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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
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
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
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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
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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
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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
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Hook BM Chen C Critical periods in the visual system Changing views for a model of experience-dependent plasticity Neuron 2007
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Mar-Apr27(2)224-32
Heuninckx S Wenderoth N Swinnen SP Systems neuroplasticity in the aging brain recruiting additional neural resources for
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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
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
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
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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
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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
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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
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
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
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
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
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
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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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
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
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
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
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
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
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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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
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
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
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
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
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
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
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
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
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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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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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contentuploads200810frankenstein-myspace-lightbeergif
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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
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
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
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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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
PresenterTitle Contact info
Neuroplasticity-A Paradigm Sea Change
This presentation is available at
httpwwwslidesharenetDMAINOneuroplasticity-a-paradigm-sea-change-2459693
httpwwwmainosmemosblogspotcom
My FaceBook Page
and
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
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
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
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
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
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
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
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
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
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
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
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