartarone A Rizzo V et al Early impairment of synaptic plasticity in patients with Downs syndrome

Neurobiol Aging 2008 Aug29(8)1272-5

Bonnier C Evaluation of early stimulation programs for enhancing brain development Acta Paediatr 2008

Jul97(7)853-8

Morice E Andreae LC Cooke SF et al Preservation of long-term memory and synaptic plasticity despite short-term

impairments in the Tc1 mouse model of Down syndrome Learn Mem 2008 Jul 1415(7)492-500

Gordon AM Schneider JA Chinnan A Charles JR Efficacy of a hand-arm bimanual intensive therapy (HABIT) in

children with hemiplegic cerebral palsy a randomized control trial Dev Med Child Neurol 2007 Nov49(11)830-8

Kapoor N Ciuffreda KJ Vision disturbances following traumatic brain injury Curr Treat Options Neurol 2002

Jul4(4)271-80

80

Ciuffreda KJ Rutner D Kapoor N et al Vision therapy for oculomotor dysfunctions in acquired brain injury a

retrospective analysis Optometry 2008 Jan79(1)18-22

Ciuffreda KJ Han Y Kapoor N Ficarra AP Oculomotor rehabilitation for reading in acquired brain injury

NeuroRehabilitation 200621(1)9-21

Zost M Diagnosis and management of visual dysfunction in cerebral injury In Maino D (ed) Diagnosis and

Management of Special Populations Mosby-Yearbook Inc St Louis 199579 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001 [Figure used with permission of the editor]

DeGutis JM Bentin S Robertson LC DEsposito M Functional plasticity in ventral temporal cortex following

cognitive rehabilitation of a congenital prosopagnosic J Cogn Neurosci 2007 Nov19 (11)1790-802

Welbourne SR Ralph MA Exploring the impact of plasticity-related recovery after brain damage in a connectionist

model of single-word reading Cogn Affect Behav Neurosci 2005 Mar5(1)77-92

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements prevent cognitive decline A

systematic review of randomized controlled trials J Hum Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among preterm infants attributable to early

supplementation of human milk with docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings and structural-functional

synergies with cell membrane phospholipids Altern Med Rev 2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function Neuroscience 20089(7)568-78

81

Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

BMC Biol 2008 Sep 9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine improves neuropsychological disorders in a child with

creatine transporter defect Neurocase 200814(2) 151-61

Forrester LW Wheaton LA Luft AR Exercise-mediated locomotor recovery and lower-limb neuroplasticity after

stroke J Rehabil Res Dev 200845(2)205-20

82

Page 57: Neuroplasticity: A Paradigm Sea Change Latest Updated File

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Map expansion increase in brain mass due to repeated behavior or exposure to stimuli

57

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Equipotentiality anatomical areas of the brain can perform disparate functions

Vicariation redundant neural systems can operate under abnormal conditions

This may explain why recovery is noted for many neurological conditions (degenerative psychiatric developmental vascular traumatic)

58

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Constraint therapy Use it and improve it

Patching penalization ldquonear activitiesrdquo during amblyopia therapy

59

IX Improving Brain Function and Neuroplasticity Optometric Clinical ApplicationsOptometric Vision Therapy

Kleim amp Jones

Use it or lose it If you do not drive specific brain functions

functional loss will occur

If you want to improve oculomotor brain neuroplastic function amp

structure therapy should be specific for that brain function

Use it and improve it Therapy that drives cortical function enhances

that particular function

If you use therapy to improve oculomotor dysfunction it should

improve

Specificity The therapy you choose determines the resultant

plasticity and function

You must choose therapy that is appropriate

60

IX Improving Brain Function and Neuroplasticity Optometric Clinical Applications

Kleim amp Jones

Repetition matters Plasticity that results in functional change

requires repetition

Do the therapy Do it again Do it yet again No quick fix

Intensity matters Induction of plasticity requires the appropriate

amount of intensity

Intensity means strength force concentration power and passion

Without these plasticity may not occur Function may not improve

Time matters Different forms of plasticity take place at different

times during therapy

Do the basics than the more advanced therapeutic procedures

61

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Salience matters It has to be important to the individual

Make the therapy matter to the patient

Age matters Plasticity is easier in a younger brain but is also

possible in an adult brain

Do not let age determine what therapy options you offer your

patients Think of Susan Barry PhD (StereoSue) and her success

Offer your patients options Let them choose Be realistic about

outcomeshelliphave outcome measures built into therapy program

62

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Transference Neuroplasticity and the change in function

that results from one therapy can augment the attainment

of similar behaviors

What you do during oculomotor therapy may affected

vergence therapy outcomes

Interference Plasticity in response to one experience can

interfere with the acquisition of other behaviors

Monitor Evaluate progress Discuss function in other areas

of your patientslsquo life

63

Why pay attention to binocular vision dysfunctions

and neuroplasticity

December 2009 issue of the Review of Optometry

The Binocular Vision Dysfunction Pandemic

In 2010 almost 170 million individuals will be wearing glasses In

2010 there will also be up to 93 million amblyopes and 12 and a half

million strabismics For children under 18 years of age that means

there will be more than 22 and a half million amblyopes and millions

of children with strabismus A clinical trial to determine the

prevalence of binocular vision dysfunction within the general

population suggested the possibility of up to 56 or 173 million men

women and children with symptoms associated with a binocular

vision dysfunction 189 million (61) with accommodative problems

and 118 million (38) demonstrating various vergence

anomalies

64

65

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Brain plasticity life long changes in the structure of the brain

Sensory substitution replacement of one sensory input by another

Measurement techniques

Voxel based morphometryhellipmeasures difference in brain volume

Fluorodeoxyglucose glucose analog PET scan tells you

distribution and metabolism of brain

Cortical thickness measures

Visual cortex of the blind turns somatic ―The eye of the tongue

Transcranial magnetic stmiulation non-invasive technique to

stimulate cortex

66

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Blind Braille readers report tingling in fingers when pressure

phosphenes are applied Blind feel tingling in tongue

Bind use tongue to perform orientation task motion perception

sensory perception Visual cortex recruited in a variety of sensory

and cognitive tasks (DM Can we use tongue as a VT tool)

Dilks Reorganizations of human adult visual system

When a region of sensory cortex is deprived of its bottom up

input the deprived region begins to respond to stimuli that

normally activate adjacent cortex

67

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Retinotopic map changes for stroke pts Cortical reorganization in

adults occurs Perceived objectshellipelongation in stroke amp AMD

What happens to deprived cortex in AMD

fMRI shows cortical reorganization in adults

Proposed mechanisms

hellipGrowth of new connections

hellipUnmasking of pre-existing connections this is true

happens within seconds

Bavelier

Action video games

68

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Bavelier

Action video games Looked at attention Gamers can track more

activities

Attention over space (me peripheral awarenress) Useful field

of view shrinks with age

Performance not VA relatedhellipis related to attention

Action game playing changes spatial resolutionhellipovercoming

crowding in VA assessment (me amblyopia therapy)

Temporal resolution of vision Backward masking

changehellipbrain changes

Visual sensitivity (contrast sensitivity) Post action game training

improves CSF

69

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Action video games correcting optics of the cortex (me this is

actualy OVT)

Games factor

Variable entry leanringhellipadapt task to skill level

Incremental learning tune task to subjectlsquos leanring steps

Motivationarousal

Rewards

Self masterself confidence

Action games factors

Pacingrate of exposure to infohellipincreasing processing speed

Dynamic display

Rich environment

Rich motor involvement

70

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Surgeons may be made to play action games

Pilot training

Amblyopia tx Dennis Levi research

PresenterTitle Contact info

Neuroplasticity-A Paradigm Sea Change

This presentation is available at

httpwwwslidesharenetDMAINOneuroplasticity-a-paradigm-sea-change-2459693

httpwwwmainosmemosblogspotcom

My FaceBook Page

and

Twitter

PresenterTitle Contact info

Questions About

Neuroplasticity-A Paradigm Sea Change

Dominick M Maino OD MEd FAAO FCOVD-A

Professor PediatricsBinocular VisionIllinois Eye InstituteIllinois College of Optometry

dmainoicoeduhttpwwwMainosMemosblogspotcom

Thanks to

httpwwwcovdorgHomeOVDJournalOVD401tabid263D

efaultaspx

httpbipolarblastfileswordpresscom200908neurojpg

httpwwwspecialcheerscomimagesanimated_braingif

httpblogmarsdencartoonscomwp-

contentuploads200810frankenstein-myspace-lightbeergif

httpwwwshangralafamilyfuncomgala-ecalvindreamgif

httppsychiatryjwatchorgcgicontentfull20082251

73

Chakraborty R Chatterjee A Choudhart S Chakraborty PK Neuroplasticitymdasha paradigm shift in neurosciences J Indian Med Assoc

2007105(9)513-4516-8520-1

Sacks O A neurologistlsquos notebook Stereo Sue Why two eyes are better than one The New Yorker 2006 Jun 1964-73

Krulwich R National Public Radio Going Binocular Susanlsquos First Snowfall Available at

wwwnprorgtemplatesstorystoryphpstoryId=5507789 (Accessed December 8 2008)

Press LJ The story behind Stereo Suelsquo and a world-famous neurologistlsquos discovery of vision therapy Optom Vis Dev 200637(2) 55-7

Levin HS Neuroplasticity and brain imaging research implications for rehabilitation Arch Phys Med Rehabil 2006 Dec87(12 Suppl

2)S1

Wiesel TN Hubel DH Single-cell responses in striate cortex of kittens deprived of vision in one eye J Neurophysiol 1963

Nov261003-17

Hook BM Chen C Critical periods in the visual system Changing views for a model of experience-dependent plasticity Neuron 2007

Oct56(2)312-26

Ramey CT Ramey SL Prevention of intellectual disabilities early interventions to improve cognitive development Prev Med 1998

Mar-Apr27(2)224-32

Heuninckx S Wenderoth N Swinnen SP Systems neuroplasticity in the aging brain recruiting additional neural resources for

successful motor performance in elderly persons J Neurosci 2008 Jan 228(1)91-9

Ge S Yang CH Hsu KS et al A critical period for enhanced synaptic plasticity in newly generated neurons of the adult brain Neuron

2007 May54(4)559-66

74

Draganski B Gaser C Busch V et al Neuroplasticity changes in grey matter induced by training Nature 2004 Jan 22427(6972)

311-2

Cannonieri GC Bonilha L Fernandes PT et al Practice and perfect length of training and structural brain changes in experienced

typists Neuroreport 2007 Jul 218(10)1063-6

Kleim JA Jones TA Principles of experience-dependent neural plasticity implications for rehabilitation after brain damage J

Speech Lang Hear Res 2008 Feb51(1)S225-39

Trojan S Porkorny J Theoretical aspects of neuroplasticity Physiol Res 199948(2)87-97

Ramamirtham R Kee CS Hung LF et al Wave aberrations in rhesus monkeys with vision-induced ametropias Vision Res 2007

Sep47(21)2751-66

Smith EL 3rd Ramamirtham R Qiao-Grider Y et al Effects of foveal ablation on emmetropization and form-deprivation myopia

Invest Ophthalmol Vis Sci 2007 Sep48(9)3914-22

Smith EL 3rd Kee CS Ramamirtham R et al Peripheral vision can influence eye growth and refractive development in infant

monkeys Invest Ophthalmol Vis Sci 2005 Nov46(11)3965-72

Ciuffreda KJ Vasudevan B Nearwork-induced transient myopia (NITM) and permanent myopiandashndashis there a link Ophthalmic

Physiol Opt 2008 Mar28(2)103-14

Hung GK Ciuffreda KJ Incremental retinal-defocus theory of myopia development--schematic analysis and computer simulation

Comput Biol Med 2007 Jul37(7)930-46

Hung GK Ciuffreda KJ A unifying theory of refractive error development Bull Math Biol 2000 Nov62(6)1087-108

75

Pang Y Maino D Zhang G Lu F Myopia Can its progress be controlled Optom Vis Dev 200637(2)75-9

Leung JT Brown B Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lenses Optom Vis Sci

1999 Jun76(6)346-54

Hasebe S Ohtsuki H Nonaka T et al Effect of progressive addition lenses on myopia progression in Japanese children a prospective

randomized double-masked crossover trial Invest Ophthalmol Vis Sci 2008 Jul49(7)2781-9

Gwiazda J Hyman L Hussein M et al A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression

of myopia in children Invest Ophthalmol Vis Sci 2003 Apr44(4)1492-500

Siatkowski RM Cotter SA Crockett RS et al Two-year multi-center randomized double-masked placebo-controlled parallel safety and

efficacy study of 2 pirenzepine ophthalmic gel in children with myopia J AAPOS 2008 Aug12(4)332-9

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged 7 to 17 years Arch Ophthalmol 2005

Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three to less than 10 years of age Am J

Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction Am J Ophthalmol 2007

Jun143(6)1060-3

Holmes JM Edwards AR Beck RW et al A randomized pilot study of near activities versus non-near activities during patching therapy for

amblyopia J AAPOS 2005 Apr9(2)129-36

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate

amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-57

76

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic

amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Convergence Insufficiency Treatment Trial Study Group Randomized clinical trial of treatments for symptomatic convergence insufficiency

in children Arch Ophthalmol 2008 Oct126(10)1336-49

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

Solan HA Shelley-Tremblay J Hansen PC et al M-cell deficit and reading disability a preliminary study of the effects of temporal vision-

processing therapy Optometry 2004 Oct75(10)640-50

Solan HA Larson S Shelley-Tremblay J et al Role of visual attention in cognitive control of oculomotor readiness in students with reading

disabilities J Learn Disabil 2001 Mar-Apr34(2)107-18

Gallaway M Boas MB The impact of vergence and accommodative therapy on reading eye movements and reading speed Optom Vis Dev

200738(3)115-20

Goss DA Downing DB Lowther AH et al The effect of HTS vision therapy conducted in a school setting on reading skills in third and

fourth grade students Optom Vis Dev 200738(1)27-32

Crutch SJ Warrington EK Foveal crowding in posterior cortical atrophy a specific early-visual-processing deficit affecting word reading

Cogn Neuropsychol 2007 Dec24(8)843-66

Helms D Sawtelle SM A study of the effectiveness of cognitive therapy delivered in a video game format Optom Vis Dev 200738 (1)19-

26

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

77

Lawton T Training direction-discrimination sensitivity remediates a wide spectrum of reading skills OptomVis Dev 200738(1) 33-47

Goldstand S Koslowe KC Parush S Vision visual-information processing and academic performance among seventh-grade schoolchildren a

more significant relationship than we thought Am J Occup Ther 2005 Jul-Aug59(4)377-89

Fischer B Koumlngeter A Hartnegg K Effects of daily practice on subitizing visual counting and basic arithmetic skills Optom Vis Dev

200839(1)30-4

Sands W Taub M Maino D Limited research and education on special populations in optometry and ophthalomology Optom Vis Dev

200839(2)60-1

Wesson M Maino D Oculo-visual findings in Down syndrome cerebral palsy and mental retardation with non-specific etiology In Maino D

(ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 199517-54 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

Cui Y Stapleton F Suttle C Developing an instrument to assess vision-related and subjective quality of life in children with intellectual

disability data collection and preliminary analysis in a Chinese population Ophthal Physiolog Optics 2008 May28(3) 238-46

Maino D Steele G Tahir S Sajja R Attitudes of optometry students toward individuals with disabilities Optom Ed 200227(2)45-50

Maino D Special populations in the optometric curriculum Optom Ed 200227(2)38-9

Maino D Overview of special populations In Scheiman M Rouse M (eds) Optometric Management of Learning-Related Vision Problems

St Louis Mosby Inc 200685-106

Maino D (ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 1995 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

78

McCarthy P Maino D Alport syndrome a review Clin Eye Vis Care 2000 Dec12(3-4)139-50

Block SS Brusca-Vega R Pizzi WJ et al Cognitive and visual processing skills and their relationship to mutation size in full and

permutation female fragile X carriers Optom Vis Sci 2000 Nov77 (11)592-9

Maino D The young child with developmental disabilities An introduction to mental retardation and genetic syndromes In Moore BD

(ed) Eye Care for Infants and Young Children Butter-worth--Heinemann Newton MA1997285-300

Amin V Maino D The Fragile X female Visual visual perceptual and ocular health anomalies J Am Optom Assoc 1995 May66

(5)290-95

Maino DM Maino JH Cibis GW Hecht F Ocular health anomalies in patients with developmental disabilities In Maino D (ed)

Diagnosis and Management of Special Populations Mosby-Year-book Inc St Louis MO 1995189-206 Reprinted Optometric

Education Program Foundation Santa Anna Calif 2001

Maino D Wesson M Schlange D Cibis G Maino J Optometric findings in the fragile X syndrome Optom Vis Sci 199168634-40

Scheiman MMOptometric findings in children with cerebral palsy Am J Optom Physiol Opt 1984 May61(5)321-3

Maino D Maino J Maino S Mental retardation syndromes with associated ocular defects J Am Optom Assoc 199061707-16

Stewart RE Woodhouse JM Cregg M Pakeman VH Association between accommodative accuracy hypermetropia and strabismus in

children with Downs syndrome Optom Vis Sci 2007 Feb84(2)149-55

Cregg M Woodhouse JM Pakeman VH et al Accommodation and refractive error in children with Down syndrome cross-sectional

and longitudinal studies Invest Ophthalmol Vis Sci 2001 Jan42 (1)55-63

79

McClelland JF Parkes J Hill N et al Accommodative dysfunction in children with cerebral palsy a population-

based study Invest Ophthalmol Vis Sci 2006 May47(5)1824-30

Duckman RH Vision therapy for the child with cerebral palsy J Am Optom Assoc 198758(1)28-35

Duckman R Accommodation in cerebral palsy function and remediation J Am Optom Assoc 198455(4)281-3

Scheiman M Understanding and managing vision deficits a guide for occupational therapists 2nd ed Slack

Thorofare NJ 2002

Maino D Binasal occlusion for the child with Cerebral Palsy J Ill Optom Assoc 198644(1)1218

Battaglia F Quartarone A Rizzo V et al Early impairment of synaptic plasticity in patients with Downs syndrome

Neurobiol Aging 2008 Aug29(8)1272-5

Bonnier C Evaluation of early stimulation programs for enhancing brain development Acta Paediatr 2008

Jul97(7)853-8

Morice E Andreae LC Cooke SF et al Preservation of long-term memory and synaptic plasticity despite short-term

impairments in the Tc1 mouse model of Down syndrome Learn Mem 2008 Jul 1415(7)492-500

Gordon AM Schneider JA Chinnan A Charles JR Efficacy of a hand-arm bimanual intensive therapy (HABIT) in

children with hemiplegic cerebral palsy a randomized control trial Dev Med Child Neurol 2007 Nov49(11)830-8

Kapoor N Ciuffreda KJ Vision disturbances following traumatic brain injury Curr Treat Options Neurol 2002

Jul4(4)271-80

80

Ciuffreda KJ Rutner D Kapoor N et al Vision therapy for oculomotor dysfunctions in acquired brain injury a

retrospective analysis Optometry 2008 Jan79(1)18-22

Ciuffreda KJ Han Y Kapoor N Ficarra AP Oculomotor rehabilitation for reading in acquired brain injury

NeuroRehabilitation 200621(1)9-21

Zost M Diagnosis and management of visual dysfunction in cerebral injury In Maino D (ed) Diagnosis and

Management of Special Populations Mosby-Yearbook Inc St Louis 199579 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001 [Figure used with permission of the editor]

DeGutis JM Bentin S Robertson LC DEsposito M Functional plasticity in ventral temporal cortex following

cognitive rehabilitation of a congenital prosopagnosic J Cogn Neurosci 2007 Nov19 (11)1790-802

Welbourne SR Ralph MA Exploring the impact of plasticity-related recovery after brain damage in a connectionist

model of single-word reading Cogn Affect Behav Neurosci 2005 Mar5(1)77-92

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements prevent cognitive decline A

systematic review of randomized controlled trials J Hum Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among preterm infants attributable to early

supplementation of human milk with docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings and structural-functional

synergies with cell membrane phospholipids Altern Med Rev 2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function Neuroscience 20089(7)568-78

81

Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

BMC Biol 2008 Sep 9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine improves neuropsychological disorders in a child with

creatine transporter defect Neurocase 200814(2) 151-61

Forrester LW Wheaton LA Luft AR Exercise-mediated locomotor recovery and lower-limb neuroplasticity after

stroke J Rehabil Res Dev 200845(2)205-20

82

Page 58: Neuroplasticity: A Paradigm Sea Change Latest Updated File

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Equipotentiality anatomical areas of the brain can perform disparate functions

Vicariation redundant neural systems can operate under abnormal conditions

This may explain why recovery is noted for many neurological conditions (degenerative psychiatric developmental vascular traumatic)

58

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Constraint therapy Use it and improve it

Patching penalization ldquonear activitiesrdquo during amblyopia therapy

59

IX Improving Brain Function and Neuroplasticity Optometric Clinical ApplicationsOptometric Vision Therapy

Kleim amp Jones

Use it or lose it If you do not drive specific brain functions

functional loss will occur

If you want to improve oculomotor brain neuroplastic function amp

structure therapy should be specific for that brain function

Use it and improve it Therapy that drives cortical function enhances

that particular function

If you use therapy to improve oculomotor dysfunction it should

improve

Specificity The therapy you choose determines the resultant

plasticity and function

You must choose therapy that is appropriate

60

IX Improving Brain Function and Neuroplasticity Optometric Clinical Applications

Kleim amp Jones

Repetition matters Plasticity that results in functional change

requires repetition

Do the therapy Do it again Do it yet again No quick fix

Intensity matters Induction of plasticity requires the appropriate

amount of intensity

Intensity means strength force concentration power and passion

Without these plasticity may not occur Function may not improve

Time matters Different forms of plasticity take place at different

times during therapy

Do the basics than the more advanced therapeutic procedures

61

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Salience matters It has to be important to the individual

Make the therapy matter to the patient

Age matters Plasticity is easier in a younger brain but is also

possible in an adult brain

Do not let age determine what therapy options you offer your

patients Think of Susan Barry PhD (StereoSue) and her success

Offer your patients options Let them choose Be realistic about

outcomeshelliphave outcome measures built into therapy program

62

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Transference Neuroplasticity and the change in function

that results from one therapy can augment the attainment

of similar behaviors

What you do during oculomotor therapy may affected

vergence therapy outcomes

Interference Plasticity in response to one experience can

interfere with the acquisition of other behaviors

Monitor Evaluate progress Discuss function in other areas

of your patientslsquo life

63

Why pay attention to binocular vision dysfunctions

and neuroplasticity

December 2009 issue of the Review of Optometry

The Binocular Vision Dysfunction Pandemic

In 2010 almost 170 million individuals will be wearing glasses In

2010 there will also be up to 93 million amblyopes and 12 and a half

million strabismics For children under 18 years of age that means

there will be more than 22 and a half million amblyopes and millions

of children with strabismus A clinical trial to determine the

prevalence of binocular vision dysfunction within the general

population suggested the possibility of up to 56 or 173 million men

women and children with symptoms associated with a binocular

vision dysfunction 189 million (61) with accommodative problems

and 118 million (38) demonstrating various vergence

anomalies

64

65

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Brain plasticity life long changes in the structure of the brain

Sensory substitution replacement of one sensory input by another

Measurement techniques

Voxel based morphometryhellipmeasures difference in brain volume

Fluorodeoxyglucose glucose analog PET scan tells you

distribution and metabolism of brain

Cortical thickness measures

Visual cortex of the blind turns somatic ―The eye of the tongue

Transcranial magnetic stmiulation non-invasive technique to

stimulate cortex

66

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Blind Braille readers report tingling in fingers when pressure

phosphenes are applied Blind feel tingling in tongue

Bind use tongue to perform orientation task motion perception

sensory perception Visual cortex recruited in a variety of sensory

and cognitive tasks (DM Can we use tongue as a VT tool)

Dilks Reorganizations of human adult visual system

When a region of sensory cortex is deprived of its bottom up

input the deprived region begins to respond to stimuli that

normally activate adjacent cortex

67

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Retinotopic map changes for stroke pts Cortical reorganization in

adults occurs Perceived objectshellipelongation in stroke amp AMD

What happens to deprived cortex in AMD

fMRI shows cortical reorganization in adults

Proposed mechanisms

hellipGrowth of new connections

hellipUnmasking of pre-existing connections this is true

happens within seconds

Bavelier

Action video games

68

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Bavelier

Action video games Looked at attention Gamers can track more

activities

Attention over space (me peripheral awarenress) Useful field

of view shrinks with age

Performance not VA relatedhellipis related to attention

Action game playing changes spatial resolutionhellipovercoming

crowding in VA assessment (me amblyopia therapy)

Temporal resolution of vision Backward masking

changehellipbrain changes

Visual sensitivity (contrast sensitivity) Post action game training

improves CSF

69

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Action video games correcting optics of the cortex (me this is

actualy OVT)

Games factor

Variable entry leanringhellipadapt task to skill level

Incremental learning tune task to subjectlsquos leanring steps

Motivationarousal

Rewards

Self masterself confidence

Action games factors

Pacingrate of exposure to infohellipincreasing processing speed

Dynamic display

Rich environment

Rich motor involvement

70

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Surgeons may be made to play action games

Pilot training

Amblyopia tx Dennis Levi research

PresenterTitle Contact info

Neuroplasticity-A Paradigm Sea Change

This presentation is available at

httpwwwslidesharenetDMAINOneuroplasticity-a-paradigm-sea-change-2459693

httpwwwmainosmemosblogspotcom

My FaceBook Page

and

Twitter

PresenterTitle Contact info

Questions About

Neuroplasticity-A Paradigm Sea Change

Dominick M Maino OD MEd FAAO FCOVD-A

Professor PediatricsBinocular VisionIllinois Eye InstituteIllinois College of Optometry

dmainoicoeduhttpwwwMainosMemosblogspotcom

Thanks to

httpwwwcovdorgHomeOVDJournalOVD401tabid263D

efaultaspx

httpbipolarblastfileswordpresscom200908neurojpg

httpwwwspecialcheerscomimagesanimated_braingif

httpblogmarsdencartoonscomwp-

contentuploads200810frankenstein-myspace-lightbeergif

httpwwwshangralafamilyfuncomgala-ecalvindreamgif

httppsychiatryjwatchorgcgicontentfull20082251

73

Chakraborty R Chatterjee A Choudhart S Chakraborty PK Neuroplasticitymdasha paradigm shift in neurosciences J Indian Med Assoc

2007105(9)513-4516-8520-1

Sacks O A neurologistlsquos notebook Stereo Sue Why two eyes are better than one The New Yorker 2006 Jun 1964-73

Krulwich R National Public Radio Going Binocular Susanlsquos First Snowfall Available at

wwwnprorgtemplatesstorystoryphpstoryId=5507789 (Accessed December 8 2008)

Press LJ The story behind Stereo Suelsquo and a world-famous neurologistlsquos discovery of vision therapy Optom Vis Dev 200637(2) 55-7

Levin HS Neuroplasticity and brain imaging research implications for rehabilitation Arch Phys Med Rehabil 2006 Dec87(12 Suppl

2)S1

Wiesel TN Hubel DH Single-cell responses in striate cortex of kittens deprived of vision in one eye J Neurophysiol 1963

Nov261003-17

Hook BM Chen C Critical periods in the visual system Changing views for a model of experience-dependent plasticity Neuron 2007

Oct56(2)312-26

Ramey CT Ramey SL Prevention of intellectual disabilities early interventions to improve cognitive development Prev Med 1998

Mar-Apr27(2)224-32

Heuninckx S Wenderoth N Swinnen SP Systems neuroplasticity in the aging brain recruiting additional neural resources for

successful motor performance in elderly persons J Neurosci 2008 Jan 228(1)91-9

Ge S Yang CH Hsu KS et al A critical period for enhanced synaptic plasticity in newly generated neurons of the adult brain Neuron

2007 May54(4)559-66

74

Draganski B Gaser C Busch V et al Neuroplasticity changes in grey matter induced by training Nature 2004 Jan 22427(6972)

311-2

Cannonieri GC Bonilha L Fernandes PT et al Practice and perfect length of training and structural brain changes in experienced

typists Neuroreport 2007 Jul 218(10)1063-6

Kleim JA Jones TA Principles of experience-dependent neural plasticity implications for rehabilitation after brain damage J

Speech Lang Hear Res 2008 Feb51(1)S225-39

Trojan S Porkorny J Theoretical aspects of neuroplasticity Physiol Res 199948(2)87-97

Ramamirtham R Kee CS Hung LF et al Wave aberrations in rhesus monkeys with vision-induced ametropias Vision Res 2007

Sep47(21)2751-66

Smith EL 3rd Ramamirtham R Qiao-Grider Y et al Effects of foveal ablation on emmetropization and form-deprivation myopia

Invest Ophthalmol Vis Sci 2007 Sep48(9)3914-22

Smith EL 3rd Kee CS Ramamirtham R et al Peripheral vision can influence eye growth and refractive development in infant

monkeys Invest Ophthalmol Vis Sci 2005 Nov46(11)3965-72

Ciuffreda KJ Vasudevan B Nearwork-induced transient myopia (NITM) and permanent myopiandashndashis there a link Ophthalmic

Physiol Opt 2008 Mar28(2)103-14

Hung GK Ciuffreda KJ Incremental retinal-defocus theory of myopia development--schematic analysis and computer simulation

Comput Biol Med 2007 Jul37(7)930-46

Hung GK Ciuffreda KJ A unifying theory of refractive error development Bull Math Biol 2000 Nov62(6)1087-108

75

Pang Y Maino D Zhang G Lu F Myopia Can its progress be controlled Optom Vis Dev 200637(2)75-9

Leung JT Brown B Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lenses Optom Vis Sci

1999 Jun76(6)346-54

Hasebe S Ohtsuki H Nonaka T et al Effect of progressive addition lenses on myopia progression in Japanese children a prospective

randomized double-masked crossover trial Invest Ophthalmol Vis Sci 2008 Jul49(7)2781-9

Gwiazda J Hyman L Hussein M et al A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression

of myopia in children Invest Ophthalmol Vis Sci 2003 Apr44(4)1492-500

Siatkowski RM Cotter SA Crockett RS et al Two-year multi-center randomized double-masked placebo-controlled parallel safety and

efficacy study of 2 pirenzepine ophthalmic gel in children with myopia J AAPOS 2008 Aug12(4)332-9

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged 7 to 17 years Arch Ophthalmol 2005

Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three to less than 10 years of age Am J

Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction Am J Ophthalmol 2007

Jun143(6)1060-3

Holmes JM Edwards AR Beck RW et al A randomized pilot study of near activities versus non-near activities during patching therapy for

amblyopia J AAPOS 2005 Apr9(2)129-36

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate

amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-57

76

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic

amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Convergence Insufficiency Treatment Trial Study Group Randomized clinical trial of treatments for symptomatic convergence insufficiency

in children Arch Ophthalmol 2008 Oct126(10)1336-49

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

Solan HA Shelley-Tremblay J Hansen PC et al M-cell deficit and reading disability a preliminary study of the effects of temporal vision-

processing therapy Optometry 2004 Oct75(10)640-50

Solan HA Larson S Shelley-Tremblay J et al Role of visual attention in cognitive control of oculomotor readiness in students with reading

disabilities J Learn Disabil 2001 Mar-Apr34(2)107-18

Gallaway M Boas MB The impact of vergence and accommodative therapy on reading eye movements and reading speed Optom Vis Dev

200738(3)115-20

Goss DA Downing DB Lowther AH et al The effect of HTS vision therapy conducted in a school setting on reading skills in third and

fourth grade students Optom Vis Dev 200738(1)27-32

Crutch SJ Warrington EK Foveal crowding in posterior cortical atrophy a specific early-visual-processing deficit affecting word reading

Cogn Neuropsychol 2007 Dec24(8)843-66

Helms D Sawtelle SM A study of the effectiveness of cognitive therapy delivered in a video game format Optom Vis Dev 200738 (1)19-

26

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

77

Lawton T Training direction-discrimination sensitivity remediates a wide spectrum of reading skills OptomVis Dev 200738(1) 33-47

Goldstand S Koslowe KC Parush S Vision visual-information processing and academic performance among seventh-grade schoolchildren a

more significant relationship than we thought Am J Occup Ther 2005 Jul-Aug59(4)377-89

Fischer B Koumlngeter A Hartnegg K Effects of daily practice on subitizing visual counting and basic arithmetic skills Optom Vis Dev

200839(1)30-4

Sands W Taub M Maino D Limited research and education on special populations in optometry and ophthalomology Optom Vis Dev

200839(2)60-1

Wesson M Maino D Oculo-visual findings in Down syndrome cerebral palsy and mental retardation with non-specific etiology In Maino D

(ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 199517-54 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

Cui Y Stapleton F Suttle C Developing an instrument to assess vision-related and subjective quality of life in children with intellectual

disability data collection and preliminary analysis in a Chinese population Ophthal Physiolog Optics 2008 May28(3) 238-46

Maino D Steele G Tahir S Sajja R Attitudes of optometry students toward individuals with disabilities Optom Ed 200227(2)45-50

Maino D Special populations in the optometric curriculum Optom Ed 200227(2)38-9

Maino D Overview of special populations In Scheiman M Rouse M (eds) Optometric Management of Learning-Related Vision Problems

St Louis Mosby Inc 200685-106

Maino D (ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 1995 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

78

McCarthy P Maino D Alport syndrome a review Clin Eye Vis Care 2000 Dec12(3-4)139-50

Block SS Brusca-Vega R Pizzi WJ et al Cognitive and visual processing skills and their relationship to mutation size in full and

permutation female fragile X carriers Optom Vis Sci 2000 Nov77 (11)592-9

Maino D The young child with developmental disabilities An introduction to mental retardation and genetic syndromes In Moore BD

(ed) Eye Care for Infants and Young Children Butter-worth--Heinemann Newton MA1997285-300

Amin V Maino D The Fragile X female Visual visual perceptual and ocular health anomalies J Am Optom Assoc 1995 May66

(5)290-95

Maino DM Maino JH Cibis GW Hecht F Ocular health anomalies in patients with developmental disabilities In Maino D (ed)

Diagnosis and Management of Special Populations Mosby-Year-book Inc St Louis MO 1995189-206 Reprinted Optometric

Education Program Foundation Santa Anna Calif 2001

Maino D Wesson M Schlange D Cibis G Maino J Optometric findings in the fragile X syndrome Optom Vis Sci 199168634-40

Scheiman MMOptometric findings in children with cerebral palsy Am J Optom Physiol Opt 1984 May61(5)321-3

Maino D Maino J Maino S Mental retardation syndromes with associated ocular defects J Am Optom Assoc 199061707-16

Stewart RE Woodhouse JM Cregg M Pakeman VH Association between accommodative accuracy hypermetropia and strabismus in

children with Downs syndrome Optom Vis Sci 2007 Feb84(2)149-55

Cregg M Woodhouse JM Pakeman VH et al Accommodation and refractive error in children with Down syndrome cross-sectional

and longitudinal studies Invest Ophthalmol Vis Sci 2001 Jan42 (1)55-63

79

McClelland JF Parkes J Hill N et al Accommodative dysfunction in children with cerebral palsy a population-

based study Invest Ophthalmol Vis Sci 2006 May47(5)1824-30

Duckman RH Vision therapy for the child with cerebral palsy J Am Optom Assoc 198758(1)28-35

Duckman R Accommodation in cerebral palsy function and remediation J Am Optom Assoc 198455(4)281-3

Scheiman M Understanding and managing vision deficits a guide for occupational therapists 2nd ed Slack

Thorofare NJ 2002

Maino D Binasal occlusion for the child with Cerebral Palsy J Ill Optom Assoc 198644(1)1218

Battaglia F Quartarone A Rizzo V et al Early impairment of synaptic plasticity in patients with Downs syndrome

Neurobiol Aging 2008 Aug29(8)1272-5

Bonnier C Evaluation of early stimulation programs for enhancing brain development Acta Paediatr 2008

Jul97(7)853-8

Morice E Andreae LC Cooke SF et al Preservation of long-term memory and synaptic plasticity despite short-term

impairments in the Tc1 mouse model of Down syndrome Learn Mem 2008 Jul 1415(7)492-500

Gordon AM Schneider JA Chinnan A Charles JR Efficacy of a hand-arm bimanual intensive therapy (HABIT) in

children with hemiplegic cerebral palsy a randomized control trial Dev Med Child Neurol 2007 Nov49(11)830-8

Kapoor N Ciuffreda KJ Vision disturbances following traumatic brain injury Curr Treat Options Neurol 2002

Jul4(4)271-80

80

Ciuffreda KJ Rutner D Kapoor N et al Vision therapy for oculomotor dysfunctions in acquired brain injury a

retrospective analysis Optometry 2008 Jan79(1)18-22

Ciuffreda KJ Han Y Kapoor N Ficarra AP Oculomotor rehabilitation for reading in acquired brain injury

NeuroRehabilitation 200621(1)9-21

Zost M Diagnosis and management of visual dysfunction in cerebral injury In Maino D (ed) Diagnosis and

Management of Special Populations Mosby-Yearbook Inc St Louis 199579 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001 [Figure used with permission of the editor]

DeGutis JM Bentin S Robertson LC DEsposito M Functional plasticity in ventral temporal cortex following

cognitive rehabilitation of a congenital prosopagnosic J Cogn Neurosci 2007 Nov19 (11)1790-802

Welbourne SR Ralph MA Exploring the impact of plasticity-related recovery after brain damage in a connectionist

model of single-word reading Cogn Affect Behav Neurosci 2005 Mar5(1)77-92

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements prevent cognitive decline A

systematic review of randomized controlled trials J Hum Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among preterm infants attributable to early

supplementation of human milk with docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings and structural-functional

synergies with cell membrane phospholipids Altern Med Rev 2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function Neuroscience 20089(7)568-78

81

Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

BMC Biol 2008 Sep 9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine improves neuropsychological disorders in a child with

creatine transporter defect Neurocase 200814(2) 151-61

Forrester LW Wheaton LA Luft AR Exercise-mediated locomotor recovery and lower-limb neuroplasticity after

stroke J Rehabil Res Dev 200845(2)205-20

82

Page 59: Neuroplasticity: A Paradigm Sea Change Latest Updated File

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Constraint therapy Use it and improve it

Patching penalization ldquonear activitiesrdquo during amblyopia therapy

59

IX Improving Brain Function and Neuroplasticity Optometric Clinical ApplicationsOptometric Vision Therapy

Kleim amp Jones

Use it or lose it If you do not drive specific brain functions

functional loss will occur

If you want to improve oculomotor brain neuroplastic function amp

structure therapy should be specific for that brain function

Use it and improve it Therapy that drives cortical function enhances

that particular function

If you use therapy to improve oculomotor dysfunction it should

improve

Specificity The therapy you choose determines the resultant

plasticity and function

You must choose therapy that is appropriate

60

IX Improving Brain Function and Neuroplasticity Optometric Clinical Applications

Kleim amp Jones

Repetition matters Plasticity that results in functional change

requires repetition

Do the therapy Do it again Do it yet again No quick fix

Intensity matters Induction of plasticity requires the appropriate

amount of intensity

Intensity means strength force concentration power and passion

Without these plasticity may not occur Function may not improve

Time matters Different forms of plasticity take place at different

times during therapy

Do the basics than the more advanced therapeutic procedures

61

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Salience matters It has to be important to the individual

Make the therapy matter to the patient

Age matters Plasticity is easier in a younger brain but is also

possible in an adult brain

Do not let age determine what therapy options you offer your

patients Think of Susan Barry PhD (StereoSue) and her success

Offer your patients options Let them choose Be realistic about

outcomeshelliphave outcome measures built into therapy program

62

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Transference Neuroplasticity and the change in function

that results from one therapy can augment the attainment

of similar behaviors

What you do during oculomotor therapy may affected

vergence therapy outcomes

Interference Plasticity in response to one experience can

interfere with the acquisition of other behaviors

Monitor Evaluate progress Discuss function in other areas

of your patientslsquo life

63

Why pay attention to binocular vision dysfunctions

and neuroplasticity

December 2009 issue of the Review of Optometry

The Binocular Vision Dysfunction Pandemic

In 2010 almost 170 million individuals will be wearing glasses In

2010 there will also be up to 93 million amblyopes and 12 and a half

million strabismics For children under 18 years of age that means

there will be more than 22 and a half million amblyopes and millions

of children with strabismus A clinical trial to determine the

prevalence of binocular vision dysfunction within the general

population suggested the possibility of up to 56 or 173 million men

women and children with symptoms associated with a binocular

vision dysfunction 189 million (61) with accommodative problems

and 118 million (38) demonstrating various vergence

anomalies

64

65

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Brain plasticity life long changes in the structure of the brain

Sensory substitution replacement of one sensory input by another

Measurement techniques

Voxel based morphometryhellipmeasures difference in brain volume

Fluorodeoxyglucose glucose analog PET scan tells you

distribution and metabolism of brain

Cortical thickness measures

Visual cortex of the blind turns somatic ―The eye of the tongue

Transcranial magnetic stmiulation non-invasive technique to

stimulate cortex

66

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Blind Braille readers report tingling in fingers when pressure

phosphenes are applied Blind feel tingling in tongue

Bind use tongue to perform orientation task motion perception

sensory perception Visual cortex recruited in a variety of sensory

and cognitive tasks (DM Can we use tongue as a VT tool)

Dilks Reorganizations of human adult visual system

When a region of sensory cortex is deprived of its bottom up

input the deprived region begins to respond to stimuli that

normally activate adjacent cortex

67

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Retinotopic map changes for stroke pts Cortical reorganization in

adults occurs Perceived objectshellipelongation in stroke amp AMD

What happens to deprived cortex in AMD

fMRI shows cortical reorganization in adults

Proposed mechanisms

hellipGrowth of new connections

hellipUnmasking of pre-existing connections this is true

happens within seconds

Bavelier

Action video games

68

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Bavelier

Action video games Looked at attention Gamers can track more

activities

Attention over space (me peripheral awarenress) Useful field

of view shrinks with age

Performance not VA relatedhellipis related to attention

Action game playing changes spatial resolutionhellipovercoming

crowding in VA assessment (me amblyopia therapy)

Temporal resolution of vision Backward masking

changehellipbrain changes

Visual sensitivity (contrast sensitivity) Post action game training

improves CSF

69

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Action video games correcting optics of the cortex (me this is

actualy OVT)

Games factor

Variable entry leanringhellipadapt task to skill level

Incremental learning tune task to subjectlsquos leanring steps

Motivationarousal

Rewards

Self masterself confidence

Action games factors

Pacingrate of exposure to infohellipincreasing processing speed

Dynamic display

Rich environment

Rich motor involvement

70

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Surgeons may be made to play action games

Pilot training

Amblyopia tx Dennis Levi research

PresenterTitle Contact info

Neuroplasticity-A Paradigm Sea Change

This presentation is available at

httpwwwslidesharenetDMAINOneuroplasticity-a-paradigm-sea-change-2459693

httpwwwmainosmemosblogspotcom

My FaceBook Page

and

Twitter

PresenterTitle Contact info

Questions About

Neuroplasticity-A Paradigm Sea Change

Dominick M Maino OD MEd FAAO FCOVD-A

Professor PediatricsBinocular VisionIllinois Eye InstituteIllinois College of Optometry

dmainoicoeduhttpwwwMainosMemosblogspotcom

Thanks to

httpwwwcovdorgHomeOVDJournalOVD401tabid263D

efaultaspx

httpbipolarblastfileswordpresscom200908neurojpg

httpwwwspecialcheerscomimagesanimated_braingif

httpblogmarsdencartoonscomwp-

contentuploads200810frankenstein-myspace-lightbeergif

httpwwwshangralafamilyfuncomgala-ecalvindreamgif

httppsychiatryjwatchorgcgicontentfull20082251

73

Chakraborty R Chatterjee A Choudhart S Chakraborty PK Neuroplasticitymdasha paradigm shift in neurosciences J Indian Med Assoc

2007105(9)513-4516-8520-1

Sacks O A neurologistlsquos notebook Stereo Sue Why two eyes are better than one The New Yorker 2006 Jun 1964-73

Krulwich R National Public Radio Going Binocular Susanlsquos First Snowfall Available at

wwwnprorgtemplatesstorystoryphpstoryId=5507789 (Accessed December 8 2008)

Press LJ The story behind Stereo Suelsquo and a world-famous neurologistlsquos discovery of vision therapy Optom Vis Dev 200637(2) 55-7

Levin HS Neuroplasticity and brain imaging research implications for rehabilitation Arch Phys Med Rehabil 2006 Dec87(12 Suppl

2)S1

Wiesel TN Hubel DH Single-cell responses in striate cortex of kittens deprived of vision in one eye J Neurophysiol 1963

Nov261003-17

Hook BM Chen C Critical periods in the visual system Changing views for a model of experience-dependent plasticity Neuron 2007

Oct56(2)312-26

Ramey CT Ramey SL Prevention of intellectual disabilities early interventions to improve cognitive development Prev Med 1998

Mar-Apr27(2)224-32

Heuninckx S Wenderoth N Swinnen SP Systems neuroplasticity in the aging brain recruiting additional neural resources for

successful motor performance in elderly persons J Neurosci 2008 Jan 228(1)91-9

Ge S Yang CH Hsu KS et al A critical period for enhanced synaptic plasticity in newly generated neurons of the adult brain Neuron

2007 May54(4)559-66

74

Draganski B Gaser C Busch V et al Neuroplasticity changes in grey matter induced by training Nature 2004 Jan 22427(6972)

311-2

Cannonieri GC Bonilha L Fernandes PT et al Practice and perfect length of training and structural brain changes in experienced

typists Neuroreport 2007 Jul 218(10)1063-6

Kleim JA Jones TA Principles of experience-dependent neural plasticity implications for rehabilitation after brain damage J

Speech Lang Hear Res 2008 Feb51(1)S225-39

Trojan S Porkorny J Theoretical aspects of neuroplasticity Physiol Res 199948(2)87-97

Ramamirtham R Kee CS Hung LF et al Wave aberrations in rhesus monkeys with vision-induced ametropias Vision Res 2007

Sep47(21)2751-66

Smith EL 3rd Ramamirtham R Qiao-Grider Y et al Effects of foveal ablation on emmetropization and form-deprivation myopia

Invest Ophthalmol Vis Sci 2007 Sep48(9)3914-22

Smith EL 3rd Kee CS Ramamirtham R et al Peripheral vision can influence eye growth and refractive development in infant

monkeys Invest Ophthalmol Vis Sci 2005 Nov46(11)3965-72

Ciuffreda KJ Vasudevan B Nearwork-induced transient myopia (NITM) and permanent myopiandashndashis there a link Ophthalmic

Physiol Opt 2008 Mar28(2)103-14

Hung GK Ciuffreda KJ Incremental retinal-defocus theory of myopia development--schematic analysis and computer simulation

Comput Biol Med 2007 Jul37(7)930-46

Hung GK Ciuffreda KJ A unifying theory of refractive error development Bull Math Biol 2000 Nov62(6)1087-108

75

Pang Y Maino D Zhang G Lu F Myopia Can its progress be controlled Optom Vis Dev 200637(2)75-9

Leung JT Brown B Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lenses Optom Vis Sci

1999 Jun76(6)346-54

Hasebe S Ohtsuki H Nonaka T et al Effect of progressive addition lenses on myopia progression in Japanese children a prospective

randomized double-masked crossover trial Invest Ophthalmol Vis Sci 2008 Jul49(7)2781-9

Gwiazda J Hyman L Hussein M et al A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression

of myopia in children Invest Ophthalmol Vis Sci 2003 Apr44(4)1492-500

Siatkowski RM Cotter SA Crockett RS et al Two-year multi-center randomized double-masked placebo-controlled parallel safety and

efficacy study of 2 pirenzepine ophthalmic gel in children with myopia J AAPOS 2008 Aug12(4)332-9

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged 7 to 17 years Arch Ophthalmol 2005

Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three to less than 10 years of age Am J

Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction Am J Ophthalmol 2007

Jun143(6)1060-3

Holmes JM Edwards AR Beck RW et al A randomized pilot study of near activities versus non-near activities during patching therapy for

amblyopia J AAPOS 2005 Apr9(2)129-36

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate

amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-57

76

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic

amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Convergence Insufficiency Treatment Trial Study Group Randomized clinical trial of treatments for symptomatic convergence insufficiency

in children Arch Ophthalmol 2008 Oct126(10)1336-49

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

Solan HA Shelley-Tremblay J Hansen PC et al M-cell deficit and reading disability a preliminary study of the effects of temporal vision-

processing therapy Optometry 2004 Oct75(10)640-50

Solan HA Larson S Shelley-Tremblay J et al Role of visual attention in cognitive control of oculomotor readiness in students with reading

disabilities J Learn Disabil 2001 Mar-Apr34(2)107-18

Gallaway M Boas MB The impact of vergence and accommodative therapy on reading eye movements and reading speed Optom Vis Dev

200738(3)115-20

Goss DA Downing DB Lowther AH et al The effect of HTS vision therapy conducted in a school setting on reading skills in third and

fourth grade students Optom Vis Dev 200738(1)27-32

Crutch SJ Warrington EK Foveal crowding in posterior cortical atrophy a specific early-visual-processing deficit affecting word reading

Cogn Neuropsychol 2007 Dec24(8)843-66

Helms D Sawtelle SM A study of the effectiveness of cognitive therapy delivered in a video game format Optom Vis Dev 200738 (1)19-

26

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

77

Lawton T Training direction-discrimination sensitivity remediates a wide spectrum of reading skills OptomVis Dev 200738(1) 33-47

Goldstand S Koslowe KC Parush S Vision visual-information processing and academic performance among seventh-grade schoolchildren a

more significant relationship than we thought Am J Occup Ther 2005 Jul-Aug59(4)377-89

Fischer B Koumlngeter A Hartnegg K Effects of daily practice on subitizing visual counting and basic arithmetic skills Optom Vis Dev

200839(1)30-4

Sands W Taub M Maino D Limited research and education on special populations in optometry and ophthalomology Optom Vis Dev

200839(2)60-1

Wesson M Maino D Oculo-visual findings in Down syndrome cerebral palsy and mental retardation with non-specific etiology In Maino D

(ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 199517-54 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

Cui Y Stapleton F Suttle C Developing an instrument to assess vision-related and subjective quality of life in children with intellectual

disability data collection and preliminary analysis in a Chinese population Ophthal Physiolog Optics 2008 May28(3) 238-46

Maino D Steele G Tahir S Sajja R Attitudes of optometry students toward individuals with disabilities Optom Ed 200227(2)45-50

Maino D Special populations in the optometric curriculum Optom Ed 200227(2)38-9

Maino D Overview of special populations In Scheiman M Rouse M (eds) Optometric Management of Learning-Related Vision Problems

St Louis Mosby Inc 200685-106

Maino D (ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 1995 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

78

McCarthy P Maino D Alport syndrome a review Clin Eye Vis Care 2000 Dec12(3-4)139-50

Block SS Brusca-Vega R Pizzi WJ et al Cognitive and visual processing skills and their relationship to mutation size in full and

permutation female fragile X carriers Optom Vis Sci 2000 Nov77 (11)592-9

Maino D The young child with developmental disabilities An introduction to mental retardation and genetic syndromes In Moore BD

(ed) Eye Care for Infants and Young Children Butter-worth--Heinemann Newton MA1997285-300

Amin V Maino D The Fragile X female Visual visual perceptual and ocular health anomalies J Am Optom Assoc 1995 May66

(5)290-95

Maino DM Maino JH Cibis GW Hecht F Ocular health anomalies in patients with developmental disabilities In Maino D (ed)

Diagnosis and Management of Special Populations Mosby-Year-book Inc St Louis MO 1995189-206 Reprinted Optometric

Education Program Foundation Santa Anna Calif 2001

Maino D Wesson M Schlange D Cibis G Maino J Optometric findings in the fragile X syndrome Optom Vis Sci 199168634-40

Scheiman MMOptometric findings in children with cerebral palsy Am J Optom Physiol Opt 1984 May61(5)321-3

Maino D Maino J Maino S Mental retardation syndromes with associated ocular defects J Am Optom Assoc 199061707-16

Stewart RE Woodhouse JM Cregg M Pakeman VH Association between accommodative accuracy hypermetropia and strabismus in

children with Downs syndrome Optom Vis Sci 2007 Feb84(2)149-55

Cregg M Woodhouse JM Pakeman VH et al Accommodation and refractive error in children with Down syndrome cross-sectional

and longitudinal studies Invest Ophthalmol Vis Sci 2001 Jan42 (1)55-63

79

McClelland JF Parkes J Hill N et al Accommodative dysfunction in children with cerebral palsy a population-

based study Invest Ophthalmol Vis Sci 2006 May47(5)1824-30

Duckman RH Vision therapy for the child with cerebral palsy J Am Optom Assoc 198758(1)28-35

Duckman R Accommodation in cerebral palsy function and remediation J Am Optom Assoc 198455(4)281-3

Scheiman M Understanding and managing vision deficits a guide for occupational therapists 2nd ed Slack

Thorofare NJ 2002

Maino D Binasal occlusion for the child with Cerebral Palsy J Ill Optom Assoc 198644(1)1218

Battaglia F Quartarone A Rizzo V et al Early impairment of synaptic plasticity in patients with Downs syndrome

Neurobiol Aging 2008 Aug29(8)1272-5

Bonnier C Evaluation of early stimulation programs for enhancing brain development Acta Paediatr 2008

Jul97(7)853-8

Morice E Andreae LC Cooke SF et al Preservation of long-term memory and synaptic plasticity despite short-term

impairments in the Tc1 mouse model of Down syndrome Learn Mem 2008 Jul 1415(7)492-500

Gordon AM Schneider JA Chinnan A Charles JR Efficacy of a hand-arm bimanual intensive therapy (HABIT) in

children with hemiplegic cerebral palsy a randomized control trial Dev Med Child Neurol 2007 Nov49(11)830-8

Kapoor N Ciuffreda KJ Vision disturbances following traumatic brain injury Curr Treat Options Neurol 2002

Jul4(4)271-80

80

Ciuffreda KJ Rutner D Kapoor N et al Vision therapy for oculomotor dysfunctions in acquired brain injury a

retrospective analysis Optometry 2008 Jan79(1)18-22

Ciuffreda KJ Han Y Kapoor N Ficarra AP Oculomotor rehabilitation for reading in acquired brain injury

NeuroRehabilitation 200621(1)9-21

Zost M Diagnosis and management of visual dysfunction in cerebral injury In Maino D (ed) Diagnosis and

Management of Special Populations Mosby-Yearbook Inc St Louis 199579 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001 [Figure used with permission of the editor]

DeGutis JM Bentin S Robertson LC DEsposito M Functional plasticity in ventral temporal cortex following

cognitive rehabilitation of a congenital prosopagnosic J Cogn Neurosci 2007 Nov19 (11)1790-802

Welbourne SR Ralph MA Exploring the impact of plasticity-related recovery after brain damage in a connectionist

model of single-word reading Cogn Affect Behav Neurosci 2005 Mar5(1)77-92

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements prevent cognitive decline A

systematic review of randomized controlled trials J Hum Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among preterm infants attributable to early

supplementation of human milk with docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings and structural-functional

synergies with cell membrane phospholipids Altern Med Rev 2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function Neuroscience 20089(7)568-78

81

Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

BMC Biol 2008 Sep 9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine improves neuropsychological disorders in a child with

creatine transporter defect Neurocase 200814(2) 151-61

Forrester LW Wheaton LA Luft AR Exercise-mediated locomotor recovery and lower-limb neuroplasticity after

stroke J Rehabil Res Dev 200845(2)205-20

82

Page 60: Neuroplasticity: A Paradigm Sea Change Latest Updated File

IX Improving Brain Function and Neuroplasticity Optometric Clinical ApplicationsOptometric Vision Therapy

Kleim amp Jones

Use it or lose it If you do not drive specific brain functions

functional loss will occur

If you want to improve oculomotor brain neuroplastic function amp

structure therapy should be specific for that brain function

Use it and improve it Therapy that drives cortical function enhances

that particular function

If you use therapy to improve oculomotor dysfunction it should

improve

Specificity The therapy you choose determines the resultant

plasticity and function

You must choose therapy that is appropriate

60

IX Improving Brain Function and Neuroplasticity Optometric Clinical Applications

Kleim amp Jones

Repetition matters Plasticity that results in functional change

requires repetition

Do the therapy Do it again Do it yet again No quick fix

Intensity matters Induction of plasticity requires the appropriate

amount of intensity

Intensity means strength force concentration power and passion

Without these plasticity may not occur Function may not improve

Time matters Different forms of plasticity take place at different

times during therapy

Do the basics than the more advanced therapeutic procedures

61

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Salience matters It has to be important to the individual

Make the therapy matter to the patient

Age matters Plasticity is easier in a younger brain but is also

possible in an adult brain

Do not let age determine what therapy options you offer your

patients Think of Susan Barry PhD (StereoSue) and her success

Offer your patients options Let them choose Be realistic about

outcomeshelliphave outcome measures built into therapy program

62

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Transference Neuroplasticity and the change in function

that results from one therapy can augment the attainment

of similar behaviors

What you do during oculomotor therapy may affected

vergence therapy outcomes

Interference Plasticity in response to one experience can

interfere with the acquisition of other behaviors

Monitor Evaluate progress Discuss function in other areas

of your patientslsquo life

63

Why pay attention to binocular vision dysfunctions

and neuroplasticity

December 2009 issue of the Review of Optometry

The Binocular Vision Dysfunction Pandemic

In 2010 almost 170 million individuals will be wearing glasses In

2010 there will also be up to 93 million amblyopes and 12 and a half

million strabismics For children under 18 years of age that means

there will be more than 22 and a half million amblyopes and millions

of children with strabismus A clinical trial to determine the

prevalence of binocular vision dysfunction within the general

population suggested the possibility of up to 56 or 173 million men

women and children with symptoms associated with a binocular

vision dysfunction 189 million (61) with accommodative problems

and 118 million (38) demonstrating various vergence

anomalies

64

65

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Brain plasticity life long changes in the structure of the brain

Sensory substitution replacement of one sensory input by another

Measurement techniques

Voxel based morphometryhellipmeasures difference in brain volume

Fluorodeoxyglucose glucose analog PET scan tells you

distribution and metabolism of brain

Cortical thickness measures

Visual cortex of the blind turns somatic ―The eye of the tongue

Transcranial magnetic stmiulation non-invasive technique to

stimulate cortex

66

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Blind Braille readers report tingling in fingers when pressure

phosphenes are applied Blind feel tingling in tongue

Bind use tongue to perform orientation task motion perception

sensory perception Visual cortex recruited in a variety of sensory

and cognitive tasks (DM Can we use tongue as a VT tool)

Dilks Reorganizations of human adult visual system

When a region of sensory cortex is deprived of its bottom up

input the deprived region begins to respond to stimuli that

normally activate adjacent cortex

67

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Retinotopic map changes for stroke pts Cortical reorganization in

adults occurs Perceived objectshellipelongation in stroke amp AMD

What happens to deprived cortex in AMD

fMRI shows cortical reorganization in adults

Proposed mechanisms

hellipGrowth of new connections

hellipUnmasking of pre-existing connections this is true

happens within seconds

Bavelier

Action video games

68

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Bavelier

Action video games Looked at attention Gamers can track more

activities

Attention over space (me peripheral awarenress) Useful field

of view shrinks with age

Performance not VA relatedhellipis related to attention

Action game playing changes spatial resolutionhellipovercoming

crowding in VA assessment (me amblyopia therapy)

Temporal resolution of vision Backward masking

changehellipbrain changes

Visual sensitivity (contrast sensitivity) Post action game training

improves CSF

69

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Action video games correcting optics of the cortex (me this is

actualy OVT)

Games factor

Variable entry leanringhellipadapt task to skill level

Incremental learning tune task to subjectlsquos leanring steps

Motivationarousal

Rewards

Self masterself confidence

Action games factors

Pacingrate of exposure to infohellipincreasing processing speed

Dynamic display

Rich environment

Rich motor involvement

70

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Surgeons may be made to play action games

Pilot training

Amblyopia tx Dennis Levi research

PresenterTitle Contact info

Neuroplasticity-A Paradigm Sea Change

This presentation is available at

httpwwwslidesharenetDMAINOneuroplasticity-a-paradigm-sea-change-2459693

httpwwwmainosmemosblogspotcom

My FaceBook Page

and

Twitter

PresenterTitle Contact info

Questions About

Neuroplasticity-A Paradigm Sea Change

Dominick M Maino OD MEd FAAO FCOVD-A

Professor PediatricsBinocular VisionIllinois Eye InstituteIllinois College of Optometry

dmainoicoeduhttpwwwMainosMemosblogspotcom

Thanks to

httpwwwcovdorgHomeOVDJournalOVD401tabid263D

efaultaspx

httpbipolarblastfileswordpresscom200908neurojpg

httpwwwspecialcheerscomimagesanimated_braingif

httpblogmarsdencartoonscomwp-

contentuploads200810frankenstein-myspace-lightbeergif

httpwwwshangralafamilyfuncomgala-ecalvindreamgif

httppsychiatryjwatchorgcgicontentfull20082251

73

Chakraborty R Chatterjee A Choudhart S Chakraborty PK Neuroplasticitymdasha paradigm shift in neurosciences J Indian Med Assoc

2007105(9)513-4516-8520-1

Sacks O A neurologistlsquos notebook Stereo Sue Why two eyes are better than one The New Yorker 2006 Jun 1964-73

Krulwich R National Public Radio Going Binocular Susanlsquos First Snowfall Available at

wwwnprorgtemplatesstorystoryphpstoryId=5507789 (Accessed December 8 2008)

Press LJ The story behind Stereo Suelsquo and a world-famous neurologistlsquos discovery of vision therapy Optom Vis Dev 200637(2) 55-7

Levin HS Neuroplasticity and brain imaging research implications for rehabilitation Arch Phys Med Rehabil 2006 Dec87(12 Suppl

2)S1

Wiesel TN Hubel DH Single-cell responses in striate cortex of kittens deprived of vision in one eye J Neurophysiol 1963

Nov261003-17

Hook BM Chen C Critical periods in the visual system Changing views for a model of experience-dependent plasticity Neuron 2007

Oct56(2)312-26

Ramey CT Ramey SL Prevention of intellectual disabilities early interventions to improve cognitive development Prev Med 1998

Mar-Apr27(2)224-32

Heuninckx S Wenderoth N Swinnen SP Systems neuroplasticity in the aging brain recruiting additional neural resources for

successful motor performance in elderly persons J Neurosci 2008 Jan 228(1)91-9

Ge S Yang CH Hsu KS et al A critical period for enhanced synaptic plasticity in newly generated neurons of the adult brain Neuron

2007 May54(4)559-66

74

Draganski B Gaser C Busch V et al Neuroplasticity changes in grey matter induced by training Nature 2004 Jan 22427(6972)

311-2

Cannonieri GC Bonilha L Fernandes PT et al Practice and perfect length of training and structural brain changes in experienced

typists Neuroreport 2007 Jul 218(10)1063-6

Kleim JA Jones TA Principles of experience-dependent neural plasticity implications for rehabilitation after brain damage J

Speech Lang Hear Res 2008 Feb51(1)S225-39

Trojan S Porkorny J Theoretical aspects of neuroplasticity Physiol Res 199948(2)87-97

Ramamirtham R Kee CS Hung LF et al Wave aberrations in rhesus monkeys with vision-induced ametropias Vision Res 2007

Sep47(21)2751-66

Smith EL 3rd Ramamirtham R Qiao-Grider Y et al Effects of foveal ablation on emmetropization and form-deprivation myopia

Invest Ophthalmol Vis Sci 2007 Sep48(9)3914-22

Smith EL 3rd Kee CS Ramamirtham R et al Peripheral vision can influence eye growth and refractive development in infant

monkeys Invest Ophthalmol Vis Sci 2005 Nov46(11)3965-72

Ciuffreda KJ Vasudevan B Nearwork-induced transient myopia (NITM) and permanent myopiandashndashis there a link Ophthalmic

Physiol Opt 2008 Mar28(2)103-14

Hung GK Ciuffreda KJ Incremental retinal-defocus theory of myopia development--schematic analysis and computer simulation

Comput Biol Med 2007 Jul37(7)930-46

Hung GK Ciuffreda KJ A unifying theory of refractive error development Bull Math Biol 2000 Nov62(6)1087-108

75

Pang Y Maino D Zhang G Lu F Myopia Can its progress be controlled Optom Vis Dev 200637(2)75-9

Leung JT Brown B Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lenses Optom Vis Sci

1999 Jun76(6)346-54

Hasebe S Ohtsuki H Nonaka T et al Effect of progressive addition lenses on myopia progression in Japanese children a prospective

randomized double-masked crossover trial Invest Ophthalmol Vis Sci 2008 Jul49(7)2781-9

Gwiazda J Hyman L Hussein M et al A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression

of myopia in children Invest Ophthalmol Vis Sci 2003 Apr44(4)1492-500

Siatkowski RM Cotter SA Crockett RS et al Two-year multi-center randomized double-masked placebo-controlled parallel safety and

efficacy study of 2 pirenzepine ophthalmic gel in children with myopia J AAPOS 2008 Aug12(4)332-9

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged 7 to 17 years Arch Ophthalmol 2005

Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three to less than 10 years of age Am J

Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction Am J Ophthalmol 2007

Jun143(6)1060-3

Holmes JM Edwards AR Beck RW et al A randomized pilot study of near activities versus non-near activities during patching therapy for

amblyopia J AAPOS 2005 Apr9(2)129-36

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate

amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-57

76

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic

amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Convergence Insufficiency Treatment Trial Study Group Randomized clinical trial of treatments for symptomatic convergence insufficiency

in children Arch Ophthalmol 2008 Oct126(10)1336-49

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

Solan HA Shelley-Tremblay J Hansen PC et al M-cell deficit and reading disability a preliminary study of the effects of temporal vision-

processing therapy Optometry 2004 Oct75(10)640-50

Solan HA Larson S Shelley-Tremblay J et al Role of visual attention in cognitive control of oculomotor readiness in students with reading

disabilities J Learn Disabil 2001 Mar-Apr34(2)107-18

Gallaway M Boas MB The impact of vergence and accommodative therapy on reading eye movements and reading speed Optom Vis Dev

200738(3)115-20

Goss DA Downing DB Lowther AH et al The effect of HTS vision therapy conducted in a school setting on reading skills in third and

fourth grade students Optom Vis Dev 200738(1)27-32

Crutch SJ Warrington EK Foveal crowding in posterior cortical atrophy a specific early-visual-processing deficit affecting word reading

Cogn Neuropsychol 2007 Dec24(8)843-66

Helms D Sawtelle SM A study of the effectiveness of cognitive therapy delivered in a video game format Optom Vis Dev 200738 (1)19-

26

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

77

Lawton T Training direction-discrimination sensitivity remediates a wide spectrum of reading skills OptomVis Dev 200738(1) 33-47

Goldstand S Koslowe KC Parush S Vision visual-information processing and academic performance among seventh-grade schoolchildren a

more significant relationship than we thought Am J Occup Ther 2005 Jul-Aug59(4)377-89

Fischer B Koumlngeter A Hartnegg K Effects of daily practice on subitizing visual counting and basic arithmetic skills Optom Vis Dev

200839(1)30-4

Sands W Taub M Maino D Limited research and education on special populations in optometry and ophthalomology Optom Vis Dev

200839(2)60-1

Wesson M Maino D Oculo-visual findings in Down syndrome cerebral palsy and mental retardation with non-specific etiology In Maino D

(ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 199517-54 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

Cui Y Stapleton F Suttle C Developing an instrument to assess vision-related and subjective quality of life in children with intellectual

disability data collection and preliminary analysis in a Chinese population Ophthal Physiolog Optics 2008 May28(3) 238-46

Maino D Steele G Tahir S Sajja R Attitudes of optometry students toward individuals with disabilities Optom Ed 200227(2)45-50

Maino D Special populations in the optometric curriculum Optom Ed 200227(2)38-9

Maino D Overview of special populations In Scheiman M Rouse M (eds) Optometric Management of Learning-Related Vision Problems

St Louis Mosby Inc 200685-106

Maino D (ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 1995 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

78

McCarthy P Maino D Alport syndrome a review Clin Eye Vis Care 2000 Dec12(3-4)139-50

Block SS Brusca-Vega R Pizzi WJ et al Cognitive and visual processing skills and their relationship to mutation size in full and

permutation female fragile X carriers Optom Vis Sci 2000 Nov77 (11)592-9

Maino D The young child with developmental disabilities An introduction to mental retardation and genetic syndromes In Moore BD

(ed) Eye Care for Infants and Young Children Butter-worth--Heinemann Newton MA1997285-300

Amin V Maino D The Fragile X female Visual visual perceptual and ocular health anomalies J Am Optom Assoc 1995 May66

(5)290-95

Maino DM Maino JH Cibis GW Hecht F Ocular health anomalies in patients with developmental disabilities In Maino D (ed)

Diagnosis and Management of Special Populations Mosby-Year-book Inc St Louis MO 1995189-206 Reprinted Optometric

Education Program Foundation Santa Anna Calif 2001

Maino D Wesson M Schlange D Cibis G Maino J Optometric findings in the fragile X syndrome Optom Vis Sci 199168634-40

Scheiman MMOptometric findings in children with cerebral palsy Am J Optom Physiol Opt 1984 May61(5)321-3

Maino D Maino J Maino S Mental retardation syndromes with associated ocular defects J Am Optom Assoc 199061707-16

Stewart RE Woodhouse JM Cregg M Pakeman VH Association between accommodative accuracy hypermetropia and strabismus in

children with Downs syndrome Optom Vis Sci 2007 Feb84(2)149-55

Cregg M Woodhouse JM Pakeman VH et al Accommodation and refractive error in children with Down syndrome cross-sectional

and longitudinal studies Invest Ophthalmol Vis Sci 2001 Jan42 (1)55-63

79

McClelland JF Parkes J Hill N et al Accommodative dysfunction in children with cerebral palsy a population-

based study Invest Ophthalmol Vis Sci 2006 May47(5)1824-30

Duckman RH Vision therapy for the child with cerebral palsy J Am Optom Assoc 198758(1)28-35

Duckman R Accommodation in cerebral palsy function and remediation J Am Optom Assoc 198455(4)281-3

Scheiman M Understanding and managing vision deficits a guide for occupational therapists 2nd ed Slack

Thorofare NJ 2002

Maino D Binasal occlusion for the child with Cerebral Palsy J Ill Optom Assoc 198644(1)1218

Battaglia F Quartarone A Rizzo V et al Early impairment of synaptic plasticity in patients with Downs syndrome

Neurobiol Aging 2008 Aug29(8)1272-5

Bonnier C Evaluation of early stimulation programs for enhancing brain development Acta Paediatr 2008

Jul97(7)853-8

Morice E Andreae LC Cooke SF et al Preservation of long-term memory and synaptic plasticity despite short-term

impairments in the Tc1 mouse model of Down syndrome Learn Mem 2008 Jul 1415(7)492-500

Gordon AM Schneider JA Chinnan A Charles JR Efficacy of a hand-arm bimanual intensive therapy (HABIT) in

children with hemiplegic cerebral palsy a randomized control trial Dev Med Child Neurol 2007 Nov49(11)830-8

Kapoor N Ciuffreda KJ Vision disturbances following traumatic brain injury Curr Treat Options Neurol 2002

Jul4(4)271-80

80

Ciuffreda KJ Rutner D Kapoor N et al Vision therapy for oculomotor dysfunctions in acquired brain injury a

retrospective analysis Optometry 2008 Jan79(1)18-22

Ciuffreda KJ Han Y Kapoor N Ficarra AP Oculomotor rehabilitation for reading in acquired brain injury

NeuroRehabilitation 200621(1)9-21

Zost M Diagnosis and management of visual dysfunction in cerebral injury In Maino D (ed) Diagnosis and

Management of Special Populations Mosby-Yearbook Inc St Louis 199579 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001 [Figure used with permission of the editor]

DeGutis JM Bentin S Robertson LC DEsposito M Functional plasticity in ventral temporal cortex following

cognitive rehabilitation of a congenital prosopagnosic J Cogn Neurosci 2007 Nov19 (11)1790-802

Welbourne SR Ralph MA Exploring the impact of plasticity-related recovery after brain damage in a connectionist

model of single-word reading Cogn Affect Behav Neurosci 2005 Mar5(1)77-92

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements prevent cognitive decline A

systematic review of randomized controlled trials J Hum Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among preterm infants attributable to early

supplementation of human milk with docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings and structural-functional

synergies with cell membrane phospholipids Altern Med Rev 2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function Neuroscience 20089(7)568-78

81

Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

BMC Biol 2008 Sep 9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine improves neuropsychological disorders in a child with

creatine transporter defect Neurocase 200814(2) 151-61

Forrester LW Wheaton LA Luft AR Exercise-mediated locomotor recovery and lower-limb neuroplasticity after

stroke J Rehabil Res Dev 200845(2)205-20

82

Page 61: Neuroplasticity: A Paradigm Sea Change Latest Updated File

IX Improving Brain Function and Neuroplasticity Optometric Clinical Applications

Kleim amp Jones

Repetition matters Plasticity that results in functional change

requires repetition

Do the therapy Do it again Do it yet again No quick fix

Intensity matters Induction of plasticity requires the appropriate

amount of intensity

Intensity means strength force concentration power and passion

Without these plasticity may not occur Function may not improve

Time matters Different forms of plasticity take place at different

times during therapy

Do the basics than the more advanced therapeutic procedures

61

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Salience matters It has to be important to the individual

Make the therapy matter to the patient

Age matters Plasticity is easier in a younger brain but is also

possible in an adult brain

Do not let age determine what therapy options you offer your

patients Think of Susan Barry PhD (StereoSue) and her success

Offer your patients options Let them choose Be realistic about

outcomeshelliphave outcome measures built into therapy program

62

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Transference Neuroplasticity and the change in function

that results from one therapy can augment the attainment

of similar behaviors

What you do during oculomotor therapy may affected

vergence therapy outcomes

Interference Plasticity in response to one experience can

interfere with the acquisition of other behaviors

Monitor Evaluate progress Discuss function in other areas

of your patientslsquo life

63

Why pay attention to binocular vision dysfunctions

and neuroplasticity

December 2009 issue of the Review of Optometry

The Binocular Vision Dysfunction Pandemic

In 2010 almost 170 million individuals will be wearing glasses In

2010 there will also be up to 93 million amblyopes and 12 and a half

million strabismics For children under 18 years of age that means

there will be more than 22 and a half million amblyopes and millions

of children with strabismus A clinical trial to determine the

prevalence of binocular vision dysfunction within the general

population suggested the possibility of up to 56 or 173 million men

women and children with symptoms associated with a binocular

vision dysfunction 189 million (61) with accommodative problems

and 118 million (38) demonstrating various vergence

anomalies

64

65

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Brain plasticity life long changes in the structure of the brain

Sensory substitution replacement of one sensory input by another

Measurement techniques

Voxel based morphometryhellipmeasures difference in brain volume

Fluorodeoxyglucose glucose analog PET scan tells you

distribution and metabolism of brain

Cortical thickness measures

Visual cortex of the blind turns somatic ―The eye of the tongue

Transcranial magnetic stmiulation non-invasive technique to

stimulate cortex

66

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Blind Braille readers report tingling in fingers when pressure

phosphenes are applied Blind feel tingling in tongue

Bind use tongue to perform orientation task motion perception

sensory perception Visual cortex recruited in a variety of sensory

and cognitive tasks (DM Can we use tongue as a VT tool)

Dilks Reorganizations of human adult visual system

When a region of sensory cortex is deprived of its bottom up

input the deprived region begins to respond to stimuli that

normally activate adjacent cortex

67

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Retinotopic map changes for stroke pts Cortical reorganization in

adults occurs Perceived objectshellipelongation in stroke amp AMD

What happens to deprived cortex in AMD

fMRI shows cortical reorganization in adults

Proposed mechanisms

hellipGrowth of new connections

hellipUnmasking of pre-existing connections this is true

happens within seconds

Bavelier

Action video games

68

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Bavelier

Action video games Looked at attention Gamers can track more

activities

Attention over space (me peripheral awarenress) Useful field

of view shrinks with age

Performance not VA relatedhellipis related to attention

Action game playing changes spatial resolutionhellipovercoming

crowding in VA assessment (me amblyopia therapy)

Temporal resolution of vision Backward masking

changehellipbrain changes

Visual sensitivity (contrast sensitivity) Post action game training

improves CSF

69

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Action video games correcting optics of the cortex (me this is

actualy OVT)

Games factor

Variable entry leanringhellipadapt task to skill level

Incremental learning tune task to subjectlsquos leanring steps

Motivationarousal

Rewards

Self masterself confidence

Action games factors

Pacingrate of exposure to infohellipincreasing processing speed

Dynamic display

Rich environment

Rich motor involvement

70

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Surgeons may be made to play action games

Pilot training

Amblyopia tx Dennis Levi research

PresenterTitle Contact info

Neuroplasticity-A Paradigm Sea Change

This presentation is available at

httpwwwslidesharenetDMAINOneuroplasticity-a-paradigm-sea-change-2459693

httpwwwmainosmemosblogspotcom

My FaceBook Page

and

Twitter

PresenterTitle Contact info

Questions About

Neuroplasticity-A Paradigm Sea Change

Dominick M Maino OD MEd FAAO FCOVD-A

Professor PediatricsBinocular VisionIllinois Eye InstituteIllinois College of Optometry

dmainoicoeduhttpwwwMainosMemosblogspotcom

Thanks to

httpwwwcovdorgHomeOVDJournalOVD401tabid263D

efaultaspx

httpbipolarblastfileswordpresscom200908neurojpg

httpwwwspecialcheerscomimagesanimated_braingif

httpblogmarsdencartoonscomwp-

contentuploads200810frankenstein-myspace-lightbeergif

httpwwwshangralafamilyfuncomgala-ecalvindreamgif

httppsychiatryjwatchorgcgicontentfull20082251

73

Chakraborty R Chatterjee A Choudhart S Chakraborty PK Neuroplasticitymdasha paradigm shift in neurosciences J Indian Med Assoc

2007105(9)513-4516-8520-1

Sacks O A neurologistlsquos notebook Stereo Sue Why two eyes are better than one The New Yorker 2006 Jun 1964-73

Krulwich R National Public Radio Going Binocular Susanlsquos First Snowfall Available at

wwwnprorgtemplatesstorystoryphpstoryId=5507789 (Accessed December 8 2008)

Press LJ The story behind Stereo Suelsquo and a world-famous neurologistlsquos discovery of vision therapy Optom Vis Dev 200637(2) 55-7

Levin HS Neuroplasticity and brain imaging research implications for rehabilitation Arch Phys Med Rehabil 2006 Dec87(12 Suppl

2)S1

Wiesel TN Hubel DH Single-cell responses in striate cortex of kittens deprived of vision in one eye J Neurophysiol 1963

Nov261003-17

Hook BM Chen C Critical periods in the visual system Changing views for a model of experience-dependent plasticity Neuron 2007

Oct56(2)312-26

Ramey CT Ramey SL Prevention of intellectual disabilities early interventions to improve cognitive development Prev Med 1998

Mar-Apr27(2)224-32

Heuninckx S Wenderoth N Swinnen SP Systems neuroplasticity in the aging brain recruiting additional neural resources for

successful motor performance in elderly persons J Neurosci 2008 Jan 228(1)91-9

Ge S Yang CH Hsu KS et al A critical period for enhanced synaptic plasticity in newly generated neurons of the adult brain Neuron

2007 May54(4)559-66

74

Draganski B Gaser C Busch V et al Neuroplasticity changes in grey matter induced by training Nature 2004 Jan 22427(6972)

311-2

Cannonieri GC Bonilha L Fernandes PT et al Practice and perfect length of training and structural brain changes in experienced

typists Neuroreport 2007 Jul 218(10)1063-6

Kleim JA Jones TA Principles of experience-dependent neural plasticity implications for rehabilitation after brain damage J

Speech Lang Hear Res 2008 Feb51(1)S225-39

Trojan S Porkorny J Theoretical aspects of neuroplasticity Physiol Res 199948(2)87-97

Ramamirtham R Kee CS Hung LF et al Wave aberrations in rhesus monkeys with vision-induced ametropias Vision Res 2007

Sep47(21)2751-66

Smith EL 3rd Ramamirtham R Qiao-Grider Y et al Effects of foveal ablation on emmetropization and form-deprivation myopia

Invest Ophthalmol Vis Sci 2007 Sep48(9)3914-22

Smith EL 3rd Kee CS Ramamirtham R et al Peripheral vision can influence eye growth and refractive development in infant

monkeys Invest Ophthalmol Vis Sci 2005 Nov46(11)3965-72

Ciuffreda KJ Vasudevan B Nearwork-induced transient myopia (NITM) and permanent myopiandashndashis there a link Ophthalmic

Physiol Opt 2008 Mar28(2)103-14

Hung GK Ciuffreda KJ Incremental retinal-defocus theory of myopia development--schematic analysis and computer simulation

Comput Biol Med 2007 Jul37(7)930-46

Hung GK Ciuffreda KJ A unifying theory of refractive error development Bull Math Biol 2000 Nov62(6)1087-108

75

Pang Y Maino D Zhang G Lu F Myopia Can its progress be controlled Optom Vis Dev 200637(2)75-9

Leung JT Brown B Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lenses Optom Vis Sci

1999 Jun76(6)346-54

Hasebe S Ohtsuki H Nonaka T et al Effect of progressive addition lenses on myopia progression in Japanese children a prospective

randomized double-masked crossover trial Invest Ophthalmol Vis Sci 2008 Jul49(7)2781-9

Gwiazda J Hyman L Hussein M et al A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression

of myopia in children Invest Ophthalmol Vis Sci 2003 Apr44(4)1492-500

Siatkowski RM Cotter SA Crockett RS et al Two-year multi-center randomized double-masked placebo-controlled parallel safety and

efficacy study of 2 pirenzepine ophthalmic gel in children with myopia J AAPOS 2008 Aug12(4)332-9

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged 7 to 17 years Arch Ophthalmol 2005

Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three to less than 10 years of age Am J

Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction Am J Ophthalmol 2007

Jun143(6)1060-3

Holmes JM Edwards AR Beck RW et al A randomized pilot study of near activities versus non-near activities during patching therapy for

amblyopia J AAPOS 2005 Apr9(2)129-36

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate

amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-57

76

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic

amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Convergence Insufficiency Treatment Trial Study Group Randomized clinical trial of treatments for symptomatic convergence insufficiency

in children Arch Ophthalmol 2008 Oct126(10)1336-49

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

Solan HA Shelley-Tremblay J Hansen PC et al M-cell deficit and reading disability a preliminary study of the effects of temporal vision-

processing therapy Optometry 2004 Oct75(10)640-50

Solan HA Larson S Shelley-Tremblay J et al Role of visual attention in cognitive control of oculomotor readiness in students with reading

disabilities J Learn Disabil 2001 Mar-Apr34(2)107-18

Gallaway M Boas MB The impact of vergence and accommodative therapy on reading eye movements and reading speed Optom Vis Dev

200738(3)115-20

Goss DA Downing DB Lowther AH et al The effect of HTS vision therapy conducted in a school setting on reading skills in third and

fourth grade students Optom Vis Dev 200738(1)27-32

Crutch SJ Warrington EK Foveal crowding in posterior cortical atrophy a specific early-visual-processing deficit affecting word reading

Cogn Neuropsychol 2007 Dec24(8)843-66

Helms D Sawtelle SM A study of the effectiveness of cognitive therapy delivered in a video game format Optom Vis Dev 200738 (1)19-

26

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

77

Lawton T Training direction-discrimination sensitivity remediates a wide spectrum of reading skills OptomVis Dev 200738(1) 33-47

Goldstand S Koslowe KC Parush S Vision visual-information processing and academic performance among seventh-grade schoolchildren a

more significant relationship than we thought Am J Occup Ther 2005 Jul-Aug59(4)377-89

Fischer B Koumlngeter A Hartnegg K Effects of daily practice on subitizing visual counting and basic arithmetic skills Optom Vis Dev

200839(1)30-4

Sands W Taub M Maino D Limited research and education on special populations in optometry and ophthalomology Optom Vis Dev

200839(2)60-1

Wesson M Maino D Oculo-visual findings in Down syndrome cerebral palsy and mental retardation with non-specific etiology In Maino D

(ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 199517-54 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

Cui Y Stapleton F Suttle C Developing an instrument to assess vision-related and subjective quality of life in children with intellectual

disability data collection and preliminary analysis in a Chinese population Ophthal Physiolog Optics 2008 May28(3) 238-46

Maino D Steele G Tahir S Sajja R Attitudes of optometry students toward individuals with disabilities Optom Ed 200227(2)45-50

Maino D Special populations in the optometric curriculum Optom Ed 200227(2)38-9

Maino D Overview of special populations In Scheiman M Rouse M (eds) Optometric Management of Learning-Related Vision Problems

St Louis Mosby Inc 200685-106

Maino D (ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 1995 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

78

McCarthy P Maino D Alport syndrome a review Clin Eye Vis Care 2000 Dec12(3-4)139-50

Block SS Brusca-Vega R Pizzi WJ et al Cognitive and visual processing skills and their relationship to mutation size in full and

permutation female fragile X carriers Optom Vis Sci 2000 Nov77 (11)592-9

Maino D The young child with developmental disabilities An introduction to mental retardation and genetic syndromes In Moore BD

(ed) Eye Care for Infants and Young Children Butter-worth--Heinemann Newton MA1997285-300

Amin V Maino D The Fragile X female Visual visual perceptual and ocular health anomalies J Am Optom Assoc 1995 May66

(5)290-95

Maino DM Maino JH Cibis GW Hecht F Ocular health anomalies in patients with developmental disabilities In Maino D (ed)

Diagnosis and Management of Special Populations Mosby-Year-book Inc St Louis MO 1995189-206 Reprinted Optometric

Education Program Foundation Santa Anna Calif 2001

Maino D Wesson M Schlange D Cibis G Maino J Optometric findings in the fragile X syndrome Optom Vis Sci 199168634-40

Scheiman MMOptometric findings in children with cerebral palsy Am J Optom Physiol Opt 1984 May61(5)321-3

Maino D Maino J Maino S Mental retardation syndromes with associated ocular defects J Am Optom Assoc 199061707-16

Stewart RE Woodhouse JM Cregg M Pakeman VH Association between accommodative accuracy hypermetropia and strabismus in

children with Downs syndrome Optom Vis Sci 2007 Feb84(2)149-55

Cregg M Woodhouse JM Pakeman VH et al Accommodation and refractive error in children with Down syndrome cross-sectional

and longitudinal studies Invest Ophthalmol Vis Sci 2001 Jan42 (1)55-63

79

McClelland JF Parkes J Hill N et al Accommodative dysfunction in children with cerebral palsy a population-

based study Invest Ophthalmol Vis Sci 2006 May47(5)1824-30

Duckman RH Vision therapy for the child with cerebral palsy J Am Optom Assoc 198758(1)28-35

Duckman R Accommodation in cerebral palsy function and remediation J Am Optom Assoc 198455(4)281-3

Scheiman M Understanding and managing vision deficits a guide for occupational therapists 2nd ed Slack

Thorofare NJ 2002

Maino D Binasal occlusion for the child with Cerebral Palsy J Ill Optom Assoc 198644(1)1218

Battaglia F Quartarone A Rizzo V et al Early impairment of synaptic plasticity in patients with Downs syndrome

Neurobiol Aging 2008 Aug29(8)1272-5

Bonnier C Evaluation of early stimulation programs for enhancing brain development Acta Paediatr 2008

Jul97(7)853-8

Morice E Andreae LC Cooke SF et al Preservation of long-term memory and synaptic plasticity despite short-term

impairments in the Tc1 mouse model of Down syndrome Learn Mem 2008 Jul 1415(7)492-500

Gordon AM Schneider JA Chinnan A Charles JR Efficacy of a hand-arm bimanual intensive therapy (HABIT) in

children with hemiplegic cerebral palsy a randomized control trial Dev Med Child Neurol 2007 Nov49(11)830-8

Kapoor N Ciuffreda KJ Vision disturbances following traumatic brain injury Curr Treat Options Neurol 2002

Jul4(4)271-80

80

Ciuffreda KJ Rutner D Kapoor N et al Vision therapy for oculomotor dysfunctions in acquired brain injury a

retrospective analysis Optometry 2008 Jan79(1)18-22

Ciuffreda KJ Han Y Kapoor N Ficarra AP Oculomotor rehabilitation for reading in acquired brain injury

NeuroRehabilitation 200621(1)9-21

Zost M Diagnosis and management of visual dysfunction in cerebral injury In Maino D (ed) Diagnosis and

Management of Special Populations Mosby-Yearbook Inc St Louis 199579 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001 [Figure used with permission of the editor]

DeGutis JM Bentin S Robertson LC DEsposito M Functional plasticity in ventral temporal cortex following

cognitive rehabilitation of a congenital prosopagnosic J Cogn Neurosci 2007 Nov19 (11)1790-802

Welbourne SR Ralph MA Exploring the impact of plasticity-related recovery after brain damage in a connectionist

model of single-word reading Cogn Affect Behav Neurosci 2005 Mar5(1)77-92

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements prevent cognitive decline A

systematic review of randomized controlled trials J Hum Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among preterm infants attributable to early

supplementation of human milk with docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings and structural-functional

synergies with cell membrane phospholipids Altern Med Rev 2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function Neuroscience 20089(7)568-78

81

Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

BMC Biol 2008 Sep 9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine improves neuropsychological disorders in a child with

creatine transporter defect Neurocase 200814(2) 151-61

Forrester LW Wheaton LA Luft AR Exercise-mediated locomotor recovery and lower-limb neuroplasticity after

stroke J Rehabil Res Dev 200845(2)205-20

82

Page 62: Neuroplasticity: A Paradigm Sea Change Latest Updated File

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Salience matters It has to be important to the individual

Make the therapy matter to the patient

Age matters Plasticity is easier in a younger brain but is also

possible in an adult brain

Do not let age determine what therapy options you offer your

patients Think of Susan Barry PhD (StereoSue) and her success

Offer your patients options Let them choose Be realistic about

outcomeshelliphave outcome measures built into therapy program

62

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Transference Neuroplasticity and the change in function

that results from one therapy can augment the attainment

of similar behaviors

What you do during oculomotor therapy may affected

vergence therapy outcomes

Interference Plasticity in response to one experience can

interfere with the acquisition of other behaviors

Monitor Evaluate progress Discuss function in other areas

of your patientslsquo life

63

Why pay attention to binocular vision dysfunctions

and neuroplasticity

December 2009 issue of the Review of Optometry

The Binocular Vision Dysfunction Pandemic

In 2010 almost 170 million individuals will be wearing glasses In

2010 there will also be up to 93 million amblyopes and 12 and a half

million strabismics For children under 18 years of age that means

there will be more than 22 and a half million amblyopes and millions

of children with strabismus A clinical trial to determine the

prevalence of binocular vision dysfunction within the general

population suggested the possibility of up to 56 or 173 million men

women and children with symptoms associated with a binocular

vision dysfunction 189 million (61) with accommodative problems

and 118 million (38) demonstrating various vergence

anomalies

64

65

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Brain plasticity life long changes in the structure of the brain

Sensory substitution replacement of one sensory input by another

Measurement techniques

Voxel based morphometryhellipmeasures difference in brain volume

Fluorodeoxyglucose glucose analog PET scan tells you

distribution and metabolism of brain

Cortical thickness measures

Visual cortex of the blind turns somatic ―The eye of the tongue

Transcranial magnetic stmiulation non-invasive technique to

stimulate cortex

66

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Blind Braille readers report tingling in fingers when pressure

phosphenes are applied Blind feel tingling in tongue

Bind use tongue to perform orientation task motion perception

sensory perception Visual cortex recruited in a variety of sensory

and cognitive tasks (DM Can we use tongue as a VT tool)

Dilks Reorganizations of human adult visual system

When a region of sensory cortex is deprived of its bottom up

input the deprived region begins to respond to stimuli that

normally activate adjacent cortex

67

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Retinotopic map changes for stroke pts Cortical reorganization in

adults occurs Perceived objectshellipelongation in stroke amp AMD

What happens to deprived cortex in AMD

fMRI shows cortical reorganization in adults

Proposed mechanisms

hellipGrowth of new connections

hellipUnmasking of pre-existing connections this is true

happens within seconds

Bavelier

Action video games

68

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Bavelier

Action video games Looked at attention Gamers can track more

activities

Attention over space (me peripheral awarenress) Useful field

of view shrinks with age

Performance not VA relatedhellipis related to attention

Action game playing changes spatial resolutionhellipovercoming

crowding in VA assessment (me amblyopia therapy)

Temporal resolution of vision Backward masking

changehellipbrain changes

Visual sensitivity (contrast sensitivity) Post action game training

improves CSF

69

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Action video games correcting optics of the cortex (me this is

actualy OVT)

Games factor

Variable entry leanringhellipadapt task to skill level

Incremental learning tune task to subjectlsquos leanring steps

Motivationarousal

Rewards

Self masterself confidence

Action games factors

Pacingrate of exposure to infohellipincreasing processing speed

Dynamic display

Rich environment

Rich motor involvement

70

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Surgeons may be made to play action games

Pilot training

Amblyopia tx Dennis Levi research

PresenterTitle Contact info

Neuroplasticity-A Paradigm Sea Change

This presentation is available at

httpwwwslidesharenetDMAINOneuroplasticity-a-paradigm-sea-change-2459693

httpwwwmainosmemosblogspotcom

My FaceBook Page

and

Twitter

PresenterTitle Contact info

Questions About

Neuroplasticity-A Paradigm Sea Change

Dominick M Maino OD MEd FAAO FCOVD-A

Professor PediatricsBinocular VisionIllinois Eye InstituteIllinois College of Optometry

dmainoicoeduhttpwwwMainosMemosblogspotcom

Thanks to

httpwwwcovdorgHomeOVDJournalOVD401tabid263D

efaultaspx

httpbipolarblastfileswordpresscom200908neurojpg

httpwwwspecialcheerscomimagesanimated_braingif

httpblogmarsdencartoonscomwp-

contentuploads200810frankenstein-myspace-lightbeergif

httpwwwshangralafamilyfuncomgala-ecalvindreamgif

httppsychiatryjwatchorgcgicontentfull20082251

73

Chakraborty R Chatterjee A Choudhart S Chakraborty PK Neuroplasticitymdasha paradigm shift in neurosciences J Indian Med Assoc

2007105(9)513-4516-8520-1

Sacks O A neurologistlsquos notebook Stereo Sue Why two eyes are better than one The New Yorker 2006 Jun 1964-73

Krulwich R National Public Radio Going Binocular Susanlsquos First Snowfall Available at

wwwnprorgtemplatesstorystoryphpstoryId=5507789 (Accessed December 8 2008)

Press LJ The story behind Stereo Suelsquo and a world-famous neurologistlsquos discovery of vision therapy Optom Vis Dev 200637(2) 55-7

Levin HS Neuroplasticity and brain imaging research implications for rehabilitation Arch Phys Med Rehabil 2006 Dec87(12 Suppl

2)S1

Wiesel TN Hubel DH Single-cell responses in striate cortex of kittens deprived of vision in one eye J Neurophysiol 1963

Nov261003-17

Hook BM Chen C Critical periods in the visual system Changing views for a model of experience-dependent plasticity Neuron 2007

Oct56(2)312-26

Ramey CT Ramey SL Prevention of intellectual disabilities early interventions to improve cognitive development Prev Med 1998

Mar-Apr27(2)224-32

Heuninckx S Wenderoth N Swinnen SP Systems neuroplasticity in the aging brain recruiting additional neural resources for

successful motor performance in elderly persons J Neurosci 2008 Jan 228(1)91-9

Ge S Yang CH Hsu KS et al A critical period for enhanced synaptic plasticity in newly generated neurons of the adult brain Neuron

2007 May54(4)559-66

74

Draganski B Gaser C Busch V et al Neuroplasticity changes in grey matter induced by training Nature 2004 Jan 22427(6972)

311-2

Cannonieri GC Bonilha L Fernandes PT et al Practice and perfect length of training and structural brain changes in experienced

typists Neuroreport 2007 Jul 218(10)1063-6

Kleim JA Jones TA Principles of experience-dependent neural plasticity implications for rehabilitation after brain damage J

Speech Lang Hear Res 2008 Feb51(1)S225-39

Trojan S Porkorny J Theoretical aspects of neuroplasticity Physiol Res 199948(2)87-97

Ramamirtham R Kee CS Hung LF et al Wave aberrations in rhesus monkeys with vision-induced ametropias Vision Res 2007

Sep47(21)2751-66

Smith EL 3rd Ramamirtham R Qiao-Grider Y et al Effects of foveal ablation on emmetropization and form-deprivation myopia

Invest Ophthalmol Vis Sci 2007 Sep48(9)3914-22

Smith EL 3rd Kee CS Ramamirtham R et al Peripheral vision can influence eye growth and refractive development in infant

monkeys Invest Ophthalmol Vis Sci 2005 Nov46(11)3965-72

Ciuffreda KJ Vasudevan B Nearwork-induced transient myopia (NITM) and permanent myopiandashndashis there a link Ophthalmic

Physiol Opt 2008 Mar28(2)103-14

Hung GK Ciuffreda KJ Incremental retinal-defocus theory of myopia development--schematic analysis and computer simulation

Comput Biol Med 2007 Jul37(7)930-46

Hung GK Ciuffreda KJ A unifying theory of refractive error development Bull Math Biol 2000 Nov62(6)1087-108

75

Pang Y Maino D Zhang G Lu F Myopia Can its progress be controlled Optom Vis Dev 200637(2)75-9

Leung JT Brown B Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lenses Optom Vis Sci

1999 Jun76(6)346-54

Hasebe S Ohtsuki H Nonaka T et al Effect of progressive addition lenses on myopia progression in Japanese children a prospective

randomized double-masked crossover trial Invest Ophthalmol Vis Sci 2008 Jul49(7)2781-9

Gwiazda J Hyman L Hussein M et al A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression

of myopia in children Invest Ophthalmol Vis Sci 2003 Apr44(4)1492-500

Siatkowski RM Cotter SA Crockett RS et al Two-year multi-center randomized double-masked placebo-controlled parallel safety and

efficacy study of 2 pirenzepine ophthalmic gel in children with myopia J AAPOS 2008 Aug12(4)332-9

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged 7 to 17 years Arch Ophthalmol 2005

Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three to less than 10 years of age Am J

Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction Am J Ophthalmol 2007

Jun143(6)1060-3

Holmes JM Edwards AR Beck RW et al A randomized pilot study of near activities versus non-near activities during patching therapy for

amblyopia J AAPOS 2005 Apr9(2)129-36

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate

amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-57

76

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic

amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Convergence Insufficiency Treatment Trial Study Group Randomized clinical trial of treatments for symptomatic convergence insufficiency

in children Arch Ophthalmol 2008 Oct126(10)1336-49

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

Solan HA Shelley-Tremblay J Hansen PC et al M-cell deficit and reading disability a preliminary study of the effects of temporal vision-

processing therapy Optometry 2004 Oct75(10)640-50

Solan HA Larson S Shelley-Tremblay J et al Role of visual attention in cognitive control of oculomotor readiness in students with reading

disabilities J Learn Disabil 2001 Mar-Apr34(2)107-18

Gallaway M Boas MB The impact of vergence and accommodative therapy on reading eye movements and reading speed Optom Vis Dev

200738(3)115-20

Goss DA Downing DB Lowther AH et al The effect of HTS vision therapy conducted in a school setting on reading skills in third and

fourth grade students Optom Vis Dev 200738(1)27-32

Crutch SJ Warrington EK Foveal crowding in posterior cortical atrophy a specific early-visual-processing deficit affecting word reading

Cogn Neuropsychol 2007 Dec24(8)843-66

Helms D Sawtelle SM A study of the effectiveness of cognitive therapy delivered in a video game format Optom Vis Dev 200738 (1)19-

26

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

77

Lawton T Training direction-discrimination sensitivity remediates a wide spectrum of reading skills OptomVis Dev 200738(1) 33-47

Goldstand S Koslowe KC Parush S Vision visual-information processing and academic performance among seventh-grade schoolchildren a

more significant relationship than we thought Am J Occup Ther 2005 Jul-Aug59(4)377-89

Fischer B Koumlngeter A Hartnegg K Effects of daily practice on subitizing visual counting and basic arithmetic skills Optom Vis Dev

200839(1)30-4

Sands W Taub M Maino D Limited research and education on special populations in optometry and ophthalomology Optom Vis Dev

200839(2)60-1

Wesson M Maino D Oculo-visual findings in Down syndrome cerebral palsy and mental retardation with non-specific etiology In Maino D

(ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 199517-54 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

Cui Y Stapleton F Suttle C Developing an instrument to assess vision-related and subjective quality of life in children with intellectual

disability data collection and preliminary analysis in a Chinese population Ophthal Physiolog Optics 2008 May28(3) 238-46

Maino D Steele G Tahir S Sajja R Attitudes of optometry students toward individuals with disabilities Optom Ed 200227(2)45-50

Maino D Special populations in the optometric curriculum Optom Ed 200227(2)38-9

Maino D Overview of special populations In Scheiman M Rouse M (eds) Optometric Management of Learning-Related Vision Problems

St Louis Mosby Inc 200685-106

Maino D (ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 1995 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

78

McCarthy P Maino D Alport syndrome a review Clin Eye Vis Care 2000 Dec12(3-4)139-50

Block SS Brusca-Vega R Pizzi WJ et al Cognitive and visual processing skills and their relationship to mutation size in full and

permutation female fragile X carriers Optom Vis Sci 2000 Nov77 (11)592-9

Maino D The young child with developmental disabilities An introduction to mental retardation and genetic syndromes In Moore BD

(ed) Eye Care for Infants and Young Children Butter-worth--Heinemann Newton MA1997285-300

Amin V Maino D The Fragile X female Visual visual perceptual and ocular health anomalies J Am Optom Assoc 1995 May66

(5)290-95

Maino DM Maino JH Cibis GW Hecht F Ocular health anomalies in patients with developmental disabilities In Maino D (ed)

Diagnosis and Management of Special Populations Mosby-Year-book Inc St Louis MO 1995189-206 Reprinted Optometric

Education Program Foundation Santa Anna Calif 2001

Maino D Wesson M Schlange D Cibis G Maino J Optometric findings in the fragile X syndrome Optom Vis Sci 199168634-40

Scheiman MMOptometric findings in children with cerebral palsy Am J Optom Physiol Opt 1984 May61(5)321-3

Maino D Maino J Maino S Mental retardation syndromes with associated ocular defects J Am Optom Assoc 199061707-16

Stewart RE Woodhouse JM Cregg M Pakeman VH Association between accommodative accuracy hypermetropia and strabismus in

children with Downs syndrome Optom Vis Sci 2007 Feb84(2)149-55

Cregg M Woodhouse JM Pakeman VH et al Accommodation and refractive error in children with Down syndrome cross-sectional

and longitudinal studies Invest Ophthalmol Vis Sci 2001 Jan42 (1)55-63

79

McClelland JF Parkes J Hill N et al Accommodative dysfunction in children with cerebral palsy a population-

based study Invest Ophthalmol Vis Sci 2006 May47(5)1824-30

Duckman RH Vision therapy for the child with cerebral palsy J Am Optom Assoc 198758(1)28-35

Duckman R Accommodation in cerebral palsy function and remediation J Am Optom Assoc 198455(4)281-3

Scheiman M Understanding and managing vision deficits a guide for occupational therapists 2nd ed Slack

Thorofare NJ 2002

Maino D Binasal occlusion for the child with Cerebral Palsy J Ill Optom Assoc 198644(1)1218

Battaglia F Quartarone A Rizzo V et al Early impairment of synaptic plasticity in patients with Downs syndrome

Neurobiol Aging 2008 Aug29(8)1272-5

Bonnier C Evaluation of early stimulation programs for enhancing brain development Acta Paediatr 2008

Jul97(7)853-8

Morice E Andreae LC Cooke SF et al Preservation of long-term memory and synaptic plasticity despite short-term

impairments in the Tc1 mouse model of Down syndrome Learn Mem 2008 Jul 1415(7)492-500

Gordon AM Schneider JA Chinnan A Charles JR Efficacy of a hand-arm bimanual intensive therapy (HABIT) in

children with hemiplegic cerebral palsy a randomized control trial Dev Med Child Neurol 2007 Nov49(11)830-8

Kapoor N Ciuffreda KJ Vision disturbances following traumatic brain injury Curr Treat Options Neurol 2002

Jul4(4)271-80

80

Ciuffreda KJ Rutner D Kapoor N et al Vision therapy for oculomotor dysfunctions in acquired brain injury a

retrospective analysis Optometry 2008 Jan79(1)18-22

Ciuffreda KJ Han Y Kapoor N Ficarra AP Oculomotor rehabilitation for reading in acquired brain injury

NeuroRehabilitation 200621(1)9-21

Zost M Diagnosis and management of visual dysfunction in cerebral injury In Maino D (ed) Diagnosis and

Management of Special Populations Mosby-Yearbook Inc St Louis 199579 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001 [Figure used with permission of the editor]

DeGutis JM Bentin S Robertson LC DEsposito M Functional plasticity in ventral temporal cortex following

cognitive rehabilitation of a congenital prosopagnosic J Cogn Neurosci 2007 Nov19 (11)1790-802

Welbourne SR Ralph MA Exploring the impact of plasticity-related recovery after brain damage in a connectionist

model of single-word reading Cogn Affect Behav Neurosci 2005 Mar5(1)77-92

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements prevent cognitive decline A

systematic review of randomized controlled trials J Hum Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among preterm infants attributable to early

supplementation of human milk with docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings and structural-functional

synergies with cell membrane phospholipids Altern Med Rev 2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function Neuroscience 20089(7)568-78

81

Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

BMC Biol 2008 Sep 9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine improves neuropsychological disorders in a child with

creatine transporter defect Neurocase 200814(2) 151-61

Forrester LW Wheaton LA Luft AR Exercise-mediated locomotor recovery and lower-limb neuroplasticity after

stroke J Rehabil Res Dev 200845(2)205-20

82

Page 63: Neuroplasticity: A Paradigm Sea Change Latest Updated File

IX Improving Brain Function and Neuroplasticity

Optometric Clinical Applications

Kleim amp Jones

Transference Neuroplasticity and the change in function

that results from one therapy can augment the attainment

of similar behaviors

What you do during oculomotor therapy may affected

vergence therapy outcomes

Interference Plasticity in response to one experience can

interfere with the acquisition of other behaviors

Monitor Evaluate progress Discuss function in other areas

of your patientslsquo life

63

Why pay attention to binocular vision dysfunctions

and neuroplasticity

December 2009 issue of the Review of Optometry

The Binocular Vision Dysfunction Pandemic

In 2010 almost 170 million individuals will be wearing glasses In

2010 there will also be up to 93 million amblyopes and 12 and a half

million strabismics For children under 18 years of age that means

there will be more than 22 and a half million amblyopes and millions

of children with strabismus A clinical trial to determine the

prevalence of binocular vision dysfunction within the general

population suggested the possibility of up to 56 or 173 million men

women and children with symptoms associated with a binocular

vision dysfunction 189 million (61) with accommodative problems

and 118 million (38) demonstrating various vergence

anomalies

64

65

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Brain plasticity life long changes in the structure of the brain

Sensory substitution replacement of one sensory input by another

Measurement techniques

Voxel based morphometryhellipmeasures difference in brain volume

Fluorodeoxyglucose glucose analog PET scan tells you

distribution and metabolism of brain

Cortical thickness measures

Visual cortex of the blind turns somatic ―The eye of the tongue

Transcranial magnetic stmiulation non-invasive technique to

stimulate cortex

66

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Blind Braille readers report tingling in fingers when pressure

phosphenes are applied Blind feel tingling in tongue

Bind use tongue to perform orientation task motion perception

sensory perception Visual cortex recruited in a variety of sensory

and cognitive tasks (DM Can we use tongue as a VT tool)

Dilks Reorganizations of human adult visual system

When a region of sensory cortex is deprived of its bottom up

input the deprived region begins to respond to stimuli that

normally activate adjacent cortex

67

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Retinotopic map changes for stroke pts Cortical reorganization in

adults occurs Perceived objectshellipelongation in stroke amp AMD

What happens to deprived cortex in AMD

fMRI shows cortical reorganization in adults

Proposed mechanisms

hellipGrowth of new connections

hellipUnmasking of pre-existing connections this is true

happens within seconds

Bavelier

Action video games

68

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Bavelier

Action video games Looked at attention Gamers can track more

activities

Attention over space (me peripheral awarenress) Useful field

of view shrinks with age

Performance not VA relatedhellipis related to attention

Action game playing changes spatial resolutionhellipovercoming

crowding in VA assessment (me amblyopia therapy)

Temporal resolution of vision Backward masking

changehellipbrain changes

Visual sensitivity (contrast sensitivity) Post action game training

improves CSF

69

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Action video games correcting optics of the cortex (me this is

actualy OVT)

Games factor

Variable entry leanringhellipadapt task to skill level

Incremental learning tune task to subjectlsquos leanring steps

Motivationarousal

Rewards

Self masterself confidence

Action games factors

Pacingrate of exposure to infohellipincreasing processing speed

Dynamic display

Rich environment

Rich motor involvement

70

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Surgeons may be made to play action games

Pilot training

Amblyopia tx Dennis Levi research

PresenterTitle Contact info

Neuroplasticity-A Paradigm Sea Change

This presentation is available at

httpwwwslidesharenetDMAINOneuroplasticity-a-paradigm-sea-change-2459693

httpwwwmainosmemosblogspotcom

My FaceBook Page

and

Twitter

PresenterTitle Contact info

Questions About

Neuroplasticity-A Paradigm Sea Change

Dominick M Maino OD MEd FAAO FCOVD-A

Professor PediatricsBinocular VisionIllinois Eye InstituteIllinois College of Optometry

dmainoicoeduhttpwwwMainosMemosblogspotcom

Thanks to

httpwwwcovdorgHomeOVDJournalOVD401tabid263D

efaultaspx

httpbipolarblastfileswordpresscom200908neurojpg

httpwwwspecialcheerscomimagesanimated_braingif

httpblogmarsdencartoonscomwp-

contentuploads200810frankenstein-myspace-lightbeergif

httpwwwshangralafamilyfuncomgala-ecalvindreamgif

httppsychiatryjwatchorgcgicontentfull20082251

73

Chakraborty R Chatterjee A Choudhart S Chakraborty PK Neuroplasticitymdasha paradigm shift in neurosciences J Indian Med Assoc

2007105(9)513-4516-8520-1

Sacks O A neurologistlsquos notebook Stereo Sue Why two eyes are better than one The New Yorker 2006 Jun 1964-73

Krulwich R National Public Radio Going Binocular Susanlsquos First Snowfall Available at

wwwnprorgtemplatesstorystoryphpstoryId=5507789 (Accessed December 8 2008)

Press LJ The story behind Stereo Suelsquo and a world-famous neurologistlsquos discovery of vision therapy Optom Vis Dev 200637(2) 55-7

Levin HS Neuroplasticity and brain imaging research implications for rehabilitation Arch Phys Med Rehabil 2006 Dec87(12 Suppl

2)S1

Wiesel TN Hubel DH Single-cell responses in striate cortex of kittens deprived of vision in one eye J Neurophysiol 1963

Nov261003-17

Hook BM Chen C Critical periods in the visual system Changing views for a model of experience-dependent plasticity Neuron 2007

Oct56(2)312-26

Ramey CT Ramey SL Prevention of intellectual disabilities early interventions to improve cognitive development Prev Med 1998

Mar-Apr27(2)224-32

Heuninckx S Wenderoth N Swinnen SP Systems neuroplasticity in the aging brain recruiting additional neural resources for

successful motor performance in elderly persons J Neurosci 2008 Jan 228(1)91-9

Ge S Yang CH Hsu KS et al A critical period for enhanced synaptic plasticity in newly generated neurons of the adult brain Neuron

2007 May54(4)559-66

74

Draganski B Gaser C Busch V et al Neuroplasticity changes in grey matter induced by training Nature 2004 Jan 22427(6972)

311-2

Cannonieri GC Bonilha L Fernandes PT et al Practice and perfect length of training and structural brain changes in experienced

typists Neuroreport 2007 Jul 218(10)1063-6

Kleim JA Jones TA Principles of experience-dependent neural plasticity implications for rehabilitation after brain damage J

Speech Lang Hear Res 2008 Feb51(1)S225-39

Trojan S Porkorny J Theoretical aspects of neuroplasticity Physiol Res 199948(2)87-97

Ramamirtham R Kee CS Hung LF et al Wave aberrations in rhesus monkeys with vision-induced ametropias Vision Res 2007

Sep47(21)2751-66

Smith EL 3rd Ramamirtham R Qiao-Grider Y et al Effects of foveal ablation on emmetropization and form-deprivation myopia

Invest Ophthalmol Vis Sci 2007 Sep48(9)3914-22

Smith EL 3rd Kee CS Ramamirtham R et al Peripheral vision can influence eye growth and refractive development in infant

monkeys Invest Ophthalmol Vis Sci 2005 Nov46(11)3965-72

Ciuffreda KJ Vasudevan B Nearwork-induced transient myopia (NITM) and permanent myopiandashndashis there a link Ophthalmic

Physiol Opt 2008 Mar28(2)103-14

Hung GK Ciuffreda KJ Incremental retinal-defocus theory of myopia development--schematic analysis and computer simulation

Comput Biol Med 2007 Jul37(7)930-46

Hung GK Ciuffreda KJ A unifying theory of refractive error development Bull Math Biol 2000 Nov62(6)1087-108

75

Pang Y Maino D Zhang G Lu F Myopia Can its progress be controlled Optom Vis Dev 200637(2)75-9

Leung JT Brown B Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lenses Optom Vis Sci

1999 Jun76(6)346-54

Hasebe S Ohtsuki H Nonaka T et al Effect of progressive addition lenses on myopia progression in Japanese children a prospective

randomized double-masked crossover trial Invest Ophthalmol Vis Sci 2008 Jul49(7)2781-9

Gwiazda J Hyman L Hussein M et al A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression

of myopia in children Invest Ophthalmol Vis Sci 2003 Apr44(4)1492-500

Siatkowski RM Cotter SA Crockett RS et al Two-year multi-center randomized double-masked placebo-controlled parallel safety and

efficacy study of 2 pirenzepine ophthalmic gel in children with myopia J AAPOS 2008 Aug12(4)332-9

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged 7 to 17 years Arch Ophthalmol 2005

Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three to less than 10 years of age Am J

Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction Am J Ophthalmol 2007

Jun143(6)1060-3

Holmes JM Edwards AR Beck RW et al A randomized pilot study of near activities versus non-near activities during patching therapy for

amblyopia J AAPOS 2005 Apr9(2)129-36

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate

amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-57

76

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic

amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Convergence Insufficiency Treatment Trial Study Group Randomized clinical trial of treatments for symptomatic convergence insufficiency

in children Arch Ophthalmol 2008 Oct126(10)1336-49

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

Solan HA Shelley-Tremblay J Hansen PC et al M-cell deficit and reading disability a preliminary study of the effects of temporal vision-

processing therapy Optometry 2004 Oct75(10)640-50

Solan HA Larson S Shelley-Tremblay J et al Role of visual attention in cognitive control of oculomotor readiness in students with reading

disabilities J Learn Disabil 2001 Mar-Apr34(2)107-18

Gallaway M Boas MB The impact of vergence and accommodative therapy on reading eye movements and reading speed Optom Vis Dev

200738(3)115-20

Goss DA Downing DB Lowther AH et al The effect of HTS vision therapy conducted in a school setting on reading skills in third and

fourth grade students Optom Vis Dev 200738(1)27-32

Crutch SJ Warrington EK Foveal crowding in posterior cortical atrophy a specific early-visual-processing deficit affecting word reading

Cogn Neuropsychol 2007 Dec24(8)843-66

Helms D Sawtelle SM A study of the effectiveness of cognitive therapy delivered in a video game format Optom Vis Dev 200738 (1)19-

26

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

77

Lawton T Training direction-discrimination sensitivity remediates a wide spectrum of reading skills OptomVis Dev 200738(1) 33-47

Goldstand S Koslowe KC Parush S Vision visual-information processing and academic performance among seventh-grade schoolchildren a

more significant relationship than we thought Am J Occup Ther 2005 Jul-Aug59(4)377-89

Fischer B Koumlngeter A Hartnegg K Effects of daily practice on subitizing visual counting and basic arithmetic skills Optom Vis Dev

200839(1)30-4

Sands W Taub M Maino D Limited research and education on special populations in optometry and ophthalomology Optom Vis Dev

200839(2)60-1

Wesson M Maino D Oculo-visual findings in Down syndrome cerebral palsy and mental retardation with non-specific etiology In Maino D

(ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 199517-54 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

Cui Y Stapleton F Suttle C Developing an instrument to assess vision-related and subjective quality of life in children with intellectual

disability data collection and preliminary analysis in a Chinese population Ophthal Physiolog Optics 2008 May28(3) 238-46

Maino D Steele G Tahir S Sajja R Attitudes of optometry students toward individuals with disabilities Optom Ed 200227(2)45-50

Maino D Special populations in the optometric curriculum Optom Ed 200227(2)38-9

Maino D Overview of special populations In Scheiman M Rouse M (eds) Optometric Management of Learning-Related Vision Problems

St Louis Mosby Inc 200685-106

Maino D (ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 1995 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

78

McCarthy P Maino D Alport syndrome a review Clin Eye Vis Care 2000 Dec12(3-4)139-50

Block SS Brusca-Vega R Pizzi WJ et al Cognitive and visual processing skills and their relationship to mutation size in full and

permutation female fragile X carriers Optom Vis Sci 2000 Nov77 (11)592-9

Maino D The young child with developmental disabilities An introduction to mental retardation and genetic syndromes In Moore BD

(ed) Eye Care for Infants and Young Children Butter-worth--Heinemann Newton MA1997285-300

Amin V Maino D The Fragile X female Visual visual perceptual and ocular health anomalies J Am Optom Assoc 1995 May66

(5)290-95

Maino DM Maino JH Cibis GW Hecht F Ocular health anomalies in patients with developmental disabilities In Maino D (ed)

Diagnosis and Management of Special Populations Mosby-Year-book Inc St Louis MO 1995189-206 Reprinted Optometric

Education Program Foundation Santa Anna Calif 2001

Maino D Wesson M Schlange D Cibis G Maino J Optometric findings in the fragile X syndrome Optom Vis Sci 199168634-40

Scheiman MMOptometric findings in children with cerebral palsy Am J Optom Physiol Opt 1984 May61(5)321-3

Maino D Maino J Maino S Mental retardation syndromes with associated ocular defects J Am Optom Assoc 199061707-16

Stewart RE Woodhouse JM Cregg M Pakeman VH Association between accommodative accuracy hypermetropia and strabismus in

children with Downs syndrome Optom Vis Sci 2007 Feb84(2)149-55

Cregg M Woodhouse JM Pakeman VH et al Accommodation and refractive error in children with Down syndrome cross-sectional

and longitudinal studies Invest Ophthalmol Vis Sci 2001 Jan42 (1)55-63

79

McClelland JF Parkes J Hill N et al Accommodative dysfunction in children with cerebral palsy a population-

based study Invest Ophthalmol Vis Sci 2006 May47(5)1824-30

Duckman RH Vision therapy for the child with cerebral palsy J Am Optom Assoc 198758(1)28-35

Duckman R Accommodation in cerebral palsy function and remediation J Am Optom Assoc 198455(4)281-3

Scheiman M Understanding and managing vision deficits a guide for occupational therapists 2nd ed Slack

Thorofare NJ 2002

Maino D Binasal occlusion for the child with Cerebral Palsy J Ill Optom Assoc 198644(1)1218

Battaglia F Quartarone A Rizzo V et al Early impairment of synaptic plasticity in patients with Downs syndrome

Neurobiol Aging 2008 Aug29(8)1272-5

Bonnier C Evaluation of early stimulation programs for enhancing brain development Acta Paediatr 2008

Jul97(7)853-8

Morice E Andreae LC Cooke SF et al Preservation of long-term memory and synaptic plasticity despite short-term

impairments in the Tc1 mouse model of Down syndrome Learn Mem 2008 Jul 1415(7)492-500

Gordon AM Schneider JA Chinnan A Charles JR Efficacy of a hand-arm bimanual intensive therapy (HABIT) in

children with hemiplegic cerebral palsy a randomized control trial Dev Med Child Neurol 2007 Nov49(11)830-8

Kapoor N Ciuffreda KJ Vision disturbances following traumatic brain injury Curr Treat Options Neurol 2002

Jul4(4)271-80

80

Ciuffreda KJ Rutner D Kapoor N et al Vision therapy for oculomotor dysfunctions in acquired brain injury a

retrospective analysis Optometry 2008 Jan79(1)18-22

Ciuffreda KJ Han Y Kapoor N Ficarra AP Oculomotor rehabilitation for reading in acquired brain injury

NeuroRehabilitation 200621(1)9-21

Zost M Diagnosis and management of visual dysfunction in cerebral injury In Maino D (ed) Diagnosis and

Management of Special Populations Mosby-Yearbook Inc St Louis 199579 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001 [Figure used with permission of the editor]

DeGutis JM Bentin S Robertson LC DEsposito M Functional plasticity in ventral temporal cortex following

cognitive rehabilitation of a congenital prosopagnosic J Cogn Neurosci 2007 Nov19 (11)1790-802

Welbourne SR Ralph MA Exploring the impact of plasticity-related recovery after brain damage in a connectionist

model of single-word reading Cogn Affect Behav Neurosci 2005 Mar5(1)77-92

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements prevent cognitive decline A

systematic review of randomized controlled trials J Hum Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among preterm infants attributable to early

supplementation of human milk with docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings and structural-functional

synergies with cell membrane phospholipids Altern Med Rev 2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function Neuroscience 20089(7)568-78

81

Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

BMC Biol 2008 Sep 9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine improves neuropsychological disorders in a child with

creatine transporter defect Neurocase 200814(2) 151-61

Forrester LW Wheaton LA Luft AR Exercise-mediated locomotor recovery and lower-limb neuroplasticity after

stroke J Rehabil Res Dev 200845(2)205-20

82

Page 64: Neuroplasticity: A Paradigm Sea Change Latest Updated File

Why pay attention to binocular vision dysfunctions

and neuroplasticity

December 2009 issue of the Review of Optometry

The Binocular Vision Dysfunction Pandemic

In 2010 almost 170 million individuals will be wearing glasses In

2010 there will also be up to 93 million amblyopes and 12 and a half

million strabismics For children under 18 years of age that means

there will be more than 22 and a half million amblyopes and millions

of children with strabismus A clinical trial to determine the

prevalence of binocular vision dysfunction within the general

population suggested the possibility of up to 56 or 173 million men

women and children with symptoms associated with a binocular

vision dysfunction 189 million (61) with accommodative problems

and 118 million (38) demonstrating various vergence

anomalies

64

65

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Brain plasticity life long changes in the structure of the brain

Sensory substitution replacement of one sensory input by another

Measurement techniques

Voxel based morphometryhellipmeasures difference in brain volume

Fluorodeoxyglucose glucose analog PET scan tells you

distribution and metabolism of brain

Cortical thickness measures

Visual cortex of the blind turns somatic ―The eye of the tongue

Transcranial magnetic stmiulation non-invasive technique to

stimulate cortex

66

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Blind Braille readers report tingling in fingers when pressure

phosphenes are applied Blind feel tingling in tongue

Bind use tongue to perform orientation task motion perception

sensory perception Visual cortex recruited in a variety of sensory

and cognitive tasks (DM Can we use tongue as a VT tool)

Dilks Reorganizations of human adult visual system

When a region of sensory cortex is deprived of its bottom up

input the deprived region begins to respond to stimuli that

normally activate adjacent cortex

67

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Retinotopic map changes for stroke pts Cortical reorganization in

adults occurs Perceived objectshellipelongation in stroke amp AMD

What happens to deprived cortex in AMD

fMRI shows cortical reorganization in adults

Proposed mechanisms

hellipGrowth of new connections

hellipUnmasking of pre-existing connections this is true

happens within seconds

Bavelier

Action video games

68

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Bavelier

Action video games Looked at attention Gamers can track more

activities

Attention over space (me peripheral awarenress) Useful field

of view shrinks with age

Performance not VA relatedhellipis related to attention

Action game playing changes spatial resolutionhellipovercoming

crowding in VA assessment (me amblyopia therapy)

Temporal resolution of vision Backward masking

changehellipbrain changes

Visual sensitivity (contrast sensitivity) Post action game training

improves CSF

69

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Action video games correcting optics of the cortex (me this is

actualy OVT)

Games factor

Variable entry leanringhellipadapt task to skill level

Incremental learning tune task to subjectlsquos leanring steps

Motivationarousal

Rewards

Self masterself confidence

Action games factors

Pacingrate of exposure to infohellipincreasing processing speed

Dynamic display

Rich environment

Rich motor involvement

70

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Surgeons may be made to play action games

Pilot training

Amblyopia tx Dennis Levi research

PresenterTitle Contact info

Neuroplasticity-A Paradigm Sea Change

This presentation is available at

httpwwwslidesharenetDMAINOneuroplasticity-a-paradigm-sea-change-2459693

httpwwwmainosmemosblogspotcom

My FaceBook Page

and

Twitter

PresenterTitle Contact info

Questions About

Neuroplasticity-A Paradigm Sea Change

Dominick M Maino OD MEd FAAO FCOVD-A

Professor PediatricsBinocular VisionIllinois Eye InstituteIllinois College of Optometry

dmainoicoeduhttpwwwMainosMemosblogspotcom

Thanks to

httpwwwcovdorgHomeOVDJournalOVD401tabid263D

efaultaspx

httpbipolarblastfileswordpresscom200908neurojpg

httpwwwspecialcheerscomimagesanimated_braingif

httpblogmarsdencartoonscomwp-

contentuploads200810frankenstein-myspace-lightbeergif

httpwwwshangralafamilyfuncomgala-ecalvindreamgif

httppsychiatryjwatchorgcgicontentfull20082251

73

Chakraborty R Chatterjee A Choudhart S Chakraborty PK Neuroplasticitymdasha paradigm shift in neurosciences J Indian Med Assoc

2007105(9)513-4516-8520-1

Sacks O A neurologistlsquos notebook Stereo Sue Why two eyes are better than one The New Yorker 2006 Jun 1964-73

Krulwich R National Public Radio Going Binocular Susanlsquos First Snowfall Available at

wwwnprorgtemplatesstorystoryphpstoryId=5507789 (Accessed December 8 2008)

Press LJ The story behind Stereo Suelsquo and a world-famous neurologistlsquos discovery of vision therapy Optom Vis Dev 200637(2) 55-7

Levin HS Neuroplasticity and brain imaging research implications for rehabilitation Arch Phys Med Rehabil 2006 Dec87(12 Suppl

2)S1

Wiesel TN Hubel DH Single-cell responses in striate cortex of kittens deprived of vision in one eye J Neurophysiol 1963

Nov261003-17

Hook BM Chen C Critical periods in the visual system Changing views for a model of experience-dependent plasticity Neuron 2007

Oct56(2)312-26

Ramey CT Ramey SL Prevention of intellectual disabilities early interventions to improve cognitive development Prev Med 1998

Mar-Apr27(2)224-32

Heuninckx S Wenderoth N Swinnen SP Systems neuroplasticity in the aging brain recruiting additional neural resources for

successful motor performance in elderly persons J Neurosci 2008 Jan 228(1)91-9

Ge S Yang CH Hsu KS et al A critical period for enhanced synaptic plasticity in newly generated neurons of the adult brain Neuron

2007 May54(4)559-66

74

Draganski B Gaser C Busch V et al Neuroplasticity changes in grey matter induced by training Nature 2004 Jan 22427(6972)

311-2

Cannonieri GC Bonilha L Fernandes PT et al Practice and perfect length of training and structural brain changes in experienced

typists Neuroreport 2007 Jul 218(10)1063-6

Kleim JA Jones TA Principles of experience-dependent neural plasticity implications for rehabilitation after brain damage J

Speech Lang Hear Res 2008 Feb51(1)S225-39

Trojan S Porkorny J Theoretical aspects of neuroplasticity Physiol Res 199948(2)87-97

Ramamirtham R Kee CS Hung LF et al Wave aberrations in rhesus monkeys with vision-induced ametropias Vision Res 2007

Sep47(21)2751-66

Smith EL 3rd Ramamirtham R Qiao-Grider Y et al Effects of foveal ablation on emmetropization and form-deprivation myopia

Invest Ophthalmol Vis Sci 2007 Sep48(9)3914-22

Smith EL 3rd Kee CS Ramamirtham R et al Peripheral vision can influence eye growth and refractive development in infant

monkeys Invest Ophthalmol Vis Sci 2005 Nov46(11)3965-72

Ciuffreda KJ Vasudevan B Nearwork-induced transient myopia (NITM) and permanent myopiandashndashis there a link Ophthalmic

Physiol Opt 2008 Mar28(2)103-14

Hung GK Ciuffreda KJ Incremental retinal-defocus theory of myopia development--schematic analysis and computer simulation

Comput Biol Med 2007 Jul37(7)930-46

Hung GK Ciuffreda KJ A unifying theory of refractive error development Bull Math Biol 2000 Nov62(6)1087-108

75

Pang Y Maino D Zhang G Lu F Myopia Can its progress be controlled Optom Vis Dev 200637(2)75-9

Leung JT Brown B Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lenses Optom Vis Sci

1999 Jun76(6)346-54

Hasebe S Ohtsuki H Nonaka T et al Effect of progressive addition lenses on myopia progression in Japanese children a prospective

randomized double-masked crossover trial Invest Ophthalmol Vis Sci 2008 Jul49(7)2781-9

Gwiazda J Hyman L Hussein M et al A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression

of myopia in children Invest Ophthalmol Vis Sci 2003 Apr44(4)1492-500

Siatkowski RM Cotter SA Crockett RS et al Two-year multi-center randomized double-masked placebo-controlled parallel safety and

efficacy study of 2 pirenzepine ophthalmic gel in children with myopia J AAPOS 2008 Aug12(4)332-9

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged 7 to 17 years Arch Ophthalmol 2005

Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three to less than 10 years of age Am J

Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction Am J Ophthalmol 2007

Jun143(6)1060-3

Holmes JM Edwards AR Beck RW et al A randomized pilot study of near activities versus non-near activities during patching therapy for

amblyopia J AAPOS 2005 Apr9(2)129-36

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate

amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-57

76

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic

amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Convergence Insufficiency Treatment Trial Study Group Randomized clinical trial of treatments for symptomatic convergence insufficiency

in children Arch Ophthalmol 2008 Oct126(10)1336-49

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

Solan HA Shelley-Tremblay J Hansen PC et al M-cell deficit and reading disability a preliminary study of the effects of temporal vision-

processing therapy Optometry 2004 Oct75(10)640-50

Solan HA Larson S Shelley-Tremblay J et al Role of visual attention in cognitive control of oculomotor readiness in students with reading

disabilities J Learn Disabil 2001 Mar-Apr34(2)107-18

Gallaway M Boas MB The impact of vergence and accommodative therapy on reading eye movements and reading speed Optom Vis Dev

200738(3)115-20

Goss DA Downing DB Lowther AH et al The effect of HTS vision therapy conducted in a school setting on reading skills in third and

fourth grade students Optom Vis Dev 200738(1)27-32

Crutch SJ Warrington EK Foveal crowding in posterior cortical atrophy a specific early-visual-processing deficit affecting word reading

Cogn Neuropsychol 2007 Dec24(8)843-66

Helms D Sawtelle SM A study of the effectiveness of cognitive therapy delivered in a video game format Optom Vis Dev 200738 (1)19-

26

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

77

Lawton T Training direction-discrimination sensitivity remediates a wide spectrum of reading skills OptomVis Dev 200738(1) 33-47

Goldstand S Koslowe KC Parush S Vision visual-information processing and academic performance among seventh-grade schoolchildren a

more significant relationship than we thought Am J Occup Ther 2005 Jul-Aug59(4)377-89

Fischer B Koumlngeter A Hartnegg K Effects of daily practice on subitizing visual counting and basic arithmetic skills Optom Vis Dev

200839(1)30-4

Sands W Taub M Maino D Limited research and education on special populations in optometry and ophthalomology Optom Vis Dev

200839(2)60-1

Wesson M Maino D Oculo-visual findings in Down syndrome cerebral palsy and mental retardation with non-specific etiology In Maino D

(ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 199517-54 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

Cui Y Stapleton F Suttle C Developing an instrument to assess vision-related and subjective quality of life in children with intellectual

disability data collection and preliminary analysis in a Chinese population Ophthal Physiolog Optics 2008 May28(3) 238-46

Maino D Steele G Tahir S Sajja R Attitudes of optometry students toward individuals with disabilities Optom Ed 200227(2)45-50

Maino D Special populations in the optometric curriculum Optom Ed 200227(2)38-9

Maino D Overview of special populations In Scheiman M Rouse M (eds) Optometric Management of Learning-Related Vision Problems

St Louis Mosby Inc 200685-106

Maino D (ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 1995 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

78

McCarthy P Maino D Alport syndrome a review Clin Eye Vis Care 2000 Dec12(3-4)139-50

Block SS Brusca-Vega R Pizzi WJ et al Cognitive and visual processing skills and their relationship to mutation size in full and

permutation female fragile X carriers Optom Vis Sci 2000 Nov77 (11)592-9

Maino D The young child with developmental disabilities An introduction to mental retardation and genetic syndromes In Moore BD

(ed) Eye Care for Infants and Young Children Butter-worth--Heinemann Newton MA1997285-300

Amin V Maino D The Fragile X female Visual visual perceptual and ocular health anomalies J Am Optom Assoc 1995 May66

(5)290-95

Maino DM Maino JH Cibis GW Hecht F Ocular health anomalies in patients with developmental disabilities In Maino D (ed)

Diagnosis and Management of Special Populations Mosby-Year-book Inc St Louis MO 1995189-206 Reprinted Optometric

Education Program Foundation Santa Anna Calif 2001

Maino D Wesson M Schlange D Cibis G Maino J Optometric findings in the fragile X syndrome Optom Vis Sci 199168634-40

Scheiman MMOptometric findings in children with cerebral palsy Am J Optom Physiol Opt 1984 May61(5)321-3

Maino D Maino J Maino S Mental retardation syndromes with associated ocular defects J Am Optom Assoc 199061707-16

Stewart RE Woodhouse JM Cregg M Pakeman VH Association between accommodative accuracy hypermetropia and strabismus in

children with Downs syndrome Optom Vis Sci 2007 Feb84(2)149-55

Cregg M Woodhouse JM Pakeman VH et al Accommodation and refractive error in children with Down syndrome cross-sectional

and longitudinal studies Invest Ophthalmol Vis Sci 2001 Jan42 (1)55-63

79

McClelland JF Parkes J Hill N et al Accommodative dysfunction in children with cerebral palsy a population-

based study Invest Ophthalmol Vis Sci 2006 May47(5)1824-30

Duckman RH Vision therapy for the child with cerebral palsy J Am Optom Assoc 198758(1)28-35

Duckman R Accommodation in cerebral palsy function and remediation J Am Optom Assoc 198455(4)281-3

Scheiman M Understanding and managing vision deficits a guide for occupational therapists 2nd ed Slack

Thorofare NJ 2002

Maino D Binasal occlusion for the child with Cerebral Palsy J Ill Optom Assoc 198644(1)1218

Battaglia F Quartarone A Rizzo V et al Early impairment of synaptic plasticity in patients with Downs syndrome

Neurobiol Aging 2008 Aug29(8)1272-5

Bonnier C Evaluation of early stimulation programs for enhancing brain development Acta Paediatr 2008

Jul97(7)853-8

Morice E Andreae LC Cooke SF et al Preservation of long-term memory and synaptic plasticity despite short-term

impairments in the Tc1 mouse model of Down syndrome Learn Mem 2008 Jul 1415(7)492-500

Gordon AM Schneider JA Chinnan A Charles JR Efficacy of a hand-arm bimanual intensive therapy (HABIT) in

children with hemiplegic cerebral palsy a randomized control trial Dev Med Child Neurol 2007 Nov49(11)830-8

Kapoor N Ciuffreda KJ Vision disturbances following traumatic brain injury Curr Treat Options Neurol 2002

Jul4(4)271-80

80

Ciuffreda KJ Rutner D Kapoor N et al Vision therapy for oculomotor dysfunctions in acquired brain injury a

retrospective analysis Optometry 2008 Jan79(1)18-22

Ciuffreda KJ Han Y Kapoor N Ficarra AP Oculomotor rehabilitation for reading in acquired brain injury

NeuroRehabilitation 200621(1)9-21

Zost M Diagnosis and management of visual dysfunction in cerebral injury In Maino D (ed) Diagnosis and

Management of Special Populations Mosby-Yearbook Inc St Louis 199579 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001 [Figure used with permission of the editor]

DeGutis JM Bentin S Robertson LC DEsposito M Functional plasticity in ventral temporal cortex following

cognitive rehabilitation of a congenital prosopagnosic J Cogn Neurosci 2007 Nov19 (11)1790-802

Welbourne SR Ralph MA Exploring the impact of plasticity-related recovery after brain damage in a connectionist

model of single-word reading Cogn Affect Behav Neurosci 2005 Mar5(1)77-92

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements prevent cognitive decline A

systematic review of randomized controlled trials J Hum Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among preterm infants attributable to early

supplementation of human milk with docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings and structural-functional

synergies with cell membrane phospholipids Altern Med Rev 2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function Neuroscience 20089(7)568-78

81

Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

BMC Biol 2008 Sep 9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine improves neuropsychological disorders in a child with

creatine transporter defect Neurocase 200814(2) 151-61

Forrester LW Wheaton LA Luft AR Exercise-mediated locomotor recovery and lower-limb neuroplasticity after

stroke J Rehabil Res Dev 200845(2)205-20

82

Page 65: Neuroplasticity: A Paradigm Sea Change Latest Updated File

65

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Brain plasticity life long changes in the structure of the brain

Sensory substitution replacement of one sensory input by another

Measurement techniques

Voxel based morphometryhellipmeasures difference in brain volume

Fluorodeoxyglucose glucose analog PET scan tells you

distribution and metabolism of brain

Cortical thickness measures

Visual cortex of the blind turns somatic ―The eye of the tongue

Transcranial magnetic stmiulation non-invasive technique to

stimulate cortex

66

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Blind Braille readers report tingling in fingers when pressure

phosphenes are applied Blind feel tingling in tongue

Bind use tongue to perform orientation task motion perception

sensory perception Visual cortex recruited in a variety of sensory

and cognitive tasks (DM Can we use tongue as a VT tool)

Dilks Reorganizations of human adult visual system

When a region of sensory cortex is deprived of its bottom up

input the deprived region begins to respond to stimuli that

normally activate adjacent cortex

67

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Retinotopic map changes for stroke pts Cortical reorganization in

adults occurs Perceived objectshellipelongation in stroke amp AMD

What happens to deprived cortex in AMD

fMRI shows cortical reorganization in adults

Proposed mechanisms

hellipGrowth of new connections

hellipUnmasking of pre-existing connections this is true

happens within seconds

Bavelier

Action video games

68

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Bavelier

Action video games Looked at attention Gamers can track more

activities

Attention over space (me peripheral awarenress) Useful field

of view shrinks with age

Performance not VA relatedhellipis related to attention

Action game playing changes spatial resolutionhellipovercoming

crowding in VA assessment (me amblyopia therapy)

Temporal resolution of vision Backward masking

changehellipbrain changes

Visual sensitivity (contrast sensitivity) Post action game training

improves CSF

69

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Action video games correcting optics of the cortex (me this is

actualy OVT)

Games factor

Variable entry leanringhellipadapt task to skill level

Incremental learning tune task to subjectlsquos leanring steps

Motivationarousal

Rewards

Self masterself confidence

Action games factors

Pacingrate of exposure to infohellipincreasing processing speed

Dynamic display

Rich environment

Rich motor involvement

70

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Surgeons may be made to play action games

Pilot training

Amblyopia tx Dennis Levi research

PresenterTitle Contact info

Neuroplasticity-A Paradigm Sea Change

This presentation is available at

httpwwwslidesharenetDMAINOneuroplasticity-a-paradigm-sea-change-2459693

httpwwwmainosmemosblogspotcom

My FaceBook Page

and

Twitter

PresenterTitle Contact info

Questions About

Neuroplasticity-A Paradigm Sea Change

Dominick M Maino OD MEd FAAO FCOVD-A

Professor PediatricsBinocular VisionIllinois Eye InstituteIllinois College of Optometry

dmainoicoeduhttpwwwMainosMemosblogspotcom

Thanks to

httpwwwcovdorgHomeOVDJournalOVD401tabid263D

efaultaspx

httpbipolarblastfileswordpresscom200908neurojpg

httpwwwspecialcheerscomimagesanimated_braingif

httpblogmarsdencartoonscomwp-

contentuploads200810frankenstein-myspace-lightbeergif

httpwwwshangralafamilyfuncomgala-ecalvindreamgif

httppsychiatryjwatchorgcgicontentfull20082251

73

Chakraborty R Chatterjee A Choudhart S Chakraborty PK Neuroplasticitymdasha paradigm shift in neurosciences J Indian Med Assoc

2007105(9)513-4516-8520-1

Sacks O A neurologistlsquos notebook Stereo Sue Why two eyes are better than one The New Yorker 2006 Jun 1964-73

Krulwich R National Public Radio Going Binocular Susanlsquos First Snowfall Available at

wwwnprorgtemplatesstorystoryphpstoryId=5507789 (Accessed December 8 2008)

Press LJ The story behind Stereo Suelsquo and a world-famous neurologistlsquos discovery of vision therapy Optom Vis Dev 200637(2) 55-7

Levin HS Neuroplasticity and brain imaging research implications for rehabilitation Arch Phys Med Rehabil 2006 Dec87(12 Suppl

2)S1

Wiesel TN Hubel DH Single-cell responses in striate cortex of kittens deprived of vision in one eye J Neurophysiol 1963

Nov261003-17

Hook BM Chen C Critical periods in the visual system Changing views for a model of experience-dependent plasticity Neuron 2007

Oct56(2)312-26

Ramey CT Ramey SL Prevention of intellectual disabilities early interventions to improve cognitive development Prev Med 1998

Mar-Apr27(2)224-32

Heuninckx S Wenderoth N Swinnen SP Systems neuroplasticity in the aging brain recruiting additional neural resources for

successful motor performance in elderly persons J Neurosci 2008 Jan 228(1)91-9

Ge S Yang CH Hsu KS et al A critical period for enhanced synaptic plasticity in newly generated neurons of the adult brain Neuron

2007 May54(4)559-66

74

Draganski B Gaser C Busch V et al Neuroplasticity changes in grey matter induced by training Nature 2004 Jan 22427(6972)

311-2

Cannonieri GC Bonilha L Fernandes PT et al Practice and perfect length of training and structural brain changes in experienced

typists Neuroreport 2007 Jul 218(10)1063-6

Kleim JA Jones TA Principles of experience-dependent neural plasticity implications for rehabilitation after brain damage J

Speech Lang Hear Res 2008 Feb51(1)S225-39

Trojan S Porkorny J Theoretical aspects of neuroplasticity Physiol Res 199948(2)87-97

Ramamirtham R Kee CS Hung LF et al Wave aberrations in rhesus monkeys with vision-induced ametropias Vision Res 2007

Sep47(21)2751-66

Smith EL 3rd Ramamirtham R Qiao-Grider Y et al Effects of foveal ablation on emmetropization and form-deprivation myopia

Invest Ophthalmol Vis Sci 2007 Sep48(9)3914-22

Smith EL 3rd Kee CS Ramamirtham R et al Peripheral vision can influence eye growth and refractive development in infant

monkeys Invest Ophthalmol Vis Sci 2005 Nov46(11)3965-72

Ciuffreda KJ Vasudevan B Nearwork-induced transient myopia (NITM) and permanent myopiandashndashis there a link Ophthalmic

Physiol Opt 2008 Mar28(2)103-14

Hung GK Ciuffreda KJ Incremental retinal-defocus theory of myopia development--schematic analysis and computer simulation

Comput Biol Med 2007 Jul37(7)930-46

Hung GK Ciuffreda KJ A unifying theory of refractive error development Bull Math Biol 2000 Nov62(6)1087-108

75

Pang Y Maino D Zhang G Lu F Myopia Can its progress be controlled Optom Vis Dev 200637(2)75-9

Leung JT Brown B Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lenses Optom Vis Sci

1999 Jun76(6)346-54

Hasebe S Ohtsuki H Nonaka T et al Effect of progressive addition lenses on myopia progression in Japanese children a prospective

randomized double-masked crossover trial Invest Ophthalmol Vis Sci 2008 Jul49(7)2781-9

Gwiazda J Hyman L Hussein M et al A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression

of myopia in children Invest Ophthalmol Vis Sci 2003 Apr44(4)1492-500

Siatkowski RM Cotter SA Crockett RS et al Two-year multi-center randomized double-masked placebo-controlled parallel safety and

efficacy study of 2 pirenzepine ophthalmic gel in children with myopia J AAPOS 2008 Aug12(4)332-9

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged 7 to 17 years Arch Ophthalmol 2005

Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three to less than 10 years of age Am J

Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction Am J Ophthalmol 2007

Jun143(6)1060-3

Holmes JM Edwards AR Beck RW et al A randomized pilot study of near activities versus non-near activities during patching therapy for

amblyopia J AAPOS 2005 Apr9(2)129-36

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate

amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-57

76

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic

amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Convergence Insufficiency Treatment Trial Study Group Randomized clinical trial of treatments for symptomatic convergence insufficiency

in children Arch Ophthalmol 2008 Oct126(10)1336-49

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

Solan HA Shelley-Tremblay J Hansen PC et al M-cell deficit and reading disability a preliminary study of the effects of temporal vision-

processing therapy Optometry 2004 Oct75(10)640-50

Solan HA Larson S Shelley-Tremblay J et al Role of visual attention in cognitive control of oculomotor readiness in students with reading

disabilities J Learn Disabil 2001 Mar-Apr34(2)107-18

Gallaway M Boas MB The impact of vergence and accommodative therapy on reading eye movements and reading speed Optom Vis Dev

200738(3)115-20

Goss DA Downing DB Lowther AH et al The effect of HTS vision therapy conducted in a school setting on reading skills in third and

fourth grade students Optom Vis Dev 200738(1)27-32

Crutch SJ Warrington EK Foveal crowding in posterior cortical atrophy a specific early-visual-processing deficit affecting word reading

Cogn Neuropsychol 2007 Dec24(8)843-66

Helms D Sawtelle SM A study of the effectiveness of cognitive therapy delivered in a video game format Optom Vis Dev 200738 (1)19-

26

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

77

Lawton T Training direction-discrimination sensitivity remediates a wide spectrum of reading skills OptomVis Dev 200738(1) 33-47

Goldstand S Koslowe KC Parush S Vision visual-information processing and academic performance among seventh-grade schoolchildren a

more significant relationship than we thought Am J Occup Ther 2005 Jul-Aug59(4)377-89

Fischer B Koumlngeter A Hartnegg K Effects of daily practice on subitizing visual counting and basic arithmetic skills Optom Vis Dev

200839(1)30-4

Sands W Taub M Maino D Limited research and education on special populations in optometry and ophthalomology Optom Vis Dev

200839(2)60-1

Wesson M Maino D Oculo-visual findings in Down syndrome cerebral palsy and mental retardation with non-specific etiology In Maino D

(ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 199517-54 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

Cui Y Stapleton F Suttle C Developing an instrument to assess vision-related and subjective quality of life in children with intellectual

disability data collection and preliminary analysis in a Chinese population Ophthal Physiolog Optics 2008 May28(3) 238-46

Maino D Steele G Tahir S Sajja R Attitudes of optometry students toward individuals with disabilities Optom Ed 200227(2)45-50

Maino D Special populations in the optometric curriculum Optom Ed 200227(2)38-9

Maino D Overview of special populations In Scheiman M Rouse M (eds) Optometric Management of Learning-Related Vision Problems

St Louis Mosby Inc 200685-106

Maino D (ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 1995 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

78

McCarthy P Maino D Alport syndrome a review Clin Eye Vis Care 2000 Dec12(3-4)139-50

Block SS Brusca-Vega R Pizzi WJ et al Cognitive and visual processing skills and their relationship to mutation size in full and

permutation female fragile X carriers Optom Vis Sci 2000 Nov77 (11)592-9

Maino D The young child with developmental disabilities An introduction to mental retardation and genetic syndromes In Moore BD

(ed) Eye Care for Infants and Young Children Butter-worth--Heinemann Newton MA1997285-300

Amin V Maino D The Fragile X female Visual visual perceptual and ocular health anomalies J Am Optom Assoc 1995 May66

(5)290-95

Maino DM Maino JH Cibis GW Hecht F Ocular health anomalies in patients with developmental disabilities In Maino D (ed)

Diagnosis and Management of Special Populations Mosby-Year-book Inc St Louis MO 1995189-206 Reprinted Optometric

Education Program Foundation Santa Anna Calif 2001

Maino D Wesson M Schlange D Cibis G Maino J Optometric findings in the fragile X syndrome Optom Vis Sci 199168634-40

Scheiman MMOptometric findings in children with cerebral palsy Am J Optom Physiol Opt 1984 May61(5)321-3

Maino D Maino J Maino S Mental retardation syndromes with associated ocular defects J Am Optom Assoc 199061707-16

Stewart RE Woodhouse JM Cregg M Pakeman VH Association between accommodative accuracy hypermetropia and strabismus in

children with Downs syndrome Optom Vis Sci 2007 Feb84(2)149-55

Cregg M Woodhouse JM Pakeman VH et al Accommodation and refractive error in children with Down syndrome cross-sectional

and longitudinal studies Invest Ophthalmol Vis Sci 2001 Jan42 (1)55-63

79

McClelland JF Parkes J Hill N et al Accommodative dysfunction in children with cerebral palsy a population-

based study Invest Ophthalmol Vis Sci 2006 May47(5)1824-30

Duckman RH Vision therapy for the child with cerebral palsy J Am Optom Assoc 198758(1)28-35

Duckman R Accommodation in cerebral palsy function and remediation J Am Optom Assoc 198455(4)281-3

Scheiman M Understanding and managing vision deficits a guide for occupational therapists 2nd ed Slack

Thorofare NJ 2002

Maino D Binasal occlusion for the child with Cerebral Palsy J Ill Optom Assoc 198644(1)1218

Battaglia F Quartarone A Rizzo V et al Early impairment of synaptic plasticity in patients with Downs syndrome

Neurobiol Aging 2008 Aug29(8)1272-5

Bonnier C Evaluation of early stimulation programs for enhancing brain development Acta Paediatr 2008

Jul97(7)853-8

Morice E Andreae LC Cooke SF et al Preservation of long-term memory and synaptic plasticity despite short-term

impairments in the Tc1 mouse model of Down syndrome Learn Mem 2008 Jul 1415(7)492-500

Gordon AM Schneider JA Chinnan A Charles JR Efficacy of a hand-arm bimanual intensive therapy (HABIT) in

children with hemiplegic cerebral palsy a randomized control trial Dev Med Child Neurol 2007 Nov49(11)830-8

Kapoor N Ciuffreda KJ Vision disturbances following traumatic brain injury Curr Treat Options Neurol 2002

Jul4(4)271-80

80

Ciuffreda KJ Rutner D Kapoor N et al Vision therapy for oculomotor dysfunctions in acquired brain injury a

retrospective analysis Optometry 2008 Jan79(1)18-22

Ciuffreda KJ Han Y Kapoor N Ficarra AP Oculomotor rehabilitation for reading in acquired brain injury

NeuroRehabilitation 200621(1)9-21

Zost M Diagnosis and management of visual dysfunction in cerebral injury In Maino D (ed) Diagnosis and

Management of Special Populations Mosby-Yearbook Inc St Louis 199579 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001 [Figure used with permission of the editor]

DeGutis JM Bentin S Robertson LC DEsposito M Functional plasticity in ventral temporal cortex following

cognitive rehabilitation of a congenital prosopagnosic J Cogn Neurosci 2007 Nov19 (11)1790-802

Welbourne SR Ralph MA Exploring the impact of plasticity-related recovery after brain damage in a connectionist

model of single-word reading Cogn Affect Behav Neurosci 2005 Mar5(1)77-92

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements prevent cognitive decline A

systematic review of randomized controlled trials J Hum Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among preterm infants attributable to early

supplementation of human milk with docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings and structural-functional

synergies with cell membrane phospholipids Altern Med Rev 2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function Neuroscience 20089(7)568-78

81

Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

BMC Biol 2008 Sep 9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine improves neuropsychological disorders in a child with

creatine transporter defect Neurocase 200814(2) 151-61

Forrester LW Wheaton LA Luft AR Exercise-mediated locomotor recovery and lower-limb neuroplasticity after

stroke J Rehabil Res Dev 200845(2)205-20

82

Page 66: Neuroplasticity: A Paradigm Sea Change Latest Updated File

66

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Petito Insights into Darkness

Blind Braille readers report tingling in fingers when pressure

phosphenes are applied Blind feel tingling in tongue

Bind use tongue to perform orientation task motion perception

sensory perception Visual cortex recruited in a variety of sensory

and cognitive tasks (DM Can we use tongue as a VT tool)

Dilks Reorganizations of human adult visual system

When a region of sensory cortex is deprived of its bottom up

input the deprived region begins to respond to stimuli that

normally activate adjacent cortex

67

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Retinotopic map changes for stroke pts Cortical reorganization in

adults occurs Perceived objectshellipelongation in stroke amp AMD

What happens to deprived cortex in AMD

fMRI shows cortical reorganization in adults

Proposed mechanisms

hellipGrowth of new connections

hellipUnmasking of pre-existing connections this is true

happens within seconds

Bavelier

Action video games

68

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Bavelier

Action video games Looked at attention Gamers can track more

activities

Attention over space (me peripheral awarenress) Useful field

of view shrinks with age

Performance not VA relatedhellipis related to attention

Action game playing changes spatial resolutionhellipovercoming

crowding in VA assessment (me amblyopia therapy)

Temporal resolution of vision Backward masking

changehellipbrain changes

Visual sensitivity (contrast sensitivity) Post action game training

improves CSF

69

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Action video games correcting optics of the cortex (me this is

actualy OVT)

Games factor

Variable entry leanringhellipadapt task to skill level

Incremental learning tune task to subjectlsquos leanring steps

Motivationarousal

Rewards

Self masterself confidence

Action games factors

Pacingrate of exposure to infohellipincreasing processing speed

Dynamic display

Rich environment

Rich motor involvement

70

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Surgeons may be made to play action games

Pilot training

Amblyopia tx Dennis Levi research

PresenterTitle Contact info

Neuroplasticity-A Paradigm Sea Change

This presentation is available at

httpwwwslidesharenetDMAINOneuroplasticity-a-paradigm-sea-change-2459693

httpwwwmainosmemosblogspotcom

My FaceBook Page

and

Twitter

PresenterTitle Contact info

Questions About

Neuroplasticity-A Paradigm Sea Change

Dominick M Maino OD MEd FAAO FCOVD-A

Professor PediatricsBinocular VisionIllinois Eye InstituteIllinois College of Optometry

dmainoicoeduhttpwwwMainosMemosblogspotcom

Thanks to

httpwwwcovdorgHomeOVDJournalOVD401tabid263D

efaultaspx

httpbipolarblastfileswordpresscom200908neurojpg

httpwwwspecialcheerscomimagesanimated_braingif

httpblogmarsdencartoonscomwp-

contentuploads200810frankenstein-myspace-lightbeergif

httpwwwshangralafamilyfuncomgala-ecalvindreamgif

httppsychiatryjwatchorgcgicontentfull20082251

73

Chakraborty R Chatterjee A Choudhart S Chakraborty PK Neuroplasticitymdasha paradigm shift in neurosciences J Indian Med Assoc

2007105(9)513-4516-8520-1

Sacks O A neurologistlsquos notebook Stereo Sue Why two eyes are better than one The New Yorker 2006 Jun 1964-73

Krulwich R National Public Radio Going Binocular Susanlsquos First Snowfall Available at

wwwnprorgtemplatesstorystoryphpstoryId=5507789 (Accessed December 8 2008)

Press LJ The story behind Stereo Suelsquo and a world-famous neurologistlsquos discovery of vision therapy Optom Vis Dev 200637(2) 55-7

Levin HS Neuroplasticity and brain imaging research implications for rehabilitation Arch Phys Med Rehabil 2006 Dec87(12 Suppl

2)S1

Wiesel TN Hubel DH Single-cell responses in striate cortex of kittens deprived of vision in one eye J Neurophysiol 1963

Nov261003-17

Hook BM Chen C Critical periods in the visual system Changing views for a model of experience-dependent plasticity Neuron 2007

Oct56(2)312-26

Ramey CT Ramey SL Prevention of intellectual disabilities early interventions to improve cognitive development Prev Med 1998

Mar-Apr27(2)224-32

Heuninckx S Wenderoth N Swinnen SP Systems neuroplasticity in the aging brain recruiting additional neural resources for

successful motor performance in elderly persons J Neurosci 2008 Jan 228(1)91-9

Ge S Yang CH Hsu KS et al A critical period for enhanced synaptic plasticity in newly generated neurons of the adult brain Neuron

2007 May54(4)559-66

74

Draganski B Gaser C Busch V et al Neuroplasticity changes in grey matter induced by training Nature 2004 Jan 22427(6972)

311-2

Cannonieri GC Bonilha L Fernandes PT et al Practice and perfect length of training and structural brain changes in experienced

typists Neuroreport 2007 Jul 218(10)1063-6

Kleim JA Jones TA Principles of experience-dependent neural plasticity implications for rehabilitation after brain damage J

Speech Lang Hear Res 2008 Feb51(1)S225-39

Trojan S Porkorny J Theoretical aspects of neuroplasticity Physiol Res 199948(2)87-97

Ramamirtham R Kee CS Hung LF et al Wave aberrations in rhesus monkeys with vision-induced ametropias Vision Res 2007

Sep47(21)2751-66

Smith EL 3rd Ramamirtham R Qiao-Grider Y et al Effects of foveal ablation on emmetropization and form-deprivation myopia

Invest Ophthalmol Vis Sci 2007 Sep48(9)3914-22

Smith EL 3rd Kee CS Ramamirtham R et al Peripheral vision can influence eye growth and refractive development in infant

monkeys Invest Ophthalmol Vis Sci 2005 Nov46(11)3965-72

Ciuffreda KJ Vasudevan B Nearwork-induced transient myopia (NITM) and permanent myopiandashndashis there a link Ophthalmic

Physiol Opt 2008 Mar28(2)103-14

Hung GK Ciuffreda KJ Incremental retinal-defocus theory of myopia development--schematic analysis and computer simulation

Comput Biol Med 2007 Jul37(7)930-46

Hung GK Ciuffreda KJ A unifying theory of refractive error development Bull Math Biol 2000 Nov62(6)1087-108

75

Pang Y Maino D Zhang G Lu F Myopia Can its progress be controlled Optom Vis Dev 200637(2)75-9

Leung JT Brown B Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lenses Optom Vis Sci

1999 Jun76(6)346-54

Hasebe S Ohtsuki H Nonaka T et al Effect of progressive addition lenses on myopia progression in Japanese children a prospective

randomized double-masked crossover trial Invest Ophthalmol Vis Sci 2008 Jul49(7)2781-9

Gwiazda J Hyman L Hussein M et al A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression

of myopia in children Invest Ophthalmol Vis Sci 2003 Apr44(4)1492-500

Siatkowski RM Cotter SA Crockett RS et al Two-year multi-center randomized double-masked placebo-controlled parallel safety and

efficacy study of 2 pirenzepine ophthalmic gel in children with myopia J AAPOS 2008 Aug12(4)332-9

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged 7 to 17 years Arch Ophthalmol 2005

Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three to less than 10 years of age Am J

Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction Am J Ophthalmol 2007

Jun143(6)1060-3

Holmes JM Edwards AR Beck RW et al A randomized pilot study of near activities versus non-near activities during patching therapy for

amblyopia J AAPOS 2005 Apr9(2)129-36

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate

amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-57

76

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic

amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Convergence Insufficiency Treatment Trial Study Group Randomized clinical trial of treatments for symptomatic convergence insufficiency

in children Arch Ophthalmol 2008 Oct126(10)1336-49

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

Solan HA Shelley-Tremblay J Hansen PC et al M-cell deficit and reading disability a preliminary study of the effects of temporal vision-

processing therapy Optometry 2004 Oct75(10)640-50

Solan HA Larson S Shelley-Tremblay J et al Role of visual attention in cognitive control of oculomotor readiness in students with reading

disabilities J Learn Disabil 2001 Mar-Apr34(2)107-18

Gallaway M Boas MB The impact of vergence and accommodative therapy on reading eye movements and reading speed Optom Vis Dev

200738(3)115-20

Goss DA Downing DB Lowther AH et al The effect of HTS vision therapy conducted in a school setting on reading skills in third and

fourth grade students Optom Vis Dev 200738(1)27-32

Crutch SJ Warrington EK Foveal crowding in posterior cortical atrophy a specific early-visual-processing deficit affecting word reading

Cogn Neuropsychol 2007 Dec24(8)843-66

Helms D Sawtelle SM A study of the effectiveness of cognitive therapy delivered in a video game format Optom Vis Dev 200738 (1)19-

26

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

77

Lawton T Training direction-discrimination sensitivity remediates a wide spectrum of reading skills OptomVis Dev 200738(1) 33-47

Goldstand S Koslowe KC Parush S Vision visual-information processing and academic performance among seventh-grade schoolchildren a

more significant relationship than we thought Am J Occup Ther 2005 Jul-Aug59(4)377-89

Fischer B Koumlngeter A Hartnegg K Effects of daily practice on subitizing visual counting and basic arithmetic skills Optom Vis Dev

200839(1)30-4

Sands W Taub M Maino D Limited research and education on special populations in optometry and ophthalomology Optom Vis Dev

200839(2)60-1

Wesson M Maino D Oculo-visual findings in Down syndrome cerebral palsy and mental retardation with non-specific etiology In Maino D

(ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 199517-54 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

Cui Y Stapleton F Suttle C Developing an instrument to assess vision-related and subjective quality of life in children with intellectual

disability data collection and preliminary analysis in a Chinese population Ophthal Physiolog Optics 2008 May28(3) 238-46

Maino D Steele G Tahir S Sajja R Attitudes of optometry students toward individuals with disabilities Optom Ed 200227(2)45-50

Maino D Special populations in the optometric curriculum Optom Ed 200227(2)38-9

Maino D Overview of special populations In Scheiman M Rouse M (eds) Optometric Management of Learning-Related Vision Problems

St Louis Mosby Inc 200685-106

Maino D (ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 1995 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

78

McCarthy P Maino D Alport syndrome a review Clin Eye Vis Care 2000 Dec12(3-4)139-50

Block SS Brusca-Vega R Pizzi WJ et al Cognitive and visual processing skills and their relationship to mutation size in full and

permutation female fragile X carriers Optom Vis Sci 2000 Nov77 (11)592-9

Maino D The young child with developmental disabilities An introduction to mental retardation and genetic syndromes In Moore BD

(ed) Eye Care for Infants and Young Children Butter-worth--Heinemann Newton MA1997285-300

Amin V Maino D The Fragile X female Visual visual perceptual and ocular health anomalies J Am Optom Assoc 1995 May66

(5)290-95

Maino DM Maino JH Cibis GW Hecht F Ocular health anomalies in patients with developmental disabilities In Maino D (ed)

Diagnosis and Management of Special Populations Mosby-Year-book Inc St Louis MO 1995189-206 Reprinted Optometric

Education Program Foundation Santa Anna Calif 2001

Maino D Wesson M Schlange D Cibis G Maino J Optometric findings in the fragile X syndrome Optom Vis Sci 199168634-40

Scheiman MMOptometric findings in children with cerebral palsy Am J Optom Physiol Opt 1984 May61(5)321-3

Maino D Maino J Maino S Mental retardation syndromes with associated ocular defects J Am Optom Assoc 199061707-16

Stewart RE Woodhouse JM Cregg M Pakeman VH Association between accommodative accuracy hypermetropia and strabismus in

children with Downs syndrome Optom Vis Sci 2007 Feb84(2)149-55

Cregg M Woodhouse JM Pakeman VH et al Accommodation and refractive error in children with Down syndrome cross-sectional

and longitudinal studies Invest Ophthalmol Vis Sci 2001 Jan42 (1)55-63

79

McClelland JF Parkes J Hill N et al Accommodative dysfunction in children with cerebral palsy a population-

based study Invest Ophthalmol Vis Sci 2006 May47(5)1824-30

Duckman RH Vision therapy for the child with cerebral palsy J Am Optom Assoc 198758(1)28-35

Duckman R Accommodation in cerebral palsy function and remediation J Am Optom Assoc 198455(4)281-3

Scheiman M Understanding and managing vision deficits a guide for occupational therapists 2nd ed Slack

Thorofare NJ 2002

Maino D Binasal occlusion for the child with Cerebral Palsy J Ill Optom Assoc 198644(1)1218

Battaglia F Quartarone A Rizzo V et al Early impairment of synaptic plasticity in patients with Downs syndrome

Neurobiol Aging 2008 Aug29(8)1272-5

Bonnier C Evaluation of early stimulation programs for enhancing brain development Acta Paediatr 2008

Jul97(7)853-8

Morice E Andreae LC Cooke SF et al Preservation of long-term memory and synaptic plasticity despite short-term

impairments in the Tc1 mouse model of Down syndrome Learn Mem 2008 Jul 1415(7)492-500

Gordon AM Schneider JA Chinnan A Charles JR Efficacy of a hand-arm bimanual intensive therapy (HABIT) in

children with hemiplegic cerebral palsy a randomized control trial Dev Med Child Neurol 2007 Nov49(11)830-8

Kapoor N Ciuffreda KJ Vision disturbances following traumatic brain injury Curr Treat Options Neurol 2002

Jul4(4)271-80

80

Ciuffreda KJ Rutner D Kapoor N et al Vision therapy for oculomotor dysfunctions in acquired brain injury a

retrospective analysis Optometry 2008 Jan79(1)18-22

Ciuffreda KJ Han Y Kapoor N Ficarra AP Oculomotor rehabilitation for reading in acquired brain injury

NeuroRehabilitation 200621(1)9-21

Zost M Diagnosis and management of visual dysfunction in cerebral injury In Maino D (ed) Diagnosis and

Management of Special Populations Mosby-Yearbook Inc St Louis 199579 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001 [Figure used with permission of the editor]

DeGutis JM Bentin S Robertson LC DEsposito M Functional plasticity in ventral temporal cortex following

cognitive rehabilitation of a congenital prosopagnosic J Cogn Neurosci 2007 Nov19 (11)1790-802

Welbourne SR Ralph MA Exploring the impact of plasticity-related recovery after brain damage in a connectionist

model of single-word reading Cogn Affect Behav Neurosci 2005 Mar5(1)77-92

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements prevent cognitive decline A

systematic review of randomized controlled trials J Hum Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among preterm infants attributable to early

supplementation of human milk with docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings and structural-functional

synergies with cell membrane phospholipids Altern Med Rev 2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function Neuroscience 20089(7)568-78

81

Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

BMC Biol 2008 Sep 9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine improves neuropsychological disorders in a child with

creatine transporter defect Neurocase 200814(2) 151-61

Forrester LW Wheaton LA Luft AR Exercise-mediated locomotor recovery and lower-limb neuroplasticity after

stroke J Rehabil Res Dev 200845(2)205-20

82

Page 67: Neuroplasticity: A Paradigm Sea Change Latest Updated File

67

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Retinotopic map changes for stroke pts Cortical reorganization in

adults occurs Perceived objectshellipelongation in stroke amp AMD

What happens to deprived cortex in AMD

fMRI shows cortical reorganization in adults

Proposed mechanisms

hellipGrowth of new connections

hellipUnmasking of pre-existing connections this is true

happens within seconds

Bavelier

Action video games

68

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Bavelier

Action video games Looked at attention Gamers can track more

activities

Attention over space (me peripheral awarenress) Useful field

of view shrinks with age

Performance not VA relatedhellipis related to attention

Action game playing changes spatial resolutionhellipovercoming

crowding in VA assessment (me amblyopia therapy)

Temporal resolution of vision Backward masking

changehellipbrain changes

Visual sensitivity (contrast sensitivity) Post action game training

improves CSF

69

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Action video games correcting optics of the cortex (me this is

actualy OVT)

Games factor

Variable entry leanringhellipadapt task to skill level

Incremental learning tune task to subjectlsquos leanring steps

Motivationarousal

Rewards

Self masterself confidence

Action games factors

Pacingrate of exposure to infohellipincreasing processing speed

Dynamic display

Rich environment

Rich motor involvement

70

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Surgeons may be made to play action games

Pilot training

Amblyopia tx Dennis Levi research

PresenterTitle Contact info

Neuroplasticity-A Paradigm Sea Change

This presentation is available at

httpwwwslidesharenetDMAINOneuroplasticity-a-paradigm-sea-change-2459693

httpwwwmainosmemosblogspotcom

My FaceBook Page

and

Twitter

PresenterTitle Contact info

Questions About

Neuroplasticity-A Paradigm Sea Change

Dominick M Maino OD MEd FAAO FCOVD-A

Professor PediatricsBinocular VisionIllinois Eye InstituteIllinois College of Optometry

dmainoicoeduhttpwwwMainosMemosblogspotcom

Thanks to

httpwwwcovdorgHomeOVDJournalOVD401tabid263D

efaultaspx

httpbipolarblastfileswordpresscom200908neurojpg

httpwwwspecialcheerscomimagesanimated_braingif

httpblogmarsdencartoonscomwp-

contentuploads200810frankenstein-myspace-lightbeergif

httpwwwshangralafamilyfuncomgala-ecalvindreamgif

httppsychiatryjwatchorgcgicontentfull20082251

73

Chakraborty R Chatterjee A Choudhart S Chakraborty PK Neuroplasticitymdasha paradigm shift in neurosciences J Indian Med Assoc

2007105(9)513-4516-8520-1

Sacks O A neurologistlsquos notebook Stereo Sue Why two eyes are better than one The New Yorker 2006 Jun 1964-73

Krulwich R National Public Radio Going Binocular Susanlsquos First Snowfall Available at

wwwnprorgtemplatesstorystoryphpstoryId=5507789 (Accessed December 8 2008)

Press LJ The story behind Stereo Suelsquo and a world-famous neurologistlsquos discovery of vision therapy Optom Vis Dev 200637(2) 55-7

Levin HS Neuroplasticity and brain imaging research implications for rehabilitation Arch Phys Med Rehabil 2006 Dec87(12 Suppl

2)S1

Wiesel TN Hubel DH Single-cell responses in striate cortex of kittens deprived of vision in one eye J Neurophysiol 1963

Nov261003-17

Hook BM Chen C Critical periods in the visual system Changing views for a model of experience-dependent plasticity Neuron 2007

Oct56(2)312-26

Ramey CT Ramey SL Prevention of intellectual disabilities early interventions to improve cognitive development Prev Med 1998

Mar-Apr27(2)224-32

Heuninckx S Wenderoth N Swinnen SP Systems neuroplasticity in the aging brain recruiting additional neural resources for

successful motor performance in elderly persons J Neurosci 2008 Jan 228(1)91-9

Ge S Yang CH Hsu KS et al A critical period for enhanced synaptic plasticity in newly generated neurons of the adult brain Neuron

2007 May54(4)559-66

74

Draganski B Gaser C Busch V et al Neuroplasticity changes in grey matter induced by training Nature 2004 Jan 22427(6972)

311-2

Cannonieri GC Bonilha L Fernandes PT et al Practice and perfect length of training and structural brain changes in experienced

typists Neuroreport 2007 Jul 218(10)1063-6

Kleim JA Jones TA Principles of experience-dependent neural plasticity implications for rehabilitation after brain damage J

Speech Lang Hear Res 2008 Feb51(1)S225-39

Trojan S Porkorny J Theoretical aspects of neuroplasticity Physiol Res 199948(2)87-97

Ramamirtham R Kee CS Hung LF et al Wave aberrations in rhesus monkeys with vision-induced ametropias Vision Res 2007

Sep47(21)2751-66

Smith EL 3rd Ramamirtham R Qiao-Grider Y et al Effects of foveal ablation on emmetropization and form-deprivation myopia

Invest Ophthalmol Vis Sci 2007 Sep48(9)3914-22

Smith EL 3rd Kee CS Ramamirtham R et al Peripheral vision can influence eye growth and refractive development in infant

monkeys Invest Ophthalmol Vis Sci 2005 Nov46(11)3965-72

Ciuffreda KJ Vasudevan B Nearwork-induced transient myopia (NITM) and permanent myopiandashndashis there a link Ophthalmic

Physiol Opt 2008 Mar28(2)103-14

Hung GK Ciuffreda KJ Incremental retinal-defocus theory of myopia development--schematic analysis and computer simulation

Comput Biol Med 2007 Jul37(7)930-46

Hung GK Ciuffreda KJ A unifying theory of refractive error development Bull Math Biol 2000 Nov62(6)1087-108

75

Pang Y Maino D Zhang G Lu F Myopia Can its progress be controlled Optom Vis Dev 200637(2)75-9

Leung JT Brown B Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lenses Optom Vis Sci

1999 Jun76(6)346-54

Hasebe S Ohtsuki H Nonaka T et al Effect of progressive addition lenses on myopia progression in Japanese children a prospective

randomized double-masked crossover trial Invest Ophthalmol Vis Sci 2008 Jul49(7)2781-9

Gwiazda J Hyman L Hussein M et al A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression

of myopia in children Invest Ophthalmol Vis Sci 2003 Apr44(4)1492-500

Siatkowski RM Cotter SA Crockett RS et al Two-year multi-center randomized double-masked placebo-controlled parallel safety and

efficacy study of 2 pirenzepine ophthalmic gel in children with myopia J AAPOS 2008 Aug12(4)332-9

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged 7 to 17 years Arch Ophthalmol 2005

Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three to less than 10 years of age Am J

Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction Am J Ophthalmol 2007

Jun143(6)1060-3

Holmes JM Edwards AR Beck RW et al A randomized pilot study of near activities versus non-near activities during patching therapy for

amblyopia J AAPOS 2005 Apr9(2)129-36

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate

amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-57

76

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic

amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Convergence Insufficiency Treatment Trial Study Group Randomized clinical trial of treatments for symptomatic convergence insufficiency

in children Arch Ophthalmol 2008 Oct126(10)1336-49

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

Solan HA Shelley-Tremblay J Hansen PC et al M-cell deficit and reading disability a preliminary study of the effects of temporal vision-

processing therapy Optometry 2004 Oct75(10)640-50

Solan HA Larson S Shelley-Tremblay J et al Role of visual attention in cognitive control of oculomotor readiness in students with reading

disabilities J Learn Disabil 2001 Mar-Apr34(2)107-18

Gallaway M Boas MB The impact of vergence and accommodative therapy on reading eye movements and reading speed Optom Vis Dev

200738(3)115-20

Goss DA Downing DB Lowther AH et al The effect of HTS vision therapy conducted in a school setting on reading skills in third and

fourth grade students Optom Vis Dev 200738(1)27-32

Crutch SJ Warrington EK Foveal crowding in posterior cortical atrophy a specific early-visual-processing deficit affecting word reading

Cogn Neuropsychol 2007 Dec24(8)843-66

Helms D Sawtelle SM A study of the effectiveness of cognitive therapy delivered in a video game format Optom Vis Dev 200738 (1)19-

26

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

77

Lawton T Training direction-discrimination sensitivity remediates a wide spectrum of reading skills OptomVis Dev 200738(1) 33-47

Goldstand S Koslowe KC Parush S Vision visual-information processing and academic performance among seventh-grade schoolchildren a

more significant relationship than we thought Am J Occup Ther 2005 Jul-Aug59(4)377-89

Fischer B Koumlngeter A Hartnegg K Effects of daily practice on subitizing visual counting and basic arithmetic skills Optom Vis Dev

200839(1)30-4

Sands W Taub M Maino D Limited research and education on special populations in optometry and ophthalomology Optom Vis Dev

200839(2)60-1

Wesson M Maino D Oculo-visual findings in Down syndrome cerebral palsy and mental retardation with non-specific etiology In Maino D

(ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 199517-54 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

Cui Y Stapleton F Suttle C Developing an instrument to assess vision-related and subjective quality of life in children with intellectual

disability data collection and preliminary analysis in a Chinese population Ophthal Physiolog Optics 2008 May28(3) 238-46

Maino D Steele G Tahir S Sajja R Attitudes of optometry students toward individuals with disabilities Optom Ed 200227(2)45-50

Maino D Special populations in the optometric curriculum Optom Ed 200227(2)38-9

Maino D Overview of special populations In Scheiman M Rouse M (eds) Optometric Management of Learning-Related Vision Problems

St Louis Mosby Inc 200685-106

Maino D (ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 1995 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

78

McCarthy P Maino D Alport syndrome a review Clin Eye Vis Care 2000 Dec12(3-4)139-50

Block SS Brusca-Vega R Pizzi WJ et al Cognitive and visual processing skills and their relationship to mutation size in full and

permutation female fragile X carriers Optom Vis Sci 2000 Nov77 (11)592-9

Maino D The young child with developmental disabilities An introduction to mental retardation and genetic syndromes In Moore BD

(ed) Eye Care for Infants and Young Children Butter-worth--Heinemann Newton MA1997285-300

Amin V Maino D The Fragile X female Visual visual perceptual and ocular health anomalies J Am Optom Assoc 1995 May66

(5)290-95

Maino DM Maino JH Cibis GW Hecht F Ocular health anomalies in patients with developmental disabilities In Maino D (ed)

Diagnosis and Management of Special Populations Mosby-Year-book Inc St Louis MO 1995189-206 Reprinted Optometric

Education Program Foundation Santa Anna Calif 2001

Maino D Wesson M Schlange D Cibis G Maino J Optometric findings in the fragile X syndrome Optom Vis Sci 199168634-40

Scheiman MMOptometric findings in children with cerebral palsy Am J Optom Physiol Opt 1984 May61(5)321-3

Maino D Maino J Maino S Mental retardation syndromes with associated ocular defects J Am Optom Assoc 199061707-16

Stewart RE Woodhouse JM Cregg M Pakeman VH Association between accommodative accuracy hypermetropia and strabismus in

children with Downs syndrome Optom Vis Sci 2007 Feb84(2)149-55

Cregg M Woodhouse JM Pakeman VH et al Accommodation and refractive error in children with Down syndrome cross-sectional

and longitudinal studies Invest Ophthalmol Vis Sci 2001 Jan42 (1)55-63

79

McClelland JF Parkes J Hill N et al Accommodative dysfunction in children with cerebral palsy a population-

based study Invest Ophthalmol Vis Sci 2006 May47(5)1824-30

Duckman RH Vision therapy for the child with cerebral palsy J Am Optom Assoc 198758(1)28-35

Duckman R Accommodation in cerebral palsy function and remediation J Am Optom Assoc 198455(4)281-3

Scheiman M Understanding and managing vision deficits a guide for occupational therapists 2nd ed Slack

Thorofare NJ 2002

Maino D Binasal occlusion for the child with Cerebral Palsy J Ill Optom Assoc 198644(1)1218

Battaglia F Quartarone A Rizzo V et al Early impairment of synaptic plasticity in patients with Downs syndrome

Neurobiol Aging 2008 Aug29(8)1272-5

Bonnier C Evaluation of early stimulation programs for enhancing brain development Acta Paediatr 2008

Jul97(7)853-8

Morice E Andreae LC Cooke SF et al Preservation of long-term memory and synaptic plasticity despite short-term

impairments in the Tc1 mouse model of Down syndrome Learn Mem 2008 Jul 1415(7)492-500

Gordon AM Schneider JA Chinnan A Charles JR Efficacy of a hand-arm bimanual intensive therapy (HABIT) in

children with hemiplegic cerebral palsy a randomized control trial Dev Med Child Neurol 2007 Nov49(11)830-8

Kapoor N Ciuffreda KJ Vision disturbances following traumatic brain injury Curr Treat Options Neurol 2002

Jul4(4)271-80

80

Ciuffreda KJ Rutner D Kapoor N et al Vision therapy for oculomotor dysfunctions in acquired brain injury a

retrospective analysis Optometry 2008 Jan79(1)18-22

Ciuffreda KJ Han Y Kapoor N Ficarra AP Oculomotor rehabilitation for reading in acquired brain injury

NeuroRehabilitation 200621(1)9-21

Zost M Diagnosis and management of visual dysfunction in cerebral injury In Maino D (ed) Diagnosis and

Management of Special Populations Mosby-Yearbook Inc St Louis 199579 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001 [Figure used with permission of the editor]

DeGutis JM Bentin S Robertson LC DEsposito M Functional plasticity in ventral temporal cortex following

cognitive rehabilitation of a congenital prosopagnosic J Cogn Neurosci 2007 Nov19 (11)1790-802

Welbourne SR Ralph MA Exploring the impact of plasticity-related recovery after brain damage in a connectionist

model of single-word reading Cogn Affect Behav Neurosci 2005 Mar5(1)77-92

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements prevent cognitive decline A

systematic review of randomized controlled trials J Hum Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among preterm infants attributable to early

supplementation of human milk with docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings and structural-functional

synergies with cell membrane phospholipids Altern Med Rev 2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function Neuroscience 20089(7)568-78

81

Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

BMC Biol 2008 Sep 9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine improves neuropsychological disorders in a child with

creatine transporter defect Neurocase 200814(2) 151-61

Forrester LW Wheaton LA Luft AR Exercise-mediated locomotor recovery and lower-limb neuroplasticity after

stroke J Rehabil Res Dev 200845(2)205-20

82

Page 68: Neuroplasticity: A Paradigm Sea Change Latest Updated File

68

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Bavelier

Action video games Looked at attention Gamers can track more

activities

Attention over space (me peripheral awarenress) Useful field

of view shrinks with age

Performance not VA relatedhellipis related to attention

Action game playing changes spatial resolutionhellipovercoming

crowding in VA assessment (me amblyopia therapy)

Temporal resolution of vision Backward masking

changehellipbrain changes

Visual sensitivity (contrast sensitivity) Post action game training

improves CSF

69

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Action video games correcting optics of the cortex (me this is

actualy OVT)

Games factor

Variable entry leanringhellipadapt task to skill level

Incremental learning tune task to subjectlsquos leanring steps

Motivationarousal

Rewards

Self masterself confidence

Action games factors

Pacingrate of exposure to infohellipincreasing processing speed

Dynamic display

Rich environment

Rich motor involvement

70

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Surgeons may be made to play action games

Pilot training

Amblyopia tx Dennis Levi research

PresenterTitle Contact info

Neuroplasticity-A Paradigm Sea Change

This presentation is available at

httpwwwslidesharenetDMAINOneuroplasticity-a-paradigm-sea-change-2459693

httpwwwmainosmemosblogspotcom

My FaceBook Page

and

Twitter

PresenterTitle Contact info

Questions About

Neuroplasticity-A Paradigm Sea Change

Dominick M Maino OD MEd FAAO FCOVD-A

Professor PediatricsBinocular VisionIllinois Eye InstituteIllinois College of Optometry

dmainoicoeduhttpwwwMainosMemosblogspotcom

Thanks to

httpwwwcovdorgHomeOVDJournalOVD401tabid263D

efaultaspx

httpbipolarblastfileswordpresscom200908neurojpg

httpwwwspecialcheerscomimagesanimated_braingif

httpblogmarsdencartoonscomwp-

contentuploads200810frankenstein-myspace-lightbeergif

httpwwwshangralafamilyfuncomgala-ecalvindreamgif

httppsychiatryjwatchorgcgicontentfull20082251

73

Chakraborty R Chatterjee A Choudhart S Chakraborty PK Neuroplasticitymdasha paradigm shift in neurosciences J Indian Med Assoc

2007105(9)513-4516-8520-1

Sacks O A neurologistlsquos notebook Stereo Sue Why two eyes are better than one The New Yorker 2006 Jun 1964-73

Krulwich R National Public Radio Going Binocular Susanlsquos First Snowfall Available at

wwwnprorgtemplatesstorystoryphpstoryId=5507789 (Accessed December 8 2008)

Press LJ The story behind Stereo Suelsquo and a world-famous neurologistlsquos discovery of vision therapy Optom Vis Dev 200637(2) 55-7

Levin HS Neuroplasticity and brain imaging research implications for rehabilitation Arch Phys Med Rehabil 2006 Dec87(12 Suppl

2)S1

Wiesel TN Hubel DH Single-cell responses in striate cortex of kittens deprived of vision in one eye J Neurophysiol 1963

Nov261003-17

Hook BM Chen C Critical periods in the visual system Changing views for a model of experience-dependent plasticity Neuron 2007

Oct56(2)312-26

Ramey CT Ramey SL Prevention of intellectual disabilities early interventions to improve cognitive development Prev Med 1998

Mar-Apr27(2)224-32

Heuninckx S Wenderoth N Swinnen SP Systems neuroplasticity in the aging brain recruiting additional neural resources for

successful motor performance in elderly persons J Neurosci 2008 Jan 228(1)91-9

Ge S Yang CH Hsu KS et al A critical period for enhanced synaptic plasticity in newly generated neurons of the adult brain Neuron

2007 May54(4)559-66

74

Draganski B Gaser C Busch V et al Neuroplasticity changes in grey matter induced by training Nature 2004 Jan 22427(6972)

311-2

Cannonieri GC Bonilha L Fernandes PT et al Practice and perfect length of training and structural brain changes in experienced

typists Neuroreport 2007 Jul 218(10)1063-6

Kleim JA Jones TA Principles of experience-dependent neural plasticity implications for rehabilitation after brain damage J

Speech Lang Hear Res 2008 Feb51(1)S225-39

Trojan S Porkorny J Theoretical aspects of neuroplasticity Physiol Res 199948(2)87-97

Ramamirtham R Kee CS Hung LF et al Wave aberrations in rhesus monkeys with vision-induced ametropias Vision Res 2007

Sep47(21)2751-66

Smith EL 3rd Ramamirtham R Qiao-Grider Y et al Effects of foveal ablation on emmetropization and form-deprivation myopia

Invest Ophthalmol Vis Sci 2007 Sep48(9)3914-22

Smith EL 3rd Kee CS Ramamirtham R et al Peripheral vision can influence eye growth and refractive development in infant

monkeys Invest Ophthalmol Vis Sci 2005 Nov46(11)3965-72

Ciuffreda KJ Vasudevan B Nearwork-induced transient myopia (NITM) and permanent myopiandashndashis there a link Ophthalmic

Physiol Opt 2008 Mar28(2)103-14

Hung GK Ciuffreda KJ Incremental retinal-defocus theory of myopia development--schematic analysis and computer simulation

Comput Biol Med 2007 Jul37(7)930-46

Hung GK Ciuffreda KJ A unifying theory of refractive error development Bull Math Biol 2000 Nov62(6)1087-108

75

Pang Y Maino D Zhang G Lu F Myopia Can its progress be controlled Optom Vis Dev 200637(2)75-9

Leung JT Brown B Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lenses Optom Vis Sci

1999 Jun76(6)346-54

Hasebe S Ohtsuki H Nonaka T et al Effect of progressive addition lenses on myopia progression in Japanese children a prospective

randomized double-masked crossover trial Invest Ophthalmol Vis Sci 2008 Jul49(7)2781-9

Gwiazda J Hyman L Hussein M et al A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression

of myopia in children Invest Ophthalmol Vis Sci 2003 Apr44(4)1492-500

Siatkowski RM Cotter SA Crockett RS et al Two-year multi-center randomized double-masked placebo-controlled parallel safety and

efficacy study of 2 pirenzepine ophthalmic gel in children with myopia J AAPOS 2008 Aug12(4)332-9

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged 7 to 17 years Arch Ophthalmol 2005

Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three to less than 10 years of age Am J

Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction Am J Ophthalmol 2007

Jun143(6)1060-3

Holmes JM Edwards AR Beck RW et al A randomized pilot study of near activities versus non-near activities during patching therapy for

amblyopia J AAPOS 2005 Apr9(2)129-36

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate

amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-57

76

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic

amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Convergence Insufficiency Treatment Trial Study Group Randomized clinical trial of treatments for symptomatic convergence insufficiency

in children Arch Ophthalmol 2008 Oct126(10)1336-49

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

Solan HA Shelley-Tremblay J Hansen PC et al M-cell deficit and reading disability a preliminary study of the effects of temporal vision-

processing therapy Optometry 2004 Oct75(10)640-50

Solan HA Larson S Shelley-Tremblay J et al Role of visual attention in cognitive control of oculomotor readiness in students with reading

disabilities J Learn Disabil 2001 Mar-Apr34(2)107-18

Gallaway M Boas MB The impact of vergence and accommodative therapy on reading eye movements and reading speed Optom Vis Dev

200738(3)115-20

Goss DA Downing DB Lowther AH et al The effect of HTS vision therapy conducted in a school setting on reading skills in third and

fourth grade students Optom Vis Dev 200738(1)27-32

Crutch SJ Warrington EK Foveal crowding in posterior cortical atrophy a specific early-visual-processing deficit affecting word reading

Cogn Neuropsychol 2007 Dec24(8)843-66

Helms D Sawtelle SM A study of the effectiveness of cognitive therapy delivered in a video game format Optom Vis Dev 200738 (1)19-

26

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

77

Lawton T Training direction-discrimination sensitivity remediates a wide spectrum of reading skills OptomVis Dev 200738(1) 33-47

Goldstand S Koslowe KC Parush S Vision visual-information processing and academic performance among seventh-grade schoolchildren a

more significant relationship than we thought Am J Occup Ther 2005 Jul-Aug59(4)377-89

Fischer B Koumlngeter A Hartnegg K Effects of daily practice on subitizing visual counting and basic arithmetic skills Optom Vis Dev

200839(1)30-4

Sands W Taub M Maino D Limited research and education on special populations in optometry and ophthalomology Optom Vis Dev

200839(2)60-1

Wesson M Maino D Oculo-visual findings in Down syndrome cerebral palsy and mental retardation with non-specific etiology In Maino D

(ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 199517-54 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

Cui Y Stapleton F Suttle C Developing an instrument to assess vision-related and subjective quality of life in children with intellectual

disability data collection and preliminary analysis in a Chinese population Ophthal Physiolog Optics 2008 May28(3) 238-46

Maino D Steele G Tahir S Sajja R Attitudes of optometry students toward individuals with disabilities Optom Ed 200227(2)45-50

Maino D Special populations in the optometric curriculum Optom Ed 200227(2)38-9

Maino D Overview of special populations In Scheiman M Rouse M (eds) Optometric Management of Learning-Related Vision Problems

St Louis Mosby Inc 200685-106

Maino D (ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 1995 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

78

McCarthy P Maino D Alport syndrome a review Clin Eye Vis Care 2000 Dec12(3-4)139-50

Block SS Brusca-Vega R Pizzi WJ et al Cognitive and visual processing skills and their relationship to mutation size in full and

permutation female fragile X carriers Optom Vis Sci 2000 Nov77 (11)592-9

Maino D The young child with developmental disabilities An introduction to mental retardation and genetic syndromes In Moore BD

(ed) Eye Care for Infants and Young Children Butter-worth--Heinemann Newton MA1997285-300

Amin V Maino D The Fragile X female Visual visual perceptual and ocular health anomalies J Am Optom Assoc 1995 May66

(5)290-95

Maino DM Maino JH Cibis GW Hecht F Ocular health anomalies in patients with developmental disabilities In Maino D (ed)

Diagnosis and Management of Special Populations Mosby-Year-book Inc St Louis MO 1995189-206 Reprinted Optometric

Education Program Foundation Santa Anna Calif 2001

Maino D Wesson M Schlange D Cibis G Maino J Optometric findings in the fragile X syndrome Optom Vis Sci 199168634-40

Scheiman MMOptometric findings in children with cerebral palsy Am J Optom Physiol Opt 1984 May61(5)321-3

Maino D Maino J Maino S Mental retardation syndromes with associated ocular defects J Am Optom Assoc 199061707-16

Stewart RE Woodhouse JM Cregg M Pakeman VH Association between accommodative accuracy hypermetropia and strabismus in

children with Downs syndrome Optom Vis Sci 2007 Feb84(2)149-55

Cregg M Woodhouse JM Pakeman VH et al Accommodation and refractive error in children with Down syndrome cross-sectional

and longitudinal studies Invest Ophthalmol Vis Sci 2001 Jan42 (1)55-63

79

McClelland JF Parkes J Hill N et al Accommodative dysfunction in children with cerebral palsy a population-

based study Invest Ophthalmol Vis Sci 2006 May47(5)1824-30

Duckman RH Vision therapy for the child with cerebral palsy J Am Optom Assoc 198758(1)28-35

Duckman R Accommodation in cerebral palsy function and remediation J Am Optom Assoc 198455(4)281-3

Scheiman M Understanding and managing vision deficits a guide for occupational therapists 2nd ed Slack

Thorofare NJ 2002

Maino D Binasal occlusion for the child with Cerebral Palsy J Ill Optom Assoc 198644(1)1218

Battaglia F Quartarone A Rizzo V et al Early impairment of synaptic plasticity in patients with Downs syndrome

Neurobiol Aging 2008 Aug29(8)1272-5

Bonnier C Evaluation of early stimulation programs for enhancing brain development Acta Paediatr 2008

Jul97(7)853-8

Morice E Andreae LC Cooke SF et al Preservation of long-term memory and synaptic plasticity despite short-term

impairments in the Tc1 mouse model of Down syndrome Learn Mem 2008 Jul 1415(7)492-500

Gordon AM Schneider JA Chinnan A Charles JR Efficacy of a hand-arm bimanual intensive therapy (HABIT) in

children with hemiplegic cerebral palsy a randomized control trial Dev Med Child Neurol 2007 Nov49(11)830-8

Kapoor N Ciuffreda KJ Vision disturbances following traumatic brain injury Curr Treat Options Neurol 2002

Jul4(4)271-80

80

Ciuffreda KJ Rutner D Kapoor N et al Vision therapy for oculomotor dysfunctions in acquired brain injury a

retrospective analysis Optometry 2008 Jan79(1)18-22

Ciuffreda KJ Han Y Kapoor N Ficarra AP Oculomotor rehabilitation for reading in acquired brain injury

NeuroRehabilitation 200621(1)9-21

Zost M Diagnosis and management of visual dysfunction in cerebral injury In Maino D (ed) Diagnosis and

Management of Special Populations Mosby-Yearbook Inc St Louis 199579 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001 [Figure used with permission of the editor]

DeGutis JM Bentin S Robertson LC DEsposito M Functional plasticity in ventral temporal cortex following

cognitive rehabilitation of a congenital prosopagnosic J Cogn Neurosci 2007 Nov19 (11)1790-802

Welbourne SR Ralph MA Exploring the impact of plasticity-related recovery after brain damage in a connectionist

model of single-word reading Cogn Affect Behav Neurosci 2005 Mar5(1)77-92

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements prevent cognitive decline A

systematic review of randomized controlled trials J Hum Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among preterm infants attributable to early

supplementation of human milk with docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings and structural-functional

synergies with cell membrane phospholipids Altern Med Rev 2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function Neuroscience 20089(7)568-78

81

Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

BMC Biol 2008 Sep 9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine improves neuropsychological disorders in a child with

creatine transporter defect Neurocase 200814(2) 151-61

Forrester LW Wheaton LA Luft AR Exercise-mediated locomotor recovery and lower-limb neuroplasticity after

stroke J Rehabil Res Dev 200845(2)205-20

82

Page 69: Neuroplasticity: A Paradigm Sea Change Latest Updated File

69

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Action video games correcting optics of the cortex (me this is

actualy OVT)

Games factor

Variable entry leanringhellipadapt task to skill level

Incremental learning tune task to subjectlsquos leanring steps

Motivationarousal

Rewards

Self masterself confidence

Action games factors

Pacingrate of exposure to infohellipincreasing processing speed

Dynamic display

Rich environment

Rich motor involvement

70

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Surgeons may be made to play action games

Pilot training

Amblyopia tx Dennis Levi research

PresenterTitle Contact info

Neuroplasticity-A Paradigm Sea Change

This presentation is available at

httpwwwslidesharenetDMAINOneuroplasticity-a-paradigm-sea-change-2459693

httpwwwmainosmemosblogspotcom

My FaceBook Page

and

Twitter

PresenterTitle Contact info

Questions About

Neuroplasticity-A Paradigm Sea Change

Dominick M Maino OD MEd FAAO FCOVD-A

Professor PediatricsBinocular VisionIllinois Eye InstituteIllinois College of Optometry

dmainoicoeduhttpwwwMainosMemosblogspotcom

Thanks to

httpwwwcovdorgHomeOVDJournalOVD401tabid263D

efaultaspx

httpbipolarblastfileswordpresscom200908neurojpg

httpwwwspecialcheerscomimagesanimated_braingif

httpblogmarsdencartoonscomwp-

contentuploads200810frankenstein-myspace-lightbeergif

httpwwwshangralafamilyfuncomgala-ecalvindreamgif

httppsychiatryjwatchorgcgicontentfull20082251

73

Chakraborty R Chatterjee A Choudhart S Chakraborty PK Neuroplasticitymdasha paradigm shift in neurosciences J Indian Med Assoc

2007105(9)513-4516-8520-1

Sacks O A neurologistlsquos notebook Stereo Sue Why two eyes are better than one The New Yorker 2006 Jun 1964-73

Krulwich R National Public Radio Going Binocular Susanlsquos First Snowfall Available at

wwwnprorgtemplatesstorystoryphpstoryId=5507789 (Accessed December 8 2008)

Press LJ The story behind Stereo Suelsquo and a world-famous neurologistlsquos discovery of vision therapy Optom Vis Dev 200637(2) 55-7

Levin HS Neuroplasticity and brain imaging research implications for rehabilitation Arch Phys Med Rehabil 2006 Dec87(12 Suppl

2)S1

Wiesel TN Hubel DH Single-cell responses in striate cortex of kittens deprived of vision in one eye J Neurophysiol 1963

Nov261003-17

Hook BM Chen C Critical periods in the visual system Changing views for a model of experience-dependent plasticity Neuron 2007

Oct56(2)312-26

Ramey CT Ramey SL Prevention of intellectual disabilities early interventions to improve cognitive development Prev Med 1998

Mar-Apr27(2)224-32

Heuninckx S Wenderoth N Swinnen SP Systems neuroplasticity in the aging brain recruiting additional neural resources for

successful motor performance in elderly persons J Neurosci 2008 Jan 228(1)91-9

Ge S Yang CH Hsu KS et al A critical period for enhanced synaptic plasticity in newly generated neurons of the adult brain Neuron

2007 May54(4)559-66

74

Draganski B Gaser C Busch V et al Neuroplasticity changes in grey matter induced by training Nature 2004 Jan 22427(6972)

311-2

Cannonieri GC Bonilha L Fernandes PT et al Practice and perfect length of training and structural brain changes in experienced

typists Neuroreport 2007 Jul 218(10)1063-6

Kleim JA Jones TA Principles of experience-dependent neural plasticity implications for rehabilitation after brain damage J

Speech Lang Hear Res 2008 Feb51(1)S225-39

Trojan S Porkorny J Theoretical aspects of neuroplasticity Physiol Res 199948(2)87-97

Ramamirtham R Kee CS Hung LF et al Wave aberrations in rhesus monkeys with vision-induced ametropias Vision Res 2007

Sep47(21)2751-66

Smith EL 3rd Ramamirtham R Qiao-Grider Y et al Effects of foveal ablation on emmetropization and form-deprivation myopia

Invest Ophthalmol Vis Sci 2007 Sep48(9)3914-22

Smith EL 3rd Kee CS Ramamirtham R et al Peripheral vision can influence eye growth and refractive development in infant

monkeys Invest Ophthalmol Vis Sci 2005 Nov46(11)3965-72

Ciuffreda KJ Vasudevan B Nearwork-induced transient myopia (NITM) and permanent myopiandashndashis there a link Ophthalmic

Physiol Opt 2008 Mar28(2)103-14

Hung GK Ciuffreda KJ Incremental retinal-defocus theory of myopia development--schematic analysis and computer simulation

Comput Biol Med 2007 Jul37(7)930-46

Hung GK Ciuffreda KJ A unifying theory of refractive error development Bull Math Biol 2000 Nov62(6)1087-108

75

Pang Y Maino D Zhang G Lu F Myopia Can its progress be controlled Optom Vis Dev 200637(2)75-9

Leung JT Brown B Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lenses Optom Vis Sci

1999 Jun76(6)346-54

Hasebe S Ohtsuki H Nonaka T et al Effect of progressive addition lenses on myopia progression in Japanese children a prospective

randomized double-masked crossover trial Invest Ophthalmol Vis Sci 2008 Jul49(7)2781-9

Gwiazda J Hyman L Hussein M et al A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression

of myopia in children Invest Ophthalmol Vis Sci 2003 Apr44(4)1492-500

Siatkowski RM Cotter SA Crockett RS et al Two-year multi-center randomized double-masked placebo-controlled parallel safety and

efficacy study of 2 pirenzepine ophthalmic gel in children with myopia J AAPOS 2008 Aug12(4)332-9

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged 7 to 17 years Arch Ophthalmol 2005

Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three to less than 10 years of age Am J

Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction Am J Ophthalmol 2007

Jun143(6)1060-3

Holmes JM Edwards AR Beck RW et al A randomized pilot study of near activities versus non-near activities during patching therapy for

amblyopia J AAPOS 2005 Apr9(2)129-36

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate

amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-57

76

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic

amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Convergence Insufficiency Treatment Trial Study Group Randomized clinical trial of treatments for symptomatic convergence insufficiency

in children Arch Ophthalmol 2008 Oct126(10)1336-49

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

Solan HA Shelley-Tremblay J Hansen PC et al M-cell deficit and reading disability a preliminary study of the effects of temporal vision-

processing therapy Optometry 2004 Oct75(10)640-50

Solan HA Larson S Shelley-Tremblay J et al Role of visual attention in cognitive control of oculomotor readiness in students with reading

disabilities J Learn Disabil 2001 Mar-Apr34(2)107-18

Gallaway M Boas MB The impact of vergence and accommodative therapy on reading eye movements and reading speed Optom Vis Dev

200738(3)115-20

Goss DA Downing DB Lowther AH et al The effect of HTS vision therapy conducted in a school setting on reading skills in third and

fourth grade students Optom Vis Dev 200738(1)27-32

Crutch SJ Warrington EK Foveal crowding in posterior cortical atrophy a specific early-visual-processing deficit affecting word reading

Cogn Neuropsychol 2007 Dec24(8)843-66

Helms D Sawtelle SM A study of the effectiveness of cognitive therapy delivered in a video game format Optom Vis Dev 200738 (1)19-

26

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

77

Lawton T Training direction-discrimination sensitivity remediates a wide spectrum of reading skills OptomVis Dev 200738(1) 33-47

Goldstand S Koslowe KC Parush S Vision visual-information processing and academic performance among seventh-grade schoolchildren a

more significant relationship than we thought Am J Occup Ther 2005 Jul-Aug59(4)377-89

Fischer B Koumlngeter A Hartnegg K Effects of daily practice on subitizing visual counting and basic arithmetic skills Optom Vis Dev

200839(1)30-4

Sands W Taub M Maino D Limited research and education on special populations in optometry and ophthalomology Optom Vis Dev

200839(2)60-1

Wesson M Maino D Oculo-visual findings in Down syndrome cerebral palsy and mental retardation with non-specific etiology In Maino D

(ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 199517-54 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

Cui Y Stapleton F Suttle C Developing an instrument to assess vision-related and subjective quality of life in children with intellectual

disability data collection and preliminary analysis in a Chinese population Ophthal Physiolog Optics 2008 May28(3) 238-46

Maino D Steele G Tahir S Sajja R Attitudes of optometry students toward individuals with disabilities Optom Ed 200227(2)45-50

Maino D Special populations in the optometric curriculum Optom Ed 200227(2)38-9

Maino D Overview of special populations In Scheiman M Rouse M (eds) Optometric Management of Learning-Related Vision Problems

St Louis Mosby Inc 200685-106

Maino D (ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 1995 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

78

McCarthy P Maino D Alport syndrome a review Clin Eye Vis Care 2000 Dec12(3-4)139-50

Block SS Brusca-Vega R Pizzi WJ et al Cognitive and visual processing skills and their relationship to mutation size in full and

permutation female fragile X carriers Optom Vis Sci 2000 Nov77 (11)592-9

Maino D The young child with developmental disabilities An introduction to mental retardation and genetic syndromes In Moore BD

(ed) Eye Care for Infants and Young Children Butter-worth--Heinemann Newton MA1997285-300

Amin V Maino D The Fragile X female Visual visual perceptual and ocular health anomalies J Am Optom Assoc 1995 May66

(5)290-95

Maino DM Maino JH Cibis GW Hecht F Ocular health anomalies in patients with developmental disabilities In Maino D (ed)

Diagnosis and Management of Special Populations Mosby-Year-book Inc St Louis MO 1995189-206 Reprinted Optometric

Education Program Foundation Santa Anna Calif 2001

Maino D Wesson M Schlange D Cibis G Maino J Optometric findings in the fragile X syndrome Optom Vis Sci 199168634-40

Scheiman MMOptometric findings in children with cerebral palsy Am J Optom Physiol Opt 1984 May61(5)321-3

Maino D Maino J Maino S Mental retardation syndromes with associated ocular defects J Am Optom Assoc 199061707-16

Stewart RE Woodhouse JM Cregg M Pakeman VH Association between accommodative accuracy hypermetropia and strabismus in

children with Downs syndrome Optom Vis Sci 2007 Feb84(2)149-55

Cregg M Woodhouse JM Pakeman VH et al Accommodation and refractive error in children with Down syndrome cross-sectional

and longitudinal studies Invest Ophthalmol Vis Sci 2001 Jan42 (1)55-63

79

McClelland JF Parkes J Hill N et al Accommodative dysfunction in children with cerebral palsy a population-

based study Invest Ophthalmol Vis Sci 2006 May47(5)1824-30

Duckman RH Vision therapy for the child with cerebral palsy J Am Optom Assoc 198758(1)28-35

Duckman R Accommodation in cerebral palsy function and remediation J Am Optom Assoc 198455(4)281-3

Scheiman M Understanding and managing vision deficits a guide for occupational therapists 2nd ed Slack

Thorofare NJ 2002

Maino D Binasal occlusion for the child with Cerebral Palsy J Ill Optom Assoc 198644(1)1218

Battaglia F Quartarone A Rizzo V et al Early impairment of synaptic plasticity in patients with Downs syndrome

Neurobiol Aging 2008 Aug29(8)1272-5

Bonnier C Evaluation of early stimulation programs for enhancing brain development Acta Paediatr 2008

Jul97(7)853-8

Morice E Andreae LC Cooke SF et al Preservation of long-term memory and synaptic plasticity despite short-term

impairments in the Tc1 mouse model of Down syndrome Learn Mem 2008 Jul 1415(7)492-500

Gordon AM Schneider JA Chinnan A Charles JR Efficacy of a hand-arm bimanual intensive therapy (HABIT) in

children with hemiplegic cerebral palsy a randomized control trial Dev Med Child Neurol 2007 Nov49(11)830-8

Kapoor N Ciuffreda KJ Vision disturbances following traumatic brain injury Curr Treat Options Neurol 2002

Jul4(4)271-80

80

Ciuffreda KJ Rutner D Kapoor N et al Vision therapy for oculomotor dysfunctions in acquired brain injury a

retrospective analysis Optometry 2008 Jan79(1)18-22

Ciuffreda KJ Han Y Kapoor N Ficarra AP Oculomotor rehabilitation for reading in acquired brain injury

NeuroRehabilitation 200621(1)9-21

Zost M Diagnosis and management of visual dysfunction in cerebral injury In Maino D (ed) Diagnosis and

Management of Special Populations Mosby-Yearbook Inc St Louis 199579 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001 [Figure used with permission of the editor]

DeGutis JM Bentin S Robertson LC DEsposito M Functional plasticity in ventral temporal cortex following

cognitive rehabilitation of a congenital prosopagnosic J Cogn Neurosci 2007 Nov19 (11)1790-802

Welbourne SR Ralph MA Exploring the impact of plasticity-related recovery after brain damage in a connectionist

model of single-word reading Cogn Affect Behav Neurosci 2005 Mar5(1)77-92

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements prevent cognitive decline A

systematic review of randomized controlled trials J Hum Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among preterm infants attributable to early

supplementation of human milk with docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings and structural-functional

synergies with cell membrane phospholipids Altern Med Rev 2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function Neuroscience 20089(7)568-78

81

Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

BMC Biol 2008 Sep 9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine improves neuropsychological disorders in a child with

creatine transporter defect Neurocase 200814(2) 151-61

Forrester LW Wheaton LA Luft AR Exercise-mediated locomotor recovery and lower-limb neuroplasticity after

stroke J Rehabil Res Dev 200845(2)205-20

82

Page 70: Neuroplasticity: A Paradigm Sea Change Latest Updated File

70

Monroe J Hirsch Research Symposium

Teaching the Brain New Tricks

Surgeons may be made to play action games

Pilot training

Amblyopia tx Dennis Levi research

PresenterTitle Contact info

Neuroplasticity-A Paradigm Sea Change

This presentation is available at

httpwwwslidesharenetDMAINOneuroplasticity-a-paradigm-sea-change-2459693

httpwwwmainosmemosblogspotcom

My FaceBook Page

and

Twitter

PresenterTitle Contact info

Questions About

Neuroplasticity-A Paradigm Sea Change

Dominick M Maino OD MEd FAAO FCOVD-A

Professor PediatricsBinocular VisionIllinois Eye InstituteIllinois College of Optometry

dmainoicoeduhttpwwwMainosMemosblogspotcom

Thanks to

httpwwwcovdorgHomeOVDJournalOVD401tabid263D

efaultaspx

httpbipolarblastfileswordpresscom200908neurojpg

httpwwwspecialcheerscomimagesanimated_braingif

httpblogmarsdencartoonscomwp-

contentuploads200810frankenstein-myspace-lightbeergif

httpwwwshangralafamilyfuncomgala-ecalvindreamgif

httppsychiatryjwatchorgcgicontentfull20082251

73

Chakraborty R Chatterjee A Choudhart S Chakraborty PK Neuroplasticitymdasha paradigm shift in neurosciences J Indian Med Assoc

2007105(9)513-4516-8520-1

Sacks O A neurologistlsquos notebook Stereo Sue Why two eyes are better than one The New Yorker 2006 Jun 1964-73

Krulwich R National Public Radio Going Binocular Susanlsquos First Snowfall Available at

wwwnprorgtemplatesstorystoryphpstoryId=5507789 (Accessed December 8 2008)

Press LJ The story behind Stereo Suelsquo and a world-famous neurologistlsquos discovery of vision therapy Optom Vis Dev 200637(2) 55-7

Levin HS Neuroplasticity and brain imaging research implications for rehabilitation Arch Phys Med Rehabil 2006 Dec87(12 Suppl

2)S1

Wiesel TN Hubel DH Single-cell responses in striate cortex of kittens deprived of vision in one eye J Neurophysiol 1963

Nov261003-17

Hook BM Chen C Critical periods in the visual system Changing views for a model of experience-dependent plasticity Neuron 2007

Oct56(2)312-26

Ramey CT Ramey SL Prevention of intellectual disabilities early interventions to improve cognitive development Prev Med 1998

Mar-Apr27(2)224-32

Heuninckx S Wenderoth N Swinnen SP Systems neuroplasticity in the aging brain recruiting additional neural resources for

successful motor performance in elderly persons J Neurosci 2008 Jan 228(1)91-9

Ge S Yang CH Hsu KS et al A critical period for enhanced synaptic plasticity in newly generated neurons of the adult brain Neuron

2007 May54(4)559-66

74

Draganski B Gaser C Busch V et al Neuroplasticity changes in grey matter induced by training Nature 2004 Jan 22427(6972)

311-2

Cannonieri GC Bonilha L Fernandes PT et al Practice and perfect length of training and structural brain changes in experienced

typists Neuroreport 2007 Jul 218(10)1063-6

Kleim JA Jones TA Principles of experience-dependent neural plasticity implications for rehabilitation after brain damage J

Speech Lang Hear Res 2008 Feb51(1)S225-39

Trojan S Porkorny J Theoretical aspects of neuroplasticity Physiol Res 199948(2)87-97

Ramamirtham R Kee CS Hung LF et al Wave aberrations in rhesus monkeys with vision-induced ametropias Vision Res 2007

Sep47(21)2751-66

Smith EL 3rd Ramamirtham R Qiao-Grider Y et al Effects of foveal ablation on emmetropization and form-deprivation myopia

Invest Ophthalmol Vis Sci 2007 Sep48(9)3914-22

Smith EL 3rd Kee CS Ramamirtham R et al Peripheral vision can influence eye growth and refractive development in infant

monkeys Invest Ophthalmol Vis Sci 2005 Nov46(11)3965-72

Ciuffreda KJ Vasudevan B Nearwork-induced transient myopia (NITM) and permanent myopiandashndashis there a link Ophthalmic

Physiol Opt 2008 Mar28(2)103-14

Hung GK Ciuffreda KJ Incremental retinal-defocus theory of myopia development--schematic analysis and computer simulation

Comput Biol Med 2007 Jul37(7)930-46

Hung GK Ciuffreda KJ A unifying theory of refractive error development Bull Math Biol 2000 Nov62(6)1087-108

75

Pang Y Maino D Zhang G Lu F Myopia Can its progress be controlled Optom Vis Dev 200637(2)75-9

Leung JT Brown B Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lenses Optom Vis Sci

1999 Jun76(6)346-54

Hasebe S Ohtsuki H Nonaka T et al Effect of progressive addition lenses on myopia progression in Japanese children a prospective

randomized double-masked crossover trial Invest Ophthalmol Vis Sci 2008 Jul49(7)2781-9

Gwiazda J Hyman L Hussein M et al A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression

of myopia in children Invest Ophthalmol Vis Sci 2003 Apr44(4)1492-500

Siatkowski RM Cotter SA Crockett RS et al Two-year multi-center randomized double-masked placebo-controlled parallel safety and

efficacy study of 2 pirenzepine ophthalmic gel in children with myopia J AAPOS 2008 Aug12(4)332-9

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged 7 to 17 years Arch Ophthalmol 2005

Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three to less than 10 years of age Am J

Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction Am J Ophthalmol 2007

Jun143(6)1060-3

Holmes JM Edwards AR Beck RW et al A randomized pilot study of near activities versus non-near activities during patching therapy for

amblyopia J AAPOS 2005 Apr9(2)129-36

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate

amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-57

76

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic

amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Convergence Insufficiency Treatment Trial Study Group Randomized clinical trial of treatments for symptomatic convergence insufficiency

in children Arch Ophthalmol 2008 Oct126(10)1336-49

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

Solan HA Shelley-Tremblay J Hansen PC et al M-cell deficit and reading disability a preliminary study of the effects of temporal vision-

processing therapy Optometry 2004 Oct75(10)640-50

Solan HA Larson S Shelley-Tremblay J et al Role of visual attention in cognitive control of oculomotor readiness in students with reading

disabilities J Learn Disabil 2001 Mar-Apr34(2)107-18

Gallaway M Boas MB The impact of vergence and accommodative therapy on reading eye movements and reading speed Optom Vis Dev

200738(3)115-20

Goss DA Downing DB Lowther AH et al The effect of HTS vision therapy conducted in a school setting on reading skills in third and

fourth grade students Optom Vis Dev 200738(1)27-32

Crutch SJ Warrington EK Foveal crowding in posterior cortical atrophy a specific early-visual-processing deficit affecting word reading

Cogn Neuropsychol 2007 Dec24(8)843-66

Helms D Sawtelle SM A study of the effectiveness of cognitive therapy delivered in a video game format Optom Vis Dev 200738 (1)19-

26

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

77

Lawton T Training direction-discrimination sensitivity remediates a wide spectrum of reading skills OptomVis Dev 200738(1) 33-47

Goldstand S Koslowe KC Parush S Vision visual-information processing and academic performance among seventh-grade schoolchildren a

more significant relationship than we thought Am J Occup Ther 2005 Jul-Aug59(4)377-89

Fischer B Koumlngeter A Hartnegg K Effects of daily practice on subitizing visual counting and basic arithmetic skills Optom Vis Dev

200839(1)30-4

Sands W Taub M Maino D Limited research and education on special populations in optometry and ophthalomology Optom Vis Dev

200839(2)60-1

Wesson M Maino D Oculo-visual findings in Down syndrome cerebral palsy and mental retardation with non-specific etiology In Maino D

(ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 199517-54 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

Cui Y Stapleton F Suttle C Developing an instrument to assess vision-related and subjective quality of life in children with intellectual

disability data collection and preliminary analysis in a Chinese population Ophthal Physiolog Optics 2008 May28(3) 238-46

Maino D Steele G Tahir S Sajja R Attitudes of optometry students toward individuals with disabilities Optom Ed 200227(2)45-50

Maino D Special populations in the optometric curriculum Optom Ed 200227(2)38-9

Maino D Overview of special populations In Scheiman M Rouse M (eds) Optometric Management of Learning-Related Vision Problems

St Louis Mosby Inc 200685-106

Maino D (ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 1995 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

78

McCarthy P Maino D Alport syndrome a review Clin Eye Vis Care 2000 Dec12(3-4)139-50

Block SS Brusca-Vega R Pizzi WJ et al Cognitive and visual processing skills and their relationship to mutation size in full and

permutation female fragile X carriers Optom Vis Sci 2000 Nov77 (11)592-9

Maino D The young child with developmental disabilities An introduction to mental retardation and genetic syndromes In Moore BD

(ed) Eye Care for Infants and Young Children Butter-worth--Heinemann Newton MA1997285-300

Amin V Maino D The Fragile X female Visual visual perceptual and ocular health anomalies J Am Optom Assoc 1995 May66

(5)290-95

Maino DM Maino JH Cibis GW Hecht F Ocular health anomalies in patients with developmental disabilities In Maino D (ed)

Diagnosis and Management of Special Populations Mosby-Year-book Inc St Louis MO 1995189-206 Reprinted Optometric

Education Program Foundation Santa Anna Calif 2001

Maino D Wesson M Schlange D Cibis G Maino J Optometric findings in the fragile X syndrome Optom Vis Sci 199168634-40

Scheiman MMOptometric findings in children with cerebral palsy Am J Optom Physiol Opt 1984 May61(5)321-3

Maino D Maino J Maino S Mental retardation syndromes with associated ocular defects J Am Optom Assoc 199061707-16

Stewart RE Woodhouse JM Cregg M Pakeman VH Association between accommodative accuracy hypermetropia and strabismus in

children with Downs syndrome Optom Vis Sci 2007 Feb84(2)149-55

Cregg M Woodhouse JM Pakeman VH et al Accommodation and refractive error in children with Down syndrome cross-sectional

and longitudinal studies Invest Ophthalmol Vis Sci 2001 Jan42 (1)55-63

79

McClelland JF Parkes J Hill N et al Accommodative dysfunction in children with cerebral palsy a population-

based study Invest Ophthalmol Vis Sci 2006 May47(5)1824-30

Duckman RH Vision therapy for the child with cerebral palsy J Am Optom Assoc 198758(1)28-35

Duckman R Accommodation in cerebral palsy function and remediation J Am Optom Assoc 198455(4)281-3

Scheiman M Understanding and managing vision deficits a guide for occupational therapists 2nd ed Slack

Thorofare NJ 2002

Maino D Binasal occlusion for the child with Cerebral Palsy J Ill Optom Assoc 198644(1)1218

Battaglia F Quartarone A Rizzo V et al Early impairment of synaptic plasticity in patients with Downs syndrome

Neurobiol Aging 2008 Aug29(8)1272-5

Bonnier C Evaluation of early stimulation programs for enhancing brain development Acta Paediatr 2008

Jul97(7)853-8

Morice E Andreae LC Cooke SF et al Preservation of long-term memory and synaptic plasticity despite short-term

impairments in the Tc1 mouse model of Down syndrome Learn Mem 2008 Jul 1415(7)492-500

Gordon AM Schneider JA Chinnan A Charles JR Efficacy of a hand-arm bimanual intensive therapy (HABIT) in

children with hemiplegic cerebral palsy a randomized control trial Dev Med Child Neurol 2007 Nov49(11)830-8

Kapoor N Ciuffreda KJ Vision disturbances following traumatic brain injury Curr Treat Options Neurol 2002

Jul4(4)271-80

80

Ciuffreda KJ Rutner D Kapoor N et al Vision therapy for oculomotor dysfunctions in acquired brain injury a

retrospective analysis Optometry 2008 Jan79(1)18-22

Ciuffreda KJ Han Y Kapoor N Ficarra AP Oculomotor rehabilitation for reading in acquired brain injury

NeuroRehabilitation 200621(1)9-21

Zost M Diagnosis and management of visual dysfunction in cerebral injury In Maino D (ed) Diagnosis and

Management of Special Populations Mosby-Yearbook Inc St Louis 199579 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001 [Figure used with permission of the editor]

DeGutis JM Bentin S Robertson LC DEsposito M Functional plasticity in ventral temporal cortex following

cognitive rehabilitation of a congenital prosopagnosic J Cogn Neurosci 2007 Nov19 (11)1790-802

Welbourne SR Ralph MA Exploring the impact of plasticity-related recovery after brain damage in a connectionist

model of single-word reading Cogn Affect Behav Neurosci 2005 Mar5(1)77-92

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements prevent cognitive decline A

systematic review of randomized controlled trials J Hum Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among preterm infants attributable to early

supplementation of human milk with docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings and structural-functional

synergies with cell membrane phospholipids Altern Med Rev 2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function Neuroscience 20089(7)568-78

81

Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

BMC Biol 2008 Sep 9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine improves neuropsychological disorders in a child with

creatine transporter defect Neurocase 200814(2) 151-61

Forrester LW Wheaton LA Luft AR Exercise-mediated locomotor recovery and lower-limb neuroplasticity after

stroke J Rehabil Res Dev 200845(2)205-20

82

Page 71: Neuroplasticity: A Paradigm Sea Change Latest Updated File

PresenterTitle Contact info

Neuroplasticity-A Paradigm Sea Change

This presentation is available at

httpwwwslidesharenetDMAINOneuroplasticity-a-paradigm-sea-change-2459693

httpwwwmainosmemosblogspotcom

My FaceBook Page

and

Twitter

PresenterTitle Contact info

Questions About

Neuroplasticity-A Paradigm Sea Change

Dominick M Maino OD MEd FAAO FCOVD-A

Professor PediatricsBinocular VisionIllinois Eye InstituteIllinois College of Optometry

dmainoicoeduhttpwwwMainosMemosblogspotcom

Thanks to

httpwwwcovdorgHomeOVDJournalOVD401tabid263D

efaultaspx

httpbipolarblastfileswordpresscom200908neurojpg

httpwwwspecialcheerscomimagesanimated_braingif

httpblogmarsdencartoonscomwp-

contentuploads200810frankenstein-myspace-lightbeergif

httpwwwshangralafamilyfuncomgala-ecalvindreamgif

httppsychiatryjwatchorgcgicontentfull20082251

73

Chakraborty R Chatterjee A Choudhart S Chakraborty PK Neuroplasticitymdasha paradigm shift in neurosciences J Indian Med Assoc

2007105(9)513-4516-8520-1

Sacks O A neurologistlsquos notebook Stereo Sue Why two eyes are better than one The New Yorker 2006 Jun 1964-73

Krulwich R National Public Radio Going Binocular Susanlsquos First Snowfall Available at

wwwnprorgtemplatesstorystoryphpstoryId=5507789 (Accessed December 8 2008)

Press LJ The story behind Stereo Suelsquo and a world-famous neurologistlsquos discovery of vision therapy Optom Vis Dev 200637(2) 55-7

Levin HS Neuroplasticity and brain imaging research implications for rehabilitation Arch Phys Med Rehabil 2006 Dec87(12 Suppl

2)S1

Wiesel TN Hubel DH Single-cell responses in striate cortex of kittens deprived of vision in one eye J Neurophysiol 1963

Nov261003-17

Hook BM Chen C Critical periods in the visual system Changing views for a model of experience-dependent plasticity Neuron 2007

Oct56(2)312-26

Ramey CT Ramey SL Prevention of intellectual disabilities early interventions to improve cognitive development Prev Med 1998

Mar-Apr27(2)224-32

Heuninckx S Wenderoth N Swinnen SP Systems neuroplasticity in the aging brain recruiting additional neural resources for

successful motor performance in elderly persons J Neurosci 2008 Jan 228(1)91-9

Ge S Yang CH Hsu KS et al A critical period for enhanced synaptic plasticity in newly generated neurons of the adult brain Neuron

2007 May54(4)559-66

74

Draganski B Gaser C Busch V et al Neuroplasticity changes in grey matter induced by training Nature 2004 Jan 22427(6972)

311-2

Cannonieri GC Bonilha L Fernandes PT et al Practice and perfect length of training and structural brain changes in experienced

typists Neuroreport 2007 Jul 218(10)1063-6

Kleim JA Jones TA Principles of experience-dependent neural plasticity implications for rehabilitation after brain damage J

Speech Lang Hear Res 2008 Feb51(1)S225-39

Trojan S Porkorny J Theoretical aspects of neuroplasticity Physiol Res 199948(2)87-97

Ramamirtham R Kee CS Hung LF et al Wave aberrations in rhesus monkeys with vision-induced ametropias Vision Res 2007

Sep47(21)2751-66

Smith EL 3rd Ramamirtham R Qiao-Grider Y et al Effects of foveal ablation on emmetropization and form-deprivation myopia

Invest Ophthalmol Vis Sci 2007 Sep48(9)3914-22

Smith EL 3rd Kee CS Ramamirtham R et al Peripheral vision can influence eye growth and refractive development in infant

monkeys Invest Ophthalmol Vis Sci 2005 Nov46(11)3965-72

Ciuffreda KJ Vasudevan B Nearwork-induced transient myopia (NITM) and permanent myopiandashndashis there a link Ophthalmic

Physiol Opt 2008 Mar28(2)103-14

Hung GK Ciuffreda KJ Incremental retinal-defocus theory of myopia development--schematic analysis and computer simulation

Comput Biol Med 2007 Jul37(7)930-46

Hung GK Ciuffreda KJ A unifying theory of refractive error development Bull Math Biol 2000 Nov62(6)1087-108

75

Pang Y Maino D Zhang G Lu F Myopia Can its progress be controlled Optom Vis Dev 200637(2)75-9

Leung JT Brown B Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lenses Optom Vis Sci

1999 Jun76(6)346-54

Hasebe S Ohtsuki H Nonaka T et al Effect of progressive addition lenses on myopia progression in Japanese children a prospective

randomized double-masked crossover trial Invest Ophthalmol Vis Sci 2008 Jul49(7)2781-9

Gwiazda J Hyman L Hussein M et al A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression

of myopia in children Invest Ophthalmol Vis Sci 2003 Apr44(4)1492-500

Siatkowski RM Cotter SA Crockett RS et al Two-year multi-center randomized double-masked placebo-controlled parallel safety and

efficacy study of 2 pirenzepine ophthalmic gel in children with myopia J AAPOS 2008 Aug12(4)332-9

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged 7 to 17 years Arch Ophthalmol 2005

Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three to less than 10 years of age Am J

Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction Am J Ophthalmol 2007

Jun143(6)1060-3

Holmes JM Edwards AR Beck RW et al A randomized pilot study of near activities versus non-near activities during patching therapy for

amblyopia J AAPOS 2005 Apr9(2)129-36

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate

amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-57

76

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic

amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Convergence Insufficiency Treatment Trial Study Group Randomized clinical trial of treatments for symptomatic convergence insufficiency

in children Arch Ophthalmol 2008 Oct126(10)1336-49

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

Solan HA Shelley-Tremblay J Hansen PC et al M-cell deficit and reading disability a preliminary study of the effects of temporal vision-

processing therapy Optometry 2004 Oct75(10)640-50

Solan HA Larson S Shelley-Tremblay J et al Role of visual attention in cognitive control of oculomotor readiness in students with reading

disabilities J Learn Disabil 2001 Mar-Apr34(2)107-18

Gallaway M Boas MB The impact of vergence and accommodative therapy on reading eye movements and reading speed Optom Vis Dev

200738(3)115-20

Goss DA Downing DB Lowther AH et al The effect of HTS vision therapy conducted in a school setting on reading skills in third and

fourth grade students Optom Vis Dev 200738(1)27-32

Crutch SJ Warrington EK Foveal crowding in posterior cortical atrophy a specific early-visual-processing deficit affecting word reading

Cogn Neuropsychol 2007 Dec24(8)843-66

Helms D Sawtelle SM A study of the effectiveness of cognitive therapy delivered in a video game format Optom Vis Dev 200738 (1)19-

26

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

77

Lawton T Training direction-discrimination sensitivity remediates a wide spectrum of reading skills OptomVis Dev 200738(1) 33-47

Goldstand S Koslowe KC Parush S Vision visual-information processing and academic performance among seventh-grade schoolchildren a

more significant relationship than we thought Am J Occup Ther 2005 Jul-Aug59(4)377-89

Fischer B Koumlngeter A Hartnegg K Effects of daily practice on subitizing visual counting and basic arithmetic skills Optom Vis Dev

200839(1)30-4

Sands W Taub M Maino D Limited research and education on special populations in optometry and ophthalomology Optom Vis Dev

200839(2)60-1

Wesson M Maino D Oculo-visual findings in Down syndrome cerebral palsy and mental retardation with non-specific etiology In Maino D

(ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 199517-54 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

Cui Y Stapleton F Suttle C Developing an instrument to assess vision-related and subjective quality of life in children with intellectual

disability data collection and preliminary analysis in a Chinese population Ophthal Physiolog Optics 2008 May28(3) 238-46

Maino D Steele G Tahir S Sajja R Attitudes of optometry students toward individuals with disabilities Optom Ed 200227(2)45-50

Maino D Special populations in the optometric curriculum Optom Ed 200227(2)38-9

Maino D Overview of special populations In Scheiman M Rouse M (eds) Optometric Management of Learning-Related Vision Problems

St Louis Mosby Inc 200685-106

Maino D (ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 1995 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

78

McCarthy P Maino D Alport syndrome a review Clin Eye Vis Care 2000 Dec12(3-4)139-50

Block SS Brusca-Vega R Pizzi WJ et al Cognitive and visual processing skills and their relationship to mutation size in full and

permutation female fragile X carriers Optom Vis Sci 2000 Nov77 (11)592-9

Maino D The young child with developmental disabilities An introduction to mental retardation and genetic syndromes In Moore BD

(ed) Eye Care for Infants and Young Children Butter-worth--Heinemann Newton MA1997285-300

Amin V Maino D The Fragile X female Visual visual perceptual and ocular health anomalies J Am Optom Assoc 1995 May66

(5)290-95

Maino DM Maino JH Cibis GW Hecht F Ocular health anomalies in patients with developmental disabilities In Maino D (ed)

Diagnosis and Management of Special Populations Mosby-Year-book Inc St Louis MO 1995189-206 Reprinted Optometric

Education Program Foundation Santa Anna Calif 2001

Maino D Wesson M Schlange D Cibis G Maino J Optometric findings in the fragile X syndrome Optom Vis Sci 199168634-40

Scheiman MMOptometric findings in children with cerebral palsy Am J Optom Physiol Opt 1984 May61(5)321-3

Maino D Maino J Maino S Mental retardation syndromes with associated ocular defects J Am Optom Assoc 199061707-16

Stewart RE Woodhouse JM Cregg M Pakeman VH Association between accommodative accuracy hypermetropia and strabismus in

children with Downs syndrome Optom Vis Sci 2007 Feb84(2)149-55

Cregg M Woodhouse JM Pakeman VH et al Accommodation and refractive error in children with Down syndrome cross-sectional

and longitudinal studies Invest Ophthalmol Vis Sci 2001 Jan42 (1)55-63

79

McClelland JF Parkes J Hill N et al Accommodative dysfunction in children with cerebral palsy a population-

based study Invest Ophthalmol Vis Sci 2006 May47(5)1824-30

Duckman RH Vision therapy for the child with cerebral palsy J Am Optom Assoc 198758(1)28-35

Duckman R Accommodation in cerebral palsy function and remediation J Am Optom Assoc 198455(4)281-3

Scheiman M Understanding and managing vision deficits a guide for occupational therapists 2nd ed Slack

Thorofare NJ 2002

Maino D Binasal occlusion for the child with Cerebral Palsy J Ill Optom Assoc 198644(1)1218

Battaglia F Quartarone A Rizzo V et al Early impairment of synaptic plasticity in patients with Downs syndrome

Neurobiol Aging 2008 Aug29(8)1272-5

Bonnier C Evaluation of early stimulation programs for enhancing brain development Acta Paediatr 2008

Jul97(7)853-8

Morice E Andreae LC Cooke SF et al Preservation of long-term memory and synaptic plasticity despite short-term

impairments in the Tc1 mouse model of Down syndrome Learn Mem 2008 Jul 1415(7)492-500

Gordon AM Schneider JA Chinnan A Charles JR Efficacy of a hand-arm bimanual intensive therapy (HABIT) in

children with hemiplegic cerebral palsy a randomized control trial Dev Med Child Neurol 2007 Nov49(11)830-8

Kapoor N Ciuffreda KJ Vision disturbances following traumatic brain injury Curr Treat Options Neurol 2002

Jul4(4)271-80

80

Ciuffreda KJ Rutner D Kapoor N et al Vision therapy for oculomotor dysfunctions in acquired brain injury a

retrospective analysis Optometry 2008 Jan79(1)18-22

Ciuffreda KJ Han Y Kapoor N Ficarra AP Oculomotor rehabilitation for reading in acquired brain injury

NeuroRehabilitation 200621(1)9-21

Zost M Diagnosis and management of visual dysfunction in cerebral injury In Maino D (ed) Diagnosis and

Management of Special Populations Mosby-Yearbook Inc St Louis 199579 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001 [Figure used with permission of the editor]

DeGutis JM Bentin S Robertson LC DEsposito M Functional plasticity in ventral temporal cortex following

cognitive rehabilitation of a congenital prosopagnosic J Cogn Neurosci 2007 Nov19 (11)1790-802

Welbourne SR Ralph MA Exploring the impact of plasticity-related recovery after brain damage in a connectionist

model of single-word reading Cogn Affect Behav Neurosci 2005 Mar5(1)77-92

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements prevent cognitive decline A

systematic review of randomized controlled trials J Hum Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among preterm infants attributable to early

supplementation of human milk with docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings and structural-functional

synergies with cell membrane phospholipids Altern Med Rev 2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function Neuroscience 20089(7)568-78

81

Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

BMC Biol 2008 Sep 9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine improves neuropsychological disorders in a child with

creatine transporter defect Neurocase 200814(2) 151-61

Forrester LW Wheaton LA Luft AR Exercise-mediated locomotor recovery and lower-limb neuroplasticity after

stroke J Rehabil Res Dev 200845(2)205-20

82

Page 72: Neuroplasticity: A Paradigm Sea Change Latest Updated File

PresenterTitle Contact info

Questions About

Neuroplasticity-A Paradigm Sea Change

Dominick M Maino OD MEd FAAO FCOVD-A

Professor PediatricsBinocular VisionIllinois Eye InstituteIllinois College of Optometry

dmainoicoeduhttpwwwMainosMemosblogspotcom

Thanks to

httpwwwcovdorgHomeOVDJournalOVD401tabid263D

efaultaspx

httpbipolarblastfileswordpresscom200908neurojpg

httpwwwspecialcheerscomimagesanimated_braingif

httpblogmarsdencartoonscomwp-

contentuploads200810frankenstein-myspace-lightbeergif

httpwwwshangralafamilyfuncomgala-ecalvindreamgif

httppsychiatryjwatchorgcgicontentfull20082251

73

Chakraborty R Chatterjee A Choudhart S Chakraborty PK Neuroplasticitymdasha paradigm shift in neurosciences J Indian Med Assoc

2007105(9)513-4516-8520-1

Sacks O A neurologistlsquos notebook Stereo Sue Why two eyes are better than one The New Yorker 2006 Jun 1964-73

Krulwich R National Public Radio Going Binocular Susanlsquos First Snowfall Available at

wwwnprorgtemplatesstorystoryphpstoryId=5507789 (Accessed December 8 2008)

Press LJ The story behind Stereo Suelsquo and a world-famous neurologistlsquos discovery of vision therapy Optom Vis Dev 200637(2) 55-7

Levin HS Neuroplasticity and brain imaging research implications for rehabilitation Arch Phys Med Rehabil 2006 Dec87(12 Suppl

2)S1

Wiesel TN Hubel DH Single-cell responses in striate cortex of kittens deprived of vision in one eye J Neurophysiol 1963

Nov261003-17

Hook BM Chen C Critical periods in the visual system Changing views for a model of experience-dependent plasticity Neuron 2007

Oct56(2)312-26

Ramey CT Ramey SL Prevention of intellectual disabilities early interventions to improve cognitive development Prev Med 1998

Mar-Apr27(2)224-32

Heuninckx S Wenderoth N Swinnen SP Systems neuroplasticity in the aging brain recruiting additional neural resources for

successful motor performance in elderly persons J Neurosci 2008 Jan 228(1)91-9

Ge S Yang CH Hsu KS et al A critical period for enhanced synaptic plasticity in newly generated neurons of the adult brain Neuron

2007 May54(4)559-66

74

Draganski B Gaser C Busch V et al Neuroplasticity changes in grey matter induced by training Nature 2004 Jan 22427(6972)

311-2

Cannonieri GC Bonilha L Fernandes PT et al Practice and perfect length of training and structural brain changes in experienced

typists Neuroreport 2007 Jul 218(10)1063-6

Kleim JA Jones TA Principles of experience-dependent neural plasticity implications for rehabilitation after brain damage J

Speech Lang Hear Res 2008 Feb51(1)S225-39

Trojan S Porkorny J Theoretical aspects of neuroplasticity Physiol Res 199948(2)87-97

Ramamirtham R Kee CS Hung LF et al Wave aberrations in rhesus monkeys with vision-induced ametropias Vision Res 2007

Sep47(21)2751-66

Smith EL 3rd Ramamirtham R Qiao-Grider Y et al Effects of foveal ablation on emmetropization and form-deprivation myopia

Invest Ophthalmol Vis Sci 2007 Sep48(9)3914-22

Smith EL 3rd Kee CS Ramamirtham R et al Peripheral vision can influence eye growth and refractive development in infant

monkeys Invest Ophthalmol Vis Sci 2005 Nov46(11)3965-72

Ciuffreda KJ Vasudevan B Nearwork-induced transient myopia (NITM) and permanent myopiandashndashis there a link Ophthalmic

Physiol Opt 2008 Mar28(2)103-14

Hung GK Ciuffreda KJ Incremental retinal-defocus theory of myopia development--schematic analysis and computer simulation

Comput Biol Med 2007 Jul37(7)930-46

Hung GK Ciuffreda KJ A unifying theory of refractive error development Bull Math Biol 2000 Nov62(6)1087-108

75

Pang Y Maino D Zhang G Lu F Myopia Can its progress be controlled Optom Vis Dev 200637(2)75-9

Leung JT Brown B Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lenses Optom Vis Sci

1999 Jun76(6)346-54

Hasebe S Ohtsuki H Nonaka T et al Effect of progressive addition lenses on myopia progression in Japanese children a prospective

randomized double-masked crossover trial Invest Ophthalmol Vis Sci 2008 Jul49(7)2781-9

Gwiazda J Hyman L Hussein M et al A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression

of myopia in children Invest Ophthalmol Vis Sci 2003 Apr44(4)1492-500

Siatkowski RM Cotter SA Crockett RS et al Two-year multi-center randomized double-masked placebo-controlled parallel safety and

efficacy study of 2 pirenzepine ophthalmic gel in children with myopia J AAPOS 2008 Aug12(4)332-9

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged 7 to 17 years Arch Ophthalmol 2005

Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three to less than 10 years of age Am J

Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction Am J Ophthalmol 2007

Jun143(6)1060-3

Holmes JM Edwards AR Beck RW et al A randomized pilot study of near activities versus non-near activities during patching therapy for

amblyopia J AAPOS 2005 Apr9(2)129-36

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate

amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-57

76

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic

amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Convergence Insufficiency Treatment Trial Study Group Randomized clinical trial of treatments for symptomatic convergence insufficiency

in children Arch Ophthalmol 2008 Oct126(10)1336-49

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

Solan HA Shelley-Tremblay J Hansen PC et al M-cell deficit and reading disability a preliminary study of the effects of temporal vision-

processing therapy Optometry 2004 Oct75(10)640-50

Solan HA Larson S Shelley-Tremblay J et al Role of visual attention in cognitive control of oculomotor readiness in students with reading

disabilities J Learn Disabil 2001 Mar-Apr34(2)107-18

Gallaway M Boas MB The impact of vergence and accommodative therapy on reading eye movements and reading speed Optom Vis Dev

200738(3)115-20

Goss DA Downing DB Lowther AH et al The effect of HTS vision therapy conducted in a school setting on reading skills in third and

fourth grade students Optom Vis Dev 200738(1)27-32

Crutch SJ Warrington EK Foveal crowding in posterior cortical atrophy a specific early-visual-processing deficit affecting word reading

Cogn Neuropsychol 2007 Dec24(8)843-66

Helms D Sawtelle SM A study of the effectiveness of cognitive therapy delivered in a video game format Optom Vis Dev 200738 (1)19-

26

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

77

Lawton T Training direction-discrimination sensitivity remediates a wide spectrum of reading skills OptomVis Dev 200738(1) 33-47

Goldstand S Koslowe KC Parush S Vision visual-information processing and academic performance among seventh-grade schoolchildren a

more significant relationship than we thought Am J Occup Ther 2005 Jul-Aug59(4)377-89

Fischer B Koumlngeter A Hartnegg K Effects of daily practice on subitizing visual counting and basic arithmetic skills Optom Vis Dev

200839(1)30-4

Sands W Taub M Maino D Limited research and education on special populations in optometry and ophthalomology Optom Vis Dev

200839(2)60-1

Wesson M Maino D Oculo-visual findings in Down syndrome cerebral palsy and mental retardation with non-specific etiology In Maino D

(ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 199517-54 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

Cui Y Stapleton F Suttle C Developing an instrument to assess vision-related and subjective quality of life in children with intellectual

disability data collection and preliminary analysis in a Chinese population Ophthal Physiolog Optics 2008 May28(3) 238-46

Maino D Steele G Tahir S Sajja R Attitudes of optometry students toward individuals with disabilities Optom Ed 200227(2)45-50

Maino D Special populations in the optometric curriculum Optom Ed 200227(2)38-9

Maino D Overview of special populations In Scheiman M Rouse M (eds) Optometric Management of Learning-Related Vision Problems

St Louis Mosby Inc 200685-106

Maino D (ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 1995 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

78

McCarthy P Maino D Alport syndrome a review Clin Eye Vis Care 2000 Dec12(3-4)139-50

Block SS Brusca-Vega R Pizzi WJ et al Cognitive and visual processing skills and their relationship to mutation size in full and

permutation female fragile X carriers Optom Vis Sci 2000 Nov77 (11)592-9

Maino D The young child with developmental disabilities An introduction to mental retardation and genetic syndromes In Moore BD

(ed) Eye Care for Infants and Young Children Butter-worth--Heinemann Newton MA1997285-300

Amin V Maino D The Fragile X female Visual visual perceptual and ocular health anomalies J Am Optom Assoc 1995 May66

(5)290-95

Maino DM Maino JH Cibis GW Hecht F Ocular health anomalies in patients with developmental disabilities In Maino D (ed)

Diagnosis and Management of Special Populations Mosby-Year-book Inc St Louis MO 1995189-206 Reprinted Optometric

Education Program Foundation Santa Anna Calif 2001

Maino D Wesson M Schlange D Cibis G Maino J Optometric findings in the fragile X syndrome Optom Vis Sci 199168634-40

Scheiman MMOptometric findings in children with cerebral palsy Am J Optom Physiol Opt 1984 May61(5)321-3

Maino D Maino J Maino S Mental retardation syndromes with associated ocular defects J Am Optom Assoc 199061707-16

Stewart RE Woodhouse JM Cregg M Pakeman VH Association between accommodative accuracy hypermetropia and strabismus in

children with Downs syndrome Optom Vis Sci 2007 Feb84(2)149-55

Cregg M Woodhouse JM Pakeman VH et al Accommodation and refractive error in children with Down syndrome cross-sectional

and longitudinal studies Invest Ophthalmol Vis Sci 2001 Jan42 (1)55-63

79

McClelland JF Parkes J Hill N et al Accommodative dysfunction in children with cerebral palsy a population-

based study Invest Ophthalmol Vis Sci 2006 May47(5)1824-30

Duckman RH Vision therapy for the child with cerebral palsy J Am Optom Assoc 198758(1)28-35

Duckman R Accommodation in cerebral palsy function and remediation J Am Optom Assoc 198455(4)281-3

Scheiman M Understanding and managing vision deficits a guide for occupational therapists 2nd ed Slack

Thorofare NJ 2002

Maino D Binasal occlusion for the child with Cerebral Palsy J Ill Optom Assoc 198644(1)1218

Battaglia F Quartarone A Rizzo V et al Early impairment of synaptic plasticity in patients with Downs syndrome

Neurobiol Aging 2008 Aug29(8)1272-5

Bonnier C Evaluation of early stimulation programs for enhancing brain development Acta Paediatr 2008

Jul97(7)853-8

Morice E Andreae LC Cooke SF et al Preservation of long-term memory and synaptic plasticity despite short-term

impairments in the Tc1 mouse model of Down syndrome Learn Mem 2008 Jul 1415(7)492-500

Gordon AM Schneider JA Chinnan A Charles JR Efficacy of a hand-arm bimanual intensive therapy (HABIT) in

children with hemiplegic cerebral palsy a randomized control trial Dev Med Child Neurol 2007 Nov49(11)830-8

Kapoor N Ciuffreda KJ Vision disturbances following traumatic brain injury Curr Treat Options Neurol 2002

Jul4(4)271-80

80

Ciuffreda KJ Rutner D Kapoor N et al Vision therapy for oculomotor dysfunctions in acquired brain injury a

retrospective analysis Optometry 2008 Jan79(1)18-22

Ciuffreda KJ Han Y Kapoor N Ficarra AP Oculomotor rehabilitation for reading in acquired brain injury

NeuroRehabilitation 200621(1)9-21

Zost M Diagnosis and management of visual dysfunction in cerebral injury In Maino D (ed) Diagnosis and

Management of Special Populations Mosby-Yearbook Inc St Louis 199579 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001 [Figure used with permission of the editor]

DeGutis JM Bentin S Robertson LC DEsposito M Functional plasticity in ventral temporal cortex following

cognitive rehabilitation of a congenital prosopagnosic J Cogn Neurosci 2007 Nov19 (11)1790-802

Welbourne SR Ralph MA Exploring the impact of plasticity-related recovery after brain damage in a connectionist

model of single-word reading Cogn Affect Behav Neurosci 2005 Mar5(1)77-92

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements prevent cognitive decline A

systematic review of randomized controlled trials J Hum Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among preterm infants attributable to early

supplementation of human milk with docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings and structural-functional

synergies with cell membrane phospholipids Altern Med Rev 2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function Neuroscience 20089(7)568-78

81

Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

BMC Biol 2008 Sep 9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine improves neuropsychological disorders in a child with

creatine transporter defect Neurocase 200814(2) 151-61

Forrester LW Wheaton LA Luft AR Exercise-mediated locomotor recovery and lower-limb neuroplasticity after

stroke J Rehabil Res Dev 200845(2)205-20

82

Page 73: Neuroplasticity: A Paradigm Sea Change Latest Updated File

Thanks to

httpwwwcovdorgHomeOVDJournalOVD401tabid263D

efaultaspx

httpbipolarblastfileswordpresscom200908neurojpg

httpwwwspecialcheerscomimagesanimated_braingif

httpblogmarsdencartoonscomwp-

contentuploads200810frankenstein-myspace-lightbeergif

httpwwwshangralafamilyfuncomgala-ecalvindreamgif

httppsychiatryjwatchorgcgicontentfull20082251

73

Chakraborty R Chatterjee A Choudhart S Chakraborty PK Neuroplasticitymdasha paradigm shift in neurosciences J Indian Med Assoc

2007105(9)513-4516-8520-1

Sacks O A neurologistlsquos notebook Stereo Sue Why two eyes are better than one The New Yorker 2006 Jun 1964-73

Krulwich R National Public Radio Going Binocular Susanlsquos First Snowfall Available at

wwwnprorgtemplatesstorystoryphpstoryId=5507789 (Accessed December 8 2008)

Press LJ The story behind Stereo Suelsquo and a world-famous neurologistlsquos discovery of vision therapy Optom Vis Dev 200637(2) 55-7

Levin HS Neuroplasticity and brain imaging research implications for rehabilitation Arch Phys Med Rehabil 2006 Dec87(12 Suppl

2)S1

Wiesel TN Hubel DH Single-cell responses in striate cortex of kittens deprived of vision in one eye J Neurophysiol 1963

Nov261003-17

Hook BM Chen C Critical periods in the visual system Changing views for a model of experience-dependent plasticity Neuron 2007

Oct56(2)312-26

Ramey CT Ramey SL Prevention of intellectual disabilities early interventions to improve cognitive development Prev Med 1998

Mar-Apr27(2)224-32

Heuninckx S Wenderoth N Swinnen SP Systems neuroplasticity in the aging brain recruiting additional neural resources for

successful motor performance in elderly persons J Neurosci 2008 Jan 228(1)91-9

Ge S Yang CH Hsu KS et al A critical period for enhanced synaptic plasticity in newly generated neurons of the adult brain Neuron

2007 May54(4)559-66

74

Draganski B Gaser C Busch V et al Neuroplasticity changes in grey matter induced by training Nature 2004 Jan 22427(6972)

311-2

Cannonieri GC Bonilha L Fernandes PT et al Practice and perfect length of training and structural brain changes in experienced

typists Neuroreport 2007 Jul 218(10)1063-6

Kleim JA Jones TA Principles of experience-dependent neural plasticity implications for rehabilitation after brain damage J

Speech Lang Hear Res 2008 Feb51(1)S225-39

Trojan S Porkorny J Theoretical aspects of neuroplasticity Physiol Res 199948(2)87-97

Ramamirtham R Kee CS Hung LF et al Wave aberrations in rhesus monkeys with vision-induced ametropias Vision Res 2007

Sep47(21)2751-66

Smith EL 3rd Ramamirtham R Qiao-Grider Y et al Effects of foveal ablation on emmetropization and form-deprivation myopia

Invest Ophthalmol Vis Sci 2007 Sep48(9)3914-22

Smith EL 3rd Kee CS Ramamirtham R et al Peripheral vision can influence eye growth and refractive development in infant

monkeys Invest Ophthalmol Vis Sci 2005 Nov46(11)3965-72

Ciuffreda KJ Vasudevan B Nearwork-induced transient myopia (NITM) and permanent myopiandashndashis there a link Ophthalmic

Physiol Opt 2008 Mar28(2)103-14

Hung GK Ciuffreda KJ Incremental retinal-defocus theory of myopia development--schematic analysis and computer simulation

Comput Biol Med 2007 Jul37(7)930-46

Hung GK Ciuffreda KJ A unifying theory of refractive error development Bull Math Biol 2000 Nov62(6)1087-108

75

Pang Y Maino D Zhang G Lu F Myopia Can its progress be controlled Optom Vis Dev 200637(2)75-9

Leung JT Brown B Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lenses Optom Vis Sci

1999 Jun76(6)346-54

Hasebe S Ohtsuki H Nonaka T et al Effect of progressive addition lenses on myopia progression in Japanese children a prospective

randomized double-masked crossover trial Invest Ophthalmol Vis Sci 2008 Jul49(7)2781-9

Gwiazda J Hyman L Hussein M et al A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression

of myopia in children Invest Ophthalmol Vis Sci 2003 Apr44(4)1492-500

Siatkowski RM Cotter SA Crockett RS et al Two-year multi-center randomized double-masked placebo-controlled parallel safety and

efficacy study of 2 pirenzepine ophthalmic gel in children with myopia J AAPOS 2008 Aug12(4)332-9

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged 7 to 17 years Arch Ophthalmol 2005

Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three to less than 10 years of age Am J

Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction Am J Ophthalmol 2007

Jun143(6)1060-3

Holmes JM Edwards AR Beck RW et al A randomized pilot study of near activities versus non-near activities during patching therapy for

amblyopia J AAPOS 2005 Apr9(2)129-36

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate

amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-57

76

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic

amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Convergence Insufficiency Treatment Trial Study Group Randomized clinical trial of treatments for symptomatic convergence insufficiency

in children Arch Ophthalmol 2008 Oct126(10)1336-49

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

Solan HA Shelley-Tremblay J Hansen PC et al M-cell deficit and reading disability a preliminary study of the effects of temporal vision-

processing therapy Optometry 2004 Oct75(10)640-50

Solan HA Larson S Shelley-Tremblay J et al Role of visual attention in cognitive control of oculomotor readiness in students with reading

disabilities J Learn Disabil 2001 Mar-Apr34(2)107-18

Gallaway M Boas MB The impact of vergence and accommodative therapy on reading eye movements and reading speed Optom Vis Dev

200738(3)115-20

Goss DA Downing DB Lowther AH et al The effect of HTS vision therapy conducted in a school setting on reading skills in third and

fourth grade students Optom Vis Dev 200738(1)27-32

Crutch SJ Warrington EK Foveal crowding in posterior cortical atrophy a specific early-visual-processing deficit affecting word reading

Cogn Neuropsychol 2007 Dec24(8)843-66

Helms D Sawtelle SM A study of the effectiveness of cognitive therapy delivered in a video game format Optom Vis Dev 200738 (1)19-

26

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

77

Lawton T Training direction-discrimination sensitivity remediates a wide spectrum of reading skills OptomVis Dev 200738(1) 33-47

Goldstand S Koslowe KC Parush S Vision visual-information processing and academic performance among seventh-grade schoolchildren a

more significant relationship than we thought Am J Occup Ther 2005 Jul-Aug59(4)377-89

Fischer B Koumlngeter A Hartnegg K Effects of daily practice on subitizing visual counting and basic arithmetic skills Optom Vis Dev

200839(1)30-4

Sands W Taub M Maino D Limited research and education on special populations in optometry and ophthalomology Optom Vis Dev

200839(2)60-1

Wesson M Maino D Oculo-visual findings in Down syndrome cerebral palsy and mental retardation with non-specific etiology In Maino D

(ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 199517-54 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

Cui Y Stapleton F Suttle C Developing an instrument to assess vision-related and subjective quality of life in children with intellectual

disability data collection and preliminary analysis in a Chinese population Ophthal Physiolog Optics 2008 May28(3) 238-46

Maino D Steele G Tahir S Sajja R Attitudes of optometry students toward individuals with disabilities Optom Ed 200227(2)45-50

Maino D Special populations in the optometric curriculum Optom Ed 200227(2)38-9

Maino D Overview of special populations In Scheiman M Rouse M (eds) Optometric Management of Learning-Related Vision Problems

St Louis Mosby Inc 200685-106

Maino D (ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 1995 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

78

McCarthy P Maino D Alport syndrome a review Clin Eye Vis Care 2000 Dec12(3-4)139-50

Block SS Brusca-Vega R Pizzi WJ et al Cognitive and visual processing skills and their relationship to mutation size in full and

permutation female fragile X carriers Optom Vis Sci 2000 Nov77 (11)592-9

Maino D The young child with developmental disabilities An introduction to mental retardation and genetic syndromes In Moore BD

(ed) Eye Care for Infants and Young Children Butter-worth--Heinemann Newton MA1997285-300

Amin V Maino D The Fragile X female Visual visual perceptual and ocular health anomalies J Am Optom Assoc 1995 May66

(5)290-95

Maino DM Maino JH Cibis GW Hecht F Ocular health anomalies in patients with developmental disabilities In Maino D (ed)

Diagnosis and Management of Special Populations Mosby-Year-book Inc St Louis MO 1995189-206 Reprinted Optometric

Education Program Foundation Santa Anna Calif 2001

Maino D Wesson M Schlange D Cibis G Maino J Optometric findings in the fragile X syndrome Optom Vis Sci 199168634-40

Scheiman MMOptometric findings in children with cerebral palsy Am J Optom Physiol Opt 1984 May61(5)321-3

Maino D Maino J Maino S Mental retardation syndromes with associated ocular defects J Am Optom Assoc 199061707-16

Stewart RE Woodhouse JM Cregg M Pakeman VH Association between accommodative accuracy hypermetropia and strabismus in

children with Downs syndrome Optom Vis Sci 2007 Feb84(2)149-55

Cregg M Woodhouse JM Pakeman VH et al Accommodation and refractive error in children with Down syndrome cross-sectional

and longitudinal studies Invest Ophthalmol Vis Sci 2001 Jan42 (1)55-63

79

McClelland JF Parkes J Hill N et al Accommodative dysfunction in children with cerebral palsy a population-

based study Invest Ophthalmol Vis Sci 2006 May47(5)1824-30

Duckman RH Vision therapy for the child with cerebral palsy J Am Optom Assoc 198758(1)28-35

Duckman R Accommodation in cerebral palsy function and remediation J Am Optom Assoc 198455(4)281-3

Scheiman M Understanding and managing vision deficits a guide for occupational therapists 2nd ed Slack

Thorofare NJ 2002

Maino D Binasal occlusion for the child with Cerebral Palsy J Ill Optom Assoc 198644(1)1218

Battaglia F Quartarone A Rizzo V et al Early impairment of synaptic plasticity in patients with Downs syndrome

Neurobiol Aging 2008 Aug29(8)1272-5

Bonnier C Evaluation of early stimulation programs for enhancing brain development Acta Paediatr 2008

Jul97(7)853-8

Morice E Andreae LC Cooke SF et al Preservation of long-term memory and synaptic plasticity despite short-term

impairments in the Tc1 mouse model of Down syndrome Learn Mem 2008 Jul 1415(7)492-500

Gordon AM Schneider JA Chinnan A Charles JR Efficacy of a hand-arm bimanual intensive therapy (HABIT) in

children with hemiplegic cerebral palsy a randomized control trial Dev Med Child Neurol 2007 Nov49(11)830-8

Kapoor N Ciuffreda KJ Vision disturbances following traumatic brain injury Curr Treat Options Neurol 2002

Jul4(4)271-80

80

Ciuffreda KJ Rutner D Kapoor N et al Vision therapy for oculomotor dysfunctions in acquired brain injury a

retrospective analysis Optometry 2008 Jan79(1)18-22

Ciuffreda KJ Han Y Kapoor N Ficarra AP Oculomotor rehabilitation for reading in acquired brain injury

NeuroRehabilitation 200621(1)9-21

Zost M Diagnosis and management of visual dysfunction in cerebral injury In Maino D (ed) Diagnosis and

Management of Special Populations Mosby-Yearbook Inc St Louis 199579 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001 [Figure used with permission of the editor]

DeGutis JM Bentin S Robertson LC DEsposito M Functional plasticity in ventral temporal cortex following

cognitive rehabilitation of a congenital prosopagnosic J Cogn Neurosci 2007 Nov19 (11)1790-802

Welbourne SR Ralph MA Exploring the impact of plasticity-related recovery after brain damage in a connectionist

model of single-word reading Cogn Affect Behav Neurosci 2005 Mar5(1)77-92

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements prevent cognitive decline A

systematic review of randomized controlled trials J Hum Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among preterm infants attributable to early

supplementation of human milk with docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings and structural-functional

synergies with cell membrane phospholipids Altern Med Rev 2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function Neuroscience 20089(7)568-78

81

Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

BMC Biol 2008 Sep 9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine improves neuropsychological disorders in a child with

creatine transporter defect Neurocase 200814(2) 151-61

Forrester LW Wheaton LA Luft AR Exercise-mediated locomotor recovery and lower-limb neuroplasticity after

stroke J Rehabil Res Dev 200845(2)205-20

82

Page 74: Neuroplasticity: A Paradigm Sea Change Latest Updated File

Chakraborty R Chatterjee A Choudhart S Chakraborty PK Neuroplasticitymdasha paradigm shift in neurosciences J Indian Med Assoc

2007105(9)513-4516-8520-1

Sacks O A neurologistlsquos notebook Stereo Sue Why two eyes are better than one The New Yorker 2006 Jun 1964-73

Krulwich R National Public Radio Going Binocular Susanlsquos First Snowfall Available at

wwwnprorgtemplatesstorystoryphpstoryId=5507789 (Accessed December 8 2008)

Press LJ The story behind Stereo Suelsquo and a world-famous neurologistlsquos discovery of vision therapy Optom Vis Dev 200637(2) 55-7

Levin HS Neuroplasticity and brain imaging research implications for rehabilitation Arch Phys Med Rehabil 2006 Dec87(12 Suppl

2)S1

Wiesel TN Hubel DH Single-cell responses in striate cortex of kittens deprived of vision in one eye J Neurophysiol 1963

Nov261003-17

Hook BM Chen C Critical periods in the visual system Changing views for a model of experience-dependent plasticity Neuron 2007

Oct56(2)312-26

Ramey CT Ramey SL Prevention of intellectual disabilities early interventions to improve cognitive development Prev Med 1998

Mar-Apr27(2)224-32

Heuninckx S Wenderoth N Swinnen SP Systems neuroplasticity in the aging brain recruiting additional neural resources for

successful motor performance in elderly persons J Neurosci 2008 Jan 228(1)91-9

Ge S Yang CH Hsu KS et al A critical period for enhanced synaptic plasticity in newly generated neurons of the adult brain Neuron

2007 May54(4)559-66

74

Draganski B Gaser C Busch V et al Neuroplasticity changes in grey matter induced by training Nature 2004 Jan 22427(6972)

311-2

Cannonieri GC Bonilha L Fernandes PT et al Practice and perfect length of training and structural brain changes in experienced

typists Neuroreport 2007 Jul 218(10)1063-6

Kleim JA Jones TA Principles of experience-dependent neural plasticity implications for rehabilitation after brain damage J

Speech Lang Hear Res 2008 Feb51(1)S225-39

Trojan S Porkorny J Theoretical aspects of neuroplasticity Physiol Res 199948(2)87-97

Ramamirtham R Kee CS Hung LF et al Wave aberrations in rhesus monkeys with vision-induced ametropias Vision Res 2007

Sep47(21)2751-66

Smith EL 3rd Ramamirtham R Qiao-Grider Y et al Effects of foveal ablation on emmetropization and form-deprivation myopia

Invest Ophthalmol Vis Sci 2007 Sep48(9)3914-22

Smith EL 3rd Kee CS Ramamirtham R et al Peripheral vision can influence eye growth and refractive development in infant

monkeys Invest Ophthalmol Vis Sci 2005 Nov46(11)3965-72

Ciuffreda KJ Vasudevan B Nearwork-induced transient myopia (NITM) and permanent myopiandashndashis there a link Ophthalmic

Physiol Opt 2008 Mar28(2)103-14

Hung GK Ciuffreda KJ Incremental retinal-defocus theory of myopia development--schematic analysis and computer simulation

Comput Biol Med 2007 Jul37(7)930-46

Hung GK Ciuffreda KJ A unifying theory of refractive error development Bull Math Biol 2000 Nov62(6)1087-108

75

Pang Y Maino D Zhang G Lu F Myopia Can its progress be controlled Optom Vis Dev 200637(2)75-9

Leung JT Brown B Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lenses Optom Vis Sci

1999 Jun76(6)346-54

Hasebe S Ohtsuki H Nonaka T et al Effect of progressive addition lenses on myopia progression in Japanese children a prospective

randomized double-masked crossover trial Invest Ophthalmol Vis Sci 2008 Jul49(7)2781-9

Gwiazda J Hyman L Hussein M et al A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression

of myopia in children Invest Ophthalmol Vis Sci 2003 Apr44(4)1492-500

Siatkowski RM Cotter SA Crockett RS et al Two-year multi-center randomized double-masked placebo-controlled parallel safety and

efficacy study of 2 pirenzepine ophthalmic gel in children with myopia J AAPOS 2008 Aug12(4)332-9

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged 7 to 17 years Arch Ophthalmol 2005

Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three to less than 10 years of age Am J

Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction Am J Ophthalmol 2007

Jun143(6)1060-3

Holmes JM Edwards AR Beck RW et al A randomized pilot study of near activities versus non-near activities during patching therapy for

amblyopia J AAPOS 2005 Apr9(2)129-36

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate

amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-57

76

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic

amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Convergence Insufficiency Treatment Trial Study Group Randomized clinical trial of treatments for symptomatic convergence insufficiency

in children Arch Ophthalmol 2008 Oct126(10)1336-49

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

Solan HA Shelley-Tremblay J Hansen PC et al M-cell deficit and reading disability a preliminary study of the effects of temporal vision-

processing therapy Optometry 2004 Oct75(10)640-50

Solan HA Larson S Shelley-Tremblay J et al Role of visual attention in cognitive control of oculomotor readiness in students with reading

disabilities J Learn Disabil 2001 Mar-Apr34(2)107-18

Gallaway M Boas MB The impact of vergence and accommodative therapy on reading eye movements and reading speed Optom Vis Dev

200738(3)115-20

Goss DA Downing DB Lowther AH et al The effect of HTS vision therapy conducted in a school setting on reading skills in third and

fourth grade students Optom Vis Dev 200738(1)27-32

Crutch SJ Warrington EK Foveal crowding in posterior cortical atrophy a specific early-visual-processing deficit affecting word reading

Cogn Neuropsychol 2007 Dec24(8)843-66

Helms D Sawtelle SM A study of the effectiveness of cognitive therapy delivered in a video game format Optom Vis Dev 200738 (1)19-

26

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

77

Lawton T Training direction-discrimination sensitivity remediates a wide spectrum of reading skills OptomVis Dev 200738(1) 33-47

Goldstand S Koslowe KC Parush S Vision visual-information processing and academic performance among seventh-grade schoolchildren a

more significant relationship than we thought Am J Occup Ther 2005 Jul-Aug59(4)377-89

Fischer B Koumlngeter A Hartnegg K Effects of daily practice on subitizing visual counting and basic arithmetic skills Optom Vis Dev

200839(1)30-4

Sands W Taub M Maino D Limited research and education on special populations in optometry and ophthalomology Optom Vis Dev

200839(2)60-1

Wesson M Maino D Oculo-visual findings in Down syndrome cerebral palsy and mental retardation with non-specific etiology In Maino D

(ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 199517-54 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

Cui Y Stapleton F Suttle C Developing an instrument to assess vision-related and subjective quality of life in children with intellectual

disability data collection and preliminary analysis in a Chinese population Ophthal Physiolog Optics 2008 May28(3) 238-46

Maino D Steele G Tahir S Sajja R Attitudes of optometry students toward individuals with disabilities Optom Ed 200227(2)45-50

Maino D Special populations in the optometric curriculum Optom Ed 200227(2)38-9

Maino D Overview of special populations In Scheiman M Rouse M (eds) Optometric Management of Learning-Related Vision Problems

St Louis Mosby Inc 200685-106

Maino D (ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 1995 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

78

McCarthy P Maino D Alport syndrome a review Clin Eye Vis Care 2000 Dec12(3-4)139-50

Block SS Brusca-Vega R Pizzi WJ et al Cognitive and visual processing skills and their relationship to mutation size in full and

permutation female fragile X carriers Optom Vis Sci 2000 Nov77 (11)592-9

Maino D The young child with developmental disabilities An introduction to mental retardation and genetic syndromes In Moore BD

(ed) Eye Care for Infants and Young Children Butter-worth--Heinemann Newton MA1997285-300

Amin V Maino D The Fragile X female Visual visual perceptual and ocular health anomalies J Am Optom Assoc 1995 May66

(5)290-95

Maino DM Maino JH Cibis GW Hecht F Ocular health anomalies in patients with developmental disabilities In Maino D (ed)

Diagnosis and Management of Special Populations Mosby-Year-book Inc St Louis MO 1995189-206 Reprinted Optometric

Education Program Foundation Santa Anna Calif 2001

Maino D Wesson M Schlange D Cibis G Maino J Optometric findings in the fragile X syndrome Optom Vis Sci 199168634-40

Scheiman MMOptometric findings in children with cerebral palsy Am J Optom Physiol Opt 1984 May61(5)321-3

Maino D Maino J Maino S Mental retardation syndromes with associated ocular defects J Am Optom Assoc 199061707-16

Stewart RE Woodhouse JM Cregg M Pakeman VH Association between accommodative accuracy hypermetropia and strabismus in

children with Downs syndrome Optom Vis Sci 2007 Feb84(2)149-55

Cregg M Woodhouse JM Pakeman VH et al Accommodation and refractive error in children with Down syndrome cross-sectional

and longitudinal studies Invest Ophthalmol Vis Sci 2001 Jan42 (1)55-63

79

McClelland JF Parkes J Hill N et al Accommodative dysfunction in children with cerebral palsy a population-

based study Invest Ophthalmol Vis Sci 2006 May47(5)1824-30

Duckman RH Vision therapy for the child with cerebral palsy J Am Optom Assoc 198758(1)28-35

Duckman R Accommodation in cerebral palsy function and remediation J Am Optom Assoc 198455(4)281-3

Scheiman M Understanding and managing vision deficits a guide for occupational therapists 2nd ed Slack

Thorofare NJ 2002

Maino D Binasal occlusion for the child with Cerebral Palsy J Ill Optom Assoc 198644(1)1218

Battaglia F Quartarone A Rizzo V et al Early impairment of synaptic plasticity in patients with Downs syndrome

Neurobiol Aging 2008 Aug29(8)1272-5

Bonnier C Evaluation of early stimulation programs for enhancing brain development Acta Paediatr 2008

Jul97(7)853-8

Morice E Andreae LC Cooke SF et al Preservation of long-term memory and synaptic plasticity despite short-term

impairments in the Tc1 mouse model of Down syndrome Learn Mem 2008 Jul 1415(7)492-500

Gordon AM Schneider JA Chinnan A Charles JR Efficacy of a hand-arm bimanual intensive therapy (HABIT) in

children with hemiplegic cerebral palsy a randomized control trial Dev Med Child Neurol 2007 Nov49(11)830-8

Kapoor N Ciuffreda KJ Vision disturbances following traumatic brain injury Curr Treat Options Neurol 2002

Jul4(4)271-80

80

Ciuffreda KJ Rutner D Kapoor N et al Vision therapy for oculomotor dysfunctions in acquired brain injury a

retrospective analysis Optometry 2008 Jan79(1)18-22

Ciuffreda KJ Han Y Kapoor N Ficarra AP Oculomotor rehabilitation for reading in acquired brain injury

NeuroRehabilitation 200621(1)9-21

Zost M Diagnosis and management of visual dysfunction in cerebral injury In Maino D (ed) Diagnosis and

Management of Special Populations Mosby-Yearbook Inc St Louis 199579 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001 [Figure used with permission of the editor]

DeGutis JM Bentin S Robertson LC DEsposito M Functional plasticity in ventral temporal cortex following

cognitive rehabilitation of a congenital prosopagnosic J Cogn Neurosci 2007 Nov19 (11)1790-802

Welbourne SR Ralph MA Exploring the impact of plasticity-related recovery after brain damage in a connectionist

model of single-word reading Cogn Affect Behav Neurosci 2005 Mar5(1)77-92

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements prevent cognitive decline A

systematic review of randomized controlled trials J Hum Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among preterm infants attributable to early

supplementation of human milk with docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings and structural-functional

synergies with cell membrane phospholipids Altern Med Rev 2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function Neuroscience 20089(7)568-78

81

Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

BMC Biol 2008 Sep 9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine improves neuropsychological disorders in a child with

creatine transporter defect Neurocase 200814(2) 151-61

Forrester LW Wheaton LA Luft AR Exercise-mediated locomotor recovery and lower-limb neuroplasticity after

stroke J Rehabil Res Dev 200845(2)205-20

82

Page 75: Neuroplasticity: A Paradigm Sea Change Latest Updated File

Draganski B Gaser C Busch V et al Neuroplasticity changes in grey matter induced by training Nature 2004 Jan 22427(6972)

311-2

Cannonieri GC Bonilha L Fernandes PT et al Practice and perfect length of training and structural brain changes in experienced

typists Neuroreport 2007 Jul 218(10)1063-6

Kleim JA Jones TA Principles of experience-dependent neural plasticity implications for rehabilitation after brain damage J

Speech Lang Hear Res 2008 Feb51(1)S225-39

Trojan S Porkorny J Theoretical aspects of neuroplasticity Physiol Res 199948(2)87-97

Ramamirtham R Kee CS Hung LF et al Wave aberrations in rhesus monkeys with vision-induced ametropias Vision Res 2007

Sep47(21)2751-66

Smith EL 3rd Ramamirtham R Qiao-Grider Y et al Effects of foveal ablation on emmetropization and form-deprivation myopia

Invest Ophthalmol Vis Sci 2007 Sep48(9)3914-22

Smith EL 3rd Kee CS Ramamirtham R et al Peripheral vision can influence eye growth and refractive development in infant

monkeys Invest Ophthalmol Vis Sci 2005 Nov46(11)3965-72

Ciuffreda KJ Vasudevan B Nearwork-induced transient myopia (NITM) and permanent myopiandashndashis there a link Ophthalmic

Physiol Opt 2008 Mar28(2)103-14

Hung GK Ciuffreda KJ Incremental retinal-defocus theory of myopia development--schematic analysis and computer simulation

Comput Biol Med 2007 Jul37(7)930-46

Hung GK Ciuffreda KJ A unifying theory of refractive error development Bull Math Biol 2000 Nov62(6)1087-108

75

Pang Y Maino D Zhang G Lu F Myopia Can its progress be controlled Optom Vis Dev 200637(2)75-9

Leung JT Brown B Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lenses Optom Vis Sci

1999 Jun76(6)346-54

Hasebe S Ohtsuki H Nonaka T et al Effect of progressive addition lenses on myopia progression in Japanese children a prospective

randomized double-masked crossover trial Invest Ophthalmol Vis Sci 2008 Jul49(7)2781-9

Gwiazda J Hyman L Hussein M et al A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression

of myopia in children Invest Ophthalmol Vis Sci 2003 Apr44(4)1492-500

Siatkowski RM Cotter SA Crockett RS et al Two-year multi-center randomized double-masked placebo-controlled parallel safety and

efficacy study of 2 pirenzepine ophthalmic gel in children with myopia J AAPOS 2008 Aug12(4)332-9

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged 7 to 17 years Arch Ophthalmol 2005

Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three to less than 10 years of age Am J

Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction Am J Ophthalmol 2007

Jun143(6)1060-3

Holmes JM Edwards AR Beck RW et al A randomized pilot study of near activities versus non-near activities during patching therapy for

amblyopia J AAPOS 2005 Apr9(2)129-36

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate

amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-57

76

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic

amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Convergence Insufficiency Treatment Trial Study Group Randomized clinical trial of treatments for symptomatic convergence insufficiency

in children Arch Ophthalmol 2008 Oct126(10)1336-49

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

Solan HA Shelley-Tremblay J Hansen PC et al M-cell deficit and reading disability a preliminary study of the effects of temporal vision-

processing therapy Optometry 2004 Oct75(10)640-50

Solan HA Larson S Shelley-Tremblay J et al Role of visual attention in cognitive control of oculomotor readiness in students with reading

disabilities J Learn Disabil 2001 Mar-Apr34(2)107-18

Gallaway M Boas MB The impact of vergence and accommodative therapy on reading eye movements and reading speed Optom Vis Dev

200738(3)115-20

Goss DA Downing DB Lowther AH et al The effect of HTS vision therapy conducted in a school setting on reading skills in third and

fourth grade students Optom Vis Dev 200738(1)27-32

Crutch SJ Warrington EK Foveal crowding in posterior cortical atrophy a specific early-visual-processing deficit affecting word reading

Cogn Neuropsychol 2007 Dec24(8)843-66

Helms D Sawtelle SM A study of the effectiveness of cognitive therapy delivered in a video game format Optom Vis Dev 200738 (1)19-

26

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

77

Lawton T Training direction-discrimination sensitivity remediates a wide spectrum of reading skills OptomVis Dev 200738(1) 33-47

Goldstand S Koslowe KC Parush S Vision visual-information processing and academic performance among seventh-grade schoolchildren a

more significant relationship than we thought Am J Occup Ther 2005 Jul-Aug59(4)377-89

Fischer B Koumlngeter A Hartnegg K Effects of daily practice on subitizing visual counting and basic arithmetic skills Optom Vis Dev

200839(1)30-4

Sands W Taub M Maino D Limited research and education on special populations in optometry and ophthalomology Optom Vis Dev

200839(2)60-1

Wesson M Maino D Oculo-visual findings in Down syndrome cerebral palsy and mental retardation with non-specific etiology In Maino D

(ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 199517-54 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

Cui Y Stapleton F Suttle C Developing an instrument to assess vision-related and subjective quality of life in children with intellectual

disability data collection and preliminary analysis in a Chinese population Ophthal Physiolog Optics 2008 May28(3) 238-46

Maino D Steele G Tahir S Sajja R Attitudes of optometry students toward individuals with disabilities Optom Ed 200227(2)45-50

Maino D Special populations in the optometric curriculum Optom Ed 200227(2)38-9

Maino D Overview of special populations In Scheiman M Rouse M (eds) Optometric Management of Learning-Related Vision Problems

St Louis Mosby Inc 200685-106

Maino D (ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 1995 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

78

McCarthy P Maino D Alport syndrome a review Clin Eye Vis Care 2000 Dec12(3-4)139-50

Block SS Brusca-Vega R Pizzi WJ et al Cognitive and visual processing skills and their relationship to mutation size in full and

permutation female fragile X carriers Optom Vis Sci 2000 Nov77 (11)592-9

Maino D The young child with developmental disabilities An introduction to mental retardation and genetic syndromes In Moore BD

(ed) Eye Care for Infants and Young Children Butter-worth--Heinemann Newton MA1997285-300

Amin V Maino D The Fragile X female Visual visual perceptual and ocular health anomalies J Am Optom Assoc 1995 May66

(5)290-95

Maino DM Maino JH Cibis GW Hecht F Ocular health anomalies in patients with developmental disabilities In Maino D (ed)

Diagnosis and Management of Special Populations Mosby-Year-book Inc St Louis MO 1995189-206 Reprinted Optometric

Education Program Foundation Santa Anna Calif 2001

Maino D Wesson M Schlange D Cibis G Maino J Optometric findings in the fragile X syndrome Optom Vis Sci 199168634-40

Scheiman MMOptometric findings in children with cerebral palsy Am J Optom Physiol Opt 1984 May61(5)321-3

Maino D Maino J Maino S Mental retardation syndromes with associated ocular defects J Am Optom Assoc 199061707-16

Stewart RE Woodhouse JM Cregg M Pakeman VH Association between accommodative accuracy hypermetropia and strabismus in

children with Downs syndrome Optom Vis Sci 2007 Feb84(2)149-55

Cregg M Woodhouse JM Pakeman VH et al Accommodation and refractive error in children with Down syndrome cross-sectional

and longitudinal studies Invest Ophthalmol Vis Sci 2001 Jan42 (1)55-63

79

McClelland JF Parkes J Hill N et al Accommodative dysfunction in children with cerebral palsy a population-

based study Invest Ophthalmol Vis Sci 2006 May47(5)1824-30

Duckman RH Vision therapy for the child with cerebral palsy J Am Optom Assoc 198758(1)28-35

Duckman R Accommodation in cerebral palsy function and remediation J Am Optom Assoc 198455(4)281-3

Scheiman M Understanding and managing vision deficits a guide for occupational therapists 2nd ed Slack

Thorofare NJ 2002

Maino D Binasal occlusion for the child with Cerebral Palsy J Ill Optom Assoc 198644(1)1218

Battaglia F Quartarone A Rizzo V et al Early impairment of synaptic plasticity in patients with Downs syndrome

Neurobiol Aging 2008 Aug29(8)1272-5

Bonnier C Evaluation of early stimulation programs for enhancing brain development Acta Paediatr 2008

Jul97(7)853-8

Morice E Andreae LC Cooke SF et al Preservation of long-term memory and synaptic plasticity despite short-term

impairments in the Tc1 mouse model of Down syndrome Learn Mem 2008 Jul 1415(7)492-500

Gordon AM Schneider JA Chinnan A Charles JR Efficacy of a hand-arm bimanual intensive therapy (HABIT) in

children with hemiplegic cerebral palsy a randomized control trial Dev Med Child Neurol 2007 Nov49(11)830-8

Kapoor N Ciuffreda KJ Vision disturbances following traumatic brain injury Curr Treat Options Neurol 2002

Jul4(4)271-80

80

Ciuffreda KJ Rutner D Kapoor N et al Vision therapy for oculomotor dysfunctions in acquired brain injury a

retrospective analysis Optometry 2008 Jan79(1)18-22

Ciuffreda KJ Han Y Kapoor N Ficarra AP Oculomotor rehabilitation for reading in acquired brain injury

NeuroRehabilitation 200621(1)9-21

Zost M Diagnosis and management of visual dysfunction in cerebral injury In Maino D (ed) Diagnosis and

Management of Special Populations Mosby-Yearbook Inc St Louis 199579 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001 [Figure used with permission of the editor]

DeGutis JM Bentin S Robertson LC DEsposito M Functional plasticity in ventral temporal cortex following

cognitive rehabilitation of a congenital prosopagnosic J Cogn Neurosci 2007 Nov19 (11)1790-802

Welbourne SR Ralph MA Exploring the impact of plasticity-related recovery after brain damage in a connectionist

model of single-word reading Cogn Affect Behav Neurosci 2005 Mar5(1)77-92

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements prevent cognitive decline A

systematic review of randomized controlled trials J Hum Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among preterm infants attributable to early

supplementation of human milk with docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings and structural-functional

synergies with cell membrane phospholipids Altern Med Rev 2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function Neuroscience 20089(7)568-78

81

Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

BMC Biol 2008 Sep 9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine improves neuropsychological disorders in a child with

creatine transporter defect Neurocase 200814(2) 151-61

Forrester LW Wheaton LA Luft AR Exercise-mediated locomotor recovery and lower-limb neuroplasticity after

stroke J Rehabil Res Dev 200845(2)205-20

82

Page 76: Neuroplasticity: A Paradigm Sea Change Latest Updated File

Pang Y Maino D Zhang G Lu F Myopia Can its progress be controlled Optom Vis Dev 200637(2)75-9

Leung JT Brown B Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lenses Optom Vis Sci

1999 Jun76(6)346-54

Hasebe S Ohtsuki H Nonaka T et al Effect of progressive addition lenses on myopia progression in Japanese children a prospective

randomized double-masked crossover trial Invest Ophthalmol Vis Sci 2008 Jul49(7)2781-9

Gwiazda J Hyman L Hussein M et al A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression

of myopia in children Invest Ophthalmol Vis Sci 2003 Apr44(4)1492-500

Siatkowski RM Cotter SA Crockett RS et al Two-year multi-center randomized double-masked placebo-controlled parallel safety and

efficacy study of 2 pirenzepine ophthalmic gel in children with myopia J AAPOS 2008 Aug12(4)332-9

Scheiman MM Hertle RW Beck RW et al Randomized trial of treatment of amblyopia in children aged 7 to 17 years Arch Ophthalmol 2005

Apr123(4)437-47

Wallace DK Chandler DL Beck RW et al Treatment of bilateral refractive amblyopia in children three to less than 10 years of age Am J

Ophthalmol 2007 Oct144(4)487-96

Cotter SA Edwards AR Arnold RW et al Treatment of strabismic amblyopia with refractive correction Am J Ophthalmol 2007

Jun143(6)1060-3

Holmes JM Edwards AR Beck RW et al A randomized pilot study of near activities versus non-near activities during patching therapy for

amblyopia J AAPOS 2005 Apr9(2)129-36

Repka MX Wallace DK Beck RW et al Two-year follow-up of a 6-month randomized trial of atropine vs patching for treatment of moderate

amblyopia in children Arch Ophthalmol 2005 Feb123 (2)149-57

76

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic

amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Convergence Insufficiency Treatment Trial Study Group Randomized clinical trial of treatments for symptomatic convergence insufficiency

in children Arch Ophthalmol 2008 Oct126(10)1336-49

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

Solan HA Shelley-Tremblay J Hansen PC et al M-cell deficit and reading disability a preliminary study of the effects of temporal vision-

processing therapy Optometry 2004 Oct75(10)640-50

Solan HA Larson S Shelley-Tremblay J et al Role of visual attention in cognitive control of oculomotor readiness in students with reading

disabilities J Learn Disabil 2001 Mar-Apr34(2)107-18

Gallaway M Boas MB The impact of vergence and accommodative therapy on reading eye movements and reading speed Optom Vis Dev

200738(3)115-20

Goss DA Downing DB Lowther AH et al The effect of HTS vision therapy conducted in a school setting on reading skills in third and

fourth grade students Optom Vis Dev 200738(1)27-32

Crutch SJ Warrington EK Foveal crowding in posterior cortical atrophy a specific early-visual-processing deficit affecting word reading

Cogn Neuropsychol 2007 Dec24(8)843-66

Helms D Sawtelle SM A study of the effectiveness of cognitive therapy delivered in a video game format Optom Vis Dev 200738 (1)19-

26

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

77

Lawton T Training direction-discrimination sensitivity remediates a wide spectrum of reading skills OptomVis Dev 200738(1) 33-47

Goldstand S Koslowe KC Parush S Vision visual-information processing and academic performance among seventh-grade schoolchildren a

more significant relationship than we thought Am J Occup Ther 2005 Jul-Aug59(4)377-89

Fischer B Koumlngeter A Hartnegg K Effects of daily practice on subitizing visual counting and basic arithmetic skills Optom Vis Dev

200839(1)30-4

Sands W Taub M Maino D Limited research and education on special populations in optometry and ophthalomology Optom Vis Dev

200839(2)60-1

Wesson M Maino D Oculo-visual findings in Down syndrome cerebral palsy and mental retardation with non-specific etiology In Maino D

(ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 199517-54 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

Cui Y Stapleton F Suttle C Developing an instrument to assess vision-related and subjective quality of life in children with intellectual

disability data collection and preliminary analysis in a Chinese population Ophthal Physiolog Optics 2008 May28(3) 238-46

Maino D Steele G Tahir S Sajja R Attitudes of optometry students toward individuals with disabilities Optom Ed 200227(2)45-50

Maino D Special populations in the optometric curriculum Optom Ed 200227(2)38-9

Maino D Overview of special populations In Scheiman M Rouse M (eds) Optometric Management of Learning-Related Vision Problems

St Louis Mosby Inc 200685-106

Maino D (ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 1995 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

78

McCarthy P Maino D Alport syndrome a review Clin Eye Vis Care 2000 Dec12(3-4)139-50

Block SS Brusca-Vega R Pizzi WJ et al Cognitive and visual processing skills and their relationship to mutation size in full and

permutation female fragile X carriers Optom Vis Sci 2000 Nov77 (11)592-9

Maino D The young child with developmental disabilities An introduction to mental retardation and genetic syndromes In Moore BD

(ed) Eye Care for Infants and Young Children Butter-worth--Heinemann Newton MA1997285-300

Amin V Maino D The Fragile X female Visual visual perceptual and ocular health anomalies J Am Optom Assoc 1995 May66

(5)290-95

Maino DM Maino JH Cibis GW Hecht F Ocular health anomalies in patients with developmental disabilities In Maino D (ed)

Diagnosis and Management of Special Populations Mosby-Year-book Inc St Louis MO 1995189-206 Reprinted Optometric

Education Program Foundation Santa Anna Calif 2001

Maino D Wesson M Schlange D Cibis G Maino J Optometric findings in the fragile X syndrome Optom Vis Sci 199168634-40

Scheiman MMOptometric findings in children with cerebral palsy Am J Optom Physiol Opt 1984 May61(5)321-3

Maino D Maino J Maino S Mental retardation syndromes with associated ocular defects J Am Optom Assoc 199061707-16

Stewart RE Woodhouse JM Cregg M Pakeman VH Association between accommodative accuracy hypermetropia and strabismus in

children with Downs syndrome Optom Vis Sci 2007 Feb84(2)149-55

Cregg M Woodhouse JM Pakeman VH et al Accommodation and refractive error in children with Down syndrome cross-sectional

and longitudinal studies Invest Ophthalmol Vis Sci 2001 Jan42 (1)55-63

79

McClelland JF Parkes J Hill N et al Accommodative dysfunction in children with cerebral palsy a population-

based study Invest Ophthalmol Vis Sci 2006 May47(5)1824-30

Duckman RH Vision therapy for the child with cerebral palsy J Am Optom Assoc 198758(1)28-35

Duckman R Accommodation in cerebral palsy function and remediation J Am Optom Assoc 198455(4)281-3

Scheiman M Understanding and managing vision deficits a guide for occupational therapists 2nd ed Slack

Thorofare NJ 2002

Maino D Binasal occlusion for the child with Cerebral Palsy J Ill Optom Assoc 198644(1)1218

Battaglia F Quartarone A Rizzo V et al Early impairment of synaptic plasticity in patients with Downs syndrome

Neurobiol Aging 2008 Aug29(8)1272-5

Bonnier C Evaluation of early stimulation programs for enhancing brain development Acta Paediatr 2008

Jul97(7)853-8

Morice E Andreae LC Cooke SF et al Preservation of long-term memory and synaptic plasticity despite short-term

impairments in the Tc1 mouse model of Down syndrome Learn Mem 2008 Jul 1415(7)492-500

Gordon AM Schneider JA Chinnan A Charles JR Efficacy of a hand-arm bimanual intensive therapy (HABIT) in

children with hemiplegic cerebral palsy a randomized control trial Dev Med Child Neurol 2007 Nov49(11)830-8

Kapoor N Ciuffreda KJ Vision disturbances following traumatic brain injury Curr Treat Options Neurol 2002

Jul4(4)271-80

80

Ciuffreda KJ Rutner D Kapoor N et al Vision therapy for oculomotor dysfunctions in acquired brain injury a

retrospective analysis Optometry 2008 Jan79(1)18-22

Ciuffreda KJ Han Y Kapoor N Ficarra AP Oculomotor rehabilitation for reading in acquired brain injury

NeuroRehabilitation 200621(1)9-21

Zost M Diagnosis and management of visual dysfunction in cerebral injury In Maino D (ed) Diagnosis and

Management of Special Populations Mosby-Yearbook Inc St Louis 199579 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001 [Figure used with permission of the editor]

DeGutis JM Bentin S Robertson LC DEsposito M Functional plasticity in ventral temporal cortex following

cognitive rehabilitation of a congenital prosopagnosic J Cogn Neurosci 2007 Nov19 (11)1790-802

Welbourne SR Ralph MA Exploring the impact of plasticity-related recovery after brain damage in a connectionist

model of single-word reading Cogn Affect Behav Neurosci 2005 Mar5(1)77-92

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements prevent cognitive decline A

systematic review of randomized controlled trials J Hum Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among preterm infants attributable to early

supplementation of human milk with docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings and structural-functional

synergies with cell membrane phospholipids Altern Med Rev 2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function Neuroscience 20089(7)568-78

81

Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

BMC Biol 2008 Sep 9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine improves neuropsychological disorders in a child with

creatine transporter defect Neurocase 200814(2) 151-61

Forrester LW Wheaton LA Luft AR Exercise-mediated locomotor recovery and lower-limb neuroplasticity after

stroke J Rehabil Res Dev 200845(2)205-20

82

Page 77: Neuroplasticity: A Paradigm Sea Change Latest Updated File

Wallace DK Edwards AR Cotter SA et al A randomized trial to evaluate 2 hours of daily patching for strabismic and anisometropic

amblyopia in children Ophthalmology 2006 Jun113(6)904-12

Convergence Insufficiency Treatment Trial Study Group Randomized clinical trial of treatments for symptomatic convergence insufficiency

in children Arch Ophthalmol 2008 Oct126(10)1336-49

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

Solan HA Shelley-Tremblay J Hansen PC et al M-cell deficit and reading disability a preliminary study of the effects of temporal vision-

processing therapy Optometry 2004 Oct75(10)640-50

Solan HA Larson S Shelley-Tremblay J et al Role of visual attention in cognitive control of oculomotor readiness in students with reading

disabilities J Learn Disabil 2001 Mar-Apr34(2)107-18

Gallaway M Boas MB The impact of vergence and accommodative therapy on reading eye movements and reading speed Optom Vis Dev

200738(3)115-20

Goss DA Downing DB Lowther AH et al The effect of HTS vision therapy conducted in a school setting on reading skills in third and

fourth grade students Optom Vis Dev 200738(1)27-32

Crutch SJ Warrington EK Foveal crowding in posterior cortical atrophy a specific early-visual-processing deficit affecting word reading

Cogn Neuropsychol 2007 Dec24(8)843-66

Helms D Sawtelle SM A study of the effectiveness of cognitive therapy delivered in a video game format Optom Vis Dev 200738 (1)19-

26

Vidyasagar TR Neural underpinnings of dyslexia as a disorder of visuo-spatial attention Clin Exp Optom 2004 Jan87(1)4-10

77

Lawton T Training direction-discrimination sensitivity remediates a wide spectrum of reading skills OptomVis Dev 200738(1) 33-47

Goldstand S Koslowe KC Parush S Vision visual-information processing and academic performance among seventh-grade schoolchildren a

more significant relationship than we thought Am J Occup Ther 2005 Jul-Aug59(4)377-89

Fischer B Koumlngeter A Hartnegg K Effects of daily practice on subitizing visual counting and basic arithmetic skills Optom Vis Dev

200839(1)30-4

Sands W Taub M Maino D Limited research and education on special populations in optometry and ophthalomology Optom Vis Dev

200839(2)60-1

Wesson M Maino D Oculo-visual findings in Down syndrome cerebral palsy and mental retardation with non-specific etiology In Maino D

(ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 199517-54 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

Cui Y Stapleton F Suttle C Developing an instrument to assess vision-related and subjective quality of life in children with intellectual

disability data collection and preliminary analysis in a Chinese population Ophthal Physiolog Optics 2008 May28(3) 238-46

Maino D Steele G Tahir S Sajja R Attitudes of optometry students toward individuals with disabilities Optom Ed 200227(2)45-50

Maino D Special populations in the optometric curriculum Optom Ed 200227(2)38-9

Maino D Overview of special populations In Scheiman M Rouse M (eds) Optometric Management of Learning-Related Vision Problems

St Louis Mosby Inc 200685-106

Maino D (ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 1995 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

78

McCarthy P Maino D Alport syndrome a review Clin Eye Vis Care 2000 Dec12(3-4)139-50

Block SS Brusca-Vega R Pizzi WJ et al Cognitive and visual processing skills and their relationship to mutation size in full and

permutation female fragile X carriers Optom Vis Sci 2000 Nov77 (11)592-9

Maino D The young child with developmental disabilities An introduction to mental retardation and genetic syndromes In Moore BD

(ed) Eye Care for Infants and Young Children Butter-worth--Heinemann Newton MA1997285-300

Amin V Maino D The Fragile X female Visual visual perceptual and ocular health anomalies J Am Optom Assoc 1995 May66

(5)290-95

Maino DM Maino JH Cibis GW Hecht F Ocular health anomalies in patients with developmental disabilities In Maino D (ed)

Diagnosis and Management of Special Populations Mosby-Year-book Inc St Louis MO 1995189-206 Reprinted Optometric

Education Program Foundation Santa Anna Calif 2001

Maino D Wesson M Schlange D Cibis G Maino J Optometric findings in the fragile X syndrome Optom Vis Sci 199168634-40

Scheiman MMOptometric findings in children with cerebral palsy Am J Optom Physiol Opt 1984 May61(5)321-3

Maino D Maino J Maino S Mental retardation syndromes with associated ocular defects J Am Optom Assoc 199061707-16

Stewart RE Woodhouse JM Cregg M Pakeman VH Association between accommodative accuracy hypermetropia and strabismus in

children with Downs syndrome Optom Vis Sci 2007 Feb84(2)149-55

Cregg M Woodhouse JM Pakeman VH et al Accommodation and refractive error in children with Down syndrome cross-sectional

and longitudinal studies Invest Ophthalmol Vis Sci 2001 Jan42 (1)55-63

79

McClelland JF Parkes J Hill N et al Accommodative dysfunction in children with cerebral palsy a population-

based study Invest Ophthalmol Vis Sci 2006 May47(5)1824-30

Duckman RH Vision therapy for the child with cerebral palsy J Am Optom Assoc 198758(1)28-35

Duckman R Accommodation in cerebral palsy function and remediation J Am Optom Assoc 198455(4)281-3

Scheiman M Understanding and managing vision deficits a guide for occupational therapists 2nd ed Slack

Thorofare NJ 2002

Maino D Binasal occlusion for the child with Cerebral Palsy J Ill Optom Assoc 198644(1)1218

Battaglia F Quartarone A Rizzo V et al Early impairment of synaptic plasticity in patients with Downs syndrome

Neurobiol Aging 2008 Aug29(8)1272-5

Bonnier C Evaluation of early stimulation programs for enhancing brain development Acta Paediatr 2008

Jul97(7)853-8

Morice E Andreae LC Cooke SF et al Preservation of long-term memory and synaptic plasticity despite short-term

impairments in the Tc1 mouse model of Down syndrome Learn Mem 2008 Jul 1415(7)492-500

Gordon AM Schneider JA Chinnan A Charles JR Efficacy of a hand-arm bimanual intensive therapy (HABIT) in

children with hemiplegic cerebral palsy a randomized control trial Dev Med Child Neurol 2007 Nov49(11)830-8

Kapoor N Ciuffreda KJ Vision disturbances following traumatic brain injury Curr Treat Options Neurol 2002

Jul4(4)271-80

80

Ciuffreda KJ Rutner D Kapoor N et al Vision therapy for oculomotor dysfunctions in acquired brain injury a

retrospective analysis Optometry 2008 Jan79(1)18-22

Ciuffreda KJ Han Y Kapoor N Ficarra AP Oculomotor rehabilitation for reading in acquired brain injury

NeuroRehabilitation 200621(1)9-21

Zost M Diagnosis and management of visual dysfunction in cerebral injury In Maino D (ed) Diagnosis and

Management of Special Populations Mosby-Yearbook Inc St Louis 199579 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001 [Figure used with permission of the editor]

DeGutis JM Bentin S Robertson LC DEsposito M Functional plasticity in ventral temporal cortex following

cognitive rehabilitation of a congenital prosopagnosic J Cogn Neurosci 2007 Nov19 (11)1790-802

Welbourne SR Ralph MA Exploring the impact of plasticity-related recovery after brain damage in a connectionist

model of single-word reading Cogn Affect Behav Neurosci 2005 Mar5(1)77-92

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements prevent cognitive decline A

systematic review of randomized controlled trials J Hum Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among preterm infants attributable to early

supplementation of human milk with docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings and structural-functional

synergies with cell membrane phospholipids Altern Med Rev 2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function Neuroscience 20089(7)568-78

81

Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

BMC Biol 2008 Sep 9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine improves neuropsychological disorders in a child with

creatine transporter defect Neurocase 200814(2) 151-61

Forrester LW Wheaton LA Luft AR Exercise-mediated locomotor recovery and lower-limb neuroplasticity after

stroke J Rehabil Res Dev 200845(2)205-20

82

Page 78: Neuroplasticity: A Paradigm Sea Change Latest Updated File

Lawton T Training direction-discrimination sensitivity remediates a wide spectrum of reading skills OptomVis Dev 200738(1) 33-47

Goldstand S Koslowe KC Parush S Vision visual-information processing and academic performance among seventh-grade schoolchildren a

more significant relationship than we thought Am J Occup Ther 2005 Jul-Aug59(4)377-89

Fischer B Koumlngeter A Hartnegg K Effects of daily practice on subitizing visual counting and basic arithmetic skills Optom Vis Dev

200839(1)30-4

Sands W Taub M Maino D Limited research and education on special populations in optometry and ophthalomology Optom Vis Dev

200839(2)60-1

Wesson M Maino D Oculo-visual findings in Down syndrome cerebral palsy and mental retardation with non-specific etiology In Maino D

(ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 199517-54 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

Cui Y Stapleton F Suttle C Developing an instrument to assess vision-related and subjective quality of life in children with intellectual

disability data collection and preliminary analysis in a Chinese population Ophthal Physiolog Optics 2008 May28(3) 238-46

Maino D Steele G Tahir S Sajja R Attitudes of optometry students toward individuals with disabilities Optom Ed 200227(2)45-50

Maino D Special populations in the optometric curriculum Optom Ed 200227(2)38-9

Maino D Overview of special populations In Scheiman M Rouse M (eds) Optometric Management of Learning-Related Vision Problems

St Louis Mosby Inc 200685-106

Maino D (ed) Diagnosis and Management of Special Populations Mosby-Yearbook Inc St Louis 1995 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001

78

McCarthy P Maino D Alport syndrome a review Clin Eye Vis Care 2000 Dec12(3-4)139-50

Block SS Brusca-Vega R Pizzi WJ et al Cognitive and visual processing skills and their relationship to mutation size in full and

permutation female fragile X carriers Optom Vis Sci 2000 Nov77 (11)592-9

Maino D The young child with developmental disabilities An introduction to mental retardation and genetic syndromes In Moore BD

(ed) Eye Care for Infants and Young Children Butter-worth--Heinemann Newton MA1997285-300

Amin V Maino D The Fragile X female Visual visual perceptual and ocular health anomalies J Am Optom Assoc 1995 May66

(5)290-95

Maino DM Maino JH Cibis GW Hecht F Ocular health anomalies in patients with developmental disabilities In Maino D (ed)

Diagnosis and Management of Special Populations Mosby-Year-book Inc St Louis MO 1995189-206 Reprinted Optometric

Education Program Foundation Santa Anna Calif 2001

Maino D Wesson M Schlange D Cibis G Maino J Optometric findings in the fragile X syndrome Optom Vis Sci 199168634-40

Scheiman MMOptometric findings in children with cerebral palsy Am J Optom Physiol Opt 1984 May61(5)321-3

Maino D Maino J Maino S Mental retardation syndromes with associated ocular defects J Am Optom Assoc 199061707-16

Stewart RE Woodhouse JM Cregg M Pakeman VH Association between accommodative accuracy hypermetropia and strabismus in

children with Downs syndrome Optom Vis Sci 2007 Feb84(2)149-55

Cregg M Woodhouse JM Pakeman VH et al Accommodation and refractive error in children with Down syndrome cross-sectional

and longitudinal studies Invest Ophthalmol Vis Sci 2001 Jan42 (1)55-63

79

McClelland JF Parkes J Hill N et al Accommodative dysfunction in children with cerebral palsy a population-

based study Invest Ophthalmol Vis Sci 2006 May47(5)1824-30

Duckman RH Vision therapy for the child with cerebral palsy J Am Optom Assoc 198758(1)28-35

Duckman R Accommodation in cerebral palsy function and remediation J Am Optom Assoc 198455(4)281-3

Scheiman M Understanding and managing vision deficits a guide for occupational therapists 2nd ed Slack

Thorofare NJ 2002

Maino D Binasal occlusion for the child with Cerebral Palsy J Ill Optom Assoc 198644(1)1218

Battaglia F Quartarone A Rizzo V et al Early impairment of synaptic plasticity in patients with Downs syndrome

Neurobiol Aging 2008 Aug29(8)1272-5

Bonnier C Evaluation of early stimulation programs for enhancing brain development Acta Paediatr 2008

Jul97(7)853-8

Morice E Andreae LC Cooke SF et al Preservation of long-term memory and synaptic plasticity despite short-term

impairments in the Tc1 mouse model of Down syndrome Learn Mem 2008 Jul 1415(7)492-500

Gordon AM Schneider JA Chinnan A Charles JR Efficacy of a hand-arm bimanual intensive therapy (HABIT) in

children with hemiplegic cerebral palsy a randomized control trial Dev Med Child Neurol 2007 Nov49(11)830-8

Kapoor N Ciuffreda KJ Vision disturbances following traumatic brain injury Curr Treat Options Neurol 2002

Jul4(4)271-80

80

Ciuffreda KJ Rutner D Kapoor N et al Vision therapy for oculomotor dysfunctions in acquired brain injury a

retrospective analysis Optometry 2008 Jan79(1)18-22

Ciuffreda KJ Han Y Kapoor N Ficarra AP Oculomotor rehabilitation for reading in acquired brain injury

NeuroRehabilitation 200621(1)9-21

Zost M Diagnosis and management of visual dysfunction in cerebral injury In Maino D (ed) Diagnosis and

Management of Special Populations Mosby-Yearbook Inc St Louis 199579 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001 [Figure used with permission of the editor]

DeGutis JM Bentin S Robertson LC DEsposito M Functional plasticity in ventral temporal cortex following

cognitive rehabilitation of a congenital prosopagnosic J Cogn Neurosci 2007 Nov19 (11)1790-802

Welbourne SR Ralph MA Exploring the impact of plasticity-related recovery after brain damage in a connectionist

model of single-word reading Cogn Affect Behav Neurosci 2005 Mar5(1)77-92

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements prevent cognitive decline A

systematic review of randomized controlled trials J Hum Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among preterm infants attributable to early

supplementation of human milk with docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings and structural-functional

synergies with cell membrane phospholipids Altern Med Rev 2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function Neuroscience 20089(7)568-78

81

Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

BMC Biol 2008 Sep 9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine improves neuropsychological disorders in a child with

creatine transporter defect Neurocase 200814(2) 151-61

Forrester LW Wheaton LA Luft AR Exercise-mediated locomotor recovery and lower-limb neuroplasticity after

stroke J Rehabil Res Dev 200845(2)205-20

82

Page 79: Neuroplasticity: A Paradigm Sea Change Latest Updated File

McCarthy P Maino D Alport syndrome a review Clin Eye Vis Care 2000 Dec12(3-4)139-50

Block SS Brusca-Vega R Pizzi WJ et al Cognitive and visual processing skills and their relationship to mutation size in full and

permutation female fragile X carriers Optom Vis Sci 2000 Nov77 (11)592-9

Maino D The young child with developmental disabilities An introduction to mental retardation and genetic syndromes In Moore BD

(ed) Eye Care for Infants and Young Children Butter-worth--Heinemann Newton MA1997285-300

Amin V Maino D The Fragile X female Visual visual perceptual and ocular health anomalies J Am Optom Assoc 1995 May66

(5)290-95

Maino DM Maino JH Cibis GW Hecht F Ocular health anomalies in patients with developmental disabilities In Maino D (ed)

Diagnosis and Management of Special Populations Mosby-Year-book Inc St Louis MO 1995189-206 Reprinted Optometric

Education Program Foundation Santa Anna Calif 2001

Maino D Wesson M Schlange D Cibis G Maino J Optometric findings in the fragile X syndrome Optom Vis Sci 199168634-40

Scheiman MMOptometric findings in children with cerebral palsy Am J Optom Physiol Opt 1984 May61(5)321-3

Maino D Maino J Maino S Mental retardation syndromes with associated ocular defects J Am Optom Assoc 199061707-16

Stewart RE Woodhouse JM Cregg M Pakeman VH Association between accommodative accuracy hypermetropia and strabismus in

children with Downs syndrome Optom Vis Sci 2007 Feb84(2)149-55

Cregg M Woodhouse JM Pakeman VH et al Accommodation and refractive error in children with Down syndrome cross-sectional

and longitudinal studies Invest Ophthalmol Vis Sci 2001 Jan42 (1)55-63

79

McClelland JF Parkes J Hill N et al Accommodative dysfunction in children with cerebral palsy a population-

based study Invest Ophthalmol Vis Sci 2006 May47(5)1824-30

Duckman RH Vision therapy for the child with cerebral palsy J Am Optom Assoc 198758(1)28-35

Duckman R Accommodation in cerebral palsy function and remediation J Am Optom Assoc 198455(4)281-3

Scheiman M Understanding and managing vision deficits a guide for occupational therapists 2nd ed Slack

Thorofare NJ 2002

Maino D Binasal occlusion for the child with Cerebral Palsy J Ill Optom Assoc 198644(1)1218

Battaglia F Quartarone A Rizzo V et al Early impairment of synaptic plasticity in patients with Downs syndrome

Neurobiol Aging 2008 Aug29(8)1272-5

Bonnier C Evaluation of early stimulation programs for enhancing brain development Acta Paediatr 2008

Jul97(7)853-8

Morice E Andreae LC Cooke SF et al Preservation of long-term memory and synaptic plasticity despite short-term

impairments in the Tc1 mouse model of Down syndrome Learn Mem 2008 Jul 1415(7)492-500

Gordon AM Schneider JA Chinnan A Charles JR Efficacy of a hand-arm bimanual intensive therapy (HABIT) in

children with hemiplegic cerebral palsy a randomized control trial Dev Med Child Neurol 2007 Nov49(11)830-8

Kapoor N Ciuffreda KJ Vision disturbances following traumatic brain injury Curr Treat Options Neurol 2002

Jul4(4)271-80

80

Ciuffreda KJ Rutner D Kapoor N et al Vision therapy for oculomotor dysfunctions in acquired brain injury a

retrospective analysis Optometry 2008 Jan79(1)18-22

Ciuffreda KJ Han Y Kapoor N Ficarra AP Oculomotor rehabilitation for reading in acquired brain injury

NeuroRehabilitation 200621(1)9-21

Zost M Diagnosis and management of visual dysfunction in cerebral injury In Maino D (ed) Diagnosis and

Management of Special Populations Mosby-Yearbook Inc St Louis 199579 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001 [Figure used with permission of the editor]

DeGutis JM Bentin S Robertson LC DEsposito M Functional plasticity in ventral temporal cortex following

cognitive rehabilitation of a congenital prosopagnosic J Cogn Neurosci 2007 Nov19 (11)1790-802

Welbourne SR Ralph MA Exploring the impact of plasticity-related recovery after brain damage in a connectionist

model of single-word reading Cogn Affect Behav Neurosci 2005 Mar5(1)77-92

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements prevent cognitive decline A

systematic review of randomized controlled trials J Hum Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among preterm infants attributable to early

supplementation of human milk with docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings and structural-functional

synergies with cell membrane phospholipids Altern Med Rev 2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function Neuroscience 20089(7)568-78

81

Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

BMC Biol 2008 Sep 9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine improves neuropsychological disorders in a child with

creatine transporter defect Neurocase 200814(2) 151-61

Forrester LW Wheaton LA Luft AR Exercise-mediated locomotor recovery and lower-limb neuroplasticity after

stroke J Rehabil Res Dev 200845(2)205-20

82

Page 80: Neuroplasticity: A Paradigm Sea Change Latest Updated File

McClelland JF Parkes J Hill N et al Accommodative dysfunction in children with cerebral palsy a population-

based study Invest Ophthalmol Vis Sci 2006 May47(5)1824-30

Duckman RH Vision therapy for the child with cerebral palsy J Am Optom Assoc 198758(1)28-35

Duckman R Accommodation in cerebral palsy function and remediation J Am Optom Assoc 198455(4)281-3

Scheiman M Understanding and managing vision deficits a guide for occupational therapists 2nd ed Slack

Thorofare NJ 2002

Maino D Binasal occlusion for the child with Cerebral Palsy J Ill Optom Assoc 198644(1)1218

Battaglia F Quartarone A Rizzo V et al Early impairment of synaptic plasticity in patients with Downs syndrome

Neurobiol Aging 2008 Aug29(8)1272-5

Bonnier C Evaluation of early stimulation programs for enhancing brain development Acta Paediatr 2008

Jul97(7)853-8

Morice E Andreae LC Cooke SF et al Preservation of long-term memory and synaptic plasticity despite short-term

impairments in the Tc1 mouse model of Down syndrome Learn Mem 2008 Jul 1415(7)492-500

Gordon AM Schneider JA Chinnan A Charles JR Efficacy of a hand-arm bimanual intensive therapy (HABIT) in

children with hemiplegic cerebral palsy a randomized control trial Dev Med Child Neurol 2007 Nov49(11)830-8

Kapoor N Ciuffreda KJ Vision disturbances following traumatic brain injury Curr Treat Options Neurol 2002

Jul4(4)271-80

80

Ciuffreda KJ Rutner D Kapoor N et al Vision therapy for oculomotor dysfunctions in acquired brain injury a

retrospective analysis Optometry 2008 Jan79(1)18-22

Ciuffreda KJ Han Y Kapoor N Ficarra AP Oculomotor rehabilitation for reading in acquired brain injury

NeuroRehabilitation 200621(1)9-21

Zost M Diagnosis and management of visual dysfunction in cerebral injury In Maino D (ed) Diagnosis and

Management of Special Populations Mosby-Yearbook Inc St Louis 199579 Reprinted Optometric Education

Program Foundation Santa Anna Calif 2001 [Figure used with permission of the editor]

DeGutis JM Bentin S Robertson LC DEsposito M Functional plasticity in ventral temporal cortex following

cognitive rehabilitation of a congenital prosopagnosic J Cogn Neurosci 2007 Nov19 (11)1790-802

Welbourne SR Ralph MA Exploring the impact of plasticity-related recovery after brain damage in a connectionist

model of single-word reading Cogn Affect Behav Neurosci 2005 Mar5(1)77-92

Jia X McNeill G Avenell A Does taking vitamin mineral and fatty acid supplements prevent cognitive decline A

systematic review of randomized controlled trials J Hum Nutr Diet 2008 Aug21(4)317-36

Henriksen C Haugholt K Lindgren M Improved cognitive development among preterm infants attributable to early

supplementation of human milk with docosahexaenoic acid and arachidonic acid Pediatrics 2008 Jun121(6)1137-45

Kidd PM Omega-3 DHA and EPA for cognition behavior and mood clinical findings and structural-functional

synergies with cell membrane phospholipids Altern Med Rev 2007 Sep12(3)207-27

Gomez-Pinilla F Brain foods the effect of nutrients on brain function Neuroscience 20089(7)568-78

81

Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

BMC Biol 2008 Sep 9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine improves neuropsychological disorders in a child with

creatine transporter defect Neurocase 200814(2) 151-61

Forrester LW Wheaton LA Luft AR Exercise-mediated locomotor recovery and lower-limb neuroplasticity after

stroke J Rehabil Res Dev 200845(2)205-20

82

Page 81: Neuroplasticity: A Paradigm Sea Change Latest Updated File

Ciuffreda KJ Rutner D Kapoor N et al Vision therapy for oculomotor dysfunctions in acquired brain injury a

retrospective analysis Optometry 2008 Jan79(1)18-22

Ciuffreda KJ Han Y Kapoor N Ficarra AP Oculomotor rehabilitation for reading in acquired brain injury

NeuroRehabilitation 200621(1)9-21

Zost M Diagnosis and management of visual dysfunction in cerebral injury In Maino D (ed) Diagnosis and

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Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

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Maya Vetencourt JF Sale A Viegi A et al The antidepressant fluoxetine restores plasticity in the adult visual cortex

Science 2008 Apr 18320 (5874)385-8

Kasper S McEwen BS Neurobiological and clinical effects of the antidepressant tianeptine CNS Drugs

200822(1)15-26

Adamcio B Sargin D Stradomska A et al Erythropoietin enhances hippocampal long-term potentiation and memory

BMC Biol 2008 Sep 9637

Chilosi A Leuzzi V Battini R et al Treatment with L-arginine improves neuropsychological disorders in a child with

creatine transporter defect Neurocase 200814(2) 151-61

Forrester LW Wheaton LA Luft AR Exercise-mediated locomotor recovery and lower-limb neuroplasticity after

stroke J Rehabil Res Dev 200845(2)205-20

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